Information Systems in Global Business Today Essay

1. Why is it important to understand the difference between computer literacy and information literacy? Answer: Computer literacy – When you are computer literate, you have a general working knowledge of computers. You understand what they can be used for. Most people know that they can type a paper, create a power point and if you have internet access, you may e-mail and search the World Wide Web for information. Information literacy- When you are information literate, you understand and are able to gather, analyze and use information gathered from the various types of technological medians – especially the internet. This person may access the internet, for instance on their cell phone, iPod, lab tops, and a multitude of medians, some which may have not yet been realized. -It is important to understand the difference of this two literacy because A literate person cannot be expected to know how to operate a computer. In essence, a person can be literate but not computer literate. But the opposite seems difficult to be true. A computer literate is often always a literate. 2. Discu ss the three elements of an information system (hardware, software and persware) that managers must consider. Which of the three do you consider the most important? Answer: Hardware- Hardware, in the computer world, refers to the physical components that make up a computer system. Software- is any set of machine-readable instructions (most often in the form of a computer program) that directs a computer’s processor to perform specific operations. Persware- that is short for ‘personware’ or ‘peopleware’, a terribly inpersonal way of referring to people as a resource, like hardware or software. – I consider being the most important element if information system is the Persware because without this persware the hardware and the software will be useless. 3. What are some of the new roles information systems are playing in organizations? * The Widening Scope of Information Systems * The Network Revolution and the Internet * New Options for Organizational Design: The Networked Enterprise * Flattening Organizations * Separating work from location * Reorganizing work flows * Increasing flexibility of organizations * The changing management process * Redefining organizational boundaries * Electronic Commerce and Electronic Business 4. Discuss the changes in the business environment brought about by technology in the last three years. Use your own personal experiences to formulate your answer. Answer: There are many changes in the business environment brought by the technology in the last three years. I believe that one of the most important changes (affecting accounting practice) that has taken place in my experience is the changed relationship between the company and its investors. There is an explosion of required disclosures, and a huge increase in the interest the investment community has in those disclosures. And the internet is the largest changes because every year there is changes on it. Many programs are approaching that every people in the society can learn many things about those programs brought by the technology.. 5. Draw your conclusions about the article â€Å"IT Doesn’t Matter† by Nicholas Carr by accessing the given url: [http://www.nicholasgcarr.com/articles/matter.html#readings]. Answer: The article explained the dilemmas that the IT industry and the end users are currently experiencing. IT used to be a way for companies to gain a competitive advantage, but nowadays IT has fused into another tool to conduct business. IT products are becoming cheaper and cheaper while yielding more power. This trend in the long run will destroy the economic incentive for IT manufacturers to continue doing business. On the other hand cheaper is better for companies implementing this technology. The author made it clear that avoiding brand new IT products and opting for slightly older IT products would save money. In addition, slightly older products have all the â€Å"kinks ironed out† yielding a more reliable system. Buying slightly older IT products is not a fail safe way of obtaining efficiency and initial cost savings.

Nursing Pressure Sore

What are pressure sores? Pressure sores are areas of injured skin and tissue. They are usually caused by sitting or lying in one position for too long. This puts pressure on certain areas of the body. The pressure can reduce the blood supply to the skin and the tissues under the skin. When a change in position doesn't occur often enough and the blood supply gets too low, a sore may form. Pressure sores are also called bedsores, pressure ulcers and decubitus ulcers. What are the symptoms of a pressure sore? There are 4 stages of pressure sores. Symptoms at each stage include the following: Stage 1.The affected skin looks red and may feel warm to the touch. The area may also burn, hurt or itch. In people who have dark skin, the pressure sore may have a blue or purple tint. Stage 2. The affected skin is more damaged in a stage 2 pressure sore, which can result in an open sore that looks like an abrasion or a blister. The skin around the wound may discolored. The area is very painful. St age 3. These types of pressure sores usually have a crater-like appearance due to increased damage to the tissue below the skin's surface. This makes the wound deeper. Stage 4.This is most serious type of pressure sore. The skin and tissue is severely damaged, causing a large wound. Infection can occur at this stage. Muscles, bones, tendons and joints can be affected by stage 4 pressure sores. Who gets pressure sores? Anyone who sits or lies in one position for a long time might get pressure sores. You are more likely to get pressure sores if you are paralyzed, use a wheelchair or spend most of your time in bed. However, even people who are able to walk can develop pressure sores when they must stay in bed because of an illness or an injury.Some chronic diseases, such as diabetes and hardening of the arteries, make it hard for pressure sores to heal because of poor blood circulation. Peripheral vascular disease,MI, Stroke,Multiple trauma,Musculoskeletal disorders/fractures/contractu res,Gibleed , Spinal cord injury (e. g. , decreased sensory perception, muscle spasms),Neurological disorders (e. g. , Guillain-Barre', multiple sclerosis),Unstable and/or chronic medical conditions (e. g. , diabetes, renal disease, cancer, chronic obstructive pulmonary disease, congestive heart failure),History of previous ressure ulcer,Preterm neonates, Dementia, Recent surgical patient. Where on the body can you get pressure sores? Pressure sores usually develop over bony parts of the body that don't have much fat to pad them. Pressure sores are most common on the heels and on the hips. Other areas at risk for pressure sores include the base of the spine (tail bone), the shoulder blades, the backs and sides of the knees, and the back of the head. How are pressure sores treated? There are several things you can do to help pressure sores heal: * Relieving the pressure that caused the sore * Treating the sore itself Improving nutrition and other conditions to help the sore heal What can be done to reduce pressure on the sore? Don't lie on pressure sores. Use foam pads or pillows to take pressure off the sore. Special mattresses, mattress covers, foam wedges or seat cushions can help support you in bed or in a chair to reduce or relieve pressure. Try to avoid resting directly on your hip bone when you're lying on your side. Use pillows under one side so that your weight rests on the fleshy part of your buttock instead of on your hip bone. Also, use pillows to keep your knees and ankles apart.When lying on your back, place a pillow under your lower calves to lift your ankles slightly off the bed. When lying in bed, change your position at least every 2 hours. When sitting in a chair or wheelchair, sit upright and straight. An upright, straight position will allow you to move more easily and help prevent new sores. You should change positions every 15 minutes when sitting in a chair or wheelchair. If you cannot move by yourself, have your caregiver help you shift your position. How should the pressure sore be kept clean? In order to heal, pressure sores must be kept clean and free of dead tissue.Stage 1 sores can be cleaned with mild soap and water. You can clean stage 3 sores by rinsing the area with a salt and water solution. The saltwater removes extra fluid and loose material. Your doctor or nurse can show you how to clean your pressure sore. Pressure sores should be kept covered with a bandage or dressing. Sometimes gauze is used. The gauze is kept moist and must be changed at least once a day. Newer kinds of dressings include a see-through film and a hydrocolloid dressing. A hydrocolloid dressing is a bandage made of a gel that molds to the pressure sore and helps promote healing and skin growth.These dressings can stay on for several days at a time. Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from the pressure sore. Rinsing the sore e very time you change the bandage is helpful. Special dressings that help your body dissolve the dead tissue can also be used. They are left in place for several days. Another way to remove dead tissue is to put wet gauze bandages on the sore and allow them to dry. The dead tissue sticks to the gauze and is removed when the gauze is pulled off.For more severe pressure sores, dead tissue must be removed surgically. Removing dead tissue and cleaning the sore can hurt. Your doctor can suggest a pain reliever for you to take 30 to 60 minutes before your dressing is changed to help reduce pain. Why is good nutrition important for healing sores? Good nutrition is important because it helps your body heal the sore. If you don't get enough calories, protein and other nutrients (especially vitamin C and zinc, which can help heal wounds like pressure sores), your body won't be able to heal, no matter how well you care for the pressure sore.Your doctor, nurse or a dietitian can give you advice about a healthy diet. Be sure to tell your doctor if you have lost or gained weight recently. What if the sore gets infected? Pressure sores that become infected heal more slowly and can spread a dangerous infection to the rest of your body. If you notice any of the signs of infection listed below, call your doctor right away. Signs of an infected pressure sore include the following: * Thick yellow or green pus * A bad smell from the sore * Redness or warmth around the sore * Swelling around the sore * Tenderness around the soreSigns that the infection may have spread include the following: * Fever * Chills * Mental confusion or difficulty concentrating * Rapid heartbeat * Weakness How are infected pressure sores treated? The treatment of an infected pressure sore depends on how bad the infection is. If only the sore itself is infected, an antibiotic ointment can be put on the sore. When bone or deeper tissue is infected, antibiotics are often required. They can be given intravenous ly (through a needle put in a vein) or orally (by mouth). How can I tell if the sore is getting better? As a pressure sore heals, it slowly gets smaller.Less fluid drains from it. New, healthy tissue starts growing at the bottom of the sore. This new tissue is light red or pink and looks lumpy and shiny. It may take 2 to 4 weeks of treatment before you see these signs of healing. How can pressure sores be prevented? The most important step to prevent pressure sores is to avoid prolonged pressure on one part of your body, especially the pressure points mentioned previously. It's also important to keep your skin healthy. Keep your skin clean and dry. Use a mild soap and warm (not hot) water. Apply moisturizers so your skin doesn't get too dry.If you must spend a lot of time in bed or in a wheelchair, check your whole body every day for spots, color changes or other signs of sores. Pay special attention to the pressure points where sores are most likely to occur. If you smoke, you shou ld quit. People who smoke are more likely to develop pressure sores. Exercise can help improve blood flow, strengthen your muscles and improve your overall health. Talk to your doctor if physical activity is hard for you. He or she can suggest exercises that can work for you, or refer you to physical therapist that can help. Pressure Sore PreventionRelieving pressure: Position must be changed on a regular basis, at least every two hours, and in the very frail at least every hour. Good Diet: A good and balanced diet contributes to healing, as well as avoiding severe nutritional and weight loss Skin Care: Keep the skin clean. Moisture should be minimized. Skin care products should be used that moisturize the skin but do not make it wet or soggy. Use continence aids if a person is unable to control their bladder or bowels. Pads, diapers, convenes or catheterizing. Inspect the skin to see if any redness or breaks in the skin are developing.Use products to relieve and treat pressure sore s; airbeds, foam bed, bed and chair protectors, chair products, continence aids can all contribute to avoiding of bed sores. Clean skin with warm water and minimal friction. Apply lotion often. ————————————————- Avoid direct pressure to bony areas such as ankles and hips. Use pillows and padded protectors to support arms, legs and vulnerable areas. Change the position of a bed-bound person every two hours. Handle and move carefully to avoid skin tears and scrapes.Change the position of a chair-bound person hourly. Discourage the bed-bound or chair-bound person from sitting with the head elevated more than 30 degrees, except for short periods of time. Check and change bed linens as often as necessary Use continence management products if necessary to reduce exposure to moisture. Padded supports, such as doughnut cushions may, themselves, become a source of pressure. Do not massage bony areas of the body. Do not massage pressure sores. Do not use remedies such as iodine, peroxide and cornstarch that may further irritate the skin.Pressure sores (bedsores, decubitus ulcers, pressure ulcers) are areas of skin damage resulting from a lack of blood flow due to pressure. †¢ Sores often result from pressure but may also result from pulling on the skin or friction, particularly over bony areas. †¢ The diagnosis is usually based on a physical examination. †¢ Treatment includes cleansing, removal of pressure from the affected area, special dressings, and, sometimes, surgery. Pressure sores can occur in people of any age who are bedbound, chairbound, or unable to reposition themselves. They are more common among older people.They tend to occur over bony projections where pressure on skin can be concentrated, such as over the hip bones, tailbone, heels, ankles, and elbows. They occur where there is pressure on the skin from a bed, wheelchair, cast, splint, or other hard object . Pressure sores lengthen the time spent in hospitals or nursing homes and increase the cost of care. Pressure sores can be life threatening if they are untreated or if underlying health conditions prevent them from healing. Causes Causes that contribute to the development of pressure sores include: †¢ Pressure Traction †¢ Friction †¢ Moisture †¢ Inadequate nutrition Pressure on skin, especially when over bony areas, reduces or cuts off blood flow to the skin. If blood flow is cut off for more than 1 or 2 hours, the skin dies, beginning with its outer layer (epidermis). The dead skin breaks down and forms an open sore (ulcer). Most people do not develop pressure sores because they constantly shift position without thinking, even when they are asleep. However, some people cannot move normally and are therefore at greater risk of developing pressure sores.They include people who are paralyzed, comatose, very weak, sedated, or restrained . Paralyzed and comatose people are at particular risk because they also may be unable to move or feel pain (pain normally motivates people to move or to ask to be moved). Traction also reduces blood flow to the skin. Traction occurs when the skin is stretched by being wedged against something or when it sticks to something, often bed linens. When the skin is stretched, the effect is much like pressure. Friction can lead to or worsen pressure sores. Repeated friction may wear away the top layers of skin.Such skin friction may occur if people are pulled repeatedly across a bed. Moisture can increase skin friction and weaken or damage the protective outer layer of skin if the skin is exposed to it a long time. For example, the skin may be in prolonged contact with perspiration, urine, or feces. Inadequate nutrition increases the risk of developing pressure sores and slows the healing process of sores that do develop. Malnourished people may not have enough body fat to pad the skin and bones or to keep the blood vessels from being squeezed shut.Also, skin repair is impaired in people whose diets are deficient in protein, vitamin C, or zinc. Did You Know†¦? †¢ Inadequate nutrition increases the chances of developing pressure sores and slows the healing of sores that do develop. †¢ Repositioning people who cannot move themselves at least every 1 to 2 hours can help prevent pressure sores. Symptoms For most people, pressure sores cause some pain and itching. However, in people whose senses are dulled, even severe sores may be painless. Pressure sores are categorized into four stages according to the severity of damage: †¢ Stage I: Redness and inflammation Stage II: Some shallow skin loss, including abrasions, blisters or both †¢ Stage III: Full-thickness skin loss down to the layer of fat. †¢ Stage IV: Full-thickness skin loss with exposure of underlying muscle, tendon, or bone Pressure sores do not always progress from mild to severe s tages. Sometimes the first noticeable sign is a late-stage sore. If pressure sores become infected, they may have an unpleasant odor. Pus may be visible in or around the sore. The area around the pressure sore may become red or feel warm, and pain may worsen if the infection spreads to the surrounding skin (causing cellulitis).Infection delays healing of shallow sores and can be life threatening in deeper sores. Infection can even penetrate the bone (osteomyelitis), requiring weeks of treatment with antibiotics. In the most severe cases, infection can spread into the bloodstream (sepsis), causing fever or shaking chills. Spotlight on Aging Aging itself does not cause pressure sores. But it causes changes in tissues that make pressure sores more likely to develop. As people age, the outer layers of the skin thin. Many older people have less fat and muscle, which helps absorb pressure.The number of blood vessels decreases and blood vessels rupture more easily. All wounds, including pr essure sores, heal more slowly. Certain conditions make pressure sores more likely to develop: †¢ Being unable to move normally because of a disorder such as stroke †¢ Having to stay in bed for a long time, for example, because of surgery †¢ Being excessively sleepy (such people are less likely to change position or ask someone to reposition them) †¢ Losing sensation because of nerve damage (such people do not feel discomfort or pain, which would prompt them to change ositions) †¢ Becoming less responsive to what is happening in and around them, including their own discomfort or pain, because of a disorder such as dementia Diagnosis Doctors can usually diagnose pressure sores by doing a physical examination. A doctor or nurse usually measures the size and depth of a sore to determine its stage and plan treatment. If the damage is severe, radionuclide bone scanning or gadolinium-enhanced MRI (magnetic resonance imaging) may be done to check whether infection has spread from the sore to bone—a disorder called osteomyelitis.To diagnose osteomyelitis, doctors may need to take a small sample (biopsy) of bone to see if bacteria grow from it (culture). Prevention Prevention is the best strategy for dealing with pressure sores. In most cases, pressure sores can be prevented by meticulous attention from all caregivers, including nurses, nurses' aides, and family members. Close daily inspection of a bedridden or chairbound person's skin can detect early redness or discoloration. Any sign of redness or discoloration at pressure areas is a signal that the person needs to be repositioned and kept from lying or sitting on the discolored area until it returns to normal.Because shifting position is necessary to keep the blood flowing to the skin, oversedation should be avoided and activity encouraged. People who cannot move themselves should be repositioned every 2 hours if they are in bed and every hour if they are in a chair—more often if possible. The skin must be kept clean and dry because moisture increases the risk of developing pressure sores. Dry skin is less likely to stick to fabrics and cause friction or traction. For people confined to bed, sheets should be changed frequently to make sure they are clean and dry.Applying noncaking body powder to skin in areas where two parts of the body press against each other (such as the buttocks and groin) can help keep the skin in these areas dry. Bony projections (such as heels and elbows) can be protected with soft materials, such as foam wedges and heel protectors. Donut-shaped devices and sheepskins should be avoided as they only shift pressure or friction from one vulnerable site to another. Special beds, mattresses, and seat cushions can be used to reduce pressure in people who are wheelchair-bound or bedridden.These products can reduce pressure and offer extra relief. A doctor or nurse can recommend the most appropriate mattress surface or seat cushion. It is important to remember that none of these devices eliminate pressure completely or are a substitute for frequent repositioning. Treatment Treating a pressure sore is much more difficult than preventing one. The main goals of treatment are to relieve pressure on the sores, keep them clean and free of infection, and provide adequate nutrition. Adequate nutrition is important in helping pressure sores heal and in preventing new sores from forming.A well-balanced, high-protein diet is recommended as well as a daily high-potency vitamin and mineral supplement. Supplemental vitamin C and zinc may help with healing as well. Electrical stimulation, heat therapy, massage therapy, and hyperbaric O2 therapy have not proven helpful. In the earliest stage, pressure sores usually heal by themselves once pressure is removed. When the skin is broken, a doctor or nurse considers the location and condition of the pressure sore when recommending a dressing. Film (see-through) dressings help protect ea rly-stage pressure sores and allow them to heal more quickly.Hydrocolloid (oxygen- and moisture-retaining) patches protect, keep the skin appropriately moist, and provide a healthy environment for deep sores. Other types of dressings may be used for deeper sores, those that ooze a lot of fluids, and those that are infected. If the sore appears infected or oozes, rinsing with saline and dabbing gently with a gauze pad are helpful. A doctor may need to remove (debride) dead tissue with a scalpel or a chemical solution. Removal of dead tissue is usually painless, because pain is not felt in dead tissue. Some pain may be felt because healthy tissue is nearby.Health care practitioners may flood (irrigate) the sore, particularly its deep crevices, with a sterile solution to help clean away hidden debris. Sometimes a bed that circulates air (an air-fluidized bed) is used in hospitals and nursing homes. This special bed helps reduce or redistribute pressure on the body. ——â₠¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€- Deep pressure sores are difficult to treat. Sometimes they require skin and muscle flaps, in which healthy, thicker tissue with a good blood supply is surgically repositioned to cover the damaged area.This type of surgery is not always successful, however, especially for frail older people who are malnourished. Often, when infections develop deep within a sore, antibiotics are given. When bones beneath a sore become infected, the bone infection (osteomyelitis) is extremely difficult to cure and may spread through the bloodstream, requiring many weeks of treatment with an antibiotic (see Bone and Joint Infections: Osteomyelitis). ————————————————- The terms decubitus ulcer and pressure sore often are used interchangeably in the medical community.Decubitus, from the Latin decumbere, means â€Å"to lie down. † Decubitus ulcer, therefore, does not adequately describe ulceration that occurs in other positions, such as prolonged sitting (eg, the commonly encountered ischial tuberosity ulcer). Because the common denominator of all such ulcerations is pressure, pressure sore is the better term to describe this condition. Pressure is exerted on the skin, soft tissue, muscle, and bone by the weight of an individual against a surface beneath.These pressures are often in excess of capillary filling pressure, approximately 32 mm Hg. In patients with normal sensitivity, mobility, and mental faculty, pressure sores do not occur. Feedback, conscious and unconscious, from the areas of compression leads inIndividuals who are unable to avoid long periods of uninterrupted pressure over bony prominences—a group of patients that typically includes elderly individuals, persons who are neurologically impaired, and patients who are acutely hospitalizedà ¢â‚¬â€are at increased risk for the development of necrosis and ulceration.These individuals cannot protect themselves from the pressure exerted on their body unless they consciously change position or have assistance in doing so. Even the most conscientious patient with an extensive support group and unlimited financial resources may develop ulceration resulting from a brief lapse in avoidance of the ill effects of pressure. [2, 3] dividuals to change body position. These changes shift the pressure prior to any irreversible tissue damage. The inciting event for a pressure sore is compression of the tissues by an external force, such as a mattress, wheelchair pad, or bed rail.Other traumatic forces that may be present include shear forces and friction. These forces cause microcirculatory occlusion as pressures rise above capillary filling pressure, resulting in ischemia. Ischemia leads to inflammation and tissue anoxia. Tissue anoxia leads to cell death, necrosis, and ulceration. à ¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€- Irreversible changes may occur after as little as 2 hours of uninterrupted preSpecialized support surfaces are available for bedding and wheelchairs, which can maintain tissues at pressures below 30 mm Hgssure. urning and repositioning the patient remain the cornerstones of prevention and treatment. The wound and surrounding skin must be kept clean and free A new international guideline with regard to the prevention of pressure ulcers was released in 2009. [11] A collaboration between the National Pressure Ulcer Advisory Panel and the European Pressure Ulcer Advisory Panel, the guideline covers the latest evidence-based recommendations for all patients in all healthcare settings.Clinical practice recommendations in regard to prevention will include: * Current definitions and classification of pressure ulcers; * Risk assessment, including the role of nutrit ion; * Skin inspection and skin care; * Positioning and repositioning patients; * Evidence for use of various support surfaces (air-fluidized beds; alternating air mattresses and cushions; foam-, gel-, or fluid-filled mattresses; overlays for operating tables; turning beds; and other aids for pressure redistribution); * Protective devices used for pressure ulcer prevention; and * Education and training for healthcare providers.

Cultural Identity Journal Research Paper Example | Topics and Well Written Essays - 2250 words

Cultural Identity Journal - Research Paper Example Having been in the United States for nine years now, my job as a yoga instructor paved the way for me to belief in the benefits accorded by meditation. I feel yoga sets us on a journey of self discovery, where we no longer need to continue searching for happiness, we realize it is already within us. Still, I do not lose track of my purpose for living and that when I die, the life I lived would be judged and would be decided on the fate of my eternal existence. II. VALUES I value relationships more than any material blessings. I treasure the times I spent with my family in Poland, especially the bond that we shared and the happiness felt by the mere presence of family members. My primary values are sharing my talents to others so that others’ lives would be enriched by their interaction with me. This would enable me to attain a sense of worth through my personal contribution to life: by doing good in the tasks and responsibilities as an interpreter and a yoga instructor. I hone stly believe that relationships are worth dying for: that we strive hard in life for the benefit of those we love. The people we love dearly are worth protecting more than any material things, which we ultimately leave on earth when we die. III. CULTURAL PATTERNS A. Application of Hofstedes's Five Dimensions I am basically a COLLECTIVIST. Poles often form extended families - with grandparents who take care of grandchildren while parents are working. In many instances children live in the same town or neighborhood where the parents and grandparents live. Polish people, especially young, are very attached to their parents, family and home in Poland and feel unsecure on their own. As explained in Hofstede’s dimension, collectivism manifests finding â€Å"societies in which people from birth onwards are integrated into strong, cohesive in-groups, often extended families (with uncles, aunts and grandparents) which continue protecting them in exchange for unquestioning loyaltyâ₠¬  (Itim International par. 2). B. UNCERTAINTY AVOIDANCE Poles are basically averse of taking risks and therefore manifest high levels of UNCERTAINTY AVOIDANCE. Polish society is not that mobile as American or western European societies from many reasons and partly because of this cultural dimension, therefore the unemployment is high in some areas of Poland but people are not willing or cannot move somewhere else. I believe that I am more than an exception to the rule since I bravely took the risk of living away from my family and pursuing opportunities in America. C. POWER DISTANCE I also believe that there are inequalities in societies but that the roles that each person plays determine their power. Therefore in terms of the POWER DISTANCE INDEX, I believe that power and inequality are matters of perspectives. I treat people of higher authority with due respect but I do not acknowledge that they are better or more authoritative than me. I contend that it is their roles and respo nsibilities that require people to classify them to belong to higher or lower levels in an organizational hierarchy, for example; but their inner self and category as a member of the universal world is just the same as mine. D. MASCULINITY versus FEMININITY In terms of defining MASCULINITY versus FEMININITY, I still believe that although contemporary societies exhibit more equality in gender, still more societies are

The Volcanic Island Arcs of the Pacific Term Paper

The Volcanic Island Arcs of the Pacific - Term Paper Example (Akusekijima) near Pacific. Iriomotejimi: In the north of Iriomotejimi Island, submarine volcano is present. This volcano is located 25 km north north east (NNE) at the tip of Iriomotejimi island. The estimated depth of the area where this island is located is about 200 to 300 meters. A major eruption took place at this volcanic island in 1924. The after effects of this eruption were terrible. The pumice rafts produced with this eruption had total volume about 1 cu km. This was carried away by water currents along the whole coast of Japan as far as Hokkaido situated in the north. The largest block formed by melted concrete also known as pumice blocks exceeded up to 1x2 meters in size. The volume of eruption proved to be the largest among all the historical eruption. The largest volume made this outbreak volcanic explosion as the largest in Japan’s history. Kikai Caldera Kikai Caldera is a massive volcano up to 12 miles in diameter. This volcano is located in Osumi islands in J apan. This volcano is the remain of ancient volcanic eruptions took place thousands years ago. Akahova eruption is directly connected to Kikai Caldera. This eruption is considered one among the largest volcanic eruptions took place during Holocene ten thousand years ago. The consequences of this volcanic eruption prolonged and about six thousand years ago, pyroclastic flows from that outbreak and the magma reached to the southern coast of Kyushu. This flow extended over an extensive area up to 62 miles away. The ash could be felt at distant areas. This eruption further produced round about 150 cubic kilometers of tephra. The Volcanic Explosivity Index was 7 due to this massive explosion. So, the ongoing conditions made this one of the most destructive and explosive in last 10, 000... The term paper "The Volcanic Island Arcs of the Pacific" talks about the Pacific tectonic plates all along the boundary situated in the West. These plates move under another and sink into the mantle of the Earth. As a result subduction zones establish in broad curves and island chains develop along these zones. These chains are known as island arcs. Islands are formed due to these volcanic activities but at the same time, there might be several other reasons. Flexing plates, sometimes, up to warp the floor of the sea, lifting it out and form islands. Moreover, if subducting plate has plentiful sediments then these sediments may be slipped off to overriding plates. This scrapped sediment portion builds up into a wedge which is called mà ©lange. Sometimes this wedge may put up so much that it converts into a ridge. This ridge further dominates the forearc. For arch is the region present in between the trench axis and island arc. When tectonic forces apply to these forearcs, they get uplift and the ridges are also uplifted and form islands. Examples of such types of islands include Yap, Guam, and Eua. The Kuril Islands formed volcanic arc composed of 45 volcanoes present on 20 islands. The Pacific Plate shifts with great velocity. This speed is about 90 mm per year. The Pacific plate subducts under Okhotsk Plate near Kuril trench. Here it goes deeper in a northwest direction. This area is seismically very active to a depth of about 680 km. the volcanoes present here are heated up with melted magma.

Cross Cultural Health Perspectives Personal Statement

Cross Cultural Health Perspectives - Personal Statement Example Q1- Even "objectively measured clinical outcomes" may be erroneous when there is a lack of cross-cultural understanding. Apart from attitudinal differences between the patient and the care provider leading to miscommunication, there could be 'real' differences like some conditions/immunities being more prevalent among some groups, and even differing responses to medication. Q 4 - Even a "conscientious" care-provider cannot eliminate all prejudice or false assumptions about other groups of people, as many of these may be deeply rooted-in his/her subconscious. Being aware of this enables me to question my assumptions, accept that I am prone to error, and retain a degree of flexibility to correct myself when the evidence points out that I may have culturally stereotyped a patient at any time. Q 5- When noting medical history where a communication barrier exists, yes or no answers are least useful (response a). It is possible that when the questions are asked, some important aspect may be ignored. My mistake in this question happened due to inattention. I gave the response for the 'most useful', instead for 'least useful'. The lesson for my in this is that I should be paying more attention, in general, when I do a task-whether reading something or listening to a patient. Lesson taken! Q 6 - The least useful technique when tackling a patient's beliefs about treatment is to tell the patient that his/her belief is false, even if this is done in a gentle manner (resp b), because beliefs could be deeply entrenched. I was unable to identify this, while doing the quiz. Q 13- Japanese men, after migration to the US, retain a lower susceptibility to coronary heart disease than the general population (resp b)-a fact which I now know. Facts like these, based on research studies, can be accessed by more study and reading. Q15 - Immigrants who go to traditional healers do not keep away from Western medicine (resp b-false) Q 17- A smile could express worry or dis-satisfaction in some cultures. (resp a) It is useful to know this, a fact which seems strange at first, but so necessary for a care provider to know so that diagnosis is correctly done. All the other responses (16 in number, as earlier mentioned) were correct. In order to maintain cultural competence-both to avoid the deficiencies as revealed in my quiz answers, as well as to strengthen my correct perceptions-I have to keep working at developing more empathy, enhance listening skills, retain openness of mind, and improve my information base by keeping myself updated about various research studies regarding health indicators of different cultural groups. Works Cited Hunt, Linda Beyond Cultural Competence in The Park Ridge Centre for Health, Faith and Ethics, , retrieved 30th Nov, 2008 The Provider's Guide to Quality and Culture , retrieved 30th

Community Action Personal Health Paper Essay Example | Topics and Well Written Essays - 750 words

Community Action Personal Health Paper - Essay Example The activity I chose to carry out was to send a letter to the Calvin Klein clothing company. The letter includes some points about the relationship between advertising and eating disorders, and how the Calvin Klein image is one of those which causes young people to hold themselves up to impossible standards. I feel that they are a company who really exemplifies the trend towards "thin at all costs" - the idea that thin is an ideal which should be pursued regardless of the consequences. I think that pursuit of this ideal is very unhealthy, particularly for young people. Because I have an eating disorder, carrying out this activity was quite empowering for me. I enjoyed it because advertising is such a powerful tool, and I firmly believe that if advertising were to change and start portraying real bodies wearing real-sized clothing, Western society's image of the ideal body would change. I am not really under the illusion that my letter will be the impetus for change but I am glad that I got the chance to express my opinions, and writing out exactly how I feel about these issues has felt really positive. Anorexia and Bulimia are increasingly in the public eye, particularly because the profile of these diseases is raised by celebrities who have battled these eating disorders. This is unfortunate in one sense because these diseases are legitimized by their association with the rich and famous. This is reinforced by the point that compulsive overeating and the morbid obesity which often results is far less socially acceptable than anorexia or bulimia. The community is far less inclined to accept compulsive overeating as an eating disorder, instead labeling sufferers as lazy and lacking in willpower. There are many organizations dedicated to promoting awareness of eating disorders. The National Association of Anorexia Nervosa and Associated Disorders is an example of an organization which operates at the national level. This association raises awareness of eating disorders with support groups, message boards and chat rooms, education packs for schools, and publicity drives with local and national media. (ANAD 2006) According to an article that appeared in the San Francisco Chronicle early this year, Bay Area residents don't have many options when it comes to finding support for eating disorders at the local level. (Harlick 2006) However support groups do exist. One such example is the Ohlhoff Eating Disorders Program, which provides a wide array of services to aid people in recovering from all types of eating disorders. (Ohlhoff 2006) Overall I think I have learned the most from completing the activity portion of this assignment. Even though I have read about and known how advertising and fashion companies have played an influential role in the increasing trend of eating disorders, actually writing to a company to express my views has really crystallized my views on the subject. References Harlick, J. People suffering eating disorders have precious few outpatient resources in the Bay Area. San Francisco Chronicle. January 6 2006. National Association of Anorexia Nervosa and Associated Disorders Retrieved May 23, 2006 from . Ohlhoff Eating Dis

WilaSeldons Leadership at Tides Centre Essay Example | Topics and Well Written Essays - 2250 words

WilaSeldons Leadership at Tides Centre - Essay Example One of the critical aspects of organizational excellence involves effective leadership in an organization. This assumes critical significance considering the fact that leadership provides the long term vision to the organization and also helps formulate a roadmap to success (Yukl, 2007, p.445). In real life there is considerable number of examples of the manner in which effective leadership has been able to generate competitive edge. This includes the likes of individuals like Steve Jobs (founder of Apple), William and Sergy Page (Google), NR Narayana Murthy (Infosys) who have shown how an effective leadership can help bring about a growth momentum for any organization (Maak & Pless, 2006, p.5-8). The aspect of leadership has been a subject matter of great academic research in various areas. There have been many leadership theories including behavioral theories, contingency theories trait as well as power and influence theories that define and classify various kinds of leaders with t heir style of leadership in an organization (Kinicki & Kreitner, 2009, p.348). The case analysis of Tides center reveals a democratic style of leadership of Wila Seldon at Tides center. A democratic leadership style involves a leader making decisions on the basis of consultations with other team members. These types of leaders seek inputs from various quarters of the organization before making a crucial decision. In other words a democratic leader takes into account the views and sentiments of the entire organization while undertaking a major decision in the organization. A democratic leader tries to ensure encourage the entire organization in the decision making process (Daft & Lane, 2007, p.44). The analysis of the leadership qualities of Wila Seldon reveals a significant correlation with the traits of the democratic leader mentioned above. In the case it was quite evident that in all her stints as a leader, where she always tried to involve the entire organization with regards to crucial decision making for the organization. The case study shows that while assuming charge at Tides center Wila Seldon instead of making decisions like an autocratic leader chose to take the employees views into account. The initiation of teams like M team, strategic management team also shows that the CEO tried to ensure that decision making and learning has a bottom up approach. This is quite contra from the perspective of an autocratic or a Laissez faire type of leaders who normally take up decisions without consulting others and do not take an active role in the decision making and leave it to the responsibility of others (Wood, 2011, p.255). Wila Seldon also displays democratic leadership straits even in cases like the introduction of the 360 degree appraisal system for measuring employee performance at the organization as well as to the decision of referring projects as customers. Unlike an autocratic leader who imposes his/her decisions on their subordinates, Wila Seldon acted as a true democratic leader when she even took views of the employees who were opposing the decision. The CEO did not act in a haste and imposed decisions but tried to indulge into a democratic decision making process. This has helped in employees getting greater responsibilities and also to the fact that employees started to think out of the box solutions. This type of leadership skill was extremely important for an organization like Tide that was in the midst of a severe crisis in business whose revamp required comprehensive and extra efforts apart from an inner drive to propel the organization towards growth. The democratic lead

Plastic Surgery Complications Essay Example | Topics and Well Written Essays - 500 words

Plastic Surgery Complications - Essay Example A very common problem in surgery that may occur is anesthesia or Sedation. Possible problems and complications including irregular heartbeat, brain injure, heart attack, blood clots, any sort of stoke, nervous breakdown, paralysis and in the worst cases, death is also possible. Ex- Miss Argentina, Solange Mahnano who was just 37 year old passed away due to a plastic surgery, leaving seven year old twins behind (CNN, 2009). Anesthesia can occasionally aggravate air passages, that may result in tremor of the vocal cords and blockage of the airway may occur. Another complication could be Malignant Hyperthermia that may result in the complicated disorder in one’s Blood pressure, heartbeat and body temperature. If not recognized and treated quickly, can lead to death. This may be inherited. In case, circulation of blood is upset up to severe extent then it may also cause Brain Damage or failure. Due to a few muscular disorders, patient might suffer Temporary paralysis. However, Temporary Paralysis can be recovered. It is always advisable to discuss complete medical history that could be any lung disease or any other disorder with your physician or surgeon. Heart Patients must not go for cosmetic surgery in any case as it could result in severe complications. In almost all the surgeries, bleeding cannot be avoided and is treated normally. Especially in hair transplant, noticeable bleeding is expected. However, bleeding at extreme level and bleeding right after the surgery can gather beneath the skin and a need of another surgery may arise. Similarly, DVT or blood clots may occur due to long operations. General anesthesia might cause DVT. It can take place as a consequence of blood pooling, especially, in the case of pregnancy etc. It is not very normal to deal with such situation. Plastic Surgery Truth published that Cosmetic surgery is very popular

Domestic Architecture Essay Example | Topics and Well Written Essays - 1000 words

Domestic Architecture - Essay Example The general plan of the houses, is very similar to the buildings of the Tudor period One of the distinguishing features of this style is that the second story projects out slightly over the first. The corners of the house are decorated with little suspended pendant-like ornaments. Both these features are typical of the medieval fashion, where the second floor would project out, and a little into the street. The website also says that it would appear that buildings so fashioned were considered more 'formal' and 'fancier'. Yet another distinguishing feature of this style is the asymmetry of the house As the article, 'Colonial Architecture' points out the Parson Capen House, was among the more modest dwellings of that time. The front door of the Parson Capen house is not quite in the center of the wall, but slightly to the right, thus asymmetrical. Also like other colonial structures, the second floor projects out. As the article states the house, "is typical of the two-story New England house of overlapping weatherboards. Northern Arizona University tells us that it was in France: that Jefferson learned of Roman architecture and its symbolic association with Greek democracy. With this inspiration, he began reworking the house he had begun in 1769, upon a small mountain, and continued to tear down and re-build it till 1809. The Wikipedia free encyclopedia mentions that Monticello in French means 'little mountain' Jefferson was inspired by the works of Andrea Palladio particularly the Villa Rotunda says the article, 'Classic(al) Revival / Jeffersonian Classicism / Roman Classicism'. Prof Paradis says that the identifying features of this style include a dentil cornice emphasized with wide band of trim, porches, temple-front entryway, and square or rounded columns, usually Doric. Another interesting feature at Monticello is the dome. This style of architecture competed with the Federal style, which was more prevalent and dominant at the time, and which drew its origins from the 'Adamesque' (Georgian) style of architecture. states the article 'Federal Style.' Another feature of this style and period is that windows have a number of small panes of glass because it was difficult to make large pieces of glass. There might be 12, 8, or 6 panes in both the top and bottom window sashes. These features can all be seen in Monticello. Another website with information on Jefferson titled '1768 to 1782 Thomas Jefferson, architect Near Charlottesville, Virginia, USA' says that, "he combined the great European traditions of Palladio with American domesticity." The difference from Palladio, the article says, lay in aspects he introduced to the Monticello like the "long horizontal wings, underground service rooms, and all sorts of "modern" gadgets. " William Low House, Charlottesville, Virginia. (1887) Frank Lloyd Wright 428 Oak Park, Illinois (1889) Shingle style. "A shingled home does not stand on ceremony. It

Dior J`adore Perfume Essay Example | Topics and Well Written Essays - 2000 words

Dior J`adore Perfume - Essay Example As J’adore is a luxury item, it adds to the personality of women customers. The main features and attributes of the product highlighted by the company are: femininity, sophistication, and emotion. The other features are its everlasting fragrance, better quality, innovation, and its brand name. The company offers free shipment for a particular range of J’adore products. Tester facility is provided to the customers, to test the perfume as a demo. They also offer attractive sale offers on particular occasions like Christmas. During Christmas season Dior offers combination like lotion with perfume. Women, who have high income, are the main consumers of J’adore. The products come in models like J'Adore L'Absolu, J'Adore Anniversaire En Or, J'Adore L'or, J'Adore L'eau. Customers are ready to spend more time in search of the product, because once they use it they always go for the same product, and they identify themselves with the picture of feminity in the perfume. They never go for a different or substitute product, because of its unique fragrance and quality. The product has been in the market for the last ten years. Flimsy bottle caps sometimes with decorated gold ribbon, brilliant, transparent and unique crystal bottle design, and attractive letter design of the word J’adore are the distinctive features of the product packing. They also use luxurious, clean, contemporary image of celebrities on the package. Dior follows the pricing strategy of competitive pricing, ie; they set the price according to the prices set by their competitors. They also adopt premium pricing strategy for particular product range, to highlight the product’s exclusiveness. The product faces competition from Chanel, Guerlain, Cartier, Lancome, Prada, Givenchy, Calvin Klein and Angel de Thierry Mugler. The perfume industry faces tight competition. Chanel is one of the well established companies in France, which always offers high quality perfumes, at high prices. But the prices of J’adore and its competitors are almost similar. So there will not be much difference for the customers in making payment for the product. J’adore has a USP (Unique Selling Proposition), driven by emotions, which make it impossible to compare with the products of its competitors. The long lasting fragrances, the prestige that the brand name of J’adore gives when women apply it, the confidence she feels when it a dds to her personality makes the product a unique one, which is very difficult for the competitors to imitate. The targeted customers are women who earn high income. Once they like the product, they

The earth and its people chapter 17 Essay Example for Free

The earth and its people chapter 17 Essay 1. Why were death rates among Amerindians so high? P. 432 2. What was the most deadly of the epidemics in the Americas? P. 432 3. What (3) New World (Americas) foods revolutionized Old World (Europe, Africa, Asia) agriculture? P. 432 4. What did the horse do for the native peoples of the Americas? P. 433-4 5. What country occupied most of the Brazilian coast? P. 434 6. How did Amerindian people respond to the imposed Christianity? P. 434 7. What kind of powers did the highest-ranking Spanish officials in the colonies have? Why? P. 435 8. What regions were included in the Viceroy of Spain? P. 435 9. What was the primary agent by which European language and culture was transmitted to Brazil and Spanish America? P. 435 10. What was the richest institution in the Spanish colonies? P. 437 11. What commodities dominated the economic development of colonial Latin America? P. 437 12. What was the â€Å"mita†? p. 439 13. What did sugar plantations in Brazil depend on? P. 439 14. Why did sugar planters prefer African slaves to Amerindian slaves? P. 439 15. What were Hidalgos? P. 440 16. What forms did slave resistance take? P. 444 17. What was manumission and how did a slave achieve that? P. 444 18. What were castas? Give examples. 444-5 19. How were the governments and economic systems of English and French colonies different than those of the Spanish and Portuguese? Why? 445 20. Were the English successful in their first efforts to establish colonies in the Americas? Give an example. 445 21. How much of Jamestown’s population died within the first 15 years? Why? P. 446 22. How did the fur trade and hunting affect the Amerindian people? P. 446 23. What was indigo grown around Charleston used for? P. 447 24. What was the Stono Rebellion of 1739? P. 447 25. What are 3 ways that immigration to the Chesapeake differed from that of Massachusetts? P. 447 26. Merchants from what European nation first colonized Manhattan Island in 1624? P. 449 27. What did French settlements emphasize? P. 450 28. Who were the enemies of the Huron and Algonquin, who then became enemies of the French? P. 450 29. What were 3 things Jesuits did in an effort to convert native people to Christianity in French Canada? P. 450 30. What was the result, politically, of the French and Indian War (Seven Years’ War)? p. 452 31. What was the purpose of the English Navigation Acts? p. 454 Free Response Focus Questions: Answer these questions in a 5-7 sentence paragraph. In your own words. Do not simply copy from the book and memorize the response. Know it. Support your response with plenty of facts. Understand where events fall historically (global context, cause/effect, etc) 1. Considering the Columbian Exchange and colonization, what were the major impacts on the peoples of the Americas? 2. What role does religion play in European settlement of the Americas? Be specific as to Spanish, Portuguese, French, and British uses of Christianity as a tool of colonization. 3. The chapter describes several different types of forced labor practices. Describe each practice and explain why each one was preferred in different locations. Compare/Contrast: Write a well-developed thesis statement which clearly addresses similarities and differences. 4. Compare and contrast Latin American with North American colonies from 1530-1770.

Medical Advancements during the Industrial Revolution

Medical Advancements during the Industrial Revolution Medical Advancements in the industrial revolution Compared with the other great time periods, the industrial revolution in particular was known to have had one of the largest impacts on the world. Some of the largest being advancements in technology leading to breakthroughs in the field of medicine. It was during the 18th century that scientists were able to discover cures for many previously incurable diseases through the use and application of these â€Å"new† technologies. The government of the time was also forced to improve living conditions in order to create better sanitation, which in turn also helped to lower the risk of disease and raise life expectancy. Disease accounted for many deaths in industrial cities during the Industrial Revolution. With a chronic lack of hygiene, little knowledge of sanitary care and no knowledge as to what caused diseases (let alone cure them), diseases such as cholera, typhoid and typhus could be lethal. As the cities became more populated, the problem worsened. Prior to advancements in medicine there had been little-to-no sanitation, and accordingly people living during this time had a very short life expectancy. Also, there was little understanding around how and why disease was constantly spreading. One of the major contributing factors was the housing conditions which the majority of the population dwelled: they were overcrowded, meaning that one small room could (and often did) house up to ten people. Houses did not have access to clean water, the water was contaminated with sewage, bacteria and other pathogens. With the majority of doctors knowledge being based upon traditional remedies that had lit tle evidence, and there being limited diagnostic tools or understanding, this also did not help the health of the population. Before and during the industrial revolution there was a common belief that disease was caused by â€Å"bad smells† and â€Å"invisible poisonous gas clouds.† With increasing numbers of people within cities, diseases and ill-health was on the rise, which promoted scientists to begin searching for scientific reasons behind diseases and thus deducting how to cure them. Throughout the industrial revolution there have been accounts of poor living conditions coupled with bad building management systems, mass siltation and poor hygiene. FRIEDRICH ENGELS was known to have said In one of these courts there stands directly at the entrance, at the end of the covered passage, a privy without a door, so dirty that the inhabitants can pass into and out of the court only by passing through foul pools of stagnant urine and excrement. (Cotton times, 2012).This quote from his memoir shows the extent of pollution and the mismanagement of waste disposal. This also shows just how filth stricken and unhygienic the streets where. This abundance of pollution and waste was defined aided the spread of disease. Until the occurrence such medical advancements surgery and other medical practices remained a task frequently done by barbers merely because they possessed the correct tools. The lack of any such pain killers, along with the continuing social disapproval due to such mortalities, created a continuous cycle where few people underwent surgery thus leading to limited knowledge and research done in the field. Therefore surgery and medicine in general progressed very little throughout the middle ages and all of that changed in the industrial revolution due to revolutionary medical advancements. It all began with the discovery of the properties of chloroform and ether in the 1850’s by numerous scientist, thus making surgery effectively painless, though there was still a significant amount of pain after the effects of the anaesthetic wore off. On screen is a chart that shows the evolution of surgery and medicine in general. Even knowing this the number of people willing to undertake surgical procedures multiplied in the following years. This caused the increase of the death of patients post operation presumably due to bacterial infection. In the decades prior such a small quantity of people were willing to undergo surgery and the patients that did most likely died on the operating table therefore bacterial infection was relatively rare and thus their causes such as operating conditions, unclean surgical instruments as well general poor hygiene where remained unexplored. After countless deaths and a plethora of research came the answer: germs In the 1850s Louis Pasture make a significant breakthrough with his revolutionary germ theory of disease. He discovered the microorganisms were causing decay because they were constantly spreading. He concluded that these microorganisms where the cause of many diseases. He carried out his experiments by collecting air in flasks and determining which ones contained more bacteria. The flasks that had more bacteria were noted as containing air from places that had been very overpopulated and dirty. He extended his theory to explain the causes of many deadly diseases such as anthrax, cholera as well as TB. Now scientist could cure sicknesses based on the discoveries made by Pasture. Without Louis Pasteur the field of microbiology would not have existed. His contributions where crucial to the development of the Industrial Revolution and his discoveries are still relevant to this day. They have acted as building blocks for further discoveries and started a general trend in medicine. His co ntributions include, instituting changes in medical practices, to minimize the spread of disease, discovering that weak forms of disease could be used as an immunisation and finally he introduced the concept of viruses to the medical world. Because of his glowing accolades many regarded him as the â€Å"father of microbiology†. Personally I believe that he deserves such title because without his work many of modern medical discoveries would not have occurred but I do accredit him solely because I believe that the advancements made in the industrial revolution where a group effort and that many scientist contributed to its occurrence. Although his research was neglected by the medical community for several years due to his unorthodox methods of practise, Edward Jenner revolutionised the study of medicine forever by creating a cure for Smallpox which has changed the practise of the prevention of many diseases with vaccines today saving countless lives. He built upon the work done by Louis pasture and created a vaccine for smallpox by inoculating his patients with cow pox. It was successful and became mandatory in Britain in 1852. With economic growth living standards were able to improve. Britain was able to turn the field of public health into a socio-medical vital to community health. Soon enough the new chapter of the revolution included focussing on the public health movement and supporting the poor who were unable to pay for medical treatment. So the Public Health Act was passed, making sanitary improvements in the slums and stationed medical officers in every district in England. Infant mortality rates where decreasing and life expectancy was finally flourishing. After several medical findings such as relief from typhoid and surgery started to become widely practised. In order to have surgery patients need to go under anaesthesia. To create anaesthetics mixed numerous chemicals and experimented to find out what effects they would have on humans. Humphrey Davies realised by experimentation that laughing gas was one factor that could reduce pain. Since this wasn’t the most effective method therefore ether was used due to its ability to put patients to sleep. In 1847 James Simpson was the first to discover chloroform’s ability to render patients unconscious. With this medical breakthrough surgery was able to become a quicker and a more efficient process. A problem with early surgery was that surgeons did not poses antiseptics this caused infections in patients and many deaths. Joseph Lister discovered that spraying patient’s wounds with carbolic acid spray would kill microbes thus preventing the occurrence of infection and allowing the patient to heal correctly without infection. His spray was eventually used in public places as a sanitary precaution but some individuals at the time reported to having reactions to this acid. In 1895 Wilhelm Rà ¶ntgen discovered the use of x-rays in medical imaging, this brought great advancement to the medical world and surgery itself. Without such a discovery the world’s medical history would not have been the same. All of these inventions and progressions in medical technology have paved the way for a successful medical world as we know it. The machines, drugs, surgeries have all originated from the time of the industrial revolution. Of course they have progressed and evolved over the years and will continue to evolve as time goes on. If there was never a revolution such as this one the world would have never seen change. Our lives and lives to come will forever be different due to the medical advancements in the industrial revolution. The industrial revolution was a turning point in history because its medical advancements improved health in the medical word, life expectancy and the spread of disease. There are many points that be argued as the most important part of the industrial revolution and turning points in history. Although many historians like to say that the advancements in medicine where not as crucial to the occurrence of mass industrialisation as agriculture, per se. While I acknowledge their points and am in no way saying that the changes in agriculture was not important but I believe that the medical advancements and the change in legislation due to these advances where crucial to the continuation and sustainability of the industrial revolution. Because, a healthy workforce is a productive workforce. Without a healthy workforce industrialisation could not have occurred and workplace based injuries would not have been able to be treated and in the case of the agricultural revolution While some people today like to focus on the work of just one person as â€Å"the† breakthrough which influenced the remainder of the Industrial Revolution, and as such shaped the medical field as we know it today, however, I disagree. I do not think it is possible to name just one man as the founder of modern medicine. Each of the scientists that I have named had unique contributions to the field, each independent of the other. Without any one of these, there would still be disease and ill-health throughout the world. To name just one man would be an injustice, thus I acknowledge each of these breakthrough scientists for their contributions and efforts to enable myself to live the safe and healthy life that I do today. I believe the most productive work that aided humanity has been done in collaboration throughout history. I believe that these advancements where a sheer coincidence and the correct number of scientist gathered at the right time under the correct circumstances lured by economic opportunities. The medical advancements in the industrial revolution caused the worldwide improvement in life expectancy and public health. That world wild phenomenon had a domino effect throughout the following years and lead us to where we are today. Without the industrial revolutions medical advancements we would not be in the position we are in today with public health and life expectancy.

Implementation of New Procurement Methods in India

Implementation of New Procurement Methods in India The construction industry in India is complex, challenging and unique. Selecting appropriate procurement method is a critical feature. In India even today traditional procurement methods are used. The options of adapting new procurement methods are open but there are various challenges in implementing them. This study will identify the barriers and difficulties which restrict the implementation of new procurement methods in India. The literature review investigated characteristics of new procurement methods. It highlighted the nature and types of projects in India. It emphasizes on structures and trends in the Indian construction Industry. It gives an insight on procurement methods used in developed economies. The chapter on characterization focuses on issues specific to Indian construction Industry such as demographics, socio-economic concerns, economical advantages, rapid growth of the industry etc. It highlights the typical procurement methods used for different types of projects in India and the regulations and administration within the construction Industry. This study gives us the nature and character of the Indian Construction Industry. Further, the study analyzes various issues, and draws attention to challenges in implementing new procurement methods. In the light of the characterization, issues and challenges this study identifies and concludes with the barriers and difficulties which restrict the implementation of new procurement methods. The worldwide construction industry includes projects of dramatically different types, size and complexity and requires extensive professional and trade skills (Groak, 1994). A construction project can refer to any building activity that includes building, repair, erection, demolition, maintenance, land clearing, earth moving, excavating, trenching, digging, boring, drilling, blasting, concreting, installation etc. (Housing Grants, Construction and Regeneration Act, 1996). All these activities involve a considerable number of goods and services as well as large number of transactions to support a project. Most significantly, goods and services should be procured at the best possible cost to meet the needs in terms of quality, quantity, time and location (Weeley, 2010). However, construction industry is a significant contributor to a nations economy. Internationally, construction industry accounts for approximately 8-10 percent of gross domestic product GDP. Currently, in India construction industry accounts 8 percent of GDP. Furthermore, main construction sectors in India are Infrastructure, housing and commercial developments. In India by 2014 the second phase of infrastructure development will be started. This will provide additional boost to the construction industry. Owing to numerous projects the significance of procurement will be very important. Considerably, a well procured construction project is completed in time with desirable quality and within estimated cost. Internationally, plentiful construction procurement methods are practiced. Worldwide effectively used, key procurement methods are Design and Build, Management Contracting, Construction Management, Build Operate Transfer, Public Private Partnerships, Strategic Partnership, Joint ventures etc. Generally, in developed economies procurement methods such as Design and Build, Construction Management and Management Contracting are widely used, due to the maturity of the industry. However, in India mainly traditional construction procurement methods are practiced. Construction industry consists of large number of scattered small firms. The professionals prefer to operate within their silos. As a result, they remain in their comfort zone of using traditional methods. Nowadays trends are changing particularly in infrastructure and large scale projects management. This is due to the increased number, size of projects and capital invested in the projects. Mainly the upcoming procurement methods are Build Operate and Transfer and Public Private Partnerships. However, these are restricted to only a few projects. Still a large number of projects are carried out in a traditional manner. Major obstacle to implement new procurement methods are large population (1.2 billion approximately) large inclusive demand, large demand spread across the country, many small projects, traditional outlook of construction professionals, segregated industry, numerous small firms, enormous unskilled work force. Other barriers include considerable number of regional languages, excess availability of skilled professionals in one part of the country and scarcity in the other parts, no standard terms of contracts, different legislation in different states, local suppliers, mon opoly of manufactures in a region etc. As a consequence it is increasingly important to explore the reasons why new procurement methods cannot be implemented in India. Some key interdependent and inter-linked issues to be investigated are economic issues, management issues, technical issues, legal issues and cultural issues. Research outcomes will be inferred by careful observation of challenges and study of difficulties for implementation of new procurement methods. 1.2 Research Aim The aim of the research is to identify the barriers and difficulties that restrict the implementation of new procurement methods in India. 1.3 Research Objectives The research objectives will include the following 1) To investigate the issues, namely economic issues, management issues, legal issues and cultural issues which act as barriers for the implementation of new procurement methods in India. 2) To investigate procurement methods such as Design and Build, Management Contracting and Construction Management and relate it to the traditional Indian procurement method, to understand the challenges of the implementation of new procurement methods in India. 3) Identifying the barriers which act as hindrances for implementation of new procurement methods in the Indian construction industry. 1.4 Scope of Study This study of identification of barriers and difficulties that restrict the implementation of new procurement methods is confined to the Indian construction industry. The data is collected from secondary sources. The main sources were U.N views on India, U.K Trade and Investment and other secondary data. It outlines various difficulties and barriers which are already present in the Indian construction industry which in turn affects the implementation of new procurement methods. This study restricts itself in identifying difficulties and barriers from the nature and character of the Indian Construction Industry. As moving into detail of all issues was not possible, it explores largely economic issues, management issues, legal issues and cultural issues and finds the barriers which prevent the implementation of new procurement methods. This study will also mainly look into procurement methods such as Design and Build, Management Contracting and Construction Management and compare it with the traditional Indian procurement method to find the challenges in implementation of new procurement methods. 1.5 Structure of Dissertation Chapter 1) This chapter gives an introduction to the topic and gives the idea about how the study will be carried out. It gives an idea of a fast developing Indian construction Industry and the need to adapt new procurement methods. It states the research aim, objectives and scope of study and also discusses the structure of the dissertation Chapter 2) This chapter reviews the literature associated with the study. It looks into new procurement methods, projects in India, Indian construction industry and important factors affecting the construction industry in India. Chapter 3) This chapter describes the research methodology adapted within the scope of the dissertation. Secondary data, semi-structured interviews with the experts and academicians were employed to address the objectives. Chapter 4) This chapter characterizes India. It describes the nature and the character of the Indian construction industry. It gives an insight into the Indian construction Industry and its approaches. Chapter 5) This chapter looks at the barriers and the difficulties that restrict implementation of new procurement methods in India. It identifies various issues and challenges in implementation of new procurement methods in India. It looks at the present construction Industry in India and its characterization and identifies the barriers and difficulties that restrict implementation of new procurement methods in India. Chapter 6) This chapter presents the conclusions and direction for further research in this area. CHAPTER 2:Â  LITERATURE REVIEW 2.0 Procurement Methods Introduction Around the world procurement methods are developed through the years as per needs. The selection of the most appropriate procurement method is critical for both the client and other project participants as it is an important factor that contributes to the overall clients satisfaction and project success. This selection will be dependent upon a number of factors such as cost, time and quality which are widely considered as being the most fundamental criteria for clients seeking to achieve their end product at the highest quality, at the lowest cost and in the shortest time (Hackett et al. 2007). The type of procurement method adopted mainly depends upon the type of project, type of ownership, nature of construction industry in that particular country and the maturity of the industry. The selection of the procurement path is much more than simply establishing a contractual relationship (Newcombe, 1992), inspite of the continuing search for maximum value for money. In the developed economies such as USA, UK, Australia, Sweden etc. procurement methods such as Design and Build, Management Contracting and Construction Management are used from a long time. This is because the construction industry is developed, the projects are needed to be delivered efficiently and the clients demand the delivery of projects within budget and in least possible time. In this dissertation the study is limited to procurement methods such as Design and Build, Management Contracting and Construction Management. 2.1 Design and Build Design-build is a method to deliver a project in which the design and construction services are contracted by a single entity known as the design-builder or design-build contractor. Design-build relies on a single point of responsibility contract and is used to minimize risks for the project owner and to reduce the delivery schedule by overlapping the design phase and construction phase of a project. Design and Build with its single point responsibility carries the clearest contractual remedies for the clients because the DB contractor will be responsible for all of the work on the project, regardless of the nature of the fault (John Murdoch and Will Hughes 2007). The Design-Build Institute of America (DBIA) takes the position that design-build can be led by a contractor, a designer, a developer or a joint venture, as long as a the design-build entity holds a single contract for both design and construction. The main contractor takes responsibility for both design and construction and will use either in-house designers or employ consultants to carry out the design. Most of the construction work will be carried out by specialist or sub-contractors. The contractor tenders against a client brief and will often follow an initial concept design prepared by consultants appointed to advise the client. The design will be developed by the contractor and the works will be completed, usually for a fixed price. Tendering is more expensive so it carries more risk for the contractor than the traditional approach. This is because the contractor has to develop an outline design and a detailed price. Tender lists will probably be shorter than for traditional contracts. However, the client commits to the cost of construction, as well as the cost of design, much earlier than with the traditional approach. Changes made by the client during design can be expensive, because they affect the whole of the Design-Build contract, rather than just the design team costs. This strategy is a low-risk option for clients who wish to minimize their exposure to the risks of overspend delays or design failure. However, the exposure to risk will increase where the design phase is rushed, where unreasonable time targets are set or where the tender documents are not fully completed. 2.1.1 Characteristics of Design and Build It provides single point of responsibility so that in event of a failure the contractor is solely responsible. There is no ambiguity between the designer and the contractor. The clients interests are safeguarded in this respect. When the client adopts Design and Build method he knows his total financial commitment early in a project. The client has direct contact with the contractor. This improves the lines of communication and enables the contractor to respond and adapt to the clients needs more promptly. In Design and Build contractor is responsible for design, planning and control. This gives him a better control over the activities and can concurrently carry out the activities which are not generally possible using traditional procurement methods. The contractor can purchase, obtain planning permission and arrange his finance simultaneously which helps him to give a better deal to the client. He can also benefit himself and the client by making use of proprietary modular designs which reduces design time and time required for approval. The contractor can start the work as soon as the approvals are obtained and sufficient information regarding the site operations is available. The design does not need to be finalized before some, at least, of the work may be commenced. The Design and Build proposals ensure economical tenders and alternate design concepts which can benefit the client. The nature of Design and Build procurement system promotes the creation of integrated design and construction team. In some countries using Design and Build system relaxes the architects code of practice, which encourages them to become full partners in design and build firms. The closer involvement of architects leads to more aesthetically pleasing buildings and leads to designs which have a greater appreciation. By using Design and Build method time and cost savings are achieved, which benefits the client. The total project completion period is also reduced. Design and Build reduces the employers financing charges, inflation has less effect and the building is operational sooner which commercially produces an early return on the capital invested. The Design and Build method facilitates novation of design with the consultants to the contractor which provides advantages to the client. The advantage of Design and Build is that the contractor has some control over the design and is able to introduce components, materials and systems which are beneficial and which he knows are more economical to construct. 2.1.2 Critique of Design and Build Design and Build is not suitable for complex projects. The traditional method of construction procurement dissociates the designers from the contractors interests, design-build does not. The contractor decides on the design issues as well as issues related to cost, profits and time exigencies, which may be the matter of concern in some situations. The client is required to commit to a concept design at an early stage and often before the detailed designs is completed. There is no design overview unless separate consultants are appointed. And there is no one appointed from clients side to manage the works or act as clients agent. If client changes the scope of the project, this can be expensive. Design-build does not make use of competitive bidding where prospective builders bid on the same design. In Design and Build the criteria to select contractor is subjective and difficult to evaluate and to justify later. 2.2 Management Contracting In management contracting the client appoints the designers and a management contractor separately and pays the contractor a fee for managing the construction works. Payment to the management contractor is done on the basis of cost of the works packages plus agreed fees. The main benefits of management contracting are the time required for design and construction is shorter. There is an early involvement of managing contractor during design phase, in which his expertise can be used. The management contractor has the responsibility to manage the project. The sub-contractors are appointed by the management contractor, thus reducing the day to day administrative responsibilities of the client. The management contractor has major role in directing the project. The lines of communications are improved. As there is a direct relation between the management contractor and the client changes and variations can be done in a project. The main advantage is that the project is completed in time as the management contractor manages the works. Because of this the client gets possession quickly and the return on investment starts. The client normally appoints the management contractor to take an active role in the project at an early stage and the client can benefit from the contractors expertise. The overall design is the responsibility of the clients consultants, but the management contractor is normally responsible for defining packages of work and then for managing the carrying out of those work packages through separate trades or works contracts. The management contractor can sometimes not be employed to undertake the work but is employed to manage the process. All the work is subcontracted to works contractors who are directly employed by the management contractor. The client usually needs to be given the opportunity to approve the terms and conditions of the trades or works contracts before the packages are subcontracted. The management contract will usually include both a pre-construction phase and the construction phase. The management contractor is responsible for the administration and operation of the works contractors. However, the management contractor is not liable for the consequences of any default by a works contractor so long as the management contractor has complied with the particular requirements of the management contract. 2.2.1 Characteristics of Management Contracting Clients and contractors adapt this system once they gain experience, which suggests that it has merits. It is generally recognized that its adoption requires mutual trust. The management contractor is appointed much earlier. He is able to become a member of design team and contribute his expertise and mainly his management expertise. Management Contracting is an effective method for the client retaining control of the design whilst drawing on the experience of a construction specialist as part of the Professional Team. The Management Contractor is paid a fee for its services as well as enters into contract with the client for work packages, generally separate works contractors are appointed to carry out work packages under the management contractor. This type of arrangement tends to be used on complex projects where early input from a construction specialist is required. Decisions regarding appointment of subcontractors are made jointly by designers and management contractor thus making use of wider experience. Specialists contractors and subcontractors compete at second stage ensuring economical tenders which benefits the client. Lines of communication are shorter between management contractor and client than with the traditional procurement method. The client has direct control over the management contractor, who is the main contractor, so that the project is completed in a better way and in shorter time. The total project completion period is reduced by parallel working. A reduced project completion period produces a corresponding reduction in financing charges and interim payments to the contractors. Inflation has less effect. The client takes the delivery of the building more quickly and obtains returns on his investment more quickly. The main functions of the management contractor may include acting as principal contractor, cost planning and cost control, consenting for works contracts, coordinating and managing works contracts, coordinating commissioning, collating pre construction information and construction phase plan, monitoring key performances and managing the site. 2.2.2 Critique of Management Contracting The client is usually given an approximate estimate of the final project cost by the management contractor early in the project life but the client does not know the final project cost until the last sub contract is entered into. On other projects he is given a guaranteed maximum cost. The architect may have less time to develop the design because he is under greater pressure from the client and contractor. The design may suffer as a result. The client should provide a good design brief as the design will not be completed until the client has committed significant resources to the project. The strategy relies on quality committed team or it may just become a mere reporting system in some cases. Management contracting is not suitable for inexperienced clients. It is less suitable for clients wanting to pass the complete risk to the contractors. Specialist contractors frequently prefer to be in contract with client rather than the management contractor appointed by the client because interim payments are usually made promptly when paid directly. 2.3 Construction Management In construction management the client appoints a construction manager for a fee to manage, programme and coordinate the design and construction activities. The client does not allocate risk and responsibility to a single main contractor. Construction work is carried out by trade contractors through direct contracts with the client for various packages. The client takes the risk. The construction manager supervises the construction process and coordinates the design team. The construction manager has no contractual links with the design team and contractors. He only provides professional expertise without assuming financial risks. On appointment the construction manager takes over any preliminary scheduling and costing information and draw up detail programme accordingly. In this method the client should have administrative or project management staff with the ability to assess the recommendation of construction manager and take actions. Adapting construction management reduces the time required for the project. This occurs because the contract strategy, construction and design can overlap. A construction manager should have a good track record in cost forecasting and cost management, as the time can be reduced but the price certainty is not achieved unless the design and construction have advanced to the extent that all the work packages have been let. This method puts so much emphasis on the role of client, if the client is experienced, with the help of construction manager he can control the project effectively. The clients continue to use construction management to their advantage, for example, the cultivation of direct, long-term relationships with trade contractors helps to secure many of the benefits more often associated with partnering. Furthermore, by employing a construction manager who is able to focus on the interests of the project, rather than on its own risk management, the client can be confident that its project objectives will be shared by the rest of the team. Construction management is distinguished by the influence of the clients and construction managers management and leadership skills on the success of the project. By adapting construction management method the client can have greater influence over the project and can have more flexibility over the contractor selection and so on. 2.3.1 Characteristics of Construction Management Construction management offers relative time saving potential for overall project duration due to overlapping of various activities. The roles, risks and relationships are clear for all the participants during most of the situations. In some situations changes in design can be accommodated later than some other strategies, without paying a premium. In construction management method the client has direct contracts with the contractors and pays them directly. This helps the contractors as they are paid promptly and there is evidence that this results in lower prices because of improved cash flow certainty. The client has direct involvement in the project as compared to most of the traditional methods. As the client is directly involved he is enabled to make prompt decisions which can be implemented without delay. This also makes possible a prompt response by the client to unforeseen site problems and also makes possible a prompt response by the contractor to changes required by the client. In this type the construction manager acts as an agent of the contractor. This benefits the contractor in managing the works. This also excludes the client for keeping his own staff for overlooking the issues which are looked by the construction manager. The central role of the construction manager is managing the project and providing administrative support to the employer. In this there is no single point of responsibility related to the delivery of the project. 2.3.2 Critique of Construction Management In construction management price certainty is not achieved until the last works packages have been let. Budgeting primarily depends heavily on design team estimates. The client should be pro-active and must provide a quality design brief to the design team in order to complete the design. The strategy relies upon the client selecting a good quality and committed team. In construction management the client has to manage and administer many contracts as there is no single contractor, all the works contracts are directly between the works contractors and the client. The client has to manage coordinate with the design team appropriately or else there increased likelihood of design change. There is a high degree of client ownership of risks associated with design including impacts of late or incomplete and uncoordinated design. In construction management the client has exposure to performance risk and exposure to consequential loss associated with trade contractor default. In construction management method there is increased administration role for the client. Construction manager owes duty of care liability only. The client is at the center of management and requires decision making capabilities. The client has to rely on management capability of construction manager. 2.4 Indian Construction Industry and Economy Indian economy has been growing from last two decades at an unprecedented rate. This is mainly because of industrialization and service sector growth. The main reason for Indias growth is its huge internal demand. In recent years particularly after the global recession in 2008 the Indian economy has shown signs of slowing down. In 2011-12 due to the current global economic scenario India found itself in the heart of managing growth and stabilizing prices. The Indian economy is grown by 6.9 per cent in 2011-12, after having grown at the rate of 8.4 per cent in each of the two preceding years. This indicates a slowdown compared not just to the previous two years but 2003 to 2011 (except 2008-09). At the same time, sight must not be lost of the fact that, by any cross country comparison, India remains among the front-runners. The Gross Domestic Product (nominal) of India is $ 1.848 trillion (Indiabudget, 2011). The Gross Domestic Product (Purchasing power parity) of India is $ 4.457 trillion (Indiabudget, 2011). The annual expenditure budget of India is Rs.1490925.29 Crores (Indiabudget, 2011). Over the years, more than half of the expenditure budget is spent on civil engineering, construction and related activities. The construction industry sets in motion the process of economical growth in the country, investment in this sector contributes 6.5% of Gross Domestic Product (GDP) growth. The construction industry in India is large and scattered. Today in India there is a massive demand in housing and infrastructure. The construction industry is the second largest industry of the country after agriculture. It makes a significant contribution to the national economy and provides employment to large number of people. The use of various new technologies and deployment of project management strategies have started to gain importance. In its path of advancement, the industry has to overcome a number of challenges. However, the industry is still faced with some major challenges, including housing, disaster resistant construction, water management and mass transportation. Recent experiences of several new mega-projects and large demand are clear indicators that the industry is poised for a bright future. It is the second homecoming of the construction profession to the forefront amongst all professions in the country. Every Re.1 investment in the construction industry causes an Rs.0.80 increment in GDP as against Rs.0.20 and Rs.0.14 in the fields of agriculture and manufacturing industry, respectively. Statistics over the period have shown that compared to other sectors, this sector of economic activity generally creates 4.7 times increase in incomes and 7.76 times increase in employment generation potentiality (Economicsurvey, 2011). Despite of the challenges in the construction industry there will be a continuous rise of the construction sector in the country, with over 4 Crore persons employed in it. 2.5 Projects in India The construction industry in India is large and diverse. In India majority of the projects are procured locally and are small in size. In recent years there is a demand for large projects such as large housing schemes, rural and urban and infrastructure projects but still there are large numbers of small projects. The projects include residential complexes, shopping centers, industrial development projects, urban roads, rural roads, water supply systems, sewerage systems and infrastructure projects such as highways, power stations, rapid mass transport systems, airports up gradation and new and ports. These projects are not concentrated in one part of the country, they are spread over the length and the breadth of the country. Except some few high profile and prestigious projects majority of the projects are due to local needs and demands. In India the metropolitan cities are experiencing a rapid growth of 25-30% in residential construction activity every year and the other non-major cities are experiencing 15-25%. The top 15 cities in India account for 18% of the total construction activity in India with Mumbai and Bangalore leading the pack. In India cities are classified as Tier I, Tier II, Tier III and Tier IV cities. Tier I cities consist of Bangalore, Chennai, Delhi, Hyderabad, Kolkata and Mumbai. Tier II cities consist of comparatively smaller cities as Ahmedabad, Jaipur, Kanpur, Pune, Surat etc. Tier III cities consists of even smaller cities and large towns such as Indore, Cochin, Jamshedpur etc. Tier IV consist of smaller towns. Approximately there are 35 cities in India with a po