Organisational Structure Key terms Chain of command Essay Example for Free

Organisational Structure Key terms Chain of command Essay Chain of command Line linking the top of the structure to the bottom workers Top to bottom Responsibility Accountability Horizontal People on the same line, but usually in different departments. A span of control is the number of people one person is in charge of. Tall Hierarchal structures Those with a long chain of command Management communicate with those directly below them and further down the line. Example: Marks and Spencer, Next, theyre normally formal organisations. They are tall because there are a lot of people working for them. Advantages Clear chain of command Staff know where they stand They know who there boss is Chances of promotion They know there entitlements and rights Specialist departments Disadvantages Takes more time to make a decision Inflexible, people only know there area of work, and cant cover for someone who is not in that works in another area. Information might get misinterpreted and distorted along the line of communication because there are so many links in the chain. Read more:Â  Walgreens Organizational Structure Matrix Structure Sometimes an organisation needs to run according to what projects they have to do. In these situations people usually work together in a team to achieve their projects goals. A person working on a project would have two bosses, the boss of the department that they work in and the leader or manager of the particular project that they are working on at the moment. A project may cover some or all of the organisations departmental areas. Senior manager heads a division or team of specialists drawn from different departments. A specialist (e.g. finance) can be part of a number of teams or divisions Advantages Promotes coordination between departments cuts across departmental boundaries flexibility and creativity Mixture of knowledge and skills Allows a range of staff to be involved which gives good experience. Disadvantages Confusion between managers who are dealing with a number of projects at one time Projects may be temporary Too many people involved to make decisions.

Joseph Conrad’s Heart of Darkness - A Modernist Novel :: Joseph Conrad Heart of Darkness

Joseph Conrad’s Heart of Darkness - A Modernist Novel Modernism began as a movement in that late 19th, early 20th centuries. Artists started to feel restricted by the styles and conventions of the Renaissance period. Thusly came the dawn of Modernism in many different forms, ranging from Impressionism to Cubism. In order to explore new venues of creativity Modernists tinkered with the perception of reality. During the Renaissance, the depiction of a subject was very straight forward. A painting had to look like what it represented. The truth was absolute and right and wrong were clearly defined. For Modernists, the world is much more obscure. In Impressionist paintings, lines are not definite and things tend to blur together. Faces usually do not differentiate one person from another. Cubism takes the opposite route for the same effect. Solid lines are drawn, but the painting itself is usually more abstract (as with Picasso). At times it can be difficult to discern what some paintings are supposed to represent. Bright, vivid colors infuse the pieces with more passion. The contrast between those not well defined objects and the punch of emotion gives cubism its personality and vitality. Many believed that Modernist works were not â€Å"art† because they did not always look like real life. But what is â€Å"real life†? A new outlook on reality was taken by Modernists. What is true for one person at one time is not true for another person at a different time. Experimentation with perspective and truth was not confined to the canvas; it influenced literary circles as well. Joseph Conrad’s Heart of Darkness is a great example of a Modernist novel because of its general obscurity. The language is thick and opaque. The novel is littered with words such as: inconceivable, inscrutable, gloom. Rather than defining characters in black and white terms, like good and bad, they entire novel is in different shades of gray. The unfolding of events takes the reader between many a foggy bank; the action in the book and not just the language echoes tones of gray. In Modernist literature, much like painting, there is experimentation with form: narration style, tone, plot line. Instead of having Kurtz tell his story, or Marlow recite the tale of his journey, the actual narrator in the Heart of Darkness is an unknown passenger on the Nellie. Joseph Conrad’s Heart of Darkness - A Modernist Novel :: Joseph Conrad Heart of Darkness Joseph Conrad’s Heart of Darkness - A Modernist Novel Modernism began as a movement in that late 19th, early 20th centuries. Artists started to feel restricted by the styles and conventions of the Renaissance period. Thusly came the dawn of Modernism in many different forms, ranging from Impressionism to Cubism. In order to explore new venues of creativity Modernists tinkered with the perception of reality. During the Renaissance, the depiction of a subject was very straight forward. A painting had to look like what it represented. The truth was absolute and right and wrong were clearly defined. For Modernists, the world is much more obscure. In Impressionist paintings, lines are not definite and things tend to blur together. Faces usually do not differentiate one person from another. Cubism takes the opposite route for the same effect. Solid lines are drawn, but the painting itself is usually more abstract (as with Picasso). At times it can be difficult to discern what some paintings are supposed to represent. Bright, vivid colors infuse the pieces with more passion. The contrast between those not well defined objects and the punch of emotion gives cubism its personality and vitality. Many believed that Modernist works were not â€Å"art† because they did not always look like real life. But what is â€Å"real life†? A new outlook on reality was taken by Modernists. What is true for one person at one time is not true for another person at a different time. Experimentation with perspective and truth was not confined to the canvas; it influenced literary circles as well. Joseph Conrad’s Heart of Darkness is a great example of a Modernist novel because of its general obscurity. The language is thick and opaque. The novel is littered with words such as: inconceivable, inscrutable, gloom. Rather than defining characters in black and white terms, like good and bad, they entire novel is in different shades of gray. The unfolding of events takes the reader between many a foggy bank; the action in the book and not just the language echoes tones of gray. In Modernist literature, much like painting, there is experimentation with form: narration style, tone, plot line. Instead of having Kurtz tell his story, or Marlow recite the tale of his journey, the actual narrator in the Heart of Darkness is an unknown passenger on the Nellie.

European Financial Aspects

Forplay, Inc. , is about to become a reality on the European market. Our company will base its distribution on strategic alliances with local mail order companies, while starting a global ad campaign targeted to an audience age 18 to 45. While we don†t expect too many difficulties in converting and repatriating our funds, the financial aspects of this operation will still have to face the upcoming European monetary integration. The new currency — the euro – could significantly impact the way international business is conducted. In January 1996, Andersen Consulting surveyed 169 companies throughout the European Union, finding that â€Å"nearly three quarters felt that deeper integration in the form of European monetary union (EMU) would enhance the single market and bring further benefits — such as a more stable currency, lower inflation, lower interest rates, cost savings, efficiency improvements, a more competitive European Union (EU), and increased foreign investment. † There are benefits for companies outside the EU too. Business with Europe will be easier, and investment choices simplified through increased visibility and comparability of prices. Medium- and small-sized companies like Forplay, Inc. , will have less trouble opening a bridgehead into an enlarged unified market, with fewer financial risks. However, there are also many uncertainties. For example, which countries will join? Member states must meet criteria for economic convergence, and it is not certain how strictly these criteria will be enforced. Sluggish economic performance is giving finance ministers little room to maneuver. In some countries, notably the United Kingdom, a significant portion of the political establishment is hostile to the whole process, while in other countries, notably Germany, there is a reluctance to relinquish a strong national currency. Adjustments for the new currency must be made between the start of 1999 and the start of 2002. As a business, we must begin planning now to minimize the cost of changing our information systems and administrative operations and address the legal issues. All software implementations will have to be consistent with the changeover needs, so decisions made in the IT field will be of paramount importance. The migration to the euro will be of concern to risk managers in the world's major banks. Long term, there are many inherent advantages to EMU for controlling financial risk, although there is a chance of â€Å"backing the wrong horse† by adopting a technical solution that is rapidly made obsolete by the market, technological advances, or unexpected legislation. In the short term, uncertainty and market volatility mean increased risk. According to Bengt Bengtsson, SAS Institute European product manager for risk management solutions, â€Å"Companies should take this opportunity to review and update their treasury operations, foreign exchange, and interest rate management. Flexibility in risk controlling systems and adequate hedging mechanisms will be vital. Liquidity risk will also come high on the agenda as new products and funding possibilities (bonds, for example) become available in the euro. One of the keys to success will be the separation of risk controlling functions from day-to-day trading activities through a risk warehouse strategy. † For a while at least, Forplay, Inc. will have to operate some form of dual accounting, with consequent additional burdens on our corporate chief financial officers (CFOs). In the meantime, CFOs will need maximum flexibility within their ledger accounting systems and their financial consolidation and reporting systems, so they should take advantage of the introduction of the euro to review both. Two types of organizations face challenges,† says Richard King, SAS Institute European product marketing coordinator. â€Å"The first is those with more than one type of transactional ledger system. They will need to consolidate and report in two currencies, based on data from several incompatible sources. Consequently they will need a solution that allows them to look at all relevant dimensions from any perspective, instantly. â€Å"The second is any organization that has standardized on a single type of transactional ledger system but nevertheless lacks flexibility when it comes to financial reporting,† adds King. CFO Vision from SAS Institute, which supports all ledger systems, gives full flexibility in reporting (including multiple currencies concurrently) while protecting existing investments. For us as marketers, the transition to the Euro also raises awkward issues that may seem insoluble to anyone exporting to the EU. For example, should prices be expressed in euros, national currencies, or both? In addition, even though our prices are extremely competitive, for many products there is a marked difference in pricing policies within different EU countries. With the introduction of the euro, prices will be more transparent and such differences more difficult to maintain. Forplay, Inc. should therefore be investing in market research and database marketing to formulate pricing and marketing strategies now to avoid loss of market share and secure the benefits of operating in a single market. Preparation will mean everything as further developments in the deployment of the euro unfold. A keen understanding of current systems, a strong business plan, and flexible technology will mean continued business success — in any language.

An American Healthcare Proposal Essay - 758 Words

The first thing that would be enacted through my optimal health care reform plan would be making employer based insurance mandatory. Individuals who are employed will be eligible for health insurance coverage and will not be able to opt out with out proof of other insurance. Employer based insurance will become more affordable for both employers and employees through a tax credit incentive. Employers will be able to choose which plans to provide to employees through the use of a Health Exchange. No less than two plan options will be available to employees. Medicaid is often mistaken as insurance strictly for the poor. This is not the case as many middle income households rely on this insurance. For this reason the program will be†¦show more content†¦Insurance companies will be monitored by a new governmental committee to prevent price gauging. If an insurance company was found to price gauge they would be heavily fined. Creating a health care reform plan for the U.S. health care system is no easy task. Multiple things must be taken into consideration. These include making insurance affordable, making sure the plan is economically feasible, and creating a plan that will still work in the future. What hindered the reshaping of health care into a sustainable system in the past, are the health sectors interests that prefer the status quo. By continuing to cling on to yesterday’s model, the health care industry is creating its own peril (Schaeffer, 2007). FUNDING AND CONCLUSION In the past what has hindered health care reform plans from being enacted were the issues surrounding how they were to be funded. When comparing the attempts of the Clinton administration, the current legislation developed by both the House and the Senate, and Britain’s National Health Service, it is in my opinion that my optimal health care reform plan be funded through taxes, cost-sharing, and fees. In order for this plan to be successful it must be economically feasible and be able to reduce overall health care costs. To get my health care reform started, the basic format of Britain’s National Health Service will be followed. It will feature large tax-based financing to fundShow MoreRelatedThe Healthcare Debate On Healthcare1312 Words   |  6 PagesThe Healthcare Debate Healthcare has been a hotly debated topic in both of the last two presidential elections. As the cost of healthcare in America continues to rise, more Americans struggle to pay doctor and hospital expenses. Health insurance is suppose to provide money to pay for medical expenses, but as costs rise so do the insurance rates. Many Americans find private insurance is too expensive. As a result, many middle class Americans and low income households decide to go uninsured forcingRead MoreObamacare Essay763 Words   |  4 Pagesproposed Senate healthcare bill to replace Obamacare will face some steep challenges before it passes, and some healthcare analysts speculate the bill is D.O.A. Senate Majority Leader Mitch McConnell announced the Senates version of healthcare reform, known as the Better Care Reconciliation Act of 2017 on Thu. June 26, which basically echoes the House version of healthcare reform that failed to pass earlier in the year. Tax Credits, Subsidies and the Senate Proposal The Senates healthcare bill focusesRead MoreShould Obamacare Be Abolished?1099 Words   |  5 PagesHealthcare has been a hotly debated topic in both of the last two presidential elections. As the cost of healthcare in America continues to rise, more Americans struggle to pay doctor and hospital expenses. Health insurance is suppose to provide money to pay for medical expenses, but as costs rise so do the insurance rates. Many Americans find private insurance is too expensive. As a result, many middle class Americans and low income households decide to go uninsured forcing taxpayers to cover theirRead MoreHealth Care Polarity Essay915 Words   |  4 PagesBest Approach to Providing Affordable Healthcare to American Citizens: Analyzing the polarity of two opposing solutions to the problem of affordable healthcare Affordable healthcare for citizens remains at the forefront of debate for American policymakers and the complex network of privatized institutions, which provides said healthcare for those fortunate enough to afford such coverage. According to data provided from the World Bank, an assessment of generated revenue shows that the United StatesRead MoreThe American Nurses Association ( Ana ) And The Health Ministries Association1272 Words   |  6 PagesThe American Nurses Association (ANA) and the Health Ministries Association (HMA) have described Faith Community Nursing (FCN) as a form of a specialized nursing practice carried out by a nurse within a faith community (American Nurses Association Health Ministries Association, 2012). The role played by the FCN is to protect, promote, and optimize health and abilities, prevent illness and injury, and respond to distress regarding the practice beliefs and the values of a faith community. The FCNRead MoreCase Study Of A Business Case For A Disease Prevention Unit For High-Risk Groups1117 Words   |  5 Pages Business Case for a Disease Prevention Unit for High-Risk Groups Our healthcare organization has an opportunity to increase revenue and be more involved in the community by providing a new service that is relevant to our community of African Americans and Latinos. We propose adding a new unit that will focus on preventive care disease testing that targets high-risk patients. Risk and Mitigation Analysis Opportunities: By identifying opportunities for improved health through preventative diseaseRead MoreThe Failed Government Policy : The Causes Of The Affordable Care Act?1272 Words   |  6 Pagesthis project will take a look at will be the healthcare reform effort of 1993-1994. This policy initiative tried to ensure universal health care to all Americans due to the perceived notion of rising costs and insurance abuse (Brinkley 2004, p. 508). One piece of the bill was that employers would have to give coverage to individuals that worked for their company which would later be enacted in the Affordable Care Act. This bill became toxic to Americans and interest groups. Conservative and LibertarianRead MoreAffordable Care Act Research Paper1034 Words   |  5 Pagescan date back to the Truman administration after World War II, this was an initial attempt to increase healthcare accessibility. President Truman proposed universal health insurance, but Congress didn’t pass the Bill. President Ei senhower didn’t make efforts for universal health insurance like his predecessor, but his administration made slight health reform proposals such as funding healthcare for military dependents and health insurance benefits for social security dependents. The Kennedy AdministrationsRead MoreThe Health Care Of America1400 Words   |  6 Pageseducation, technology, and healthcare are the main criteria that determine a great country. Among the developed countries, U.S. is the number one country in the world which provides advanced and finest health care (Kane). However, the healthcare cost in America is the highest in the world because of the great consumers of medical technology and diagnostic imaging. (Kane). Numerous individuals are not able to afford their health care. Many people in U.S. do not have healthcare insurance. It is weird thatRead MoreEssay about The Policy Process1585 Words   |  7 PagesWhen a policy is formulated there are two major parts; agenda setting an d development of legislation. After these stages then the implementation stage begins. The way issues emerge can bring public awareness to a situation, such as the need for healthcare reform in the United States and eliminating the uninsured population. There are various stages of the policy process required to address this issue which include the formulation stage, legislative stage and the implementation stage. Policy formulation

Bill O Reilly And Martin Dugard Essay - 1191 Words

Bill O’Reilly, Martin Dugard, â€Å"Killing Reagan: The Violent Assault That Changed a Presidency†, New York, Henry Holt and Company, 2015, pp336, $30.00 Bill O’Reilly and Martin Dugard attempt to bring the reader to the events, through a thrilling story-like account of the assassination attempt on President Ronald Reagan and its impact on the rest of his presidency. The main points examined in this book, include, of course the assassination attempt on Reagan’s life, but it goes deeper to look at the impact on the remaining days of his Presidency. It examines John Hinckley and what causes him to commit this evil act against the President, and also examines Reagan’s political ambitions and ideas during his career as a Hollywood, years before he would hold political office. He does this all, not to diminish Reagan’s accomplishments as President, but to add to it to reinforce the great accomplishments, and what Reagan overcomes to achieve them. Bill O’Reilly and Martin Dugard have co-written several historical books that have reached the top of the New York Times bestselling list. The â€Å"Killingâ₠¬  series include six books co-written by Dugard and O’Reilly. In addition, Dugard has written several bestselling historical books. Bill O’Reilly, in addition to being a bestselling author, hosts the number one rated cable news show, The O’Reilly Factor, on Fox News. He graduated from Marist College, in New York, with a bachelor’s degree in History. He also holds a masters of arts degreeShow MoreRelatedKilling Lincoln By Bill O Reilly And Martin Dugard1609 Words   |  7 PagesKilling Lincoln by Bill O Reilly and Martin Dugard is a book that captures the days leading up to and surrounding President Abraham Lincoln’s death. The purpose of this book is to give the reader insight about anything relating to President Abraham Lincoln in his final days. Bill O’Reilly hosts his own news television show called â€Å"The O’Reilly Factor† which is aired on the Fox News Channel where he talks about political issues. He has written many other books with Dugard like Killing Kenn edy: TheRead MoreKilling Reagan By Bill O Reilly And Martin Dugard1601 Words   |  7 PagesKilling Reagan was wrote by Bill O’Reilly and Martin Dugard as a part of their series to talk about the deaths, assassination, and near deaths of certain historical people. O’Reilly and Dugard write about the events leading up to the attempted assassination of Ronald Reagan including discussing the attempted assassin, John Hinckley, and the events after up until his death. The authors present the viewpoint as if one were there to witness the lives of the people in the book. Killing Reagan talks aboutRead MoreKilling Kennedy: The End of Camelot1606 Words   |  6 Pages Killing Kennedy: The End of Camelot The authors Dugard Reilly make the point that 8 percent of Americans actually have this belief that Lee Harvey Oswald is the man that had something to do with the death of Abraham Lincoln. However, the authors in this book want the reader to know that is considered to be one explanation for Killing Kennedy, which happens to be the current book written by authors Bill OReilly and Martin Dugard. They clearly wanted to turn a presidential murder into a humanRead MoreKilling Lincoln : The Shocking Assassination That Changed America Forever Essay1761 Words   |  8 PagesBill O’Reilly and Martin Dugard write Killing Lincoln: The Shocking Assassination That Changed America Forever , a book about the assassination of President Abraham Lincoln and the events leading up to the assassination. The purpose of the book is to strategically break down the days and events leading up to the death of Abraham Lincoln and provoke thoughts in the minds of the readers. The authors want to uncove r proven and alleged conspiracy theories. Bill O’Reilly writes a plethora of other booksRead MoreLincoln Is A Great Talented Man1716 Words   |  7 Pagesmany views behind his name. However, there is a book called, â€Å"Killing Lincoln† that explains his assassination. The assassination has changed American forever. The book was released on September 27, 2011. The authors of the book were Bill O’ Reily and Martin Dugard at that time. Meanwhile, this is going to be a brief summary to the follow up of his assassination. First, this book explains many battles and plans to regards of the Civil War. The Civil War was based on the presence of slavery inRead MoreAbraham Lincoln, The Sixteenth President Of The United1813 Words   |  8 PagesGeneral Grant would be attending the Ford s Theater on April 14, he decided to make his move. Since Booth has been an actor himself, he knew the theater well because he had performed there many times before. Around 2:00 PM on April 14, Billy O Reilly says, Abernathy 2 ...Booth walks downstairs to the Grover s manager s office. It s empty. Sitting at the desk, Booth removes a paper and an envelope from the pigeonholes. He then writes a letter to the editor of the NationalRead MoreAssassination Of John F. Kennedy1168 Words   |  5 PagesJFK’s assassination, he faced many world problems such as the Bay of Pigs and the Cuban Missile Crisis. These actions lead up to his death because many people, like Lee Harvey Oswald, did not see eye to eye on Kennedy’s politics. For example, author Bill O’Reilly states in Killing Kennedy: The End of Camelot, â€Å"The cold war that has raged between the two nations for more than a decade†¦ Many in Washington believe that overthrowing the pro-soviet Castro will go along way toward restoring equilibrium toRead MoreAnalysis Of Killing Patton By Bill O Reilly1592 Words   |  7 Pagesa scale that will probably never be seen again. Her full strength was finally unleashed and the world sa w her full might. This strength was displayed on the battlefields behind one of World War â… ¡Ã¢â‚¬â„¢s most audacious generals: General George S. Patton. Bill O’Reilly’s book Killing Patton is a story of a famous American general’s role in latter parts of World War â… ¡. Patton was in charge of America’s Third Army and was highly by the Allies and Hitler himself. His passion for war and aggressiveness on theRead MoreJfk s Alleged Assassin By Geoff Hamilton Claims1223 Words   |  5 PagesJohn F. Kennedy. Trauma, vol. 13, no. 3, 2011, pp. 245-249 ProQuest Central, http://rccproxy2.rockinghamcc.edu:2048/login?url=http://search.proquest.com/docview/875950116?accountid=13568.doi:http://dx.doi.org/10.1177/1460408610392885. O Reilly, Bill, and Martin Dugard. Killing Kennedy: the end of Camelot. New York: Henry Holt and Company, 2012. Print. The Day Kennedy Died . Dir. Leslie Woodhead. Perf. Kevin Spacey . Documentary . N.p., 17 Nov. 2013. Web. 4 Feb. 2017.Read MoreThe Legacy Of John F. Kennedy1800 Words   |  8 PagesJFK’s assassination, he faced many world problems such as the Bay of Pigs and the Cuban Missile Crisis. These actions lead up to his death because many people, like Lee Harvey Oswald, did not see eye to eye on Kennedy’s politics. For example, author Bill O’Reilly states in Killing Kennedy: The End of Camelot, â€Å"The cold war that has raged between the two nations for more than a decade†¦ Many in Washington believe that overthrowing the pro-soviet Castro i ll go along way toward restoring equilibrium

Science Is The Pursuit And Application Of Knowledge Essay

In order to understand how each ideology interacts and it interrelated you must first understand the definition and function of each. The board spectrum of interdisciplinary disciples pertaining to Science, Math, Technology and Engineering provide a broad spectrum of knowledge and opportunity for segregated sectors of discovery and interpretation. Each spectrum offers and promotes different methodology and ideology yet work together. Educators and researchers use crossed disciplinary approaches to satisfy the needs of our societal demands in this new and upcoming culture. According to the dictionary Science is the pursuit and application of knowledge and understanding of the natural and social world following a systematic methodology based on evidence. Science has been defined in many ways, and its meaning has changed with time. In its most fundamental sense, modern science is a process by which we try to understand how the natural world works and how it came to be that way. It is NOT a process for merely collecting facts about, or just describing, the natural world, although such observations do provide the raw material for scientific understanding. Scientific knowledge is the inferences that scientists draw from the data - the models for how things work. As a process, certain rules must be followed, but there is NO one scientific method, contrary to its popular treatment in textbooks. The rules of science are intended to make the process as objective as isShow MoreRelatedScience Is The Pursuit And Application Of Knowledge971 Words   |  4 PagesThe question, â€Å"What is science?† has a complicated answer. Is science doing lab experiments or sifting through layers of soil to find artifacts? Is science making observations through telescopes of the movements of heavenly bodies or discovering through microscopes the processes of cell division? Is science about explaining natural phenomena or learning about the life of a coral reef? We all know that science is all of these. But, what is science? According to the Science Council (http://www.sciencecouncilRead MoreThe Intellectual Pursuit and Its Social Counterpart in Frankenstein1056 Words   |  5 PagesIntellectual Pursuit and Its Social Counterpart Victor Frankenstein, as a scientist, has a burning passion and an infinite curiosity for the science of reanimation. After spending years studying what is known of the subject, Victor makes a discovery that would have been considered an enormous scientific breakthrough. However, once Frankenstein applies this new science, the science becomes a detriment to society, never to be attempted again. Frankenstein ignored the social implications of the science of reanimationRead MoreMoral And Ethical Issues In Frankenstein Essay1492 Words   |  6 Pagesquestion of all science fiction can be summed up by this sentence: â€Å"‘If this goes on, where will it lead?’†(Sawyer) By asking this basic, yet perplexing question, writers extrapolate on a known scientific principle to its most extreme case, and thereby create a catalyst for the events of the stories they write. Inside this story, the innate natures and behaviors of human beings are revealed through the charactersâ₠¬â„¢ reaction to the new threat that an advance in technology or scientific knowledge presentsRead MoreA Positive Perspective On The Pursuit Of Knowledge1278 Words   |  6 Pagesis essential in the pursuit of knowledge†. The knower has to have a positive perspective in order to attempt to pursue the knowledge that the knower desires. To pursue something, there has to be a motive or drive for the knower to do so. I feel like without the positive perspective to drive the knower’s desire to gain knowledge, the pursuit of knowledge is meaningless to the knower. Even if knowledge is gained, the knowledge becomes meaningless because there is no application. Knowing means the knowerRead MoreTechnology and Morality in Shelleys Frankenstein - Is Knowledge Always Evil?952 Words   |  4 PagesFrankenstein: Is Knowledge Always Evil? nbsp; As of this writing, I have decided to regard the local TV channels The more you know... commercials as being evil. I do not understand how anyone could regard knowledge as anything but evil. The more you know... the more your mind feels the need to explorer for more knowledge and the more evil it will encounter. The more you search, the more ignorant you realize you are and the more open to pain you become. Who needs to have the knowledge possessedRead MoreStatement of Purpose962 Words   |  4 Pagesin my academic pursuits by increasing my hunger for knowledge but ensured that I was amongst the best in all my classes. What can be more interesting and fascinating than the structure of the world around us? I asked myself this question when I was deciding which course to pursue in my undergraduate studies. I knew two things at the time; the first was that the world can be thought of as a vault of data and secondly, that mathematical statistics is basically the science of extractingRead MoreApplication for Master Degree in Theory and Computational Science955 Words   |  4 Pagescomprehensive foundation in the field of Computer Science. Within this field, I have developed a deep interest in the area of Theory and Computational Science. More specifically I find algorithms and theory of computation the most appealing areas due to their application in solving many real world problems. My undergraduate course in the field of Electronics Engineering has given me a comprehensive exposure to all the core fields of computer science and mathematics. In my junior year, I participatedRead MoreIs Science Dangerous? By Lewis Wolpert955 Words   |  4 PagesIn his commentary â€Å"Is science dangerous?†, Lewis Wolpert attempts to answer the age-old question of whether knowledge (and therefore science, as the source of knowledge), poses a risk to society. In order to do so, he makes a crucial differentiation between pure science as knowledge that enhances our understanding of the world, and technology, which is the application of scientific research (Wolpert 281). If we agree that pure science is void of morality, then the real question becomes: does theRead MorePresident Park Geun Hye Of South Korea1606 Words   |  7 Pagescertain type of effects to the people’s pursuit of knowledge. Using examples from astrology/science and history, I would investigate whet her knower’s perspective is always or is not essential in the pursuit of knowledge through usage of language and emotions. In this essay, perspective is defined as a concept or opinion built upon one’s experience or background such as gender, race, religious position, historical era, education experiences, and ‘pursuit of knowledge’ as act of learning or researchingRead MoreAnalysis Of The Book The Monster 1482 Words   |  6 PagesES 124 Book Project Question (60 points) Ms. Nguyen Winter 2017 Your answers should be typed, using MLA format A. Knowledge 1. Write the title of your book and the author’s name 2. List the characters and describe them a. Captain Robert Walton: As a failing writer, he sets out on a voyage to the North Pole in hopes of the fame in new scientific discoveries. He rescues the main character, Victor Frankenstein, and record the story as told by Frankenstein. b. Victor Frankenstein: Frankenstein narrates

Sepsis in the Emergency Department Improvements free essay sample

Sepsis remains one of the most deadly diseases in the country. According to the literature, a majority of sepsis cases filter though the Emergency department. The diagnosis and treatment of sepsis are complex and the barriers to improving these things are even more intricate but the fact remains that improvement of sepsis care begins in the ED. Early recognition of sepsis using the SIRS criteria followed by multidisciplinary rapid response diagnostic testing and treatment are the keys to improvement of sepsis care in the ED. Introduction Sepsis is defined by the Surviving Sepsis Campaign (SSC) as the presence (probable r documented) of infection together with systemic manifestations of infection (Dellinger et al. , 2013). Severe sepsis is defined by the SSC as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion (Dellinger et al. , 2013). Despite advances in treatment modalities, the current literature reports mortality for severe sepsis and septic shock ranges from 20% to 60% (Burney et al. , 2012; Dickinson Kellef, 2011; Turi Von, 2011) making it the 10th leading cause of death in the United States. The prevalence of sepsis is markedly higher among the elderly opulation and rises exponentially after the age of 65 (Gaieski et al. , 2010). With the baby boomer generation now approaching this age, systematic and effective treatment of sepsis has never been more important. Severe sepsis until the last decade was a grossly under recognized and undertreated illness. Although treatment protocols have improved impart due to the Surviving Sepsis Campaign, there exists an urgent need for improvement of prompt, methodical and aggressive care of severe sepsis and septic shock. More than 500,000 cases of severe sepsis are initially anaged in US emergency departments annually with an average ED length of stay for these patients of 5 hours (Wang et al. , 2007). The SSC strongly recommends seven, time sensitive, initiatives. Within three hours of suspected, or diagnosed sepsis, the clinical team must measure lactate level, obtain blood cultures, administer broad spectrum antibiotics, and correct any hypotension or lactic acidosis with the administration of 30mL/kg crystalloid. Within 6 hours, the SSC recommends applying vasopressors for sustained hypotension, measuring central venous pressure (CVP) nd central venous oxygen saturation (Scv02) and remeasuring lactate if initial lactate was elevated (Dellinger et al. , 2013). What is not obviously evident in these recommendations is the workload associated with completing these tasks, which for nurses, includes inserting multiple large bore IVs, multiple blood draws, assisting with invasive procedures and for physicians includes inserting invasive lines and managing a critically ill patient. This puts a huge emphasis as well as a burden on the ED, for the improvement in recognition and initial management of sepsis. Definitions of Sepsis Sepsis is a physiologic response to an infection that begins with the systemic inflammatory response syndrome (SIRS). SIRS, originally defined in 1992, is characterized by a presence of two of the following five physiologic changes: 1 . Temperature 98. 60 F or 100. 40 F 2. Heart rate 90/min 3. Respiratory Rate 20/min Body 4. Hyperventilation, indicated by a PaC02 of 12,000/uL or the presence of 10% immature neutrophils (Simpson Pitts, 2010) Severe sepsis is the presence of sepsis with the presence of organ failure separate from the site of infection. The hallmark signs of organ failure summarized by the American College of Chest Physicians includes: 1. Hypotension 2. Renal failure that manifests as a creatinine value increase 0. 5 mg/dL, poor urine output (defined as 0. 5 mL/kg for 1 h), or the need for renal replacement therapy 3. Altered mental status (from individual patient baseline) 4. Thrombocytopenia ( 100,000 platelets/mL) 5. Respiratory failure that manifests by arterial hypoxemia (Pa02/F102 300) 6. Coagulation abnormalities (international normalized ratio 1. 5 or activated partial thromboplastin time 60 s) 7. Ileus 8. Hyperbilirubinemia (plasma total bilirubin level 4 mg/dL) 9. Hyperlactatemia ( upper limit of normal) (Simpson Pitts, 2010) Management of Severe Sepsis: More than 500,000 cases of severe sepsis are initially managed in the US emergency departments annually, with an average ED length of stay of 5 hours. The cornerstones of management of severe sepsis includes prompt diagnosis, timely administration of appropriate antibiotics, and aggressive resuscitation. Recognition of Sepsis in the ED. It is well known within health care professionals as well as the general public that, in the first hours of a myocardial infarction or cerebral vascular ccident, time is tissue. This is also the case in severe sepsis and because of this, early recognition of sepsis is vital to improving outcomes. SIRS is the first line diagnostic for the recognition of sepsis. If the patient meets SIRS criteria, the next line of diagnostics is to test the serum lactate. Lactate is believed to be due to decreased end-organ perfusion, leading to anaerobic glycolysis and lactate production. Serum lactate is commonly used as a prognostic test for illness severity in ED patients with sepsis (Green et al. , 2011). Resuscitation in the ED. Rapid Quantitative resuscitation is recommended in all patients with tissue hypoperfusion. According to the SSC guidelines, the goals of fluid resuscitation include a CVP of 8-12 mm Hg, a MAP 65 mm Hg, urine output 0. 5 mukg/hour and an Scv02 of 70%. The strategy of resuscitation, completed in the first 6 hours was associated with a 15. % reduction in 28 day mortality (Dellinger et al. , 2013). Crystalloids should be the first initial fluid choice during resuscitation. If the patient remains hypotensive, vasopressor therapy should be initiated using norepinephrine as the tirst choice Dellinger et al. , 2013). Antimicrobial Therapy in the ED. The administration of broad- spectrum antimicrobials with the first hour of re cognition of sepsis is vital to patient mortality. In multiple studies, each hour of delay in antibiotic administration is associated with a measurable increase in patient mortality (Dellinger et al. 2013). Another vital component of treatment is the choice of empirical antimicrobial therapy. Kumar et al. , found that survival rates after appropriate and inappropriate initial therapy were 52. 0% and 10. 3% respectively (Kumar et al. , 2009). This is a huge isparity for patients and therefore a large focus for EDS. Barriers to Care and Suggestions for Improvement Suboptimal treatment of sepsis is widespread. Compliance with the 6 hour resuscitation pundle is poor, ranging from 19% to 52% (Aitken et al. , 2011). For example, even though the Surviving Sepsis Campaign (SSC) has distributed guidelines, reflecting the Early Goal Directed Therapy (EGDT) studied by Rivers and colleagues, suggesting the administration of antibiotics within 1 hour of suspected bacterial infection, the average time for the first infusion of antibiotics exceeds 3 hours. Other suboptimal findings include choosing the wrong type of antibiotic, lack of consistent hemodynamic monitoring, lack of treatment order sets and protocols and lack of support for processes needed to complete EGDT (Aitken et al. 2011). There is an urgent need in healthcare for improvement of prompt, methodical and aggressive care of sepsis. Sepsis Recognition and Alert. The early diagnosis of sepsis is extremely difficult. By the time patients with sepsis have apparent vital sign changes, they are critically ill and needing aggressive treatment. For this reason, early recognition of SIRS is vital. Identifying SIRS takes comprehensive knowledge of th e criteria and meticulous assessment of patients. This has proven to be a major barrier to implementing the SSC guidelines (Turi Von, 2011). In one study conducted by Burney et al. , more than 85% of nurses reported that they were somewhat or not at all familiar with SIRS criteria and only 15. 8% of nurses reported that abnormal vital signs were reported in a timely fashion by support staff (Burney et al. , 2012). This is why one of the most important improvements that can be made in sepsis care is education on the criteria of SIRS and signs of severe sepsis ithin the ED. All staff whom interact with the patient, not Just RNs, need to be provided with this education. Once a patient with SIRS is identified a rapid response needs to be initiated and treatment should begin immediately. This effort should not only be a multidisciplinary rapid response team (RRT), which has been indicated to improve outcomes (Tromp et al. , 2010), but also should involve members from each of the units and services needed for treatment (ED, CU, Surgery if needed). This wide involvement will help to utilize all resources as well as assist to streamline the atient to a critical care environment with staffing levels to support the patient. Treatment protocol. When surveyed, registered nurses considered delay in diagnosis by physicians to be the most significant cause of treatment interruption among patients with sepsis. Also, the majority of staff surveyed (89. 5% of nurses and 86. 0% of physicians) stated that a written protocol, similar to the ones already in place for the management of acute coronary syndrome and pneumonia, would help them to manage patients with sepsis (Burney et al. , 2012). If a nurse suspects sepsis, based on the recognition ot SIRS, literature sugges s that this lead to the use ot a predominantly nurse driven, sepsis protocol where baseline diagnostic tests are ordered and the rapid response team is notified at the minimum, but also suggests that protocol-directed care in the areas of fluid and vasopressor therapy is becoming more commonplace and has been shown to be safe (Aitken et al. , 2011). This type of protocol can significantly improve the rapid diagnosis of sepsis and improve chances of SSC guideline completion (Tromp et al. , 2010). If the patient meets diagnostic criteria for sepsis, then the physician should initiate the institutional sepsis bundle. This sepsis bundle should include recommendations from the SSC including qualitative resuscitation (based on CVP, MAP, Scv02, and urine output), broad- spectrum antibiotics, as well as source identification and control. The physicians orders should also include central and arterial line placement and vasopressors if indicated. Antibiotic Availability and Selection. Widely agreed upon is the fact that the most important of the initiatives recommended by the SSC is the early administration of antibiotics. A study in Critical Care Medicine by Gaieski et al. (2010), nalyzed for elapsed time from triage to the appropriate antibiotic administration to determine if there was a significant association. The researchers found a significant association at the one-hour time cutoff for both triage to antibiotics (mortality 19. 5 vs. 33. 2%) as well as qualification for EGDT to antibiotics (mortality 25. 0 vs. 38. 5%). This supports the argument that the prompt administration of appropriate antibiotics is a primary determinant of mortality in patients with severe sepsis (Gaieski et al. , 2010). Unfortunately, studies have found that an incorrect antimicrobial agent is chosen in p to 35% of cases where the physician chooses the agent based on clinical judgment (Miano et al. , 2012) and when surveyed only half of the physicians (50. 0%) were very confident in choosing appropriate antibiotics for a patient with severe sepsis (Burney et al. , 2012). Antibiotic algorithms, based on common isolates and their susceptibility patterns, are highly effective at correcting these deficiencies. It should also be noted that resistance patterns should be monitored at a local and institutional level so that algorithms can be adjusted.