Human Existence and Human Suffering Essay - 1920 Words

All throughout our history, we humans have constantly evolved and developed to an extent where we can give an account to the world we live in. From Epicurus to Thomas Aquinas, from Aristotle -who taught one of the greatest kings namely Alexander the Great- to Sartre and Camus were all for the search of why we are on this planet. What drives us to live or perhaps to die, even if it is by one’s own hand. When arguing about the meaning of life, one has to take into account that every doctrine, thesis, antithesis, thought and emotion can only be explained and defined through the human perspective. It can be said that humans see the world through a specific lens, which is not only a cultural and political one, but a human one. We are limited in†¦show more content†¦Defining 200.000 years in ratio to 12 billion Julian years one will get a percentage of 0.00142%. To put it in other numbers one would have to live human history 70.000 times to reach the â€Å"Big Bang†. It is important to be aware of where humans stand in the face of time and space when it comes to existentialism. Since we all live in tempus et spatium. Connected to this, the paper will try to explain: In what form does human suffering shape human existence, and to what extent does it need to shape our lives? The following essay will draw a comparison between Camus and Sartre on human existentialism. The thesis will argue against the Camusian concept of essence before existence. The paper will also compare for the concept that the Absurd and Man are not opposed to each other, but exist in a juxtaposed coherence. Sartre’s main argument is that human beings have no essence before existence, thus humans are destined to be free, where God is non-existent. Therefore â€Å"existence precedes essence† (Sartre:5). First of all man comes into being and only after that he start defining himself and the world around him. Sartre being an atheist believes that God does not exist and humans are left alone without excuse, bearing full responsibility of their acts. He believes that death in itself gives meaning to our free, individual existence. Our choices define who and what we become, whereShow MoreRelatedThe Sickness Onto Death And Sartre1539 Words   |  7 Pagescontemporary inauthentic living through an idea he calls â€Å"Bad Faith†. Both Kierkegaardian Despair and Sartrean Bad Faith involve human suffering not at a psychological or physical level, but rather an existential level. I strongly believe that the individuals suffer more from Despair than Bad Faith, as there are aspec ts of nothingness and anguish of Bad Faith that intensify the suffering. â€Å"The Sickness onto Death† by Kierkegaard encompasses the notion of inauthentic living. Kierkegaard defines Despair asRead MoreJob and Gilgamesh: a Comparison of Inevitable Suffering1028 Words   |  5 PagesJob and Gilgamesh: A Comparison of Inevitable Suffering It has been said that pain is inevitable but suffering is optional. But is it? When looking at extraordinary pieces of literature such as the biblical Book of Job and the Epic of Gilgamesh, describing such physical and emotional pain and the mental and spiritual suffering that the main characters endured, it tells us that their suffering was just as inevitable as their pain. However, the two men dealt very differently with the tragediesRead MoreThe Existence Of Evil By Blackburn Theory1264 Words   |  6 Pagesam going to argue that his theory the existence of evil strongly suggests that there does not exist a God who is all-good, all-knowing and all-powerful to be false. In my argument I will try to present facts that show the existence of God and why there is evil. Exposition: 313 In Blackburn’s argument he basically mentions that because there is evil in the world there is no existence of a present creator. It is impossible to see the suffering that’s going on in the world and suggestRead MoreSecular Humanism Rejects The Idea And Existence Of God1650 Words   |  7 PagesSecular humanism rejects the idea and existence of God. It is a philosophy of life, which views that humans are the supreme beings of the universe. They believe that the creation of the universe and life is an incredible coincidence. They believe that human existence is fully explained without any references to spiritual occurrences. Secular humanists have no religion and reject the idea of faith and spirituality. They believe that science is the only source of knowledge and reveals the laws of natureRead MoreThe Between Science And Metaphysical Frameworks1568 Words   |  7 Pagesentirety of the human condition. A much more authentic question that the individ ual can ask themselves is â€Å"what does my life mean to me?† Crowell (2010) summarizes existentialism in a way that separates us from the dichotomy of science and metaphysical frameworks. He surmises that to understand what defines a human being and individual requires the awareness to know all the truths that natural sciences (including the science of psychology) can tell us do not define what it means to be a human. The individualRead MoreDoes God Exist1483 Words   |  6 PagesExist The question of God’s existence has lingered in the mind of man since the dawn of religion. The simple fact that billions of people consider themselves to have some allegiance to a deity means that this question deserves to be seriously considered. In this paper I will argue for the sake that God does exist and the reasons why. I will include many of the arguments found in our philosophy book and those covered in class as well as other subjects such as human suffering and the reasons God choseRead MoreThe Problem of Evil Essay1536 Words   |  7 PagesSwinburne argues that the existence of evil in the world is consistent with the existence of all-knowing, all-powerful and all-good God. To start, Swinburne bases his argument on two basic types of evil: moral and natural. Moral evil encompasses all the ills resulting from human action, whether intentional or through negligence; natural evil included all evils not caused or permitted by human beings. Whereas moral evil such as abortion, murder, terrorism, or theft comes from humans acting immorally, naturalRead MoreThe Noble Truth Of Suffering988 Words   |  4 PagesAll human beings suffer. There are many forms of suffering that effect individuals lives. Suffering has to come from somewhere, and Buddhists use the Four Noble Truths to explain what suffering is and where it comes from. The Four Noble Truths are the doctrines of Buddha. These truths explain the way to the purification of beings (Walsh, 335). The First Noble Truth is the Noble Truth of Suffering. Maurice Walshe, the main editor of The Long Discourses of the Buddha, helps explore the Noble TruthRead MoreEssay about Life is Suffering1124 Words   |  5 PagesIn Studies in Pessimism, Schopenhauer argues that suffering is intrinsic to human existence; that by nature we will experience suffering regardless of how we live our lives. Similar to Epictetus’ view, Schopenhauer states that the only way to minimize the amount of suffering one feels is by living a life of pure reason. This paper will examine both Schopenhauer’s characterization of human suffering and his recommendations for how to best live our lives. It will then argue that while his characterizationsRead MoreThe Nature And Existence Of God1364 Words   |  6 PagesThe existence of suffering in the world provides a case against the existence of God as the problem of evil. It seems that the God of classical theism is incompatible with the reality of the world around us; could such an all-loving, all-powerful and all-knowing God exists in conjunction with instances of immense and seemingly pointless suffering? It does seem unlikely that such a God exists alongside evil. However, it is questionable whether this is a proof that God does not exist. The problem of

Digital Crime and Terrorism Case Study Essay - 1524 Words

Digital crime and terrorism is one of the remaining challenges that law enforcement must address to guarantee greater global security and harmony. Law enforcement agencies therefore need better means through which they can forecast the past, present and future aspects of digital crimes so that they can be well equipped to restrict the actions of those who perpetrate such crimes. This paper is going to analyze the eight key forecasts that are related to digital crime and how law enforcement agencies can come with strategies to combat these crimes. Forecast 1: The need for allocating law enforcement agencies more resources to combat cyber crimes The forecast highlights the need for a shift in law enforcement and justice agencies across†¦show more content†¦Law enforcement agencies need to partner with advocacy groups to make consumers and business owners aware of the different means which cyber criminals use to swindle them of their cash. A list of the various fraud schemes can be published, which can give the users of e –commerce precautions to avoid losing their money to fraudsters (Mansell Raboy, 2011, p. 509). The most common ways through which people are swindled, is through unauthorized withdrawals from their credit cards and scams whereby some online portals receive payments for certain goods and later do not deliver the goods to the clients. Prevention strategies therefore must be emphasized to ensure that internet users are made aware of the fraud schemes. Forecast 3: Increase in the level of virtual crimes in online networking sites. There is a likelihood of an increase in the number of incidents of crimes of a psychological nature committed against internet users in a shared community through insults, ridicule, hate campaigns, child abuse and incitation. Such crimes make the targeted user to be vulnerable because they can be harmed by the content that is posted online or which is sent to them. Bullying in forums of users of school going age and workplace infringement of sensitive company information by aggrieved employees are also avenues for such crimes.Show MoreRelatedThe Problem Of Cyber Crime988 Words   |  4 Pageslimited since, for those investigating or examining cyber-crime must be highly trained specialists, requiring detective and technical skills, including knowledge of various IT hardware and software, and forensic tools. Nevertheless, in the modern world computer or computer related crime makes up a great amount of p ercentage of all the crimes happiness which is bound to increase. The Office for Victim Assistance ensures that victims of crimes investigated by the FBI are presented the opportunity toRead MoreThe Four Major Categories Of Computer Crimes Essay1341 Words   |  6 Pagesthis writing assignment, I will discuss the four major categories of computer crimes. I will explain the most common forms of digital crime and why cyber terrorism is the greatest threat. I will also discuss the roles of the U.S. government, court systems, and law enforcement agencies in combating computer crime. First, we will define the four major categories of computer crimes. -The technical definition of computer crimes is an act performed by a knowledgeable computer user, sometimes referred toRead MoreUse Of Our Knowledge Of Digital Forensics1489 Words   |  6 Pages Digital Forensics Scenario Supervisor – Mr. Ernest Foo Use our knowledge of Digital Forensics to set up a challenge scenario. We need to set up and develop evidence that can be examined to determine a sequence of events. Scenarios can include disk forensics, network forensics and memory forensics or a combination of all. Prasad Prasannakumari Sasikumar [n9065041] 8/14/2015 â€Æ' Title The present period can be seen as the time of the digital revolution, described by boundless, simpleRead MoreEssay on Criminal Justice Fields982 Words   |  4 Pagesscientific fields related to the solving of crimes. The earliest forms of forensic sciences were first used in 16th century Europe by medical practitioners in the army and universities to gather information on the cause and manner of death, though writings on these topics did not begin to appear until the 18th century. (Kind S, 1972) The science of forensics is now recognized as a critical ingredient in law enforcement and in the solution of crimes. Protecting a crime scene from contamination, gatheringRead MoreForensics: Three Basic Aspects for Identification Essay1098 Words   |  5 Pagesconsidered a science of the judicial system, where as evidence is obtained regarding criminal acts to determine the innocence or guilt of individual(s). There is a wide area of forensic studies; this paper will discuss three of these topics Digital Apprehension, DNA, and Interpol. Digital Apprehension is just as it says digital, meaning pictures and various technologic devices. DNA (deoxyribonucleic acid) is an inherent identifying marker of cells be, human or plant; that is now a mainstay of criminalRead MoreThe Internet And Its Effects On The Environment1538 Words   |  7 Pagesfor improvement. Lastly, it will offer recommendations as conclusion. The threats of virtual dimensions The conceptions of security in the contemporary digital age are remarkably distinct from the traditional Cold War landscape. Technology and globalization are among the major contributors to the emergence of the new realm in security studies. 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For example, a cyber attack on a company can expose million’sRead MoreLaw Enforcements Perceptions And Preparedness956 Words   |  4 Pages427.5148  · jl03738@georgiasouthern.edu EDUCATION Cyber Crime Graduate Certificate Armstrong State University, Savannah, GA Graduation: December 2016 GPA: 3.50 Masters of Arts in Social Sciences in Criminal Justice and Criminology Georgia Southern University, Statesboro, GA Graduation: May 2016 GPA: 3.80 Thesis: Law Enforcements’ Perceptions and Preparedness to Address Child Exploitation via Hacking Bachelor of Science in Justice Studies Georgia Southern University, Statesboro, GA Graduation:Read MoreSurveillance : The Act Of Surveillance1526 Words   |  7 Pagespart of business operation or road safety management due to video recorded proof in case of any crime. We stand at an age where nothing is anymore private or personal in terms of data and information confidentiality. 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Amba 604 Free Essays

string(24) " skills to the project\." Acme Home Improvement de Mexico, SA de CV Project Plan Team Four: Folasade Bamidele Alibaloye John C Caputo Garner Frederick Hixson Hector G Rosado AMBA 604, Section 9093 Professor Stewart February 6, 2004 Acme Project Plan Table of Contents Section I. II. III. We will write a custom essay sample on Amba 604 or any similar topic only for you Order Now Executive Summary Introduction Project Organization Organization Chart Project Responsibilities Staffing Plans IV. Management Process Management Objectives Priorities Monitoring/Controlling Mechanisms V. Technical Process Plan Computing System Project Plan Modification Process Computer Usage Policies Construction Guideline Support Project Acceptance Process Lessons Learned Documentation VI. Work Packages, Dependencies, Schedules Budgets Work Packages Dependencies Project Budget Summary Tasks on the Critical Path Assignment Matrix 3 4 5 5 6 7 10 10 10 10 11 11 12 12 13 13 13 14 14 17 20 23 24 25 2 Page VII. Appendix A Appendix B Acme Project Plan I. Executive Summary Acme Home Improvements has determined it essential that expansion into international markets take place immediately. Acme Home Improvements has initiated a joint venture with local partners in Mexico City to form Acme Home Improvements SA de CV. The intent of this partnership is to open Acme’s first ‘Do It Yourself’ – (DIY) home improvement store outside of the United States, to meet the competition head on and establish a foothold in international markets. This document spells out our plan for the project’s success. The project’s sponsor is the Acme CEO, Alex R. Fitzgerald. This project is the first step in his strategic initiative to expand Acme into international markets. Based on assessments, it is critical that Acme SA de CV complete the opening of this store in 12 months or less with a budget of up to $7. 5 million. A key risk is Acme’s lack of experience in international markets. As a result, we will rely heavily on our partners to help us mitigate ‘soft’ cultural issues and navigate local nuances of business. Because of the soft issues, remaining on schedule is a key driver of project success. To mitigate risks to the project’s critical path, we have built feeding buffers into the schedule, and added a project buffer to the project end. Our plan outlines staff responsibilities and a staffing plan for project execution. This staff has strong support from corporate headquarters, a defined scope, budget, timeline, and 3 processes by which to execute the plan. Included in these processes is a structured change control process that ensures changes are relevant, followed through, and controlled. In addition, this document, and the accompanying project plan clearly identify dependencies that can impact project execution. We have separated these dependencies into mandatory, external, and discretionary dependencies (Schwalbe, 2004). Doing this has enabled us to maximize scheduling efficiency. Acme SA de CV has an established technology infrastructure to draw upon. Our plan will leverage this technology through wireless local area networks, corporate servers, and use of project management software. Finally, we will utilize a feedback process to capture lessons learned for our future expansion into international markets. Acme Project Plan II. Introduction Acme Home Improvements de Mexico, SA de CV intends to build a 100,000 sq ft retail 4 facility in Mexico Distrito Federal (DF). This effort is part of Acme’s strategy to expand into the international home improvement markets. Our Mexico City store will be the initial push into Mexico to meet our competitors head-on outside the United States. This project is critical to Acme’s long-term strategy to expand beyond the US borders. Headquarters has allocated $7. 5 million to complete this task. Strategic alignment with Acme’s long-term goals, experience with similar projects, and an assessment of the competition dictates that we complete this project within 12 months. Our project is a joint venture with local interests. The project will be challenging for Acme, with inherent risk laying in our inexperience in international joint ventures. ‘Soft’ issues, cultural human resource issues will be as much of a driver of cost and schedule as the ‘hard’ issues like planning and execution. It is critical to the success of this project, and perhaps the organization’s international growth strategy, that this project be completed on time, and on budget. The organization anticipates possible schedule delays and cost overruns due to cultural assumptions and misunderstandings. Knowing that schedule delays will affect costs and international expansion strategy, we pay particular attention to the project’s critical path (see Appendix A, and the accompanying MS Project file’s network diagram view). To deal with these risks, the team has built several feeding time-buffers into the work breakdown schedule, at constraints along the critical path (Goldratt, 1998). A large project buffer has also been added to protect the end of the project. Attention to the safety buffers along the critical path will contribute to the team’s successful execution of the project. This plan presents an overview of the project organization, including the team’s organization chart, project responsibilities, and staffing plans. Next, the plan addresses the organization’s management process related to this project. Management’s objectives, priorities, Acme Project Plan and monitoring and control mechanisms are covered in this section. The project’s technical process plan is covered next, reviewing such things as the IT support and guidelines for the project, processes for modification, and acceptance of the plan, and the process for documenting lessons learned on the project. Lastly, this plan discusses the work packages, dependencies, schedules and project budget. We begin with a look at the project organization plan. III. Project Organization Organizational Chart: 5 Acme Home Improvements de Mexico Site Construction Opening Project Organization Chart Prepared by: John Tarea, Project Manager John Tarea Acme Projects Project Manager Sade Venda Acme Store Manager Anita Socio Acme Mexico HR Manager Donna Promueva Acme Mexico Marketing Fred Conde Acme Finance Joe Martillo Construction Manager Maria Diseno Architectural Contractor This organizational chart shows the authority and communications organization for the project. Every one of the team members reports to the Project Manager. Team members are from different knowledge areas and each will contribute with their knowledge and skills to the project. You read "Amba 604" in category "Essay examples" Acme Project Plan Project Responsibilities: Project Sponsor, Alex R. Fitzgerald, CEO Acme Home Improvements. Mr. Fitzgerald 6 has been CEO of Acme Home Improvements for 10 years. He started with the company 25 years ago, working in one of the first Acme Stores. He started as a traditional department manager and worked his way up through Acme’s chain. He attended business school at the University of Maryland University College. Mr. Fitzgerald has unsurpassed expertise in the DIY Home Improvement business and has lead Acme through an unprecedented period of growth. Mr. Fitzgerald has a strategic vision that mandates Acme’s expansion into international markets. His high level of interest in this project cannot be overemphasized. His role as project sponsor is to take ultimate responsibility for the project. He must sign off on the project charter, confirm successful completion of project milestones, and provide leadership and support to the project manager. At a recent executive retreat, Mr. Fitzgerald commented, â€Å"With the growth of technology, and productivity, the world has never experienced the level of wealth and opportunity for homeownership that it is experiencing now. Our ability to remain competitive and grow is completely dependent on our ability to expand into international markets. † John Tarea, Project Manager: John is in charge of managing the whole project, and the members that are in charge of the project activities. Also, he is in charge of working with the sponsor and any general people involved with the project. His role is important since he should be able to manage the problem in an effective manner for the project to meet its goal. Joe Martillo, Construction Manager: Joe is in charge of managing the construction activities of the project. As a heavily tasked team member, project planners will watch for constraints associated with this project resource. To enable Joe meet the construction project schedule, he has been allocated the necessary budget to contract various local trades-people and construction specialty firms. Acme Project Plan Maria Diseno, Architectural Contractor: Maria is the architect that researched 7 competitive stores in Mexico, became familiar with Acme store designs in the U. S. , and designed the store to be constructed in this project. Fred Conde, Acme Finance: Fred is in charge of financial oversight of the project. He will assist team members in analyzing bids, projecting costs, and controlling expenditures. Sade Venda, Acme Store Manager: Sade will be in charge of managing the store when it is operational. She will also collaborate with H. R. anager, Anita Socio, and Anita’s staff in the recruitment, interviewing, and training of new employees. Anita Socio, Acme Mexico HR Manager: Anita will be in charge of the recruitment effort and training of the personnel hired to work in the store. She will work closely with the Store Manager. Donna Promueva, Acme Mexico Marketing: Donna will collaborate with Maria Diseno and Sade Venda on the design and layout of the store interior, displays, and inventory. She is to ensure the store reflects the marketing strategy for the Mexico City market. She is in charge of performing local market analyses, selecting products, and designing merchandising, advertising and promotional efforts for the store. An assignment matrix can be seen in appendix B. Staffing Plan The following charts illustrate the project’s staffing and training plans from three perspectives. The first graph presents baseline staffing plans, not taking into consideration feeding buffers that will likely push the actual dates closer to the store-opening deadline of March 1, 2006. The second chart depicts preliminary training targets, and the third illustrates contractor staffing needs. Acme Project Plan 8 Acme Staffing Plan 100 90 80 70 60 50 40 30 20 10 0 Jan Mar May Jul Sept Nov Project Managers Acme- Accts, IT, Supt Lead Contractor Sub-Contractors Sub-Contractor Laborers Training Team Functional Leads Department Heads Store Employees 1 Dec as opening goal Acme SA de CV Training 100 90 80 70 60 50 40 30 20 10 0 Jan Mar May Jul Sept Nov Training Team Functional Leads Department Heads Store Employees Acme Project Plan 9 Acme SA de CV Construction Team 30 25 20 15 10 5 0 Jan Mar May Jul Sept Nov Lead Contractor Sub-Contractors Sub-Contractor Laborers Now that we have discussed the project staffing and responsibilities, we turn to the project management processes, including the objectives, priorities, and monitoring and controlling mechanisms of the project. Acme Project Plan IV. Managerial Processes This section of the project plan provides an overview of Acme’s perspective of this 10 project from the point of view of the top managers. Included in this section will be a discussion of top management’s objectives, priorities, Management Objectives The Acme de Mexico project has three primary objectives: 1) Complete the six site component preparation activities on time and at/below cost. ) Execute the Acme Mexico FD site opening with a staff fully trained and integrated into the company. 3) Leverage success in Mexico FD to expand and compete across the greater Mexico. Priorities The first priority is completing the construction site on schedule. Operations must quickly assess the impact of unknown and unexpected events as they occur. Delays to the schedule drive up our costs. The second priority, which becomes the first priority as the site nears completion, is the hiring and training of a store staff. The staff must be fully knowledgeable and fluent in Acme’s processes and procedures. Monitoring/ Controlling Mechanisms Acme is new to Mexico and thus requires some very specific tools and techniques to ensure that we remain in control of the project. Given the amount of variables that we may come up against in this project we will have a very strong change control process. This change control process will meet three main goals (Schwalbe, 2004): 1. Influence the factors that create change; ensure that the change is beneficial and impact to time, scope, and budget is understood. 2. Determine that the desired change has occurred. Acme Project Plan 3. Manage the changes as they occur; trying to minimize the number of changes the project is subjected to. (p. 122). 11 There are specific criteria that will drive changes. Specifically, we have a management reserve pot set aside. The reserve will be called upon if our SPI falls below 90%. The additional capital spent will be tightly focused upon the current problem and prevention of reoccurrence. Should both our SPI and CPI fall below 90% senior management will become involved to assess status and affect needed changes. V. Technical Process Plan Having now seen the project’s organization plans and managerial process plans, we turn now to a few technical aspects of the project. This section describes the technical approaches to control and support this project. In it, we describe the technical processes and approaches relating to this project’s computing system, computer usage policies, plan modification processes, construction guidelines, acceptance process, and documentation process of lessons learned. We begin with an overview of the computing system used to support the project. Computing System This project will utilize Acme’s wide area network, via wireless access at the construction site, temporary office locations, and residences. Utilizing portable personal computers, the project manager and team will access the various project tools using MS Project, synchronizing local copies with the master file on the company server. Acme will utilize MS Project Server and MS Project Web Access features to allow project team members to view, collaborate, and update project information from various remote locations and connections. All project plan outputs will be date and time stamped. Modifications to the plan will be tracked electronically, logging a record of who changed what, and when the changes were made. Acme Project Plan Project Plan Modification Process Only the Project Manager will be able to modify the schedule, budget, and the work 12 breakdown structure (WBS) portions of the work plan. Changes resulting in delays greater than five workdays or adding more than $5,000 to the budget estimate must be approved first by the project sponsor. All other changes may be made at the discretion of the project manager. Individual team members will be able to update task completion progress in the work plan. All changes must be requested on the following Change Request Form: Change Request Form Project Name: Date Request Submitted: Title of Change Request: Change Order Number: Submitted by: (name contact information) Change Category: Scope Schedule Description of change requested: Events that made this change necessary or desirable. Justification for the change/why it is needed/desired to continue/complete the project: Impact of the proposed change on: Scope: Schedule: Cost: Staffing: Risk: Other: Suggested implementation if the change request is approved: Required approvals: Name/Title Cost Technology Other Date Approve/Reject (Schwalbe, 2004, p. 630) Computer Usage Computer use will comply with Acme Home Improvement, Inc. ‘s corporate computing policies, available online to employees on the company intranet. Employees can access the corporate intranet through the company server WAN, or over the Internet. Acme Project Plan Construction Guideline Support Standards for implementing the site construction will comply with Acme Home Improvement, Inc. ‘s Construction Guidelines. Since the guidelines were developed for use in U. S. onstruction projects, however, the project team will consult Mexico City based law firm, 13 Goodrich, Riquelme y Asociados (anonymous, n. d. ). The team will coordinate activities related to zoning, environmental practices, and compliance with other local and federal regulations with the law firm. Project Acceptance Process The project manager is responsible for obtaining sign-off from the project sponsor and project manager at each milestone, and at project completion. The following form will be used to document acceptance of the project: Client Acceptance/Project Completion Form Project Name: Project Manager: I (We), the undersigned, acknowledge and accept delivery of the work completed for this project on behalf of our organization. My (Our) signature(s) attest to my (our) agreement that this project has been completed. No further work should be done on this project. Name Title Signature Date 1. Was this project completed to your satisfaction? Yes No 2. Please provide the main reason for your satisfaction or dissatisfaction with this project. 3. Please provide suggestion on how our organization could improve its project delivery capability in the future. Schwalbe, 2004, p. 633) Lessons Learned Documentation: Acme Project Plan The project manager is responsible for completing a summary of lessons learned throughout the project. The lessons will be documented on the form below, added to Acme Home Improvement’s repository of project lessons learned, accessible through the company intranet. Lessons Learned Report Prepared by: Project Name: Project Sponsor: Project Manager: Project Dates: Final Budget: 1. Did the project meet scope, time, and cost goals? 2. What was the success criteria listed in the project scope statement? . Reflect on whether or not you met the project success criteria. 4. In terms of managing the project, what were the main lessons your team learned? 5. Describe one example of what went right on this project. 6. Describe one example of what went wrong on this project. 14 7. What will you do differently on the next project, based on your experience working on this project? (Schwalbe, 2004, p. 624) VI. Work Packages, Dependencies, Schedules and Budgets Work Packages The seven major activities of which Acme’s construction project consists, involve various work packages. By definition, work packages are tasks at the lowest level of the work breakdown structure or WBS (Schwalbe, 2004). The preparation of the site and laying of the foundation is the first course in the construction process. The foundation is the most important part of construction and requires a substantial amount within the apportioned budget for building materials, as well as time. This stage involves the preparation of the site, which may involve some weeding, smoothing and sectioning, before the laying of the sewer pipes, concrete slabs and the sectioning of drainage Acme Project Plan 15 gutters. These different tasks are altogether estimated to take a total of about 50 days, a little over 5 weeks or over a month. Factored into the time is the acquisition of the necessary materials and labor. The next step is the building of the walls, floor and roof of the structure. Once the foundation is underway, the next step is to start building the actual store structure. This involves several work packages including the framing of the floor and walls, and the construction of the roof of the building. The carving out of the different sections of the store, such as the offices, break rooms, greenhouse and bathrooms also occur here. The estimated time here is about 45 days. The dependency here is of the ‘Finish to Start’ type (Schwalbe, 2004), which necessitates that the construction of the walls, floors etc, will not take off before the completion of the foundation. Since these construction work packages are on the critical path, and the construction resources could become a constraint, we inserted a fifteen-day feeder buffer to ensure any delays in the critical path construction activities do not delay the rest of the project. Next is the installation of the electrical and plumbing fixtures. Pipes are run through the building at this point for water outlets at designated spots, including the break rooms and bathrooms. Plumbing fixtures such as water closets, toilets, sinks and drinking fountains are installed. Electrical work is being done at this point, with the installation of wiring, cabling, outlets, the installation of electrical generators, and subsequently the connection to service for both electricity and water. Work here is slated for a total of 45 days. Building construction wraps up with the finishing of the interior, and the stocking of inventory. Here, the necessary dry walling, painting and finishing is applied to the interior of the building, thereafter, the interior decorators take up the job of smoothing and designing to the specifications provided. Other work packages at this point are floor planning for product location and shelf arrangement. The last part of the interior is the stocking of the shelves with products; after all interior fixtures have been tested for safety and durability. Acme Project Plan 16 The building of the garage is not directly dependent on most of the preceding processes up to this point, but does necessarily occur after the preparation for the site has taken place. So, this portion of the project starts after the foundation for the site has taken place and the adjacent wall has been erected. The construction of this, like the main building, will involve installation of the garage foundation and the framing of its walls, which are then painted, and ending with the marking of parking spaces. The schedule for finishing the store and the garage allows for 155 days, which includes another feeding buffer of twenty days. Acme’s construction plan includes an outer garden, and landscaping for this is for 10,000 square feet. This activity will involve the landscaping of the already sectioned area, which entails the layering with soil, rock and concrete slab placing as designed; paving installation and finally, the planting of selected plants and flowers. This is scheduled for a total of 40 days. This time takes into consideration the various needs of the selected plants and the time needed to ready the soil for planting. Throughout these activates, the marketing and promotion planning proceeds. Scheduled to conclude as the store becomes ready for opening, the marketing work package begins with an analysis of the market, including a competitive analysis, a consumer analysis, and an analysis of Acme’s strengths and opportunities in the market. Next, the project calls for the development of a product, pricing, and promotion plan. Last comes preparation of the merchandising, advertising, and grand opening promotion plan. These marketing activities are scheduled to take 180 days, but they do not fall on the critical path, nor do they require resources that appear at risk of being a project constraint. The last order of the project is to hire and train the employees for each of the departments. This process will involve the advertisement of vacancies. It will also involve a selection process of interviewing, checking of references and candidate consideration. The training may likely be done in groups and will entail customer service dynamics and necessary need-to-know information on products being sold. This takes time and has been scheduled to Acme Project Plan take 65 days, twenty of which are a feeding buffer at this potential constraint along the critical path for a timely store opening. Dependencies Work on the site is dependent upon several things and based on several assumptions. There is an assumption that we have a specific piece of commercially zoned real estate selected 17 and purchased. There is also the assumption that we have, in hand, the required permits to begin construction and open for business. Acme could not begin the joint venture with its local partners without these items in hand. We would rely heavily on our partners’ knowledge of local and regional governmental processes and procedures. Our 12-month timeline could not start until this initial hurdle was cleared. With permits in hand, construction could begin. The mandatory dependencies are such that a natural progression of events must occur for the completion of the structure. Each event is a unique task, however, many are highly dependant on other activities. Certain tasks, like laying the foundation, have finish-to-start relationships with their predecessors. The foundation cannot be poured, obviously, until the site is cleared, leveled, and otherwise prepared. Other activities, like establishing a mobile construction site office, can start simultaneously with another activity, such as beginning to prepare the site, but no sooner. This would be an example of a start-to-start relationship. Of course, other dependencies are also possible. Some tasks must finish along with other activities, while others must finish before another can start. Following is a look at dependencies in the project. As already mentioned, the site must be prepared before the foundation can be laid. Similarly, construction of the walls and floors is dependant upon the foundation being established first. Another finish to start dependency involves building the roof. The walls must be finished before a roof can be constructed. Any delay in completing the wall will push back the start of constructing the roof. A feeding buffer is inserted at this point on the critical path to guard Acme Project Plan against slippage on the project schedule by the construction resource, which is used heavily at this point of the project. Likewise, the walls must also be constructed before wires and plumbing can be run 18 throughout the building. Wiring is designated as having a start to start dependency with installing the generator and electrical circuit boxes. Installing the electrical fixtures, however, is dependant on three predecessors being completed first. Wires must be run, walls must be dry-walled, and electrical service must be established with the utility provider. Much like the electrical fixtures, plumbing fixtures cannot begin to be installed until the pipes have been run, drywall installed, and water service established with the utility provider. Finishing the interior presents another series of finish to start dependencies. Walls and roof must be up before they can be dry-walled. The dry wall must also be installed before they can be painted. Painting is a necessary precedent to installing the shelves and display units. Since these activities fall on the critical path where resources are close to being overloaded, an additional feeding buffer is added here. If any of the string of finish to start dependant activities falls behind schedule, the feeding buffer will help maintain the project schedule. Stocking the inventory cannot begin until the interior is finished. We, therefore, have another finish to start dependency. The construction of the garage is a task that would drive how much inventory we can handle, assuming it is used partly to store inventory. With the interior complete we could stock a certain amount of inventory but the garage would have to be complete before we could finish taking receipt of our entire inventory. This would really be a both an external dependency and discretionary dependency. It is a discretionary dependency in that we could stagger our inventory ordering to take receipt based on how the store is completed. If for, example the lights take the longest to receive, from an inventory perspective, we could stagger the completion of the Acme Project Plan 19 interior portion of the structure. We could order our lighting inventory while completing a different area’s interior first and stock it, then come along and finish the interior of our lighting department in time to take receipt of the inventory. It is also an external dependency because we do not control the timetable that our suppliers deliver on. There is inherent risk in setting up a ‘just-in-time’ approach to taking receipt of inventory. If, for example, our supply of wiring for electrical instillation is unstable or unpredictable, we may not be able to wire-up our lighting department in time to take receipt of our staggered inventory order. The extent of discretionary dependency that we establish is contingent on our tolerance for risk. Completion of paving and landscaping is purely discretionary. We could build the parking lot and landscaping almost entirely independent of the rest of the project but it would not make much sense. This task must simple be finished prior to opening the business. Most of our vendors would need the paving completed for access to the property. It would be a start-start for our inventory. It seems sensible to pave the parking lot simultaneously with paving the garage, making this a start-to-start dependency with pouring the garage concrete. Hiring and training employees is both a discretionary and external dependency. At a macro-level it is externally dependent upon the retail and construction job market in Mexico City, it we hire, rather than contract for, construction workers. If the construction market is soft in Mexico City in the window where we are to hire employees, it is likely we will have many applicants with construction expertise applying for work, in an effort to supplement their incomes. If the construction market is brisk when we are to hire, we may have a harder time finding experienced construction labor. Acme Project Plan 20 As a discretionary dependency, we can begin hiring and training when we deem best. While it is optimal to train most of the floor employees in a fully stocked facility that is nearly operational, we could train the core of the store’s management/ department heads at one of our American stores. It would be desirable for these new managers to see how a fully functional store runs and meet with US counterparts to gain lessons learned. Acme SA de CV will groom promising managers at its Mexico City site to open new stores across Mexico, so it is to our advantage to train new managers as early as possible. Having discussed the work packages, and task dependencies in the project, we turn now to a breakdown of the $7. 5 million project budget. Project Budget Acme Home Improvements de Mexico, SA de CV 12 Month Construction Budget DIRECT COST DESCRIPTION 1. Construction Materials Temporary Utilities/Rentals Excavation / Blasting Footings / Drainage Foundation/Waterproofing Retaining Walls Underground Utilities Trenching, Backfill, Rough Grading Concrete Slab City Water / Well Pump City Sewer / Septic System Sewer/Septic/Underground Connections City Water/Underground Connections Gutters and Downspouts Interior Masonry Rough Framing Materials Structural Steel Trusses Lumber Other wood types Plumbing fixtures Fire System HVAC Electrical – Lighting, Cabling, etc. Electrical Generators SUBTOTALED AMOUNT 1 Acme Project Plan Exterior Stairs Rough Framing Labor Roofing materials Windows Exterior Doors Garage Framing Garage Doors Exterior Stucco Exterior Siding/Masonry Exterior Painting Insulation Sheetrock/Taping Vanities Cabinets Interior Trim Interior Doors Hardware – Bolts, screws, cords, etc. Carpentry Landscaping Soil Granite / Rocks Plants Walkway Slabs Interior Shelving units Equipment rental Safety Equipment Other Total Materials Cost 2. Overheads and Other Costs Personnel salaries – Direct Project Workers Consultants / Professionals Administrative personnel Construction Laborers Accommodation Travel Utilities (Phone, electricity, water) Supplies (Stationery, postage, printing, etc. ) Insurance (Workers Compensation) Teachers / Trainers Other Total Overheads and Other Costs 3. Inventory Labor Costs Shipping Products Truck rentals Loading Off loading Other Labor Duties (Customs Excise) Total Inventory Costs 40% or USD 3. 0 million 3 20% or USD 1. 5 million 2 40% or USD 3. 0 million 21 Acme Project Plan 2 Considerations: 1 The percentages and USD estimates are based on a USD 7. 5 million budget. Wages and Salaries may vary significantly, especially with the current exchange rate of 1USD = 11. 1345 MXN and the difference in the cost of living between both countries. This is cheaper in Mexico and since most labor used will be local, the cost of it may be lower than estimated. 2 3 It is possible that the cost of inventory may vary from the above stated due to considerations such as; delays and pressures of delivery, but with more of a leaning towards an increase. Assumptions: The assumption of the total cost for construction materials is derived from the size of the facility to be built and all that will be required to build it, with a sizeable amount of the cost gong towards the materials for the foundation and walls. Mainly personnel wages and salaries rule the total budget amount for the overheads, with a majority of this going to the professionals or experts in charge of various sections of the project. The total number of people working on this project, aside from its management committee, is estimated to be in the neighborhood of 78. The division is as follows: Approximately 60 for all construction activity and interior work. Among these, professionals are estimated to be five, with a distribution of 1 garage expert, 2 interior designers and 2 building experts. Approximately eight for landscaping duties, with one professional among them. Approximately 10 company professionals for the initial hiring and training of employees. The products to be for inventory will likely cost about as many dollars as the construction effort, if not more, due to shipping, handling and the payment of duties on them. Acme Project Plan VII. Summary Acme Home improvement’s international expansion strategy begins with this project. The 23 company’s joint venture in Mexico City, will lead to the company’s first store outside the United States. Within twelve months, and $7. 5 million, the project team is expected to plan, locate, construct, and open the company’s first international home improvement store. This plan provided an overview of the project organization, management processes, technical processes, work packages, dependencies, schedules and project budget. Accompanying this document is a MS Project work plan, and Project Charter. We believe the information contained in these documents lay out a realistic plan to enable Acme Home Improvements to successfully open its first store outside the U. S. By executing the plan above, we believe Acme can complete this strategically critical project on time and on budget. Acme Project Plan Appendix A: 24 Tasks on the Critical Path Task Prepare site Lay foundation Site Foundation Ready Build walls Construct roof Feeding Buffer Install floors Dry Wall Paint Feeding Buffer Stock Inventory Duration 40d 10d 0d 15d 5d 15d 10d 10d 10d 20d 10d Start Finish Dependncy 3 4 6 7 8 9 22 23 25 26 27FF 37 38 39 40 Resource Construction Concrete Paving Joe Martillo Construction Construction John Tarea Concrete Paving Drywall Painters John Tarea Stock Workers Joe Martillo Human Resources John Tarea Human Resources Anita Socio John Tarea Mon 2/28/05 Fri 4/22/05 Mon 4/25/05 Fri 5/6/05 Fri 5/6/05 Mon 5/9/05 Fri 5/6/05 Fri 5/27/05 Mon 5/30/05 Fri 6/3/05 Mon 6/6/05 Fri 6/24/05 Mon 6/27/05 F ri 7/8/05 Mon 7/11/05 Fri 7/22/05 Mon 7/25/05 Fri 8/5/05 Mon 8/8/05 Mon 9/5/05 Fri 9/16/05 Mon 8/8/05 Fri 9/2/05 Fri 9/16/05 Fri 9/16/05 Fri 9/16/05 Interior Finished Inventory Stocked 0d â€Å"Recruit, interview hire employees† 30d Feeding Buffer Train employees Employees Hired Trained Project Buffer 20d 15d 0d 82d Mon 9/19/05 Fri 10/14/05 Mon 10/17/05 Fri 11/4/05 Fri 11/4/05 Fri 11/4/05 Mon 11/7/05 Tue 2/28/06 Note: Feeding buffers have been inserted along the critical path where resource constraints exist, and a project buffer has been added to protect the end of the project. Acme Project Plan Appendix B: Responsibility Assignment Matrix: Responsibility Assignment Matrix for Acme Home Improvements de Mexico Site Construction and Opening Project 25 Prepared by: John Tarea, Project Manager Date: 2/5/05 1. 1 Joe Martillo Donna Promueva Anita Socio Construction Concrete Paving Electricians Plumbers Drywall Painters Stock Workers Landscapers Human Resources P R 1. 2 R 2. 1 R 2. 2 R 2. 3 R 3. 1 R 3. 2 R 3. 3 R 3. 4 R 3. 5 R 3. 6 R 3. 7 R 3. 8 R 4. 1 R 4. 2 R 4. 3 R 5. 1 6. 1 R 6. 2 R 6. 3 R 7. 1 R 7. 2 8. 1 8. 2 R R R P P P P P P P P P P P P P P P P P P P P P R P R = Responsible for task P = Performing task P Acme Project Plan Resources: Anonymous. (No Date). Mexico business opportunities and legal framework. Retrieved February 4, 2005 from http://www. exico-trade. com/firm. html#gra. Anonymous. (No Date). Mexico business opportunities and legal framework. Retrieved February 4, 2005 from http://www. mexico-trade. com/sense. html#zon. Goldratt, E. (1998). Critical chain. Great Barrington, MA: The North River Press. Hampton Group, The. (2001). PMTalk newsletter. The project management knowledgebase http://www4pm. com. Retrieved Febru ary 3, 2005 from http://www. 4pm. com/articles/PMTalk07-24-01. pdf. Rigby, Ken (2003). Technical Management – a pragmatic approach. 2nd Edition. Retrieved February 3, 2005 from http://home. btconnect. om/managingstandard/techman. htm. 26 Reed Construction Data. (2004). RSMeans ® preliminary cost estimate. Retrieved January 29, 2005 from http://www. firstsourceonl. com/Means/members/result. asp? prname=project=300gsf=100000zip=Calculate. x=24Calculate. y=2Calculate= submit. Schwalbe, K. (2004). Information technology project management (3rd ed. ). Boston: Course Technology. State of Texas, Department of Information Resources. (2003, April 17). Planning guideline: Template project development plan. Retrieved February 2, 2005 from http://www. dir. state. tx. us/eod/qa/planning/projplan. htm#techplan. How to cite Amba 604, Essay examples

Complex Nursing Care Drug Alternatives

Question: Describe about the Complex Nursing Care for Drug Alternatives . Answer: All the blood spots on his clothes should be removed using detergent and it should be sterilized using disinfectant. Disinfectant used should be alcohol and formaldehyde. Dont allow Mr Barber to wear clothes with blood stains. Discard immediately syringes and needle used for Mr. Barber. Surface of the floor should be disinfected, where Mr. Barber vomited. Bedding of Mr. Barber should be changed twice a day (Glen Mayhall, 2013). List of PPE : Gloves, mask, eye protection, face shield, gown and linen. Barbers heart rate is little more than normal heart rate which is called tachycardia, he also has shallow breathing which is littler more than normal which is called tachypnea and his blood pressure is little less than the normal blood pressure. These all vital signs directly correlate with the blood loss in Barber which is called hypovolemic shock. As all these vital signs are slightly deviated from normal values with ADDS score of 1 (Talley OConnor, 2013). Ondansetron is medication specifically used for the prevention of nausea and vomiting. This medication can be administered both by oral route and intravenous route. It exhibits its action by acting as antagonist of serotonin 5-HT3 receptor with less affinity for dopamine receptor. Occurrence of these 5-HT3 receptors is on vagal nerve terminals peripherally and in the chemoreceptor trigger zone of area postrema centrally. Enterochromaffin cells of the small intestine release serotonin and this serotonin stimulates vagal afferents by acting on 5-HT3 receptors which stimulates vomiting reflex. Thus antagonizing effect of ondansetron on 5-HT3 receptors results in the stimulation of vomiting reflex (Christofaki Papaioannou, 2014). Mr. Barber has rapid heart rate. Due to rapid heart rate, P waves are hidden in the preceding T wave and it produces camel hump appearance (Gertsch, 2013). 3. MRN: 0598371 Family Name: Barber Given Name: Frederick Date of Birth: 2/3/1931 S I am EN Ms.A in Emergency ward. I am mentioning about Mr. Barber. I observed that Mr. Barber has haematemasis, epogastric pain, high pulse rate and respiratory rate, low blood pressure. B Mr. Barber was admitted to emergency department on 6/3/2013 at 8 p.m. with haematemasis, epigastric pain. Mr. Barber had Diverticulitis, Emphysema, Ischaemic disease, osteoarthritis and morbid obesity. There is no change in his condition. A I think his blood vomiting is still there. He is taking medication to stop vomiting, however it is not stopping. I have given him IV fluids and analgesic drugs. R It is recommended that, he should undergo gastroscopy. (Porche, 2008) What do you think, who are the most suitable people to take your wife in your absence? Is she would be fine with neighbors or he would like to call upon his relatives who can better understand her feelings and her condition. Whether you required any trained personnel to take care of your wife because, with this nursing staff she would be holistic nursing care. Is there any cultural hindrance in your community to share medical condition to the health care professionals? Because sharing exact medical condition is very important in nursing practice to make effective nursing care plan. Is there requirement to arrange prayer of God for his wife?. Because due to prayers there is the possibility she may get peace of mind and freedom from fear and anxiety (Yousefi Abedi, 2011). Nurse should take consent from Barber to give information to the neighbor about his condition. Nurse should inform neighbor that Mr. Barber is stable now and he is showing improvement in his condition. Frequency of his vomiting is also reduced and he is responding well to the medications. He will be discharged soon and he will with his wife soon. Nurse should inform neighbor that he is inquiring about his wife and asking them to take her of her in proper way. Nurse should tell neighbor that Barber informed that neighbor should consider her forgetfulness and assist her in all her activities (Holzeme Klainberg, 2014). 6. Written consent should be taken from Mr. Barber. Request/consent form should be there with information containing Mr Barber name, date of birth, age, full address, clinical history and medications. Consent form should contain information about nature of testing, complexity of examination, risk related to the procedure and Barbers wish for testing (Daniels, 2014). While transferring to the radiology department each one qualified person form the cardiology and respiratory department is there. Mr. Barber is having low blood pressure which is called hypotension and due to fear of radiological testing it can also affect further his blood pressure. His heart rate is also little more than normal which is called tachycardia and it can also get affected due to anxiety of testing. Hence, for continuous monitoring of his blood pressure and heart rate, expert form cardiology department is required. His respiratory rate is also little higher than normal respiratory rate which is called tachypnea and due to fear and anxiety of radiological testing there may be further shallowness in his respiratory rate. Mr. Barber has very high BMI. To assess and observe respiratory rate, expert form the respiratory department should be there at the time of radiology. Along with this radiology expert and radiographer or radiology technician required for Mr. Barbers radiol ogy testing. Radiology expert and radiographer well trained in manual handling of radiography machine without any discomfort to the patient. This radiography techniques is widely used for the patient with ostoarthritis (Talley OConnor, 2013). 7. D - Danger Danger due to osteoarthritis was checked and there is no danger of fall due to osteoarthritis. R- Response Response was checked by rubbing on his body parts and it is observed that he is conscious. A-Airway Airway was checked and it is observed that his airway is clear. B-Breathing Breathing was checked by keeping ear near to the mouth and chest. It is observed that he is having shallow breathing. C-Circulation Circulation was performed and it is observed that there are 40 chest compressions for every 2 breaths. D- Defibrillator Defibrillator is applied. (Talley OConnor, 2013). Form these assessments it is observed that Mr. Barber is having mild hypovolemic shock due to the loss of blood through vomiting. From the above assessment it is evident that there is increased heart rate per breaths in Mr. Barber. In case of blood loss there is the increased heart rate because to maintain supply of blood to the tissues which is reduced due to blood loss, heart pumps more blood and there is increased heart rate. Also, form the assessments it is evident that there is the increased respiratory rate. Due to blood loss, there is reduced oxygen saturation as compared to the carbon dioxide. To maintain oxygen saturation, lungs breaths at faster rate. Hence, these variations in heart rate and breathing rate are little more than normal values, there is little loss of blood through vomiting (Talley OConnor, 2013). 8. Seretide Accuhaler is the combination of medications like fluticasone propionate and salmeterol xinafoate. Emphysema is a type of chronic obstructive lung disease which occurs due to the inflammation of the lung and due to which there the shortness of breath due to narrowing of airways due to inflammation and followed by structural changes in the airways. Fluticasone propionate is a corticosteroid and it is used as anti-inflammatory agent. Fluticasone propionate reduces inflammation in the respiratory tract by inhibiting recruitment of inflammatory cells. These inflammatory cells produce variety of markers which produces acute exacerbations of emphysema. Thus inhibiting inflammatory cells can reduce acute exacerbations of emphysema. Salmeterol xinafoate is a long-acting ? adrenergic receptor agonist which produces bronchodilator action. Due this bronchodilator action salmeterol xinafoate prevets or reverse narrowing of the airways and useful in preventing wheezing, coughing and sh ortness of breath which are the common symptoms of emphysema (Chen et al., 2013). b. Hold accuhaler in one hand and open it by pushing thumb to the right so the mouthpiece is visible. Hold the mouthpiece of acchaler directing towards you and push the lever away from you. Breathe out to the extent of maximum of your capacity and mouthpiece should be put on your lips. You should breathe through your accuhaler and not the nose and slowly breathe out. Silde the thumb grip back to original postion to close the accuhaler (Chen et al., 2013). Voltaren Emulgel is an external application used for relieving osteoarthritic pain in Mr. Barber. Voltaren Emulgel contains diclofenac sodium which is non-steroidal antiinflmmatory drug use dot reduce pain, swelling and inflammation. Diclofenac sodium exhibits its action by inhibiting prostaglandin synthesis through cyclooxygenase enzyme inhibition. Oxucodone is a opioid pain medication used for reducing osteoarthritis pain of Mr. Barber. Oxycodone is available in the form of controlled release tablet and it produces pain relieving effect over the period of 12 hrs. Thus it helps to improve quality of life. Oxycodone acts a selective full agonist of -opioid receptor and lesser affinity for the other opioid receptors like -opioid and -opioid receptors. Once oxycodone binds to -opioid receptor, G-protein complex released which inhibits neurotransmitter release. As a result cAMP level reduced and it closes calcium channels and open potassium channels. Naproxen in the orally administered nonsteroidal anti-inflammatory drug (NSAID) drug used for reducing pain due to osteoarthritis in Mr. Barber. Naproxen acts by inhibiting prostaglandin synthesis which is pain and inflammatory marker. Naproxen inhibits prostaglandin synthesis by inhibiting both Cox 1 and Cox2 enzymes. Panadol Osteo is a sustained release tablet containing paracetamol. Paracetamol is useful for relieving mild to moderate pain and it acts specifically on the Cox 2 enzyme. Panadol Osteo has two layers of paracetamol. Out layer released within 30 minutes of its administration and second layer released over period of 8 hrs. to give relief from pain to Mr. Barber. Aspirin is also used for the management of pain in Mr. Barber. Aspirin acts by inhibiting Cox1 enzyme and modifying the action of Cox 2 enzyme (Balch, et al., 2011). Nurse should ask him about the pain in the knees, hips and wrists. During what type of activities Mr. Barber is facing problem. Is he having problem in flexion and extension movements of joints? Nurse should ask him to grade his pain score during different activities on a scale of 1-10. Also, nurse should ask him, according to him how bad is his arthritis and ask him to designate either of the mild, moderate and severe. Due to this osteoarthritis his daily activities affected are clothing and putting buttons, washing hair, getting up from chair, getting up from the bed after completion of sleep, taking bath and use of toilet (Sadosky eta l., 2010). Nurse should remove the bandage check the severity of wound due to cut. Nurse should remove the bandage and clean the wound with the help of antiseptic and apply antiseptic lotion on it and apply new bandage. Nurse should advise Mr. Barber not to put water on the leg. Because wound is not properly filled currently and due to water, there may be possibility of infection on the wound. Nurse should daily check the severity of wound, clean it properly and apply new bandage on the daily basis. Nurse also should advise Mr. Barber not to remove bandage on his own, until he gets instructions from the nurse or other medical staff (Peate Glencross, 2015). Nurse should try to convince him about the importance of gastroscopy in his current condition. Nurse should give him confidence that, his wife is going to be taken care nicely by his neighbors. He should be perfectly fine to take his wife. For this purpose, he needs to get recovered completely. Until and unless he performs gastrocopy, it would be difficult to know the exact reason behind his blood vomiting and planning for the concerned intervention. If Mr. Barber is not ready undertake gastroscopy, even after all these efforts, nurse should try to manage blood vomiting with medications for few days and ask him to come back for gastrosopy (Yao, 2013). Mr. Barber is having osteoarthritis problem. So, physiotherapist is the most suitable allied health worker for Mr. Barber. Physiotherapist is associated with the hospital since long time and this physiotherapist is skilled enough to take care of osteoarthritis patients. Physiotherapist is beneficial for Mr. Barber because he can promote moderate exercise in Mr. Barber which helps to reduce pain and improve functioning. Physiotherapist teach Mr. Barber stretching and strengthening exercise which helps to improve free joint motion and make stronger the muscles around the affected joint. Physiotherapist applies cold packs to the affected joints after exercise to relax it and to reduce pain. Also there should be interaction with psychologist who can give moral boost to Mr. Barber in his disease condition. Nurse should assist Mr. Barber in his all daily activities. There should be coordination between physiotherapist, psychologist and nurse for providing holistic community care to Mr. Bar ber (Page Hinman, 2011). References: Balch, J. F., Stengler, M., Young-Balch, R. (2011). AARP Osteoarthritis and Osteoporosis Drug Alternatives. John Wiley Sons. Chen, L., Heng, R.L., Delele, M.A., Cai, J., Du, DZ., Opara, U.L. (2013). Investigation of dry powder aerosolization mechanisms in different channel designs. International Journal of Pharmaceutics, 457(1):143-9. Christofaki, M., Papaioannou, A. (2014). Ondansetron: a review of pharmacokinetics and clinical experience in postoperative nausea and vomiting. Expert Opinion on Drug Metabolism Toxicology, 10(3), 437-44. Daniels, R. (2014). Delmar's Guide to Laboratory and Diagnostic Tests. Cengage Learning. Gertsch, M. (2013). The ECG: A Two-Step Approach to Diagnosis. Springer Science Business Media. Glen Mayhall, C. (2013). Hospital Epidemiology and Infection Control. Lippincott Williams Wilkins. Holzemer, S. P. Klainberg, M. (2014). Community Health Nursing. Jones Bartlett Publishers. Page, C.J., Hinman, R.S., Bennell, K.L. (2011). Physiotherapy management of knee osteoarthritis. International Journal of Rheumatic Diseases, 14(2), 145-51. Peate, I., Glencross, W. (2015). Wound Care at a Glance. John Wiley Sons. Porch, R. A. (2008). High-Alert Medications: Strategies for Improving Safety. Joint Commission Resources. Sadosky, A. B., Bushmakin, A. G., Cappelleri, J. C., Lionberger, D.R. (2010). Relationship between patient-reported disease severity in osteoarthritis and self-reported pain, function and work productivity. Arthritis Research Therapy, 12(4), R162. Talley, N. J, OConnor, S. (2013). Clinical Examination: A Systematic Guide to Physical Diagnosis. Elsevier Health Sciences. Yousefi, H. Abedi, H. A. (2011). Spiritual care in hospitalized patients. Iranian Journal of Nursing and Midwifery Research, 16(1), 125132. Yao, K. (2013). Zoom Gastroscopy: Magnifying Endoscopy in the Stomach. Springer Science Business Media.

Project Management and Virtual Teams free essay sample

Athabasca University Abstract Due to advanced communication technologies, globalization and outsourcing most of the project management teams are based on groups of individuals called virtual teams who work across time and space using communication technologies. Members of virtual teams may be employees of same company from same country, or they can be contractors, suppliers and company employees around the globe. Managing projects using virtual teams have some advantages and disadvantages. Also several studies have been done to try to determine the factors that are positively co-related to the effectiveness of virtual teams (Schwalbe, 2011). To manage virtual teams successfully in project management, the project manager must manage these factors successfully and also minimize the impact of disadvantages. This paper discusses the advantages and disadvantages of the virtual teams in project management and outlines the factors that are positively correlated to the success of projects based on virtual teams. The paper also outlines some of the recommendations to successfully manage the virtual team in information technology projects. We will write a custom essay sample on Project Management and Virtual Teams or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Keywords Globalization, outsourcing, virtual teams, video conferencing, telecommuting, Project Management, Trust and relationship, Advantages of Virtual teams, Disadvantages of virtual team. Introduction Imagine that you are a project manager in a multinational organization and managing a project to upgrade the server operating system and your team members are from different countries with different cultures and working in different time zones. To complete the project successfully that is based on virtual teams, project manager must understand the advantages and disadvantages of managing virtual teams and factors that positively affect the team members. Today most of the project management teams are based on virtual teams whose members work across time and space using communication technologies and project managers cannot rely on previous methods of project team management where they were able to build trust between team member by social interaction, face-to-face meetings, and direct observations of fellow team member commitment. Kirkman, Rosen, Gibson, Tesluk, McPherson, 2002). Literature Review Virtual teams do have some advantages and disadvantages. Some of the advantages outlined by Kathy Schwalbe are: 24/7 availability of workers increasing competiveness and responsiveness, lowering the cost of project as many virtual team members do not need office space and support, providing more flexibility and expertise as project managers have access to the talent around the globe and increasing the work/life balance for team members by eliminating fixed office hours and the need to travel to work. (Schwalbe, 2011). Communication and trust are the most important factors that influence the virtual team performance. Saonee Sarker and others discussed the â€Å"theoretical linkages among trust, communication, and team member performance in virtual teams†. (Sarker1, Ajuja, Sarker, Kirkeby, 2001). To prove their argument the researchers identified and tested three proposed models (additive, interaction, and mediation) describing the role of trust in its relationship. The results of the study indicated that the â€Å"mediating† model best explains how communication and trust work together to influence the performance of virtual team members. In simple words them study proves that â€Å"a communicative individual will be more likely to be trusted and will therefore be more likely to be a high performer†. (Sarker1, Ajuja, Sarker, Kirkeby, 2001) Radostina K. Purvanova reviewed experimental literature and emerging field research on virtual teams. Author compared the â€Å"results from both type of literature and found that experimental literature has largely reported negative results for virtual teams, whereas ? eld investigations and case studies of real virtual teams employed by business organizations report positive outcomes for virtual teams. (Purvanova, Feb 2014) According to the article although results reported by experimental versus field studies are quite different, author concludes that both literatures have revealed negative attitudes toward virtual communication media. Advantages of Virtual Teams The main advantages of virtual teams include: The biggest advantage of virtual team enjoyed by an organization is the associated cost savings. The organization can save huge expenses on real estate, office spaces, utility bills such as gas, electricity, water etc. and executive’s travel. Team members can work from anywhere and anytime of the day. They can choose the place they work based on the mood and the comfort. You can recruit people for their skills and suitability to the job. The location does not matter. There is no time and money wasted for commuting and clothing. Physical handicaps are not an issue. Another advantage is the labour laws, some organizations prefer to have virtual teams because of strict local labour laws. Since the members span the time zones, there could be different team working on the same project 24/7, so when one member sleeps there will be another one somewhere else who would start work where the former had left. This shortens the product development time as well as faster response time to demands in both global and local markets. Disadvantages of Virtual Teams Disadvantages of virtual teams include: Since team members do not frequently meet or do not meet at all, the teamwork spirit may not be present. Some people prefer to be in a physical office when working. These people will be less productive in virtual environments. To work for virtual teams, individuals need to have a lot of self-discipline. If the individual is not disciplined, he or she may be less productive. The cultural difference between the members of virtual teams gives rise to number of conflicts. For example, while an employee from one part of the world would write a straightforward email describing a bad situation; this would be perceived as impolite by a member of the team from other part of the world. This would lead to conflicts, mistrust and difficulties in fruitful collaboration which is so vital for the success of virtual team functioning. These challenges are also precipitated by the absence of non-verbal cues so intrinsic to face-to-face interactions. Many members of virtual teams are adversely affected by the lack of physical interactions. Most of the communications in virtual environment is task-oriented. In today’s society where job is an important social force for most of us because many of our workplace colleagues also constitute our close friends, this gives a not-so-good feeling of social isolation. This in turn counter-effects productivity as well as leads to stress. In the virtual environment, it is better to communicate, clarify, and confirm everything to make sure that all members have the same understanding about the task at hand. This produces of ton of paperwork and files that could quickly fill your archives. Factors that positively affect virtual teams Succession planning and promotions involving virtual team members are important factors and if managed properly, virtual team members will feel that they are receiving recognition and credit and as a result they will be satisfied and their productivity will be increased. (Leonard, 2011) Since team members are not communicating face to face, constructive team and individual feedback early and often becomes more important and if managed properly can avoid many problems before hand. Trust between team members and project leader is an important factor that can affect the performance of team members. One important way to build trust between team members is effective communication. The more they communicate with each other and with project more they build the trust. Well defined and documented team process also important which saves a lot of time for especially new team members to find answers to their questions related to policies and procedures. A team member selection and role preference is also important factor to successfully manage the virtual teams. Dr. Meredith Belbin defined a team role as a tendency to behave, contribute and interrelate with others in a particular way. 15 It is important to select team members carefully and to form a team where all roles are covered. Each virtual team member must also understand his or her role(s) on the team. † (Schwalbe, 2011) Discussion and Conclusions Organizations such as IBM, Microsoft, Whirlpool as well as SMEs are reaping the benefits of virtual teams for some time now. It has been a well-recognized fact that virtual team is not a passing tide but it is here to stay. Virtual teams are rising in numbers nowadays and even small technology companies are now adapting virtual team practice for recruiting the best people from all over the globe and reduce the cost. As outlined in previous sections, virtual teams do have advantaged and some disadvantages as well. To benefit from advantages and to minimize the impact of disadvantages a project manager can focus on factors that positively affect the virtual team’s performance. As indicated by previous researchers, increase in trust, comfort level and communication effectiveness leads to better project success. All of the above discussed disadvantages can be overcome by following a different leadership approach, trainings, greater role clarity and effective communication strategies. Also earlier discussed factors that affect virtual teams, if managed properly can result in a successful project. In addition, the companies using virtual teams can minimize their operating costs and maximize the profit margins. Additionally, the employees working in virtual teams are at advantages when it comes to working in their own home, own time, and reduction of commuting costs. Therefore, organizations should look into setting up virtual teams for different tasks whenever possible. To reap the benefits of virtual teams in projects and minimize the impact of disadvantages virtual team managers should manage the outlined factors properly and should also follow best practices outlined in next section. Best Practices When running virtual teams, some of the best practices include: An instant messaging program can be used to create a sense of presence amongst members of the team. Chat is a good way to have side conversations during meetings to gain consensus, confirm understanding or ask questions. Quick questions can be asked through instant messenger as a substitute for popping into someone’s cubicle. Services for syncing files, bug tracking, project management, source control, web conferencing, conference calls, screen recording, usability testing and so on. A virtual phone system allows mapping of phone extensions to any phone number. Advance features allow callers to dial by name, get placed into a phone queue or get recorded answers back from a phone tree. In-person meetings are also a good option; it helps build team cohesion and trust and can help people get to know each other on a deeper level. But they are by no means critical. Bringing everyone together once a year may cost a little, but it’s still often cheaper than paying local salaries and rent, and increases the efficiency of team.

Free Online Public Schools for Michigan Students

Free Online Public Schools for Michigan Students Michigan offers resident students the opportunity to take public school courses online for free. This public school option is for parents who prefer a flexible, home-based environment for their children.  The online schools use certified teachers and follow a curriculum designed to provide the students with an education that equals that of other public school students. Most virtual schools offer full-time and part-time enrollment. The online schools offer core courses similar to the standard courses offered by other programs. They meet all the academic requirements for graduation and for potential admission to colleges. Honors courses and Advanced Placement college-level courses are also available.   All the virtual programs require that students provide a computer and an internet connection. In some cases, the programs provide a computer and an internet allowance to families who cannot afford the equipment. The family is expected to provide a printer,  ink,  and paper. In most cases, online students are free to attend school activities in their district. Several no-cost online schools currently serve grades K-12 in Michigan.   Michigan Free Online Public Schools Highpoint Virtual Academy of Michigan  serves Michigan students in grades K-8. Students are offered the same core courses that are available to students in a brick-and-mortar school. Textbooks and instructional materials are provided for the student. Virtual students are invited to participate in school outings and field trips and other social events. Jenison International Academy is available in West Michigan. Because Jenison is a School of Choice district, any family not residing in the Jenison district can simply apply for non-resident enrollment. JIA is a tuition-free public school serving students in grades K-12.Insight School of Michigan is a full-time only free virtual public school authorized by Central Michigan University. Currently, the Insight School of Michigan offers grades 6-12. Michigan Connections Academy  is a free K-12 virtual charter school. State-certified teachers provide instruction with support from trained counselors and administrative staff.Michigan Great Lakes Virtual Academy  serves students in grades K-12. Parents do not pay tuition for their students to attend an online public school. The academy offers core, comprehensive, honors and AP courses.Michigan Virtual Charter Academy  offers full-time enrollment for grades K-12. Because Michigan Virtual Charter Academy is part of the public school system, there is no charge for the curriculum.   Michigan Virtual School  offers two free classes per academic term at no cost to parents of students in Michigan. Additional courses require payment of a fee.Virtual Learning Academy Consortium serves students in grades K-8. The Virtual Learning Academy Consortium  serves students in Genesee, Lapeer, Livingston, Oakland, Washtenaw and Wayne counties.VLAC also serves students in grades 6-8 in Kala mazoo county. Choosing a Michigan Online Public School When choosing an online public school, look for an established program that is  regionally accredited  and has a track record of success. Be wary of new schools that are disorganized, are unaccredited or have been the subject of public scrutiny. For more suggestions on evaluating virtual schools see  how to choose an online high school. About Online Public Schools Many states now offer tuition-free online schools for resident students under a certain age (often 21). Most virtual schools are charter schools; they receive government funding and are run by  private organizations. Online charter schools are subject to fewer restrictions than traditional schools. However, they are reviewed regularly and must continue to meet state standards. Some states also offer their own online public schools. These virtual programs generally operate from a state office or a school district. Statewide public school programs vary. Some online public schools offer a limited number of remedial or advanced courses not available in brick-and-mortar public school campuses. Others offer full online diploma programs. A few states choose to fund seats for students in private online schools. The number of available seats may be limited and students are usually asked to apply through their public school guidance counselor.

Finance C1 Essay Example | Topics and Well Written Essays - 1250 words

Finance C1 - Essay Example ence on the textile import from Asia especially from China, Pakistan , India and Bangladesh coupled with China’s traditional superiority in producing cost effective products gave EU a opportunity to increase its trade volume with the region and with it the currency of the trade also. The recent economic happenings in the world economy are clearly suggesting a weakening American economy which is lingering from its subprime crisis and now seems to be engulfing into the energy crisis as the oil prices have started to raise also. The overall situation suggests a different story, a new feature, and new rules of the economic superiority in the world. Though the US is the largest single economy in the world however, its neighboring countries are not that powerful in terms of their economic standing therefore any kind of regional pacts such as EU may not provide a more and better economic power to US to further influence the world economy. In the spring of 2008, dollar traded nearly at $1.6 per Euro suggesting the slide of Dollar against the Euro in the recent past. The rising dollar against the Euro as well as a mild to medium recession into the US economy is suggesting a hint of decrease in the overall competitiveness of the US economy. The consistent slide of dollar in the international market against another major currency suggest that the future may develop itself into a new face where the currency of competition within the international markets may no longer remain as dollar but may very well see Euro as the major currency for trade in international market. The British Prime Minister has recently said that all the Europe will combine together to bail out the current crisis into the international markets and many observers view this statement within the context of the dominance of the EU over the world markets if it succeed in bringing the required stability into the world economic markets. (Rhodes, 2008). The qu estion whether the Euro will lead the future

Rise of Capitalism Essay Example | Topics and Well Written Essays - 1500 words

Rise of Capitalism - Essay Example In a capitalist society there is competition in the market. Friedrich (1995) states that competition in the capitalist system is based on the assumptions that there are many buyers and sellers in the market, This assumption means that the existence of many buyers and sellers means that the prices and conditions in the market cannot be controlled by one buyer or seller. The other assumption is that there are zero barriers to entry and exit into an industry by firms, this means that the market supply and demand depends ion the nature of market where if only some firms controlled the market than competition will be limited and prices determined by the firm in the industry. The other assumption is that consumers have knowledge regarding prices in the market. This means that a consumer has information regarding the quality and price of a product and therefore firms will compete in the market to meet consumer price and quality requirements. Therefore the capitalist society is characterised by competition and this competition leads to the proper allocation of resources of production, the other systems have limited competition where in the socialist society no competition is evident because this system is based on equality philosophy. Motivation:The capitalist society through its competitive nature helps in promoting increased production and innovative ideas. The nature of the capitalist society motivates individuals to involve themselves in production activities unlike other forms.... Therefore this system is different from the socialist and feudal systems in that there is private ownership of property. Competition: In a capitalist society there is competition in the market. Friedrich (1995) states that competition in the capitalist system is based on the assumptions that there are many buyers and sellers in the market, This assumption means that the existence of many buyers and sellers means that the prices and conditions in the market cannot be controlled by one buyer or seller. The other assumption is that there are zero barriers to entry and exit into an industry by firms, this means that the market supply and demand depends ion the nature of market where if only some firms controlled the market than competition will be limited and prices determined by the firm in the industry. The other assumption is that consumers have knowledge regarding prices in the market. This means that a consumer has information regarding the quality and price of a product and therefore firms will compete in the market to meet consumer price and quality requirements. Therefore the capitalist society is characterised by competition and this competition leads to the proper allocation of resources of production, the other systems have limited competition where in the socialist society no competition is evident because this system is based on equality philosophy. Motivation: The capitalist society through its competitive nature helps in promoting increased production and innovative ideas. The nature of the capitalist society motivates individuals to involve themselves in production activities unlike other forms of economic organisation. Given that production resources are scarce the individuals in the economy will compete

Explain the evolution of the portrait of the Arab in Modern Hebrew Essay

Explain the evolution of the portrait of the Arab in Modern Hebrew Literature Nation and nationalism in Haim Hazaz's 'The S - Essay Example Consequently, the formation of an independent state has produced a series of new conditions that have heightened the flourishing of Hebrew literary works in Israel in the not so distant past. While this narrative has frequently been recounted, the continuity between the development of Hebrew literature and the formation of the state has altered the historiographic viewpoint on the era (Band 2003). The perspective has been basically natural: the Hebrew literature and the Arabic identity are depicted as parallels maturing together. Credit is given to the pre-state literary works of Haim Hazaz and other established authors. Although it is customary to focus upon what appears to be the new attempts to provide expression to the developing reality of Arabic identity and statehood, the consequent reality is unfinished. Even when creating a literary narrative distantly, most scholars prefer to group the authors of a literary era together and afterwards interpret authors and literary works in dependently, mapping out their growth from time to time in their lives. This is perhaps the most logical means to address the diversity and evolution of artistic output (Band 2003). If we aspire to make sense of the contemporaneous nature of a literature in a particular period, how authors and spectators of different periods interrelate in reality, how social and political circumstances might have influenced them as a generation, we should delve deeply into the dominant themes, such as the evolution of Arab identity and nationalism in Haim Hazaz’s seminal work ‘The Sermon’. These initial remarks on the development of Israel literature present a fundamental perspective for this essay: an interpretation of how Haim Hazaz contributed substantially to the formation of the Zionist story, as well as the modern representation of the Arab identity and nationalism. Although a great deal has been written on the development of Zionism and Hazaz, there has been a lack of suf ficient evaluation of his important contribution in this vital project. Recognition is frequently given to his essay ‘The Sermon’, yet the unrelenting position of Hazaz in the heart of the literary period as the standard, well-liked author of the Labour Party, the major cultural and political strength of the state and the Yishuv in its initial decades (Band 2003), has not been acknowledged. This limitation is the reasonable consequence of the widespread historiographic prejudice that emphasises the revolutionary in each period to the abandonment of the general image of literary construction in any generation. Authors are part of the generation when they initially made a radical difference. Evolution of the Arab Identity and Nationalism in Haim Hazaz’s ‘The Sermon’ The portrait of the Arab in Modern Hebrew literature as shown in ‘The Sermon’ is a remarkable illustration of the Arab cultural and political development. To be examined in Haz az’s essay is the degree to which Modern Hebrew literature acknowledges Arab identity or distinctiveness. Particularly, to what level does Yudka’

Effectiveness of Guidelines in Improving Patient Care

Effectiveness of Guidelines in Improving Patient Care This brief considers the empirical literature on the use of clinical guidelines in patient care. It is argued that negative guideline characteristics and justified concerns amongst doctors negate satisfactory adherence. Clinical guidelines have been part of the UK landscape for many decades, as a means of improving health care for patients (Woolf et al, 1999). Research evidence suggests that a significant proportion of physicians do not adhere to clinical guidelines in patient care (e.g. Grol et al, 1998; Forsythe et al, 1999; Sherr et al, 2001; White, 2001; Thomas et al, 2003). Sherr et al (2001) investigated adherence of Obstetric Units in the UK and Eire to antenatal HIV testing policies. The Department of Health and Royal College of Obstetricians have both issued specified guidelines, which require that antenatal HIV testing be offered to all pregnant women, and adherence to these benchmarks has generated some debate. Data from 89% of antenatal units was analysed. Only 10% of units offered testing to all presenting women, and these units were concentrated in areas of high HIV prevalence (i.e. London). Other units operated selective screening policies (offering antenatal testing to some women, identified on the basis of clinical criteria) or ‘on request’ screening. Forsythe et al (1999) studied adherence of senior NHS staff (consultants, general practitioners) towards BMA guidelines on the ethical responsibilities doctors have towards themselves and their families. The Academy of Royal Medical Colleges, and the General Medical Council both endorse these guidelines, which generally require that doctors do not assume responsibility for their own personal (or family’s) health care. Questionnaire data was collected from four randomly chosen NHS Trusts and three local medical communities in the London (South Thames) area. Personal use of health services was the outcome measure. Results showed that although most doctors (96%) were registered with a GP, the majority (63% of GPs and 59% of consultants) had not consulted their GP in the past year. Almost a quarter (24%) of consultants stated they would never see a GP before obtaining consultant advice. The majority (71% of GPs and 76% of consultants) self-prescribed drugs ‘usually’ or ‘sometimes’. Forsythe et al (1999) concluded â€Å"senior doctors are not following the BMA guidelines on looking after their own and their families health† (p.608). Clinical guidelines are thought to have significant benefits for patient care (Woolf et al, 1999). However, research findings on the impact of guidelines are mixed (Morrison et al, 2001; Bennewith et al, 2002; Bousquet et al, 2003). Bousquet et al (2003) conducted a randomised controlled trial assessing the value of guidelines of the International Consensus on Rhinitis (ICR) in caring for patients with seasonal allergic rhinitis. GPs were randomised into two groups: one group followed ICR guidelines (patients received an oral anti-histamine, a topical corticosteroid, and/or a topical ocular cromone) while the other group were free to choose appropriate treatment for patients. Outcome measures were degree of impairment[1] and symptom medication scores. Patients treated by the guidelines strategy GPs generated lower symptom scores over a three-week period compared with patients assigned to free-choice GPs. Furthermore, patients in the guideline group reported greater reductions in their degree of impairment compared to the free choice group. This trial clearly demonstrated the benefits for patients of implementing clinical guidelines. Diggory et al (2003) reviewed the results of five audits relating to cardiovascular-pulmonary resuscitation (CPR) at the Mayday University Hospital. At least one audit focused on doctors’ adherence to elderly care policy and guidelines recommended by the Royal College of Physicians. Documentation of a CPR decision, review of all patients, and documentation of any changes to the CPR decision became policy in the emergency department. CPR decisions were documented by both trainee doctors and consultants for >91% of cases. Consultants reviewed 93% of patients within 24hours, and documented a CPR decision in 81% of cases. Benefits for patients seemed to present in a reduction in DNAR[2] orders. Other research suggests that the benefits of guideline adherence for patients may be more limited. Morrison et al (2001; Bennewith et al, 2002) assessed the impact of clinical guidelines for the management of infertility, in both primary and secondary care settings. . Figure 1 Clinical investigations completed for intervention and control practices (Morrison et al, 2001) Over 200 general practices and NHS hospitals accepting referrals for infertility in Greater Glasgow were randomised to a control or intervention condition. The intervention group received clinical guidelines. No group differences were found in referral rates, albeit referrals from intervention practices were more complete, incorporating all essential clinical investigations (e.g. semen analysis, rubella immunity) (see Figure 1). No group differences emerged in the percentage of referrals in which a management plan was achieved within one year, in the mean duration between first appointment and date of management plan, and costs of referrals. On the whole, this study demonstrates a differential effect of guideline adherence across different criteria of patient care. Despite the (modest) increase in the number of recommended clinical investigations performed prior to referral, clinical guidelines were no more cost effective than having no guidelines. Overall, research findings are mixed regarding the benefits of guideline adherence for patient. Nevertheless, improvements in some aspects of care have been demonstrated. What guideline characteristics are pertinent to adherence? Michie et al (2004) assessed the reasons why GPs do not always conform to guidelines. The focus was on guidelines set by the UKs National Service Framework (NSF) for Coronary Heart Disease (CHD). London based GPs, who were classified as either ‘high implementers’ (adhered to five or more of 6 CHD standards) or ‘low implementers’ (adhered to 1 or 2 guidelines), were interviewed on their beliefs, self-reported behaviours, and organisational context. Several issues differentiated the two groups: views about evidence based practice; control over clinical practice; and the repercussions of adhering to guidelines. Low implementers were more sceptical about evidence-based practice, more worried about the lack of control over the development and implementation of guidelines, and their own professional duties as doctors, and adverse consequences for GPs/patients that outweigh any benefits. This study highlights the importance of GP attitudes towards guideline adherence. Irani et al (2003) emphasised the methodological characteristics of the guidelines themselves. They assessed the quality of national clinical practice guidelines (CPGs) on benign prostatic hyperplasia, and lower urinary tract symptoms. Two independent assessors appraised methodological quality of the CPGs using the St.Georges Hospital Medical School Health Care Evaluation Unit Appraisal Instrument. This tool incorporates items gauging three criteria: rigour of development (e.g. ‘Is there a description of the sources of information used to select the evidence on which the recommendations are based?’), context and content (e.g. ‘Is there a satisfactory description of the patients to which the guidelines are meant to apply?’), and clinical application (‘Does the guideline document suggest possible methods for dissemination and implementation?’). Analysis revealed substantial variability in quality across CPGs. Grol et al (1998) found an association between guideline characteristics and adherence. An observation design was used to study 47 specific recommendations from 10 clinical guidelines in relation to 12 different guideline characteristics. For example, evidence base, clinical experience, concerned with daily practice, and ambiguity. Regression analysis revealed three key characteristics that predicted most of the variance in compliance rate: ‘the recommendation is vague and not precisely defined’, ‘the recommendation demands change of fixed routines’, and ‘the recommendation is controversial and not compatible with current values’. Figure 2 Rates of compliance across guideline attributes (present or absent) (Grol et al, 1998) Figure 2 illustrates differentials in adherence rates as a function of the presence or absence of different guideline attributes. In general practitioners were more likely to comply in the presence of an evidence base, capacity to solve clinical problems, precisely described, and media publicity. Compliance was also more probable in the absence of capacity to provoke patients, requiring change to clinical routines, significant consequences for management, demanding new skills/training, controversy, complexity, and ambiguity. Clinical guidelines in the UK have historically been prescribed by a multiplicity of agencies, notably the Department of Health, and profession-specific bodies, such as the Royal College or Surgeons, Royal College of Nursing, and British Medical Association. The National Centre for Clinical Excellence (NICE) currently sets clinical guidelines. This body continually publishes benchmarks for most areas of clinical practice. The Department of Health has also established Essence of Care standards, which have a more generic focus (DOH, 2003). Guidelines are purportedly based on empirical evidence, notably randomised control trials, hence satisfying the requirement for evidence-based practice. However, reservations amongst GPs about the notion of evidence-based guidelines, which often fall outside their clinical experience, has been identified as one reason for low adherence amongst doctors (The BRIDGE Study Group, 2002; Michie et al, 2004). GP scepticism is partly justified. Morice and Parry-Billings (2006) discuss the validity of such ‘evidence’, identifying several important important issues. Firstly, NICE, the DOH, and other relevant prescribing bodies rely on clinical trials, many of which select patient groups â€Å"to give the trial treatment maximum scope to show an effect†. Then there is publication bias –studies showing positive or dramatic effects are more likely to be published than studies showing no difference/effect. Guidelines are often linked to meta-analyses, which by definition will be ‘infected’ by the research biases already mentioned. What is worrying is that many national guidelines are adapted locally, in the form of hospital policy (e.g. Sherr et al, 2001; Diggory et al, 2003), and these adaptations may have an even weaker evidence base than the national benchmarks set by NICE, DOH, and other prescribers. None of this is likely to improve GPs attitudes towards guideline adherence. Do doctors need guidelines? In a discussion of heart disease regulations in the UK, Petch (2002) argued that the specification of treatment criteria has not been very successful in the USA and other countries. Adherence to guidelines is criticised on three grounds. Firstly, guidelines imply universal health care, an ideal most nations cannot afford, least of all the UK, which relies on rationing (i.e. waiting) due to limited health resources. Attempting to implement similar standards for every single patient is expensive. Secondly, recommended treatments can often have complications/side effects, so that certain treatments may be inappropriate for certain patients, but yet be a mandatory therapy, which the doctor is compelled to follow regardless. Thirdly, administering the same treatment to all patients is not cost-effective. The treatment may not benefit every patient. It is usually not clear â€Å"which patients will benefit from which drugs and hence the victim of a heart attack will be recommended to take aspirin, a statin, a ÃŽ ² blocker, and an angiotensin converting inhibitor, in addition to other drugs†¦Ã¢â‚¬  (p.474). Nevertheless, guidelines remain an integral element of patient care. This raises an important question: what kind of support do GPs require in order to adhere to guidelines? Marshall et al (2001) investigated factors that facilitate guideline acceptance in health professionals. Representatives from general practices in the NHS Northern and Yorkshire region were interviewed. Thematic analysis highlighted several issues including the need for training (staff often lacked the requisite clinical expertise to implement some guidelines), a conflict between responsibility and control (nurses/doctors are responsible for implementing criteria, but have no say over resource allocation), the and ‘cul-de-sac’ of patient non-compliance (e.g. little can be done if patients refuse treatment, and this is interpreted as failure of staff to adhere to guidelines). CONCLUSION Several key issues have emerged from this review. Firstly, research findings are mixed regarding the benefits of clinical guidelines for patient care. There is clearly a need for more randomised controlled trials. The benefits for patients probably vary across disease types, clinical setting, and doctor and patient characteristics. Doctors have serious concerns about the use of guidelines in patient care, and these reservations are mostly justified. Perhaps the most defensible concerns relate to questionable evidence base, the need to account for differences in how individual patients respond to treatment, and poor guideline characteristics, such as ambiguity. Unsatisfactory guideline implementation by doctors will probably persist until these problems are fully addressed by NICE and the Department of Health. BIBLIOGRAPHY Bennewith, O., Stocks, N., Gunnell, D., Peters, T.J., Evans, M.O. Sharp, D.J. (2002) General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial. British Medical  Journal, 324, p.1254. Bousquet, J., Lund, V.J., van Cauwenberge, P., Bremard-Oury, C., Mounedi, N., Stevens, M.T. El-Akkad, T. (2003) Implementation of guidelines for seasonal allergic rhinitis: a randomised controlled trial. Allergy, 58, pp.733-741. Diggory, P., Cauchi, L., Griffith, D., Jones, V., Lawrence, E., Mehta, A., O’Mahony, P. Vigus, J. (2003) The influence of new guidelines on cardiopulmonary resuscitation (CPR) decisions. Five cycles of audit of a clerk proforma which included a resuscitation decision. Resuscitation, 56, pp.159-165. Forsythe, M., Calnan, M. Wall, B. (1999) Doctors as patients: postal survey examining consultants and general practitioners adherence to guidelines.  British Medical Journal, 319, pp.605-608. Grol, R., Dalhuijsen, J., Thomas, S., Veld, C.I., Rutten, G. Mokkink, H. (1998) Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. British Medical Journal, 317, pp.858-861. Irani, J., Brown, C.T., van der Meulen, J. Emberton, M. (2003) A review of guidelines on benign prostatic hyperplasia and lower urinary tract symptoms: are all guidelines the same? British Journal of Urology, 92, pp.937-942. Marshall, J.L., Mead, P., Jones, K., Kaba, E. Roberts, A.P. (2001) The implementation of venous leg ulcer guidelines: process analysis of the intervention used in a multi-centre, pragmatic, randomised, controlled trial.  Journal of Clinical Nursing, 10, pp.758-766. Michie, S., Hendy, J., Smith, J. Adshead, F. (2004) Evidence into practice: a theory based study of achieving national health targets in primary care. Journal of  Evaluation in Clinical Practice, 10, pp.447-456. Morice, A.H. Parry-Billings, M. (2006) Evidence based guidelines – a step too far?  Pulmonary Pharmacology and Therapeutics, 19, pp.230-232. Morrison, J., Carroll, L., Twaddle, S., Cameron, I., Grimshaw, J., Leyland, A., Baillie, H. Watt, G. (2001) Pragmatic randomised controlled trial to evaluate guidelines for the management of infertility across the primary care-secondary care interface. British Medical Journal, 322, pp.1-5. Petch, M.C. (2002) Heart disease guidelines, regulations, and the law. Heart, 87, pp.472-479. Sherr, L., Bergenstrom, A., Bell, E., McCann, E. Hudson, C.N. (2001) Adherence to policy guidelines – a review of HIV ante-natal screening policies in the UK and Eire. Psychology, Health and Medicine, 6, pp.463-471. The BRIDGE Study Group (2002) Responses of primary health care professionals to UK national guidelines on the management and referral of women with breast conditions. Journal of Evaluation in Clinical Practice, 8, pp.319-325. Thomas, A.N., Pilkington, C.E. Greer, R. (2003) Critical incident reporting in UK intensive care units: a postal survey. Journal of Evaluation in Clinical Practice, 9, pp.59-68. White, S.M. (2001) An audit of audit and continued educational and professional development. Anaesthesia, 56, pp.1003-1004. Woolf, S.H., Grol, R., Hutchinson, A., Eccles, M. Grimshaw, J. (1999) Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines.  British Medical Journal, 318, pp.527-530. Footnotes [1] Using the Standardised Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). [2] ‘Do not attempt resuscitation’