Descriptive Essay Beach Bums - 913 Words

Beach Bums Our designated driver is on the floor. With a mouthful of sharp beach sand in his mouth, he stays down and screams â€Å"Darn!† Disoriented and dehydrated I look to the top and I see my partners in crime, yelling at the top of their lungs from the roof of sun beaten lifeguard tower, â€Å"Throw some beer in his mouth!† With smile football stadiums wide I look down at my bare skin. Covered only by boxers, soaked by the oceans bitter cold waters, there I was; tears running down my cheeks freezing like a nude fool. I had found what I was always looking for, and it turned out what I was looking for I had the entire time. Growing up with depression can be hard. It can be especially hard when you don’t know you have it. I was informed of my depression after a series of test and numerous trips to the doctors. I didn’t enjoy many of things other people did when I was younger due to my depression, but as I got older, dealing with my depression came to b e harder and harder. I showed no interest in anything or anyone. Things I ones use to love to do no longer called my name. My guitar gathered dust, my skateboards corroded with the seasons, my hopes to ever feel normal again gone. Constantly getting different medications was the worst part. I never knew if that day I would be happy, sad, mad, or my all-time favorite, suicidal. Eventually I learned how to deal with my depression, given the right cocktail of pills that is. As the years went by, it got easier to talk about my

Western Civilization Review for Rome exam Free Essays

Macedonian professional army-advantages Included a wide range of specialists, strict dullness and elongation of large numbers of noncombatant servants 2. Battle of Charlene- ended Greek city state freedom once and for all. 3. We will write a custom essay sample on Western Civilization Review for Rome exam or any similar topic only for you Order Now Philip of Macedon- by his death he had installed his despotic rule throughout Greece 4. Alexander-was motivated by the desire for personal power and glory 5. Despotism-absolute power- of authority of rulers who represented themselves as at least semi-divine 6. Hellenic age government- the dominant form In lands conquered by Alexander except mainland Greece was despotism 7. Hellene economics- was generally prosperous owing to the growth of trade, the emergence of an International money economy, rice of cities 8. Cynics- philosophical movement that advocated a natural and self sufficient life 9. Stoics- argued that all events are rigidly determined and that therefore no individual is in control of his or her destiny 10. Democratic- Greek thinker that founded materialistic atomics and epicureans basic beliefs 1 1 . Epicureans- taught that the state Is a mere convenience that absolute justice Is a fiction, and no wise man would take an active part In politics. 12. Skepticism-believed hat we cannot prove anything 13. Hellenic Religion- personal emotional religions, elaborate ritual salvation 14. Matthias- a lieutenant of Agrarianism’s omnipotent god Aura-Mazda 15. Mathis- appealed to the lower classes because it offered an elaborate ritual and promise of salvation 16. Populous- historian who argued that nations pass through predictable cycles of growth and decay 17. Utopias- descriptive accounts of Ideal states 18. Corinthian column- very ornate signature of Hellene. Arch. 19. Hellene sculpture- contained extreme naturalism, the desire to create something unique, and exaggerated postures 20. Almagest- heavenly bodies revolved around the earth, classic ancient astronomy 21 . Euclid- master of geometry 22. Elements of Geometry- by Euclid, until sass’s was the accepted basic study of math 23. Horseshoes of Chalcedony- breakthroughs In medicine 24. Restaurants founder of physiology and separate science 25. Archimedes- physical, experimental science 26. Roman geography- easy to invade, militarism 27. Etruscan-skilled metal worked, trades, gods human form, respect for women 28. Senate- council of elders, veto power over royal 29. Consuls-lobbyist- senators acting for the royals 30. Roman religion-served to benefit and protect state 31 . Punic Wars-increased roman territory, expansion, legal changes good for wives 32. Karachi Brothers- for social economics- gob land for the landless 33. Julius Caesar- unused land for economic inequities, unite Rome/loyalty, saw significance of NW Europe 34. On The Nature of Things- Lucrative – roman poet, removed fear of supernatural, peace of mind 35. Cicero- Stoic philosopher program incentives for provinces, elimination of tax farming 38. Marcus Aurelia’s- last roman Stoics, not helpful 39. Roman Literature- golden age, vigorous and uplifting, silver age less calm, lanced 40. Roman Arch- Participate period, symbolized power 41 . Crisis of Third Century- civil war, economic chaos, disease 42. Neo-Platonism- emanation, asceticism, mysticism 43. Romeos decline- political, economic, cultural failings led to collapse. Contributions: a. Architecture: monumental, symbol power grandeur, round arch, vault, dome, brick, stone, concrete, , pantheon coliseum b. Sculpture reaches, columns, relief, altars, busts, statues. Individuality naturalism. Vanity, aristocracy, portraiture busts- humanity. C. Roman Law: civil law: for roman city, law of the people, for all commonalities and natural law. Augustus. D. Romeos contribution to future – transmission of Greek civilization to W Europe 1 . Neolithic Period- change- hunting/ gathering to sedentary agriculture 2. Ice Age- species disappear from W Asia 3. Nutcracker Man-advanced ape walked erect 4. Villages- sedentary agriculture 5. Near East-first seed agriculture group 6. History/pre-history- written records 7. Warfare began with a surplus of material goods/food 8. Hyssop invade Egypt-foreigners attack/ lead to Egypt empire 9. Papyrus- leaf/ paper Egg freedom to write/literature 10. Manner- Unified the Egypt nation 1 1 . Egypt contributions- monotheism- writing systems, monumental arch 12. Senator’s artistic revolution- naturalist cycle 13. Egypt women- owned property 14. Old kingdom, Egypt, changed economy, public-works Jobs during flood season for farmers 15. Nubian- notions of kingship religion 16. Ethiopia- embraced Christianity as state religion 17. Summer- S Mesopotamia 18. Sarong the Great- Summer under Skidpan domination for 2 centuries 19. Sumerian economic/political decline- colonization 20. Gujarat- Sumerian temple terraced tower, shrine 21 . Hebrew contributions- history, literature, ethics, religion 22. Ancient Assyrian- hated nation, people revolt-destroy 23. Saul- Hebrew, monarchical gob, coronation of first king 24. Epic of Galoshes- secular philosophy of life, affirmed human experience/action on earth 25. Chanceries- mighty and seal his military victories, constructed Nineveh 26. Salmon’s Temple-N tribes seceded from Hebrew state 27. Indus Valley Civilization- urban society/sops trade 28. Zoroastrian- one supreme god- Aura-Mazda 29. Trojan War- commercial/ between Aegean trading rivals/ cause piracy 30. Heimlich Schlemiels- showed Homer’s Iliad fact 31 . Mycenae- geared toward warfare 32. Greek Philosophical control to W Civic- truth from Q 34. Greek Dark Ages Politics- held by kings warriors 35. Spartan- political sys based on checks and balances 36. Peloponnesus War- destruction of city and state/ Athens 37. Greek medicine- disease has natural cause 38. Helots-slave farm laborers mostly Spartan 39. Calisthenics- 1st real democracy in Athens 40. Herodotus- Father of history 41 . Plato- higher spiritual realm, elitist state ruled by philosophers 42. Philip of Macedon- despotic/dictator rule throughout Greece 43. Macedonian professional army- specialist, discipline, eliminated many servants 44. Alexander- motivated by desire, power, glory 45. Epicureans-Taught state convenience, absolute Justice fiction, no wise man/ politics 46. Solon- Paid political positions- wealth/birth 47. Hellenic sculpture- naturalism, unique, exaggerated postures 48. Wholesale of Chalcedony- breakthroughs medicine 49. Battle of Charlene- Greek city/state freedom 50. On The Nature of Things- Lucrative – roman poet, removed fear of supernatural, peace of mind 51 . Romans pass cultural contributions borrowed from the Greeks 52. Roman geography- easy to invade, militarism 53. Karachi Brothers- for social economics- gob land for the landless 54. Sprat’s Lesson- cannot afford to ignore cultural pursuits while seeking military control 55. Ancient Roman Plebeians’ victories- greater share in gob, admission to the assembly 56. Roman religion-served to benefit and protect state 57. Romans, Etruscan, Greeks, dominated Italian peninsula before sixth century 58. Punic Wars-increased roman territory, expansion, legal changes good for wives 59. Julius Caesar- unused land for economic inequities, unite Rome/loyalty, saw significance of NW Europe 60. Roman Arch- Participate period, symbolized power How to cite Western Civilization Review for Rome exam, Papers

Mary Shelley’s Frankenstein Essay Paper Example For Students

Mary Shelley’s Frankenstein Essay Paper For the entire creation scene the camera shows the point of view of Dr. Frankenstein using camera angles and shots from his perspective, however, when Frankenstein does pull the creature up on the chains hanging above the laboratory the camera shows a high angle shot looking down on Frankenstein from the creatures view, this enforces the idea to the audience that the creature still alive but also that the creature has emotions and feelings. An extreme close up is used when the creatures eye flickers open, this builds up the tension for the audience and again portrays the life in the creature, the camera then pans round to the doctor who believes the creature has lost all life and his experiment didnt work, in doing this the camera pans the room giving the audience an idea of how much work went into the creation due to the state and busyness of the laboratory. A close up shot is used when Frankenstein is standing in front of the mirror reflecting upon what he has done and the little he thinks he has achieved, this gives the audience another insight into his way of life during the creation. Sound is also used in the creation scene to build up the tension, fast music is used when the doctor is preparing to bring the creature to life, over the music, once the creature has been brought to life, the clattering and hammering of the monster can be heard from inside the casket, until it bursts open. All of this builds up tension and suspense for the audience. Before the casket breaks open you can hear Frankenstein talking to himself. Yes, yes There is then a few seconds silence in which he uses to listen for movement from the creature but this is also used to engage the audience into whats happening. However, the silence is broken by Frankensteins loss when he thinks he has lost the monster. No, no, no, no, no This is then followed by a loud bang from the monster to which the doctors response is; Its alive, its alive The silences are used to create tension and suspense for the audience but also give the audience time to reflect on what they have heard and feel for the character. This is specifically obvious when the realisation hits Frankenstein. What have I done? What have I done? This is followed by six church bells that could be used to represent a new beginning, as in a wedding or Christening bells are used to show the beginning of something new and for Frankenstein this was only the beginning. In conclusion Kenneth Branagh has adapted Mary Shelleys Frankenstein in many ways most of which are because it has been made into a film which uses different methods to portray things such as feelings and emotions which in a book can be written down but in the film these feelings must be shown through the characters themselves. However, he has adapted other things so as to keep realism throughout the film for example in the book there is no mention of the monster being in embryonic fluid, but Kenneth Branagh adapted this so as to portray the feeling that it may not have been such a ridiculous idea to try to create new life from old life and many of the ideas Dr. Frankenstein had were logical and methodical. In doing this Kenneth Branagh may have reduced some of the scepticism in the modern day audience.

Relation between business and culture free essay sample

To know before you go is an essential but often overlooked skill in the world of business. Competing in todays global economy means the successful business person must understand the relationship between culture and international business. Brush up on international etiquette, tips and customs. The advent and emerging popularity of the Internet changed the way we conduct business. It all but eliminated the geographic limitations of handling business affairs and negotiating trade. Now a corporation in Wyoming can conduct transactions with a company in Shanghai in real time. An automotive plant in Maine can order parts from Japan with the click of a mouse. Despite these advances, some things in the world of business have not changed. To be competitive in business and successful in professional dealings, companies have to understand how another countrys culture affects the way we do business with them. Brief definition of business: Business is an economic activity, which is related with continuous and regular production and distribution of goods and services for satisfying human wants. We will write a custom essay sample on Relation between business and culture or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page All of us need food, clothing and shelter. We also have many other household requirements to be satisfied in our daily lives. We met these requirements from the shopkeeper. The shopkeeper gets from wholesaler. The wholesaler gets from manufacturers. The shopkeeper, the wholesaler, the manufacturer are doing business and therefore they are called as Businessman. Brief defnition of culture: Culture describes the cumulative influences on a group of people or society–their collective knowledge, characteristics and learned behaviours. This knowledge is passed on from generation to generation and accounts for the different cultures that we can see around the world, for example Western culture, Eastern culture, Middle Eastern culture, African and Latin culture. Each of these cultures is defined by the values, traditions, social habits and behaviours, language, belief systems, concepts of the universe, dress, food, music and arts that they encompass. Culture determines what is acceptable or unacceptable, important or unimportant, right or wrong, workable or unworkable. It encompasses all learned and shared, explicit or tacit, assumptions, beliefs, knowledge, norms, and values, as well as attitudes, behavior, dress, and language. What is Business Culture? Companies that have to compete with others in the marketplace set themselves apart by their ability to interact on a personal level with their clients and vendors. Companies that conduct business internationally should take precautions not to offend their potential clients. They must understand that the slightest breach in etiquette can destroy years of positive relations. ex: It is John’s first trip overseas to meet a potential client in China for his company, ToysInc. Upon arrival he greets the first man he sees with a loud, boisterous hello and a firm hug. After being formally introduced, he calls his potential client by his first name, and shoves the business card he was given carelessly into his pocket. Later in the day he joins his new team for a business lunch where he arrives five minutes late. There John takes the initiative to begin eating, using a fork, and takes the last of the food on the table. During the meal he is loud, and makes an attempt to tell a joke when there is silence at the table. John’s outgoing, friendly personality makes him a great employee of Toys Inc. in the United States; however, his behavior with the Chinese clients could cost Toys Inc. their business. Communication and business practices vary greatly from country to country. It is important for business men and women to study the way business is conducted in other countries as there are very different norms for behavior across borders. This not only includes the way meetings and negotiations are run, but how greetings are done, whether gifts are appropriate, what types of verbal and non-verbal communication are used, as well as cultural attitudes. It is also imperative to learn how to behave in a social setting, because in many countries a personal relationship precedes that of a business relationship. Thomas Jaffee once said that first impressions- looking good and having a friendly greeting for someone- will go a long way. In business, this is much harder than it sounds because looking good and being friendly must be catered specifically to each culture. On a first encounter, eye contact, distance, introduction styles, dress, gifts, and language are all things that should be studied before a meeting takes place. In this research, two countries will be explored in details China and the United States of America. Appropriate Business Behavior in China Of these two countries, business culture in China is the most reserved, and is perhaps most unlike that of the United States. First and foremost, a contact should always be established before representatives of a business are sent to China. Trips to China are best if scheduled between the months of April to June, and September through October, when they will not conflict with any Chinese holidays (Morrison, Conaway, and Borden, 1994). On arrival, the business person should not touch people because touching makes the Chinese uncomfortable, especially if it is the first meeting. Inappropriate touching would include patting on the back or squeezing the arm. In China a light handshake is accepted, but the Chinese business associate should initiate the action. Bowing is common and is done with the palms together while facing each other. Holding eye contact is a sign of disrespect and should be done cautiously, especially in a social setting. When entering a room full of potential business partners, greeting the most senior person first is important, as is using appropriate titles. Sometimes the last name is said first in Chinese culture, and individuals will expect to be addressed formally until they say otherwise. Also, if greeted with applause, return the gesture. Chinese often show little to no emotion. Generally joking is not accepted because they may not interpret humor in the same way as others. Exchanging business cards is something of great importance in China. Business cards should be printed in both English and Chinese and in plain lettering. Cards should be accepted using both hands, read, and placed somewhere safe. It is inappropriate to write on another’s card in front of the person who gave it. Business dress in China is conservative and formal. Women should wear a high neckline, and should avoid high heels if they make them taller than their host. Gift giving should be done only after a relationship has developed, and should be modest . It is important to consider carefully what is given. Researching potential cultural superstitions and hidden meanings is a very good idea. For example, a clock, anything given in a group of four, and white flowers all symbolize death. If a gift seems appropriate for a particular business situation, a nice pen or cognac is a good choice. A gift received should not be opened immediately; it is polite to open it at a later time. Business Behavior in the United States In the United States, the first impression is key to a successful business relationship. Americans like direct eye contact and a firm handshake from a client or partner. They often perceive a weak handshake as a sign of weakness in all aspects of life. When being introduced, American business people typically give a full name but insist that they are called by their first name. citizens of the United States are the most casual in both addressing one another and in dress. When meeting in a purely social environment, the foreign business person should expect to come dressed casually, rather than in proper business attire . Americans tend to be very friendly and will go out of their way to say hello or wave from afar. Like the other cultures, business cards are given frequently but are not treated with the same amount of respect as other countries. They are usually presented after the first meeting with the other party rather than the beginning . In the United States, gift giving is not practiced very often and is discouraged by law, but it is still done in some settings. In two situations gifts are appropriate: if attending a function at the person’s home or after a deal is closed . The Impact of Cultural Differences Styles of communication, both verbal and nonverbal, are different in many cultures. Words and phrases can be interpreted differently, as can gestures. Something as simple as a nod can be interpreted in two completely different ways in two countries. Seating arrangements and the distance between two people are also something that varies form culture to culture. It is important to be sensitive to the place business is being conducted. Also important for the traveling business person, is to observe things like speaking volume, posture, touching, typical conversation, and how something is written. Business Negotiation and Acceptable Practices in China Negotiating business in China is very different from American practices. It is good practice to send the same representative to do business in China every time. This builds the strong, solid relationship that the Chinese prefer. While in a meeting, the Chinese will be very vague in their propositions so that those propositions may be adjusted in the future if needed. It would not be unusual to ask the same question in many different ways in order to test a potential partner for consistency, although this practice tries the patience of the other negotiating party . Losing face is an important issue in Chinese culture, so that confrontation and direct questioning should be avoided at all costs. It is considered rude to question authority, speak loudly, or to give a negative answer. In a negotiation only a leader should be singled out; it is important not to single out others. It is easy to spot the leader because he or she will be the only person speaking, and the one to make the final decisions. As the Chinese behave in a modest manner, a business partner, client, or employee should act accordingly. As an example, if one is selling something, it is preferable to solicit the opinions of others on the sale item, in addition to those of the seller. This will be appreciated much more . People of the Chinese culture are very reserved and hard working, and it is vital that visiting business people remain modest and polite while conducting business there. Business Practices in the United States When arriving for a scheduled meeting in the United States, the business person should be sure to be punctual or even a few minutes early. If a guest arrives late, Americans perceive them as being rude or highly disorganized. An action plan or agenda with a clear cut schedule is provided at almost all formal business meetings, and contracts are written out ahead of time. That way time is not wasted in the drafting of new contracts and previously contracts may be easily modified. In negotiating, American business people are more likely to be very open and direct, and normally do not enjoy haggling. The United States produces the fastest negotiators in the world. Although they are competitive, Americans value flexibility and spontaneity, and these characteristics play key roles when trying to close out a deal. Often Americans will accept subpar deals towards the end of a negotiation, due simply to an impatient desire to complete the transaction . Americans tend not to be comfortable with silence and will make every effort to maintain constant communication. Interruptions are not always welcomed either; in presentations all questions and comments should be held to the end of a gathering unless otherwise specified . In less formal business settings, Americans are more relaxed and place great emphasis on personal achievement. Fairness and the ability for a person to move up and down the business ladder are highly valued; however, businesses in the United States also value teamwork. Unlike many other countries, business in the United States is based on personal power rather than class, status or seniority. Hiring family or friends solely based on favoritism is completely unethical in the United States . Americans are not as reserved about their personal opinions and express themselves freely in the work environment, including giving input on important decisions. Managers tend to delegate many of their responsibilities, and it is not uncommon to see lower ranked employees questioning superiors. Decisions are made on all levels . Americans think big and are constantly planning for and anticipating the future. A job description is appreciated when interviewing because clear cut roles are preferred in a business environment. Once at a job, all employees are expected to be immediately loyal. Changing jobs is very common. A person does not usually stay at one job his or her entire career. Americans are risk takers; they are likely to take chances to achieve goals. In this environment, money equals power and status . Conclusion Every country has a different way of communicating and a unique way of doing business. Chinese tend to be reserved and patient and do not like to be pressured during negotiations and its relationships are developed before business takes place. For the United States of America,The emphasis is on deal making in it. Americans do not feel it is necessary to form a personal relationship before entering into a business contract with someone. A fast-paced, scheduled plan is the way negotiations are conducted, and for the most part, individuals in the United States do not like to haggle. This research has illustrated the importance of knowledge of other cultures as the key to reducing risk of failure in business relationships. Revisiting John’s trip to China from earlier, it is now easy to identify exactly what he did wrong. His company is also to fault for not making sure he was prepared to meet with Chinese clients before he was sent. Today, globalization is the norm, and it is important that people go to different  countries prepared to do business and behave in a socially acceptable manner. This includes having a sense of communication styles, being aware of body language, learning meeting and negotiation skills, dressing appropriately, giving proper greetings, and learning how social events are conducted. It is best to be sensitive to other cultures and always treat people with respect. Goethe once said, â₠¬Å"There is nothing more frightful than ignorance in action. † This applies to international business and business people should be aware that informed actions will be appreciated by all.

Cultural Assimilation essays

Cultural Assimilation essays Each year federal quotas permit a percentage of immigrants to migrate to the United States. The land of freedom and justice has opened its doors to those who seek new options and better opportunities. This is seen more in Miami-Dade County than in most American cities. Miami is developing and emerging into a dynamic and multicultural metropolis rather rapidly. The issue at hand is what occurs once residency is obtained in Miami-Dade County. As new immigrants increasingly concentrate in native-born minority neighborhoods, interaction among different ethnic groups becomes both more frequent and more important (Stepick). The rise of immigrant population affects education, sub cultural associations, and different native-born mindsets in which stereotypes for future generations are established. By age fifteen, substantial numbers of immigrant and native-born youth are at risk of reaching adulthood unable to adequately meet the requirements of the workplace, the commitments of relationships in families and with friends, and the responsibilities of participation in a democratic society...These youth are among the estimated seven million young people - one in four adolescents - who are extraordinarily vulnerable to school failure and multiple high-risk behaviors (Stepick). A very important factor of academic achievement is determined by students educational orientation, the students perception that education is or is not a path to success. Unfortunately, many native-born and immigrant school children underachieve, drop out, and fail to pursue higher education. Previous research has concentrated on why native minority students tend to adopt an adversarial academic orientation, while immigrant students incline toward a positive academic orientation (Stepick). As immigrants co ncentrate in native minority neighborhoods, interaction among different ethnic groups becomes more frequent and i...

Definition and Examples of the Colloquial Style

Definition and Examples of the Colloquial Style The term colloquial refers to a style of writing that conveys the effect of informal spoken language as distinct from formal or literary English. As a noun, the term is a  colloquialism. A colloquial style is commonly used, for example, in  informal  emails  and  text messages. You wouldnt use it where you need to sound professional, serious, or knowledgeable, such as in presentations, meetings, business letters and memos, and academic papers. As a literary device, it would be used in fiction and theater, especially in dialogue and internal narration of characters. Its more likely to be in lyrics as well. Colloquial writing is a conversational style, but its not writing exactly how you talk, either, Robert Saba said.  To do that would be bad writing - wordy, repetitive, disorganized.  A conversational style is  a default style, a  drafting  style, or point of departure that can serve as a consistent foundation for your writing. It is the style of a painter doing sketches for a painting, not the painting itself. Conversational writing as a style, then, is still more refined, composed, and precise than talking because of the ability to self-edit and polish the words. On using the conversational style in essays, critic Joseph Epstein wrote, While there is no firmly set, single style for the  essayist, styles varying with each particular essayist, the best general description of essayistic style was written in 1827 by  William Hazlitt  in his essay  Familiar Style.  To write a genuine familiar or truly English style, Hazlitt wrote, is to write as any one would speak in common conversation who had a thorough command and  choice of words, or who could discourse with ease, force, and perspicuity, setting aside all pedantic and  oratorical  flourishes. The style of the essayist is that of an extremely intelligent, highly commonsensical person talking, without stammer and with impressive  coherence, to himself or herself and to anyone else who cares to eavesdrop. This self-reflexivity, this notion of talking to oneself, has always seemed to me to mark the essay off from the lecture. The lecturer is always teaching; so, too, frequently is the critic. If the essayist does so, it is usually only indirectly. One should not go too informal in writing, either. According to Tracy Kidder and Richard Todd, Breeziness has become for many the literary mode of first resort, a ready-to-wear means to seeming fresh and authentic. The style is catchy, and catching, like any other fashion. Writers should be cautious with this or any other stylized jauntiness - especially young writers, to whom the  tone  tends to come easily. The colloquial writer seeks intimacy, but the discerning reader, resisting that friendly hand on the shoulder, that winning grin, is apt to back away. Mark Twains Style In fiction, Mark Twains skill with dialogue and ability to capture and portray dialect in his works are highly lauded and make his style and voice distinct.  Lionel Trilling  described it: Out of his knowledge of the actual speech of America Mark Twain forged a classic prose...[Twain] is the master of the style that escapes the fixity of the printed page, that sounds in our ears with the immediacy of the heard voice, the very voice of unpretentious truth. See this example from  Adventures of Huckleberry Finn, 1884: We catched fish and talked, and we took a swim now and then to keep off sleepiness. It was kind of solemn, drifting down the big, still river, laying on our backs looking up at the stars, and we didnt ever feel like talking loud, and it warnt often that we laughed - only a little kind of a low chuckle. We had mighty good weather as a general thing, and nothing ever happened to us at all - that night, nor the next, nor the next. George Orwells Style George Orwells goal in writing was to be clear and direct and to reach as many people as possible, ordinary folks, so his was not a formal or stilted style. Richard H. Rovere explains it this way: There is not much to do with [George] Orwells novels except read them. Nor is there much to be said about his style. It was colloquial in diction and sinewy in construction; it aimed at clarity and unobtrusiveness and achieved both. Orwells opening line of the novel 1984 starts simply yet jarringly, It was a bright cold day in April, and the clocks were striking thirteen. (1949) Sources Composing to Communicate. Cengage, 2017Good Prose: The Art of Nonfiction. Random House, 2013 Introduction. The Best American Essays 1993. Ticknor Fields, 1993The Liberal Imagination, Lionel Trilling, 1950Introduction to The Orwell Reader, 1961

Writing a report about 4 presentations and discuss them each Coursework

Writing a report about 4 presentations and discuss them each presentation 2 pages - Coursework Example n time we may become addicted to the internet and this presentation allowed us to judge our usage of internet and whether we need to take steps to curtail our growing addiction. This topic is very important and should be taken up by every class. In terms of the presentation, I very acutely felt that at this level, groups should not be reading material from their notes or slides. They should come well-prepared. Even though the group was well dressed and presentable, they did not focus on delivering a strong presentation. The group was not very professional in my opinion and one member was too quiet. The final speaker did not seem well-rehearsed. Since the final speaker was not very convincing, at the conclusion, the presentation seemed to fall apart. Since the last part remains in the minds of the viewers the most, the presentation became weak due to this. The beginning and end should always be strong to retain interest of the viewers. The good point of the presentation was the fact that the group was able to properly define the scope of their topic. In this way, they were able to exclude irrelevant information which made the presentation crisp and easy to understand. This also made the conclusion clearer and easier to grasp. However, the presentation lacked a little due to the fact that it was not very interest grabbing. If the group had included case studies in the presentation, the topic would have become more interesting and the students would have taken the concept home. They could have taken people from their own surroundings and researched on them. A profile of these addicts could have been developed which would have made the presentation more appealing to us- the viewers. Apart from that, the research depended on scholarly research which made the research more credible. Additionally, the content was up-to-date and taken from 2011 studies which was another good point. This aspect of the research made it convincing and created a professional look of the

Art of Negotiation - effective negotiation skills Assignment

Art of Negotiation - effective negotiation skills - Assignment Example require managers that can negotiate with businesses located in overseas regions as managers will have to bargain an effective and profitable deal for their own business if they want to operate overseas (Katz, 2011). Another issue that is taking place due to globalization is that the level of competition between organizations has increased. Organizations do not only complete in their host nations, they even have to compete in global regions. Due to this it has become essential for organizations to obtain resources while paying the lowest cost. In order to obtain resources and services at low cost managers need to have good negotiation skills (Benoliel, 2011). Good negotiation skills have even become very important for managers in order to deal with people from different backgrounds. A manager cannot use the same negotiation skills while dealing with people and business from different parts of the world. Therefore, a manager needs to have diverse negotiation skills in order to understa nd the likes and dislikes of people around the world and negotiate with

Interest Rates Affects on the Is-Lm Model Essay Example for Free

Interest Rates Affects on the Is-Lm Model Essay Assignment 4 5. According to the IS-LM model, what happens to the interest rate, income, consumption and invest under the following circumstances. a. The central bank increases money supply. An increase in the money supple shifts the LM curve downward. The equilibrium moves from point A to point B. Income rises from Y1 to Y2 and the interest rate falls from r1 to r2. Therefore this increase in money supply causes a decrease in interest rate, an increase in income, an increase in consumption and an increase in investment. LM Income, output, Y b. Government increases government purchases An increase in government purchases result in a shift in the IS curve to the right. The equilibrium moves from point A to point B. Income rises from Y1 to Y2 and interest rate rises from r1 to r2. This increase in government purchases therefore causes interest rate to rise and income also rises. Consumption will also increase but the increase in government purchases will cause investment to decrease. interest rate, r LM IS2 IS1 Income, output, Y c. The government increases taxes. An increase in taxes shifts the IS curve to the left. The equilibrium moves from point A to point B. Income falls from Y1 to Y2 and the interest rate from r ¬1 to r 2. Therefore increase in taxes will bring about a decrease in interest rate, cause income to also decrease which will decrease consumption also but will result in an increase in investment. interest rate, r LM IS1 IS2 Income, output, Y d. The government increase government purchases and taxes equally 6. Consider the following economy of Hicksonia. a. The consumption function is given by C= 200 + 0. 75 (Y T) The investment function is I= 200-25r Government purchases and taxes are both 100.

Romeo and Juliet: Joseph A. Bryant’s Considerations :: Romeo and Juliet Essays

William Shakespeare’s Romeo and Juliet has always been a very popular play. Joseph A. Bryant states this in his introduction, but there was never really contention. Most likely written in 1595, we learn from Bryant that this is thought to be one of Shakespeare’s more mature works that shows the pinnacle of his creativity (xxviii-xxx). Because of this creativity, audiences love Romeo and Juliet. However, Bryant also tells us that "[a]mong professional scholars the play has sparked less enthusiasm" (xxiii). For even though the play possesses an "ingenuity of the language" and has a particular "brilliance of the characterizations" (xxiii) , Bryant informs us that critics are upset by the importance Shakespeare places on pathos, and therefore feel that the play lacks real ethics. Bryant also concerns his introduction on the aesthetics of Romeo and Juliet with special consideration on the structure, the language, and the characters of the play, as well as how good of an exa mple of a tragedy the play is. Many readers may feel that Romeo and Juliet relies too much on pathos; that it’s just a tear-jerking love story. However, Bryant’s answer to those who think that the play lacks real ethics is that they are looking at it from a modern standpoint. The play really needs to be looked at from the point of view of the Elizabethan audience of 1595. Bryant tells us that "[t]hey knew by training what to think of impetuous young lovers who deceived their parents and sought advice from friars" (xxiv). Elizabethan audiences also knew that suicide was a sin (xxiv). This was common sense knowledge, and if looked at through the conventions of society at this time then, as Bryant states, the play "must have had automatically an abundance of ethical import" (xxiv). Bryant also commends Shakespeare for not attacking these commonly held ethical conventions, even though today’s readers can clearly see that Shakespeare thought nothing wrong with the relationship and did not even hold Romeo and Juliet entirely responsible for the consequences (xxiv). But some modern readers, Bryant tells us, are also uncomfortable with the numerous references to fate and destiny, and assume "that Shakespeare meant the play to be deterministic" (xxiv). Bryant tells us that Shakespeare does promise "in the Prologue to show the ‘misadventured piteous overthrows’ of a ‘pair of star-crossed lovers’" and then lets his characters continue to refer to destiny for the rest of the play (xxv).

Doctrine of adequacy and sufficiency Essay

This essay critically explores the doctrines of consideration and sufficiency within the context of contract law, with references to the matter of Thomas v Thomas from 1842. In assigning significance to these matters, it is noted that Sir John Patteson, a judge in 1830 who was appointed to the Court of King’s Bench, (later the Privy Council) was knighted shortly after making the landmark decision regarding the doctrine of consideration in the case of Thomas. The ratio decidendi in Thomas, was ‘[c]onsideration must be of value and involve benefit or detriment’ postulating further that ‘although consideration must be sufficient, it need not be adequate. ’ CONSIDERATION Eleanor Thomas sued the executors of her husband’s estate where the court ruled the agreement entered into, was neither nominal nor a voluntary gift, but sufficient in consideration. Consideration is the intention to create legal relations through a bargaining process affording a mutual exchange of a promise for a promise. In Beaton v McDivitt, it is evident that if a transfer was a gift, the essential component of bargaining would be absent. Consideration must be quid pro quo and result in a transfer between the promisor and the promisee, and result in the creation of a relationship of cause and effect. Only the parties involved can enforce the agreement. Consideration may also be a promise to refrain from doing something as Lush J in Currie v Misa states, ‘a valuable consideration, in the sense of the law, may consist in some right, interest, profit, or benefit accruing to the one party, or some forbearance, detriment, loss or responsibility, given, suffered, or undertaken by the other. ’ Consideration can involve the forbearing to sue even if the case is unfounded. Past consideration may be valid where it was preceded by a request, however services that would not have been performed but for the implied promise of payment amounts to good consideration. WHEN CONSIDERATION IS NOT CONSIDERATION Consideration may be invalid as in Jones v Padavatton where under the doctrine of presumption, arrangements between family are not binding. Salmon LJ in Jones, in the dissenting obiter dictum, determined that the original agreement created an intention to create legal relations due to the financial consequences of the promise involved, however held there was no binding contract suggesting there was insufficient evidence to rebut the presumption against domestic arrangements. Consideration must be furnished at the time of agreement. Consideration is not valid where a promise to make payment has occurred after the act has been performed. Bargains and conditional gifts for a person who performs an act is not good consideration, nor is a promise to perform an existing duty, or an existing public duty, except where performance goes beyond required expectations. Illegality in consideration is not enforceable giving rise to the expression ‘ex dolo malo non oritur actio’ meaning ‘[n]o court will lend its aid to a man who founds his cause of action upon an immoral or an illegal act. ’ Illusory consideration, where one party’s obligations are amorphous, is not binding. Limitations and exceptions can apply to consideration however, where additional risks are undertaken. DOCTRINE OF SUFFICIENCY As in Thomas, common law substantially rests on the precept that consideration must be of value to be sufficient, even if it is nominal, without any quantitative economic postulation. Some may suggest such fiscally nominal or token consideration while sufficient, is commercially inadequate in the eyes of a reasonable person, and is itself, illusory. It may be suggested the court has extended itself to invent consideration, where equity may uphold promises not supported by good consideration, through the provision of promissory estoppel. It is incumbent on the parties only to determine the subjective and adequate worth of a promise. Patteson J articulates in Thomas, ‘although consideration must be sufficient, it need not be adequate. ’ CONCLUSION Blackburn J statement of objective interpretation suggests the objective test must always apply in assessing how a reasonable person would view the situation. It can be concluded that consideration is a matter of essential promissory exchange, while adequacy and value, are the fiscal or functionary exclusive domain of the parties involved. Word count 691

Friedrich Froebel’s Ideas On the Role of Play In the Early Years Education Essay

Play is probably the very first thing that comes to our minds when we start thinking about our childhood. Certainly it’s hard to talk about early years without referring to play, as it is a part of children’s natural behaviour, embedded in their spontaneous day-to-day life. The fact that the play is enjoyable is generally agreed, but the value of play in school, however, has been in the centre of much debate in the past (and it seems like that debate is still going on today). The roots of contemporary understanding of the role of play in early childhood education extend clearly to Friedrich Froebel, a German educator, who organized and systematized the methods of early childhood in accordance with the idea of â€Å"the spontaneous, self-sustaining nature of children† (E. Evans, 1971, p. 43). Froebel believed that every child had within him all he was to be at birth, and that the proper educational environment was to encourage the child to grow and develop in the most favourable manner. â€Å"Young children are to be regarded and tended essentially like plants. Like these, if they were given the right conditions, they would grow and unfold and flower, by their own law, each according to its individual capacity and destiny. † (E. Lawrence, 1969, p. 195) In his study of child-nature one of the most marked characteristics, which attracted Froebel’s attention, was the child’s inborn desire for activity, which reveals itself in play. According to Froebel, â€Å"play is the freest active manifestation of the child’s inner self which springs from the need of that inner living consciousness to realize itself outwardly. † (H. Bowen, 1907, p. 116) Froebel made a significant contribution to early childhood education by seeing play as a process in which children bring to realization their inner nature. He recognized that children began to learn as soon as they began to interact with the world, and he reasoned that since the interaction was mostly in the form of play, the way to educate a child was through play, â€Å"as a means of awakening and developing the active and presentative side of his nature; wherefore none, not even the simplest gifts from a child, should ever be suffered to be neglected. † (F. Froebel, 1901, p. 77) Froebel’s continuous studies of the function of play in a child’s life came to fruition in the concept of the Kindergarten ? a place where children â€Å"instruct and educate themselves† and where they develop and integrate all their abilities through play. Froebel believed that play provided the means for a child’s intellectual, social, emotional and physical development. Games were not just idle time wasting, but the most important steps in the child’s development, and they were to be watched by teachers as clues to how the child is developing. â€Å"It is through play that the child learns the use of his limbs, of all his bodily organs, and with this use gains health and strength. Through play he comes to know the external world, the physical qualities of the objects which surround him, their motions, action, and reaction upon each other, and the relation of these phenomena to himself, ? a knowledge that forms the basis of that which will be his permanent stock for life. † (H. Bowen, 1907, p. 101) However, Froebel didn’t think that the play of young children should be unprompted at all times. For him the skill of adults was in knowing how and when to intervene, how to support and extend children’s play to help them â€Å"to grasp and to try out their learning in concrete ways. † (T. Bruce, 1997, p. 23) To stimulate learning through well-directed play Froebel designed a series of instructional materials, which he called â€Å"gifts† and â€Å"occupations†.

War or no war essays

War or no war essays December 7, 1941 was the opening battle of the Second World War for the United States of America. But Pearl Harbor also marked the closing of one historical period and the opening of another. America finally ended its self-imposed isolation from world affairs on that day, and for the next 50 years was to be deeply involved in the global struggle against fascism and then against communism. W.G. Hyland explains that the massacre at Pearl Harbor put an end to American isolationism and began the era of international awareness. Until this point the United States did not want to involve itself in World War II which had been going on in Europe. Americans had many different views toward the war, which resulted in the inactivity of Americans until the massacre at Pearl Harbor. The U.S. was forced to engage in World War II at this time because innocent Americans had been killed and they could no longer set back and let disastrous actions take place. The U.S. was very hesitant to join in worldwide destruction because of past problems and present issues. After 1918 came a feeling, amounting almost to a national neurosis, that the United States had been tricked into the First World War. The sentiment was carefully nourished by a revisionist campaign. The country retreated into isolation lasting throughout the era of the Long Armistice from 1918 to 1939. During the years form 1929 to 1941 the U.S. was suffering from the Great Depression. Americans were worried about surviving the depression rather than helping foreign countries with their problems. The economy was in a severe decline; harsh living conditions and economic shortages were punishing the public. First and foremost Americans wanted to rise out of the depression and live in peace and prosperity. European conflicts did not register in the minds of Americans and therefore isolationism was the prevalent view of the American public. The Europea...

Business munciation for Non-Verbal

As the workplace b es a more plex place with myriad of inter-relationships and   work being assigned mostly in teams rather than to individuals, the significance of munication is perhaps more significant than ever (Fielding, 2006). However, when we consider munication, the focus tends to be too much on the verbal aspects which are where all the training is majorly focused on. In the process, a major aspect of munication which constitutes of non-verbal munication is ignored. However, it is noteworthy that majority (i.e. about 80%) of the munication that a person engages in is through non –verbal munication. Here essentially no words are spoken but essentially through the use of gestures, symbols and body language pivotal munication is facilitated (Bonaccio et. al., 2016). The objective of the given essay is to highlight the significance of non-verbal munication or cues and how potentially this mode of munication is more critical than the verbal aspect of munication in the wor kplace context. As highlighted above, a large majority of the munication an individual typically indulges is in the form of non-verbal munication facilitated primarily through the use of body language. Further, in the workplace, the non-verbal munication is given more importance than the verbal munication. This is primarily because while the verbal munication is controlled by the conscious mind, the non-verbal munication is highly more spontaneously and at times the gestures an individual engages in, even he/she may not be aware of the same but it municates vital information to the other party (Means, 2009). Hence, it is a mon practice at workplace when there is lack of consistency between the verbal and non-verbal aspects of munication; it is the latter which is accorded more weightage. This is primarily because the verbal munication is often driven by diplomacy and other factors and thus is paratively much easier to manipulate in parison with the non-verbal munication which as mentioned before ten ds to take place spontaneously and hence less prone to conscious manipulation.   As a result, in various situations, individuals tend to be driven more by the non-verbal munication rather than the verbal munication (Lunenburg, 2010). Consider for example, an HR manager is taking an interview for a potential recruit. It is a mon practice on the part of the candidates to claim that they have all the requisite qualities and to endorse themselves. However, there are subtle non-verbal clues which the interviewers tend to grasp which indicates that the claim made by the candidate may not be entirely true and provides avenues for further probing so as to recruit the right candidate for the available vacancy. This interaction between the verbal and non-verbal modes of munication is frequent at the workplace and plays a critical role in the manner in which the messages are interpreted at the workplace. Usually, the message municated through verbal munication need requisite support of non-verbal munication in order to make sense to the receiver and hence ensure that munication is effective (Mcintosh and Luecke, 2008). Further, as a supervisor or manager, it is imperative to pay attention to the non-verbal munication which more often than not is more vital than the verbal munication. One of the situations that non-verbal munication is of particular importance is contradiction (Fielding, 2006). For instance, the manager floats a new proposal based on which, certain employees every week would be required to e on weekends to the office. When the supervisor asks for the suggestion from the employees, it is possible that due to the higher authority that he/she represents, the employees may be resultant to voice their dissent and thus may agree to it. But the manner in which this agreement is municated coupled with various other cues such as the body language after the proposal has been floated around would provide key indicators as to whether there is actual consent or not (Guffey and Loewy, 2009). Usually, this is imperative as taking initiatives would typically involve costs and resource allocation an d hence it is imperative that the same should have backing of the underlying subjects for whose benefit it is being done. This could be true for various training initiatives that may be taken for the employees which do not yield much improvement in performance since from the beginning there might have been lack of enthusiasm but still for fear of repercussions, no concern would have been raised by any employee (Bonaccio et. al., 2016). Additionally, non-verbal munication plays a critical role in reinforcement which is critical when a given individual is presenting a new proposal to a client. Through non-verbal munication, the extent of conviction that the person concerned presenting the idea has can be indicated which goes a long way in convincing the client (Lunenburg, 2010). If on one hand, there is a sales pitch for a product, service or business idea but an inconsistent body language shows reluctance or doubts with regards to critical aspects of the underlying good, then it is highly likely that sale would not happen as reinforcement was missing from the end of the presenter. Non-verbal munication also plays a vital role in ascertaining the level of understanding the employees or team members are experiencing without actually disturbing the group (Mcintosh and Luecke, 2008). For instance, imagine a situation where the project manager is briefing the team members about a particular new project whereby the team m embers can be nodding indicate to the project manager that they are actually able to understand what is being said by the project manager and in the process there is no interruption for the project manager. This is also applicable in case of various presentations that may be made to senior management or clients where the concerned individual may look for subtle non-verbal clues to ascertain if he/she is one the right track or not and whether the intended audience is able to resonate with the viewpoints captured by the speaker (Fielding, 2006). Besides, non-verbal munication goes a long way in the expression of subtle emotions which are considered vital at the business place. This is particularly significant in dealing with the concerns and grievances of the employees (Bonaccio et. al., 2016).. As a result, non-verbal munication is highly critical for the role of a human resource manager. Irrespective of the final solution to the problem, it is essential that the HR manager must show sensitivity towards the employee and make attempts to understand the perspective of the employees. The sensitivity on part of the HR is usually indicated through the non verbal munication which would employ gestures during listening which essentially are meant to pacify the employee so that he/she can vent out the frustration (Means, 2009). Unlike personal relations, where emotions are expressed by a greater use of verbal munication, professional relationships are characterized by expressions of emotions more at the level of non-verbal municati on.   This makes the non-verbal munication even more vital for the workplace for it essentially b es a humane place where gestures by individuals are considered critical for the overall munication (Lunenburg, 2010). This empathy which is municated through non-verbal munication is the lynchpin of service businesses whose success rests on the same. The employees intend to provide a superior service experience to the customers through the use of various friendly gestures such as greeting customers,   having a smile while talking or otherwise also, voluntarily extending help to clients which help as key differentiators of service between rival firms. A service firm without the requisite non-verbal munication would be destined to fail as the requisite warmth would never been able to municate to the client (Fielding, 2006). This is b ing more apparent with the advent of online shopping and services where customers tend to miss the personal touch and the non-verbal munication which the concerned person at the store would display through various gestures. Additionally, the lack of non-verbal munication tends to prove a hurdle in virtual teams where the munication is through verbal messages but are fou nd to be less effective and results is greater issues of coordination since non-verbal munication provides appropriate context to the verbal munication by either reinforcement or contradiction (Guffey and Loewy, 2008). Based on the above discussion, it is apparent that non-verbal munication plays a larger role than verbal munication at the workplace. One of the reasons that is responsible for the same is the fact that verbal munication is more open to manipulation unlike non-verbal munication which is more intuitive and spontaneous and hence more representative of the true feedback of the listener. Concentrating on non-verbal munication is pivotal for the managers so as to understand the reactions of their team members about various proposals which otherwise may not be represented in verbal munication. This also plays a crucial role for the HR manger who effectively relies on the same to placate the employees and thereby enhance the overall employee satisfaction. Also, with regards to clients or customers, non-verbal munication can be the key differentiator especially in the service business. Thus, it would be fair to establish while non-verbal munication can exist in isolation, it is typically not possible for the verbal munication to exist and make sense in the absence of non-verbal munication which is apparent in the case of virtual teams and the underlying issues faced. Bonaccio, S., Reilly, J., Sullivan, S. and Chiocchio, F. (2016)Nonverbal Behaviour and munication in the Workplace: A review and an Agenda for Research, Journal of Management, 42(6) pp.14-17. Fielding, M. (2006) Effective munication in organisations. 4th edn.Claremont: Juta and pany Ltd. Guffey, E. M. and Loewy, D. (2014) Business munication: Process and Product. 8th edn.Boston:Cengage Learning. Lunenburg, C.F.(2010) Lounder Than Words: The Hidden Power of Nonverbal munication in the Workplace. International Journal of Scholarly Academic Intellectual Diversity, 12(1), pp. 3-5. Mcintosh, P. and Luecke, A. R. (2008) Interpersonal munication Skills in the Workplace.2nd edn.New York: AM Div American Mgmt Assn. Means, T. (2009) Business munication.2nd edn.Boston: Cengage Learning.

A critical response to the Marketing Myopia Assignment

A critical response to the Marketing Myopia - Assignment Example Additionally, the article presents marketing strategies that can help business management overcome competition and other external forces, which threaten a business. Therefore, this discussion seeks to critically analyze the strengths and weakness of this article, with a focus to understanding the plausibility of the ideas it present. The strength of this article is identifiable in addressing the causative factors for business success or failure. The article clarifies on the misconception held by many people that external forces are the major causes of a business failure. However, according to the article, the reason behind the success or failure of any business is not due to environmental factors such as market saturation, threatened growth or competition. The success or failure of any business or organization is solely determined by the management (Levitt, 2004). The reason the failure of any business has to be attributed to the management because; when the business of an industry d eclines, it is not because the industry was not best suited to serve the people. The industry declines because the management is not able to protect its business from their competitors, who eventually take their customers away from them (Levitt, 2004). If the management can apply strategies for protecting their customer base, their business in any industry will continue thriving. This is one of the strengths of this article, since it emphasizes on the role of prudent management in ensuring the success of a business. Secondly, the article presents another credible argument that serves as another of its strength. Broader focus is the key to success of any business or industry (Levitt, 2004). The article observes that businesses fail because they perceive their investment narrowly, considering competitors to be only those offering similar products and services. This makes the management of the business forget to focus on the whole industry and how it can affect their business. For exam ple, people operating in the railway business will only focus their competitors as those other companies or individuals who own trains, forgetting that they are not in the narrow railroad business, but operating in the transport industry (Levitt, 2004). Therefore, the elaboration given by the article is credible because, in focusing narrowly at the business, the owners of a business are only concerned about the product or service they offer, at the expense of focusing on the customer (Levitt, 2004). Thus, for the success of any business, a wider focus on customer needs is important than focusing on the suitability of the products and services which a business offers. Businesses will succeed more if they focus on understanding and meeting customer needs. Therefore, a business should focus on the overall needs of the customer in the industry it is operating, rather than focusing narrowly on direct competitors. This is because, customer needs can be met by the indirect competitors, who take away the customers served by a business, and meet their needs in a different manner (Levitt, 2004). According to this article, the strength and success of any business lies in its internal innovation. If a business can tailor its innovativeness towards meeting customer needs at the expense of improving the efficiency of its products, the business is sure to succeed (Levitt, 2004). For example, a business operating in the petroleum industry should focus on the needs of the customers in the whole of the energy industry. This would mean that the business works towards meeting the needs of the

Outline the causes of income inequality in the UK and evaluate the Essay - 2

Outline the causes of income inequality in the UK and evaluate the measures that could be used by the UK government to achieve a more equal distribution of wealth - Essay Example A report in anatomy of economic disparity in the UK scrutinizes the level of more inequality display for over thirty years. The paper may create an uncomfortable interpretation for the labor government though it signposts that a considerable obligation lies with the Tories who led the intense divisions in 1980s and the early 1990s (Summit 2010, page 27-63). Changes in the income distribution, where individual earnings change in time, thus affecting the high and the low income earners in the UK (Incorporating one society 2012, page 12-32). Those in public sectors fail to experience wage increase thus largely affected by income distribution. Difference in wealth, that is, people who own assets like rental houses earn extra income, those who inherited money may set up an industry with a likelihood of high incomes thus differing from the poor and those unable to generate capital for the creation of wealth. Unemployment causes poverty in the UK as the benefits of unemployment are rather low. With the lack of a job, the income tends to lower, unlike those in employment. The pensioners experience low incomes, especially those relying on the state pensions have an income below average wage (Summit 2010, page 27-63). The single mothers and those on a disability allowance rely on the state benefits and tend to have low incomes. Those working in public sectors have wages lower than the comparable jobs in the private sectors as the government relaxes in the salary increase. Education is a key factor to income inequality. As the parents grow professionally, their children may tend to acquire better and more academic qualifications, unlike the uneducated parents who may disregard the importance of quality education for their children, thus leading to income disparity (Summit 2010, page 27-63). One of the measures includes government investment in the private sectors. Investing more in the private sectors, lead to the creation of employment. Thus, it reduces the chances

I'm Still Human Essay Example | Topics and Well Written Essays - 1250 words

I'm Still Human - Essay Example Racism is a perfect example. Whites have always been marked as superior to the blacks in the United States and the blacks have been negatively stereotyped. Although many efforts have been taken since decades for uniting the human race and sorting out the differences between them, these problems still exist in our society where a particular group of people are sidelined and neglected (Biss 2008). This inferiority is not just assigned to a particular group on the basis of their physical appearance but also owing to their mental skills and capabilities. I can truly relate to this with my life as I have a son who suffers from autism and I have taken care of him for eight years after his condition was identified. My child was diagnosed with autism at the age of four years and though he is in possession of great skills and abilities, he is looked down upon owing to his disease which makes him different from other children. The article, â€Å"Autism: Why Some Children ‘Bloom’ and Overcome Their Disabilities† sheds light upon the positive outcomes that can be obtained in autistic children if early interventions are prescribed in these children. While going through this article, I assessed the importance of the need of optimism and positivity in the life of autistic children. It triggered thoughts in my mind regarding my son and how proper support and interventions can actually make his life better. Autistic children are not received with warmth and love in our society. They are sidelined and are not judged on the basis of their positive traits but are rather judged on the basis of their shortcomings. This makes their progress and development worse (Szalavitz 2012 a). Children suffering from autism are not treated well in our society and this can clearly be assessed by the report of a recent research. The results of the research revealed that young school going children who suffered from autism were bullied five

Meaning, form and use: The past

Meaning, form and use: The past The role of grammar in English language teaching For many teachers, grammar plays a central role in their classroom methodology. However, in 1980s there was an anti-grammar movement which was influenced from the idea of Krashen that grammar can be acquired naturally from meaningful input and opportunity to interact in the classroom: in other words, the grammartical competence can be developed in a fluency-oriented environment without conscious focus on language forms. For Hymes, said that rules of use without which the ruled of grammar would be useless. Just as rules of syntax can control aspects of phonology, and just as rules of semantics perhaps control aspects of syntax, so rules of speech acts enter as a controlling factor for linguistic form as a whole ( Hymes 1972 : 278 ) From his suggestion, the grammar is one of the most important factors in language teaching and learning, especially it is the communicative element to communicative language ability. The components of communicative language ability are linguistic competence, pragmatic competence, discourse competence strategic competence and fluency. The linguistics competence is composed from a knowledge of spelling, pronunciation, vocabulary, grammatical structure and linguistic semantics. Meaning, form and use : The past Course description This course is involved the past tense which refers to the meaning of the tense, the form of the tense and the use of the tense. The learners must know the rules of the tense and can form the patterns of the tense and can use it correctly. The learners are able to apply the tense in the real situations. Content The past tense is divided into 3 categories which are: Past simple tense past continuous tense Past perfect tense Past perfect continuous tense The four types have their own forms, meanings and uses. Past Simple is used to indicate the actions which already happened in the past and finished at the specific time in the past. The actions might be long or short. And there are some kinds of rules should be remembered about this tense : regular verb , irregular verbs, questions and negative sentences. Past Continuous is used to describe the past actions in progress. Past Perfect is used to talk about the situations which begin in the past and continue to the period of time in the past and then finish at the time. The Model of teaching grammar: the PPP model There are 3 stages to teach grammar: presentation, practice and production. The first stage is presentation. These are some kinds of activities of teachers to apply in their teaching, for example, the teachers present new language in context so that meaning is clear. The teachers may present the new form in a natural spoken or written text so that students can see its use in discourse. Then, he/ she links the new form to what students already know. Next, he/ she checks comprehension. The teacher elicits the form from students where possible and exploit their existing knowledge. The second stage is practice. The teacher helps the students memorize the form and produce the word order. Then, he/she give intensive practice through repetition and provide opportunities for feedback and error correction. Next, the teacher develop confidence of the students. The last stage is production. The teacher reduces control and encourage students to find out what they can do. Then, the teacher encourage the students to use the forms in expressing their own content and teacher helps students see the usefulness of what they have learned and then to check what has been learned and diagnose problems. Example of the lesson plan This is a good example of the lesson plan which is a very interesting one and can help all language teacher to teach and try new way to teach grammar through narrative. Narratives in the Simple Past Teacher: Catherine Eslinger Class: Linguistics 577 Date of Explanation: October 14th, 1997 Proficiency Level: Beginning Age of Learners: High School Age and Above Objectives: Students will be able to compliment others past actions. Students will be able to describe actions in the past using the simple past tense. Students will be able to understand and recognize the simple past forms in a folktale. They will be able to supply some of these forms when asked. Materials Required: A simple folk tale, colored markers, 1117 paper, a personal photograph, photographs that students have brought from home. Warm up/Review: Model giving compliments in the present tense, which students have recently studied. Give several examples and write them on the board, such as I like your smile and I like the way you read aloud. Have students move around the room giving compliments to each other, following this model (in addition to listening to Students as they practice, give class members compliments). Presentation Practice Evaluation: Stop the fluid pair activity and model giving compliments that use the past tense: I appreciated the way you helped return papers to the class yesterday or I loved the food you cooked for our class party last week. Write these forms on the board, underlining the time expression. Write some of the compliments students gave each other that use the same verbs in the present tense. Underline the verbs. Have students induce the rule. Include auxiliaries in the past, particularly in question formation. Play Alibi. Have two students leave the room, pretending to be suspects of a crime. Model the types of questions students could ask of a suspect, writing some patterns on the board. One suspect returns when called and students ask questions about his or her whereabouts at the time of the crime. When they have exhausted the questioning possibilities, the first student again leaves the room and the second is asked the same questions to see if their alibis match. Pay attention to students use o f the past tense. Are they able to use it correctly? Note any irregular verbs for which students have overgeneralized the rule for putting in the past tense. Present patterns for types of irregular past tense verbs that students have used in Alibi. If students have used these and overgeneralized, present categories like feel-felt, steal-stole, bring-brought and begin-began. Preview Llama and the Great Flood by talking about legends and folk tales in other cultures, finding Peru on a map, etc. Read it aloud, leaving out regular and irregular verbs the students have just studied in the past tense. Ask them to supply those verbs. Cue them with the present tense of the verb. Listen to the students. Are they able to supply the correct form of the verb in the simple past tense? If other irregular forms have come up in the folktale, present these exceptions to the rule. Show students a personal photo of some interesting past event. Describe it using the simple past tense. Have the students write a short description of their own photo in the simple past. In pairs, they will share their description and photo with another class member. Contingency plan: If some students have forgotten photos, have them imagine the scene of a photo they have at home. Listen to the pairs practice. Are the students able to use the past tense fluently and accurately? Note any new irregular past tense forms that come up. If other irregular verb forms have come up in the descriptions of photos, present those exceptions to the rule. If not, I will not present any new material at this time. Although this activity provides more practice, it is primarily intended to evaluate students learning. Post six pieces of 11 x 17 paper around the room. Each page has a different sentence prompt on it. These include: When I was a child. . . , When I first started to learn English. . . , Last week. . . , After my last birthday . . . , Yesterday. . . , and This morning . . . . In teams of three, each team with a different colored marker, students go around the room to the various papers and write narrative endings to these prompts. To correct serious errors, send a student from a team that is doing that aspect of the activity correctly to help the struggling team for a moment. Note the names of team members using particular colors and examine the papers after class to see which students are struggling with the forms. If students have again overgeneralized the rule for the simple past in other categories of verbs, present those verbs to them. Allow students to add to the sheets of paper with prompts on them using the irregular verbs they have just learned. Pay attention to how students are forming all past forms, particularly the irregular ones. Again, note who is struggling by identifying teams using particular colored markers. Application: Assign students to find a picture from a magazine or book of a fashionable item of clothing people wore in the past. It can be from any time period in the past, whether the nineteen sixties in the U.S. or the fifteenth century in their own countries. Students will show the class the picture of this clothing, tell who wore it, in what time period, and in what place. They must also tell the class for what occasions they believe the clothing was worn, and any other information they know or have found out about the clothing. Finally, they should tell the class whether or not they would like to wear it, and where and when they would wear it. Self-evaluation: This lesson is too long and has too little focus on narratives to really be effective. I have underestimated the time required for students to induce rules, be able to apply them in the story, and especially write and then tell their own past narrative about a photograph. I dont want to have to rush that; Im hoping it will be interesting and important enough to them that they will want to tell the full story, and tell it well. I have decided that although Alibi is a good game for practice of the past tense, it doesnt belong in this lesson. It can come in a later lesson.

Public Vrs. Private Essay -- essays papers

Public Vrs. Private The Eternal Question: Public or Private Consider this, you drive into the parking lot of the public school and see the same five squad cars as every day, business as usual you think. You and your friends walk up to the door and wait in line for the metal detectors. You put your keys in the tray and walk through the detector, it goes off. Two cops walk up to check your backpack. Pager in the pocket got to go back to the car and put it away. Back through the metal detectors and they do not go off, thank God. You go to first period, sit in your seat and the teacher locks the door. The drug dogs must be coming today. Second period and the dogs are still here, there must be something wrong. Third period starts and the class files in. The teacher is about to start and in walks the cops, they walk straight in your direction and up to the kid next to you. The kid stands; the cop puts the hand cuffs on him and escorts him out. Oh, well! There goes another one. Next is gym where your locker has no pad lock because last week t wo girls got into a fight and one beat the other one with your lock. The rest of the day is pretty usual, a couple of fights and a test. Sound extreme? Not for the students of Bloom High School, this is a good day. In the same town a mile away there is a Private Catholic High School; this is their day. I drive to school and pull up; in my Mercedes in the parking lot, there is an Escalade in front of me and a Porche behind me, and I hate having a cheap car. I park the car and file into school, walk in the front door and to my locker to put my books away. There is the drug dealer with another customer at the locker next to me, "Hi, Andy". Oh, no! Here comes a nun, better tuck my shirt in. To late, another detention, but on the up side here comes Jon; he is so hot it is too bad he does steroids. I go through a usual day, some quizzes and a test. At 2:20pm, schools over, back outside to the car and drive to Andy's. I guess everyone is following me today. Hey look at all the squad c ars at Bloom, I wonder who got busted today? I sit down on the couch and talk while everyone else smokes a blunt. Now it is time to go, I will see everyone at the party tonight. I have to go do homework; after all it is only Tuesday. So which is better for a student, private school or public school? I know first hand what it is ... ... that is required. Which high school to attend is a big decision and one that is often made by the parents, but I do not see any reason why a parent who can afford a private school would want to put their child through a public school when the private school is obviously the better choice. There are many students who have made it through college from a public school and who have made it through high school and gone on to have great jobs, but the odds are in definite favor of us. Bibliography: Works Cited Anyon, Jean. "Social Class and The Hidden Curriculum of Work." Rereading America. Ed. Gary Colombo, Robert Cullen, and Bonnie Lisle. Boston:Bedford, 2001. 162-73. Heaney, Karen. "Which is Better? A Private or State Education." Spark Learning Institution. 2 Oct. 2001. "Pros and Cons of Educational Options." 20 Feb. 2000. 1 Oct. 2001. Ramirez, A.Y. "Fred". '"Parent Involvement is like Apple Pie' A look at Paternal Involvement in Two States." High School Journal 85.1 (2001): 1-9. 5 Nov. 2001. "Report Card for all Illinois Public Schools: Bloom High School". 1 Aug. 2001. "Report Card for all Illinois Public Schools: Lincoln-Way High School". 1 Aug. 2001.

Nurture debate in relation to the development of an individual Essay

The major debate concerning nature and nurture has been going on for decades and is still unresolved. Many people like to believe what we have inherited and our genes are what make us unique (the way we are and how we develop). Other people believe that the way we are raised and our experiences, that make us the way we are and how we grow. Physically the way we are built and look can be mainly due to nature. The genes that we inherit from our parents make the way of we look. For example, people say ‘Don’t you look like your mother?’ Genetic inheritance can define our eye colour (blue or hazel), whether we have straight or curly hair or how small we might be. We could also inherit certain genetic diseases which can seriously impact on our health. Though, we can still make decisions on how we look and how we change our appearance. There are multiple different cosmetic procedures available to alter our look. How we choose to live out our life and the choices that we make can have an influence on how we look. For ex, constantly eating junk food and not doing any exercising could lead to obesity. The environment that we are raised in and the experiences we go through can influence our health which contributes to physical growth. An ex of how nature and nurture can affect our physical growth is; we might carry genes that could lead us to be in danger of developing type 2 diabetes, but if we were to eat a healthy diet and get ample exercise, we might not develop the disease. Nature: Jades mother’s childhood was very unlike to what it is today, her life could have been called a difficult life, and her mother was bought up on her own by her own mother as her father died when she was 6 months old. As she grew up without a father figure in her life she closed herself off emotionally from males in general. Jades mother grew up around a lot of uncles and aunts so she was always well looked by her family. Jade grew very close to her gran over the years as she wasn’t getting the attention she wanted off her mother, as she had gotten remarried she had become very distant. When her gran died jades mother was very alone, she hardly ever spoke to her mother apart from at meal times and after she’d get in from being out with her friends. This got increasingly more awkward as time went on as the new husband never showed her any kindness so her mother stayed out  to avoid the arguments. Nurture: Where jades mother spent a lot of time in hospital during her life she was also slower to develop as a person as she wasn’t with her friends often enough to have developed personality traits. As she got older she started staying out overnight and going to parties where there would be lots of alcohol, drugs and sex. She also began hanging out with the older boys and girls; this meant that she was developing at a much faster rate than what she would normally have done. The environment that the she was raised in was very tranquil, peaceful and gentle neighbourhood; there was barely ever any trouble around where she grew up. Nevertheless as she got older she began to get more curious about the rough area’s around where she lived later on during her life she found herself surround by people who lived in these rough areas. This altered the way she saw her own life and what she has been taking for granted. Evaluate how the nature and nurture debate in may affect the p hysical, intellectual, emotional and social development of two life stages of the development of your chosen family member Nature As each cell in the body contains 23 pairs of chromosomes, one chromosome from each pair is inherited from your mother and one is inherited from your father. These chromosomes contain the genes you inherit from your parents. There may be different forms of the same gene. These different forms are called alleles. For example, for the gene that determines eye colour, there may be an allele for green eyes and an allele for hazel eyes. You may inherit a hazel allele from your mother and a green allele from your father. In this instance, you will end up with hazel eyes because hazel is the dominant allele. Those different forms of genes are caused by changes in the DNA coding. The same holds true for medical conditions, there may be a faulty gene that would result in a medical condition, and a normal version that might not cause any health anomalies. If your child ends up with a medical condition it will depend on certain biological factors including: What genes they inherit, whether the gene for that condition is dominant or recessive, their environment, including any treatment they may receive a genetic disease or  disorder is the consequence of changes, or mutations, in an individual’s DNA. A mutation is an alteration in the letters (DNA sequence) that makes up a gene. It’s more commonly referred to as a â€Å"spelling† mistake. Gene codes for proteins, the molecules that carry out majority of the work, perform most life functions, and make up the majority of cellular structures. When a gene is mutated so that its protein product can no longer carry out its normal function, a disorder can result. Genetic diseases can be inherited because they are mutations in the germ cells in the body – the cells involved in passing genetic information from parents to offspring. Genetic diseases can also result from changes in DNA in somatic cells, or cells in the body that are not germ cells. Some genetic diseases are called Mendelian disorders – they are caused by mutations that occur in the DNA sequence of a single gene. These are normally rare diseases; such as Huntington’s disease and cystic fibrosis. Many genetic diseases are multifactorial—they are caused by mutations in several genes compounded by environmental factors. Some examples of these are heart disease, cancer, and diabetes. Adolescence: Physical & Social development: Nurture affected the physical and social development of Katherine’s mother Emma. During her adolescence phase Emma thought that she’d have to change the way she looked to fit into society (as she was obese). Emma began to blame herself and others because of the way she looked, she has had to face a ton of criticism from her close family and some friends; as they used to say stuff like â€Å"you’ve got such a pretty face but if you lost a bit of weight you’d be so much better off†. Throughout this time Emma looked towards the rest of her friends for acceptance which meant that to fit in with them she had to have the same stuff that everyone else had (clothes, technology etc.). This was obviously very difficult because of the fact she was quite overweight she couldn’t purchase the same type of clothes that her friends wore; this made her stand out of the crowd which gave her that extra  attention that she didn’t want. Emma spent a lot of time trying to fit in during her teenage years but she found out being herself was more important than losing who she was just to fit in. Emma stayed up late chatting with her friends. A lack of sleep could also affect our body; it would increase blood pressure and cholesterol level, increase stress hormones, etc. Sleep is really important, at this age as she should be having at least 7-9 hours of sleep. Intellectual development: Nature affected Emma intellectually throughout this period as Emma wasn’t really sure on what type of career she wanted to do, however after some thought she decided she wanted to that pursue a career that would evolve helping the elderly. She accomplished in getting a job whilst being at school as this would help her to develop some new skills and allow her to make her own money, although she knew that wasn’t the career path she wanted to stay in. Emma also began to volunteer at a care home; this is what helped her to decide on what career path she wanted to go down. Emotional development: Nurture also affected Emma emotionally during her adolescence; Emma had poor self-image and low self-esteem. She also began to resent her friends and her mother as they both wanted her to be someone that she was not, when it was clear that she was never going to be able to keep the act up forever. During adolescence Emma began to question her own self-worth as some friends were also making snide little comments whilst her back was turned. Emma began to hang around with men as she went into this life stage as she thought that they were a lot less cruel. The boys accepted her more as part of their group so she began to build up her self-image up again, giving her more confidence and self-belief. Adulthood: Physical development: Emma was affected by nature during her adulthood. During her adulthood she discovered that she was at risk of developing a variety of different genetic diseases (diabetes type one, lung cancer, breast cancer, asthma etc.). Emma  also discovered that she may not be able to have children of her own because she has Polycystic ovary syndrome (PCOS) which sometimes genetic. If any relatives, such as your mother, sister or aunt, have PCOS then the risk of you developing it is often a greater chance than usual. As she began to get older her hair began to get darker and she began to get grey bits through her hair, she also has had more problems with her teeth as they are falling out or being damaged due to decay. As she got older she also began to put on weight as her metabolism started slowing down. During this life stage Emma became pregnant with Katherine and there were some complications during the birth as she had to have caesarean due to preeclampsia. Intellectual development: Emma was less influenced by nature as an adult as she can make her own choices and decision. When she was deciding on what course is she was going take after finishing secondary school, she knew what she wanted to do after volunteering in elderly care home. When she turned 20 Emma got her first job in a care home she was working double shifts because of the love that she had grown towards her job. After working in a care home for the terminally ill, my mother decided that she wanted a change her job outlook and she started working in a domestic abuse centre for women. When Emma became pregnant with me she started doing hairdressing from home. This was more of a hobby for my mother as she would only do family or close friends. She had had to give up her job at domestic abuse centre because it would have meant putting Katherine in danger and the people at the centre wouldn’t allow it. Emotional development & Social development: Emma was both emotionally and socially affected by nurture. Emma was influenced by friends and new work colleagues in adulthood, as you grow more work connections as you get older. Emotionally she began to ponder about life as a teenager, and recognized that the choices she made were the best for her. When Emma reached this life stage she found love and spent 20 years with Katherine’s father which ended after attempting to save their relationship for 2 years. Their relationship had been very successful for 18 years, but after Emma’s mother died he began to try to control her. Emma found it very difficult to deal with after her mother died as she had a few  regrets about the way their relationship ended. Emotionally Emma also found out that after her mother died that she could inherit a variety of genetic diseases. This made it hard for Emma to focus on the positives after splitting up with my father and her mother dying. Socially Emma relied on her friends a lot more as she got older as her family didn’t really contact her after her mother had died. Emma had several best friends that were there to support after her relationship had ended and her mother had died.

Electronic Medical Records

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