No Comfort Zone By Marla Handy Essay - 1461 Words

In No Comfort Zone, Marla Handy brings to the surface something many people tend to avoid: post-traumatic stress disorder. Unlike for many members of society, for Handy, it is not and never will be something she can avoid. She works to, momentarily, at least, bridge this gap for her readers by describing some of the symptoms that she and many others with PTSD live with on a frequent basis. Handy is one of about 8% of people who have been diagnosed with PTSD, defined as â€Å"a disorder that develops in some people who have experienced a shocking, scary, or dangerous event† (Carani). Here it is important to note, however, that this definition does not completely encapsulate Handy’s and some others’ situations. While it uses the singular event, Handy does not have one single moment, day, or occurrence that directly led to her PTSD. Rather, years of child abuse as well as sexual abuse and rape all led to symptoms that manifest in different ways through different triggers. While not many past perceptions of post-traumatic stress disorder can be found due to it being a relatively new diagnosis, the ones that can are largely negative and dismissive. People with PTSD were â€Å"generally viewed as crazy and faking symptoms because they didn’t have an organic cause† (Carani). While this has changed somewhat in current times, there is still a long way to go. For cases like Handy’s that do not stem from one specific event, many are still dismissive: I can only assume that it’s too difficult,Show MoreRelatedLibrary Management204752 Words   |  820 Pagesglobalization, ever-changing technology, and the pace of change. The only constant in today’s organizations is change. Although all change is challenging, that occurring at the present presents particular problems, for as the British management expert Charles Handy has stated, it is not change as we have known it in the past, but discontinuous change, which is particularly disturbing and confusing.5 Libraries will need good managers at all levels to manage the change as they face the redefined world of information

Admiration Free Essays

I love my parents, but I personally admire an American leader, Steve Jobs. In my opinion he was the best CEO of Apple and of course the most famous. As you know he is no longer alive, however his accomplishments are still remembered by people worldwide. We will write a custom essay sample on Admiration or any similar topic only for you Order Now In fact Jobs was not an easy person to work for – by that I mean he had a temper and many people found It hard to work with him, but they still did! This was because he was an absolute genius and his subordinates knew that he would make the company thrive. Many people, Including me don’t really care about his attitude problems since his Inventions are fantastic. SYNC has named Steve Jobs the most Influential person of the last 25 years. Thus, he Is also my hero and without him I would never have been able to play games with the touch screen, listen to music, take photos and make phone calls on the same device. It Is clear that Steve Jobs had an undeniable passion for what he did. Passion Is to make a difference. Such passion Is well established as one of the key ingredients in the world’s most successful businesses. It’s something I ‘eve come to actively look for to become a successful individual. As a result, stilettos is always the basketballs for s ©eking 4 success There are some leaders who are great because of their charisma while others are famous for their intelligence. Steve jobs is a perfect example of this It is a shame he died at such a young age, I think he could have helped society much more with his inventions – but I guess that was his fate. How to cite Admiration, Papers

Computer Interaction for End User of Tele-Health

Question: Discuss about the Computer Interaction for End User of Tele-Health. Answer: Introduction Tele-health is a new approach of technological development and it is related to health service and information. The service and information are distributed electronically over the internet (De Luca et al., 2015). It gives the facility to the old patients or the patients living in long distance to contact with the physician and get advice, care or information about their health remotely. Tele-health is an online health management system that integrates the practical data in their system and generates a report for its patients (ONeil et al., 2014). Positioning The patients interact with the clinicians over video conference form the tele-health tablet provided to the patient. The tablet is connected various tele-health device like Total ECG, TotalVitals, ClearProbe Ultrasound, etc. (Ringbk et al., 2015) These devices take the reading form the patients and transmit the data to the tele-health servers and the tele-health servers in return generate report from the raw data provided and identify the problem of the patient. Problem Statement The main problem associated with the Tele-health system is the management of the database where the patients records are kept. There may be inaccurate assessment of the health of the patient due to an error in the assessment device provided to the patient. The problem of There may be a case when the patient is using a faulty appliance and the data collected thus have an error. Planning the infrastructure to increase the capacity and analyzing the historical trends Monitoring the endpoint status at a real time and the capacity of the network (Lee et al., 2015) Affects When the data is uploaded to the tele-health servers an inaccurate report is generated and the physician may lead the patient in a wrong way and this can cause a life risk. In case of intruder attack the patient data base can be used by the hackers or modified for profit of another business organization(Ringbk et al., 2015). The credit or debit card details can also be accessed by the hacker from the tele health database servers. the impact of which is Improper diagnosis of the health can cause life risk of the patient. The patient may face loss of money due to the intruder attack. a successful solution would be The devices provided to the patients for checkup should have a routine maintenance and the device should be checked before use (Grant, Rockwood Stennes, 2015). The security for the network and the cloud servers should be increased and the data should be kept in encrypted form to prevent unauthorized access. Product Position Statement The tele-health system is a unique product and if implemented would have a great response throughout the world. Using this system all the users would be benefited, the patients benefit would be reducing the cost for the health checkup and cutting the travelling cost(Lakenauth Tang, 2014). The physical would be benefited as they can visit more number of patients throughout the world and the health care system would be benefited by reaching to the peoples located in the rural areas and dont have access to the modern treatment process. For The people of older age, Rehabilitated patients, Patients of rural areas Who The older aged people who cannot travel long distance for consult the physician or the rehabilitated patients who have changed their place due to some reasons or the peoples living in village and not have access to the modern facilities and service(De Luca et al., 2015). The (product name) Tele-health system That It would provide facilities to have a clinical checkup from any location in the world without travelling long distance and reducing the wastage of time. Unlike It is different from the traditional clinical method where the patient have to travel and search for the specialized doctor Our product Using the Tele-health system the patients can have conversation with the doctors sitting at home(Grant, Rockwood Stennes, 2015). They can also fix appointment according to their time. Tele-health is the recent trend of consulting the doctor and get an accurate health report Stakeholder Descriptions Here in the tele-health system the main stake holders are the patient, clinical staffs and the administration. Stakeholder Summary Name Description Responsibilities Patients Clinical staffs Administrator Patients are the client and using the tele-health system The clinical staffs are the physician or the specialized doctors. The administrator may be the hospitals which have deployed the tele-health system or some private organization The key responsibility of the stake holders is to use the system as per the requirement and provide proper solution regarding the diagnosis report they get after the assessment of the patients health (ONeil et al., 2014). The administrator should properly manage the system and avoid the errors in the system. User Environment There is an online interaction between the clinical expert and the patient. The patient health is checked using different Tele-health devices and the data is uploaded to the server and a report is generated according to the gathered data (Lee et al., 2015). This need a very less amount of time and if the patient is outdoors and not carrying the tele-health devices then he might face problem because then the clinical expert cannot check the patient health condition and thus cannot give a diagnosis report(Grant, Rockwood Stennes, 2015).. The traditional database servers are used for the storage of the patient data and other data but it could be moved to the cloud platform to make the system more efficient. Product Overview Tele-health is the best solution for the patient to have a consult with the physician and get the accurate test report of the health. Recommendation according to the report are also provided by the clinical expert using the tele-health service. Product Perspective The main Vision of the tele-health system is to reach all the people in the world. Using the product the patient can independently get clinical advice from the clinical expert i.e the patient does not have to wait for the system(De Luca et al., 2015). The patient can interact with the clinical expert using a tablet or any mobile device anytime. Assumptions and Dependencies The adoption of cloud platform in the tele-health system would benefit the patient and the system. The patient can access the system from any location and it would take less response time to respond to the patient (Lakenauth Tang, 2014). The patient can success tele health system from any platform and this would provide flexibility to the user. Needs and Features Need Priority Features Planned Release To reach the patients in every part of the world High It give medical suggestion that ca be applied for the betterment. The next release version would include support for the patients in all part of the world. Alternatives and Competition The alternative that is available to the patient is the traditional process of treatment that includes travelling time and waiting time to reach the final treatment process. Other Product Requirements The product should meet the requirement of all the users and should have easy to use interface such that the older people and the people living in the rural areas should find it easy to use. References De Luca, R., Bramanti, A., De Cola, M. C., Trifiletti, A., Tomasello, P., Torrisi, M., ... Calabr, R. S. (2015). Tele-health-care in the elderly living in nursing home: the first Sicilian multimodal approach.Aging clinical and experimental research, 1-7. Grant, L. A., Rockwood, T., Stennes, L. (2015). Client Satisfaction with Telehealth in Assisted Living and Homecare.Telemedicine and e-Health,21(12), 987-991. Lakenauth, G., Tang, S. (2014, May). Benefits of Telehealth across different socio-economic communities. InSystems, Applications and Technology Conference (LISAT), 2014 IEEE Long Island(pp. 1-6). IEEE. Lee, J. F., Schieltz, K. M., Suess, A. N., Wacker, D. P., Romani, P. W., Lindgren, S. D., ... Dalmau, Y. C. P. (2015). Guidelines for developing telehealth services and troubleshooting problems with telehealth technology when coaching parents to conduct functional analyses and functional communication training in their homes.Behavior Analysis in Practice,8(2), 190-200. ONeil, A., Taylor, B., Sanderson, K., Cyril, S., Chan, B., Hawkes, A. L., ... Amerena, J. (2014). Efficacy and feasibility of a tele-health intervention for acute coronary syndrome patients with depression: Results of the MoodCare randomized controlled trial.Annals of Behavioral Medicine,48(2), 163-174. Ringbk, T., Green, A., Laursen, L. C., Frausing, E., Brndum, E., Ulrik, C. S. (2015). effect of tele health care on exacerbations and hospital admissions in patients with chronic obstructive pulmonary disease: a randomized clinical trial.International journal of chronic obstructive pulmonary disease,10, 1801.

The Big Bang Theory Essays - Physical Cosmology, Big Bang, Universe

The Big Bang Theory The Big Bang Theory It is always a mystery about how the universe began, whether if and when it will end. Astronomers construct hypotheses called cosmological models that try to find the answer. There are two types of models: Big Bang and Steady State. However, through many observational evidences, the Big Bang theory can best explain the creation of the universe. The Big Bang model postulates that about 15 to 20 billion years ago, the universe violently exploded into being, in an event called the Big Bang. Before the Big Bang, all of the matter and radiation of our present universe were packed together in the primeval fireball?an extremely hot dense state from which the universe rapidly expanded.1 The Big Bang was the start of time and space. The matter and radiation of that early stage rapidly expanded and cooled. Several million years later, it condensed into galaxies. The universe has continued to expand, and the galaxies have continued moving away from each other ever since. Today the universe is still expanding, as astronomers have observed. The Steady State model says that the universe does not evolve or change in time. There was no beginning in the past, nor will there be change in the future. This model assumes the perfect cosmological principle. This principle says that the universe is the same everywhere on the large scale, at all times.2 It maintains the same average density of matter forever. There are observational evidences found that can prove the Big Bang model is more reasonable than the Steady State model. First, the redshifts of distant galaxies. Redshift is a Doppler effect which states that if a galaxy is moving away, the spectral line of that galaxy observed will have a shift to the red end. The faster the galaxy moves, the more shift it has. If the galaxy is moving closer, the spectral line will show a blue shift. If the galaxy is not moving, there is no shift at all. However, as astronomers observed, the more distance a galaxy is located from Earth, the more redshift it shows on the spectrum. This means the further a galaxy is, the faster it moves. Therefore, the universe is expanding, and the Big Bang model seems more reasonable than the Steady State model. The second observational evidence is the radiation produced by the Big Bang. The Big Bang model predicts that the universe should still be filled with a small remnant of radiation left over from the original violent explosion of the primeval fireball in the past. The primeval fireball would have sent strong shortwave radiation in all directions into space. In time, that radiation would spread out, cool, and fill the expanding universe uniformly. By now it would strike Earth as microwave radiation. In 1965 physicists Arno Penzias and Robert Wilson detected microwave radiation coming equally from all directions in the sky, day and night, all year.3 And so it appears that astronomers have detected the fireball radiation that was produced by the Big Bang. This casts serious doubt on the Steady State model. The Steady State could not explain the existence of this radiation, so the model cannot best explain the beginning of the universe. Since the Big Bang model is the better model, the existence and the future of the universe can also be explained. Around 15 to 20 billion years ago, time began. The points that were to become the universe exploded in the primeval fireball called the Big Bang. The exact nature of this explosion may never be known. However, recent theoretical breakthroughs, based on the principles of quantum theory, have suggested that space, and the matter within it, masks an infinitesimal realm of utter chaos, where events happen randomly, in a state called quantum weirdness.4Before the universe began, this chaos was all there was. At some time, a portion of this randomness happened to form a bubble, with a temperature in excess of 10 to the power of 34 degrees Kelvin. Being that hot, naturally it expanded. For an extremely brief and short period, billionths of billionths of a second, it inflated. At the end of the period of inflation, the universe may have a diameter of a few centimetres. The temperature had cooled enough for particles of matter and antimatter to form, and they instantly destroy each other, producing fire and a thin haze of matter-apparently because slightly more matter than antimatter was formed.5 The fireball, and the smoke of its burning, was the

Robby Gamble Essays (1075 words) - Automation, Factory, Free Essays

Robby Gamble Essays (1075 words) - Automation, Factory, Free Essays Robby Gamble Professor Kelly EH1102-024 9 March, 2017 Is a robotic takeover upon us? Would you believe me if I told you in the near future 70 percent of the occupations American youth are aspiring to fill will be replaced by automation? As outlandish as this claim may sound, history has proven it to be true. In the early 19 th century the majority of the American workforce was centered around farms . As time progressed and the Industrial Revolution came along, a plethora of new jobs were generated in factories, and based around the machinery produced in theses factories. Thus , many Americans left their jobs on farms and flocked to factories . "Today automation has eliminated all but 1 percent of [farmer's] jobs, replacing them, (and their work animals) with machines (Kelly 299)." This concept is the premise of what Kevin Kelly, an author, founding member, and senior maverick at Wired , discusses in his article "Better than Human: Why Robots Will-and Must- Take Our Jobs". Kelly believes that an automation takeover is unavoi dable, and through this takeover , humans will be further advanced as a species. While I do believe Kelly ' s argument holds truth and validity, I do no t necessarily believe this takeover will be completely beneficial to the human race, the time period in which this takeover supposedly will happen is up for debate . Kelly begins his article by discussing the various methods by which automation and artificial intelligence has and is already being integrated into the American work force. He gives an example of an AI name d B axter. There are three things that separate Baxter from different forms of automation; Baxter has eyes, so he can sense his surroundings making him less hazardous than other machinery; Baxter can be easily programmed, so it does not take a higher level of education to program him , it does not take long to program him , and he will consistently preform whatever task he is assigned; a nd finally, Baxter is less costly than AI that is similar to him . As Kelly moves forward in his argument, he shifts his focus from different forms of automation to the actual relationship humans have with automation. Kelly uses a visual aid to convey the human robotic relationship. His visual aid can be broken down into four quadrants: Jobs today that humans do-but machines will eventually do better, Current jobs that humans can't do but machines can, Robots jobs that we can't even imagine yet, and Jobs that only huma ns will be able to do- at first. His visual aid serves as an excellent method to explain his idea that robots will take over the jobs we currently have, and they will force us to create new jobs. This continuous cycle will allow humans to focus on art, music, and other creative outlets that define the essence of being human. Finally, Kelly closes his argument by giving his readers something similar to the five stages of grief, but it is seven stages long and focus on accepting robots replacing humans in the workplace. While I do support Kelly's claims I do not do so whole heartedly. Kelly fails to i nclude the fact that people from every day citizens to the president of the United States are already arguing that jobs are being shipped across seas and taken over by robots. With that being said, I do not believe it will be easy to further integrate artificial intelligence into the workplace on a large scale swiftly. I truly believe that survival is something that comes natura l l y to humans, so its unlike ly that robots have the potential to wipe humans off the face of the planet, however I do question the human ability to maintain a high level of creativity and innovation. Kelly is very optimistic about this cycle of creation; however, it is hard to determine how long originality will last. An example is found in modern music. Major artists, such as Kanye West, are guilty of sampling music created in previous generations to create new music. While some may argue that looking to the past for inspiration can

Angular Acceleration in a Rotational Motion Lab Report

Angular Acceleration in a Rotational Motion Summary sheet Objective The experiment aims at determining terminal angular velo and angular acceleration in a rotational motion. It also aims at determining involved moment of inertia in the experiment and compares the experimental value with the theoretically computed value. Method The experiment used a wheel, a rope, and a suspended mass. The wheel was fixed at a height and the mass suspended on the rope that was attached to the freely rotational wheel. The radius of the wheel was measured and recorded. The height between the affixed mass and the floor, representing the distance to be travelled by the mass, was then measured and recorded. The mass, 20 grams, was then released to fall over the height. Time taken by the mass over the distance was measured and the experiment repeated three times. The experiment was repeated for different masses, 50 g, 70 g, and 100 g, and the time taken for each mass to travel over the distance noted. Results The research results and subsequently derived values are shown bellow. mass 20 g 50 g 70 g 100 g distance 0.9 m 0.9 m 0.9 m 0.9 m time tken by the falling mass first trial 4.135 2.79 2.03 1.89 second trial 4.25 2.58 2.37 1.8 third trial 4.085 2.62 2.1 1.99 average time 4.15 2.66 2.16 1.89 average velocity 0.216 0.34 0.417 0.479 final velocity 0.436 0.68 0.8358 0.956 acceleration 0.105 0.255 0.3857 0.507 angular acceleration 1.039 2.522 3.815 4.99 tension in the tape 0.149 0.478 0.659 0.931 torque acting on the wheel axle 0.02 0.0483 0.0667 0.0941 total mass of the wheel (M) 3.799kg circumference of the wheel 0.655 m radius of the wheel 0.1011m frictional torque from the graph 0 calculated inertia 0.0194 measured inertia 0.191 moment of inertia, percentage difference 1.53 % Applications One of the practical applications of rotational motion and its associated inertia is the balancing of weight on bicycles. While a bicycle is stationary, it is very difficult to balance its weight and other weights that may be placed on it. The rotational force of the wheels that results in the vessels motion however induces inertial that makes balancing easier and prevents the bicycle from falling. The concept of rotational inertia is also applicable in explaining relatively larger forces in operating objects with circular shapes. An example is an umbrella whose opening and closing requires larger forces that even the mass of the objects. The extra force is determined by the distribution of particles in the umbrella and not mass only. Consequently, an umbrella has a larger inertia, relative to its mass, because of rotational properties that are characteristics of its particles’ distribution (Goswami, p. 105). Calculations Average and final velocities are computed from the formula, Velocity = distance/ time. For the 20 g mass, Average velocity= 0.9/4.15 = 0.216 m/s (trancated) The other velocities are similarly calculated from corresponding distances and times. Acceleration =change in velocity/ time. Therefore acceleration for the 20 g mass= 0.436/4.15 =0.0105. The other accelerations are similarly calculated. Percentage error = {(calculated inertia- measured inertia)/calculated inertia}*100 ={(0.0.0194-0.0191)/0.0194}*100 =(0.0003/0.0194)*100 =1.54 % Works cited Goswami, Amit. The physicists’ view of nature. New York, NY: Springer

MATH PROJECT Term Paper Example | Topics and Well Written Essays - 1000 words

MATH PROJECT - Term Paper Example In this work the cross-section of a gutter has been optimized to contain maximum water with a fixed amount (length) of the material of construction. A gutter is to be made of plastic to catch water at the edge of a roof. Naturally the manufactures would like to have a design of a gutter that hold maximum of water with a given amount of material required to fabricate the gutter. Now the problem is what should be the shape of the cross section of the gutter. This appears to be a problem of maxima and minima. Looking at the suggested cross – sections the problem reduces to minimizing the periphery of the gutter cross section for a given area of the cross-section, this is because, while the periphery is made of the construction material (here plastic) the cross-section hold the water. Let us assume that the length of material (here plastic) is ‘l’ and this is folded to make different cross – sections for the gutter with area ‘A’. Now for a given area ‘A’, the length of the material ‘L’ should be minimized or for a given length of the material ‘L’, the cross-sectional area ‘A’ should be maximum. In this analysis, four shapes will be considered – Triangular cross - section, Rectangular Cross –section, Semicircular cross – section and circular cross –

Report Essay Example | Topics and Well Written Essays - 500 words - 13

Report - Essay Example The author, Klitzman, gives detailed information on the procedure that would help prevent passing on of the gene mutations (1). The author uses a critical language and calls for attention to the ethical and social issues surrounding the PGD. Additionally, the topic of the article is in the form of a question. It asks whether genetic testing of humans is playing God. This shows that Klitzman calls for attention to genetic testing of humans. The article is comprehensive and articulates numerous instances of the severity of Huntington disease and that of the pre-implantation genetic diagnosis procedure. The author articulates that Woody Guthrie succumbed to Huntington disease. He also notes that some people opt not to be tested because they fear getting a genetic test is similar to acquiring a death sentence. Additionally, the author also articulates how a woman he interviewed was afraid to know whether she had the Huntington disease. Though the woman wanted to safeguard her children against the disease, she was worried too that she would be playing with God. These examples have been used to emphasize on the criticality of the matter in discussion. Klitzman, Robert. "Opinion: Is genetic testing humans playing God? .com." CNN. CNN, 22  Feb.  2014. Web. 24  Feb.  2014. . This article details how the popularity of CNN, one of the biggest News Channel in the world, has gone down considerably because of reporting errors. According to the author, Carr, the biggest blow to CNN was the error report they gave on the defeat of President Obama’s health care law. However, many people still impulsively look to CNN when big news breaks. The broadcasting station also dealt a blow on its reputation after CNN’s correspondent King reported that a suspect had been arrested, which later turned out to be false (Carr 1). The article also

A mom before the Prom Essay Example for Free

A mom before the Prom Essay Teen pregnancy has been gravelly increased in the last few years. Bad media influences (Many programs at TV programs or sexual content movies as well as other mediums) can be the factors that teen girls nowadays are getting a wrong advice that teen motherhood can a common way to live. Partners and friends’s bad influence is making them think that is right to have sex at a young age and will make them feel more popular. In that regards, this essay by Cristina page is restating the issue that more forms of bad media and wrong people’s influences are available today than ever before and consequently teens girls are much more exposed to a lot of information and these sometimes switch teen girl’s mind to do something wrong when they think is totally normal and it also has made teen girls to believe that having children at a young age might be beneficial because they think giving a child for adoption might improve their fortune giving them away for millions of dollars , so it can’t ruin her adolescence too but in reality it can really affect them. Personally I can share the view of the author in this essay: Teen pregnancy is in reality one of the most difficult experiences a teen girl might ever face when that can interrupt her education or other plans such as getting a better career or maintain fathers with them, but most of the time it doesn’t work and that’s when the situation gets worse. Children usually grow without a father figure when their parents have them at a very young age or sometimes they don’t even live with both parents because they can’t take care of them or support them economically. So when this children start to live without a parental guide , they grow adopting a bad behavior and getting the wrong advices from other bad people and turned into criminals , stealers, or other people of bad reputation because they live in a poor ambient without having a parent who can guide and help them to raise their levels of education. Most of the time, when teen moms decide to have a baby, teen girls don’t really take care of their babies when they are still formatting inside their body as old mothers and because of their immaturity, sometimes they don’t realize the huge damage they cause to their babies if they start smoking and drinking or working so hard because now they need to support themselves economically carrying heavy stuff when they have to rest the most during their pregnancy. Children are tending to born prematurely, with a disease, a mental retardation or even born death. Usually we think that there’s not any difference of acquiring the same standards of education or a good life when a kid’s parents are so young and the other’s parent are more mature. The children of teen parents can suffer more of abuse at home and at school or disregard from their parents and grow more with farness or adopt a bad behavior, so that implies that they could not do so well at school, they could get lower grades and repeat their classes or drop out from High School without completing their education. This might increase the raise of poverty in families with young parents too and this leads society into decreasing its economy too. I really enjoyed reading this essay because it deals with a controversial issue and restates the causes of why teen pregnancy is becoming a worldwide problem, it must be thought in class so we can share our own viewpoints about it. 10-) – I encourage people to consider more this issue because if we want a better life for our

ECON 4131, International Finance, Spring 2002, Exam 3 Final Essay examp

Final Exam Questions -- Economics 4131, Spring 2006 1. Explain how the gold standard operated in the classical period (1870-1914). What were the advantages and disadvantages? Some say the gold standard sacrificed internal balance to external balance. How? What were the â€Å"rules of the game† and what would happen when they were violated? What would happen when the demand for monetary gold rose faster than the supply, and why was this a problem? 2. Explain the functioning of the Bretton Woods currency arrangement. Why was it designed as it was? What strains appeared over time, and what factors led to its collapse? What was â€Å"Triffin’s dilemma†? 3. Use the national income accounting identity to explain the phenomenon of â€Å"twin deficits.† Explain how the surge in the U.S. fiscal deficit has spilled into a need for international finance. What are the current sources of this finance? Describe the dilemma facing the Asian central banks. Describe the â€Å"hard landing† scenario. What needs to be done to ensure a â€Å"soft landing†? 4. Explain step-by-step why and how a central bank might w...

Disorder/Illness of hand

The hand of a man is one of most active organs of the body. It consists of various parts such as bones, muscles, fingers, thumbs, nerves and skin all of which can be affected by different forms of ailments. Common disorders in the hands include injuries, ganglia, and infections, ailments of the nerves, blood vessels, skin, osteoarthritis and tendonitis. Injuries can result to fractures on part of the bone, rupturing of ligaments and even dislocations (David, 2004). The largest part of the hand is composed of fingers.Disorders in this part of the hand may occur on the joints as a result of strained activity or due an infection of arthritis. The curling of the fingertip which leads to failure of the fingertip to straighten is known as the mallet finger. In most cases, this disorder results from an injury which leads to tearing of the tendon from the bone. This condition is treated by placing the affected finger in a straight position and maintaining it for some time to let the conditio n heal. Button-hole deformity is a disorder which affects the joint of the middle finger.The finger bends in a fixed position in the direction of the palm. In addition the outermost finger tends to portray an excessive bending in the direction away from the palm. This disorder is caused by the rheumatoid arthritis infection. The swelling on the finger joints forming cysts is known as osteoarthritis of the hand causes painful swellings on affected the part of the hand (David, 2004). Ganglion is another disorder which presents itself in form of gelatinous swellings which appear on the back of the palm or wrist.They develop into firm shaped swellings which protrude above the surface of the skin. Even though they are painless, ganglia causes a lot of discomfort on the patient which limits efficient use of hands. Infection disorders may be related to bacterial and viral infections. Common bacterial infections on the hand cause abscess or swellings. These may occur on parts with injured c ells such as wounds and bites. Application of antibiotic prevents the possibilities of getting these kinds of infections. Infections of the soft pulp tissue of the fingertip are known as felon.This causes swelling leading to death of surrounding tissues. The common viral infection on hand results in Herpetic Whitlow which is caused by the infection of herpes which spreads to hands forming fluid-filled blisters on the skin of the fingers. This disorder however disappears with treatment of herpes infection. Osteoarthritis presents itself through the extension of the bones over the outermost joints. This leads to formation of painful swelling on the finger joints. Joints between the fingers are not affected by the condition.The affected joints may be misaligned forming a crooked hand. Erosive osteoarthritis forms a swelling around the affected tissues. Sometimes the bands of the fibrous tissue (tendons) along the palms may tighten forming a claw like hand. This is known as palmar fibro matosis. It is treated trough injection of corticosteroid into the tendons. Severe cases may require a corrective surgery. This condition has been found to have hereditary characteristics and in most cases it affects men over the age of 45 years (Taylor, 2008).Numbness on hand is caused by the cutting of supply of blood or compression of the nerves at the wrist due to the bending of the wrist. This mostly happens when one is sleeping. Numbness as a result of compression of the nerves is referred to as Carpal Turner Syndrome (David, 2004). One is advised to keep the hand straight to prevent the development of this condition. Concisely, most of the ailments of the hands lead to a restriction on the use of the affected hands. Seeking of proper medical attention is necessary to rectify any condition in time.

As Ict

Edexcel GCE Applied Information and Communication Technology Unit 3: The Knowledge Worker January 2013 Scenario Paper Reference 6953/01 The scenario should be distributed to candidates at least three working weeks before the examination. Practice files: whitecaps_practice. xls, fixtures_practice. txt, haway_practice. txt This scenario should be used for the purposes of preparing candidates for the examination. This copy must not be taken into the examination. The information contained in the scenario will be included in the examination paper.Further details are in the Instructions of the Conduct of Examinations (ICE), available from the Edexcel website for this qualification. Edexcel will not accept any request for special consideration should candidates be given the incorrect scenario for the examination they are sitting. Turn over W41049A Â ©2013 Pearson Education Ltd. 6/ *W41049A* Scenario Havering Whitecaps Maddy Wright and Katy Parrish have supported Havering Whitecaps since th eir boyfriends played for the team. Their boyfriends’ careers and the teenage romances are now very much in the past but their support of the team remains as strong as ever.Until 15 years ago the Whitecaps were a struggling non-league team with little support. There were times, on wet and cold November afternoons, when Maddy and Katy were the only supporters. In 1999 a magical thing happened to the Whitecaps. At that time the team’s position, both in football terms and financially, was perilous to say the least. However, a financial backer appeared in the form of Harold Adenyi. Harold had studied at the local college and even played a few games for the Whitecaps. His progress as a footballer was hampered by a lack of ability.He gave up on a career as a footballer to concentrate on what he was good at, which was IT and mathematics. He made a large amount of money by creating an online accountancy website called lesstax. com. Harold was looking for things he could offset against a huge tax bill and a loss-making football club seemed to be a good start. He bought the Whitecaps from the previous owners for ? 1 and immediately started to spend money on it. Harold’s flair for business meant that the loss-making football club did not stay loss-making for long.Harold signed a talented former football league manager and with his advice, spent money on players who all turned out to be good investments. The way the manager had the team playing soon started to increase its fan base, so Harold built a new stadium. The team continued to be successful and the new stadium was soon filled at every match, putting the club on a healthy financial footing. Financial success and playing success went hand-in-hand and, in 2001, Havering Whitecaps was elected to the Football League. After a few seasons, when the Whitecaps struggled to establish themselves, there followed a eriod of gradual success including promotion to the 1st Division and two years later the Cha mpionship. Last season the Whitecaps won the Championship and are currently looking forward to their first season in the Premier League. Throughout this period of development, Maddy and Katy have been screaming encouraging words to their team (and the occasional discouraging one to the opposition) and they have hardly missed a match. It was inevitable that as the Whitecaps’ two most dedicated supporters they would become the chairman and secretary of the supporters’ club.One of their main tasks is to organise away trips for fans. This involves buying the tickets, booking the coaches and deciding what to charge for the ticket and transport packages. With 14,678 registered supporters, organising the away trips is not an easy task. With the possibility of over 400 coaches travelling to an away match, the number of transport firms the pair could use was limited. Since the Whitecaps were promoted to the Championship Maddy and Katy have used ‘Rubicon Transport’ whose rates are reasonable and who can supply enough coaches on a match day. 2 W41049ARubicon charge a fixed sum of ? 350 per coach, plus a ? 1. 50 fuel surcharge for every 100 miles travelled. In addition, Rubicon’s regulations state that a driver cannot be in charge of the coach for more than 9 hours a day. Should the whole trip last more than 9 hours (including the match time) a second driver would be required. There is a charge of ? 75 for the second driver. Premier League ticket prices vary greatly and Maddy has been quoted a range of prices varying between ? 30 and ? 54 by the Premier League clubs. Maddy and Katy do not need to make an overall profit.Their main aim is to get as many fans as possible to away matches. Although they can afford to make a loss on individual trips, they cannot afford to make a loss overall. Therefore an accurate prediction of the number of people who will want to go to a particular match is vital. They are also aware that more people will wan t to go to some matches than others. To help find out how many people are likely to go to each match they ran an online survey. This was completed by 94% of their registered supporters. To make data analysis easier, Katy has classified the teams as shown in the table.EG Teams fighting for European glory MT Mid-table teams RD Teams likely to be involved in the relegation dogfight PR Newly promoted teams In addition to the classification of the team, she found that other things affect the number of people likely to go to away matches. Fewer people would go if the match was played on a weekday rather than a Saturday (or Sunday). The longer the travelling time, the fewer supporters were prepared to travel. Finally, the overall cost of the package would discourage some from attending certain matches. W41049A 3 Turn over Description of the modelMaddy and Katy have to be as accurate as they can when setting the prices as they don’t need to make a profit but cannot afford to make a l oss. Maddy and Katy need a model to help them decide on prices. Therefore, Maddy has persuaded her brother Kieran, who works in IT, to create a model. Kieran wanted to make the model reusable so that he could sell it to other supporters’ clubs. Unfortunately, before he could finish the model, the company Kieran worked for sent him to Dubai on a three-year contract. Maddy has asked you to complete the model and use it to suggest prices for the next season’s away matches.Kieran has left you these notes. Worksheet Description Teams This is the worksheet that will be used to set the package prices. I have listed the teams in the Premier League along with Katy’s classifications. For ease of viewing I have included information from other worksheets and have calculated the total costs, revenue and profit. There is a profit for each trip and a total profit for the season. The worksheet will also calculate the total number of supporters going to away matches. Cell B2 con tains a drop-down box to choose the team you support. FixturesThis worksheet is a calculated page which lists the dates of the home and away fixtures. Lookups This worksheet contains a number of lookup tables. There are two blank areas, these will contain the fixture information provided by the Premier League. There are other tables to look up the day of the week, the likely support based on the teams’ classification, the number of registered supporters and the ticket costs for the various clubs. Distances, Times These worksheets contain the distances between the grounds and the average times it would take a coach to travel those journeys.I got these from a very helpful man at the RAC. Customer This worksheet is incomplete. Once completed it will predict the number of supporters who would travel to each away match. This is based on the number of registered supporters and then adjusted according to the home team classification, then package price and finally the travel time. I haven’t finished the analysis of the survey yet so I cannot put in formulae to take into account the travelling time and the overall cost. A friend of mine is doing the analysis for me and he will forward the results to you as soon as he has them. TransportIn this worksheet I calculate how many coaches are needed, the cost per coach and the overall transport cost for the trip. Transport Rates In this worksheet I have entered the transport rates as quoted by Rubicon Transport. I hope you find it easy to understand my notes. Good luck completing it. Kieran Wright 4 W41049A Some cells in the model are password protected. Should you wish to experiment with the model, the password is edexcel. Be aware that if you change the contents of any protected cell the model may not work. Please note that the Football League and Premier League referred to in this scenario are fictitious. W41049A 5

How to Perform Better at the Examination

How to Perform Better at the Examination Does Persistent Studying Improve Your Performance? Would you believe me if I told you that taking a 360-degree shift in your study routine during one of the semesters could transform and change your grades for the better? As the adage goes, ‘practice makes perfect. Every endeavor, be it sports, singing competition or a spelling bee, practice is essential to guarantee good results. University education is no exception, and persistent studying is vital for delighting grades. Is this article relevant and helpful to you? Did its title spark questions in you like what type of a student and reader I am? Am I conducting my studies the right way and so forth? Did it attract, make you curious to find out what its contents were perhaps because you thought the information would be of help to you? If not, were you on the internet and came across it? The purpose of these questions is to demonstrate that reading at the university is dissimilar to other forms of text. For example, reading a thriller novel by your favorite author is utterly different from university reading. Even though many students are aware of this fact, a majority do not practice constant studying and only get engaged when the examination is nearly approaching. Persistent reading has a considerable impact on your performance as it tends to improve it. A students ability to read and understand a great deal of content has two main benefits. Foremost, at the institutions of higher learning, students are required to read plenty of materials for different subjects and expected to attain a particular grade in an examination. Being able to read and understand within a short period will come in handy. The other benefit is that great reading skills will help you sail through the not so exciting topics you need to learn regardless. As opposed to reading an amusing article from a fashion magazine or a novel that you have picked for yourself, some university materials can be not as engaging. The objective of this article is to provide you with some studying and revision techniques that will guide you as you prepare for the exam but have little time on your side to go through all the notes. What is persistent reading? According to the Cambridge English Dictionary, an inert person is who has little or no impact on something and lack the desire to do so. Similarly, a passive reader does not bother to examine, scrutinize or appraise any content. On the contrary, an active reader takes the whole process to another level as they put in more effort. They not only read through the pages, but they are eager to know why the author is inclined to their views or statements, they are inquisitive. Reading to them is like a deliberation, the reader seeks facts, critiques and evaluates the information before processing it. Three phases characterize the study activity; before the study, during the research and post-study and the three stages play a different role in the study process. Active and passive readers will employ different tactics through the three stages of studying. Before the study, an enthusiastic reader kicks off the process by identifying the topic under review, think about it and highlight the things they need to know at the end of the study. For the duration of the study, the lively reader will divide the topic into small sections/subheadings that will organize the process as each subsection is assigned a specific time. Additionally, the learner poses queries which they anticipate the material to respond to as the contents unfold. Ultimately after completing the study, an active reader will make short notes that recap what they have learned. The remaining question that lingers is, how do I become an active reader? Or if you are already one, how do you perfect this art? Well, the answer is simple, practice, dedication and more practice. Below are some tacks that will guide you as you endeavor to polish your reading habits. Popular active studying methods Flick through the material Perusing through the material is the practice of highlighting and memorizing the important parts of the content exclusive of an in-depth revision. Flicking through is convenient for you especially when you are facing time constraints although, for an active reader, this is merely the beginning of the study process. During the period leading to the examination, browsing through the chapters will shed some light on what the topics are about giving you a rough idea of what to expect. Lively learners do not regard perusing as a study technique as it comes before the reading process (outlined earlier). Perusing is only intended to feed their curiosity of what to anticipate. Analytical studying Parallel to active studying where the students pose many queries that the material needs to clear up as it unfolds, analytical studying is comparable to this. Analytical studying involves the reader trying to get into the mind of the author, understand what they were thinking and feeling at the time and figure out the relevance of their message in regards to the context. Afterward, the students offer a critique of the material. Analytical reading and critiquing the material read does not imply that you have to be disapproving and pessimistic, but you give your honest opinion. However, in many cases, analytical studying involves being disapproving. Examining Examining is the process of paying close attention to something. Dissimilar to flicking through the material, scrutinizing takes more time as it seeks to find a specific answer to a particular question. Suppose you are doing your math take away assignment and cannot quite remember how to solve the problem, carefully examining how you went about it in class will help you solve the problem. Examining is particularly vital for the ‘after study phase. The SQ3R System The SQ3R is one of the most successful studying systems that a majority of students apply. This system advises students to survey (S), question (Q), read, recall, and review (3R). SQ3R is a sophisticated study technique perfect for students in higher learning institutions. The method will assist you as read either journals, textbooks, discussion papers and so forth. Unlike the other study methods discussed earlier, the SQ3R will give you a better understanding of the materials you are reading. This understanding, however, does not come easy, the SQ3R is time-consuming. The SQ3R reading technique will improve your study speed while reading classroom-related materials, but longer compared to reading articles that are of interest to you, say an article on Forbes Magazine on the 10 Richest Entrepreneurs in the World. The use of SQ3R results in better performance making the efforts exerted profitably rewarding. Consequently, what is SQ3R all about? Survey The survey involves perusing through the materials and identifying the important aspects such as the title, the outline, table of contents and if there are any demonstrations like charts, tables, graphs and pictures in the chapter. Essentially, by surveying, you are observing the chapter to determine the theme(s) that run through to get a feeling of what to expect when you begin reading. You will also want to be on the lookout for jargons (words you are seeing for the first time and do not know how to pronounce or spell them). Surveying gives you ample time to research the words on the internet or by using a dictionary. Ideally, the survey should take as little time as you possibly can depending on the length of the chapter. At this juncture, critical reading and evaluation are of no importance since you only need to get a hold of the principal theme. Question At this point, you need to ask yourself these four main questions and attempt to answer them. What is the fundamental idea? Is there any proof to uphold the idea? What are they? Are there illustrations used as proof? How does this idea associate to the journal (or any other material you are reading) and to me as a person? The best way to go about this is to read every first heading, subheading, sentence of each passage and convert it into a question. The questions will to some extent convey the idea(s) the author is trying to put across. Forming the questions is not the only task at this stage. You are also required to answer them or at least make an effort. By simply forming the questions you will not have satisfied the conditions necessary for this step, and your efforts will have been in vain. Read This word means exactly how it spells, read. Take your time and study. Studying can be tiresome as it is a weak competitor for most students, but still, you need to study. To break the monotony, take a short break ranging from 10-15 minutes between your studying. You can choose to use the Pomodoro system of productivity and assign each topic a specific time incorporating short breaks in between. This method will help you remain focused on accomplishing the mission at hand. The best way to ensure that you truly understand what you are reading is by writing short notes, highlighting or writing on the margin. The short notes should be the main points, facts or formula you come across while studying. The benefit of writing short notes or highlighting is it not only improves your level of comprehension, but it also guarantees that you capture the man ideas expressed. In case you are using the marker, ensure you do not go on a making spray as the aim is not to be the best ‘highlighter but fathom the material. Recall This step is the defining factor that concludes whether you have grasped and understood what you have been reading. Different people term it differently, but the meaning remains uncorrupted. The suggested procedure is first to put your books aside and try to recall what you have learned and recognized vociferous (you can record for future usage). Finally, look at the questions you had set up and establish whether you answered them or not and if not, repeat the process and reread the materials and see if you will capture something new. If you have fully understood, reciting the content will be a walk in the park, but if not, you will find it a challenge and, in this case, it advisable that you go through the chapter and re-read. Each student has unique cognitive capabilities. Some students can recite a whole chapter while others might find it difficult and prefer to recite after every subsection. Recollecting a whole chapter from memory can prove to be an intricate test after all are we not humans? It is entirely up to you to figure out where you lie and pick the option more suitable for you. Review Reviewing is the last step in the SQ3R reading system. Reviewing is perhaps the most important step that as a student you should adhere to carefully. Owing to the human nature, we tend to forget things over time and as such, you should constantly review what you read, recite it over and over again and in case you have forgotten, please consult your book. A few days to the test, you should reread your materials more frequently (maybe in the morning and at night before going to bed), but if the exam is a few weeks away, weekly reviews should be enough. To put it briefly†¦ At the beginning of this article, we introduced you to the concept of lively and inert readers. My advice, strive to be as enthusiastic as you can during your class readings as it matters a lot. For your other leisure readings, you can be inert or decide to take the active reading all the way. Subsequently, we introduced you to the different methods of persistent studying (try and recall them). The SQ3R stood out form the rest due to its unique features; besides being time consuming and effort dependent, it yields satisfying results. Investigate which one works best for you and run with it towards your goal of becoming a competent reader. Persistent studying is vital for any student especially for article writing and responding to argumentative questions. Active studying not only improves the students comprehension ability, but it also makes them good at articulating issues by asking questions before processing any information. ‘Change is the only constant thing in life, most people say. Change takes time, and you should not pressure yourself beyond your ability while adopting the new study techniques. Take each day at a time in perfecting your art of reading, and with time, you will get there.

Summary of God's relationship with Hebrew people Essay

Summary of God's relationship with Hebrew people - Essay Example food and companions to the first couple; God’s punishing of the first couple and serpent; Cain and Abel’s offerings to God; God’s interaction with Noah; God’s second punishment -- the Great Flood; God’s promise to Abraham; and God’s encounter with Jonah and Job. Collectively, God’s relationship with the Hebrews was established through the Hebrew understanding and living of the themes carried out by these Biblical events. Moreover, the relationship was also strongly made out of the fact that Hebrews, just like the other races, came from the same descendants -- the first couple. Specifically, the Hebrew was said to be a race coming from Shem -- one of Noah’s children. The extent to which God’s relationship to the Hebrews domineered any other relationship. This was significantly reflected on the Hebrew’s dedication. This dedication came to fruition through the writing of the Bible. Consequently, the Hebrew people were able to pass God’s will through an emphasis on themes to the next generation of worshippers. Because of this emphasis on themes, time-lines were ignored and contradicting facts ensue (Dj Love, Chapter 15, Study

Principal institutions of European Union Essay Example | Topics and Well Written Essays - 1500 words

Principal institutions of European Union - Essay Example Britain joined the European Economic Community in 1973 and since then, European law has become a significant part of the laws of the UK (Adams, 2013). The Maastricht Treaty which came to force in 1993 officially changed the name of the EEC to the European Union and integrated the three main wings of the European communal cooperations into the European Union. The European Communities Act of 1972 integrated European Union Law into UK Law (Adams, 2013). This implies that the UK is a signatory to the European Union and it has to adhere to rules, regulations and directives. The various institutions of the European Union therefore engage in laws that are directly or indirectly applicable to the UK. The main institutions of the EU are hereby discussed below alongside their impact on the making of European Union laws. The European Council of Ministers is the main legislative arm of the European Union (Gerven, 2010). The Council of Ministers was set up by the Treaty of Nice that all the member states of the European Union signed. Article 203 of the Treaty of Nice states that "a representative of each member state at ministerial level authorised to commit the government of the Member State". This means that the Council of Ministers, popularly known as Council of Europe is constituted of a minister of state who is recognised under international law. Such ministers come together to make laws and rules for the Union. The Council of Ministers varies according to the matter or subject under discussion. Thus, if the matter in question is about Agriculture, the Agricultural Ministers of each member state would have to be present at the council meeting and when they make laws, it is authorised and approved by the states through their ministers (Richardson, 2012). The primary function of the Council of Ministers is to coordinate and make policies that are binding on the institutions and

Library Research Assignment Example | Topics and Well Written Essays - 1500 words

Library Research - Assignment Example For our company performance play a vital role in determining pay, promotions, transfers, terminations and other such decisions that impact well-being as well as the overall company performance. Thus access to objective performance evaluation systems is key to the overall benefit of the company, employees and the society. An objective performance management system will help improve the relationship between the managers and their subordinates as well as boost motivation (Jackson et al.2011). As a newly designated manager for the HR department, we would ensure that performance management is properly designed, documented and implemented (Pope, ). It should be clearly understood that proper execution of the program cannot be done without cooperation of line managers and unless the top management shows commitment to it. Activities such as ensuring performance management is embraced on a daily-basis, timely completion of performance reviews, providing valuable feedback throughout the process and making developmental opportunities available to high performers are all responsibilities of line managers. Thus it is the proper execution of the performance management program by management and line-managers that can make or break it. The role of HR for this proper execution would be to: According to the evaluation of past organizational practices, some departments have informally attempted to introduce performance-based pay systems in the form of appraisals. This process needs to be properly documented and managed by the HR department in coordination with other department managers. It has been proven in a study conducted by Subramanov, Krause, Nortom and Burns in 2008 that creating a model for competitive pay can be used as incentive to enhance a company’s performance via enhanced employee performance (Chow et. Al, 2012). Some aspects that the new appraisal system should incorporate are: The role of performance of company executive and their management teams

Segmentation Essay Example | Topics and Well Written Essays - 250 words

Segmentation - Essay Example The alternate subgroup requires packaging services for their shipping items. The items are usually large or fragile, and they require expert packaging services to clear them from any liability. Shipping customers are mostly those buying or selling items through the internet. Those who require packaging, additionally, most likely are too busy to spare some time and would rather pay for the packaging service. The Mail Box customer segment involves those customers who require Private Mail Boxes. This need for Private Mail Boxes can be brought about by different reasons. They include legality issues, convenience of location, hours of operation, amongst others. Mail Box Customers also prioritize convenience over most other things. Mail Box shipping station services use real street addresses and deliver and pick up mails right at the customer’s doorstep as opposed to the Post Office. Additionally, those who move around a lot are offered a permanent mail address at the shipping stations to avoid the loss of their mails. This customer segment involves customers who require a fax transmittal service, for receiving or sending a fax but do not own or are unable to access a fax machine to meet their service requirement. This segment maintains a stable demand for fax transmittal services even with the advent and development of the email

The Effects of Tax Avoidance

The Effects of Tax Avoidance Summary Tax avoidance has been a major menace in many governments worldwide. Therefore, this article will focus on tax avoidance by multinationals and the tax loopholes that motivate this unfair practice among nations. Companies such as Starbucks, HSBC, Google, Barclays bank and Amazon have been accused on more than one occasion of corporate tax avoidance. How do they go about this and get away with it? Do governments favor big corporations at the expense of domestic small and mid-level companies? At the end of this article, it will be clear and evident that indeed tax avoidance is morally wrong unless monitored under stringent government rules and regulations. In essence, this article focuses on the extent to which tax avoidance limits government expenditure (thus government spending) and the extent to which this problem affects the economy and society as a whole. The Moral violation of Tax Avoidance in a nutshell In these hard economic times of recessions and escalating unemployment in Europe and America, governments are implementing budget cuts in an effort to cope with national debts and the aftereffects of this global economic pandemic as a whole. Inflation reports have become the business norm of major mainstream media houses like CNN and BBC. It has become almost impossible to hear of a rise in employment levels or deflation in prices. What this means in essence is that as governments implement budget cuts, they also result to internal borrowing measures such as increasing taxes on goods and services in their respective local markets. At the end of the day, the ordinary hard-working citizen is left to grapple with how to balance an increasingly insufficient paycheck with ever-increasing prices of goods and services. It is because of this reason that tax avoidance shifts the tax burden from the evasive and tricky corporation to the honest middle and low income earning citizen. This is clearly a sign of tax bias practiced in broad daylight. The sad bit about this is that many governments don’t have stringent measures to punish such big ‘untouchables’. Is it that someone within is pulling the strings to ensure that justice isn’t upheld? Are these mysterious government entities ‘sufficiently compensated’ by tax avoiding multi-national corporations for a ‘job well done’? Because the interesting bit about tax avoidance is that it doesn’t amount to tax evasion. For instance, in 2011, the Google firm in the UK had amassed a whooping 395 million pound turnover. But as it turns out, the United Kingdom treasury only received 6 million pounds; an astoundingly tiny fraction of the profits. Similarly, Amazon had sales of 3.35 billion in the same year but contributed a mere 1.8 million pounds to the British Treasury . As absurd as these two randomly picked incidences sound, what these companies did was legal. Essentially, no laws were broken despite the moral absurdity of such obvious, draconian and potentially ‘tax evasive’ actions. Why aren’t there any laws to address such malice? Does it mean that someone is not doing his job and is being paid by these multinationals to keep quiet? Because at the end of the day, money is power thus more money translates to more power; to control, to manipulate, and eventually, to destroy economies and thus the society as a whole. The problem with tax avoiding firms is that their global market presence translates to humongous profits. This of course means too much money and thus too much power. And unfortunately, their power exceeds that of many government officials who are more than willing to do their devious bidding for that ‘extra pound’. Just taxation practice is based on the tenets of fairness and equality across the board not just within the circle of multinationals, but also within economies as a whole. The entire population has got to be convinced that the burden of tax is evenly spread across varying income levels and corporate profits. Tax avoidance by ‘the elite’ however brings about unnecessary tension due to economy class favoritism that’s making someone bear more unjust burden than he ought to. When the citizenry sees such tax injustices, then it’s bound to demand for the law to curb such dubiously lawful menaces. Facts supporting the moral absurdity of tax avoidance and how some countries are curbing the menace Tax avoidance potentially amounts to financial impunity. Incorporated tax laws with gaping holes and obvious loose ends are the biggest aids of tax avoiding multinationals (Samuel, 2005). In essence, firms are subject to business taxes whereas individual income earners are subject to personal taxes. For firms to practice tax avoidance in business taxes, they usually relocate their branches to offshore tax havens thus registering as alien business entities offshore. This makes firms avoid generating income onshore more and more with every alien business subsidiary that they register offshore. Thus, American based Google and Amazon avoid paying taxes in the UK by being classified and registered as non-resident business entities. This entitles them to avoid being taxed not only as resident businesses, but also as resident alien businesses. This is despite the fact that they enjoy all government rights and services similar to resident businesses in the host offshore havens. This in turn makes them pay less taxes to the American tax collector, also known as the IRS. FTSE 100 firms and Banks based in the UK are also key culprits in this menace, with 38% of their subsidiaries located in tax havens. High street banks such as The HSBC, Barclays bank, Lloyds and IBS have a combined total of 1,649 companies (Action Aid). A unanimous FTSE company is claimed to have transferred pricing payments so as to enable a whopping 100 million pound shift from subsidiaries based in developing country into tax havens where a ridiculously lower tax rate is incurred. A lack of stringent regulations on transfer pricing leaves loopholes for tax avoidance as taxable profits move to tax havens without breaking any law. Luxemburg, Liechtenstein principality, Delaware State, Nauru and Cayman islands are in fact the leading offshore tax havens that are menacingly unregulated and house profits that extend to dealings in drugs and arms trade. While in host offshore havens, these multinationals are usually private and secretive in regards to their finances thus raising eyebrows in regards to the integrity of their financial reports. The ignorance, inability and inexperience of developing countries such as China, India and Brazil to deal with the tax avoidance menace further aggravates the situation (Phyllis, 2003). This also brings in the problem of the inability to measure precisely how much worth of tax avoidance has been practiced in these countries. Multinationals are actually taking advantage of this by rapidly expanding their offshore investments to the detriment of offshore haven governments which don’t benefit from such investments as they ought to. For instance, the budget deficit for the Chinese government amounted to 3% of its GDP. Also in Mexico, it’s estimated that a whooping 40% of its entire citizenry might be untaxed (Gori, 2001). This goes to show how the citizenry in itself can be its own worst enemy when it comes to combating tax avoidance within resident businesses (Das-Gupta 1995). India has also been a victim too considering the fact that tax revenue percentage of GDP dropped sharply from 9.8% in 1991 to 8.95% in 1999. Exploding liberalization in these developing countries has sparked massive inflow of foreign investments. In fact, when direct foreign investment recipients are considered by merit, Brazil, China and Mexico have been at the zenith of this list for the past ten years. European, American and Japanese multinationals have been the biggest contributors to this direct foreign investment inflow thus playing key role in the growth of these developing economies. Interestingly enough, the local businesses have not enjoyed the chunk of foreign trade since related multinational firms in these tax havens control a majority of foreign trade (Chan, 1998). They do this by exercising sophisticated profit shifting mechanisms via manipulation of prices to dodge stringent measures enforced upon foreign exchange hence significantly cutting down on uncertain socioeconomic outcomes. In essence, intermediaries and basic raw materials are over invoiced while at the same time exports are underpriced thus enabling record tax avoidances. The Chinese open-door economic reform has made it maintain its enviable position as the greatest absorber of foreign direct investment (FDI) among developing nations to date. For instance, according to the 2002 United Nations Economic report, China got 28% of all FDI flowing into developing nations in 2001. The year 2002 was particularly good for FDI enterprises in China as 409,000 foreign investment enterprises were approved with a net worth of 425 million USD. Consequently, foreign direct investments in China have been key to its economic growth. The evidence is quite clear when it’s considered that 52% of China’s imports and 50% of its exports can be attributed to foreign investment enterprises (FIEs) within the country. Yet strangely enough, a resounding majority of these foreign investment enterprises is reporting record losses despite expanding at an astronomical rate. This automatically entitles them to avoid taxes. Tax avoidance escalated sharply in 2000 with a record $1.22 billion worth of noncompliance being reported ( Ming, 2001). This sparked a sharp rise in tax related audits in 2001. Brazil on the other hand exercises some fairness in taxation by taxing local and alien enterprises similarly. In fact, tax rules and laws applied to limited liability companies and corporations alike are similar irrespective of whether the firm is resident or non-resident. This is because foreign enterprises prefer taking the forms of corporations and limited liability companies. But interesting to note is the fact that limited liability companies aren’t obliged to disclose their financial reports to the public. However, corporations possess the comparative advantage of raising capital through IPOs (Initial Public Offers) of the share capital. Brazil has however come under sharp criticism as having a sophisticated taxing mechanism that hinders its business competitiveness globally. Despite this obstacle, the country has proven to be less naà ¯ve when it comes to dealing with tax avoidance incidences by adopting the principle of ‘If you can’t beat them, then join them.’. This is because it has taken advantage of tax avoidance tendencies by FEIs by offering tax incentives for establishment in distinct underdeveloped regions. For instance, a 50% tax cut on income is offered by the Brazilian government to industrial and agricultural enterprises that establish themselves in the marginalized and less developed North East and Amazon regions. In addition, a firm that sparks development in industrial technology has the right to an incentive on technical services and a 50% tax credit discount on royalties. Expatriates who have achieved the status of Brazilian residents are also obligated to pay a progressive income tax on their worldwide paycheck up to a maximum of 27.5%. This is because taxation upon individuals is implemented on cash basis. A factor to consider is that expatriates are considered residents if they’ve domiciled in Brazil for more than a year. Brazil also tackles tax avoidance by taxing a 25% withholding tax on nonresidents living in tax havens compared to a 15% withholding tax on those who don’t. This is because nonresidents are entitled to royalties, dividends and interest. When it comes to transfer pricing, proper laws that are compatible with OECD have been enacted to ensure the proper determination of import and export prices. Conclusion The rationale behind payment of taxes is that we owe a duty to three entities; namely to the state, the community, and last but not least, to God. Therefore in as much as tax avoidance is morally unjustified and inexplicable, it is distinctively clear that governments worldwide should take the initiative to curb this menace. Better still, governments can take advantage of the situation and enact sound laws that create morally acceptable tax avoidance, such as tax incentives and tax breaks offered by the Brazilian government to develop marginalized areas and to spark innovative development. That way, an equitable tax basis is maintained and society is generally happy to share the burden of tax on the basis of a non-secretive, convincingly just and morally acceptable manner. Work Cited Jesse A. Schmitt Legal Off Shore Tax Havens: How to Take LEGAL Advantage of the IRS Code and Pay Less in Taxes Atlantic Publishing Company, 2008 Phyllis Lai Lan Mo Tax avoidance and Anti-avoidance Measures in Major Developing Economies Greenwood Publishing Group, 2003. Alain Deneault Offshore: Tax Havens and the Rule of Global Crime New Press, Jan 24, 2012 Samuel Blankson Tax Avoidance a Practical Guide for UK Residents Lulu Press Incorporated, 2005. Ronen Palan, Richard Murphy, Christian Chavagneux Tax Havens: How Globalization really Works Cornell University Press, Feb 1, 2013

Oedipus The King-a Tangled Web :: Oedipus Rex, Sophocles

The choir represents the voice of the people, the voice of the masses. People often conform to this uniform truth, they want to be like other people. This conformation leads to a uniform voice from the public. This voice is often ignorant to the truth, seemingly to the point that it creates its own truth. This is seen often in Oedipus the King, by Sophocles. They believe that Oedipus is godly, even when they have found out that he is the cause of their plague. It is not until the end that their haze of false truth clears, and they turn against Oedipus.   Ã‚  Ã‚  Ã‚  Ã‚  The idea that the people speak with a unified voice is seen whenever they speak. Never does one individual stray from this one voice. This is seen in the Strophes and Antistrophes, the choir speaks as a whole. At the start of the, the choir shows unquestioning faith in Oedipus. They believe that he is godly, that since he ended the Sphinx’s reign of terror, that he would stop the plague. They believed this without question, they had no doubts that Oedipus would find a cure. They even came to Oedipus with “olive boughs all wreathed in woe,'; the same way one would go to a altar when they wanted something urgently. This shows their faith in Oedipus.   Ã‚  Ã‚  Ã‚  Ã‚  This faith blinds them to the truth. When they find out that it could be Oedipus that is the cause of the plague, they still follow Oedipus blindly. They do not see the truth, they create their own. They become so deeply entwined in their own web of falls truths, that they do not realize what is really happening. They do not believe the Oracle, “Show me the man speaking stone from Delphi damned'; shows their disbelief in the oracle. This further reinforces their false truths, their blind faith toward Oedipus. Eventually this haze of false truths clears, and they see reality.   Ã‚  Ã‚  Ã‚  Ã‚  Even when they are confronted with the truth, they follow Oedipus. When Oedipus is pondering whether or not he could have killed King Laius, they encourage Oedipus. “But wait until you’ve heard the witness speak. Have hope,'; this shows their faith in Oedipus. “Your Laius prophecies are turned to lies'; shows their belief in the oracle. They feel he is lying, and continue their praise of Oedipus. This belief does not last forever, the web of false truths dissipates, and they see Oedipus for who he really is.

Lack Of Standards For Ehr Health And Social Care Essay

In 21st century Information Technology played an sole function in upper limit of the Fieldss ; nevertheless, health care is one noticeable exclusion. Harmonizing to surveies, U.S. infirmaries and multiple-facility wellness systems are â€Å" merely get downing to round out their clinical webs, but are much farther along than physician patterns. † ( David B. Meinert ) While many inmate or infirmary installations migrating from paper charts to electronic records, but a small advancement has been made in the ambulatory or outpatient scene. Vast bulk medical professionals including doctors have been loath to utilize electronic medical records and go on to trust on paper records. Paper medical records are informations rich by nature, but information is hapless as doctors and other wellness attention suppliers have limited clip to delve through volumes of paper to recover information, use it in decision-making and/or portion it with patients. EMR/EHR systems hold enormous promise fo r non merely bettering the measure and quality of clinical informations that can be recorded, but more significantly the ability to entree wellness attention informations to better quality of attention. This survey will seek to see the perceptual experience of medical professionals towards Electronic medical record. Study has been done as a comparative survey among two different types of scenes that is hospital which are utilizing EMR ( paperless infirmaries that is category A ) and infirmaries which are holding their ain information system where the paper-based medical records are scanned and used ( Category B infirmaries ) . Electronic Medical Record ( EMR ) Harmonizing to the Healthcare Information and Management Systems Society ( HIMSS ) , an EMR is a constituent of an electronic wellness record which is owned by the health care supplier. ( Dr. Chris Hobson ) This engineering, when to the full developed, meets provider demands for real-time informations entree and rating in medical attention. EMR besides provides the mechanism for longitudinal informations storage and entree. The content of an EMR is correspondent to the paper record, but the electronic format creates useable informations in medical result surveies, improves the efficiency of attention, and makes for more efficient communicating among suppliers and easier direction of wellness programs. ( Electronic Medical Record: The Link to a Better Future, Texas Medical Association ) Electronic Health Record ( EHR ) is an electronic version of a patient ‘s medical history, that is maintained by the supplier over clip, These have been used extensively by general practicians in many developed states and include patient designation inside informations, medicines and prescription coevals, laboratory consequences and in some instances all healthcare information recorded by the physician during each visit by the patient. ( Electronic wellness records: manual for developing states. WHO ) EHRs are the following measure in the continued advancement of health care that can beef up the relationship between patients and clinicians.A The informations, seasonableness and handiness of it, will enable suppliers to take better determinations and provide quality attention. For illustration, the EHR can better patient attention by: Reducing the incidence of medical mistake by bettering the truth and lucidity of medical records. Making the wellness information available, cut downing duplicate of trials, cut downing holds in intervention, and patients good informed to take better determinations. Reducing medical mistake by bettering the truth and lucidity of medical records.Background:Hospital information systems ( HIS ) and Electronic Medical Records ( EMRs ) are considered requirements for the efficient bringing of high quality wellness attention in infirmaries. However, a big figure of legal and practical restraints influence on the design and debut of such systems ( Dick RS, Steen EB ) Hence, many EMR execution undertakings do non take at presenting the EMR and extinguishing the paper-based opposite number in one measure ( Laerum H ) . As a start, the EMR is introduced along with its paper-based opposite number, and both are kept updated. In such environments, wellness attention workers have to cover with a intercrossed electronic and paper-based solution. This likely limits the usage of EMR ( Laerum H ) . Furthermore, mistakes are prone to develop due to cumbersome care of the medical record information in double storage media. In many states, most hospital EMR undertakings have non passed beyond this stage ( Dick RS, Steen EB )Electronic Medical Records- the altering tendency:aˆ? Paper based records are being bit by bit replaced by computing machine based records ( which is in being in the West since 2 decennaries ) aˆ? It has non achieved the same incursion in health care as in finance or other industry. Deployment varies in statesAims:To reexamine already bing information system of both class of infirmaries To happen out existent versus perceptual troubles while utilizing EMR both classs infirmaries To analyze the overall perceptual experience of infirmaries about EMR To mensurate satisfaction from EMR in class A infirmary To bring forth a checklist for bettermentMethodology:Overview: Assorted surveies which has been done globally has been surveies to happen out statement of job, since no such survey has been found in Indian context, so all premises from other states has been considered as relevant. Sing the less version of EMR usage, this survey tries to happen out existent versus perceptual advantages, disadvantages and functionality etc to acquire the clear image. Sample: entire four infirmaries have been selected under two different scenes for comparing. Each scene has two infirmaries of same sort. For easiness both scenes have been given name class A and class B. Class A infirmary are EMR user infirmary while class B infirmary are holding their ain infirmary information system in topographic point along with the paper record. For easiness footings category A and B in whole papers alternatively of EMR user and EMR nonuser infirmaries Sample size: Excluding 4 IT caputs, entire 120 responses has been collected form clinical staffs, which includes physicians, occupants, caputs of sections and nurses etc. Thirty responses from each infirmary have been collected. Questionnaire: questionnaires had been used for roll uping informations from both category infirmaries. Questions are of near ended, rated on the footing of likert graduated table from 1-5. Response recording has besides been done for happening out the jobs, so that better suggestions can be made. Interviewing: in deepness interviews has been taken by IT caputs of all the four infirmaries to understand all the factors from their point of position, and to understand their return on different jobs addressed by their clinical staff. Since none of the infirmary is utilizing EHR, so complete survey had been done about EMR merely. Data aggregation had been done as follows- Questionnaires have been used for roll uping informations from medical staff. In depth interview with IT caputs of all the four sections Reappraisal of literature related to EMR Reappraisal of the literature to understand perceptual experience of medical professionals sing EMR usage. Inclusion standards: to guarantee cogency of sample, two inquiries were set in questionnaire. Harmonizing to that who were working in infirmary for more than three months ; were eligible. Another inclusion standard was straight related to patient attention. Those who were utilizing computing machine for come ining patient information/ recovering patient information/ trial consequence retrieval etc ; were eligible.Literature reappraisalThere are many maps associated with patient wellness records. This record is non merely used to document patient attention, but it besides used for entering fiscal and legal information and research and quality betterment intents. ( Young, Kathleen M. ) The conventional paper-based medical record has several restrictions. Though this traditional method is utile for entering patient ‘s inside informations for work outing medical issues, tracking down patients and for organizing in health care procedure, but it has so many disadvantages. These types of records are frequently ailing indexed and sometimes illegible, fragmented, because these records are manus written. The most disadvantageous factor of utilizing this method is that the medical record would be accessible to merely one individual at a clip. These medical records can non be made available to everyone at the same clip. Last but non least there is the job of storage of paper record, most of the times these are non stored decently, which in bend cause failure in retrieval of information, whenever required. Medical record is systematic certification of a individual patient ‘s medical history and attention across clip within one peculiar wellness attention supplier. The medical record includes a assortment of types of â€Å" notes † entered over clip by wellness attention professionals, entering observations and disposal of drugs and therapies, orders for the disposal of drugs and therapies, trial consequences, x-rays, studies, etc. The electronic wellness record ( EHR ) provides the chance for healthcare organisations to better quality of attention and patient safety. â€Å" The greatest challenge in the new universe of incorporate health care bringing is to supply comprehensive, dependable, relevant, accessible, and seasonably patient information to each member of the health care squad, whether in primary or secondary attention and whether a physician, nurse, allied wellness professional, or patient/consumer † ( Schloeffel ) An electronic medical record ( EMR ) is a computerized medical created in an organisation that delivers care, such as a infirmary or doctor ‘s office. Electronic medical records tend to be a portion of a local stand-alone wellness information system that allows storage, retrieval and alteration of records. Some definitions: Harmonizing to National Alliance for Health Information Technology ( NAHIT ) EMR: The electronic record of health-related information on an person that is created, gathered, managed, and consulted by accredited clinicians and staff from a individual organisation who are involved in the person ‘s wellness and attention. EHR: The aggregative electronic record of health-related information on an person that is created and gathered cumulatively across more than one wellness attention organisation and is managed and consulted by accredited clinicians and staff involved in the person ‘s wellness and attention.Purpose of medical record:The chief intent of medical records and medical notes is to record and pass on information about patients and their attention. If notes are non organised and completed decently, it can take to defeat, argument, clinical mishap and judicial proceeding. medical records are now used non merely as a comprehensive record of attention but besides as a beginning of informations for hospital service activity coverage, supervising the public presentation of infirmaries and for audit and research. Many of the causes of inaccurate clinical cryptography of this secondary informations are rooted in the quality of medical notes History of Electronic Medical Records: Doctors are expected to document brushs they have with patients to guarantee important information for decision-making is recorded and actions taken are besides recorded. Documentation is besides required as an archival record of what happened in instances of difference. To a great extent, physicians resent the undertaking of certification, as it detracts from their primary undertaking: taking attention of patients. Doctors besides resent the duplicate of attempt required with certification, as every medicine that is written on a prescription tablet, every lab trial ordered, every X ray ordered has to be re-written in the chart to keep a good record. Communication between practicians is hard as in many instances the information collected is fragmented, often excess and voluminous. Finally, doctors are invariably inundated with new information and have no tools to assist them integrate new techniques and interventions into their daily activities, other than utilizing their memories or holding to tote around big text editions. The thought of entering patient information electronically alternatively of on paper -the Electronic Medical Record ( EMR ) -has been around since the late 1960 ‘s, when Larry Weed introduced the construct of the Problem Oriented Medical Record into medical pattern. Until so, physician ‘s normally recorded merely their diagnosings and the intervention they provided. Weed ‘s invention was to bring forth a record that would let a 3rd party to independently verify the diagnosing. In 1972, the Regenstreif Institute developed the first medical records system. Although the construct was widely hailed as a major progress in medical pattern, doctors did non flock to the engineering. In 1991, the Institute of Medicine, a extremely respected think armored combat vehicle in the US recommended that by the twelvemonth 2000, every doctor should be utilizing computing machines in their pattern to better patient attention and made policy recommendations on how to accomplish that end. Advantages OF THE EHR: advantages of EHR can be divided as following-1 ) Clinical resultsa ) Quality of attention: Improving quality of attention is one of the chief focal points of many EHR surveies. Quality of attention has been defined as â€Å" making the right thing at the right clip in the right manner to the right individual and holding the best possible consequences † , in short â€Å" a procedure for doing strategic picks in wellness systems † .A Quality of attention includes six dimensions, effectivity, efficiency, patient safety, handiness or seasonableness, just entree, and patient-centeredness or acceptableness, but most EHR research has focused on the first three. Last three constituents needed more research in their corresponding Fieldss. Erstwhile patients may non adhere to outdo pattern guidelines ; even the suppliers have best purpose. This sort of state of affairs can originate due to assorted factors like- Clinicians are non cognizant with the guidelines. Clinicians may non recognize that a peculiar guideline applies to a given patient. Lack of clip during the patient visit. EHR systems proved rather effectual in managing such sort of issues and improved attachment rates. For illustration, research workers found that computerized physician reminders increased the usage of grippe and pneumococcal inoculations from practically 0 % to 35 % and 50 % , severally, for hospitalized patients ( exter PR, Perkins S, Overhage JM, et al. ) . Similarity other surveies with computerized reminders on inoculation rates, shows important better attachment to immunisation guidelines. Lower berths the hazard of disease eruptions in communities: There are many other researches have conducted that focused on other preventative services and studied consequence of EHRs on different results to better attention efficaciously. Willson et Al found in his survey on hospitalized patients that after implementing computerized reminders targeted to hospital nurses, there is 5 % decrease in the development of force per unit area ulcer after 6 months. It proves a important association between computerized reminders and hazard of disease. Effective wellness attention bringing: Research workers have besides found that there is a profound relation between EHRs and efficiency in wellness attention bringing. Here efficiency refers to the turning away of blowing resources, including supplies, medical equipment, money, thoughts, and energy. One such signifier of waste involves excess diagnostic testing. Performing excess trials is dearly-won and may take to more false-positive consequences, which will so take to even more costs. Tierney et Al found a 14.3 % lessening in the figure of diagnostic trials ordered per visit and a 12.9 % lessening in diagnostic trial costs per visit when utilizing an EHR with CDS and CPOE constituents. Other, unrelated surveies found an 18 % lessening in trials ordered for medical visits in the exigency section, a 27 % lessening in excess research lab trials of antiepileptic medicine degrees in hospitalized patients, and a 24 % decrease in excess research lab trials in a infirmary. Reduced medicine mistakes: A well-known survey group found in their survey that merely presenting CPOE system reduced serious medicine mistake by 55 % in the infirmary scene. Whereas subsequently in followup survey the same group expert found that, these medicine mistakes can be reduced every bit much as 86 % by adding CDS system together with CPOE system. A similar, more recent survey in the outpatient puting found that cybernation resulted in an mistake rate decrease from 18.2 % to 8.2 % . ( Devine EB, Hansen RN, Wilson-Norton JL, et al. ) . On the other manus many other surveies have concluded that by presenting computerised system, the figure of appropriate medicine orders affecting dosing degrees or dosing frequence can be increased. Better clinical result: Many of the surveies besides focused on clinical results. Randomized test research design used for carry oning these surveies in a clinical scene. An extra organic structure of literature has examined, observationally, comparing of public presentation in between infirmaries that implemented EHRs and other computerized capablenesss with its opposite numbers that have non. For illustration, Menachemi et Al found that Florida infirmaries with greater investings in EHR engineerings had more desirable rates on a assortment of normally used quality indexs. Patient Safety: The challenge of reading handwritten notes, orders, and prescriptions has been eliminated with the EHR. Patients ‘ chart information is clear and legible. Reports and letters to other specializers and patients are comprehensive, professional, and easy to make. Chart information is ever accessible and found in the same topographic point. Paper charts, on the other manus, can go littered with a batch of necessary but misplaced information.2 ) Organisational results:Surveies analyzing organisational results have focused on EHR usage in both the inmate and outpatient scenes. Such results have often included increased gross, averted costs, and other benefits that are less touchable, such as improved legal and regulative conformity, improved ability to carry on research, and increased job/career satisfaction among doctors. Increased gross comes from multiple beginnings, including improved charge capture/decrease in charge mistakes, improved hard currency flow, and enh anced gross. Several writers have asserted that EHRs aid suppliers in accurately capturing patient charges in a timely mode ( Schmitt KF, Wofford DA ) Electronically available patient information generated so many efficiencies, which straight help in debaring cost. Some of these efficiency includes increased use of trials, reduced staff needed for patient direction, decreased written text costs, reduced costs associating to supplies needed to keep paper files, and the costs associating to chart pulls. EHRs besides cut down the redundant usage of trial or the demand to get off difficult transcripts of trial study to all suppliers that save money and clip of organisation. ( Chen P, Tanasijevic MJ, Schoenenberger RA, et Al ) . Surveies have besides shown that holding an EHR can cut down written text costs through electronically available structured certification processs instead than a paper file. ( Agrawal A. ) In add-on, research workers in Massachusetts have found that doctors utilizing an EHR had fewer paid malpractice claims. They found a doctor without EHR have much higher ( 10.6 % ) history of paid malpractice claims compared to those doctors with EHRs ( 6.1 % ) . This decrease is potentially the consequence of better communicating among health professionals, increased discernability and completeness of patient records, and increased attachment to clinical guidelines.3 ) Social results:Another less touchable benefit associated with EHRs is an improved ability to carry on research. As patient informations stored electronically that makes handiness of informations much easier which leads excessively many quantitative analyses to place evidence-based best patterns more easy ( A Aspden P.A ) . Furthermore, public wellness and other interdisciplinary research workers are actively utilizing electronic clinical informations that are existent informations aggregated across populations to brin g forth good research determination, which is good to society. Till today handiness of clinical informations is much limited but as suppliers will get down utilizing EHRs, this dataset will besides get down turning. Subsequently by uniting this clinical information with more informations from other beginnings like nonprescription medicine purchases and school absenteeism rates, our researches and public wellness organisation can break supervise disease eruptions and better surveillance of possible biological menaces ( Kukafka R, Ancker JS, Chan C, et Al ) . Research workers have besides found an association between EHR usage and physician satisfaction with their current pattern, A together with their calling satisfaction.A Harmonizing to many surveies, physician satisfaction should be a precedence in wellness attention organisations, because it is associated with better quality of attention, better prescribing behaviors, and increased keeping in medical patterns, peculiarly those in underserved countries. ( A Elder KT, Wiltshire JC, Rooks RN, et al.A ) Chaudhry et al noted that a big proportion of the surveies that found benefits from EHR were conducted in a selected figure of academic medical Centres in infirmary scene. Due to this ground many research workers are besides seting a inquiry about the generalisation of identified benefits of EHR in existent universe where they may neither hold similar fiscal and human resources nor a decades-long committedness to wellness information engineering. More research on the varying types and grades of benefits associated with EHR is warranted, particularly in community scenes such as physician patterns and non-academic infirmary scenes.Barriers TO THE EHRAlthough Electronic Health Records ( EHRs ) bring enormous benefits to patient attention and to the health-care supplier, usage of the ambulatory EHR alternatively of the paper chart did non become widespread among the independent doctors during the 1990s. Even though the motive of improved patient attention and handiness of medical informa tions was present, health-care suppliers were hesitating to get down utilizing this medical tool. Specii hundred grounds have been hypothesized for the deficiency of EHR execution, and they are outlined below.A Lack of Standards for EHR SystemsThe content within the systems did non hold uniformity for compatibility or interoperability. Assorted plans offered different characteristics and the exchange of informations was non possible. Besides, criterions for the security of confidential information through encoding or informations unity had non been set. The quality of EHR plans and computing machine webs was non sufficiently dependable to forestall downtime, therefore ensuing at times in the deficiency of entree to patient information or medical information. Data for clinical protocols, direction of patient attention, and determination support through algorithms were non yet standard for EHRs.Unknown Cost and Return on InvestmentHealth-care suppliers found it hard to accurately ciph er costs and Return on Investment ( ROI ) with the usage of an EHR. The full cost of an EHR includes the package purchase monetary value, extra computing machine hardware, execution including the preparation of staff, customization of the system, ongoing proficient support, system care, and future plan ascents. Measuring ROI includes intangible, unmeasurable, and nonfinancial information, such as improved patient attention, patient safety, and more efficient procedures. Measurable ROI includes addition in income from more accurate cryptography, greater clip efficiency as a consequence of rapid chart certification, expanded patient burden because of this efficiency, and decreased office supply costs such as paper, charts, and printing supplies. It was hard to accurately cipher costs and ROI with the usage of an EHR.Difficult to OperateDoctors perceived that it took more clip for informations entry than handwriting. A physician order signifier may hold been simpler to handwrite than t o treat through a computing machine system. Learning where the information should be entered or accessed was complicated and computing machines were non ever accessible at the point of attention. System warnings and medical qui vives incorporating critical information had non been developed. The long-run benefit were hard for some health care suppliers to value over the sensed troubles of operationSignificant Changes in Clinic ProceduresAlthough an EHR can be customized for specific medical patterns, there is ever some procedure alteration required by the supplier and medical staff. An EHR may convey a more stiff construction for come ining information than tossing through a paper chart. Adapting to new criterions of operation for come ining and turn uping information can be hard ab initio. Some EHRs have specifications or specific modus operandis for practising medical specialty that the supplier may non accommodate to easy. The health-care supplier may non be able to turn to and a nalyse jobs in the same ways that may hold been done in the yesteryear, even though the information in an EHR is more thorough and immediately available. New tools for improved patient attention require retraining, new procedures, and alterations in the medical pattern civilization.Lack of Trust and SafetyA concern for the security of the medical record stored electronically alternatively of on paper is common. Health-care suppliers may be concerned that the electronic medical record could be altered without their consent or cognition. Suppliers must hold the confidence that the medical records are safely stored for future handiness. Power outages, computing machine â€Å" clangs, † viruses, concerns about equal backup, and so on are issues suppliers must get the better of to be confident in utilizing an EHR.Use of EHR plans, peculiarly in the small- to moderate-sized patterns, is spread outing quickly. About 78 per centum of doctors in private pattern are within this market group of eight or fewer physicians. With the explosive growing of EHR execution in this section of the medical community, a great demand has been generated for both clerical and clinical support staffs that have professional preparation and exposure to the EHR. Concerns about the passage from traditional paper charts to EHRs are now being overcome. Many of the concerns expressed about EHRs have been addressed more to the full in recent old ages. Although the motives vary from a pattern desiring to merely â€Å" go paperless † to another pattern desiring to better patient attention, medical clinics are rapidly acknowledging the unbelievable tool the EHR is conveying to the medical pattern.Disadvantages of EMROn the reverse of advantages some writers have identified several possible disadvantage of utilizing EHRs. These include fiscal issues, alterations in work flow, impermanent loss of productiveness associated with EHR acceptance, privateness and security concerns, and sever al unintended effects. Significant cost: A major ground for deterrence for following and implementing EHR is its cost. It includes loss of gross associated with impermanent loss of productiveness, declines in gross, acceptance and execution costs and on-going care costs. Here EHR acceptance and execution costs includes buying and installation hardware and package, change overing paper charts to electronic 1s, and preparation of end-users. Different surveies documented this cost in both inmate and outpatient scenes. Like a survey conducted in 2002 at a 280-bed ague attention infirmary, the projected entire cost for a 7-year-long EHR installing undertaking was about US $ 19 million. In the outpatient scene, early research workers estimated an mean initial cost of US $ 50,000-US $ 70,000 per doctor for a three-physician office. However, as EHR engineerings have become more platitude over the past decennary, the initial cost of systems has come down dramatically ( Schmitt KF ) , ( Agrawal A ) Care cost besides can be cumbersome as hardware needs to replace clip to clip and package demands to upgrade on regular footing. In add-on, suppliers must hold ongoing preparation and support for the end-users of an EHR. Harmonizing to one survey conducted on 14 solo or small-group primary attention patterns, estimated on-going EHR care costs averaged US $ 8412 per FTE supplier per twelvemonth. Out of entire cost around 91 % of this was related to hardware replacing, seller package care and support fees, and payments for information systems staff or external contractors ( Fleming NS, Culler SD, McCorkle R, et Al ) Break of work-flows for medical staff and suppliers: Another major disadvantage of implementing EHRs is break of everyday work-flow for medical-staff or supplier, which consequences to loss of impermanent productiveness. This break may be because of preparation of end-users which potentially leads to loss in gross. One survey that involved several internal medical specialty clinics estimated, a productiveness loss of 20 % in the first month, 10 % in the 2nd month, and 5 % in the 3rd month before productiveness return to its original degrees as in get downing ( Wang SJ, Middleton B, Prosser LA, et al. ) Research workers besides have estimated that EHR end-users spent around 134.2 hours on execution activities that includes acquiring and larning a new system. These hours spent on nonclinical duties had an estimated cost of US $ 10,325 per doctor ( Fleming NS, Culler SD, McCorkle R, et al. ) Hazard of patient privateness misdemeanors: Another possible drawback of EHRs is the hazard of patient privateness misdemeanors, which is an increasing concern for patients due to the increasing sum of wellness information exchanged electronically between suppliers. To face such sort of state of affairss, policymakers have taken steps to guarantee safety and privateness of patient informations. For illustration, recent statute law has imposed ordinances specifically associating to the electronic exchange of wellness information that strengthen bing Health Insurance Portability and Accountability Act privateness and security policies. Although few electronic informations are 100 % secure, the strict demands set Forth by the new statute law make it much more hard for electronic informations to be accessed unsuitably. ( Zurita L, Nohr C. Patient sentiment: EHR appraisal from the users perspective. ( Stud Health Technol Inform. ) Not merely acts do interchanging electronic wellness informations secure but besides many infirmaries and doctors are implementing rigorous regulations like no tolerance punishments for employees who entree files unsuitably. For illustration, a infirmary in Arizona terminated several employees after they unsuitably accessed the records of victims who were hospitalized after the January 2011 hiting affecting a US Congresswoman. ( Innes S. ) Although privateness will probably go on to be a concern for patients, many stairss are being taken by policymakers and single organisations to guarantee that EHRs comply with the rigorous Torahs and ordinances intended to guarantee the privateness of clinical information.Decrease face-to-face clip with patients, depersonalize brushsEHRs may do several unintended effects, such as increased medical mistakes, negative emotions, alterations in power construction, and overdependence on engineering. ( Campbell EM, Sittig DF, Ash JS, et al. ) Research workers have found an association between increased medical mistakes and CPOE due to faulty system or untrained end-user. Additionally, end-users of an EHR may see strong emotional responses as they struggle to accommodate to new engineering and breaks in their work flow. Changes in the power construction of an organisation may besides happen due to the execution of an EHR which makes it rather more machine-controlled. For illustration, a doc tor may lose his or her liberty in doing patient determinations because an EHR blocks the ordination of certain trials or medicines. Overdependence on engineering may besides go an issue for suppliers as they become more reliant upon itInvention credence:The beginnings of attitude and behaviour day of the month back to every bit early as 1862, when psychologists began developing theories demoing how attitude wedged behaviour. Those surveies by societal psychologists continued and in 1925, many new theories emerged proposing that â€Å" attitudes could explicate human actions † ( Ajzen & A ; Fishbein, 1980, p. 13 ) Several theoretical accounts have been developed and utilized to analyse the credence of engineering. Some of the of import theoretical accounts are as follows-Theory of Reasoned Action ( TRA )Harmonizing to this theoretical account, a individual ‘s behaviour is determined by his/her behavioural purposes ( BI ) to execute that behaviour. That BI is itself determined by both a individual ‘s attitude toward the behaviour and subjective norm refering the behaviour.Theory of Planned Behavior ( TPB )The theory of planned behaviour was proposed by Icek Ajzen in 1985 through his article â€Å" From purposes to actions: A theory of planned behaviour. † The theory was developed from the theory of sound action, which was proposed by Martin Fishbein together with Icek Ajzen in 1975. Harmonizing to the theory of sound action, if people evaluate the suggested behaviour as positive ( attitude ) , and if they think their important others want them to execute the behaviour ( subje ctive norm ) , this consequences in a higher purpose ( motive ) and they are more likely to make so.Technology Acceptance Model ( TAM )Based on the theory of sound Action, Davis ( 1986 ) developed the Technology Acceptance Model which deals more specifically with the anticipation of the acceptableness of an information system. This theoretical account suggests that the acceptableness of an information system is determined by two chief factors: perceived usefulness and sensed easiness of usage. Perceived utility is defined as being the grade to which a individual believes that the usage of a system will better his public presentation. Perceived easiness of usage refers to the grade to which a individual believes that the usage of a system will be effortless Unified Theory of Acceptance and Use of Technology ( UTAUT ) The UTAUT purposes to explicate user purposes to utilize an information system and subsequent use behaviour. The theory holds that four key concepts ( public presentation anticipation, attempt anticipation, societal influence, and easing conditions ) are direct determiners of usage purpose and behavior. Gender, age, experience, and voluntariness of usage are posited to intercede the impact of the four key concepts on usage purpose and behaviour.Factors Affecting EMR AcceptanceAcceptance is defined as the willingness within a user group to use information engineering to the undertakings it is designed to back up ( Dillon & A ; Morris, 1996 ) . Many research workers have stressed the importance of credence survey. For illustration, Kirk ( 2003 ) urged pressing actions on supplying legal and societal model for credence andintroduction of EMR. Likewise, Gefen ( 2003 ) , Zdon ( 1998 ) , Anderson ( 1997 ) , Moore ( 1996 ) , Baroudi ( 1986 ) , Bardram ( 1997 ) , Bowers ( 1995 ) , Graham ( 1996 ) , and Hubona ( 1996 ) , all discussed similar issue. Furthermore, past experiences show that the attempt to present EMR will ensue in failure and unforeseen effects if their proficient facets are over emphatic and their societal and organisational factors such as the user credence and the diffusion of information system are overlooked ( Gefen, 2003, Anderson, 1999, Moore, 1996 ) . Kirk ( 2003 ) has noted that presently there is no societal model for EMR credence. The closest model theoretical account, which measures perceived usefulness and sensed easiness of usage, that can be adopted is the Technology Acceptance Model ( TAM ) proposed by Davis ( 1989 ) . Tsiknakis ( 2002 ) , Einarson ( 1993 ) , and Neilder ( 1997 ) added that hapless presentation of patient ‘s informations can take to ill informed clinical professionals, medicine mistakes, inappropriate repeat of probe, unneeded referrals, and waste of clinical clip and other resources. Indeed, hapless presentation of patient ‘s information is an interface issue, which warrants more investigation.In obtaining the user credence of wellness attention, peculiarly its system interface, Rosenbaum ( 1998 ) proposed six successful techniques: Involving the user community in needs analysis and demands definition. Designating members of the user community who are involved in the system design as don ( people who receive first preparation and extended preparation ) . Conducting undertaking analysis of the full work procedure, non merely the partsinvolving the clinical information system. Performing user surveies of preliminary paper and pencil paradigms with typical users. Conducting iterative serviceability testing of consecutive paradigms. Visiting infirmaries and other scenes of usage to detect the work procedure, usage of predecessor systems, and beta-test installing Surveies statistics: There is scarce of surveies sing EMR usage in Indian context. Results of some relevant surveies are as follows- Consequence of a research done by Sequist et Al was as follows- The overall response rate was 56 % . Of reacting clinicians, 66 % felt that the EHR execution procedure was positive. One-third ( 35 % ) believed that the EHR improved overall quality of attention, with many ( 39 % ) feeling that it decreased the quality of the patient-doctor interaction. One-third of clinicians ( 34 % ) reported consistent usage of electronic reminders, and self-report that EHRs improve quality was strongly associated with increased use of the EHR ( odds ratio 3.03, 95 % assurance interval 1.05-8.8 ) . The bulk ( 87 % ) of clinicians felt that information engineering could potentially better quality of attention in rural and underserved scenes through the usage of tools such as on-line information beginnings, telemedicine plans, and electronic wellness records. In a survey conducted in the United States, the most normally cited barriers to utilize of EMR systems in infirmaries were unequal capital for purchase ( 74 % ) , care costs ( 44 % ) , opposition on the portion of doctors ( 36 % ) , ill-defined return on investing ( 32 % ) , and deficiency of handiness of trained staff ( 30 % ) . Hospitals that had adopted EMR systems were less likely to mention four of these five concerns ( all except doctors ‘ opposition ) as major barriers to acceptance than were infirmaries that had non adopted such systems. When most of the infirmaries or professionals speaking approximately high cost of EMR, a cost benefit analysis of EMR in primary attention done by Wang et Al shows, In the 5-year cost-benei ¬?t theoretical account ( Table 3 ) , the net benei ¬?t of implementing a full electronic medical record system was $ 86,400 per supplier. Of this sum, nest eggs in drug outgos made up the largest proportion of the benei ¬?ts ( 33 % of the sum ) . Of the staying classs, about half of the entire nest eggs came from decreased radiology use ( 17 % ) , decreased charge mistakes ( 15 % ) and betterments in charge gaining control ( 15 % ) . Though non all benei ¬?ts of an electronic medical record are mensurable in i ¬?nancial footings ; other benei ¬?ts include improved quality of attention, reduced medical mistakes, and better entree to information.CURRENT SCENARIO IN INDIAThe Department of Information Technology ( DIT ) , Ministry of Communication an Information Technology ( MCIT ) have funded several undertakings during the past decennary for development of IT based Healthcare solutions. During the class of these undertakings, the demand for a standard EHR for the state has been strongly felt for interoperable health-care solutions. During the meetings of the National Knowledge Commission for making the national wellness information sciences vision for India, the demand for standard EHR with unafraid storage and entree of EHRs in a storage system crossing. TheA currentA wayA ofA developingA andA usingA healthcareA informationA storeA systemsA hasA led toA aA chaoticA stateA ofA affairsA dueA toA followingA grounds: aˆ? TheyA haveA beenA developedA independentlyA andA doA notA easilyA interoperateA withA each other. aˆ? TheyA followA theirA ownA conventionA ofA making, A maintaining, A andA storingA Electronic HealthA RecordsA ( EHRs ) A ofA patients. aˆ? IfA aA patientA isA treatedA atA differentA hospitalsA atA differentA cases, A differentA EHRs areA generatedA andA storedA forA theA sameA patientA byA theA twoA differentA information systemsA inA useA atA theA twoA hospitals.A AA singleA EHRA forA anA individualA isA desirable irrespectiveA ofA his/herA timeA andA placeA ofA intervention. aˆ? EachA systemA hasA itsA ownA wayA ofA creatingA andA managingA itsA storageA ofA EHRs. Obviously, A such A an A information A shop A is A based A on A both A relational A database engineering, A due A to its A ubiquitousness A and A adulthood A in A pull offing A big A volume A of information, A andA mediaA storageA package, A forA exampleA XrayA pictureA file awaying. DifferentA systemsA useA differentA relationalA databasesA andA differentA mediaA storage softwareA makingA dataA transferA acrossA systemsA impossible/inconvenient. aˆ? MostA ofA theA existingA systemsA useA centralizedA storage, A leadingA toA limitedA scalability andA poorA reliabilityA ( singleA pointA ofA failure ) . AsA aA consequence, A itA hasA becomeA difficultA toA exchangeA EHRsA acrossA differentA systemsA andA to haveA aA unifiedA informationA systemA toA dealA withA oneA EHRA perA person, A irrespective ofA theA timeA andA placeA ofA treatmentA ofA anA person.