Inspiration from Anywhere

INSPIRATION FROM ANYWHERE As I missed my international flight home to Houston from Trinidad today, I was suddenly struck with an inspiration. Writers can find their muse anywhere at any time. Now, you may be wondering why being stuck at a foreign airport alone with absolutely no money and no lay of the land could inspire this thought in my mind. But just think about it. I’m sitting here, computer on my lap, just tapping away at the keys. Doesn’t matter that I’m in a place completely unfamiliar to me or that I’m completely clueless as to where I’ll lay my head tonight. It’s just me and the keyboard spending some good quality time together. So while I’m here at the airport with a whole lot of nothing to do, I’d like to take these moments to give you some ideas about where you can find inspiration for your own writing. Remember back to things that made you happy in your childhood. Do you recall the first time you ever rode your bike, or the time Santa left the toy you had wanted so badly under the tree? Did you play dress up in your grandmother’s attic or sell lemonade on a hot summer day? Memories like these formed you as a person, and they are the perfect way to dig deep when you feel your writing has lost some of its meaning. Take in the scenery around you. Write about the gorgeous nature (or lack thereof) that resides around you. Watch people as they walk by – each of them unique in character and offering something special to the world. The diversity that is found in all things is a wonderful way to open your eyes (and pen) to new content. Get out. Do you ever feel stuck in the same routine? Do something different. Go somewhere different. Take a drive, go salsa dancing on a Tuesday, sit in the sand at the beach, and hike in the mountains. Simply remove yourself from the norm that is your life, and don’t act surprised when inspiration finds you out of your element. Read. Read books, newspapers, magazines, advertisements, blogs, articles, or whatever else tickles your fancy. Open your eyes to the way others interpret the world through writing, and inspiration may come right out and smack you in the face. What inspires you? We’d love to hear.

United States Vs Wade Involves a Defendant in the Robbery of a Federally Insured Bank essays

United States Vs Wade Involves a Defendant in the Robbery of a Federally Insured Bank essays UNITED STATES v. WADE, 388 U.S. 218 (1967) involves a defendant in the robbery of a federally insured bank who was placed in a lineup several weeks after he had been indicted. The lineup was conducted without notice to and in the absence of his counsel. He was identified by two witnesses as being the robber at the lineup and the trial and was subsequently convicted of the crime. The defendant argues that the lineup violated his Fifth Amendment privilege against self-incrimination and his Sixth Amendment The question in the case was whether courtroom identifications of an accused at trial are to be excluded from evidence because the accused was exhibited to the witnesses before trial at a post-indictment lineup conducted for identification purposes without notice to and in the absence of counsel. The court held that the lineup did not violate the Fifth Amendment, but did find that the Sixth Amendment guarantees an accused the right to counsel at any critical confrontation by the prosecution at pretrial proceedings where the results might well determine his fate and where the absence of counsel might impede the right to a fair trial. Identification procedures, which had theretofore been treated as a purely factual matter left largely for lay jurors to handle, for the first time took on constitutional dimensions and created a new per se rule of constitution law for identification procedures. The catalyst was the determination that a police lineup was deemed to be a "critical stage," thereby entitling an accused who was forced to stand in a lineup to the Sixth Amendment right to the assistance of counsel. The rule applies to any identification technique and a fortiori to a face-to-face encounter between ...

Distinguish among the five types of customer markets Essay

Distinguish among the five types of customer markets - Essay Example Consumer durables are another subtype. Converse to the characteristics of FMCGs, these goods have low volume but high unit value. This can further be categorized into white goods and brown goods. Refrigerators, pressure cookers, dishwashers, washing machines, microwave ovens, etc are primary examples of white goods. Electronic items such as personal computers, video game consoles, multi-media players, etc are good examples of brown goods. Consumer Market is characterized by aggressive marketing campaigns, for consumers tend to be disloyal to brands and can easily switch from one to another. Also, competing companies are focused on innovating and improvising their products and production models to garner greater market share. *Business Markets â€Å"buy goods and services for further processing or for use in their production process, whereas Reseller Markets buy goods and services to sell at a profit.† (Part 2, p.66) The metals industry is a good example of Business Market. Her e, raw metals (sometimes in the form of ores) are bought by private companies from government agencies. The former then go on to process and add value to the metal before selling it to other industries or end consumers. A good example of Reseller Market is the retail industry, which comprises of Supermarket chains, Specialty stores, Chemists, and other retail dispensaries.

Did the New Deal work Why or why not Essay Example | Topics and Well Written Essays - 1000 words

Did the New Deal work Why or why not - Essay Example Hence, prompted intense debates that persisted during the New Deal’s implementation. However, the New Deal eventually realized its goals giving the president during then a firm base meant to response to his critics’ opinions boldly while citing the then improvement of economic sector in all aspects including people’s lives. The New Deal despite at its inception and during implementation faced numerous criticisms from disbelieving opponents, it worked efficiently evident in the way it met its economic targets. As Roosevelt stated, â€Å"substantial gains well known to all of you have justified our course (Roosevelt, â€Å"Relief, Recovery, Reform and Reconstruction†)†. In this case, gains encompassed numerous and varied improvements that characterized then economy besides heightening people’s welfare. The president was even elaborative in defending his strategy with statistics though hesitantly to mention because those whom he was telling espe cially his opponents knew much about them. They encompassed gain in â€Å"average weekly pay† and reemployment of numerous people especially by private sectors, hence his strategy not only was economic-focused but also touched on citizens’ lives. ... this led to reducing incidences of bankruptcy and uncertainties, which the state together with its industrial firms earlier experienced due to economic unpredictability. In this case, Walker’s sentiments aimed at arousing his audience’s thoughts concerning what used to be the norm in comparison to the economy after implementing the New Deal whose benefits they could measure and experience. Therefore, this acted as a wakeup call for the citizens and especially critics of the then idea to see huge federal’s amount of money that had gone into stabilizing the economic and emerged successfully. This was in alignment with the New Deal intentions, which many before its inception thought was ineffective. New Deal’s emergency gave birth to the rise of varied the then emergent agencies aimed at heightening citizens’ welfare irrespective of their respective political persuasions. According to Mooney, â€Å"†¦.the legislation passed in the first â€Å"Hu ndred Days† of the Roosevelt administration created an array of new federal agencies intended to organize the economic recovery (Mooney, 96).† Agencies in the entire framework of the New Deal comprised varied aspects whose intentions were citizen-centered, for instance, WPA. Since, each state’s economic progress is the measure of citizens’ welfare and ability to offset daily bills satisfactorily without compromising regime of the day’s financial goals. Therefore, through strategy the state not only managed to help the people but also met their respective goals through establishment of agencies, though critics seemed too â€Å"blind† to notice them. The inception and taking over of New Deal contrary to numerous debates successfully managed to change

Statistics are Misleading in the Media Essay Example | Topics and Well Written Essays - 1250 words

Statistics are Misleading in the Media - Essay Example Many of the unsuspecting readers are often oblivious of the fact that people creating and quoting statistics do have personal agendas and vested interests (Hodges 2). Thus most of the social statistics is often colored by such devious intentions. The journalists in their zeal for bolstering on the issue under consideration do tend to exaggerate or subdue the available statistical findings (Calif 2). Many a times the entities like governments, political parties and NGOs purposely furnish tainted statistical data and studies so as to accentuate or dilute a specific issue. Thus it is important for any discerning citizen to investigate the basic parameters surrounding a statistical quote that is the entity who created a statistical study (Best 27), the purpose for which a given statistical data was created (Best 28) and the manner in which a statistical research was carried out (Best 29). Sad, but true, many of the subscribers are mostly not so astute, systematic and methodical in their analysis of the statistics published in media and are therefore vulnerable to ending up with faulty perceptions, false notions and misguided views. It is really imperative to understand the dynamics by which statistics is exaggerated, downplayed or manipulated by the media to send a specific message to the masses. Many a statistical studies prefer to choose the samples as per their convenience (Best 52). The samples for statistical studies are often chosen by the media in a non scientific way and at random that go well with their limited budgetary resources. Hence such samples fail to represent the total population and do yield false conclusions. Besides the statisticians hired by the media houses are oft deficient in the expertise to wean out the mutations incorporated while sampling a population. There is no denying the fact that the statistical studies conducted in an academic environment are not bound by the compulsion to yield black and white results. It is a reality that if an academic study ends up with open ended conclusions, the researchers do prefer to leave them as such and never rush in to deduce faulty hypothesis. However, this is not always true so far as media reports are concerned. Most of the media reports by their very nature are expected and bound to give concrete conclusions underlying a statistical study. Thus when the journalists are pushed by their voracious readers to yield results, they often do not hesitate from culling out nonrealistic guesses from the available statistical figures (Best 32). In fact, to sensationalize their news reports, media houses even go to the extent of exaggerating or downplaying the results attributed to a given statistical study. If nothing else, commercial success is often too big a motivation to prevent them

Case Study Of Unstable Angina

Case Study Of Unstable Angina The patient in context is a 61 year old male, Mr. X, admitted to hospital in the late evening for a case of unstable angina. Presenting complaints include left-sided chest pain which was less severe than that of his previous admission and localized pain during rest. Absent symptoms are profuse sweating as well as nausea and vomiting, orthopnea and paroxysmal nocturnal dypsnoea, cough and fever. Patients past medical history includes diabetes mellitus and hypertension diagnosed 6 years ago, ischaemic heart disease (IHD) since 3 years ago, for which the last hospital admission was 11 months ago. In the previous admission for IHD, Mr. X also suffered from pneumonia and ventricular failure, his electrocardiogram (ECG) indicated right bundle branch block, his serum troponin I levels were 0.3 ng/mL (normal levels 0-0.1 ng/mL), and his creatinine levels were 5.0 mg/dL (normal for males 0.2-0.6 mg/dL). Mr. X is also afflicted with chronic kidney disease, for which his baseline creatinine dur ing his last admission was 208 ÃŽÂ ¼mol//L. Mr. X has retired from the military and is living with his wife, who monitors his medications and compliance. He used to be a chronic smoker but has stopped smoking 15 years ago. His previous medication history is as below: Drug and Form Strength Frequency Furosemide tabs 40 mg BD Omeprazole tabs 20 mg PRN Amlodipine tabs 10 mg OD Simvastatin tabs 20 mg ON Perindopril tabs 4 mg OD Table 1: Table showing past medications of Mr. X. Mr. X takes no non-prescription medications and has no known drug allergies. On examination he appears to be alert and comfortable on his nasal cannula for delivery of oxygen 3L/min. His blood pressure is 134/81 mmHg, pulse rate is 76 bpm, body temperature 37oC, SpO2 of 99%, abdomen feels soft and non-tender, and no pedal oedema was observed. A blood glucose strip test reveals that Mr. Xs glucose levels were 10.3 mmol/L. Emergency ECG shows right bundle branch block and no ischaemic changes. The tentative diagnosis was unstable angina and further tests were scheduled, including a full blood count (FBC), renal profile (RP), liver function test (LFT), troponin and creatinine (CKMB) investigations, as well as a urine full examination and microscopy (UFEME). The immediate plan was to give Mr. X subcutaneous enoxaparin 60 mg stat and twice daily thereafter, aspirin 75 mg tablets once daily, lovastatin 20 mg tablets once daily, sublingual glyceryl trinitrate when required, and to continue the 3L/min oxygen cannula. Clinical Progress Day 1 Morning Patient was well, free from chest pain, tolerating orally and suffering from no nausea or vomiting. He had minimal shortness of breath (SOB). Troponin I levels were at 0.15 ng/mL and ECG showed no acute or evolving changes. Fasting plasma glucose was at 4.8 mmol/L (within normal range). Secondary dehydration was observed using the skin pinch test, so patient was started on intravenous normal saline drip (3 x 500 mL bag per 24 hours). Patient was found to be anaemic due to pre-existing chronic renal failure. Evening Patient reported mild chest pain and SOB. His troponin I levels were 0.15 ng/mL and other vitals were normal. His creatinine levels were 423 ÃŽÂ ¼mol/L. Day 2 Patient felt comfortable and his vitals were normal. His creatinine levels decreased to 345 ÃŽÂ ¼mol/L. Day 3 Patients condition was well, no chest pain was reported but he was still experiencing some SOB in the morning, which subsided in the afternoon. Patient was put on continuous peritoneal dialysis in the late morning. Patients vitals were normal, and he was taken off enoxaparin in the evening. Day 4 Patient complained of chest pain in the morning, with minimal SOB. His vitals were normal. Subcutaneous enoxaparin 60 mg was given and the IV saline was continued. Lab Findings Urine Biochemical Analysis (Day 1) Investigation values Normal values Protein ++100 mg/dL Glucose negative negative Blood negative Leucocytes +-10 WBC/ÃŽÂ ¼L Ketone negative negative Bile negative negative Urobillinogen normal Specific gravity 1.025 1.003 1.040 pH 5.5 4.6 8.0 Nitrite negative negative Table 2: Results of urine biochemical analysis on Day 1 Lipid Panel Fasting Serum Lipid Plasma total cholesterol / mmol/L 4.5 Desirable Borderline 5.17-6.19 High risk >6.20 Plasma triglyceride / mmol/L 1.27 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Desirable Borderline 1.7-5.64 High risk >5.65 Plasma LDL-cholesterol / mmol/L 2.91 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Desirable Borderline 3.36-4.12 High risk >4.13 Plasma HDL-cholesterol / mmol/L 1.01 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Desirable >1.03 High risk Total cholesterol / HDL-cholesterol 4.5 Desirable Borderline 3.8-5.8 High risk >5.9 Table 3: Results of lipid panel (fasting serum lipid levels). Renal Profile Electrolytes Measured levels on Day 1-1.14am Measured levels on Day 1-12.54am Measured levels on Day 2-10.47am Normal range Urea / mmol/L 22.8 22.4 21.1 2.8-7.2 Sodium / mmol/L 129 128 129 136-146 Potassium / mmol/L 5.3 4.8 4.7 3.5-5.1 Chloride / mmol/L 98 94 101 98-107 Creatinine / ÃŽÂ ¼mol/L 423 398 345 58-96 Table 4: Renal profile of Mr. X showing levels of electrolytes and creatinine. Plasma troponin I 0.15 ng/mL Liver Function Test Measured level Normal range Plasma total protein 81 g/L 66-83 g/L Plasma albumin 34 g/L 35-52 g/L Plasma globulin 47g/L 25-44 g/L A/G ratio 0.7 0.9-1.8 Plasma alkaline phosphatase 119 u/L 30-120 u/L Plasma aspartate transaminase 19 u/L Plasma alanine transaminase 43 u/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ Plasma total bilirubin 6 ÃŽÂ ¼mol/L 5-21 ÃŽÂ ¼mol/L ESR 47mm/hour à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ 0-20 mm/hour Table 5: Results of liver function test showing protein and liver enzyme levels in plasma. Full Blood Count (FBC) (Beckman Coulter) Cell type Measured level Normal range WBC 9.9109/L 4-10109/L RBC 3.341012/L 3.8-4.81012/L Haemoglobin 95g/L 120-150g/L Haematocrit 0.273L/L 0.36-0.46L/L Mean cell volume 81.8fl. 83-101fl. Mean cell haemoglobin 28.4pg. 27-32pg MCH concentration 347g/L 315-345g/L Platelets 353109/L 150-400109/L RDW 19.4% Neutrophils 3.3 2-7 x109/L Lymphocytes 1.74 1-3 x109/L Monocytes 0.55 0.2-1.0 x109/L Eosinophils 0.21 0.02-0.5 x109/L Basophils 0.03 0.02-0.1 x109/L Table 6: Full blood count of Mr. X. Vital Stats Chart Date Time Blood Pressure/ mmHg Temperature / oC Pulse Rate/ bpm SpO2/ % Blood Glucose levels/ mmol/L Day 0 11.05 pm 140/80 37 91 100 13.9 11.30 pm 137/84 37 80 100 Day 1 8.30 am 130/80 37 70 4.8 (fasting) 3.55 pm 130/70 37 90 10.30 pm 108/64 37 81 Day 2 8.20 am 119/69 37 78 4.50 pm 130/90 37 82 9.6 9.45 pm 140/90 37 80 6.7 Day 3 8.50 am 114/77 37 72 98 6.6 Table 7: Records of vital stats of Mr. X from Day 0 3. Disease Overview Pharmacological Basis of Drug Therapy Acute coronary syndrome (ACS) is a broad term used to classify a continuum of symptoms and events stemming from acute ischaemic episodes affecting the cardiac muscle.1 This includes unstable angina, non-ST segment elevation myocardial infarction (NTEMI), and ST segment elevation infarction. It is usually characterised by chest pain which increases in its severity at rest or with physical exertion. The ischaemic events usually arise from the development of unstable atheromatous plaques,2 which explains the fact that stable angina (due to a stable coronary atheromatous plaque) is not included under this umbrella term. Rupture, ulceration or fissures of the atherosclerotic plaque often leads to formation of a thrombus, causing occlusion of coronary arteries and inadequate blood flow and, subsequently, inadequate supply of oxygen and nutrients to the cardiac muscle. This can be precipitated by acute stress factors on the sclerotic cap usually consisting of fibrous material, which is caus ed by local blood flow disturbances or vasospasms3. Unstable angina usually occurs without cardiac muscle damage while myocardial infarction (MI) may occur with or without myocardium damage. The thrombus formed in unstable angina is labile and obstruction is transient, and not a full-on occlusion as would occur in MI.4 Unstable angina occurs at rest and is almost indistinguishable from a non-ST segment elevated myocardial infarction except in the severity of cardiac muscle ischaemia. Theoretical definitions of unstable angina would include changes in usual patterns of stable angina after a stable pain-free period, or severe acute anginal pain causing almost total incapacity5, though it is difficult to define it exactly as the term is often used by medical professionals to describe a range of different conditions intermediate between stable angina and MI. The primary clinical symptoms of unstable angina are: sudden occurrence of chest pain that persists for more than 20 minutes which may be felt in other areas such as the jaw, arm, shoulder, neck or back; without cause (as opposed to stable angina which stems from physical exercise); shortness of breath, rapid pulse rate, and sometimes a rapid drop in blood pressure. Patients suffering from an ACS have a high risk of MI and possible even death; immediate hospitalization is often required1 and treatment is of a more urgent nature compared to that of stable angina. It has been suggested by the National Health Service (NHS) Hospital Episode Statistics in 1998 that 1000 out of every million per population is affected with unstable angina, or 10 acute hospital admissions per week.6 On a more recent note, NHS has reported in 2009 that angina affects between 10-15% of women and 10-20% of men aged 65 and above in England.7 Due to the close relationship between unstable angina and coronary events, it is worth noting that the highest averaged rates of cardiovascular events were observed in Glasgow and Belfast (UK), North Karelia and Kuopio (Finland), Newcastle (Australia), and Warsaw (Poland).8 Diagnosis of an unstable angina episode, or any ACS in that matter, is based on several aspects9. Physical symptoms include anginal pain at rest that lasts for 20 minutes or more; new onset angina severely limiting ability of physical activity; or changes in existing angina intensity, frequency or length of attack. One or more of these symptoms are an urgent indication that the patient is suffering from an ACS attack. Upon admission to hospital, ECG and blood tests should be performed to confirm the type of ACS in order to initiate treatment. In unstable angina, the ST segment is not elevated and levels of cardiac enzymes are normal (especially troponin T and I). If the onset of symptoms is unclear as to indicate ACS, a measurement of serum troponin concentration should be carried out 12 hours from presentation to establish the diagnosis.10 Treatment of unstable angina and NSTEMI are similar in terms of pharmacological management; indeed they are at presentation indistinguishable exc ept in terms of the severity and extent of cardiac muscle ischaemia, in which the ischaemia is less severe in unstable angina and less troponin T and I are released into the bloodstream. Antiplatelet agents. Aspirin and clopidogrel are the immediate emergency drugs used in the ambulance, both being antiplatelet drugs. Aspirin is an irreversible inhibitor of arachidonate cyclooxygenase (COX) enzyme, in which covalent acetylation of the serine moiety in a hydrophobic channel in the enzyme11 reduces synthesis of thromboxane A2 in platelets and prostaglandins in the endothelium. This prevents platelet aggregation and further enlargement of the thrombus formed in the coronary artery. Clopidogrel is an inhibitor of the ADP-dependent activation of the GPIIb/IIIa receptor and prevents the formation of fibrinogen bridges between glycoprotein IIb/IIIa receptors on the surfaces of platelets11, subsequently preventing platelet activation. Glycoprotein IIB/IIIA receptor antagonists, eg, abxicimab, have the advantage of inhibiting all pathways in the platelet activation process by inhibiting the glycoprotein IIB/IIIA receptor. Anticoagulants. Unfractionated heparin is an activator of antithrombin III, which inhibits the action of thrombin and serine proteases. The heparin also binds to thrombin; the combined effect of this and the heparin-antithrombin complex formed inhibits thrombin, which decreases the conversion of fibrinogen to fibrin and reduces platelet aggregation. In contrast, low molecular weight heparins (LMWH) have molecular sizes that are too small to bind to thrombin but still bind to antithrombin III, which inactivates all serine proteases including Factors XIIa, IXa, and Xa11, preventing the coagulation process. Direct thrombin inhibitors such as hirudin and bivalirudin inhibit thrombin reversibly. These agents can bind to free and bound thrombin, thus have the ability to prevent and dissolve preformed clots. Synthetic pentasaccharides (fondaparinux) is a selective indirect inhibitor of Factor Xa. It binds to antithrombin III reversibly, catalyzing the inactivation of Factor Xa12 and inhibit ing the coagulation cascade. Beta blockers. All beta blockers bind to beta-adrenoceptors, competitively antagonizing the action of catecholamines. These drugs block the beta-1 adrenoceptors at the heart, achieving a decreased heart rate and force of cardiac contractions, as well as lowering blood pressure. Atenolol is relatively specific for cardiac beta-1 adrenoceptors and exerts fewer side effects associated with beta-2 adrenoceptor blockade, for example bronchospasm in asthmatics. Nitrates. Organic nitrates mimic the actions of endogenous nitric oxide to relax vascular smooth muscle by increasing the synthesis of cGMP, leading to the dephosphorylation of myosin light chains.11 Vasodilatation of coronary arteries causes increased coronary blood flow and coupled with its effects of decreasing arterial pressure and also cardiac output, the myocardial oxygen consumption is largely reduced. Statins. Also termed HMG-CoA reductase inhibitors, these medicines inhibit the rate-limiting enzyme in the synthesis of cholesterol, in which this enzyme converts HMG-CoA to mevalonic acid. ACE inhibitors are diuretics acting on the rennin-angiotensin system which inhibit the angiotensin-converting enzyme (ACE) and block the production of angiotensin II from angiotensin I. This reduces vascular resistance, increases tissue perfusion, and reduces cardiac afterload. Angiotensin II receptor inhibitors also act on the same system as the ACE inhibitors, except that they block the angiotensin II receptors directly instead of inhibiting their formation. The outcome is the same as above. Evidence for Treatment of the Condition Antiplatelet Agents The SIGN guidelines advocate that aspirin and clopidogrel be given to patients with ECG ischaemic changes or increased levels of cardiac markers; and aspirin is advocated for all patients suffering from ACS. A meta-analysis of 287 randomised trials proves the protective effect of aspirin on patients with unstable angina, halving the rate of cardiovascular events, including death, non-fatal MI and strokes, or also termed the first primary outcome; while in those with an acute MI, it reduces the rate of coronary events by almost a third13. Long-term use of aspirin for these patients was also shown to be a beneficial antiplatelet therapy. According to the same study, reduction of serious vascular events by clopidogrel was 10% compared to aspirin. The combined use of clopidogrel and aspirin as compared with a placebo and aspirin showed significantly higher success rates in reducing occurrences of first primary outcomes (9.3% compared to 11.4%, P On the flipside, although short term studies have shown that antiplatelet medications are effective for patients with renal failure in the prevention of serious vascular events13, the risks of bleeding is increased by renal disease15, posing a possible contraindication for antiplatelets to Mr. X. A clinical study found that treatment for NSTEMI ACS in patients with chronic renal disease (mild to moderate stages) was less aggressive than those with normal renal function, despite the risk that these patients with renal disease would experience greater adverse outcomes from insufficient treatment for ACS compared to the other patient group16. However the available information on adverse effects of antiplatelets on patients with varying degrees of renal disease is limited and it would appear that this would result in the reluctance of medical professionals in using this class of drugs for patients with chronic renal disease as well as ACS. It can be inferred that Mr. X would gain the maximum benefits if his medications were changed to aspirin 300 mg and clopidogrel 300 mg stat and aspirin 75 mg and clopidogrel 75 mg thereafter, in which the patient should be closely monitored for signs of bleeding. Heparins LMWHs A 2003 review of 7 studies involving 11,092 patients with non-ST elevation ACS found that low molecular weight heparins (LMWH) were more effective than unfractionated heparins in reducing MI events, requirement for revascularization procedures, and thrombocytopenia17. No difference in the mortality, recurrent angina, major and minor bleeds were observed in the two types of drugs. A meta-analysis of 12 randomised trials with 17,157 patients involved found that patients who have had a non-ST elevation ACS who were put on aspirin experienced no significant difference in benefits in efficacy (preventing MI or death) or safety (major and minor bleeding complications) when they were put on unfractionated heparin or LMWH17, implicating no difference in the thrombolytic effect in both classes of drugs. These results are partially similar to those of the first review. Another meta-analysis of 2 phase-3 trials comparing enoxaparin and unfractionated heparin, on the other hand, showed a signifi cant (20%) difference in reducing death or severe cardiac ischaemic events18. From an economic point of view, authors of yet another meta-analysis on the subject stated that the cost of LMWH is 3-5 times higher than unfractionated heparin19. From these data it can be concluded that LMWHs does indeed have additional positive treatment outcomes compared to unfractionated heparins22; it does not show significantly decreased side effects (bleeding). Enoxaparin has, though, an increased bleeding effect on patients with renal disease as reported by an investigation of 106 patients, in which total bleeding complications occurred in 22% of normal patients and 51% of patients with impaired renal function (p It is still the drug of choice for patients present with non-ST elevated ACS, and this is applicable to Mr. X with unstable angina. Beta-Blockers Beta-blockers were not prescribed for Mr. X. The SIGN guidelines states that beta-blockers should be the drug of choice for first line treatment of anginal pain in patients with non-ST elevated ACS. A meta-analysis of 5 trials consisting of 4700 patients in all showed a 13% reduction in anginal pain with the use of beta blockers (initially IV then oral for a week) in patients with non-ST elevated, MI-characterised chest pain23. It was stated in the clinical progress Mr. X had chest pain on Day 1 and 4, thus the addition of a beta blocker to his medications would be useful in alleviating his pain. Despite the popular belief that beta-blockers are contraindicated in patients with diabetes mellitus, it is possible to treat these patients using beta-blockers as long as good glycaemic control is achieved and the patient is monitored regularly24. This would further support its use in Mr. X; furthermore, several studies have shown that diabetic patients derive a significant benefit from the use of beta-blockers after an MI, in which diabetic patients had a significantly lower mortality 1 year post-discharge25, total mortality after 3 years, and deaths from cardiac events26. A multicentre randomized trial, the HINT trial, on patients with unstable angina found that metoprolol, a relatively cardioselective beta blocker, reduced occurrence of myocardial ischaemia or progress to MI within 48 hours, indicating that metoprolol has a short term beneficial effect on patients not already taking beta blockers prior to the unstable angina episode27. It has been suggested that beta-blockers be the first line treatment for unstable angina and if patients remain unstable, a calcium channel blocker should be added28. Statins The beneficial effects of statins in reducing mortality and cardiovascular events have been proven by a meta-analysis of large, randomized controlled trials (n=90,056) where coronary artery disease was present or absent29. The positive results were also proven spanning a large range of serum cholesterol levels. Investigations comparing the use of intensive versus moderate doses of statins in the early stages and post-ACS showed positive results: a meta-analysis of 4 large trials (n=27,548) shows a 16% reduction in cardiovascular deaths or MI, as well as a 16% reduction in cardiovascular deaths or coronary events30. This view is shared by another meta-analysis of the same subject of 13 randomised controlled trials which found a decrease in mortality and coronary events after 4 months of treatment31. These data support the use of statins by Mr. X. Nitrates Nitrates have been widely used in relieving pain from unstable angina, despite its lack of clinical evidence in supporting its role in improving survival and reducing the rate of MI and cardiovascular events32. ISIS-433 and GISSI-334 reports no significant difference of the use of glyceryl trinitrate post-MI in reducing the overall mortality; however this may be explained by the fact that more than 50% of patients in the controlled group are also on other forms of nitrate therapy, such as intravenous glyceryl trinitrate. Despite this, nitrates will still be of use for reducing the pain in post-MI patients and those with unstable angina. The BNF advises against the use of nitrates in patients with serious anaemia (Hb Glycaemic control Mr. Xs plasma glucose levels were elevated on the day he was admitted to hospital (13.9 mmol/L). Diabetes mellitus has been proven to be a strong independent risk marker for coronary heart disease: patients with poorly controlled diabetes at hospital admission have a worse outlook on prognosis and future development of cardiovascular events35. The DIGAMI investigation reports that the use of intensive insulin therapy increased long-term prognosis (P=0.011) of patients presenting with hyperglycemia (>11mmol/L) at admission compared with those on standard antidiabetic therapy36. These data support the use of insulin to control the blood glucose levels of Mr. X which were highly increased upon admission. This is also supported by the SIGN guidelines which advocate immediate control of blood glucose is carried out for MI patients with glucose levels of more than 11.0 mmol/L for at least 24 hours. ACE Inhibitors The SIGN guidelines recommend that patients with unstable angina should be given ACE inhibitors as long-term therapy. In patients at high risk of cardiovascular events, ACE inhibitors (ramipril was investigated in a report37) have been proven to reduce overall mortality, MI, and stroke, particularly in patients with diabetes mellitus. Perindopril was found to reduce cardiovascular risk (relative risk reduction =20%, P=0.0003) in a population with stable coronary heart disease in absence of heart failure38 in a double-blinded, randomized multicentre trial involving 13,655 patients. A meta-analysis of the 2 above trials and a third one (PEACE) showed a reduction in overall mortality, cardiovascular death, non-fatal myocardial infarction, stroke, heart failure, and coronary artery bypass surgery by ACE inhibitors39. This demonstrates the benefits of ACE inhibitors in patients with atherosclerosis: as patients who had an ACS event would have a higher rate of cardiovascular events, the po sitive outcomes of ACE inhibitors can perhaps be extrapolated to this population in order to decrease coronary events and improve prognosis. However, the BNF advises caution and close clinical monitoring if ACE inhibitors are to be used in patients with hyponatremia ( Oxygen therapy On admission, Mr. Xs SpO2 was 99% and remained high throughout his stay in the hospital. The use of oxygen therapy is significantly beneficial only in hypoxic patients (with SpO2 Anaemia and Unstable Angina Anaemia can disturb the balance between myocardial oxygen supply and demand: a decrease in the number of red blood cells can lead to a reduction in the supply of oxygen to the myocardium. Thus correction of the causative factor would be sensible in the treatment of unstable angina for the patient in context. Mr. X was given a combination of ferrous fumarate, vitamin B complex, and folic acid for treatment of his anaemia. From the data in Table 6, it can be seen that Mr. X has low haemoglobin concentrations (95 g/L) and a low mean cell volume (81.8 fl.). To confirm that Mr. X is indeed suffering from iron-deficiency anaemia (as suggested by his treatment medication), three parameters must be established namely the plasma iron, the plasma ferritin, and total iron binding capacity. However, as very few conditions can cause abnormalities in the mean cell volume, and a decreased value is due to iron-deficiency anaemia or thalassemia42, it is safe to assume that Mr. Xs anaemic condition is due to an insufficiency of iron. Iron supplements are given to correct the iron status of the patient, in which the ferrous form given orally is found to be cheap, safe and effective in the majority of patients with iron-deficiency anaemia2. Vitamin B complex and folic acid are only indicated in patients with the respective deficiencies2; there is little evidence that they would be of any significant benefit in patients with iron-deficiency anaemia. Summary Based on the evidence given, Mr. Xs aspirin dose should be changed to 300 mg stat and 75 mg thereafter, and clopidogrel should be added into his medication profile in the same doses. These changes ensure that Mr. X is obtaining sufficient antiplatelet effects from his medications to prevent another attack of unstable angina or even a myocardial infarction. Present drugs that were given for his condition that are suitable and supported by evidences include enoxaparin, lovastatin, insulin, and GTN: these can be safely continued without problems. A beta-blocker (metoprolol tablets) may be given additionally in doses of 50-100 mg as evidences described above have shown that they can be safely used in diabetic patients contrary to popular belief; an ACE inhibitor (perindopril as previously used by Mr. X) may be initiated coupled with regular electrolyte

Stewardship Essay -- essays research papers

Around the world in Christian and secular circles we hear the word stewardship. Not only is stewardship one of the basic issues discussed in scripture, but it’s also something we neglect as something we need to concentrate on while going through our own Christian walk. We live in a society that is very individualistic, concentrating on whatever will bring pleasure and make us feel good. Stewardship definitely doesn’t fit into the way society is today. Before going to far into this, what exactly is stewardship? Stewardship is taking care of or managing every God-given resource with an attitude of responsibility directing such resources for his intended purposes. To truly understand stewardship, we need to first look at what God says in his inherent word about this issue. The stewardship principle is a three-part practice.   Ã‚  Ã‚  Ã‚  Ã‚  To break this process down, one can see the simplicity and complexity of this process and how it fits into God’s perfect plan. First, we were all created in God’s image. Being image bearers of Christ gives us great responsibility to those who know and love Christ because everyday we are representing the King of Kings wherever we go. The second principle of stewardship is the redemption principle. Since Christ died for us on the cross, he set us free from the bondage of sin. Even though we are fallen people and sin daily, Christ has already paid the price in full, and has forgiven us of those sins in advance. The last part of th...

 “Hawk Roosting” and “Golden Retrievals” Essay

In the two poems Ted Hughes’s, â€Å"Hawk Roosting,† and Mark Doty’s, â€Å"Golden Retrievals†, the writers use tone and visual imagery to present the animals’ unique point of view in the poems. The tone of â€Å"Hawk Roosting† is powerful, sinister, and arrogant compared to the lighthearted, playful tone that is set in â€Å"Golden Retrievals.† The hawk’s monologue in â€Å"Hawk Roosting† shows how the Hawk sees the world with such power and a sense of ownership as he tells the reader that he â€Å"kills where [he pleases] because it is all [his]† (line 14), in difference the k-9 in â€Å"Golden Retrievals† who sees it in a playful and distracted manner. The egoistic narrator in â€Å"Hawk Roosting† is a hawk that uses imagery make the reader envision the world from his eyes. The reader can imagine the narrator’s â€Å"each feather/ hooked head and/ feet locked upon the rough bark† (4, 9, 11). The wording seen during the course of the poem â€Å"Hawk roosting† creates an image for the role that the Hawk thinks he plays in the world. The Hawk views the world from â€Å"the top of the wood† and as the Hawk is able to fly he â€Å"the earth’s face [is] upward for [his] inspection† (8) showing his excellent view of his surroundings and how he views the world as his own. In â€Å"Golden Retrievals† the distracted narrator paints a picture in the reader’s mind of how many objects he encounters and allows the reader to imagine the dog constantly chasing after a new object on a daily basis. He â€Å"sniff[s] the wind, then/ [is] off again† (4-5) while the owner is â€Å"sunk in the past, half [their] walk,/ thinking of what [the owner] never can bring back† (7-8). In contrast to the Hawk, the Golden retriever is much more of a carefree character. The wording used in this poem is much more energetic than the diction seen in â€Å"Hawk Roosting.† The narrator speaks of things that remind the reader of dogs and their nature such as â€Å"Fetch, Balls and sticks, [Bunnies], a squirrel†. Hughes uses a dark tone to portray the hawk as a very powerful, wild, and sinister animal. The Hawk states, â€Å"There is no sophistry in my body:/ My manners are tearing all heads-† (15-16) showing how he views himself as a ruthless king of the earth and the â€Å"whole of Creation† (10). In opposition  to Hughes, Doty uses a more playful and distracted tone to depict a character who is concerned with fetching and is easily distracted because â€Å"Balls and sticks capture [his] attention/seconds at a time†(1-2). The Dog views himself as a friend to its owner, and although the Dog is distracted with running, chasing squirrels, and fetching, the Dog also is aware of its owner Doty uses the playful thoughts of a dog while Hughes contrasts with the stark thoughts of a commanding hawk. These opposing characterizations help the narrators convey very different animalistic perspectives of the world. While the Hawk views the world with ownership, the Dog is easily di stracted by passing objects and enjoys the little things in life.

Macroeconomic Stabilisation Theory and Policy

The level of economic stability in any economy depends on both macro and microeconomic variables. Within the scope of the macroeconomic tools various, markets are deemed to be influential. These include the money market, the goods/commodity market, the labour market, capital and also foreign market. For stabilisation purpose, all the markets should be at equilibrium both in the supply and demand sides. The labour market remains a fundamental market that models the nature and status  Ã‚   of economic stability. Labour market is the general portfolio within the market which figures the broad scope of the demand and the supply of labour. Within the economy, labour interacts with the firms to provide the relevant implication to each other. Labour within the economy is provided by the households. It is paid in terms of wages and other remunerations. Either, the firms produces consumption goods and also services for use by the household. Consequently, stability in the labour market provides a stake in defining the levels of economic functionality. This is basically through shaping the nature and scope of unemployment which is a macroeconomic variable. Unemployment is also determined by the existing levels of equilibrium between labour demand and supply. Economically, the aggregate labour market is cleared at the economic disposition when the level of labour demand and supply are deemed equal.   Broadly, the aspect of the demand and the supply of labour for such market clearing are defined in terms of the market level of wages. Wage is the price levied for the supply and demand of labour. From the two sides, the household is deemed to be the supplying component of the labour service while the firms are the demand function of labour. The aspect of market clearing therefore tries to establish the most functional level of wage rate which makes both the demand and supply of labour equal within the labour market. Therefore, the household and firms seldom rely on the levels of the market wage rate as benchmarks for support with which the labour substitution can be made. (Ron, Philip, 2002, p.90) The basic concept is however the determination of the most adequate levels of market wage rates which creates market clearing. For stability purpose, the level of labour supply and labour demand should always be at equilibrium. This wage rate is called market clearing wage   rate which is used by the hidden   hand of the market for clearing   the excess levels and also deficits in the demand and supply of labour. Market clearing in labour market is described by the concept of the basic economic law of the labour demand and supply.   This law states that, with all other factors being at a constant, the increase in wage rate leads to an increase in labour supply by the household in the short run. However, a decrease in wage rate brings a  Ã‚   disincentive for labour supply by the household which ultimately leads to lower levels of labour supply. The feasibility in the levels of labour supply and demand is fundamental in relating the existing relationship between employment and unemployment as a key factor in defining the stability scope of the economy. A low level of unemployment is important in describing the level with which the economy stabilises. Generally, the market clearing intercept in the labour market is provided by the equilibrium functionality between the labour supply and the demand. This is to mean that, the exact level of labour force supplied by the household is exactly equal with what is needed by the firms   within the economy. The functional aspect of wages determines the basic scope with which efficiency can be explained in the labour market. The basic levels of inequality between the supply and demand of such labour is what brings the idea of inefficiencies allied to unemployment. (Michael, 2002, p. 103) Economically in the commodity market, firms are the suppliers of services and goods to the household (consumers). However, in the labour market, these firms seldom becomes the consumers of the labour force. The need for labour force by the firms is for   making various   scope of products. The demand for labour in the different firm functions is dependent on the level of wages in the labour market. The clearing state for labour is determined by the related cost of the same which determines the related level of supply and demand. Consequently, the cost of labour in the market is what yields market wage rate. The level of supply and demand for labour is therefore a function of the wage rate. The desire by the firms in purchasing labour at the existing levels of market wage rates goes up to the point where both the wage rate and the marginal revenue product are equal. The marginal revenue product of labour would thus signify the level with which an additional unit of labour would generate to the firm’s revenue. Equilibrium levels in the labour market is what provides the market labour clearance. The equilibrium level of market labour is arrived  Ã‚   at when the aggregate levels of both demand and supply are equal. Generally, aggregate labour supply denotes the sum total of all the labour supplying units/ personnel in the market. Elsewhere, aggregate demand is what is captured by the sum total of all labour demand units by the firms in the market. For equilibrium, both the levels in supply and demand should equate one another. Equilibrium is denoted by the interception capacity of the labour demand and supply curves. (Gilles, 2000, p.87) The clearing tool in the labour market is operational within two scopes. The market could be unrestricted where the supply and demand levels are freely volatile to be determined by the basic circumstances in the market. Elsewhere, the market could be restricted to certain level of wage rate which therefore helps to control the wage rate from going below or above the specific levels of wage rate. The unrestricted market function implies that the level of market wage rate is determined by the scope of labour supply and labour demand. This is through the use of the basic law of demand and supply of labour by household and firms. When the wage rate is high, the level of labour supply is also high. However, when the wage rate is low, the supply of the wages is also low. With wages being restricted, the labour supply and demand is restricted by both wage ceilings and wage floors. Wage ceiling implies the highest level of wages which should not be surpassed above (it is made to protect the firms from   exploitation by the labour suppliers). Elsewhere, price floor is the lowest level of wage rate which should not be paid below it.   This is made to protect the labour suppliers from the basic exploitation by the firms through very low wage set up. The stability in the labour market plays an important role in the general commodity market, where the supply and demand for goods is depended on the price level within the market. (Andres, 1988, p.78) Generally, the level of consumption (both goods and services within the market is determined by the level of the income held by the households). Ideally, the same income is gotten through the sale of their labour services to the firms. Either, the supply of such goods and services by the firms is determined by many factors   which include the level   of labour   which is a basic   factor of production. Consequently, equilibrium in the labour market is a passive tool for providing   support   for a strongly functional   commodity market.   Through the sale of their labour services, the households get money which they use in purchasing their consumption requirements from the firms. Elsewhere, firms use the labour force from the workers to produce goods and services for use by the households. Therefore, the equilibrium state between the aggregate labour demand and aggregate labour supply is arrived at, at the point of intersection between both curves. Such an intersection point is important in claiming the level of the equilibrium level of wage rate as well as determining the level of economic state of employment. Within the competitive market   (unrestricted), the profitability level of the firms is determined by the level with which such firms hires labour until it reaches the level of equality between marginal cost of labour and marginal revenue product   of labour . (Ben, 1998, p.46) Conventionally therefore, market   clearing in the labour   markets is achieved by the   condition when   the level   of quantity demanded is equal to the quantity supplied. This is important in safeguarding against any form of shortages or even surplus quantities in the market. The stability status of the labour market provides an adequate status for safeguarding the level and implication of the rates of unemployment   in the economy. Generally, macroeconomic conception dictates that high labour supply than its demand produces labour surplus in the labour market. This is a basic indication towards a higher rate of unemployment within the economy. Elsewhere, high demand for labour than its supply causes labour deficits. This substantially causes an increasingly high level of unemployment. Altogether, a stable state between both labour demand and   supply   remains   fundamental   indication   in furnishing   the basic threshold   that determines   the scope of   unemployment . As a broad   macroeconomic variable, the speculation towards   reducing   the general   impact   in unemployment also captures stability   in other operating p[parameters between   the labour market. Generally therefore, stability in the   labour market provides   a ground work condition for its market clearing where the general demand supply are adequately at equilibrium. As a rule for such market clearing its fundamentals are basically projected by the capacity with which the market demand and supply of labour   would fundamentally yield substantially a stable position which limits the impacts of a high levels   of unemployment in the market. (Frank, 2006, pp.84) The support for market clearing in labour   market is expanded by the   Keynesian neoclassical model on a labour . He proposed that equality between aggregate supply and aggregate demand for labour would act to provide a groundwork favourable environment towards low states of unemployment. At the equilibrium level is the equilibrium amount of wage rate which helps to provide a high standard for rationality in reducing the level of unemployment. The equilibrium level of wage rate acts as a supportive tool for the implementation protocol where the level of supply is deemed rationally compatible with the theoretical wage levels. Elsewhere, the levels of demand would also be equal to the level of wages. As a rule therefore, the level of equilibrium within the labour market plays a fundamental attribute in a rationalising for a stable state of commodity market. (Frank, 2006, pp.98)   Also, since the labour market is one of the economic markets, its stability also provides a condition for a   strong defence towards a stable   state   of economy   where labour deficits   and surpluses would not be available hence a strong sense in the economic stability. Generally therefore, the basic concept behind labour market clearing is the basic threshold with which the level of quantities of labour supplied is equal with what is demanded. This provides a substantial position for strengthening the level of economic stability within the general economy. As an important macroeconomic tool, a stable state of employment within the economy is provided by the degree of compatibility between the labour market. High levels of unemployment cause instability in other facets of economic growth where low levels of consumption is deemed the basic implication of high unemployment. Therefore, great importance should be attached in the state of the relationship between the demand and supply of labour for a greater scope of economic functionality. Bibliography Andres, D. (1988) Real Wages and Employment: Keynes, Monetarism, and the Labor Market. London, Routledge, pp.78 Ben, F. (1998) Labor Market Theory: A Constructive Reassessment. London, Routledge,pp.46 Frank, M. (2006) Towards Labor Market Liberalisation. London Routledge, pp. 84,98 Gilles, S. (2000) The Political Economy of Labor Market Institutions. Oxford, Oxford University Press, pp.87 Michael, H. (2002) Labor Market Planning Revisited. Palgrave, Macmillan, pp.103 Ron, M & Philip, M. (2002) Geographies of Labor Market Inequality. London,

How to Build the Ultimate PC essays

How to Build the Ultimate PC essays For the case I chose the AOpen HX08 full tower ATX computer case. It comes with 7 high expansion slots and 13 drive bays to allow upgrade to your hearts content. Its dimensions are 420mm depth x 590mm height x 198mm width. Bend in edges ensures safe assembly and installation so you wont get cut. It has three 8cm fans and holes poked into the case to ensure cooling. I would upgrade the 300-watt power supply that comes with the case to the Enermax EG651P-VE power supply, which is 550 watts. For the processor I chose the 2.4 GHz Intel Pentium 4 processor that is also the fastest on the market. It has a 400 MHz front side bus with 512kb cache. To be able to harvest this processor I would buy the ASUS P4T-E motherboard. The motherboard has 5 PCI slots, 4 USB ports, an ATA 100 controller, one 4x AGP pro slot, system bus speed up to 400mhz, memory capacity of 2GB, it uses the Intel 850 chipset, and uses PC 800 RDRAM. Next up I would buy two single Toshiba 512mb PC 800 RDRAM chips to have a total of 1024MB of ram. Toshiba offers a lifetime warranty with these. The more RAM that your computer haves, the faster it can perform and prevent lockups. I would add the Adaptec ASC-29160N Ultra SCSI adapter. It is the fastest SCSI adapter on the market. With a data transfer rate of 160 MB per second it leaves its competition in the dust. It out performs its competition the Ultra ATA 100 by 60 MB per second. To take full effect of this adapter I choose 2 Seagate Cheetah 73 ST173404LCV hard drives. For a total of 146 gigabytes you will be happy for a long time. It has rotation speed of 10,000 rotations per minute. The highest rotation speed of an ATA hard drive is 7,200 rpm. It has a faster seek time then the Ultra ATA hard drives. The fastest seek time of an Ultra ATA hard drive is 8.9ms. The fastest seek time of an average Ultra 160 SCSI hard drive is 5.2ms. The Ultra SCSI comes with a 4mb buffer cache while the Ultra ATA comes with a 2mb bu...

Stop motivating your employees Research Paper Example | Topics and Well Written Essays - 1000 words

Stop motivating your employees - Research Paper Example When employees are recognized for their distinctive associations, the motivation premise will set in easily. This helps them to grow beyond a certain point and get encouraged all the same. Nearly each and every employee has a characteristic of their own which needs to be appreciated within the domains of an organization. This can be discerned through meeting employees who stand a chance to get recruited within the domains of an organization. What this implies is the fact that these potential employees are asked for certain questions which suggest for their motivation levels. If they are de-motivated then this is a good time to know why this is the case (Robbins et al., 2008). If they are encouraged properly, they shall find a way to get motivated because it is every organization’s priority number one. There cannot be any two opinions about new employees who should be motivated enough to run the reigns of an organization. When strong relations are built with employees, they bec ome motivated to carry out their respective tasks. If these relations turn into positive ones, there would be more delight amongst the employees and they will always appreciate the organization for all its efforts, endeavors and undertakings (Sirota et al., 2006). It will essentially stop de-motivating the employees who are proactively looking for a way through which they can learn new avenues and seek novel grounds as far as their working domains are concerned. Hence it is a good measure if the de-motivation comes to a halt immediately, whereby there is more room to grow and develop for the employees and workers to boost the business in the real sense of the word. Another way through which de-motivation can be avoided within employees is to set individual goals for them so that they achieve them without much difficulty. It makes their tasks cut out and they know exactly what is required of them from an organizational standpoint. When the employees have hard specific and achievable goals up their sleeves, they will always remains motivated enough to come back to work day in and day out. They will know exactly what is required of them and what resources they must employ to attain their respective results (Sirota et al., 2006). This is a very significant aspect of learning new methodologies while remaining motivated all this while. What is even more necessary is the fact that employees must always know that whatever they are trying their hands at is achievable right from the outset. This shall shape up their actions and tell them exactly how they are going along with their respective work domains (Robbins et al., 2008). If they believe they cannot achieve these tasks, then there is bound to be more de-motivated existent within their ranks. Providing feedback on employees’ performance is one of the few ways through which their work regimes get measured. This could either be done in an annual feedback session or through semi-annual programs (Robbins et al., 2008). The need is to tell the employees exactly where they stand and what more they can do in the future. It shall always motivate the employees because their respective domains mean that the business will start to prosper (Sirota et al., 2

An interventional approach for patient and nurse safety Dissertation

An interventional approach for patient and nurse safety - Dissertation Example The theoretical framework that was used in this study was the model of impaired sleep developed by Lee et al. The framework is based on a scientific theory (Burns & Grove, 2009) as it uses previous research linking sleep quality with errors and lack of alertnessTheoretical Model Discussion The theoretical framework is clearly discussed as having a direct significance with the research topic It is stated impaired sleep consists of either sleep deprivation (inadequate sleep) or sleep disruption (fragmented sleep). The model implies that impaired sleep results in cognitive, behavioural, physiological, social, and emotional responses. The paper elaborates how a targeted fatigue countermeasures program for nurses (FCMPN) can intervene and prevent or alleviate the cognitive and behavioural impacts (like sleep duration, daytime sleepiness, and alertness) and reduce patient-care errors. The following figure from the paper captures the conceptual and the theoretical framework employed: The fr amework is therefore discussed well to outline what variables are to be measured pre and post the FCMPN intervention. 2. Major Study Variables Research Variables: 1. Sleep Quality 2. Sleep Duration 3. Daytime Sleepiness 4. Vigilance 5. Risk for Accidents and Errors 6. Short Term Memory 7. Problem Solving and Coping. Conceptual Definition Sleep Duration was defined as the time duration that participants spent in uninterrupted sleep. Sleep Quality was clearly conceptualized to mean sleep which is not fragmented and which is of adequate duration. While the remaining variables were not clearly defined, conceptually they could be understood to mean the following: Daytime Sleepiness – tendency to doze during the daytime work-hours Vigilance – Drowsiness and Unplanned Sleep Episodes during work hours Risk for Errors – Any perceived deviations from standard practice Short Term Memory – Recall of errors Problem Solving and Coping – How errors were managed O perational Definition Sleep Duration was measured using the log book entries made by the participants. Sleep Quality was measured using the Pittsburgh Sleep Quality Index PSQI (Buysse, Reynolds, Monk, Berman, & Kupfer, 1989). Daytime Sleepiness was measured using Epworth Sleepiness Scale (Johns, 1991) while other variables (Vigilance, Risk for Accidents and Errors, Short Term Memory, Problem Solving and Coping) were measured using the log book entries using the self-report method 3. Sample and Setting a. Sample Inclusion/Exclusion Criteria Full-Time Hospital Staff Surgical nurses were used as the sample. In addition, the selection criteria included that the nurses should be working at least 36 hour per week. Advanced practice nurses, nurse managers, or nurses in specialized roles such as discharge planning were excluded. b. Sampling Method The paper mentions using three surgical nursing units in Michigan using convenience method for selection, though the rationale or the specific fa ctors that led to the selection of the method is not listed. The qualifying nurses were contacted using the official mailing list and out of the 126, 62 consented to participate in the research. c. Sample Size 62 Power analysis indicated that 30 sample size would be sufficient to establish the impacts of FCMPN on the variables that are researched. d. Refusal to Participate Number and Percentage 62 out of the 147 full-time hospital staff nurses (43%). e. Sample attrition or Mortality Number and Percentage Out of the 62 selected for participation, 15 (24%) did not continue with the study for the complete duration. f. Informed Consent Process/Institutional Review Board The 147 nurses that comprised of the qualified the inclusion criteria were sent a preliminary survey to provide demographic information and give their interest to participate. Once the intent of