Juvenile Rheumatoid Arthriris Essays - Rheumatology, Arthritis

Juvenile Rheumatoid Arthriris A chronic, inflammatory disease that may cause joint or connective tissue damage. The onset occurs before Age 16. Causes, incidence, and risk factors: JRA is thought to belong to the collagen classes of disease (those diseases that involve connective tissue). It is a complicated disease. The primary manifestation is arthritis, but the disease may involve other body systems such as the heart and lining around the heart (pericardium), lungs and lining around the lungs (pleura), eyes, and skin. Systemic arthritis affects 20% of those with juvenile arthritis and includes fever, rash, and enlarged spleen (splenomegaly) in addition to joint inflammation. JRA is generally divided into five broad groups depending on whether a large number of joints are involved or just a few, whether the rheumatoid factor (a blood test) is positive or negative, and whether there is eye involvement or not. The five categories of JRA may be roughly broken down as follows: many involved joints and a positive rheumatoid factor many involved joints and a negative rheumatoid factor few involved joints and a positive antinuclear antibody few involved joints and a positive HLA B27 surface antigen systemic JRA (throughout the body) A specialist in rheumatology generally makes the category determination. The onset of arthritis may be slow or extremely rapid. An early sign of slow onset may be stiffness on arising in the morning. Swollen, painful joints characterize the arthritis of JRA with pain on motion and sometimes to touch. The skin over the joints is generally not red but can be. The systemic form of JRA may first appear with high fevers, chills and a rash but without joint pain. In the systemic form, arthritis may develop months after the appearance of the fever. The two forms of JRA where there are only a few joints involved often have associated eye disease. The most severe form of eye disease, chronic iridocyclitis of JRA, may lead to lead to visual problems or blindness. The milder form of JRA-associated eye disease is acute iridocyclitis, which generally heals without permanent damage. The cause of juvenile rheumatoid arthritis is unknown. Growth may be affected during periods of active disease. Girls are affected more often than boys are. The peak onset occurs between the ages of 2 to 5 years old and between 9 to 12 years old. Risk factors may be a family history of the disease and recent rubella infection or vaccine. Prevention: There is no known prevention for JRA. Symptoms: General symptoms: joint stiffness on arising in the morning limited range of motion slow rate of growth hot, swollen, painful joints fever, low grade (with multiple-joint type disease) fever, high spiking with chills (with systemic form of disease) rheumatoid rash rheumatoid nodules (at sites of pressure) Symptoms of eye involvement: red eyes eye pain photophobia visual changes Other symptoms: chest pain shortness of breath abdominal pain Signs and tests: Physical examination may show an enlarged liver (hepatomegaly), enlarged spleen (splenomegaly), or swollen lymph nodes (lymphadenopathy). There may also be signs of: anemia iridocyclitis pericarditis pleuritis myocarditis Tests include: CBC ESR ANA RA factor HLA antigens immunoelectrophoresis - serum synovial fluid analysis X-ray of a joint X-ray of the chest ECG slit-lamp exam of the eyes Treatment: Treatment is aimed at preserving mobility and joint function and supporting the patient and family through a long chronic illness. Therapeutic medications include: aspirin nonsteroidal anti-inflammatory agents (NSAIDS) corticosteroids topical ophthalmic corticosteroids mydriatics gold therapy chloroquine agents immune suppressing agents (rarely used in children) Note: Talk to your health care provider before giving aspirin or NSAIDS to children! Physical therapy and exercise programs may be recommended. Surgical procedures may be indicated, including joint replacement. Expectations (prognosis): JRA is seldom life threatening. Long periods of spontaneous remission are typical. Often JRA improves or remits at puberty. Approximately 75% of JRA patients eventually enter remission with minimal functional loss and deformity. The stress of illness can often be helped by joining a support group. Here, members share common experiences and problems.. Complications: loss of vision or decreased vision total joint destruction of the major weight-bearing joints chronic spondyloarthropathy

Statistics and Data Essay

Statistics and Data Essay Statistics and Data Essay Suppose that you are a fourth grade teacher and you’ve saved extensive records of all your students for the past five years. Assume that your students are a sample of all fourth graders in your state and you can use your student data to test some ideas. 1. What is the major problem with your assumption? The major problem with this assumption is that all the data collected came from the students of one particular teacher and does not represent all fourth graders in the state since these students all had two major things in common, the school and the teacher. If the teacher was an extraordinary teacher or a terrible teacher or if the school was in a really wealthy district or a really poor district than the results would be skewed. A random sample of all fourth graders would have to come from all over the state in different schools districts and different elementary schools. 2. You’re wondering if the distribution of grades was roughly Normal. How would you check this? I would do a histogram and look at the shape of the data. If the data follows a bell-shaped distribution, the Gaussian distribution, it would be considered normal. 3. You have a nagging idea that shorter students tend to have better grades; how could you check to see if there is a link between height and grades? Maybe you could roughly predict a new student’s final grade by their height? How would you do that, and how accurate might that prediction be? I would complete a scatter plot graph to look at the correlation of the data. I could make predictions based on the height by simply looking up the height and go with the corresponding grade on the line. To test how accurate my prediction would be I would then calculate the strength of the correlation (r) the closer to -1 or 1 the stronger the relationship is and the more likely my prediction would be accurate. 4. 4th graders in the US take a standardized test for math. The national average score is 237. Did your state, as represented by your students, outperform the national average using a statistically significant measure? I would figure out the average score of my students and compare them to the average score of the national students. I would then do a two sample t test for significance with the Ho = 237 and Ha 237. If I find for Ha than my students would have outperformed the national average. 5. December holidays always seem such a distraction to 4th graders. Are your students’ December grades significantly worse than their October grades? If so, by how much? I would compare the October data with the December data and then do a paired t-test. Ho would equal the mean of the October data and Ha would be less than the mean of the October data. If I find for Ho

Experience MIS Assignment Example | Topics and Well Written Essays - 250 words

Experience MIS - Assignment Example b). Samantha has a competitive strategy which gives her an advantage over her rivals. During slow business times, she calls her former clients to remind them of the importance to trimming their trees on a daily basis. She reminded them of the services she provides to the members (O’Brien, James, Marakas & George, 2006). C). Knowledge of her competitive advantage would help her greatly in her sales and marketing efforts. Since during times when business is weak she calls her clients to remind them of her services, this gives her a competitive advantage over her rivals who do not do the same. The idea of reminding customers is a marketing tool that would retain customers thus increasing sales (O’Brien, James, Marakas & George, 2006). d). The information system that Samantha needs to use is the ABC model to lock in customers. According to Kroenke, Bunker, and Wilson, Samantha can use this model to make it expensive for her customers to switch to another service provider. Therefore, Samantha should make use of this system to keep customers (Kroenke, Bunker & Wilson,

Critical Evaluation of the Three Approaches to International Human Essay

Critical Evaluation of the Three Approaches to International Human Resource Management - Essay Example This research will begin with the statement that businesses are no more restricted by boundaries. Most of the large companies of the world have been witnessed to carry out an important part of their business functions presently outside the boundaries of their respective countries of source. There are various organisations attempting to make their presence powerful and prominent in other countries, especially overseas. The success or the failure of such organisations largely depends on their human resources and their management. Human resources are considered to be an integral and crucial part of an organisation. The success of an organisation depends on the management of its resources related to production but it is greatly reliant on the way it manages its workforce or human resources. Proper management of the human resources would facilitate in triggering and delivering the actions desired by the organisation. These desired actions contribute significantly towards the success of th e organizations. Cross-cultural approach refers to the assessment or rather the evaluation of the behaviour related to the human resources in a particular organisation. The carrying out of businesses is progressively growing to be further global by expanding in various countries and so it has become an indispensable part to manage the human resources in this global perspective. It becomes quite necessary to manage and to control the human resources of the other countries and this is where International Human Resource Management comes into play.... It becomes quite necessary to manage and to control the human resources of the other countries and this is where International Human Resource Management comes into play (Schuler & et. al., 2002). Human Resource Management (HRM) and International Human Resource Management (IHRM) differ in two vital areas. HRM does not need to deal with the complications of functioning in various countries involving different cultures like IHRM. Secondly, HRM in the domestic context is engaged with workforce that falls under the national boundary whereas IHRM requires to handle and to manage the workforces of three national groups, that is firstly, the home country where the headquarter is situated, secondly the country where any subsidiary would be situated and thirdly the other countries which cater to the finance, labour or research as well development (Pattberg, 2006). It was stated by Taylor & et. al. (1996) that IHRM was treated as a structure of the Multinational Enterprises (MNEs) which compris es certain diverse behaviours, procedures and operations that are carried out with the intention of drawing, sustaining and building up of a workforce or rather human resources in the MNEs. Schuler and Tarique (2007) stated IHRM to be the effectual way of controlling and handling the human resources in the international markets. This is done for the MNEs in order to obtain a chief basis of competitive advantage along with attaining international success. It was suggested by Milliman & et. al. (1991) that IHRM needs to be put into practice with a professional approach of ‘flexible and fit’ in order to make certain of the suitable harmonisation and management among the companies and its respective

Final reflection Assignment Example | Topics and Well Written Essays - 250 words

Final reflection - Assignment Example Among the various styles of artwork, I was particularly impressed with the surrealist style of art. I think that the surrealist art is the most honest expression of human consciousness, since it portrays dreams which one does not have control upon. I think I shall practice more and excel in the surrealist art style. It would also allow me to produce open work for the audiences, following Eco’s idea, since people looking at my paintings from different perspectives would draw different inferences from my art. Perhaps, these diverse interpretations of my artwork would provide me with an opportunity to better understand my own sub-consciousness. This course has not only equipped me with the knowledge of art, but has also refined me both as a painter and an art critic. Having taken this course, my ability to judge the extent to which a certain artist’s painting does justice to the intended theme has

Challenges Hospital Management In Nepal

Challenges Hospital Management In Nepal The WHO defines health as A complete state of physical, mental and social wellbeing, not merely the absence or disorder (WHO, 1948). It means that complete state of wellbeing is health and hospitals one of the major tool for promotion of health. WHO in 2010 has addressed the role and importance of hospital management for a quality health (WHO, 2010). There is no internationally accepted clear definition for hospital. There are several types of hospitals based on the facilities, equipments and services, i.e. district hospitals, provincial hospitals, speciality hospitals and referral hospitals, teaching University hospitals and other types of health care facilities. There is no international standard defining what should be the minimum services that each hospital should provide during a health crisis. Each country has to develop a national policy and technical guidelines to deal with a health crisis. Before defining the essential services, the ministry of health has to define the essential health services that the health sector will provide to the community in order to identify what more specific services will be delivered by hospitals (WHO, 2009). Management is defined as the organization and coordination of the activities of an enterprise in accordance with certain policies and in achievement of defined objectives. Management is included as a factor of production along with machines, materials and money. Renowned guru of management Peter Drucker (19909-2005) has said that the basic task of management is two fold: marketing and innovation. Practice of modern management owes its origin to the 16th century enquiry into low efficiency and failures of certain enterprises, conducted by the English statesman Sir. Thomas Moore (1478-1535). As a discipline, management consists of the interlocking services of formulating corporate policy and organizing, planning, controlling and directing an organizations resources to achieve the policies objectives (Walden University, 2011).Hospital managenmnet.net suggests that Hospital Management provides a direct link between healthcare facilities and those supplying the services they need ( Hospit al management.net 2011) . WHO in 2009 suggests understanding by hospital management as an effective and combined management of, the following factors:- (a) Acute care for emergency patients; (b) Out Patient Department (OPD) activities; (c) Investigation (laboratory; X-ray; other diagnostic elements); (d) Referral for primary health care (PHC); specialized consultations or services; (e) Contribution to public health programmes; (f) Part of health information system (surveillance system, including a EWS Component); (g) Public information and education; and (h) Preparedness for health crisis management. Nepal is a landlocked country which is mostly covered by hills and mountains and it has a population of 25.8 million as estimated in 2006. It is in the south Asian continent, north to India and south to China. Its area is 147,181 sq. km (WHO, 2007). It has been facing several challenges to establish a functional health management system (Thapa, 2010). This proposal deals with the challenges which Nepali health system is facing at present and suggests the possible ways for its improvement. Statement of the problem Nepals health system is in transition. Nepal is an underdeveloped country where most of the geographical part (85%) is covered by mountains and hills. India is in the south and China is in the northern part of the landlocked country. The southern boarder is open where the northern part is separated by the high mountains called Himalayas. The health indicators are very poor. The health service facility is not adequate to Nepali people. So the hospitals are (Dixit, 2005). Nepals hospital bed per ten thousand populations is 4.26 (2001/02), physician per ten thousand populations is 2 and Nurses per ten thousand population is also 2 as per the data of 2004 Similarly, Total Expenditure on Health (THE) as % of Gross Domestic Product (GDP) 5.3% and Public Expenditure on Health (PHE) as % of Total Expenditure on Health (THE) is 28 while Private Expenditure on Health (PvtHE) as % of Total Expenditure on Health (THE) 72(WHO, 2007). If it is compared with the other developing countries in the sa me region i.e. south east Asian region, the level of the problem may be perceived. Maldives, a small tiny country with population 298 thousand has Total Expenditure on Health (THE) as % of Gross Domestic Product (GDP) 6.2. Maldives Public Expenditure on Health (PHE) as % of Total Expenditure on Health (THE) is 89 as compared with 28 of Nepal. Private Expenditure on Health (PvtHE) as % of Total Expenditure on Health (THE) in Maldives is 11. It shows that the state has better involvement in Maldives than in Nepal. More over, the population per hospital bed is 381, which are 26.2 hospital beds per 10000 populations. Similarly, number of populations per physician 959 and nurses per 10000 populations are 33 (WHO, 2007). It clearly shows the scenario of health development of Nepal. As part of health, curative health services have a major role in providing quality health service to the people. Until the health care provider organizations are strong, the curative health service can not be delivered to the beneficiaries properly (Edelman and Mandle 2006). Hospitals are the key component of health care delivery system and they needs to be reformed to ensure a quality health care system (McKay and Healy, 2000).Unfortunately the hospitals in Nepal have very poor in quality management and they are not able to deliver quality health services to the people (Dixit, 2005). To address the needs and requirement of the hospital, the government of Nepal ( GON), Ministry of Health and Population ( MOHP) has published The guideline on the establishment, Operation policy and standard and infrastructure for Private and Public Health Hospitals in 2004 ( MOHP,2004). But it is still lacking in the formulation of the standard for the hospitals run by the government (Dixit, 2005). However, the policy published by the MOHP tries to clarify on the basic parameters of the infrastructures required for the hospitals which may be applied for the general hospitals as well. But the document does not speak about the application in the government run hospitals (MOHP, 2004). That is why; there is a lack of clear cut guideline for the management of hospital. Nepals health sector is facing a challenge regarding the management (Dixit, 2005). As part of whole system of health in Nepal, management of the hospitals is also a sever challenge for the country. 1.2 Summary of the problem Nepal has set a target to achieve the millennium Development goals by 2015. It has to meet the target in all health indicators. Goal no 3 and 4 are c loosely related with health and as part of curative health, hospital and hospital management have crucial role in health promotion. In Nepalese context, hospital management skill and concept of hospital management is still beyond the priority of the government and the government still does not have any policy guidelines over the hospital management sector (Dixit, 2005). People skill is a key asset for the development of key management styles. Dealing the people is a professional skill in itself. Being able to see from the perspective of others is essential, and caring for their welfare is also of prime importance. There are many high-profile examples of how to develop a successful management style. Managers like Bill Gates and Warren Buffett have famously developed their own distinctive management style from which others can learn. However, the fact that the two examples are very different management styles shows that there is no single route to success (Bono and Hellers, 2009). But unfortunately, there are no clear guidelines or policy found in the government documents. The recent document on the guideline on the requirement of a hospital, government does not speak about the hospital management, its skill development and transfer for the improvement of a hospital (MOHP, 2004). Lack of professional skill in the person responsible to manage the hospitals has created a problem in hospital management. The government run or supervised hospitals still do not have positions for the hospitals. MOHP in its policy document has not mentioned anything about the hospital managers (MOHP,2004). However, the private hospitals have started hiring them which is still out of the government policy (Thapa, 2010). Nepal is an underdeveloped country where the literacy rate is only 62.7% for male and 34.9% for female as per the report of census 2001 (CBS, 2001). It means still 64.1% women are out of literacy coverage. Nepal has poor health facilities all over the country except in capital Kathmandu and other urban areas. Most of the doctors are not willing to go to the rural areas hospitals and they are often running without (qualified) doctors (Dixit, 2005). In conclusion, the poor socio-economic conditions, hard geographical conditions and lack of awareness of the people and traditional beliefs and superstitions, lack of will in the political parties and their leaders are the main burning issues for the improvement of health sector in Nepal (Chaulagain, 2004). These all are problems associated with the hospitals and ultimately with their management. The factors associated to hospital management are still not uncovered in Nepal (Thapa, 2010). So, it Purpose of the study As mentioned above, it has been obvious that Nepal is facing the problems to strengthen the management of the health sector. The documents are not found to have been lacking regarding the strategies and policies on the health management. So, the proposal aims to identify the hindering factors affecting the hospital management in Nepal. It will study the existing policies and strategies of the government of Nepal on hospital management, international principles, theories and practices on hospital management and identify the factors which are affecting the betterment for hospital management sector of Nepal. So, the purpose of the study is to identify the hindering factors of hospital management in the case of Nepal and suggest the concerning authorities about improving the hospital management system, formulating the policies and implementing them. This proposal will analyse the strength and limitations of the hospital management system in Nepal and help all the concerned to mitigate and minimize them. Main research question The study can not answer all questions that come on surface while studying about the issue. So, to narrow down the study area and sharpen the focus, the study has defined the main study questions as follows:- What are the hindering factors that effect the hospital management in Nepal? Subsidiary Questions To supplement the main research question, these questions are defined as subsidiary questions as follows:- What will be the appropriate modality or best practices of hospital management that are applied in the world by other countries and What are the factors that are hindering in the betterment in the hospital management in Nepal? What is the most influential factor to promote the hospital management in Nepal? Hypothesis Lindsen and Jong (2005) have defined hypothesis as an alternative explanation of residual switch trial costs or, more precisely, of the empirical finding that the repetition trial (RT) distribution for switch trials with a long preparation intervals can be modelled as a mixture of the RT distributions for repetition trials and for switch trials with a short preparation interval (Lindsen and Jong, 2010). In here, the hypothesis tries to establish an alternative factor that might be supposed to be the commonest hindering factor for the management of hospitals in Nepal. The hypothesis taken here is the lack of professionalization of hospital managers or the persons who are involved in the management of either government run or private or community run hospitals in Nepal is the most influential limiting factors in hospitals in Nepal. Significance of Study As mentioned above there are no special policies and practices established for hospital management in Nepal. The hospitals are managed by the medical doctors or surgeons so far (MOHP, 2004). The doctors are not entitled to diagnose the patients, treat them, run medical and surgical and public health cams campaigns in the hospitals or in the periphery of the hospitals. The Medical council is liable to assign the job responsibilities of the doctors in the case of Nepal. But it has not mentioned about the management part of the hospital and its regulation, Nepal Medical Council Act, 1964 (amended in 2001).It does not speak who is responsible for that (Nepal Medical Council, NMC, 2001). There is no one professionally responsible for the hospital management in the present context. In the country where the government policy about the medical sector does not speak about the role of hospital management, it becomes obvious that the hospital management sector is not running smoothly. No presen ce of the monitoring body to supervise and evaluate the hospital management is found in the present documents whether published by the government or private organizations. So, the studies significance is in establishing the fact what are the main barrier and other minor barriers in the hospital management of Nepal. That is why this study is has a significance value. Literature Review 2.1 Concept of Hospital Management Hospital management provides a direct link between health care facilities and those supplying the service they need. This enhances the capacity of deciding and managing hospitals and health care centres and all other health care providers and other health care industries (Hospital management.net, 2011). The discipline hospital management is found to be conceptualised from the WHO Ottawa Charter for Health Promotion in 1986. It was introduced in the name of Health Promoting Hospitals (HPH) in the beginning since hospital was regarded a mean of health promotion. So, this concept is only 25 years old and newer to other disciplines. The Ottawa Charter recognised five areas of hospital management i.e. health promoting hospital setting, health promoting workplaces, the provision of health related services, training, education and research. It has identified the hospital sector as the change agent and advocate for health promotion (WHO, 2011). From the declaration of WHO, it becomes obvious that hospital is not only a place of treating the patients, but also a place where the activities for health promotion are run, all heath services are provided, trainings are conducted, education is given and researches are carried out. It rules out the understanding of the government on hospitals. Th e Bir Hospital, which is one of the units or part of the Ministry of Health and Population and the biggest government run hospital (MOHP) of Nepal has defined Bir Hospital only as a treatment and diagnosis service centre. In this definition, the other four parts defined by the Ottawa Charter are missing. However, it adds something in its website as its activities. According to it, Bir Hospital offers training to the students through its Post Graduate programme of its Medicine School (Bir Hospital, 2008). It clearly shows that the government of Nepal has some how realised the integrated approach of the hospitals, but not mentioned in its policy or strategy. There seems a gap between the Ottawa Charter and the understanding of the Government of Nepal in terms of its concept. National Health Service (NHS) of the UK has presented a model of its Week Hospital in its journal. It says that it has developed and validated an innovative integer programming model, based on clinical resources allocation and beds utilization. According to NHS, the model aims at scheduling Week Hospital patients admission/discharge, possibly reducing the length of stay on the basis of an available timetable of clinical services. The performance of the model has been evaluated, in terms of efficiency and robustness, by considering real data coming from a Week Hospital Rheumatology Division. The experimental results have been satisfactory and demonstrate the effectiveness of the proposed approach (NHS, 2011). We can see the factors that contribute in hospital management by this example mentioned above. The hospital management has become an emerging field in India, the neighbouring of Nepal and a developing country in the south Asian sub-continent. India education in its home page of its website says that hospital management and administration has become a priority and importance for healthcare industry and providing health and hygiene care in India. The government of India is paying attention on providing healthcare in both rural and urban areas by improving the management of the hospitals. It further adds that hospitals are expected to deliver quality service 24 hours a day at a minimal cost. The urgent nature of its work and the level of efficiency that is expected have increased the need of well-formulated hospital management system throughout the world (India Education, 2011). It shows that India has seriously taken the hospital management stream to upgrade the quality of the service delivery of the hospitals in India. These literatures presented above describe the concept of h ospital management. 2.2 Benefit of Hospital Management Worlds renowned management Guru Peter Drucker developed the concept of Management by Objective (MBO) in 1954. He has defined MBO as a systematic and organised approach that allows management to focus on achievable goals and to attain the best possible results from available resources. He has further said that the strong management system of the organization increases its performance by aligning the goals and subordinate objectives through out the organization. He adds that the employee get strong input to identify their objectives and timeline for completion. He has described the benefits of management to have supporting in setting objectives, organising groups, motivating and communication, measuring performance and developing people ( Peter Drucker,1954). NHS has defined its hospitals as organizations where high qualities of health care services are delivered to the clients (NHS, 2011). So, all the theories of the organization may be applied in hospitals and the importance of the hospitals may be assumed based on the benefits of a good management system as described Drucker. So, it has become obvious that to achieve the goals of the nation, the hospital management sector should be regarded as an important discipline in the context of Nepal as well. Limitations of Hospital Management Management is not a solution, but only the means of the solution which organises the resources in a proper way. For the effective management, every surrounding factor should be appropriate. Verzuh (2001) has identified five sectors that are required for effective management. They are good agreement between service providers and clients, an effective and realistic plan, constant and effective communication, a controlled scope and upper management support (Verzuh, 2001). Hospital as an organization can not provide its best services if the factors mentioned above are not available. In Nepalese context, the hospital management can not take the hospitals in the position to achieve its goals until there is an effective service giving and taking culture, until the planning body is capable enough, until the inter and intra organizational communication is strongly developed and there is a political commitment to prove upper support toward the bottom. So, these are the limitations of the hospi tal management. Barriers of Hospital Management in Nepal Nepals literacy rate is low, the national income and per capita income is also low. The difficult geographical situation is not also favourable for rapid development in Nepal. The socio-economic development is far behind as compared with other developed and even with developing countries (Dixit, 2005). As mentioned above, financial strength, political commitment, social culture and context need to be favourable for the good management of every development sector and the hospital is not an exception. The people can not consume the facilities well if they are not aware about the facilities they have been provided with (Thapa, 2010). But hospitals are managed by the Department of Health Services under the Ministry of Health Population and the, So, for the hospital management, this context has become a barrier. Hospital management practice in different countries i.e. Nepal, USA, UK, India, Japan and Thailand Hospital management is a new discipline. In Nepal, the Pokhara University strated Hospital Management course in 2001 only. Then it has put a milestone in the way of hospital management. Then some private hospitals have started to recruit hospital managers due to its influence and the government is in the way to start thinking on the need of separate hospital management stream under the health service (NOC, 2011). In USA, the hospitals are governed by the United States Department of Health. Its history goes to 1798 from when USA has started on managed health service (USDHHS, 2001). UK established National Health Service ((NHS) in 1948 from which it has been running the hospitals. All together, 12000 doctors are working in its hospitals all over the UK (NHS, 2011). Ministry of Health and Family Welfare is responsible for hospital management in India. It has Department of Health and National Rural Health Mission for managing the hospitals (Ministry of Health and Family Welfare, India, 2011). Likewise, Ministry of Health, Labour and Welfare looks health activities in Japan. It has Health Policy Bureau under the ministry and it looks after the hospitals and it has prepared a policy to manage the hospitals properly (Ministry of Health, Labour and Welfare, 2011). In Thailand, Ministry of Public Health looks after the hospital management. Under the ministry, there is Department of Health and under th is, there are 9n divisions. They are supporting the hospitals for their management in an integrated way (Department of Health of Thailand, 2011) 2.6 Previous empirical research findings on challenges in hospital management The Hospital; of St Raphael in UK has written in its website about the challenges it suffering in terms of the management. It says that the demand is growing and the challenge is increasing. Patient satisfaction concerns, hospital management demand, smart mind and smart technologies to keep healthcare system smoothly are the challenges seen in the present context. Likewise, recruiting hospital management and their turnover are other challenges (St Raphael Hospital, 2011). In Nepal context, There are no special resources are found either in published copies or in the websites. The National Open College has written about the importance of the Hospital Management course which is like an advertorial (NOC, 2011). But it does not speak about the challenges of the hospital management. So, relevant literatures are not enough as per the topic. Discussion and Conclusion After studying the literature and analysing the present hospital management system in Nepal, the points come into mind to be discussed:- The Government of Nepal has still not considered the hospital management as a separate sector. There is a lack of Hospital management professionals. There is no proper policy addressing hospital, management issues in Nepal. Hospital management sector has not been regarded as an integrated issue so far. Public and private sector are also not actively participating for the professionalization of hospital management human resources. In conclusion, we can say that hospital management is a new discipline. The developed countries like UK have already started to think on the management issues of hospitals as a separate sector. But in Nepal, the hospital management sector is not visible separately and it has not been regarded as a separate need or requirement. The hospital has not felt the need of hospital managers to manage the hospital smoothly. Lack of awareness, culture and customs low literacy rate, low income and difficult geographical situation are the factors which are hindering the hospital management sector to grow and become strong. Methodology 3.1 Instrument The study was carried out by using systemic literature review method. The literatures were searched in the website of the Universities of UK i.e. Bournemouth. The Medical Journal of America and USA were searched. The government policies of NEPAL, India, USA, Japan, Thailand and UK were other sources. The documents were collected, materials were searched and the materials retrieved were analysed before applying them in this search. The WHO website and other journals were considered as most reliable sources. Library use was the mostly used mean for search and writing the paper. This study will apply qualitative methodology to find the hindering factors of hospital management in Nepal where face to face interviews will be arranged during this study. 4 Conclusions The hospital management is a new term which is derived from the separate words hospital and management. Hospital is a mean of healthcare delivery while management is a way to utilize the resource in an efficient way. The hospital management is not very old concept in even in the developed countries while the countries while Nepal is very far behind in the development of this sector. Lack of professionalization of the existing human resources, less availability of skilled human resources, poor socio-economic situation, low interest of government towards the hospital are the hindering factors for the development of hospital management in Nepal. These all information was collected through literature review available in the library and websites developed by the governments, universities and academic institutions. It recommends the government of Nepal to recognise the hospital management as a separate and independent discipline under the health service. It suggests the academic institutions to focus on the development of hospital management professionals in their course and curriculum. It also suggests the private sector involved in running private hospitals in Nepal to start hospital management principles in their management.

Just Taxation :: essays research papers

Index: I.  Ã‚  Ã‚  Ã‚  Ã‚  Introduction  Ã‚  Ã‚  Ã‚  Ã‚  2 II.  Ã‚  Ã‚  Ã‚  Ã‚  Introducing the problem  Ã‚  Ã‚  Ã‚  Ã‚  2 III.  Ã‚  Ã‚  Ã‚  Ã‚  Income vs. Consumption Tax  Ã‚  Ã‚  Ã‚  Ã‚  3 IV.  Ã‚  Ã‚  Ã‚  Ã‚  A just tax base?  Ã‚  Ã‚  Ã‚  Ã‚  5 V.  Ã‚  Ã‚  Ã‚  Ã‚  Liberutopia  Ã‚  Ã‚  Ã‚  Ã‚  6 VI.  Ã‚  Ã‚  Ã‚  Ã‚  Conclusion  Ã‚  Ã‚  Ã‚  Ã‚  8 VII.  Ã‚  Ã‚  Ã‚  Ã‚  References  Ã‚  Ã‚  Ã‚  Ã‚  9 Table of Figures: Figure 1: Consumption vs. income tax  Ã‚  Ã‚  Ã‚  Ã‚  3 Figure 2: Floating money and deposit money  Ã‚  Ã‚  Ã‚  Ã‚  4 I.  Ã‚  Ã‚  Ã‚  Ã‚  Introduction In the debate of just taxation an argument came up, which insisted that any tax that distorts individual preferences should be considered as unjust. This argument is known as the â€Å"fairness-to- savers-argument†. The intention of this essay is to explain of what the fairness to savers argument consists, how to approach it and foremost why it is wrong. At first I will therefore explain the argument on the basis of it’s most common example. The following chapter will then provide a better insight into to exact circumstances, under which the fairness to savers argument might arise. Here the functionalities of the, in the example presented, tax bases will be addressed. To approach the rejection of the argument correctly, it will be necessary to determine what exactly â€Å"just† means and this will lead us to some assumption, which need to be made to prove the argument wrong. But before that, I will present the approach Murphy and Nagel make in their book â€Å"The myth of ownership† and why they are not able to reject the argument completely. Afterwards I will introduce my approach, which basically will show, that any kind of taxation will distort individual preferences and there from I derive, that the fairness to savers argu-ment must be invalid. II.  Ã‚  Ã‚  Ã‚  Ã‚  Introducing the problem The basic problem of the fairness to savers argument, is the effect of different tax bases on individual preferences. The name of the argument follows from it’s most vivid example, which I want to address at first, for a better understanding of the issue. The example is often illustrated with the comparison between two individuals preference for saving, both taxed once under an income tax and once under a consumption tax. Let’s consider two people, Steve and John, both earn in t0 100$, the rate of return is in every period constantly at 10% and they are in every aspect totally similar, despite their individual time preference, which is for Steve at 3% and for John at 9%. That means exactly, that Steve is willing to save his money as long he gets at least a net return rate of 3% and John is willing to save his money as long he gets at least a net return rate of 9%. In case their time preference is higher than the net return rate, the utility they derive from immediate co nsumption will be greater than the utility they derive from saving, thus they won’t save their money.

Personal and organizational values Essay

What are personal and organizational values? Values are one of the most special achievements as human beings. A person acts not just in service to personal needs, but also out of a broader sense of what is important, purposeful and meaningful (Cynthia D. Scott, 1993). Values are the building blocks of organizational culture. They represent an organization’s basic guidelines about what is significant; how business is conducted; how people relate to one another; its clients and customers relationships; and its decision making strategies. Values affect every aspect of the organization, and take years, constant attention, and perseverance to change. Values serve to inspire and foster commitment, motivation, innovation and trust around principles of conduct that are held inviolate. They reflect intentions and provide guidance for every action when there is a gap between intentions and reality. When actions do not comply with stated intentions, the gap becomes a source of cynicism and loss of confidence and momentum toward change and innovation. Values are represented in decision making processes, interpersonal interactions, leadership actions, reward structures, supervisory styles, and information and control systems. Each plays a role in sustaining the structure of a value, and each serves as a lever of change. To stimulate an organization toward change, we must minimize or fill the gap between the stated values and value actions (Rodney Napier, 1997). Conflict between personal and organizational values and goals How do organizational and personal goals differ? Organizational goals are carefully and logically determined. Frequently, this must be discussed with other people in order to define them exactly. An organizational goal is one that we understand and commit to intellectuality. A personal goal, on the other hand, is a private and often purely emotional commitment (Merrill E. Douglass, 1993). Value conflicts arise when people are working in a situation where there is a conflict between personal and organizational values. Under these conditions, employee may have to struggle with the conflict between what they want to do and what they have to do (Diane F. Halpem, 2005). This can be a distracting experience as you face changes, contrasts and a few surprises, and have to make some sense of all this (Henry Tosi, 2000). For example, people whose personal values dictate that it is wrong to lie may find themselves in a job where lying becomes necessary for success. Successful job performance may require a bold lie, or perhaps just a shading of the truth. People who experience such a value conflict will give the following kinds of comments: â€Å"This job is eroding my soul,† or â€Å"I cannot look at myself in the mirror anymore knowing what I’m doing. I can’t live with myself. I don’t like this.† If workers are experiencing this kind of mismatch in values on a chronic basis, the burnout is likely to arise. However, a Machiavellian individual, who believes that the end justifies the means, will have a better fit with a job in which lying is essential to success and will probably not experience value conflict and many other situations (Diane F. Halpem, 2005). Value-driven management Value-driven philosophy is designed to develop effective and value-driven leadership at every level in the organization. The decision making and leadership styles of effective business leaders are value-driven men and women who create value for their organizations that goes far beyond mere stockholder value. This is not to suggest that they should disregard profitability as an important corporate goal, but it is instead to state that the financial bottom line—as a value—is integrated with other value drivers in their leadership behavior. Value Driven Management and value driven leadership are interactive and synergistic. Value-driven organizations will tend to develop value-driven leaders, and value driven leaders will create value over time for their organization and their organizations are becoming more valuable and fulfilled, and continue to grow and thrive throughout their lifetimes. This view is especially significant in today’s growing force of high employment, knowledgeable workers, and the concept of measuring and managing organizational knowledge as intangible financial assets. There are 8 value drivers that impact organizational and individual decision making. These value drivers are to some degree interrelated and overlapping, but in total, they encompass the universe of the organization, combining the internal and external variables it must confront throughout its existence:   external cultural values, organizational cultural values, individual employee values, customer values, supplier values, third-party values, owner values and competitor values. When these value drivers are used systematically and properly in the company’s decision processes, and when their individual and collective impact is weighed and balanced, in organizational decision making, the firm will create value for –itself over time—particularly in the long run (Randolph A. Pohlman, 2000). Collegial vs. meritocratic structure of value Better fit between individuals’ and organizations’ values predicted higher levels of satisfaction and commitment and lower turnover. Leadership organizations have a tough, but not, harsh, view of change. They focus on accountability for actions and give some emphasis to the discussions of goals and means. Although these organizations are still basically compliance-oriented, their documents portray the change process less impersonally and more persuasively, seeking to encourage employees to comply with the requirements rather than simply expecting it. In the meritocratic value structure, this appears to be a much greater emphasis on motivating employees to play a constructive role in change. This emphasis involves explaining both the goals of change and the means for bringing it about. Meritocratic structures can be characterized as trying to challenge or energize employees. Change, although difficult, is associated with achieving important goals, and the organization signals that people’s efforts and achievements are recognized and appreciated. This is characterized by themes of striving, effort, goals, achievement, motivation and recognition. Only collegial organizations view change in a positive way and emphasize employee participation. Collegial ones do not challenge their employees to achieve organizational goals; instead, they emphasize the benefits change brings to internal and external stakeholders and depict an enthusiastic, responsive orientation to change (Boris Kabanoff, 1995). Entrepreneurial vs. bureaucratic values (differences in social origins, including gender and cognitive ability) Differences in social origins, such as gender and cognitive skills create different sets of belief concerning the qualities of a good job. According to Miller and Swanson theory (1958), the theory identifies two major value systems—the entrepreneurial and bureaucratic. These values are oftentimes merged, and thus form beliefs about the desirable attributes of jobs, by comparing expected returns against expected risks in the search of opportunities for future economic wellbeing. Some people may embrace either of the entrepreneurial or bureaucratic orientation is determined mainly by entrepreneurial skills and attitudes towards risk, which in turn can be affected by family background, schooling, gender, and cognitive skills. The adult achievements are favored by early family and schooling forces, and the very same personal qualities that give in to advantages for achievement, also creates expressions of preference that favor entrepreneurial type over the bureaucratic job properties. Cognitive ability and gender, being the most powerful sources of variation in job values, are followed by years of schooling. Parental education, occupational status, self-employment and income all geared towards entrepreneurial over bureaucratic job properties. Significant other’s influence, educational aspirations and years of schooling, aside from favoring entrepreneurial over bureaucratic values, create a very strong preference for esteem over all other job properties and is significantly related   in the value system geared towards   achievements (Halaby, 2003). Cultural values on problem solving, teams, gender, stress and ethics National culture plays an important role and leads to differences in how problems are solved and in the quality of the solutions. Chinese employees are more likely to delay informing a manager about a problem until the manager sees the problem on his or her own. The employees are also likely to minimize the seriousness of the problem. In western cultures, managers are more likely to appreciate and give credit to an employee who draws attention to a problem, and therefore, problems are more rapidly identified and brought to the attention of management.    The result is that Western managers are more likely to speak directly about the problem. In collectivist cultures, decision making is more likely to rely on consensus while managers from individualist rely more on their own experience and training when making decisions. It is also   found that Australians prefer a decision making style based on having a selection choices that require careful individual thought, whereas the Japanese prefers styles that require more references to other people. In Japan, individuals are likely to measure their personal success by the success of their team and organization (Siverthome, 2005). Impact of technology While technology has increased the ability to communicate, one might question whether it has increased or diminished the capacity to connect with co-workers in the workplace. It is through feeling this connection that we derive our sense of teamwork, community, attachment, and belonging—all essential aspects of what humans needs to feel: valued, respected and acknowledged. It is these core social and emotional elements that lubricate human beings and keep them going in times of difficulty, be it a personal, professional, or even a national crisis (Lewis, 2006). Dealing with value conflicts What can be done to alleviate burnout? One approach is to focus on the individual who is experiencing stress and help him or her to either reduce it or cope with it. Another approach is to focus on the workplace, rather than just the worker, and change the conditions that are causing the stress. The challenge for organization is to identify interventions that target those particular areas (Diane F. Halpem, 2005). What implications these have for managers?   Value configurations may motivate and support the organization’s coherence, strength, and stability. They also offer managers a framework for conceptualizing the nature and purpose of organizational change. One possible explanation for the high failure rate of company mergers and acquisition is â€Å"culture incompatibility† and â€Å"culture collisions.† (Boris Kabanoff, 1995)          References: BORIS KABANOFF, R. W., MARCUS COHEN (1995) Espoused Values and Organizational Changes Themes. Academy of Management Journal, 38, 1075-1104. CYNTHIA D. SCOTT, D. T. J., GLENN R. TOBE (1993) Organizational Vision, Values and Mission, Thompson Crisp Learning. DIANE F. HALPEM, S. E. M. (2005) From Work-family Balance To Work-family Interaction: Changing The Metaphor, Routledge. HALABY, C. N. (2003) Where Job Values Come From: Family and Schooling Background, Cognitive Ability, and Gender. American Sociological Review, 68. HENRY TOSI, N. P. M., JOHN R. RIZZO (2000) Managing Organizational Behavior, Blackwell Publishing. LEWIS, G. W. (2006) Organizational Crisis Management: The Human Factor, New York, Auerbach Publications. MERRILL E. DOUGLASS, D. N. D. (1993) Manage Your Time, Your Work, Yourself AMACOM American Mangement Association. RANDOLPH A. POHLMAN, G. S. G. (2000) Value Driven Management: How to Create and Maximize Value Over Time for Organizational Success, AMACOM American Management Association. RODNEY NAPIER, C. S., PATRICK SANAGHAN (1997) High Impact Tools and Activities for Strategic Planning: Creative Techniques for Facilitating Your Organization’s Planning Process, McGraw-Hill Professional. SIVERTHOME, C. P. (2005) Organizational Psychology in Cross-cultural Perspective, NYU Press.

Restaurant †Eating Essay

One of my favorite restaurants is Olive Garden. Without going to Italy to taste their traditional food just come in to Olive Garden and experience the Italian food. They offer wide varieties of Italians food. While the restaurants are similar in the type of food they prepare the difference in their atmosphere, menu and services will assist the customers in making the big decision on which one they like to satisfy their appetite. Olive Garden is the perfect place for a meal if you’re looking for both exquisite and casual dining. The atmosphere is very comforting and the mood is relaxed with the dà ©cor being contemporary but restrained. The tables are in a good distance apart so the diners are given their privacy, but at the same time do not feel isolated from others. When my first time walked in their restaurant, I said to my self that this is a place that I can bring my family to enjoy our dinner together. Even though, I have to spend time waiting to get the table, but it is worth to wait. While the atmosphere is a place to go so do their services. The staffs are friendly, welcoming and efficient. They are always willing to go to lengths to help make your dining experience as memorable as possible. My family and I were very new to the restaurant; the waitress came make us feel like home. She took us to the table and asked to order the drink. She greed us and told us that she will be your table service for tonight. The service was very knowledgeable of the menu and was very polite while taking order. Olive Garden offers wide varieties of Italian food. You can order from an exclusive range of starters, main courses and desserts. The dishes are quite reasonable price range from $10 to $25 including entrà ©e and dessert. I was order Chicken Alfredo which is my favorite. While we were waiting for our main course the entrà ©e came with the salad and breadsticks and also the wine are exclusively sold only at Olive Garden for their customer to taste; then our order came in a short time after. While we were eating the waitress came asked for drink refill or how did we enjoy the food. We were really enjoying our dinner at Olive Garden where we can enjoy good food, a place where we can relax and the staffs treat us as family. We brought friend and family their many time after and everything is treating us the same way even better. This is our favorite Italian restaurant of all time.

Emily Dickinson1 essays

Emily Dickinson1 essays Emily Elizabeth Dickinson was an American poet of the nineteenth century. She was one of the greatest masters of the short lyric poem. Not much is known about her life, but what is known is unusual and interesting. Emily Dickinson was born in Amherst, Massachusetts on December tenth, eighteen hundred thirty, to a prominent family. [ 9. kutztown.edu/faculty/ reagan/*censored*inson.html ] She was the second child of three children. Her grandfather, Samuel Dickinson, was one of the founders of the Amherst College. Edward Dickinson, her father, held several political positions. He was on the General Court of Massachusetts, Massachusetts State Senate, and United States House Representatives. Edward was also a lawyer and the treasurer for the college. [ 9. kutztown.edu/faculty/reagan/*censored*inson.html ] Emily's mother, Emily Dickinson, was a simple woman. She was dedicated to her home and family. Emily's mother suffered a long term of illness so she took care of her. Dickinson had an older brother, Austin, who also served as the treasurer for the college and other civic positions. Austin married Emily's best friend, Susan Gilbert. Lavinia was Emily's younger sister. She didn't marry anyone so she stayed in the family house. The three siblings shared a very close relationship. Their parents didn't have a close relationship wi th them, but they did love and care for them. Emily's parents made sure she had a good education. She went to a primary school for four years then she attended Amherst Academy from eighteen hundred forty through eighteen hundred forty-seven. After that she went to Mary Lyon's Female Seminary ( Mount Holyoke Female Seminary ) for only a year. [ 7. gale.com/library/resrcs/poets_cn/*censored*nbio.htm ] The seminary insisted on religious as well as intellectual growth. Emily didn't like the religious environment and was under considerable pressure to bec...

Care Plan. 745769 Essay Example | Topics and Well Written Essays - 750 words

Care Plan. 745769 - Essay Example Specifically, limitation of tissue oxygenation directly due to a sluggish blood flow is the major pathophysiologic feature of sickle cell anemia. End- organ damage may result when tissue hypoxia is prolonged, which then can lead to death (Smeltzer & Bare, 2006, p. 886). II. Clinical Manifestations (Signs & Symptoms): Severity of the clinical manifestations depends largely on the proportion of RBCs that have sickled. That is, when more cells are sickled, the chances of thrombosis also increase, thus causing decreased oxygen supply to tissues and organs. Pain is one of the most common manifestations as hypoxic tissues generate lactic acid that easily irritates nerve endings and other pain receptors. When the heart tissue is involved, acute chest pain manifests and more commonly associated with tachycardia, fever, falling hemoglobin levels, and sometimes bilateral infiltrates seen on the chest x-ray. Since these cells have relatively shortened life- span, simultaneous hemolysis raises b lood bilirubin level up to toxic levels. This is manifested as jaundice. Complications result from chronic hemolysis or thrombosis (Smeltzer & Bare, 2006, p. 887). III. ... On the other hand, chemotherapy using hydroxyurea increases hemoglobin F levels in affected patients, therefore reducing the formation of sickle cells. Still, there has been no evidence yet if the drug reverses organ damage. Lastly, chronic RBC transfusion is particularly helpful in acute exacerbations of the condition causing severe anemia and infections. However, the patient may also develop complications due to iron overload and thrombosis (Smeltzer & Bare, 2006, p. 888). Nursing interventions are focused on providing continuous pain relief by prompt administration of pain medications prescribed by the physician and helping the client relax and reduce anxiety. Prevention of infection by maintaining a therapeutic environment and using aseptic technique in nursing procedures performed must be an integral part of the care plan. IV. Diagnostic Studies/Lab analysis: Blood tests reveal the presence of sickle RBCs. WBC Count- 9x103/mm3 (N: 3.54-9.06 x103/mm3). Hemoglobin level is 7 mg/ d l (N- 13- 16 mg/dl) which implies anemia and decreased tissue oxygenation, thus, necessitating blood transfusion. Discharge Planning and Client Teaching Continue medications as prescribed by physician. Determine learning needs and educate as necessary especially the common triggers of an exacerbation. Inform S.B. and his mother about his increased risk of acquiring infection and provide directions to prevent it. Caution about severe chest pain and other signs of exacerbations that warrant immediate hospitalization. NURS 401 NURSING CARE PLAN Growth and Development According to Erickson Stage: 6 Crisis: Intimacy vs. isolation (Videbect, 2007, p. 53) I. Describe your patient’s ability to achieve

Communication in Organizations Essay Example | Topics and Well Written Essays - 1250 words

Communication in Organizations - Essay Example It is an established company with a wide scope that involves extensive communication within the organization and with other stakeholders. Its administration is as a result characterised by a number of management meetings for ‘decision-making’. The company’s organizational structure consists of a board of directors at the top with seven directors, a chairperson, a general manager, and line managers. Decisions are made through deliberations in meetings and resolutions passed to line managers for implementation. Communication refers to a process in which a party sends a message to another who receives the message, comprehends it, and submit a feedback to the sender. In any organizational set up, effective communication leads to successful pursuit of objectives while poor approaches to communication undermines objectives and may lead to negative impacts. Kelly however argues that people can achieve effective communication through â€Å"vigilance, perseverance, and by using their power to change course† and laid down structures (2011, p. 199). This means that success in a communication process depend on the parties capacity as well as skills towards effective communication (Kelly, pp. 199, 200). ... Effective communication also means clarity in message content as well as accuracy in targeting the recipient. The subject of communication should not be vague and should directly target the intended recipient. Similarly, effective listening skills facilitate a successful communication process through enhancing the recipient understanding of the communicated piece of information. Attitudes, as developed by either the sender or the recipient, also affect effectiveness of a communication process (Auer and Blumberg, p. 113). Theories into communication have also been used to explain the communication process. Trait theory for instance explains that people have different characteristics that define their personality and behaviour. Such traits determine a person’s ability to demonstrate the essential elements of effective communication. A person’s characteristics will for example defines the applied level of attentiveness to the communication process as well as attitude towar ds the communication process. Negative traits therefore undermine effectiveness of a communication process (Littlejohn and Foss, 2007, p. 66- 68). Consistency theories, another communication theory, explain the essence of consistency among parties to a communication process. Such consistencies are necessary with respect to the parties’ attitudes, the parties’ behaviour as well as between behaviour and attitude. The fundamental principle is that while consistency creates a favourable environment for effective communication, its absence initiates change in attitudes that may adversely affect a communication (Littlejohn and Foss, 2007, p. 78). Similarly, the theory of identity suggests that a person’s identity affects his or her