Poverty, Education and Health Care Essay

Abstract Poverty and education play an important role in access to health care. A low socioeconomic status influences the health of people. This paper provides a general overview of how poverty and education determines access to health care. It provides a description of the consequences of poverty and education on health care accessibility. Finally it provides solutions as how to address the issue. The link between poverty, education and access to medical care has received considerable attention. Health influences all the activities of an individual. All societies are concerned with varying levels of health among their members. They are also concerned about marginalized sections of society have access to health care. Poverty and its effects on society People belonging to poor communities have poorer health outcomes. They have less access to primary care as compared with more affluent residents. They are also less likely to have health insurance and regular doctor. They are more likely to have chronic health problems. They are more likely to get hospitalized for conditions which can be detected and treated at an early stage. Despite an expansive public insurance program these health problems remain. At least 18 percent of Americans are without medical insurance. This means a total of 44 million are without health insurance out of a population of 300 million. An estimated 87 percent of people are covered by government or employee based health care insurance (Cutler, 2004). People with low socioeconomic status face many challenges in maintaining their health. They have a high mortality rate. They are more likely to be suffering from some disease. They have limited health care resources. They live in poor environmental situations. The United States has one of the world’s most impressive standards of living. At least 32 million Americans live below the poverty line. In addition to poor people an estimated 50 million people live in poverty like conditions. Health risk factors like smoking, obesity and sedentary lifestyle are found in poor Americans (Cutler, 2004). They have a higher prevalence of disability and chronic illness. They have a shorter life expectancy. Children belonging to poor families are more likely to be malnourished. Many poor Americans live in houses which have lead paint. This can cause growth problems in children. Poor people eat inexpensive food which is fatty and lacks important nutrients. Poor people cannot afford health insurance coverage. Patients postpone their medical care and they are more likely to go without prescription medicines. Low income workers are at the highest risk of being uninsured because they are ineligible for Medicaid coverage. They work in low wage jobs that do not offer insurance. They cannot afford the high premiums associated with health care insurance. The lack of a usual source of care is another barrier to seek adequate health care. The challenges associated with poverty create conditions that can diminish lifesavings, lower learning ability and reduce physical, mental and emotional well being. All of these factors are a threat to people’s health. Urban areas in the United States have many health care facilities. However poor people cannot make use of these services. The major challenge is the high cost of visiting doctors, medicine and hospital care. Social factors like language barriers and prejudice by providers also hinder the accessibility of health care by poor people. The government also faces challenges in trying spreading health education in poor communities. Health care services are vital for the survival and livelihood of poor people. Illness persists in poor people. It stops people from working and forces them to sell assets. They fall into debt and are lead into a vicious cycle of dependency and poverty. Failure to treat themselves leads to illness and disability. This further reduces the ability to work in poorer households. People living in rural areas are forced to bear high transport costs. This is difficult and expensive for them. The lack of local health centers in rural areas further hinders the ability of poor people to access adequate health care (Crichton, 1997). The huge time that takes for poor people to obtain treatment is one of the greatest barriers which they face. Time away from jobs results in lost income. Health services run by governments are usually inefficient and are characterized by neglect. The quality of service is low. There is shortage of staff. There is no proper medicine and equipment. In many countries there is no safe water to drink. In developing countries there are high costs to health care. Besides the official fees there are corrupt staff members who demand bribes and fees in return for ordinary services. These services can include registration, tests and being given medicine. They can also pressurize a sick person to make unnecessary visits to the hospital. Payment methods are not flexible in many developing countries. Payment usually has to be made in advance and in cash. This causes considerable hardship for poor people (Crichton, 1997). Â  Education and its effects on society Education also plays an important role in health care. Many people with low literacy cannot read and understand directions written on medications. They cannot complete medical consent forms. They have problems in accessing health care and dealing with health related issues. Health literacy is the ability to read and understand words and procedures related to health care. It consists of comprehension, communication and appropriate action. The direct effects of low health literacy are medication errors. The indirect issues can include insurance issues, accessibility to health care and poor health behavior (Shi, 2003). Low health literacy affects people of all ages, races, educational levels and social classes. It is driven by a variety of factors. It is a multidimensional issue. Understanding written materials has been part of extensive health literacy in the past few years. Sensitivity to culture has also become part of health literacy due to the diverse population of the world. Messages and images have to be tailored to meet the diverse beliefs and values of people. Health literacy is concerned with understanding the information necessary to manage health (Shi, 2003). It is estimated that at least 90 million people in the United States cannot read. The health of such people is at risk. Ethnic minority groups are also affected by low health literacy. Older patients, recent immigrants, people with chronic diseases and those with low income are also vulnerable to having low health literacy. Many people with average or strong literacy skills have found medical terminology and concepts confusing. There are many health consequences associated with a low literacy level. Research has found that at least one third of patients have health problems because of failure in taking prescription medication correctly. People with low health literacy cannot comply with prescribed treatments and self care routines. They also have a high rate of failure in seeking preventive care. They are more at risk for hospitalization. They lack the skills to successfully move in the complex healthcare system (Shi, 2003). Patients with low health literacy have glycemic control. They are also more likely to report eye problems caused by diabetes. The annual health care costs for individuals with low health literacy are five times higher than those with higher health literacy skills. People with low health literacy are more likely to use health care services. Additional health care expenditures result from low health literacy skills. People cannot feel part of the social structure. They are also vulnerable to anxiety and other mental disorders. They can also alienate other people. Research has also found that people with low literacy levels are more vulnerable to die. While federal and state lawmakers continue to debate about how to increase access to health care, some of them are thinking of reinsurance system which might be affordable for poor people. In order to understand the concept of insurance it is essential that policy makers understand the concepts, benefits and limits of reinsurance mechanism. Reforms in Health care Reinsurance in health care refers to risk transfer or risk pooling arrangements. These are designed to remove the barriers which low income workers and minorities face when accessing health care. Risk transfer arrangements can help in this matter but they cannot lower health care costs. Policy makers must design policies which encourage participation from insurers and remove incentives to transfer costs to taxpayers. Reinsurance is defined as an insurance company buying insurance itself. The primary insurer is protected against the rare set of circumstances which might produce losses that it cannot fund on its own. Property and casualty insurance are the areas where reinsurance has been successfully implemented. Companies working in these areas can take heavy losses due to natural disasters in a short time period. This induces insurers to buy reinsurance on the commercial market. Poor people cannot afford health insurance coverage. This directly affects their ability to access medical care. Patients postpone their medical care and they are more likely to go without prescription medicines. Low income workers are at the highest risk of being uninsured because they are ineligible for Medicaid coverage (Kling, 2004). Public health plays a vital role in countering the effects of poverty on health care. It also minimizes the disparities in health by income. Public health policies protect the health of the population. It also plays an important role in reducing contagious diseases and providing low cost health services to marginalized sections of society. There are many examples of public health functions. Immunizing babies, improving sanitation, combating sexually transmitted diseases, protecting the environment and containing tuberculosis are some of the public health functions. Public health focuses on reallocating resources to communities which have low incomes. The US government has a network of community health centers, public clinics, school based clinics and health clinics for low income workers, migrants, minorities and homeless people. The National Health Service Corps is an organization which provides services and places physicians in vulnerable communities. Public health services also focus on specific diseases like tuberculosis. They also increase immunization efforts against this disease. They provide services which improve the health of low income families. Neighborhoods are cleaned from lead paint, pollution control and nutrition programs are launched. Women and children are fed through special programs. Poor people with low income and education have poorer health outcomes. They have less access to primary care as compared with more affluent residents. They are also less likely to have health insurance and regular doctor. They are more likely to have chronic health problems (Kling, 2004). Medicaid is the largest public programs that have improved access to health care. It provides health services to low income population. It finances health and long term care insurance for over 40 million low income Americans. Before Medicaid the poor people were essentially without any medical care. They relied on charity of physicians and hospitals. Public hospitals and clinics were also visited by poor people. Medicaid has made health services available to poor people. It has improved their health status and access to quality care. It has also created satisfaction amongst the poor people. Uninsured poor people lag well behind those people who have coverage with Medicaid. People with Medicaid have even fared comparably with private insurance (Kling, 2004). Despite the fact that these programs offer valuable assistance to low income populations, the deficits in access and coverage faced by low income population cannot be easily overcome. Increase in income does produce a substantial contribution to removing health differentials. However this is the need for insurance coverage and support for community based resources to eliminate health disparities by income. Poverty is hazardous for the physical and mental well being of an individual. Low income and homeless people are poor physical functions. They have a high prevalence of health risk factors and chronic health conditions. They also are more vulnerable to depression and other mental disorders. Research has shown that people living in vulnerable communities have a higher rate of being diagnosed with mental disorders as compared with more affluent communities (Kling, 2004). There is a need for prevention, intervention and treatment of diseases for poor people. Welfare reform cannot succeed without taking into account the special health problems of poor people and children. Poverty is associated with depression and other symptoms. It contributes to depression. People with insufficient personal support have no assistance in raising children. They live under the chronic stress of having children but little money to support them. They are at a higher risk for depression. There is a strong link between single-parent status, responsibility for young children, social isolation, and lack of social supports as well as to poverty. Welfare recipients have many barriers towards employment. They have low skills, substance abuse, health limitation or children with chronic medical conditions. They have serious forms of barriers. They have also high level of distress. They seek help from general medical, specialized and human service sources. Poor people with low income and education have poorer health outcomes. They have less access to primary care as compared with more affluent residents. They are also less likely to have health insurance and regular doctor. They are more likely to have chronic health problems. They are more likely to get hospitalized for conditions which can be detected and treated at an early stage. Despite an expansive public insurance program these health problems remain. At least 18 percent of Americans are without medical insurance. This means a total of 44 million are without health insurance out of a population of 300 million. An estimated 87 percent of people are covered by government or employee based health care insurance. Rising health care costs have become unbearable in the world. This is a problem for poor people in the Western countries and the situation is even worse in developing countries. There is a need for reform in the health care system. Many poor people are not covered by health insurance. Critical care medicine in high technology hospitals are only for a small group of patients (Ham, 2004). The first step should be rationing in containing health care costs. Public health care resources are limited. It is not possible to satisfy all medical needs for all people at all times. An appropriate goal for developing countries is to provide basic health care for the people. Some luxury medical procedures must be left for individuals to purchase with their own resources. Â  A basic level of health care must be provided for all people. Providing the best care is practically impossible. The government can however provide a basic level of care. Prevention oriented and ordinary treatment oriented goals must be set for developing countries and their health care systems. Inexpensive medical prevention is more effective and appropriate for poor people. Finally there should be a system of support which should help people with special expensive medicine care. Special foundations should come to the rescue of poor people for emergency and life saving procedures (Cundiff, 2005). Conclusion The health and well being of poor communities is an issue confronting both developed and developing countries. Research has found links between poverty and the health of people. Inside the United States many poor people do not have health insurance. Some of them can’t even think of affording health insurance. They are more concerned with the basic amenities of life. People in developing countries are even worse off. They have access to state hospitals and clinics which do not have trained staff, prescription medicine and advanced hospital care (Cundiff, 2005). A low health literacy rate is also dangerous for the well being of people. It can have adverse negative economic and social impacts. They can die at from treatable causes and get hospitalized because of their lack of health literacy skills. They are also prone to suffering from mental diseases like anxiety and depression. Â  There is the need for health reform in the entire world. Governments must provide a basic level of health care to all citizens. Advanced hospital care must be made available by foundations and donations. Governments working in coordination with community support groups can effectively counter the affects of poverty and low education on the health care of poor people. Some health responsibilities and policies should be transferred to community groups. The international community must help poor countries in developing basic and adequate health care system. References Cutler, David M. (2004). Your Money Or Your Life: Strong Medicine for America’s Health Care System. US: Oxford University Press. Crichton, Anne (1997). Health Care: A Community Concern?. US: University of Calgary. Shi, Leiyu (2003). Delivering Health Care in America: A Systems Approach. US: Jones and Bartlett. Kling, Arnold S. (2004). Crisis of Abundance: Rethinking How We Pay for Health Care. US: Cato Institute. Ham, Christopher (2004). Health Care Reform: Learning from International Experience. US: McGraw-Hill Education. Cundiff, David E. (2005). The Right Medicine: How to Make Health Care Reform Work Today. US: Humana Press.

Automobile Air Pollution Essay

Efforts to improve the standard of living for humans, through the control of nature and the development of new products have also resulted in the pollution of the environment. Much of the world’s air, water, and land is now partially poisoned by pollution. Some places have become uninhabitable. This pollution exposes people all around the globe to new risks from disease. Many species of plants and animals have become endangered or are now extinct. The air pollution comes from lots of sources but the paper will be about air pollution cause by automobiles. As a result of tremendous amount of air pollution, primarily for automobile governments have passed laws to limit or reverse the threat of environmental pollution. There are lots of sources other than the automobile for air pollution. Nature itself is one of the causes. Sometime nature causes the air pollution by activities like a forest fire, volcanic, hurricane. These are temporary dislocations that nature balances and accommodates to modern economic development, however, sometimes disrupts nature’s delicate balance. The other source is from factories. Factories are release smokes and chemical in the air. In many places smoke from factories and cars combines with naturally occurring fog to form smog and create a midday sky. It had happened in London, â€Å"London, England, has been subjected to the danger of smog, long recognized as a potential cause of death, especially for elderly persons and those with severe respiratory ailments† (pollution). Transportation by car though, is the major source of air pollution. Early in the century human invented, internal combustion engine, engine that use fuel as gasoline or diesel. Those engines were used to manufacture an automobile for fast travel from one place to another. Because they were not much in use, those few cars were not enough to threat the environment. Those engines were not fast enough so mastermind humans invented bigger and faster engines and those take more fuel. When these engines burn fuels they introduce smoke and other, less visible, by products. Once they are released into the air, the products of incomplete combustion, particulate matter (soot, ash, and other solids), unburned hydrocarbons, carbon monoxide, sulfur dioxide, various nitrogen oxides, ozone, and lead, undergo a series of chemical reactions in the presence of sunlight. The result is the dense haze characteristic of smog. â€Å"Smog may appear brownish in color when it contains high concentrations of nitrogen dioxide, or it may look blue-gray when it contains large amounts of ozone† (Danger). The cumulative effect of air pollution poses a grave threat to humans and the environment. Smog causes number of children and elderly to die because children’ lungs are still developing, also they breath more rapidly than adults, and they play outdoor. Most elderly people loose the red cells that cause diseases to go out of control. That lead them to the development of chronic lung diseases. † The costs of air pollution are enormous. The American Lung Association sites sulfur-dioxide exposure as the third leading cause of lung disease after active and passive smoking† (Justification) Air pollution does not only cause health hazard but also cause acid rain to fall. Acid rain causes damage to structure or life. Plants and animal marine animal are most effected by acid rain. Acid rain or snow pollute the water and soil the major source for plants and marine species to survive. Acid rain or snow falls when sulfur dioxide emissions from exhaust of an internal combustion engine combine with particles of water in the atmosphere. â€Å"In Canada, Scandinavia, and the northeastern United States, acid rain is blamed for the deaths of thousands of lakes and streams† (Acid rain). Another new and troubling form of air pollution comes from a variety of chemicals called chlorofluorocarbons, also known as CFCs. For many years it was used by automobile industries. These chemicals were used in the air conditioning systems of the car. CFCs takes decade to get in the upper atmosphere but when it gets there it combines with other molecules. Then, by attaching themselves to molecules of ozone, CFCs transform and destroy the protective ozone layer. The result has been a sharp decline in the amount of ozone in the stratosphere. â€Å"At ground level, ozone is a threat to our lungs, but in the upper atmosphere ozone works as a shield to protect against ultraviolet radiation from the sun† (Ozone). If the ozone shield gets too thin or disappears, exposure to ultraviolet radiation can cause crop failures and the spread of epidemic diseases, skin cancer, and other disasters. The automobile has a big impact on over our environment. Today we have trillions of automobiles on the road. Each car produce smoke and chemicals that hazardous to our world. Sometimes people take that threat seriously and they try to find solution. It is necessary to burn fuel completely because unburn fuel release more chemicals than burned fuel. Most new cars have two oxygen sensors that monitor and control the burning of fuel (Toyota Eng. ). I think problem is that as oxygen sensors age, their warm-up response slows considerably. Even government says, â€Å"The major cause of air pollution is the internal-combustion engine of automobiles. Gasoline is never completely burned in the engine of a car, just as coal is never completely burned in the furnace of a steel mill† (EPA). Other than two oxygen sensors some engineers came up with electric. These cars are good for our environment because they do not use gasoline as fuel. Even they don’t produce any smoke. It has some problem with it too like electric cars need to recharge more often and the are not fast enough. The other problem is that after while the batteries needs to replace. You imagine if trillion cars need to replace batteries than it will fill our safe chemical deposal sites in few years than we have more chemical waste in our environment. The solar cars are not that bad in the futuristic problems but cars aren’t fast enough. â€Å"Air pollution has been the target of some of the most complicated and far-reaching legislation ever enacted. In 1970, the United States Congress passed legislation aimed at curbing sources of air pollution and setting standards for air quality. A few years later, Congress passed laws designed to phase out the use of lead as an additive in gasoline† (EPA). That helped us because the level of lead in the average American’s bloodstream has declined. We still didn’t do much about cause of acid rain and it is continually debated in North America and throughout Europe. â€Å"In late 1987, more than 20 nations signed an agreement to limit the production of CFCs and to work toward their eventual elimination† (EPA).

LAND LAW II Essay Example | Topics and Well Written Essays - 2750 words

LAND LAW II - Essay Example These exceptions include: (a) An act of generosity (Helsop v Burns, which you already mentioned it) (b)Service Occupancy (Crane v Morris) (c) Occupancy by virtue of office (d) Occypancy prior to completion of contract of sale Indeed, by definition, the very first requirement for a lease is exclusive possession. Without an exclusive possession, there is no way a lease can be finalized. This is so because the exclusive possession taken by the person taking the lease, and hereby known as the tenant gives that person the right to exclude all people from the property in question. Such exclusion does not only involve third parties and people outside the transfer transaction but also includes the landlord and all agents of the landlord. This underlining legal phenomenon notwithstanding, it has been argued in most quarters of statutory practice that an occupier who enjoys exclusive possess is not necessarily a tenant (Gray and Grey, 2009, p. 341). A major premise to this argument is given in Street v Mountford [1985]. In the case, the court gave a clear judgment to the effect that a person’s occupation of a property could either amount to being a tenant or only a licence. What was rather very relevant in determining tenancy was the content of the agreement and not what the parties choose to call their agreement. This is in regard to what Lord Templeman stated while giving judgement that â€Å"an agreement for exclusive possession for a term at a rent creates a lease or tenancy, regardless of what the parties call it† Street v Mountford [1985]. Heslop v Burns [1974] is another case that throws some light on the statement that even though a tenant must have exclusive possession, an occupier who enjoys exclusive possession is not necessarily a tenant. In the case, it is seen that in situations where there is an act of generosity, charity or friendship, even if exclusive possession occurs, this may not amount to the occupier becoming a tenant if there are no intentions to create a legal relation. The fact of the case has it that a wealthy man allows friends to occupy his house for free without rent. This notwithstanding, the friends had exclusive possession; and latter the wealthy man died. Meanwhile in principle, it is contested that the presence of exclusive possession is only worth being regarded as a licence if it comes about as a friendly arrangement with no intentions to create legal relations. Indeed, the same basis of the principle was held in the judicial hearing, concluding that the arrangement was only a licence. This is a very clear confirmation that as posited by Lord Templeman, an exclusive possession is not always equal to a tenancy. In another case, of Rhodes v Dalby [1971], a premise is given to the effect that a person may have occupancy with exclusive possession but may not necessarily be a tenant. The fact of that case has it that a man who was travelling abroad asked a friend to live in his bungalow whiles he was aw ay. Between the two parties, what existed was a â€Å"gentleman’s agreement†, ordering the friend to be taking care of the property and keeping it in shape. In the situation, and in situation of this nature, because the owner of the property leaves the property

Role of Accreditation in Healthcare Essay Example | Topics and Well Written Essays - 500 words

Role of Accreditation in Healthcare - Essay Example Research shows that accredited health facilities offer a high level of patient care and service than unaccredited institutions. In essence therefore, by accrediting health facilities, government and registered healthcare accreditation bodies are offering patients with a map on where and where not to seek treatment. Without accreditation, people seek healthcare services would easily fall for quacks, and in the process endanger their health. The second role of accreditation is that it acts as a basis for protecting and fighting for patient rights (Manley et al, 2008). What this means is that in case health provision goes wrong and harms a patient’s health, the patient has a basis for seeking legal redress. For instance, a patient can seek legal help through the accreditation body. Alternatively, the patient can enjoin the accreditation body, when seeking legal redress from an accredited healthcare organization. Without accreditation and clear cut rules on how healthcare facilities should handle their patients, it would be difficult for a patient to seek legal redress in case something goes wrong. This is because; there would be no set benchmarks against which, health care service is measured against. The third role of accreditation in healthcare is statistics, budgeting and government fiscal planning. What this means is that through accreditation, the government is able to collect variable data on the current status of the healthcare sector (Sears et al, 2015). For instance, the government can easily collect data from accredited institutions on the prevalence of lifestyle diseases like diabetes. It can then act on such data and come up with measures for combating such diseases. Without accreditation, it would be difficult to know how many healthcare facilities are in operation leave alone collect valuable healthcare data from them.

Sickle cell disease Essay Example | Topics and Well Written Essays - 500 words

Sickle cell disease - Essay Example The chance of one of her parents being a carrier is 1 in 2 (1/2). Assuming that one of her parents had normal copies of CFTR and the other parent was a carrier, the chances of their siblings being a carrier is 1 in 2 (1/2). So the chances of my friend being a carrier is x , i.e , one out of four. Assuming that both my friend and her fianc are carriers, the chances of their baby having the disease are 1 in 4. Therefore, the overall chance of their baby having cystic fibrosis is x x . 1/32, one in a 32. Sickle cell disease: Sickle cell disease is a genetic disorder caused by mutations of the -globin gene. There is a mutation of one single nucleotide from A to T, which results in a glutamic acid being replaced by valine at position 6 of the -globin gene. GAG, a codon, which codes for glutamic acid is changed to GUG resulting in replacement with valine (Pauling et al., 1949). In several forms of this disease, the red blood cells (RBC's) change their shape (Herrick, JB., 1910), upon deoxygenation caused by polymerization of abnormal sickle hemoglobin (Hanh and Gillespie, 1927). This results in the damage of the RBC's and can lead to these cells getting stuck in capillaries. The downstream tissues that are supplied by these capillaries are deprived of oxygen causing ischemia, leading to organ damage, as in stroke.

USGAAP and iGAAP Essay Example | Topics and Well Written Essays - 500 words

USGAAP and iGAAP - Essay Example There is a similarity between both the US GAAP and iGAAP, regarding the treatment of the impairment of assets that are held for disposal (Ochoa, 2010). Under both accounting methods, the impairment of the assets that is held for disposal is to be treated as the difference between the assets carrying amount, and the assets fair value. This difference becomes the amount of the loss of value of the asset, which is to be treated as expenditure. The other similarity in the treatment of intangible assets; is in the treatment of intangible assets acquired through business combination, especially when such intangible assets can be treated as different from the goodwill. The differentiation in such assets exists, if such assets can be transferred, licensed, rented, or exchanged (McClenahen & Jusko, 2002). Under both the US GAAP and iGAAP, such asset should be treated as normal business assets. There is a major disparity in the treatment of expenditure in research and development, under both the US GAAP and iGAAP. The US GAAP requires that all the expenditure that is incurred in the generation of internal intangibles to be factored in, as expenditure (Crovitz, 2008). Therefore, any costs involved in research and development is to be treated as expenditure, under US GAAP. However, the case is different under the iGAAP, which provides that there should be a distinction between the research expenses and the development expenses. The argument is that, the cost incurred in research has no certainty of generating future economic value, and thus it should be treated as expenditure (McClenahen & Jusko, 2002). On the other hand, all the costs incurred in development, which could lead to the generation of future income benefits, such as the development of brand value, should be treated as capital expenditure, and thus placed under capital (Ochoa, 2010). While both US GAAP and iGAAP treat the assets acquired

Case Study -- Report Essay Example | Topics and Well Written Essays - 1750 words

Case Study -- Report - Essay Example The paper is directly relevant to the case in which management of employee relations and commitment to the organization is the crux of all problems encountered at Ancol. (Wilde, 1985) The second paper is â€Å"Fostering an environment of employee contribution to increase commitment and motivation† by Geoffrey C Lloyd. This paper uses a case study to relay its point. It is in light of British Gas Company which succeeded after they implemented their chief executive’s suggestion. The paper emphasizes on various ways in which an environment of employee contribution can be cultivated in an organization. It lays focus on the importance of empowerment, speeding up of communication process between management and employees and offers advice to companies who are thinking of restructuring their organization. The paper is very relevant to Ancol. Even Ancol is struggling with encouraging work place productivity, curbing absteeniesm and establishing sound relations between management and employees. The paper will offer insight into ways of improving things at Ancol and has a rich literature that will give more room for critical thinking and analysis. (LIoyd, 1996) The third paper is â€Å"Work Structuring for employee motivation† by Lyndon Jones. ... This is a relatively small yet important paper that explains ways in which good healthy relationships can be fostered in a work place environment; on the kind of human resource policies that should be adopted. Analysis: Sims had been only recently appointed as the manager of the Sheparton plant of Ancol. This was a very important point in his career and he wanted to set things straight at Ancol by making effective use of his management expertise. When Sims entered Ancol, he realized that the management and employee relations were severely strained within the organization. There were some major tiffs between them and they were not eye to eye with respect to the organizational goals. Hence, the center of all his focus was improving ties between the management and employees. In this bid to improve ties between the management and the employees, he order the removal of time clocks from the plant. He felt that this gesture will bring about a new level of credibility and strengthen relation s between the employees and the management at the site. The impact of this move was not completely productive. It did prove to be fruitful initially but did not have far reaching positive repercussions. The gesture was appreciated initially and many felt that was a positive effort by the plant manager. But the problems began cropping up two months later. Absteenism in the plant rose, productivity levels declined and other issues started emerging. This problem had to be tackled. Sims tried to solve the problem by giving additional responsibilities to supervisors of looking after emplolyee entrance and leaving problems and discussing it with them. but the supervisors had no prior experience at all this and did not have the

Defensive Communication Essay Example | Topics and Well Written Essays - 1000 words

Defensive Communication - Essay Example By examining these forms of messages in the context of interpersonal communication, I shall reaffirm previous research findings that defensive communication results in 'losses in efficiency in communication' (Gibb 14). The strategy of defensive communication has various tactics and in the limited space afforded by this paper I will separately analyse in the following order only control messages, dogmatic messages, messages of indifference, and messages of superiority. Control messages predominantly operate as imperatives, commands, and instructions. Control messages therefore imply authority, that is, the 'right to give orders or make decisions' (Lewis). Authority, however, implies varying degrees of power. 'A power relation is a causal relation between the preferences of an actor regarding an outcome and the outcome itself' (Pettigrew 188). For example, a police officer has authority to issue commands and power to enforce those commands. In contrast, a teacher has authority to issue commands and instruction but less power to enforce those commands. Parents like teachers have authority and a limited degree of power. What is more, as the context of one's communication becomes more personal authority and power wan, so that no real power relations exist between friends. For instance, in intimate relations defensive communication can occur when 'individuals are sensitive about their own flaws as well as the flaws of others close to them' (Becker, Ell evold and Stamp 95). Complicating the matter is that not all communication is verbal - body language for instance. So that, without explicit messages or in fact any intent, one may communicate irritation or annoyance. Furthermore, control is not simply the directing of action; 'information may become an instrument for advancing, attacking, or defending status' (Burns and Stalker cited in Pettigrew 189). For example, one may use control messages to avoid a topic of discussion, as in family secrets (see for example Caughlin et al.). Dogmatic messages fall within the compass of defensive communication by virtue of the denotation of dogma; 'a doctrine or code of beliefs accepted as authoritative' (Lewis). In contrast to control messages, that expose authority and power, dogmatic messages expose censorship. Defensive communication in general, and dogmatic messages in particular, involve 'a self-perceived flaw that an individual refuses to admit to another person' (Becker, Halbesleben and O'Hair 144). Resisting the model of a dialogue (Pope 173), dogmatic messages rely on the monologue. For, 'every word is directed towards an answer and cannot escape the profound influence of the answering word that it anticipates' (Bakhtin cited in Pope 235). We may think of a dialogue as the collaboration between people to come to a mutual understanding. Yet in contrast, dogmatic messages attempt to curtail the give-and-take of communication. Such messages contain a deep irony; for, despite the effort to avoid a topic or point via an assertion of strength, the effort itself communicates a defensive attitude grounded on weakness. Dogmatic messages, therefore, undermine any authority or power asserted by a conversational partner. Furthermore, because a dogmatic message

Chinese Beer Market Essay Example for Free

Chinese Beer Market Essay China’s beer industry has enjoyed impressive growth over the past three decades—ranking first in the world in terms of output in 2010. But despite its achievements, the industry now faces serious challenges, including slowing growth rates and slim profit margins. To break the bottleneck, the industry must look to new growth sources. Promising strategies could include introducing high-end products in China’s urban markets and launching low-cost but still high-quality products in rural areas. To make these strategies work, Chinese beer companies will need to strengthen their operations on three fronts: brand positioning, distribution and cost control. 2 | Accenture Institute for High Performance | Copyright  © 2012 Accenture. All rights reserved. China’s Beer Industry: Breaking the Growth Bottleneck Despite its achievements, the industry has encountered several obstacles. For one thing, spectacular growth rates from earlier decades have recently lost steam. From 26 percent during 1980-1990, production CAGR shrank to 12 percent in 19902000 and 7 percent during 2000-2009. And while per-capita consumption has increased in China, it pales in comparison to numerous other countries—suggesting considerable room for growth. The industry also has meager profit margins, in part because low-end products account for 85 percent of the domestic market. Fluctuations in prices for critical raw materials such as barley and hops; soaring promotion costs aimed at launching higher-end offerings; and relentless price wars have whittled margins to 6. 4 percent—3. 9 percentage points lower than the industry average. Figure 1: Beer production in China, 1980-2011 (million tons) Industry production has enjoyed an average compound annual growth rate (CAGR) of nearly 15%. CAGR 14. 7% 4899 69 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989. 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Since 1980, the Chinese beer industry has seen steady escalations in production as well as consumption. (See Figures 1 and 2. ) The top four players—Tsingtao Brewery, China Resources Breweries, Yanjing Beer and Anheuser-Busch InBev— accounted for 58 percent of the nation’s beer sales in 2011. Still, there is no â€Å"national† beer brand; indeed, the industry has decidedly different characteristics across China. The big beer makers are concentrated in China’s eastern, central and northeast regions. In these saturated markets, companies compete to serve urban consumers through well-established sales channels including supermarkets, restaurants and clubs. In China’s rural regions, characterized by relatively few sales outlets and high transportation costs, beer drinkers can find a slim variety of offerings mostly at small stores. Source: China Industrial Economic Statistical Yearbook, data of 2010 from China National Sugar and Alcoholic Commodities Fair, EPS. Figure 2: Beer consumption in China, 2003-2011 (liters) Per-capita beer consumption surged from 19. 6 liters in 2003 to 36. 36 liters in 2011. 36. 36.

Consulting Project Plan - Executive Summary Essay Example for Free

Consulting Project Plan Executive Summary Essay My name is Lisa. I am a consultant from Hexi Consultation Firm. My expertise lies in interpersonal, training, and sales consultations. I was brought in by Mr. Joseph Wilson, your CEO, to research what he believed to be the company problem, diagnose it, and come up with a solution. First, I want to let each and everyone one know that I am here to help. I am here to help not only find out what has gone wrong but to help those who this is affecting come out of this with a better way of operating his/her department or duties, improve interpersonal relationships, insure everyone knows how to perform their job by providing him/her with the necessary material and training possible. Along the way, I want each person to who I interact with to feel free to question a statement, a recommendation, or a decision. We will be in this project together. I want everyone involved to understand this is your workplace, your home away from home, your livelihood. I am here to help improve the environment and conditions in which it operates. Upon completion of this project, I want everyone to feel that the changes made were fore the best and made this company a better place to work. How we achieve that will be by: * Creating a Communication Plan * Scheduling and conducting meeting for areas where research and change are involved. * Organize and Conduct a Feedback Meetings * Corporate and Regional * Beginning to End of Project * Devise an Implementation Plan I look forward to the opportunity to work alongside of everyone involved.

Definition Of The Term Authentic Material

Definition Of The Term Authentic Material During the last decades, English language has been expanding considerably all over the world. In fact, people have started to talk about English language as the new global language. As a consequence of this impressive evolution, our nation has applied several educational measures to the general curriculum of education in order to teach correctly English as a second language in schools. The creation of the program Inglà ©s abre puertas and the changes made to the studying plans of MINEDUC are clear examples of this initiative. Notwithstanding, these attempts of improving the English level in our students did not work at all. Last year, a proficiency test called SIMCE was taken so as to evaluate the level of English language in students of third year of high school, and the results obtained by this assessment were really deficient. Indeed, 89% of all students evaluated were not able to certificate a basic level of English. In light of this pitiful scenario, this paper proposes the use of authentic materials as an interesting and useful ESL teaching technique which can contribute to ameliorate the low level of English in students. In the following paragraphs, it will be stated the definition of the concept authentic materials in the ESL field and the sources where teachers can get them. Furthermore, guidelines for the correct selection of these teaching materials will be provided, and the advantages of using them will be described in detail and supported firmly. As the title of this project says, the subject of study is the use of authentic materials in ESL lessons. Thereby, it is necessary to start by defining what authentic materials really are. Firstly, the conceptualization of teaching/learning materials has to be stated concisely and explicitly. In essence, the term material refers to resources in the classroom which students are able to use with the purpose of improving and complementing their learning process. For instance, a book, a photocopied handout, a poster, a flashcard, a whiteboard, or any technological equipment can be defined as material because they act in a complementary way in the teaching/learning process and include the characteristics mentioned before. As Tomlinson (1998) asserts, they are anything which is used to help to teach language learners.à ¢Ã¢â€š ¬Ã‚ ¦ anything which presents or informs about the language being learned.(p.11). Although it is easy to delineate the meaning of the term teaching/learning materials, the concept of authenticity is a bit more complex of classifying since there are several different authors who have attempted to define it in the field of second language teaching. For example, Heitler (2005) states that authentic materials are any texts written by native English speakers for native English speakers (p.5), while Tomlinson (1998) ascertains that an authentic text is a text not written or spoken for language teaching purposes. Likewise, Kramsh (1993) adds the term authentic has been used as a reaction against the prefabricated artificial language of textbooks and instructional dialogues, it refers to the way language is used in non-pedagogic, natural communication, and Little and Singleton (1988) declares that an authentic text is a text that was created to fulfill some social purpose in the language community in which it was produced. In the same line, Harmer (1991) defines authentic texts as materials which are designed for native speakers; they are real texts; designed not for language students, but for the speakers of the language, and Sanderson (1999) complements the description of authentic materials saying that they are materials that we can use with the students in the classroom and that have not been changed in any way for ESL students. A classic example would be a newspaper article thats written for a native-English-speaking audience (p.3). As it can be seen, there is a spectrum of distinct conceptualizations of authenticity. However, there is an agreement with some specific characteristics of genuine resources among the definitions established before. One of those shared features is the non-pedagogic purpose. Authentic materials are not produced nor adapted so as to be used for teaching or learning a second language; in fact, they are taken as genuine as possible from the reality. In this way, the artificiality of language is avoided completely. A pos itive consequence since the artificial nature of the language and structures used, make them very unlike anything that the learner will encounter in the real world and very often they do not reflect how the language is really used (Berardo, 2006, p.62). In order to complete this pursuit of genuineness, it is essential to obtain materials produced by native speakers. They interact with their peers inevitably in the target language because it is their innate language. Actually, there is not a better version of spoken or written English than the one made by the people who lives in English spoken cultures, so native production becomes another key aspect in the classification of authentic materials. Considering that any interaction between two native speakers can be used as an authentic material, it is unavoidable to look for common situations with the intention of getting real communication in English. Every person uses his own language to transmit a message to other person, and this pr ocess of normal communication among people has to be captured so as to have the authenticity desired in ESL teaching. Thus, real communication is a vital facet in the conceptualization authentic materials. In sum, the three basic characteristics of authentic materials are non-pedagogic purpose, native production, and real communication. For the purpose of this paper, authentic materials will be classified and identified in respect of those features. Nowadays, there is a huge variety of different sources where materials with the characteristics established before can be found, so the task of selection of adequate genuine resources has become a tough one. Even though, the globalized world offers multiple options to look for proper authentic materials for ESL lessons, there are three prime sources which are the most typical used: internet, literature, and mass media. The first one provides a limitless range of useful materials for ESL classroom. In internet, teachers can find podcast, videos, songs, websites, images, advertising, and plenty of other resources which can serve as authentic materials. All these resources possess the benefits of being constantly updated, and additionally most of them are interactive. Unquestionably, this source is the one which contains more available resources among the three named before, and the procedure of searching for specific information is easy to do as well. These advantages of abundance and easiness plus the others mentioned above make internet a valuable source for ESL teaching. Opposite to the advantages of internet, literature works with others aspects of language. It does not provide many resources to be used as authentic materials; indeed, it mainly provides books. Despite the fact that poems and fairy tales can also be utilized for ESL teaching, they are not applied in lessons in a frequent mode. In regard to books, they not only serve as genuine resources for English teaching/learning, but they also function as a reflection of the community in which was written. From literature, students can extract relevant information about cultures and know in depth their linguistic characteristics. As Sanderson (1999) states, language and cultures are intrexicably linked (p.2), so the cultural background is an important advantage of using literature as a source. In addition to this benefit, there is a special contribution to students made by literature. Most of the books are written with the purpose of transferring human experiences to readers, and these experiences have an intrinsic emotional significance. Hence, teachers can use literature to teach students human values so as to educate them integrally. In that way, they will be exploiting totally these authentic materials, and completing one of the major tasks for educators. By the same token, the other main source for finding genuine resources exhibits benefits akin to the previous ones. Mass media play an essential role in the communication of modern society, and their relevance can be demonstrated with the fact that today people are informed about all the important events which happen in the world due to their communicative labor. Mass media function as a way of global communication, and their product is abounding and immediate information. There are several resources from mass media which can be utilized for ESL teaching as magazines, TV programs, live radio and newspapers, but just the last men tioned provides numerous benefits as authentic material. According to Sanderson (1999), there are numerous reasons to use newspapers in classroom, and the stronger ones are general educational value, cultural background, reader interest, and varieties of English. The first one refers basically to the fact that newspapers inform people about what is happening in the world and elaborate on their general knowledge about their reality. The second one refers to the reflection of the culture where a newspaper is written in the language used within it. It is similar to the contribution of books in ESL lessons. The third reason is explained by the assortment of topics and sections which a newspaper contains. Due to that diversity of subjects, readers can be motivated and interested in working with them. The final argument points out the wide range of text types and language styles that newspapers offer to ESL teachers. It is not easy to find this multiplicity in others resources. In view of the advantages of using newspapers described before, they are definitely a beneficial and practical material for ESL teaching. Regardless the fact that plenty of texts can be taken from the three prime sources named in the previous paragraph, it does not mean that all the materials contained in them will be appropriate for ESL teaching. Actually, many examples of language use could be too complex, or too informal for L2 pedagogy. Thus, there are certain criteria which serve as filter for this profusion of resources. According to Berardo (2006), some specific traits have to be pondered in the selection of authentic materials. The most important one is the suitability of the text. The material has to be related to the needs of the students, and additionally it must be motivating for them. For instance, it will be absurd to use a conversation about the construction of a building between two engineers as a learning material if the learners are studying medicine or law because the resources utilized do not fit with the needs of the students. For this purpose, it is necessary to know as many aspects of the student s as possible, so teachers can look for attractive and relevant genuine resources. A useful way of collecting likes and dislikes of students is the use of surveys. By using that technique, teachers can accrue the necessary knowledge about the target group so as to find apt materials. Other factor to consider in selecting materials is exploitability. The text which will be used in class must have a teaching purpose. It should demand coherent and significant tasks from students in order to be helpful for the ESL lesson. Even though authentic material contains real English language, they could not have a use in the classroom if they do not require students to do fruitful exercises. Consequently, the fact of providing native English language is not enough to select a material for an ESL lesson. The texts extracted from the sources must be compatible with the objectives of the class. In addition to this, the complexity of a text should be also considered in the process of deciding if a m aterial is appropriate for ESL teaching. The language level of the genuine resource chosen must match with the language level of students. Linguistic features as structural and lexical ones can affect directly the understanding of students about the text, as well as the amount of new vocabulary and any new grammatical forms present in the material. A teacher cannot pretend to work with materials which their students are not even able to comprehend. The last element which needs consideration in the choice of proper teaching resources is presentation. The contextualization of the authentic material is a detail that cannot be sidestepped. Pictures, photographs, realia and concept maps can help students not only to grasp correctly the gist of the text, but also can aid to construct an imaginary image of the context in which the genuine resource was created. Besides, those elements add attractiveness to materials and stimulate students to learn the target language. The appearance of text s is the first aspect that students notice when materials a represented to them, so it is vital factor in the attempt of getting the attention of students. Considering the explanations and justifications of each criterion in the procedure of choosing materials, it would be beneficial for the teaching and learning of a second language to apply them. Therefore, teachers have to use the four criteria described thoroughly in the previous lines with the purpose of selecting practical and adequate materials for ESL lessons. As it has been already defined the term authentic materials and has been proposed guidelines to select appropriately them, it is the time to say explicitly why genuine resources should be used in ESL classes since that argument is the gist of this research paper. In concise words, the main reason for utilizing genuine resources in ESL lessons is they provide varied and exclusive advantages to the teaching/learning process of English language. Actually, numerous investigators of the field as Nuttal, Widdowson, Berardo, or Martinez have identified many benefits from the use of authentic materials, and in the following lines the most important ones will be presented to support the idea stated. The first and chief advantage of using authentic materials in ESL class is the exposure to real English. One of the central principles in the application of this kind of teaching resource is to immerse students to as much natural language as possible because learners are accustomed to receive an artificial version of the target language in their normal classes. Inevitably, the English language adapted to instructional purposes loses certain incidental features of genuine communication and reproduces the view of teaching designed by the people in charge, whereas using authentic materials provides readers with the chance to practice English with real models of language and to realize differences between communication of native speakers and non-native speakers. This last sentence offers a convenient bridge to explain the sense of achievement which will be the second advantage highlighted in this section. As students do not commonly work with authentic materials in English classes, they can feel afraid of misunderstanding the whole texts or committing mistakes when they will be working with them. The fear towards materials made in foreign countries affects directly the way in which students acquire the target dialect, and the sense of achievement can be explained with regard to that assumption. As it is believed that genuine resources are complex and hard to work with, students feel really happy and proud of themselves when they are able to grasp the main ideas of texts or to complete the tasks demanded for the material. Any improvement produced by learners pertaining to the comprehension and exploitation of authentic material will be significant for them. It is a unique and progressive procedure of delight in learners. Similar to the last benefit of using authentic materials, the next one is also concerned with the affective dimension of learners. Indeed, the third advantage which will be examined in depth is motivation. Generally, students react in a positive way upon the use of novel teaching/learning materials in everyday classes. These innovative pedagogic resources stimulate learners to practice language in an enthusiastic mode. Introducing authentic materials to an English lesson can attain the affective consequences named before since that kind of materials are unusual for students. Besides, genuine resources usually contain diverse visual stimuli which make them more appealing for learners. Videos, newspapers, brochures, and job advices are examples of that motivating characteristic. In light of the advantages about motivation and sense of achievement, it is important to mention that the affective factors of learning a second language have been investigated exhaustively during the last decades. As a matter of fact, Krashen (1977), who is considered one of the most important authors in the field of second language acquisition, states a hypothesis called affective filter which is about the relevance of feelings and attitudes in the L2 acquisition process. Returning to our focus, the fourth advantage of using authentic materials in ESL lessons is cultural background. By way of genuine resources are real communicative situations extracted from their natural context, there are traits of the context embed in them. Thus, cultural information about a country or a community can be obtained from the use of this type of teaching/learning material. Students not only learn a foreign language when using authentic materials, they also learn about cultures from different parts of the world. Thereby, learners can develop a global knowledge of the lifestyles outside of their country and be acquainted with what is going on in the world around them. In the section about sources of possible materials, there were described some resources which include this advantage as their primary characteristic. The final advantage which will be outlined against the use of common instructional materials is variety. This facet of the use of authen tic material possesses two connotations. The first one refers to the multiplicity of types of texts that teachers can utilize as genuine resources. In the part of the paper where it was discussed the diversity of sources, there were named around twenty distinct authentic resources which can be utilized in ESL class. In there, it was demonstrated that there is an abundance of kinds of genuine resources, and teachers only have to select one according to their teaching purposes. Besides, this wide range of texts includes a variety of language styles too. Students can benefit from them, and develop their basic skills of English language. For example, learners can ameliorate their listening skill by hearing different accents in conversations extracted from native speakers from distinct countries, or they can improve their reading skill by comparing diverse writing styles presented in books which were made in different cultures. The second connotation refers to the assortment of topics wh ich can be found in the sources of genuine resources. This mixture implicates teachers can choose materials considering likes and needs of their students and prepare a lesson which will be relevant and motivating for them. As it has been confirmed in previous paragraphs, the interest of students upon a learning resource can change radically the effectiveness of the class. With all these unique and practical features at their disposal, ESL teachers have to start questioning why they do not use authentic materials commonly in class because at the moment there is not a solid argument to stand out these advantages and benefits. It is compulsory for ESL educators to investigate about different ways to teach English so as to possess a spectrum of distinct methodologies or techniques. Thereby, they can choose an appropriate one pondering the characteristics and needs of their target group of learners. In this respect, authentic materials are teaching resources easy to find and select, and additionally they provide exposure to real English, sense of achievement, motivation, cultural background and variety to ESL classes. Therefore, they must be considered as a valuable and useful teaching/learning material for teachers in the ESL field, and undoubtedly they must be used in a more frequent way in their lessons.

Elements of Marketing New Zealand for Tourism :: Tourism Destination Marketing

Introduction The Bay of islands is one of the most beautiful parts of New Zealand and has 144 islands. It can also claim to be the birth place of New Zealand. The Bay Island with its warm climate and water based activities is a popular destination for New Zealand holiday makers and international tourist. The bay has many interesting historic towns including Pahia, Russell, Waitangi and Kari Keri. There is a broad range of accommodation in the bay of island, as well as attractions and activities, place to eat, and entrainment of all age. Tourists are more dependable on website to get the information and overview of destination. Therefore one of the website of bay of island is www.tourism.net.nz, which gives complete information. In this assignment, we will mainly discuss about marketing mix, customer wants, creating value for the customer, destination location and tangible experience from tourism marketing perspective. Marketing Mix 1) Product A service is something that cannot be touched. This means that it is harder to market, than a physical Product. Its quality cannot be perceived before it is used. This can complicate convincing a potential tourist to acquire the service and to choose one service offering over any other. Many of the services/products that Bay of Islands offers could easily be offered by other destinations in New Zealand or even abroad. What distinguishes Bay of Islands is that they were first to the market with this type of nature and culture-based tourism product in New Zealand. This is a simple rule of business and it applies greatly in the case of New Zealand. Bay of Islands has managed to carve out some sort of niche product for itself in the north of New Zealand. It is seen as the exemplar of the natural, adventure and heritage product that New Zealand has to offer. 2) Price A very important factor in the marketing mix is the price. Since a service is not physical, its value must be carefully thought out. The price is sometimes the first thing which tourists look at. Depending on the type of service, perceptions of value differ. The price can act as an indicator of quality. A low price may seem as an attempt to cheat the customer in some way. People expect quality to cost and are willing to pay a higher price for it. That is why the service provider must be aware of how much people would pay for his service and why.

Avon Marketing Channel Essay -- essays research papers

History of Avon Avon was founded in 1886 as the California Perfume Company by a book salesman named Mr. David McConnell. He got the idea of opening this company when he discovered that the rose oil perfumes he was giving away with the books were the primary reason people were buying his books not the book it self. In 1914 the first international office opened in Montreal, Canada and in 1916 California Perfume Company first incorporated in New York State and by 1964 Avon stocks have been listed on New York Stock Exchange. The company changed its name to Avon products, Inc., in 1939 by the new president of the company the son of the founder after the river that runs through Stratford-On-Avon in the English Midlands. The name is a tribute to McConnell's favorite playwright, William Shakespeare, who hailed from the town. From only $500 revenues a day, which was recorded for the first time in December 1897, in 1920 the company’s revenues reached $1 million a year and by 1972 it reached $1 billion for the first time. In 2004 the total revenue of Avon was $7.7 billions!! In 1999Avon names its first-ever female CEO with the appointment of Andrea Jung in November and in 2001Avon’s Board of Directors elected her as the company’s first female Chairman of the Board. She is one of five female chief executives of Fortune 500 companies, and is one of three holding the titles of chairman and chief executive. Facts about Avon: Avon is the world's leading direct seller of beauty and re...

Stefan’s Diaries: Origins Chapter 26

I cannot say how long I ran. The night was clear and cold, and my heart felt as though it were pounding in my neck, in my brain, in my feet. I occasionally pressed my hand to the wound on my neck, which was still bleeding. The area was warm to the touch, and I felt dizzy whenever I put my hand on it. With each footstep, a new image appeared in my head: Katherine, bloodstained foam collecting at the corner of her mouth; Father, standing above her with a stake. Memories blurred, so I wasn't sure whether the red-eyed, shrieking monster who was on the floor was the same person who'd lunged at me with her teeth, who'd caressed me in the pond, who haunted my dreams and my waking hours. I shivered uncontrollably and lost my footing, tripping over a felled branch. I landed on the dirt, on my hands and knees, and retched repeatedly, until the iron-like taste in my mouth disappeared. Katherine was about to die. Father hated me. I didn't know who I was, or what I should be doing. The entire world was turned upside down, and I felt dizzy and weak, sure that no matter what I did, I would cause destruction. This was all my fault. All of it. If I hadn't lied to Father and kept Katherine's secret †¦ I forced myself to catch my breath, then stood up and began running again. As I ran, the scent of the vervain in my pocket filled my nostrils. Its sweet, earthy fragrance wafted through my body, seeming to clear my head and imbue my limbs with a wakeful energy. I turned left on the dirt path, surprised at the course I was choosing, but for the first time in weeks, I felt certain about my actions. I burst into the sheriff's office, where Sheriff Forbes sat with his feet up on the desk, asleep. In the one holding cell, the town drunk, Jeremiah Black, was snoring loudly, obviously sleeping off a bad night at the saloon. Noah, a young officer, was also nodding off on a wooden chair outside the cell. â€Å"Vampires! There are vampires at Veritas!† I yelled, causing Sheriff Forbes and Jeremiah to simultaneously snap to attention. â€Å"Let's go. Follow me,† Sheriff Forbes said, grabbing a club and a musket. â€Å"Noah!† he yelled. â€Å"Get the wagon and follow behind with Stefan.† â€Å"Y sir,† Noah said, jumping to his feet. He es, pulled a club from a hook on the wall and passed it to me. Just then, I heard a piercing noise, and I realized that Sheriff Forbes was ringing the alarm outside the sheriff's office. The bell clanged over and over again. â€Å"I can help. Please?† Jeremiah slurred, both hands on the bars. Noah shook his head and hurriedly ran through the building, his boots echoing against the wooden floor beams. I followed him, stopping to watch as he hastily hitched two horses to a long iron wagon. â€Å"Come on!† Noah called impatiently, holding his whip. I jumped up onto the seat next to Noah and watched as he cracked the whip, causing the horses to gallop at breakneck speed down the hill and into town. People were standing outside their houses in nightclothes and rubbing their eyes, some hitching horses to wagons and coaches. â€Å"Attack at the Salvatore estate!† Noah called, over and over again, until his voice almost broke. I knew I should help. But I couldn't. Instead, I felt fear grip my heart as the wind whipped my face. I heard the clip-clopping of horses in the distance, and saw doors being flung open and more townspeople in their nightclothes hastily grabbing rifles, bayonets, and any other weapon they could find. As we galloped through town, I noticed the apothecary was closed tightly. Could Anna and Pearl be at home? If so, I needed to give them a warning. No. The word came so strongly, it was as if my father had whispered it in my ear himself. I needed to make things right for me, for the Salvatore name. The only people I cared about were Father and Damon, and if anything happened to them †¦ â€Å"Attack at the Salvatore estate!† I yelled, my voice breaking. â€Å"Attack at the Salvatore estate!† Noah repeated, his words sounding like a chant. I looked up at the sky. The moon was a tiny sliver, and clouds obscured any hint of starlight. But suddenly, as we rode up the hill, I saw Veritas lit up like morning, with a mob of what looked like a hundred people brandishing torches and standing on the steps of the porch, yelling. Pastor Collins stood on the porch swing, calling out prayers, as several people watched him, kneeling on the ground and praying. Next to him was Honoria Fells, yelling to anyone who would listen about demons and repentance. Old Man Robinson was brandishing his torch and threatening to burn down the entire estate. â€Å"Stefan!† Honoria called as I jumped off the wagon before it stopped. â€Å"For your protection,† she said, proffering a branch of vervain. â€Å"Excuse me,† I called hoarsely, as I pushed through the horde, using my elbows, and ran to the carriage house and up the stairs. I heard angry voices from the chambers. â€Å"I will take her! We'll leave, and you won't see either of us again!† Damon's voice, as low and ominous as incoming thunder. â€Å"Ungrateful!† Father roared, and I heard a sickening crack. I bounded up the stairs and saw Damon, slumped against the doorway, a trickle of blood oozing from his temple. The door had cracked from the impact of Damon's body. â€Å"Damon!† I called, falling onto my knees next to my brother. Damon tried to struggle to his feet. I winced as I saw the blood flooding from his temple. When he turned toward me, his eyes blazed with anger. Father stood, stake in hand. â€Å"Thank you for getting the sheriff, Stefan. Y did the right thing. ou Unlike your brother.† Father reached out toward him, and I gasped, sure he would hit him again. But instead he stretched out his hand. â€Å"Stand up, Damon.† Damon slapped away Father's hand. He stood on his own, wiping the blood from his head with the back of his hand. â€Å"Damon. Listen to me,† Father continued, ignoring the look of pure hatred on Damon's face. â€Å"Y were bewitched by the demon †¦ by that ou Katherine. But now she will disappear and you must side with what's right. I showed you mercy, but these people †¦Ã¢â‚¬  He gestured toward the window and the angry mob beyond it. â€Å"Then let me be killed,† Damon hissed, as he stormed out the door. He brushed past me, hitting me hard with his shoulder as he ran down the stairs. From inside the room, an agonizing shriek emerged. â€Å"Sheriff?† Father called, swinging open the door to Katherine's chambers. I gasped. There was Katherine, a leather muzzle over her face, her white arms and legs bound together. â€Å"She's ready,† Sheriff said grimly. â€Å"We'll take her to the wagon and add her to the list. Gilbert's got the compass and is rounding up the vampires in town. By daybreak, we will have rid the town of this scourge.† Katherine stared at me, a desperate, pleading expression in her eyes. But what could I do? She was lost to me now. I turned down the stairs and ran.

Microbiology Coursework: Bacillus Cereus

Microbiology Coursework: Bacillus cereus After investigation following on outbreak of food poisoning at a pizza restaurant, it was found that all suffers had consumed a portion of side salad from the self-service salad bar alongside their main dish. Subsequently, this was further traced to a rice salad. Environmental Health Officers investigating this outbreak suspected it may have been caused by Bacillus cereus (B. cereus). The presence of large numbers of B. cereus in a food is indicative of active growth and proliferation of the organism and is consistent with a potential hazard to health. The diagnosis of B. ereus can be confirmed by the isolation of more than 105 B. cereus organisms per gram from epidemiologically implicated food, but such testing is often not done because the illness is relatively harmless and usually self-limiting 1. Design a method(s) to enumerate the: i)Total bacterial count ii)Bacillus cereus count In the rice saladThis outbreak of food poisoning could be i nvestigated by performing an enumeration (plate count) of the total viable bacteria in the rice salad on a general non-selective agar using either the pour or the spread plate method. To confirm that the outbreak had been caused by any B. ereus present in the rice salad a selective media agar, such as mannitol egg yolk polymixin agar (MEYP/MYP), should be used. Once B. cereus has been confirmed a further enumeration of the B. cereus should be performed on the MEYP/MYP agar selective media plate to show whether the amount of B. cereus present is within the range known to cause food poisoning 105–107 cells g? 1 of food for Diarrhoeal syndrome, or 105–108 cells g? 1 of food for Emetic syndrome. (Granum & Lund, 2006) To perform a total cell count and the confirmation of B. cereus by either the pour or spread plate method the equipment required is as follows:General non-selective agar Mannitol egg yolk polymixin agar (MEYP/MYP) Petri dishes Glass or disposable â€Å"hockey stick† spreader Bunsen burner Test tubes Ringers solution Pastettes / Pippettes Food blender Before a cell count can be performed a serial dilution of an homogenate of the rice salad is required. For this one part rice salad is blended to nine part ringers solution, from this initial homogenate that the serial dilution is created by taking 1ml of this original and adding it to 9ml of ringers solution thereby creating a 1:10 dilution of the original.This step is repeated a further 5 times, each time taking 1ml from the dilution created in the previous tube and adding it to 9ml of ringers solution thereby with each step the original sample is diluted by a further factor of 10, (Figure 1). Once the serial dilution has been completed down to a dilution of 1:1,000,000 (10-6) either the pour or spread plate method of plating out of the samples can be performed Figure 1: Serial dilution When using a general non-selective agar both the pour and spread plate methods can be used for en umeration of the total bacteria in the rice salad.With both methods all plates are performed in triplicate. Along-side the non-selective agar, an agar such as MEYP/MYP selective agar which is selective for B. cereus can be used to confirm that B. cereus is present in the original sample. In the pour plate method 1ml or 0. 1ml of each of the dilutions prepared earlier within the serial dilution are added to individual petri dishes and a nutrient agar which is held at around 50oC is poured over each of these samples, the petri dishes are swirled causing gentle agitation and mixing the bacteria with the agar.After the agar has solidified the plates are incubated, after this incubation the pour plates show bacterial growth both on and within the agar due to aerobic and anaerobic bacteria. In the spread plate method 0. 1ml of each of the serial dilution solutions is pipetted onto the surface of a pre-poured agar plate and spread using a â€Å"hockey stick† spreader, the agar plate s are then incubated. Bacterial colonies only grow on the surface of the spread plate, (Figure 2) Figure 2: Method of Pour and spread plate technique. Microbial Growth, 2011) Once the plates have been incubated they are examined and the number of colonies counted, only plates that show between 30-300 colonies are counted, if the number of colonies is above 300 then the plate is discarded as too numerous to count, if below 30 it is discarded as too few to count. After the plates showing between 30-300 colonies have been counted the number of bacteria in the original sample can be worked out using the calculation Number of colonies on plate x dilution of sample = number of bacteria / mlIf growth has occurred on the MEYP/MYP plates, a Gram stain can be performed on a sample from one of the colonies, when the gram stain is examined under oil immersion B. cereus should appear as large Gram-positive bacilli in short-to-long chains; with spores that are ellipsoidal, central to subterminal, and that do not swell the sporangium. (Tallent, Rhodehamel , Harmon, & Bennett, 2012) (Figure 3) Figure 3: flow diagram showing order of events leading to the enumeration of total bacteria and Bacillus cereus in a sample of food. 2.Explain why MEYP/MYP agar is selective for Bacillus cereus B. cereus is mannitol-negative. The mannitol content of the medium thus allows differentiation of the accompanyingmannitol-positive microbial flora which are identified by a change in colour of the indicator phenol red to yellow. B. cereus is not affected by concentrations of polymyxin which inhibit the common accompanying microbial flora (Donovan, 1958). Addition of polymyxin is necessary, however, if the sample material is suspected to contain high-numbers of accompanying microorganisms B. cereus produces lecithinase.The insoluble degradation products of egg-yolk lecithin accumulate around the Cereus colonies to form a white precipitate. A lecithinase reaction occurs very early in many strains, Cereus colonies can, therefore, often be rapidly identified before accompanying polymyxin-resistant microorganisms have had a chance to fully develop. Incubation: 18-40 hours at 32  °C. B. cereus appears as rough, dry colonies with a pink to purple base which are surrounded by a ring of dense precipitate. Colonies surrounded by a yellow or a clear zone are not Bacillus cereus.Further tests should be performed to confirm the identity of Bacillus cereus (anaerobic degradation of D(+)glucose, degradation of gelatin, positive nitrate reduction). (Merck, 2012) 3. Suggest how health officers may have come to the tentative conclusion of B. cereus poisoning. Health officers may have come to this conclusion based on the short incubation time to the sudden onset of illness, and due to rice already being implicated as the source of this type of food poisoning in other cases. 4. Suggest ways in which: i. The rice salad might have been infected by the Bacillus cereus; ii.The Bacillus cereus c ould have survived the normal cooking process of the rice; iii. Bacillus cereus causes food poisoning. B. cereus is present in the outer casing of rice and, because it is able to form spores that are very resistant to low or high temperatures, it can therefore easily survive cooking and less-than perfect refrigeration. Improper storage of food stuffs is the issue. Bacillus cereus spores can survive boiling and if the food, in this case rice is stored at ambient temperature, the spores can germinate into toxin producing bacteria. Herriman, 2009) Bacillus cereus has been reported to be present in stools of healthy humans at varying levels (Johnson, 1984) therefore if an individual had not washed their hands after going to the toilet then handled the serving spoon any B. cereus from the hands could be transferred to the serving spoon which in turn could either infect the rice salad or the hand of the person next using the spoon. When rice is boiled and then stored in the fridge without being cooled first, these spores can germinate on the cooked rice and grow well at 4oC.If the rice is then used in a stir fry or similar dish, where the cooking time is relatively short, or the rice is held at an insufficient temperature enough of the bacteria survive to be ingested. Bacillus cereus causes food poisoning of two different types, emetic and diarrhoeal. (Table 1) Table 1. Characteristics of the two types of disease caused by Bacillus cereus Diarrhoeal syndromeEmetic syndrome Infective dose105–107 (total)105–108 (cells g? 1) Toxin producedIn the small intestine of the hostPreformed in foods Type of toxinProteinCyclic peptide Incubation period8–16 h (occasionally >24 h)0. –5 h Duration of illness12–24 h (occasionally several days)6–24 h SymptomsAbdominal pain, watery diarrhoea and occasionally nauseaNausea, vomiting and malaise (sometimes followed by diarrhoea, due to additional enterotoxin production? ) Foods most frequently implicatedMeat products, soups, vegetables, puddings/sauces and milk/milk productsStarch-rich foods; Fried and cooked rice, pasta, pastry and noodles The form that produces diarrhoea is accompanied by symptoms that are virtually indistinguishable from those caused by the Clostridium perfingens bacteria.The affected person experiences abdominal cramps and severe watery diarrhoea within about 15 hours of eating the contaminated rice. Vomiting rarely occurs but the diarrhoea carries on between 1 and 2 days. The diarrhetic syndromes observed in patients are thought to stem from the three toxins Hemolysin BL Hbl, Nonhemolytic Enterotoxin Nhe and Cytotoxin K CytK. These enterotoxins are all produced in the small intestine of the host, thus thwarting the issue of digestion by host endogenous enzymes. Some strains of the bacteria have an extra plasmid that carries a gene for a toxin that causes severe vomiting.These strains cause the emetic form of Bacillus cereus and produce symptoms very similar to food poisoning by Staphylococcus aureus. After ingesting rice contaminated with these strains, vomiting begins between 1 and 5 hours. The effects are fairly short-lived and the digestive system usually returns to normal within about 24 hours. The emetic form is commonly caused by rice that is not cooked for a time and temperature sufficient to kill any spores present, then improperly refrigerated. It can produce a toxin, cereulide, which is not inactivated by later reheating. This form leads to nausea and vomiting 1–5 hours after consumption.It can be difficult to distinguish from other short-term bacterial foodborne pathogens such as Staphylococcus aureusReferences Microbial Growth. (2011). Retrieved March 3, 2012, from The Growth Of Bacterial Cultures: http://classes. midlandstech. com/carterp/Courses/bio225/chap06/Microbial%20Growth%20ss5. htm Donovan, K. O. (1958). A selective medium for Bacillus cereus in milk. J. Appl. Bact. (21), 100-103. Granum, P. , & Lun d, T. (2006, January 17). Bacillus cereus and its food poisoning toxins. FEMS Microbiology Letters, 157(2), 223-228. doi:10. 1111/j. 1574-6968. 1997. tb12776. x Herriman, R. (2009, September 13). Food-Borne Intoxication – Bacillus Cereus. Retrieved March 6, 2012, from ezinearticles. com: http://ezinearticles. com/? Food-Borne-Intoxication—Bacillus-Cereus&id=2915150 Johnson, K. M. (1984). Bacillus cereus food-borne illness. An update. J Food Prot, 47, 145–153. Merck. (2012). MYP Agar. Retrieved March 01, 2012, from Merck Microbiology Manual 12th Edition: http://www. mibius. de/out/oxbaseshop/html/0/images/wysiwigpro/MYP_Agar_105267_engl. pdf Tallent, S. M. , Rhodehamel , E. , Harmon, S. M. , & Bennett, R. W. (2012, February 02). BAM: Bacillus cereus. Retrieved March 05, 2012, from FDA U. S. Food and Drug Administration:

Hcs 571

Capital Project HCS/571 Capital assets are generally purchased to improve quality of care, or to provide needed equipment for a new service or expansion of an existing service. The key element in capital budgeting is that the building or piece of equipment being acquired has a lifetime that extends beyond the year of purchase and it is a capital asset or long-term investment for the hospital. Capital assets are good financial investments for the organization. (Finkler, Ward, & Baker, 2007). The Electronic health record software system is one of the important operational priorities in the US healthcare.The change from paper-based record system to electronic record system supported by technologies and help for reducing errors and improving quality of care based on best practice. (Song, McAlearney, Lausanne, Robbins, & McCullough, 2011). Research a capital purchase of software for filing patient records costing more than $5000 Health care organizations have invested heavily in computer technology. The health care organizations use computer technology and electronic health record in the actual delivery of care and to support clinical areas.The four principal uses of computers for nursing are for general information, clinical applications, research, and financial management. (Finkler, Ward, & Baker, 2007). The health care organizations are in the process of major transformation, and becoming more complex. It is very important to maintain the safety of patient and to provide high quality care. (Ting, Tsang, Ip, & Ho, 2011). The electronic health record system is considered as a means of technological efficiency to reduce the cost in healthcare organization.The need for EHR in healthcare organization is based on certain evidences like, It supports guideline-based care, increased patient monitoring, act as an efficient technological tool for effective communication in areas related to patient care, and improves coordination of care(Song, McAlearney, Lausanne, Robbins, & McCullough, 2011). The electronic health record system act as an easy access for medical literature and it is considered as a fast access system due to the effective utilization of information technology and enhances the healthcare efficiency system. Hillestad, 2005). Employee development The computer software and electronic health record advances will continue to evolve and that computer use by staff nurses will become commonplace in most healthcare organizations. In the long run this will likely increase the quality of patient care due to more accurate and timely information, while creating at least some efficiency in the use of nursing time. This should release more nurse time for patient care. (Finkler, Ward, & Baker, 2007). Computerization should work both to reduce nursing shortage and to increase nursing satisfaction.The health care organizations struggle to allocate sufficient funds for information system implementation, maintenance, and upgrade. The computerization of the nursing units has been a potential solution for nursing shortage. (Finkler, Ward, & Baker, 2007). Management goals The EHR implementation and governance are related to each other and it is mainly focus on the mission, vision, and behavior related to the management. The decision and action from managers level management is very essential factor for the effective purchase of EHR. Jarvenpaa & Ives, 1991). The support system in the organization related to EHR implementation helps to support and motivate the employees in difficult situation related to the technical failure of the system. (Miller & Sim, 2004). The successful implementation of EMR depends upon the team and technology of the organization. Team refers to people and issues related with organization. The technology related to the choice of the software, hard ware, and design set up of the organization to meet the implementation process.The main components of implementation process are people, process, and technology. The main focus of the change management is people and the related objective is to change the behavior for the acceleration of change process. (McCarthy & Eastman, 2010). Cost containment The software related Electronic health record implementation need to be appropriate for the needs of the organization and budget. (Swab, & Ciotti, 2010) The EHR software system has many areas of market depending upon the size of the hospital bed size.The first criteria for the vendors according to the bed with 100 and small hospital The Electronic health record system cost about between $ 1 million and 2 for the electronic health record system The electronic health record software cost for the organization about medium hospital cost is much larger than the first one. It comes around three to ten million. The hospital and organization with more than average bed cost for the electronic health record system will be higher amount than the other one.The cost and amount of electronic health record system will dep end upon the size of the hospital . The management has to decide about the budget for the organization. (Swab, & Ciotti, 2010). The organization must evaluate its mission and goals in light of its particular strengths and weakness and in light of the demand for services and competition in the external environment. Based on that evaluation it can make a plan that will take advantage of opportunities like Electronic health record implementation according to the goals of an organization. (Finkler, Ward, & Baker, 2007).The planning process explicitly address whether the implementation of new services and programs that make up the majority of operations of the organization are being retained at a steady-state level or whether they are to be contracted or expanded in scope. (Finkler, Ward, & Baker, 2007). The successful implementation of EMR depends upon the team and technology of the organization. Team refers to people and issues related with organization. The technology related to the c hoice of the software, hard ware, and design set up of the organization to meet the implementation process.The main components of implementation process are people, process, and technology. The main focus of the change management is people and the related objective is to change the behavior for the acceleration of change process. (McCarthy & Eastman, 2010). The computerization of the nursing units has been a potential solution for nursing shortage. (Finkler, Ward, & Baker, 2007). Quality assurance The management of the organization need to review the costs of the software system related to Electronic health record implementation with users of the selection committee before the system demos.The committee includes staff from clinical areas like pharmacy, radiology, laboratory, operating room, and emergency department. The committee needs to invite physician champions to participate and observe EHR system demonstrations before selecting the system. (Swab, & Ciotti, 2010). The managemen t of the organization needs to clarify the all of the costs such as travel costs, training class tuition fees, files conversion fees, and other ancillary system fees with the vendors. Another factor need to consider while implementing Electronic health record system is the costs of additional staff required to operate the EHR system.The organization need to consider adding the IT staff, Nurse informaticist, and Chief medical information officer. (Swab, & Ciotti, 2010). Once the plan has been finalized and formalized, it serves as a guide for a number of years. Long- range plans are typically prepared only once every three or five years. Creating a new plan each year would only lead to constant changes in the organization’s direction. This would lead to wasted efforts, and money. The long-range budgets or strategic plans look in general terms at the entire organization over a period of years. Finkler, Ward, & Baker, 2007). Program budgeting techniques are equally effective for reviewing the operations of an ongoing unit as for evaluating a new program like Electronic health record implementation. Business plans are becoming essential for the introduction of new programs. Such plans help managers complete a comprehensive examination of a proposed program. By making such a thorough review, the manager and the organization gain an in-depth understanding of the program as well as its financial implications for the organization. Finkler, Ward, & Baker, 2007). Patient care, clinical research, and leadership role The Electronic health record software system support efficient and good health care. Electronic health record improve the completeness and accuracy of patient records and they improve communication among health care professionals. (Hayrinen,Saranto, &Nykanen, 2008). The larger hospitals, especially academic medical centers with a high acuity case mix, may benefit from investing in Electronic health record adoption.The hospitals with high patient volume s and with complex medical problems need to adopt Electronic health record as a capital asset for the organization. (MCcullough, Casey, Moscovice, & Prasad, 2010). Team refers to people and issues related with organization. The technology related to the choice of the software, hard ware, and design set up of the organization to meet the implementation process. The main components of implementation process are people, process, and technology. The main focus f the change management is people and the related objective is to change the behavior for the acceleration of change process. (McCarthy & Eastman, 2010). The monitoring of EHR implementation process mainly focused on areas like project costs, project progress, schedule controls, control changes, scope of the project, quality management, and risks. (Noblin, Cortelyou, & Ton, 2011). The EHR implementation is considered as a high-cost project. The management needs to consider and monitor equipment costs including hardware and softwar e costs.The workflow inefficiencies need to monitor and need to redesign during the implementation phase is an important step to overcome the failure. (Spector, 2010). The workflow reflects the ability of the employee to use the resources to complete the work in an effective manner to achieve better results and it also shows the efficiency of team work. (Lee, Cain, Young, Chockley, & Burstin, 2005). The EHR implementation requires strong leadership and all workers need to participate to deliver their own role for the success of the implementation process.The redesigning process improves the work efficiency and job satisfaction. (Spector, 2010). The change from paper medical records to electronic medical record system improve the quality of healthcare, reduce the administrative cost, reduce medical errors, and decrease the unnecessary expenditures for the issues related to medical errors occur during paper charting. (Huryk, 2010). The electronic medical record system is considered as a means of technological efficiency to reduce the cost in healthcare organization.The need for EHR in healthcare organization is based on certain evidences like, It supports guideline-based care, increased patient monitoring, act as an efficient technological tool for effective communication in areas related to patient care, and improves coordination of care(Song, McAlearney, Lausanne, Robbins, & McCullough, 2011). The electronic health record system act as an easy access for medical literature and it is considered as a fast access system due to the effective utilization of information technology and enhances the healthcare efficiency system. Hillestad, 2005). Research studies shows that the paper record system is inadequate to give all informations regarding patient to caregivers for the effective care. (Thakkar & Davis, 2006) The effective use of EHR minimize the problems related to healthcare disparities, allows the involvement of patients and their families in treatment plan, a nd maintain adequate privacy and security. (Podgurski, 2008). Computer uses for clinical care fall into two general areas. The first area is assement of patients.This includes computers used in laboratories to measure blood levels, in radiology for magnetic resonance imaging, and for physical assessment measures such as blood pressure. The second clinical area is storage and management of patient information. Often called the hospital information system, these computer systems store data such as patient demographics, admission, transfer, and discharge information, and documentation of nursing care provided. (Finkler, Ward, & Baker, 2007).Although clinical information systems are not directly related to financial management, data produced by these systems can be used to make financial decisions. Clinical systems are used to directly link the use of services to the billing for them. Ultimately, financial management is based on the allocation of resources; clinical information systems offer the manager data about the use of resources in the organization. Clinical information systems that combine information from a variety of sources such as laboratory, radiology, dietary, and nursing are called fully integrated systems.In these systems the data are entered once and are accessible all over the organization with appropriate confidentiality precautions. These integrated systems improve the flow of information. (Finkler, Ward, & Baker, 2007). The implementation of EHR in healthcare organization is influenced by human and technological factors. The implementation process depends upon many factors starting from employee attitudes and concerns to various technology.The main factors are readiness for the employee to accept the changes related to EHR implementation, resources available for the change, technical concern, availability of finance for the implementation of EHR, motivation of the employee, time, and ability of the individual to use computer for the effective i mplementation of EHR. (McGinn, Grenier, Duplantie, Shaw, Sicotte, Luc, Leduc, Legare, & Gagnon, 2011). The managers need to take interventions to overcome the factors influencing the implementation process early in the planning stage. (Spector, 2010).The budget development in the initial phase of change process reflects the initial cost and all other related expenses of an electronic health record system. The hardware expense needs to be classified on a yearly basis. The organization need to consider the cost of upgrading the hardware and software system to maintain the efficiency of the system. The cost for the replacement of hardware and maintenance of the computer need to be considered. The Information System Success Model evaluation measures the quality and technical achievement of the system.The system quality depends on the elements like reliability, accessibility, and security of the system. (Delone, & McLean, 2003). The user satisfaction level needs to be evaluated because i t reflects the level of competency, skills, and experience of the users. The overall measurements include quality of care in terms of patient safety, and effectiveness of care, accessibility of care, and productivity. ( Lau, Hagens, &Muttitt, 2007)The implementation process requires skilled people in areas like computer networking, informatics, administration, management, and clinical workflow.The monitoring and controlling of the proper utilization of the resource specialist will help for the cost management. (Wang, 2003). Consultant packages The consultant from outside the organization for any change process need to be assessed, monitored, and controlled as per the organizational policy and management decision. The health care organization may need assistance from outside consultants for the effective implementation of EHR and that will cause an extra cost for the implementation process and the management need to monitor the necessity of the consultant for the process. Noblin, Cor telyou, & Ton, 2011). The quality assurance of the Electronic health record software system can be done by the evaluation process. The evaluation process need to focus on certain elements like care, human, educational, administrative, technical, and social aspects. (Shaw, 2002). The care aspect of evaluation consists of monitoring the quality of care, continuity, system acceptance from patients and other professionals. The evaluation of organizational aspects mainly focuses on examining the interconnection between different care providers in different settings. (Shaw, 2002).The educational aspects of evaluation focus on the quality of the information system for the retention of the staff, training of employees, and user satisfaction related to EHR implementation. The administrative aspect of evaluation addresses the changes related to EHR implementation and the after effect on health care services and mainly focus on areas like access to care, interactions between clients and health care workers, and changes in cost effectiveness related to new electronic system. The technical aspects of evaluation measure the technical quality, reliability, and security of the settings.The social aspects of evaluation focus on the changes in the level of social interaction after the implementation of new system. (Shaw, 2002). The other measurement strategies include evaluating the output of new system by reviewing employee satisfaction and user satisfaction. The organization need to conduct post go-live reviews after the implementation process to assessment of system. Conclusion The Electronic health record software system is one of the important operational priorities in the US health care and it should be capital assets for the organization.The health care organizations that are decided to purchase an Electronic health record system should always search for the software system with right vendors, share the costs with selection committee members, and need to think about the costs of additional staff members required to operate the software system. (Swab, & Ciotti, 2010). The other measurement strategies include evaluating the output of new system by reviewing employee satisfaction and user satisfaction. The organization need to conduct post go-live reviews after the implementation process.The successful implementation requires teamwork and effective communication technique between the vendors, health care staff, management, administration, and outside consultants. The health care organization may need assistance from outside consultants for the effective implementation of EHR and that will cause an extra cost for the implementation process and the management need to monitor the necessity of the consultant for the process. (Noblin, Cortelyou, & Ton, 2011). References Delone, W. H. , & McLean, E. R. (2003). The DeLone and McLean Model of Information Systems Success: A Ten-Year Update.Journal of Management Information Systems,19(4), 9-30. Hayrinen,K. K. , Saranto, P. , Nykanen, P. (2008). Definition, structure, content, use, and impacts of Electronic health records: A review of the research literature. International Journal of Medical Informatics, 77(5), 291-304 Hillestad, R. (2005). Can electronic medical record systems transform healthcare? Potential health benefits , savings, and costs†. Health affairs, 2(1), 8-10. Huryk, L. (2010). Factors influencing nurses' attitudes towards healthcare information technology. Journal of nursing management, 8(5), 606-612. Jarvenpaa, S. L. , ; Ives, B. (1991).Executive involvement and participation in the management information technology. Journal of Medical Informatics, 15(2), 205-225. Lau, F. , Hagens, S. , ; Muttitt, S. (2007). A Proposed Benefits Evaluation Framework for Health Information Systems in Canada. Electronic Healthcare, 10(1), 112-118. Lee, J. , Cain, C. , Young, S. , Chockley, N. , ; Burstin, H. (2005). The adoption gap: Health information technologyin small physician pract ices. Health Affairs, 24(5), 1364-1366. McCullough, J. M. , Casey, I. , Moscovice,S. , Prasad,S. (2010). The effect of health information technology on quality in US Hospitals.Health Affairs, 29(4), 647-654. McGinn, C. A. , Grenier, S. , Duplantie, J. , Shaw, N. , Sicotte, C. , Luc, M. , Leduc, Y. , Legare, F. , ; Gagnon, M. (2011). Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC medicine, 9(46), 2-10. Miller, R. H. ,Sim,I. (2004). Physician’s use of electronic medical records : Barriers and solutions. Health Affairs, 23(2),116-126. Noblin, A. M. , Cortelyou, K. W. , & Ton, S. (2011). Electronic Health Record Implementations- Applying the Principles of Monitoring and Controlling to Achieve Success.The Health Care Manager, 30(1), 45-50. Podgurski, S. A. (2008). Finding a cure : The case for regulation and oversight of electronic health record system†. Harvard journal of law and techn ology, 22(1), 107-110. Shaw, N. T. (2002). ‘CHEATS': a generic information communication technology (ICT) evaluation framework. Comput Biol Med, 32(3), 209-220. Song, P. H. , McAlearney, A. S. , Lausanne, E. F. , Robbins, J. , & McCullough, J. S. (2011). Exploring the business case for ambulatory electronic health record system adoption. Journal of healthcare management, 56(3), 169-180.Spector, B. (2010). Implementing organizational change: Theory into practice (2nd ed. ). Upper Saddle River, NJ: Prentice Hall. Swab, J. , Ciotti, V. (2010). What to consider when purchasing an EHR system. Health care Financial Management, 64(5), 38-41 Thakkar, M. , & Davis, D. C. (2006). Risks, barriers, and benefits of EHR systems: A comparative study based on size of hospital. Research Journal in Health Information Management, 3(5), 10-12. Wang, S. (2003). A cost-benefit analysis of Electronic medical records in primary care. American Journal of Medicine, 114(5), 397-403.