Ethical Leadership Reputation Matrix Essay

1. â€Å"There is no I in Team.† One for all and all for one best describes utilitarianism 2. â€Å"There is no I in team, but there is an M and a E (me).† To seek the greatest amount of pleasure for self and the majority of the group best describes Hedonism. 3. â€Å"I will do my best to do my duty†¦Ã¢â‚¬  To strive for excellence in everything you and others do and say best describes   Deontology. Multiple Choice 4. According to the Executive Ethical Leadership Reputation Matrix, is an executive characterized as a weak â€Å"moral person† and a strong â€Å"moral manager.† a) Unethical leader b) Ethical leader c) Ethically neutral leader d) Hypocritical leader 5. According to the Executive Ethical Leadership Reputation Matrix, is an executive characterized as a strong â€Å"moral person† and a strong â€Å"moral manager.† a) Unethical leader b) Ethical leader c) Ethically neutral leader d) Hypocritical leader 6. Which of the following is false? C a) Any attempt to change an organization’s ethics must consider the entire cultural system. b) A cultural system includes both formal and informal systems. c) An effective culture change may take as long as 1 to 2 years. d) New rules and values must be reinforced via training programs and reward systems. 7. Weak organizational cultures are: B a) desirable if an organization has many subcultures. b) desirable if an organization wants diversity of thought and action. c) desirable if an organization wants behavioral consistency. d) undesirable in all situations. 8. True or False? Given the less hierarchical organizational structures that are more common place today, it is less important to have strongly aligned ethical culture to guide employees in their independent decision-making. False 9. It is sufficient for executive leaders to be ethical persons and make ethical decisions. Employees do as they see. False 10. Cognitive moral development tells us that most people are looking outside of themselves for guidance on decision-making. This means that stated organizational policy can be an important source of guidance for employees in making decisions. True 11. The more a firm demands unquestioning obedience to authority, the more likely the firm will experience higher levels of unethical conduct among their employees. True 12. Describing the decision-making process in the language of ethics does not help individuals make more ethical decisions. False 13. An ethical culture is maintained through alignment between the formal and informal systems. True 14. A 2006 study found that 82 percent of Americans would prefer to be paid less but work for an ethical company than be paid more and work for an unethical company. True Reference: Matching Key Terms and Definitions a) Strong organizational culture b) Weak organizational culture c) Socialization (or enculturation) 15. Standards and guidelines that are known and widely shared by all. A 16. Subcultures within divisions or departments that are more likely to guide behavior. B 17. Process promoted through formal and informal transmission of norms. C Reference: Matching Key Terms and Definitions a) Heroes b) Norms c) Rituals d) Myths 18. Symbolically tells employees what the organization wants them to do and how it expects them to do it. C 19. Standards of behavior that are accepted as appropriate by members of a group. B 20. Symbolic figures who set standards of performance by modeling certain behaviors. A 21. Anecdotes about a sequence of events drawn from an organization’s history. D True or False? 22. It is unethical for managers to â€Å"control† employees’ ethical behavior through direct management and the organization’s formal and informal cultural systems. False Multiple Choice 23. Students may need more ethics training because research has found that they rank lower in moral reasoning than other students. a) Philosophy b) Political science c) Business d) Medicine 24. Ethical behavior can be influenced by a) an individual’s religion b) an organization’s culture c) ethical training d) an individual’s personality e) all of the above 25. According to the authors, ethical behavior is defined as: a) a set of moral principles or values that guide an individual b) rules of behavior set by the Federal government c) principles, norms, and standards agreed upon by society d) none of the above True or False? 26. According to the authors, most people are guided by a strict internal moral compass and will False 27. When employees come to an organization, they have already developed into â€Å"good† or â€Å"bad† apples. Therefore, there is little a manager can do to impact an employee’s ethical behavior. False 28. Federal laws define what is ethical. Therefore, all unethical behavior is considered unlawful. False 29. Discarding the few â€Å"bad apples† will usually solve all of the ethical problems within an organization. False Multiple Choice 30. of the following statements about the Organization for Economic Cooperation and Development (OECD) Anti-Bribery Convention (the â€Å"Convention†) which are untrue. a.Participating countries include countries in Western Europe and North America b.The Convention requires signatories to make it a crime to bribe foreign public officials c.The Convention includes the application of criminal penalties d.The Convention bans gifts to political parties e.The Convention outlaws tax deductibility for bribes f.All are statements are true g.Statements d and e are untrue Bonus Questions: IBriefly describe and provide examples of three steps involved in changing an organization’s culture. 1. Diagnosis of the current state of the organization’s culture 2. Implementing a plan of change 3. Evaluating the state of the organizational culture after a plan has been implemented. IIIs there a difference between ethics, and morals? Explain your answer. Ethics is what is considered a right course of actions. (The Norm) Morals are what you consider a right course of action. (Personal Belief) IIIExplain why ethics without religion appears beneficial to the Theist as well as the Non-theist (Atheist)? Ethics without religion is an acceptable norm for theists and non-theists. An example of ethics without religion may include traffic lights. They are created for the greater good of society without regards to religious beliefs.

Generally Accepted Accounting Principles and Owners Equity

Fundamental Concepts Professor Deanna McKenzie Accounting Module – Practice Questions Name: Date: 1 . Identify the Assets, Liabilities and Owners' Equity below: Assets Liabilities Owners' equity Truck Accounts Payable Retained Earnings Wages Payable Cash Salaries Payable Equipment Pre paid Rent Land Note Payable Office Supplies Building Furniture Prepaid Insurance Accounts receivable Common Stock 2. ABC Company issued common stock and received $4000. Please complete the accounting equation below: Assets 4,000 = Liabilities + Owners' Equity + 4,000 3.ABC Company then purchased Office supplies on Account for $200. Please complete the accounting equation below (after the purchase): cash 4,000 = Liabilities + Owners' Equity Office Supplies 200 †Accounts Payable 200 + 4,000 4. a) The owners of XYZ Corporation received $5000 from Mr. Brown and issued him common stock. The company then borrowed $20,000 from the bank and purchased a delivery truck (cash) for $7000. What type of accounts on the balance sheet (Categories) are affected? Owners' Equity Liabilty b) List the specific accounts affected and the amounts.Common Stock 5,000 Cash 18,000†¦20-7+3) Notes Delivery Truck 7,000 c) Write the Accounting Equation below: 5. A company generates $200,000 in revenue in 2011, the gross profit was recorded as $175,000. What their cost of Goods sold? ANSWER: 25,000 200,000 -COGS 175,000 6. XYZ Company's total expenses for 2001 was $450,000. The net Income recorded was $100,000. How much did they generate in revenues? ANSWER: 550,000 Revenue -450,000 1 oo,ooo 7. Stewart's Company purchased an asset with useful life of 5 years for $40000. The salvage value of the asset is $5000.Using the straight line depreciation method: a) How much is the asset depreciated by each year? ANSWER:7K 40,000-5,000 35,000 b) What is the depreciation expense at year 4? 7K c) What is the accumulated depreciation at the end of year 3? 21 K d) What is the value of the asset at the end of year 4? 12K 8. Company A purchased an equipment to print T-shirts. This equipment cost $30,000 and is expected to remain useful for 7 years. The residual value of the equipment is $2000. Find the depreciation expense and the accumulated depreciation after 5 years.

Eagle Fire Department Staffing Analysis Health And Social Care Essay

The job was the Eagle Fire Department lacks the cognition of whether or non a staffing alteration in 2003 has been effectual in run intoing the demands of community stakeholders by dramatically cut downing the mean clip it takes firemans to â€Å" turnout † for a call for service to an exigency scene. The intent of this research was to find if the staffing theoretical account that the Eagle Fire Department presently employs is effectual in supplying for a sufficient figure of forces when volunteer/paid-on-call employees are out of the community working at their regular occupations and are unavailable to reply exigency calls for service. This undertaking would carry on quantitative research to find to find if the 2003 staffing alteration resulted in a lessening of turnout clip to exigency calls for service by the organisation. The research would uncover a important lessening in turnout clip when the section was staffed with on-premises forces.IntroductionThe Eagle Fire Department is a preponderantly volunteer/paid-on-call municipal fire section located in rural southwesterly Waukesha County, Wisconsin. A sleeping room community to the Milwaukee and Madison, Wisconsin metropolitan countries, Eagle lacked a sufficient degree of staffing during daytime exigency events in the community. To decide this, the community began funding paid-on-premises staffing in 2003. The job is the Eagle Fire Department lacks the cognition of whether or non the staffing alteration in 2003 has been effectual in run intoing the demands of community stakeholders by dramatically cut downing the mean clip it takes firemans to react to an exigency scene. A quantitative survey would necessitate to be conducted to turn to this issue. The intent of this research is to find if the staffing theoretical account that the Eagle Fire Department presently employs is effectual in supplying for a sufficient figure of forces when volunteer/paid-on-call employees are out of the community working at their regular occupations and are unavailable to reply exigency calls for service. If a staffing lack is identified, this research would show the demand for the Town and Village of Eagle to increase staffing beyond what is presently being provided. This undertaking would carry on appraising research to reply the undermentioned inquiries: a. ) what was the turnout clip during responses from 1996 – 2003 prior to the paid-on-premises staffing? B. ) what was the turnout clip during responses from 2003 – 2010 after paid-on-premises staffing was added? c. ) does the information discovered through research demonstrate that the Eagle Fire Department is run intoing province and federal guidelines that govern fire section staffing and response? e. ) Based on these consequences, should the Eagle Fire Department urge staffing alterations to the Town and Village of Eagle boards?Background and SignificanceEagle, Wisconsin is a diverse community located in rural southwesterly Waukesha County, Wisconsin, about 35 stat mis from business district Milwaukee. The community is surrounded by the pristine lands of the Southern Kettle Moraine province wood which is regionally revered for its stat mis upon stat mis of hike, biking and sno wmobiling trails. Because 40 % of Eagle is province Department of Natural Resources or nature conservancy land, the community is stifled by its inability to turn to the West and north and as a consequence, Eagle retains much of its small-town quaintness and capturing entreaty to occupants looking for an flight from the bunco and hustle of large metropolis life. Eagle is 36 square stat mis and is comprised of two separate municipalities: the Town and Village of Eagle, each of which retains full liberty from one another but works together and financess several joint community ventures such as the fire section, library, and park and diversion scheduling. The combined population of the community is 5,471. Like many little southeasterly Wisconsin communities, Eagle is considered a sleeping room community for the Milwaukee metropolitan country as most of the occupants work outside of the community during the twenty-four hours. Eagle is home to many concerns and industries and has a strong touristry base due to the province wood and Old World Wisconsin, which is a â€Å" life museum † tourer attractive force that accurately depicts the history of rural life by securing historical edifices and so traveling them to the museum site. Actors and actresses depict Wisconsin colonist life to funny and frequently baffled invitees. The community is served and protected by the preponderantly volunteer/paid-on-call Eagle Fire Department [ EFD ] , a full-service combination fire section. The section operates out of one fire station that is centrally located within the community and responds to all exigencies within the Town and Village of Eagle, every bit good as common assistance aid to adjacent communities. The Eagle Fire Department protects critical substructure which includes State Highways 59 and 67 every bit good as the Wisconsin and Southern Railroad, each of which bisects and transverses the full community. The section was originally organized in 1927 by a group of husbandmans who saw the demand for a fire section to protect the community. The mission of the organisation did non alter until about 50 old ages subsequently when in the early 1970 ‘s the section began supplying exigency medical services to the community through an ambulance plan. With the execution of exigency medical services, the preparation demands to go a voluntary fireman and exigency medical technician began increasing and the one-year call volume doubled from about 75 to 150 calls. The rank of the organisation remained strong with between 40 – 50 voluntaries on the roll at any given clip. During the 1980 ‘s and 1990 ‘s, province mandated preparation demands continued to increase and lodging developments began to shoot up as available farming area began to slowly lessening. Many more occupants of the community were transposing to work and were non able to volunteer as much clip to the organisation. As a consequence of the needed addition in preparation hours, rank began to easy worsen. In 2003 the organisation reached a hamlets and was holding trouble staffing for exigency calls that occurred during the twenty-four hours. A determination was made to staff the fire station with paid-on-premises firefighter / exigency medical technicians who would work from 6:00 am – 6:00 autopsy Monday through Friday. This staffing agreement allowed at least one individual to reply a call for service while trusting on the voluntaries who were able to react during the twenty-four hours for extra work force. In 2006 the section hired a full-time calling Fire Chief to pull off the twenty-four hours to twenty-four hours operations. The section is still staffed for 12 hours a twenty-four hours with paid-on-premises forces. During the eventide and nighttime hours, the community is entirely protected by its dedicated voluntary work force. Because the current staffing theoretical account still relies so to a great extent on the voluntary work force, it can be highly hard to foretell concern hours staff handiness which complicates the section ‘s ability to efficaciously react to exigency calls for service. There has ne'er been a conclusive survey done to find if the bing staffing theoretical account utilized by the Eagle Fire Department is effectual. As a consequence, the section is powerless to find if it should seek extra support to spread out the bing paid-on-premises plan, hire extra calling firemans, or remain position quo.Literature ReviewThe literature reappraisal for this applied research undertaking focused on reexamining anterior research conducted on staffing preponderantly volunteer/paid-on-call fire sections and ordinances that exist at the province and federal degree that regulate or dictate fire section staffing. Staffing Models Harmonizing to Wilson ( 2009 ) , the stating â€Å" Do more with less † seems to hold been the unofficial slogan of the fire service for more than 200 old ages. Wilson affirms that there will come a clip when firemans will be able to make merely so much before on scene resources are depleted. From fires to EMS calls and everything in between, no affair how a individual looks at it, the fire service is the last line of defence when it comes to a community in an exigency state of affairs. So the outlook of making more with less is non appropriate to this occupation. Varone ( 1995 ) held that surveies have been conducted in respect to firefighter staffing and the increased efficiencies found with the addition of forces staffing but no conclusive surveies have been done to find if there is a correlativity between fireman staffing and on scene incident safety of forces. Varone discovered that informations from the Providence ( RI ) Fire Department staffing survey in 1990 – 1991 showed that reported hurts in the studied firefighting companies decreased from 42 during the control period when staffing was three members per setup [ fire truck ] , to 31 during the survey period when the survey companies were staffed with four members. This represented a 23.8 per centum decrease in hurts. Bay City, Michigan is no alien to cutbacks, holding closed a fire station in 2009 that led the firemans brotherhood and other outraged citizens to proclaim that shuting a fire station would do an addition in response times which would impact the quality of life for all occupants of the metropolis ( Editorial Board, 2011 ) . Harmonizing to the Bay City Times ‘ ( 2011 ) column board, Fire Chief Gregory Michalek told the City Commission that in 2009, the mean response clip was 5 proceedingss and 48 seconds. In 2010, the clip had plummeted about a minute, to 4 proceedingss 43 seconds. The National Fire Protection Association recommends response in less than 6 proceedingss. The betterment in Bay City is even though the quicker response would look to undersell the chief statement that the firemans brotherhood has made in recent old ages whenever metropolis functionaries bring up fire section budget cuts – that fewer Stationss and fewer firemans would be longer delaies until aid arrived at a fire or medical exigency. The Bay City Commission early in January 2010 decided to do lasting a impermanent closing of Station 5 at 1209 E. Smith St. in the Banks country. This was after a argument in 2009 over the shutting in which the firemans brotherhood warned, and occupants worried, approximately predicted longer delaies as fire crews responded to the country. That seemingly has n't happened. Fire crews from the Central Fire Station at 1401 Center Ave. on the East Side and at Station 4, 212 Dean St. , on the West Side each are about three stat mis off from Fire Station 5 ( Editorial Board, 2011 ) . Internationally, Australia utilizes a nationalized voluntary fire system dwelling of over 60,000 voluntaries. These firemans, who respond in the rural countries of the state, supply the first line of defence against the 100s of 1000s of shrub fires that burn yearly. Because volunteer/paid-on-call firemans work in the field because they want to instead than depending on the occupation as a exclusive agency of income, voluntary keeping and occupation satisfaction is paramount ( Rice & A ; Fallon, 2011 ) . Harmonizing to Rice & A ; Fallon ( 2011 ) , unpaid motive can be conceptualized within the model of societal exchange theory – in order for voluntary attempts to be sustained over clip, the wagess to the voluntary must transcend, or at minimal, balance out the costs. The determination to go on volunteering is typically re-evaluated throughout the voluntary ‘s term of office, where appraisals are made about the comparative wagess and costs of their engagement. There must be a delicate balance when measuring staffing in a preponderantly volunteer/paid-on-call section. The demands of the community must be balanced with the keeping involvement within the voluntary corps. An extra factor that assists with voluntary keeping is acknowledgment and recognition. Despite high degrees of service bringing, it has been argued that those working within the exigency services in Australia experience a wide deficiency of acknowledgment. Recognition of voluntaries is of peculiar concern to exigency service bureaus given that organisational surveies repeatedly find that staff often quit in cases where they feel undervalued. Harmonizing to Janke ( 2009 ) and Compton & A ; Graninto ( 2002 ) , staffing strategies are by and large a local issue and are dependent on the frequence of fires, budgetary considerations, the community hazard degree, and the demand for services. Other factors include the population protected, denseness of the population, and the type of constructions protected. In the terminal, staffing degrees may change widely from section to section. Keeping an unfastened duologue with members of the organisation is built-in to the success of any staffing theoretical account alteration. Laws and Standards Governing Fire Department Operations The United States fire service is efficaciously governed by a set of criterions that are established and reviewed every four old ages by the National Fire Protection Association [ NFPA ] . There are legion criterions that exist that govern fire section operations and the minimal figure of firemans that must be present on an exigency scene to prosecute in operations. NFPA 450, the Guide for Emergency Medical Services and Systems, Chapter 5, Section 5.5.2.3.4 provinces, â€Å" most experts agree that four respondents [ at least two trained in advanced cardiac life support ( ACLS ) and two trained in basic life support ( BLS ) ] are the lower limit required to supply ACLS to cardiac apprehension victims † ( National Fire Protection Association, 2009 ) . While it is by and large acknowledged by most fire sections that exigency medical services is the staff of life and butter of their operations, construction fires and incidents necessitating specialized deliverance accomplishments are really dependent on work force. NFPA 1720, the Standard for the Organization and Deployment of Fire Suppression Operations by Volunteer Fire Departments, Chapter 4, Section 4.3.1 provinces that, â€Å" the fire section shall place lower limit staffing demands to guarantee that a sufficient figure of members are available to run safely and efficaciously. † Further, based on NFPA 1720, a matrix has been developed which indicates that the Eagle Fire Department should hold a minimal staff of six firemans respond to the scene within 14 proceedingss of the call for service and be able to run into that standard 80 % of the clip. However, one time on scene, National Fire Protection Association relates that between 19 and 23 forces typically constitute the first-alarm assignment to a confirmed single-family brooding fire, as observed by rating squads. However, non fewer than 24 firemans and two head officers, one or more safety officers, and a rapid intercession squad ( s ) should react to high-hazard tenancies ( schools, infirmaries, nursing places, explosive workss, refineries, high-rise edifices, and other high-life jeopardy or tenancies with big fire possible ) . Not fewer than 16 firemans, one head officer, a safety officer, and a rapid intercession squad should react to medium-hazard tenancies ( flats, offices, mercantile, and industrial tenancies non usually necessitating extended deliverance or firefighting forces ) . Not fewer than 14 firemans, one head officer, a safety officer, and a rapid intercession squad should react to low-hazard tenancies ( one- , two- , or three-family homes and scattered little concerns and industrial tenancies ) . At least 12 firemans, one head officer, a safety officer, and a rapid intercession squad shall react to rural dismaies ( scattered homes, little concerns, and a farm edifice ) ( National Fire Protection Association, 2008 ) . The Occupational Safety and Health Administration [ OSHA ] mandates that two firemans be equipped in full protective equipment with a ego contained take a breathing setup be stationed outside of an environment that is imminently unsafe to life and wellness. Dearly, this is known as the two in/two out regulation which requires a lower limit of four firemans to prosecute in structural firefighting operations. There is an exclusion to this regulation if a life safety jeopardy exists and if firemans moderately believe a deliverance can be made it is allowable to go against this regulation ( Occupational Safety and Health Administration, 2008 ) . At the Wisconsin province degree, there are several steering administrative codifications that affect fire section scene operations. Wisconsin Comm. 30, the Fire Department Safety and Health Standards, do non proclaim a minimal staffing degree for operations straight, instead, the codification references antecedently cited NFPA and OSHA criterions. Based on the literature reappraisal, there is no constituted minimal degree of staffing that must be present expecting a call for service. Rather, systems must be designed such that when a call for service is received, the system responds in an expedient mode within the guidelines established at the province and federal degree.HypothesissThe void hypothesis is that the 2003 staffing alteration of the Eagle Fire Department had no consequence on norm turnout clip. Alternate hypotheses include: ( a ) the staffing alteration in 2003 did hold an consequence on diminishing the norm turnout clip. ( B ) call type ( EMS, Fire, and MVA ) had an consequence, either positive or negative, on the norm turnout clip. ( degree Celsius ) winter months had an consequence, either positive or negative, on the norm turnout clip.MethodologyThe original research for this undertaking was initiated via the cyberspace where a cursory reappraisal of literature related to volunteer staffing both domestically and abroad was sought. Beginnings were so identified in an effort to find what guidelines and criterions exist at the province and federal degree to modulate fire section staffing and response. Eagle Fire Department staff were assigned to roll up and analyse run study statistics for calls for service that the organisation responded to from 1996 – 2010. With the exclusion of 2008 and 2009 calls for service, which were recorded electronically, all informations had to be entered into a database manually, from manus written records. Data sought was the day of the month of the call for service, the twenty-four hours of the hebdomad, the clip the call was dispatched, the clip the first unit responded en path to the call for service, the clip that the first unit arrived on scene, and the figure of forces that responded to the call for service. Because a alteration in staffing occurred in 2003, the information was analyzed to find if the alteration caused a lessening in the norm turnout clip – the elapsed clip between when the call is dispatched by the 911 centre until the clip that the first unit acknowledges en path. The information could be so be analyzed to find if the organisation was run intoing province and federal guidelines with respect to exigency response, if any exist. The dependant variable in this analysis is whether or non the station was staffed at the clip an exigency call for service was dispatched. Several independent variables were identified. First, the type of call for service is of import to find whether or non call fluctuation has an impact in the turnout clip. For this undertaking, calls for service were grouped into three chief classs: Fire, Emergency Medical Services ( EMS ) , and Motor Vehicle Accident ( MVA ) . Calls for service coded as â€Å" EMS † were all calls necessitating exigency medical services, whether it was advanced or basic life support. Calls were coded as â€Å" Fire † if the call for service was fire related such as a edifice fire, field fire, natural gas leak, or other public aid call. Finally, calls were coded as â€Å" MVA † if the call for service was for a motor vehicle accident. Other independent variables identified involved the month that a call for service occurred. This was of import because the conditions could play a important factor in response efficiency when the fire station was unstaffed. For the intent of this survey, the months of November, December, January, February, and March were identified as months that would hold the highest likeliness of snow and icy conditions which would halter the section ‘s ability to react quickly when volunteers/paid-on-call firemans had to react to the fire station to obtain equipment and setup. So that accurate statistics were identified as related entirely to the Town and Village of Eagle, common assistance calls to other organisations were excluded from this survey as they would ‘ve increased the mean response clip well due to the geographic location of the Eagle Fire Department and the distance the section must go to supply aid to other communities. While reacting common assistance to help another bureau, 20 – 30 minute travel times are non uncommon. From the information collected, arrested development analysis was conducted to find if the void hypothesis should be rejected or accepted. Arrested development analysis was chosen because it allows the research worker to show the strength of the relationship between the identified independent variables against the dependent variable of turnout clip. Multicollinearity would be investigated to find if two or more independent variables are extremely correlated. Based on the information gleaned from the survey, consequences would be presented to the Eagle Fire Commission and Town and Village of Eagle boards to inform them whether or non the section ‘s bing staffing theoretical account is effectual, and, if non, urge alterations for the hereafter.ConsequencesThe first research undertaking sought to find the norm turnout clip of respondents prior to the paid-on-premises plan being implemented in 2003. The 2nd research inquiry dovetails on the first and sought to find the mean response clip after the paid-on-premises plan was implemented in 2003. There were 4084 instances, or calls for service, that the Eagle Fire Department responded to 1996 – 2010. From this information, it was determined when the station was and was non staffed. Turnout times were calculated from by deducting the clip the first unit went en path to a call for service from the clip that the call was dispatched. This was known as the TD to ER clip. Based on the information evaluated, it was determined that the Eagle Fire Department ‘s norm turnout clip was 4:02 for all calls for service that occurred 1996 – 2010. However, when the independent variable of staffing is introduced, there was a important decrease in the norm turnout clip to 2:23. When comparing the dependant and independent variables, the r-squared value is.404. Therefore, 40 % of the fluctuation in turnout clip can be explained by the independent variable which is the station being staffed. The incline between the dependant and independent variable of the station being staffed is -1.815. This indicates that when the station was staffed during a call for service, one can anticipate an mean clip turnout clip decrease of 1.815 proceedingss versus when the station was non staffed. Is the relationship between the dependant and independent variable statistically important? The t-score of -52.603 corresponds to a significance degree of 0.00, intending that there is a less than one in 1,000 opportunity that the relationship between turnout clip and the station being staffed is due to error. Insert table 1 here Insert table 2 here Based on these consequences, we can reject the void hypothesis and accept the alternate hypothesis. Staffing does hold an impact on the norm turnout clip of the Eagle Fire Department. There are several other variables that could hold an consequence on the norm turnout clip of the Eagle Fire Department. One illustration that could hold an consequence is the type of call for service that is being responded to. Calls for service such as construction fires or motor vehicle accidents require particular protective cogwheel that must be put on, or donned, prior to go forthing the fire station. Would these types of calls have an impact on turnout times? Harmonizing to the informations analyzed, exigency medical ( EMS ) calls for service were the baseline analyzed at 4.02. Calls affecting â€Å" fire † took somewhat longer to turnout for, with an norm of 4.134. The incline is somewhat different between the dependant and independent variables. For FIRE, the incline is.114 which indicates that when a call for service is related to fire, it takes an extra.114 proceedingss to turn out versus a standard EMS call. The t-score of 2.574 corresponds to a significance degree of 0.010, intending that there is a 10 % opportunity that the relationship between turnout clip and fire calls for service is due to error. Calls for service affecting motor vehicle accidents ( MVA ) took less clip to turnout for, averaging 3.998 proceedingss. For these calls for service, the incline is -.022 which indicates that when a call for service is related to MVA, it takes.022 fewer proceedingss to turn out versus a standard EMS call. The t-score of -.419 corresponds to a significance degree of 0.675, intending that there is a 67.5 % alteration that the relationship between turnout clip and fire calls for service is due to error. Insert table 2 here One other country that could hold an consequence on informations involves the clip of twelvemonth that a call for service is dispatched. Apparently, calls for service that occur in the winter months would hold an impact on unstaffed response times as the volunteer/paid-on-call employees must foremost react to the fire station before reacting to a scene. What impact do these months have on norm turnout clip? For the intents of this undertaking, winter months were considered to be November, December, January, February, and March as these were the months when Wisconsin snow and ice would reasonably impact the section ‘s ability to react in an efficient mode. Based on the information evaluated, it was determined that the Eagle Fire Department ‘s norm turnout clip was 4:00 for calls for service that occurred during these five months from 1996 – 2010. When comparing the dependant and independent variables, the r-squared value is.405. Therefore, 41 % of the fluctuation in turnout clip can be explained by the independent variables which are the clip of twelvemonth ( winter versus non-winter ) that a call for service was received. The incline between the dependant and independent variable of the winter months is varied between -0.092 to 0.073. This indicates that conditions did hold an impact on the norm turnout clip, though the alteration in norm was negligible. Is the relationship between the dependant and independent variable statistically important? The t-score scope identified corresponds to between an 18 % and 62 % opportunity that the relationship between turnout clip and the winter months identified is due to error. Insert table 6 here Insert table 8 here Tolerance and the discrepancy rising prices factor ( VIF ) are two statistical countries that help to set up if multicollinearity exists. A little tolerance value indicates that the variable under consideration is about a perfect additive combination of the independent variables already in the equation and that it should non be added to the arrested development equation. All variables involved in the additive relationship will hold a little tolerance. Some suggest that a tolerance value less than 0.1 should be investigated farther. If a low tolerance value is accompanied by big standard mistakes and nonsignificance, multicollinearity may be an issue. The VIF measures the impact of collinearity among the variables in a arrested development theoretical account. The Variance Inflation Factor ( VIF ) is 1/Tolerance, it is ever greater than or equal to 1. There is no formal VIF value for finding presence of multicollinearity. Valuess of VIF that exceed 10 are frequently regarded as bespea king multicollinearity, but in weaker theoretical accounts values above 2.5 may be a cause for concern. ( Research Consultants, 2010 ) . The consequences of this undertaking revealed that multicollinearity was non an issue. Tolerance was in surplus of 0.900 and VIF was between 1.0 and 2.2 for all independent variables. Insert table 2 here Insert table 8 hereDecisionThe research has revealed that there are no Torahs or criterions necessitating communities to supply paid staffing on premises in their fire Stationss. The National Fire Protection Association, Occupational Health and Safety Administration, and the State of Wisconsin mandate lower limit staffing demands one time on scene of an exigency. The National Fire Protection Association ( NFPA ) recommends that calling fire sections, which are by and large comprised of full-time paid forces, turn out within 60 seconds ( National Fire Protection Association, 2010 ) . There is no known criterion that exists for voluntary or paid-on-call fire sections, nevertheless. Though most people would impute the â€Å" fire section † to merely seting out fires, in most instances 80 % + of all calls for service in an bureau are medical in nature. An unstaffed volunteer/paid-on-call fire section must hold first respondents go to the fire station, obtain the necessary setup, and so react to the exigency scene. In some instances, this oversight in clip is O.K. as the nature of unwellness is minor and lives are non at interest. In other instances, the badness can be much higher and seconds can do the difference between life and decease. In a sudden cardiac apprehension, when a victim ‘s bosom stops all of a sudden whipping, there are merely proceedingss with which bystanders and exigency medical technicians can impact a deliverance. The encephalon needs a changeless supply of O and foods to map. Cerebral hypoxia occurs when there is non adequate O acquiring to the encephalon because the bosom is non pumping any blood throughout the system. Brain cells are highly sensitive to a deficiency of O. Some encephalon cells start deceasing less than 5 proceedingss after their O supply disappears. As a consequence, encephalon hypoxia can quickly do terrible encephalon harm or decease ( Hoch, 2011 ) . Though the literature reappraisal revealed that NFPA 450 does non mandate a minimal figure of respondents present on premises available to react, the criterion does urge at least four people to supply effectual advanced life support attention ( National Fire Protection Association, 2009 ) . The information revealed that the Eagle Fire Department ‘s response clip is an norm of 4:02 when the station is unstaffed. This leaves 58 seconds for an ambulance to make a victim ‘s place to get down supplying resuscitative attention to a sudden cardiac apprehension victim before lasting encephalon harm consequences. With a response country of 36-square stat mis, this can be a daunting challenge. Harmonizing to Compton and Granito ( 2002 ) , fire suppression operations have three basic maps: ( 1 ) deliverance, ( 2 ) work affecting ladder, physical entry, and airing, and ( 3 ) the application of H2O. To raise ladders, ventilate, hunt, and deliverance at the same time takes speedy action by at least four and frequently eight or more firemans, each under the supervising of an officer. If approximately 16 trained firemans are non runing at the scene of a on the job fire within the critical clip period, so dollar loss and hurts are significantly increased as is fire spread. As firefighting tactics were conducted and judged for effectivity, the writers held that five-person companies ( squads ) were 100 % effectual at executing these undertakings in an expeditious mode. Four-person companies were 65 % effectual, and three-person companies were 38 % effectual. Under the current staffing matrix of the Eagle Fire Department, during current staffed periods, the section operates at the two-person company degree whose effectivity as non been measured. When the section is unstaffed, the section typically operates at a three or four-person company though response can significantly detain due to the handiness of volunteer/paid-on-call employees and their single response to the fire station to obtain equipment and setup. In a 2008 study, the Eagle Fire Department concluded that in order to increase staffing to one individual, 24 hours per twenty-four hours, a budget addition of $ 87,000 would be needed to fund this plan, non including capital disbursals needed to upgrade the fire section installation to suit nightlong staffing. In order to supply four fireman / exigency medical technicians on a full-time footing, twenty four hours a twenty-four hours, the section would necessitate to budget about $ 1.5-million yearly for wages and benefits. This would ensue in a 600 % addition of the current operating budget. This option was non financially executable ( Heim, 2008 ) . This undertaking has revealed, nevertheless, that staffing the fire station does supply a touchable benefit of cut downing the norm turnout clip by about half. Though the current staffing matrix merely provides for one exigency respondent, there is a batch that one individual can make at a medical scene or fire until auxiliary staff arrives from the volunteer/paid-on-call ranks. Expanding this plan to twenty four hr coverage would be of important benefit to the community as it would let the section to react efficiently and run into the demands of community stakeholders. The challenge in implementing such a plan will be to procure gross to fund the plan. Expanding coverage would still necessitate an extra $ 87,000 yearly and revenue enhancement levy restrictions would most likely prevent the municipalities from implementing such a plan without seeking a referendum. A 2009 Town of Eagle referendum that was proposed to supply support to staff the paid-on-call plan failed with a 3-1 bord er ( Nixon, 2009 ) . Several restrictions were encountered while carry oning research for this undertaking. First, bing informations keeping policies limit the records kept in storage to the old 15 old ages. Records older than 15 old ages are destroyed. Therefore, information was merely available from 1996 – 2010 which allowed for seven old ages of unstaffed and eight old ages of staffed responses to be evaluated. This disparity may somewhat skew the consequences. Second, the Eagle Fire Department switched despatch bureaus in 2006. It is the despatch bureau ‘s duty to keep accurate records of clip, nevertheless it is acknowledged that during times of heightened call volumes, the starter may non hold been wholly accurate in entering all times. This disparity may somewhat skew the consequences, though the discrepancy is expected to be minimum. Further rating should be done to formalize the consequences of this survey finding if other like-sized fire sections that have undergone staffing alterations which involved transitioning from an unstaffed fire station to one that is staffed have experienced the same decrease in norm turnout clip. Additionally, surveies should be done in volunteer/paid-on-call fire sections to find if on-premises staffing as an consequence on the loss of life and belongings loss as a consequence of fire.

The Correlation between Unemployment and Divorce Rates in the United Term Paper

The Correlation between Unemployment and Divorce Rates in the United States - Term Paper Example A tendency to emphasize the social and economic costs of unemployment on society in the aggregate avoids the clear and definite problems that joblessness creates in the home. Some of these household challenges are responsible for lowering levels of subjective well-being in society, which exacerbates the negative overall effects of unemployment. One particularly troubling hypothesis is that divorce tends to increase to some degree in proportion to unemployment rates in developed countries (Jensen & Smith, 1990). The marriage destabilization caused by the loss of a job and the perhaps long-term unemployment that results may explain a great number of divorces. However, especially as one deals with aggregate population data from past years, one is not dealing with causal inferences but rather correlational observations. While it is intuitive to speculate that unemployment increases risk to divorce, one could wonder whether divorce is likely to increase unemployment. It does not seem out of the question that marital instability increases one’s chances of being dismissed or issuing a resignation from his or her work. In fact, Rogers and May (2003) found a significant correlation between increases in marital discord (defined as thoughts or actions supportive of divorce) and declines in job satisfaction. Finding a statistical correlation between unemployment and divorce would signify a number of things, namely that individuals facing long-term unemployment but are happy in their marriages should take steps to ensure the sustainability of that relationship through financial hardships. At a broader level, predictors of unemployment can also be taken as predictors of higher divorces, which give society a chance to plan for increased levels of marital instability in addition to unemployment

Defining Racial Profiling and Utilitarian Argument Essay

Defining Racial Profiling and Utilitarian Argument - Essay Example The article will also deals with delineating the incongruence in the arguments in favor of racial profiling and reinforce the arguments against racial profiling. Finally, it will be argued that a number of utilitarian objections that have been leveled against racial profiling are impenetrable by those that support racial profiling that. Definition of Racial Profiling In order to maintain the logical soundness and defensibility of any argument, one must clearly define racial profiling the before marching into any discussion about the moral problem it poses. The term â€Å"racial profiling† was coined to criticize certain abusive investigation methods of the police force and, as a result, has widely been associated with being unjust and the unjustifiable (Gross & Livingston, 2002). In this essay, however, the term will be used without any bias and the implication of illegitimacy. When racial profiling will be referred in the article, it would be on the basis of Risse and Zechhau ser’s (2004) broad definition that will be introduced later in the article. Ramirez (2000) defines racial profiling as â€Å"any police-initiated action that relies on the race, ethnicity, or national origin, rather than the behavior of an individual or information that leads the police to a particular individual who has been identified as being, or having been, engaged in criminal activity.† Here, the definition puts together race, ethnicity, and nationality along with the use of an individual’s behavior or information. By doing so, Ramirez describes profiling in a way seeks moral disapproval against the complete reliance on race and ethnicity in police investigation. It is clear that according to this definition, the unjustified racial profiling is when the race and ethnicity are the sole motivation for a police action (Risse & Zeckhauser, 2004). Despite its general soundness at a first glance, the definition fails to consider the cases that involve a combinat ion of race and information (Risse & Zeckhauser, 2004). Hypothetically, if the police stopped disproportionately more blacks than whites for petty violations of the law, such as driving with a broken tail light or exceeding a speed limit by 10mph, it should be considered racial profiling. However, Ramirez’s definition cannot be used to establish whether this case is racial profiling or not because in this example, both race and information are used in the police action (Risse & Zeckhauser, 2004). On the other hand, Risse and Zeckhauser (2004) define racial profiling in a more comprehensive manner by suggesting that racial profiling is â€Å"any police-initiated action that relies on the race, ethnicity, or national origin and not merely on the behavior of an individual.† Through this definition, it can be deduced that racial profiling is when police action relies on a combination of information and race to punish those involved in committing crime. Tests for Justified Racial Profiling Even though, Risse and Zechhauser’s definition of racial profiling is comprehensive and helpful in understanding the kind of police action that

The Effects of Social Media on Employment Essay

The Effects of Social Media on Employment - Essay Example The report has considered reliable secondary data sources to analyze the gained data in order to meet the report objective. The report has summarized important facts that have come through data analysis in order to meet the developed assignment objective.As the discussion stresses social media can be defined as social interaction activities among individuals in which those individuals develop and share ideas and information in virtual networks and communities. Adoption and implementation of social media in business operation processes can be considered as an effective business strategy for the employers. Employers can identify right and appropriate talent for their organisations through the use of social media networking websites. On the other hand, several graduates and job seekers used to follow several leading social media networking sites and processes in order to get effective employment or job opportunity. Therefore, it can be stated that use of social media can obviously benef it both employees and employers in their employment activities.  It is true that several leading organisations around the globe are trying to capitalize on potential business opportunities that have been developed due to globalisation and technological advancements. Each and every leading domestic as well as international organisation is trying to develop and implement unique business operation strategies in order to gain potential competitive advantages over competitors.

The British Invasion Essay Example | Topics and Well Written Essays - 500 words

The British Invasion - Essay Example The chords of their music were also simple (but beautiful) that everybody can relate. The themes of the lyrics of their music are also universal that anybody can relate whatever the generation, background or orientation of the listener. Themes like love and hope contained in the lyrics Let it Be and Here There and Everywhere are universal human aspiration that will always find an audience regardless of generation. Yes it is. The combination of skiffle, rock and roll, folk and to some extent jazz that characterizes the music of the Beatles still have a following in this generation and such, it is still applicable today. The Beatles were also real artists. Meaning, they wrote their own song, composed their music and arranged their own melodies unlike with many of today’s performers whose music pre-made by recording companies and they are just asked to perform. In fact, artists who make their own music are more esteemed today. Are there any non-American bands or performers that you regularly listen to today and how does their national identity figure into their music and public presentation (are you aware of the nationality of your favorite bands)?   I listened to Bob Marley. Yes I am very much aware about his national identity and his brand of music. He is a Jamaican singer-songwriter and musician. His national identity influenced his genre of music which reggae. I believe that Bob Marley is Jamaica’s equivalent of Beatles in Great Britain. He is very popular even outside Jamaica and his music also finds audience in different generation. Their music are timeless (finds new audience in every generation) and can cross varying cultures speaking about the same themes of human experience such as frustration in No Woman No Cry, love and hope in Redemption Song and One Love that would always touch audience whatever generation or nationality they may belong. His presentation also speaks well of

Work is a theatre and every business is a stage. Discuss Outline

Work is a theatre and every business is a stage. Discuss - Outline Example e the reader with a discussion and analysis of this particular quote and the impacts and ramifications that it has with regards to the business world and the individual employee. Moreover, marketing theory and social psychological theory will be used a means of helping the reader to come to the understanding that even though certain processes and decisions may seem as second nature, there are theories and powerful matrices of â€Å"choice†/†behavior† that effect the way in which a person behaves within any given business engagement. Through understanding these â€Å"roles†, the reader can come to a more informed understanding with regards to the fact that theory plays a defining role in helping to shape these interactions and define these engagements. Whereas all of the theories that have been put forward area useful with regards to understanding human action, they must also be understood in terms of motivating roles that constrain and nearly require individuals to behave in certain predisposed manner. Although it is most certainly true that people have a free will and can exercise their own rational choice with regards to what roles they fulfill and what level of engagement they offer, the theories and approaches that have thus far been put forward provide help to underscore the fact that even decisions that are seemingly made â€Å"independently† are in fact constrained by powerful choice mechanisms that lie nearly outside the control of the individual within the business environment. By engaging with such a reality and understanding these dynamics more closely, the business leader can more effectively target their approach to appeal to these core determinants. Smith, W. K., Gonin, M., & Besharov, M. L. (2013). Managing Social-Business Tensions: A Review and Research Agenda for Social Enterprise.  Business Ethics Quarterly,  23(3), 407-442.

System analysis and design 251 Essay Example | Topics and Well Written Essays - 1000 words

System analysis and design 251 - Essay Example Due to the disadvantages of this system, Helen McPherson seeks information systems that are crucial to the achievement of modern business organizations. Information systems are the hardware and software applications that sustain data-intensive functions. They involve  an integrated set of mechanisms for gathering, storing, and handling data and for provision of information, facts, and electronic products (Stair and Reynolds 2013, 120). Business corporations (OT included) and other institutions depend on information systems to implement and manage their functions, interrelate with their consumers and suppliers, and contend in the marketplace to gain competitive advantage. With this system in place OT will be able to serve their customers efficiently and accurately. This Functional Requirements Report provides information system fundamentals that will facilitate the Customer Booking system including accommodation booking of OT (Stair and Reynolds 2013, 156-200). This Functional Requirements Report identifies the required system capabilities that would enhance OT customer booking and accommodation facilities to improve general performance of OT (Institute for Systems and Technologies of Information, Control and Communication 2006, 264). The capability of incorporating IT efforts with business activities and purposes. This potential is to administer organizational preparations, structure procedures and staffing tacking any predicaments in OT booking arrangements Functional Requirements Report provides new information system’s scope through context Data Flow diagram. It is easy to analyze the scope through the diagram. This Functional Requirements Report identifies the below procedures as critical information system that would enhance OT’s customer booking system. OT novel customer booking system allows integrate OT management, accommodation department, customer request, departures, marketing, and

Marketing Cultures Essay Example | Topics and Well Written Essays - 500 words - 1

Marketing Cultures - Essay Example Subway India unlike USA offers various veg and non-veg stations specialized in fast food services. These stations give fast food service ranges from: This is a crunchy, crispy, and delicious Veggie Delite sandwich. It is a tasty combination of tomatoes, garden fresh lettuce, green peppers, olives, onions and pickles sandwiched on freshly baked bread Most vegetarian who loves this subway fast food livened up! It is a light, golden brown patty that combines the flavors of high-quality carrots, beans, bell peppers, and other assorted ingredients. As Indians say, the spice of life is variety! All these varieties emerge from the various veg and non-veg stations in Subway India but one may not necessarily get them in Subway USA due to the fact that there is only one veg and non-veg station in Subway USA. The Subway sandwich chain intended to team up with Softcard in an effort to offer customers a means of buying food via their own mobile phones (Gong, 2013:28). Indeed, Subway lived to its words and kicked off the NFC-based mobile payments using Softcard, a payments venture engineered by T-Mobile USA, AT&T Mobility and Verizon Wireless. Previously known as Isis Wallet, Softcard provided an app which supported mobile payments in at least 80 mobile devices sold by T-Mobile, AT&T and Verizon and was preloaded on at least 30 different devices. Consumers were now able to utilize their NFC-enabled mobile devices to access payment terminal at their regional Subway restaurant in USA when paying for their food. This pilot program was only launched in Subway USA in 2013 and not in Subway India. The intention of payment service from the NFC-enabled mobile device was to reach at least 26,000 Subway locations within the US. The question as to whether iPhone 6 users will tap into Apple Pay to take advantage of these new systems was still valid by late 2013. However, Softcard and

Service Operations Management Research Paper Example | Topics and Well Written Essays - 1250 words

Service Operations Management - Research Paper Example Standard Chartered Bank in the United Arab Emirates serves both the Consumer and the Wholesale Banking customers. The Consumer Banking section provides deposit taking, personal loans, credit cards, mortgages, and wealth management services to various individuals and to small to medium-sized enterprises. The Wholesale Banking section provides the corporate and institutional customers with services ranging from lending, trade finance, custody, cash management, debt capital markets, foreign exchange and corporate finance (Standard Chartered). This noble bank in the United Arabs Emirates is well established in the growth markets where it aims at being the right business partner, mainly for its clients. Standard Charted Bank in the United Arab Emirates combines in-depth local knowledge together with global capability to offer the best financial services to its customers. The Bank is well trusted across its numerous branches and networks for its high standards of governance as well as its commitment in making a huge difference in the various communities where it operates. Standard Chartered Bank is the world's leader in the emerging markets' banks, and its headquarters are in London. However, the bank’s businesses are always overwhelmingly international (Standard Chartered). ... llowed by the Branch Cash Officers who are responsible for the back office of the branch operations followed by the bank tellers or cashiers who are responsible for the daily operations of depositing as well as withdrawing cash for the various clients in the bank. It is worth noting that these noble people always work in harmony in order to achieve the bank’s mission and vision statement whereby each employee is expected to fully know their various roles. Each employee of the bank has their individual targets, which they are supposed to attain in order to remain in employment, and this makes them to surpass their targets since there are bonuses and other incentives that are awarded by the bank if an employee surpasses their targets (Parker 03). There are various key Tactical and Strategic Challenges that are faced by the Operations Managers as they continue working on a daily basis. Such challenges include keeping a keen eye on the numerous transactions that the branch of the bank is undertaking. This is a paramount challenge since the bank deals with other people’s money, and any loss would result to diverse repercussions to the entire bank as well as ruining its reputation. A bank’s operations manager in Standard Chartered bank in UAE is not even supposed to deal with customers on a face-to-face basis since they will not be able to concentrate on their noble work effectively. They are also supposed to authorize various transactions, especially those that deal with a large amount of money. They have to know anti-money laundry laws, which the bank has to adhere to efficiently, govern the real source of the money since the bank. This is a key function of the bank’s operations manager and also a tactical and strategic challenge since any mistake can affect the

Fuel economy in automobiles Essay Example for Free

Fuel economy in automobiles Essay Driving one of the new high-tech hybrids — cars that combine the power of a gas engine with an electric motor to reduce fuel consumption and emissions — may seem like something only an environmentalist or an engineer could get revved up about. The fact is, however, that a new generation of hybrid cars and trucks due to go on sale within the next 12 months offer a number of very practical advantages for families, from saving money to helping save the planet. Many experts are predicting 2004 will be the year that hybrids turn the corner from eco-friendly novelty to mainstream transportation. Theres never been a better time to consider a switch to one of these green, clean, gas-saving machines. Here, eight reasons a hybrid may be perfect for your family. 1. Theyre as comfortable to drive as conventional cars. Theres no difference between a hybrid and the gas-powered car parked in your garage — it can accelerate just as quickly and cruise just as fast on the highway, and it handles just as smoothly. Most important, hybrids are just as safe to drive. Well, there is one difference: Hybrids are super-quiet — sometimes you cant tell whether the engine is running or not! When power is not needed — at a red light, say, or in bumper-to-bumper traffic — the engine completely shuts down and revs up again when you press on the accelerator, meaning you dont waste gas or emit toxins. Hybrids run on a rechargeable battery and gasoline rather than gas alone, but the power shift between the gas engine and electric motor is so seamless that youre likely to forget about all the advanced technology moving you down the road. And theres no need to plug them in as you would with an all-electric car; the electric motor also acts as a generator during deceleration and braking to continually recharge the batteries as you drive. 2. Youre sure to find a model that fits your familys lifestyle. Currently, there are three popular hybrids on the market: Hondas compact two-seat Insight coupe, along with the midsize Toyota Prius four-door hatchback and the Honda Civic hybrid sedan, both of which seat five. But with half a dozen new hybrid models on their way, larger families will soon have more good choices. Look for everything from midsize family cars like the Honda Accord hybrid to hybrid versions of midsize sport-utility vehicles, like the Ford Escape, Toyota Highlander, and Lexus RX 400h, to full-size pickup trucks from Chevrolet, GMC, and Dodge to turn up in your local dealers showrooms within the next year. 3. Youll save money on gas. With gas prices soaring to more than two bucks a gallon in many parts of the country, theres no smarter reason to switch to a hybrid than fuel efficiency. Just compare the miles per gallon youre getting now with, for example, a Toyota Priuss 60 mpg in the city and 51 mpg on the highway. In fact, hybrid cars can go for more than 600 miles between fill-ups, meaning you should be able to cut visits to your neighborhood gas station in half, saving you time as well as money. If you drive 1,000 miles a month and your current car averages 20 miles per gallon, driving a hybrid could save $700 or more a year at the pump. 4. Youll be doing your part to help protect the environment. Not only do gasoline-electric hybrids get much better mileage than many standard cars, but most also produce about 90 percent fewer smog-forming tailpipe emissions compared with the average new car, according to Dave Hermance, head of Environmental Engineering for Toyota. 5. Youll set a good example for your kids. If you like the notion of leaving the world a better place for your children, driving a hybrid is one good way to transform that lofty ideal into a concrete move. Our actions as parents speak louder than our words, even with seemingly simple decisions. Owning an eco-friendly car does more to impart environmental values to your children than countless talks about saving the planet. 6. Youll get cash back from Uncle Sam. Federal tax credit up to $3,400! More financial incentive to buy a hybrid: The IRSs Clean Fuel Vehicle Tax Deduction allows you to take $1,500 off your 2004 federal tax bill (the deduction decreases by $500 a year until its phased out in 2007). You may also qualify for additional financial incentives offered by state and local agencies; log on to the U. S. Department of Energys Clean Cities Website (www.ccities. doe. gov/vbg/progs/laws. cgi) to learn more. 7. Theyre not all super-expensive. Hybrids tend to cost $1,500 to $2,400 more than mainstream cars (dont forget about that tax break and major gas savings). But they are becoming extremely popular: Many dealerships have a several-month waiting period for a new one. And it is perhaps this growing demand for hybrids that has sent a message to American automakers — whove been slower than their Japanese rivals to adopt this new technology — to build cleaner, more socially responsible cars. 8. Youll boost your coolness quotient. You cant put a price on this aspect of hybrid ownership, but suffice it to say, driving a hybrid car is a surefire conversation starter among coworkers, fellow parents, neighbors, and even total strangers. Just ask Hollywood hipsters Jennifer Aniston, Brad Pitt, Cameron Diaz, Larry David, and Leonardo DiCaprio — all happening hybrid owners. Reality Check Although hybrids offer some significant benefits, there are a couple of points to consider before you sign on the dotted line. * Energy efficiency All hybrids get better mileage than conventional cars, but there are two different approaches to the powering mechanism, in both current and upcoming models. Some, for example, get better fuel mileage in stop-and-go traffic, while others do better on the highway. Before you settle on a particular model, keep in mind how youll use the car — as a neighborhood shuttle service or a long-distance commuter-mobile. * Fuel emissions. If your goal is to drive the car or truck with the least possible environmental impact, youll want to spend some time researching your options. Different engine and even transmission choices can have a significant effect on a cars emissions profile. For example, a Honda Insight with a manual transmission gets better fuel economy than the automatic version, but the automatic version emits fewer pollutants. Essentially, some hybrids are cleaner than others — and conventionally powered cars with low emissions can be cleaner than certain hybrids. veraging 8. 5 million barrels/day.

Effects of Ketamine on the Human Body

Effects of Ketamine on the Human Body The desire to alter consciousness is a fundamental human trait. From being something impossible to finding numerous chemicals in controlling the mind, the process of discovery has also created opportunities for us to explore the effects and mind-tricks behind it. Just like any other new inventions in technology, there is always a path that leads to a wrong destination. The use of psychoactive drugs has turned into a trend amongst the younger generation, endangering both their own lives and the stability of the society. It has been said that this ingenious discover has benefited the forward of our medical industry; yet in our 21st century many have become a tool to escape from stress and reality. These so called party drugs are now produced in large amounts and distributed to young people at bars, nightclubs and house parties around the globe. The disastrous impact behind this irresponsible crime has led to thousands of innocent people condemned and forced to dwell in a living hell. Different people have their own definitions of the term abuse. It is hard to have a universal definition for the word as the bottom line of an individual is drawn upon their own decision. Therefore using the definition published by the World Health Organization, psychoactive substance abuse is defined as a maladaptive pattern of use indicated by continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use [or by] recurrent use in situations in which it is physically hazardous.  [1]  In addition, chronic abuse in this context will be defined as a relapsing disease characterized by compulsive drug seeking and use despite harmful consequences as well as neurochemical and molecular changes in the brain.  [2], in other words, chronic abuse is addiction. Addiction is mostly dependent on previously exposed rewards such as food, alcohol, sex, and in this case, on the psychoactive dru g Ketamine. http://www.tjipr.com/images/enji.jpg http://healthimpactnews.com/wp-content/uploads/2011/06/VariousPills-300225.jpg What is Ketamine? Psychoactive Drugs Before answering the above question, it is important to know how ketamine is categorized as a psychoactive drug and its evolvement in human history. The term psychoactive drug is used to describe any chemical substance that affects mood, perception or consciousness as a result of changes in the functioning of the nervous system (brain and spinal cord).  [3]  These drugs are often termed mind-altering because they change the perceptions and the behavior of the individual using them. Psychoactive drugs can be classified into seven different categories: stimulants, depressants, narcotics, cannabis, inhalants, hallucinogens and club drugs. Stimulants are mostly used to relieve tiredness and increase alertness. The most common stimulants are nicotine, which can be found in tobacco products, and caffeine, which is mixed in soft drinks and coffee. The more these drugs are consumed, the more our body will depend on it to maintain the desired effects. Cannabis acts in a similar way, only that it is a plant mainly in forms of marijuana and hashish. Depressants and Narcotics work in the opposite way. They are often used to dull senses and depress the functioning of the central nervous system. These two types of drugs are used medically as anesthetics and analgesics. Small doses of depressants may help more to relax muscles and produce calmness, while larger doses may cause difficulties with reflexes and judgement. Alcohol is a depressant which is widely found in our daily lives, and Narcotics such as opium and heroin are mostly used to relieve pain, yet a long-term dependence on these two may cause addiction and abuse. Hallucinogens and inhalants are synthetic drugs that distort the perception of reality and produce feelings of euphoria. These drugs may cause a short period of excitation and light headedness as it quickly acts on the body as it enters the bloodstream through inhalation. A good example of hallucinogenic drugs is Phencyclidine (PCP), which is mostly used as a sedative in operations before switching to Ketamine. Ketamine is the most common club drug found in the society nowadays. Club drugs have the effect of both stimulants and hallucinogens, and are most popular at party venues such as house parties and nightclubs among the younger generation. Other Club drugs include Ecstasy and Gamma-Hydroxybutryic Acid (GHB). The latter one is odorless and tasteless, therefore gaining the reputation as a date-rape drug as it may cause deep sleep a nd unconsciousness when administered with high dosage.  [4]   Ketamine As mentioned above, Ketamine was used to replace Phencyclidine (PCP) as an anesthetic medicine.  [5]  PCP  was originally tested as a surgical anesthetic in the 1950s.5 It is known as a  dissociative  anesthetic because it can make a person feel a sense of detachment, as if the mind is separated from the body.  [6]  PCP was used in veterinary medicine to anesthetize large animals, but was never approved for use in humans because many patients became agitated, delusional and irrational while recovering from their operations.  During 1960s, PCP was widely abused as it could be easily distributed in pill forms. The powdered form of PCP was developed in 1970s, commonly known as rocket fuel, superweed, etc. which is sprinkled on top of tobacco or marijuana for smoking. PCP  can be easily synthesized; as a result it is often sold off on streets as another drug such as mescaline or Lysergic acid diethylamide (LSD). Due to the worse effects illustrated by patients after the use of PCP, Ketamine was developed in 1962 to replace PCP. It was first known as Cl-581, discovered by scientist Calvin Stevens. Ketamine was then tried in humans as an anesthetic for the first time by Professor Edward Domino, and this is what he said afterwards, Our findings were remarkable! The overall incidence of side effects was about one out of three volunteers. Frank emergence delirium was minimal. Most of our subjects described strange experiences like a feeling of floating in outer space and having no feeling in their arms or legs.   [7]   The successful effects soon encouraged the drug to be patented by the company Parke-Davis for use as an anesthetic in humans and animals. Nonetheless, Professor Domino described Ketamine as a potent psychedelic drug and named it as a dissociative an anesthesia. Ketamine was first used in large quantities in the Vietnam War by the USA Army, where it was used as an anesthesia for soldiers on field. Ketamines chemical structure, mechanism of action and effects are similar to those of PCP, but it acts for a shorter duration and is less potent than PCP. The drug provides dissociative anesthesia, which is a combination of analgesia with superficial sleep. This state is characterized by spontaneous ventilation, relative preservation of airway reflexes and hemodynamic stability, and explains why Ketamine has remained the anesthetic drug of choice in the developing world and for mass casualties in the field.  [8]  Ketamine is tasteless and odorless, so it can be added to food and drinks u ndetected. Because of this, the drug is sometimes used in sexual abuse at entertainment venues and therefore referred to as drug rape. Ketamine is known on the streets as special K, K and cat tranquilizer. Ketamine has plenty of other street names that have changed throughout the years. Originally it was known as rockmesc or mean green  [9]  , and then it evolved to numerous different slang names including Jet, Super K, Vitamin K, New Ecstasy, Honey oil, Mauve, Keller, Bump and Super Acid. Uses and effects of Ketamine exposure in medicine One of the most important happenings in the modern society is our breakthrough in the development of effective medicine for clinical procedures. Advances in technology has prospered the birth of new operation methods such as laparoscopic and robotic surgeries, enabling medical practitioners to increase efficiency to max, at the same time lowering the cost and risk of the procedure. These improvements have greatly ameliorated the side effects of conventional open surgery, allowing patients to heal faster with better comfort. Medicine becomes an indispensable need in our daily lives, and the more it improves, the more we rely on it. I have attended a medical lecture over the summer holidays on the background of surgery. The professor explained the four most important factors behind all the surgeries, namely the 4As: Anesthetics, Analgesics, Antibiotics and Antiseptics. Among these four, Ketamine has already covered two of these factors. Ketamine has several clinically useful properties, including analgesia and less cardiorespiratory depressant effects than other anesthetic agents  [10]  ; in fact it causes some stimulation of the cardiovascular system. Ketamine is soluble in water and is prepared with the sodium salt benzethonium chloride as a preservative. It is a basic compound and is dissolved in a solution of pH 3.5-5. The ketamine molecule contains an asymmetrical carbon atom with two optical isomers (enantiomers). The S (+) isomer is about three times more potent and longer acting as an anesthetic than the R (-) isomer. It is believed that the R (-) isomer is the part of the molecule that is the root o f the cause of some undesirable side effects.  [11]  Studies recently have shown that the S (+) Ketamine isomer is a stronger analgesic with a faster clearance and less side effects than the R (-). It has shown to provide a more rapid motor and sensory block, shorter duration and less motor blockade in elder males.  [12]  Ketamine interacts with N-methyl-D-asparate (NMDA), opioid, monoaminergic, muscarinic receptors and voltage sensitive Ca2+ channels. However, unlike other general anesthetic agents, ketamine does not interact with GABA receptors. The NMDA receptor is a member of the glutamate receptor family. It is an example of an ion channel coupled receptor with excitatory properties which has been implicated in the mechanism of general anesthesia, analgesia and also in neurotoxicity. Ketamine is a non-competitive antagonist of the NMDA receptor which interferes with the action of excitatory amino acids  [13]  . In addition, at clinically relevant concentrations, ket amine interacts with the phencyclidine (PCP) binding site leading to significant inhibition of NMDA receptor activity. This only occurs when the calcium ion channel has been opened. Effects of Ketamine on our body We were always informed with purely the basic consequences of drug abusing. For instance, we were taught that drug abusing may cause serious damage to our body but what exactly is our body suffering from? Central Nervous System Ketamine is the only anesthetic available which has analgesic (pain relieving), hypnotic (sleep producing) and amnesic (short term memory loss) effects. When used correctly it is a very useful and versatile drug.  [14]  Clinically, Ketamine has been reported to produce not only general but also local anesthesia. Ketamines site of action is primarily in the thalamus and limbic systems. It does not suppress respiratory drive unless high doses are used, or smaller doses given rapidly. Unlike other anesthetic agents, patients who have had ketamine may have their eyes opened and make reflex actions during the operation; therefore it is not suitable for use in eye surgeries. However, use of ketamine increases the intracranial pressure, therefore patients who have recent head injuries should avoid using it to prevent further damage. The reason behind was that the rise in mean arterial pressure caused a rise in cerebral perfusion pressure and therefore intracranial pressure. Moreover ket amine is a very effective analgesia and may be used without other analgesics intraoperatively. Due to the frequent occurrence of hallucinations after operation, the patient may be in agitation during recovery. These can be reduced by premedication and by recovering the patient in a quiet area.  [15]   I recently read several medical research papers on the effect of anesthetics and sedatives for the developing brain. A study performed by Dr. John Olneys laboratory demonstrated widespread neuronal degeneration following the repeated administration of ketamine in newborn rats, as well as long-term decreases in neuronal density and impaired neurocognitive function in adulthood following an exposure to other anesthetic drugs.  [16]  It is further discovered that drugs used to provide clinical anesthesia and sedation are thought to affect proper formation of the central nervous system as it interferes the NMDA-type glutamate receptor function. Moreover, several studies have examined the effects of Ketamine on the developing brain of monkeys and have observed widespread neuronal cell death following the administration of multiple doses up to 75mg/kg.  [17]  Another study by Dr. Fredriksson and colleagues demonstrated that a single ketamine exposure of 50mg/kg in new-born mice cau sed abnormal behavior and impaired learning and memory acquisition in adolescence. Experimental data also indicate that NMDA glutamate receptor agonists and GABA receptor antagonists trigger cell death.  [18]   As laboratory investigation on humans is not allowed, scientists may only conduct their research on rats and monkeys. The potential mechanism of anesthetic neurotoxicity is still under investigation; however, it is further complicated by the lack of understanding of exact mechanisms of consciousness and anesthesia. Therefore these results may only be interpreted as a reference to the effects that relate back to ketamine abuse. Respiratory System By using ketamine, the airway is usually well maintained as the airway reflexes and skeletal muscle tone are relatively preserved. Aspiration is a potential hazard despite the retention of protective reflexes. Ketamine is an effective bronchodilator and its action may be mediated either via an increase in blood catecholamine or by its direct smooth muscle relaxant effect.  [19]  When ketamine is given slowly respiration is usually well maintained, after rapid intravenous injection the breathing may stop for a short while but usually restarts within a minute.  [20]  Because of this, ketamine becomes a very useful anesthetic agent in places where there is only limited oxygen available. Cardiovascular System Ketamine is able to increase both blood pressure and heart rate. These variables reach a peak 2-4 minutes after an intravenous injection, then slowly decline to normal values over the next 10-20 minutes. Ketamine produces its cardiovascular effects by stimulating the central sympathetic nervous system and, to a lesser extent, by inhibiting the reuptake of norepinephrine at sympathetic nerve terminals. Individual responses may vary occasionally as there can be a large rise in blood pressure. This risk is not related to a preoperative history of hypertension, but related to the usage of ketamine. This may increase the workload of the heart; hence ketamine should be avoided in those patients with ischemic heart disease. Induced bladder dysfunction Bladder dysfunction associated with ketamine abuse was first voiced out in 2007 by researchers in Canada and Hong Kong. Dr. Shahani and his team presented a series of 9 patients who are all daily ketamine users presented with dysuria, frequency, urgency and frank hematuria. The CT scans revealed a thickened bladder wall, small capacity bladder and perivescicular stranding.  [21]  Dr. Chu and his team presented a series of ten patients with severe bladder dysfunction following regular ketamine abuse. From the statistics of their research, all patients had severe lower urinary tract symptoms and small functional bladder capacity varying from 20 to 200mls.  [22]  A scan of the bladder (cystoscopy) also revealed that the epithelial layer of the bladder has inflammation.  [23]  These reports were from Hong Kong and Canada where ketamine is a popular drug. Dr. Cottrell and his team reported nine patients presenting with similar urinary symptoms and cystoscopy findings following chronic ketamine usage.  [24]  These symptoms are currently left unexplained, but with increasing popularity of the drug in the younger generation, more and more ketamine users could present with ketamine induced bladder dysfunction. As we can see from the above effects, ketamine is already able to induce a lot of problems for our body and affects the whole body system when it responses to the drug in medical uses. Some may be beneficial, but most can cause severe damage to our body, so why is ketamine still on the streets endangering our future generations? Ketamine in our society Back in Hong Kong, I often hear reports from the public media reporting that the police force discovers another drug dealing club/bar with underage drinking and drug abuse. Although we were educated with the basics of the consequences of drug abuse, one simply will not be able to know thoroughly about the essential damage that the drug does to the body. Take smoking as an example: Tobacco has existed for centuries, and people nowadays have beautifully wrapped cigarettes packed in delicate boxes. They can easily gain access to buying one of this highly toxic substance back home for their own enjoyment and pleasure. Putting aside the lack of awareness in the old days, nowadays all the education systems around the globe include the effects of smoking into our classes, no matter taught in Liberal Studies or specifically Biology, most people who have received education are equipped with the basic knowledge of the harmful effects of smoking. Even packages of cigarettes are posted with phot os of the disastrous effects of smoking, for example, a photo of a dissected lung of a chronic smoker, still does not stop smokers from getting on with their habit. In the 1970s, the drug was approved by the FDA to be used clinically on children and adults, yet at the same time it also started to flow into drug markets in public. Most of them were firstly sold by hospital staff; later on it became trendy to produce it in large amounts to divert ketamine into wider population. Over the past 20 years, Ketamine has emerged as a testing replacement for PCP to one of the most popular party drugs at underground parties and raves. In the late 20th century, the drug has already gained its reputation around the globe as one of the mainstream dance culture drugs in society. In the year 1999, The Drug Enforcement Agency in the United Sates made ketamine a schedule three drug. This means that this particular drug is illegal to buy or sell without a prescription.  [25]  Ketamine is considered to be a Class C drug in the UK and Mexico, the equivalent of a schedule three in the United States; and schedule one in Canada. It was legal to possess ketamine in England, Scotland and Wales before 2006. Most countries currently have ketamine under controlled substance act in which it can be used as a medication but not recreationally, for instance ketamine is regulated under Schedule 1 of Hong Kong Chapter 134 of Dangerous Drugs Ordinance. It can only be used legally by health professionals, for university research purposes, or with a physicians prescription.  [26]   Taking the data of ketamine abuse in Hong Kong, in recent years, it has become more common among the teens. In Hong Kong, since 2005 it has become the commonest drug of abuse among persons aged 21 years or less; compared to the first three quarters of 2005, the number of ketamine abusers among teenagers has doubled in the first three quarters of 2008.  [27]  In 2008, ketamine abuse constituted 85% of all kinds of drug abuse among persons aged below 21 years, compared to 61% in 2005. Also, data collected by the Hospital Authority Hong Kong Poison Information Centre (HKPIC) showed that ketamine abusers represented 16% of all drug abusers attending accident and emergency departments in the period of 1 July 2005 to 31 December 2005, while the proportion rose to 40% in the period of 1 January 2008 to 30 June, indicating a steep increase of the number of ketamine abusers.  [28]   Solutions? The reason I decided to put a question mark after this sub topic is because there is no concrete evidence that the treatments I list below will 100% cure the patient. To overcome the psychological dependence on ketamine, the ultimate factor during the process will be the patients endurance and willpower. Without consistency to finish the whole course of treatment is no different to receiving no treatment. Just like antibiotics, you have to finish the whole course in order to fully recover from your illness. We live in an inconsistent and contradictory society. On the bright side, we advise the society not to abuse drugs and say no to the people who sell or offer them to you; yet on the other hand, medical practitioners are encouraging us to take medicine that might cause similar effects and consequences as drugs like ketamine. While we tell young people that ketamine is illegal and dangerous for their health, we ignore to a large extent the bad effects that alcohol has on health, thus making it legal even if it has devastating effects on our body as well. The world has slowly turned into a place where benefits and money take hierarchy over the health of the public. There is an increase in frequent reports of making fake milk powder and eggs, as well as drug manufacturers such as the recent incident of Contergan taking the blame of causing Phocomelia in infants whose parents had taken the medicine. One of the main reasons that ketamine is still one of the most popular party drugs nowaday s is due to the commercial income it brings when it comes to selling and buying. Drug dealing is happening around the globe every day, and what attracts people to do it is not the drug, but the money. Values have been overthrown by the nature of human kind, where selfishness topples conscience in the business world, no matter legal or illegal. Laws and regulations are developed over time to control the extent of these shameful behaviors, yet ultimately there is no thorough solution to this problem. Most societies are uncomfortable with people going off into trance and hallucinatory intoxications, and indeed setting up the laws against the usage and possession of drugs are to discourage people from falling into those in-built worlds of their own. But innate, neuropsychological changes in a persons body cannot be controlled by legislation. Provided that they have the desire to take the drug, they will always be satisfied by themselves. Alcohol may no longer fulfill the need for teenagers to take off from reality into their virtual world of desires after they become fully exposed to it, and slowly they turn to seek stronger effects by trying out drugs like marijuana and ketamine. As they become satisfied with the effects given by the drugs, trying gradually becomes abusing. They start to develop unwise behavior as they reckon that the feeling is brought by the pills rather than from their own nervous systems getting into trouble when the pills no longer work so well. Their drug abuse becomes more frequent and compulsive, yet with less reward. This misconception is the first step to developing drug dependence, no matter whether the drug is marijuana or ketamine or if it produces physiological dependence or not. Dependence on the drug cannot be broken until the misconception is cleared. Drug abusers live on their own reasons to continue, and only those who realize that he/she has been using the drug merely as an excus e for having an experience that is superficial comes to see that the drugged state is not exactly the same with the experience he/she wants. Alternatively, they will start looking for ways that may fulfill the slight desire to lift up from reality, such as meditation and sleeping. If we look in closely to the successful examples of quitting drugs: Many drug abusers give up drugs for consciousness, but little gives up consciousness for drugs. Conclusion We see people travelling through time and going into the mind of others to retrieve thoughts and ideas in fiction and movies, and it is definitely something that I would love to do as well. Yet is it possible to live in dreams and neglect whats really happening in the world we exist in? By altering the state of our consciousness, our brain is simply sending the wrong signal back to ourselves, putting us into a world of our own desires and fantasies. Ketamine can definitely achieve this, but after the short-lived dreams disappear, we will only fall deeper into the K-hole and become more dependent on the drug. We must be clear about the severe effects and consequences that ketamine brings to the individual and the society, and reiterate these problems to the public to prevent further abuse of it. Psychoactive drugs will always be present as a part of our life. The society needs to recognize the problems caused by the misuse of ketamine and deal with them immediately in an open and realistic way. Drug abuse is now connected with other social problems as well, such as social deprivation or family issues. We actually do not know whether the people who abuse it really likes it, but all we need to know is how ketamine can vastly change a persons life when you become addicted to it. From the medical research evidence shown, ketamine can really ruin your life when you are associated with it, yet why blame the drug when it is down to you to choose the reality or to stay in the dreams built by your own desires?

Nursing Role in Elderly Person Discharge Planning

Nursing Role in Elderly Person Discharge Planning Title: Critically discuss the role of the nurse in the planning and implementation of safe discharge for the hospitalised elderly person. 1. define your understanding of discharge planning linking it to the ageing process and the reasons why older people are more susceptible to poor discharge planning. The NHS is effectively a rationed service with a finite limit on its resources. Coast points out that one of the major limiting factors which determines the overall ability of the NHS to deliver appropriate healthcare is the number of beds which are available at any given time (Coast et al. 1996) A direct consequence of this statement is the realisation that the availability of beds in the NHS as a whole is a reflection on the bed occupancy and also the efficiency with which potential patients can get into these beds. (Costain et al. 1992). It also directly follows that the efficiency with which patients can be safely discharged back into the community (or to other destinations) has a profound impact on the overall availability of beds for new patients. A patient’s discharge is ultimately dependent on an enormous number of interdependent variables, not the least of which are their physical, mental, emotional and financial state. (Gould et al. 1995). Clearly other factors such as their support networks and the availability of appropriate carers may play a critical role. If we accept that the elderly are more likely to be dependent as a demographic group, then it is clear that all of these issues must be addressed in a timely and positive fashion before a typical elderly patient can be safely discharged from hospital. If we accept that it is not ideal or practical for all of these factors to be assessed by one healthcare professional, then best practice would suggest that it is appropriate to assimilate information that is available from a number of different agencies in order to allow a proper evidence based decision to be made. (Sackett, 1996). Common clinical practice is to invoke the help of a multidisciplinary discharge team. In the context of this essay, we should note that the elderly may face a number of different discharge options and the multidisciplinary discharge team should ideally consider all of them as appropriate. We shall not discuss them all in detail here, but provide an overview of the most commonly utilised options. Victor Nazareth (et al 1994) point to the fact that multidisciplinary discharge planning may be subsumed by expediency in some cases where some immediately attractive schemes such as discharge to a nursing home may be employed as it requires only a modest investment of planning time but effectively shifts the patient sideways out of an acute hospital bed. Such options may appear to be attractive in the short term but the implications for the elderly patient and their family can be profound if they are not explored properly prior to discharge. (Stojcevic N et al. 1996) Some centres utilise the mechanism of nurse-led inpatient rehabilitation care for the elderly who no longer require medical attention, but this does not address the issue of releasing hospital beds. (Steiner 1997) The elderly, as a group, may frequently fall into a category where they are not quite well enough or independent enough to be discharged home but yet are not really ill enough to remain in hospital. (Closs et al. 1995). In these circumstances the multidisciplinary discharge team may consider the option of a Hospital at Home which acts effectively as a transition stage where help at an enhanced level can be provided in the short term which allows the elderly patient to be safely discharged from hospital thereby releasing the bed for another acutely ill patient and the original patient can recuperate in their own home until well. (Fulop et al. 1997) Martin points to the fact that, in order to be effective, a multidisciplinary discharge team needs to ensure that appropriate facilities are put in place in a timely fashion prior to patient discharge. (Martin et al 1994). Failure to do this will render the whole scheme less than optimally effective, as the patients may not get the full range of appropriate facilities, not derive appropriate benefit and this may culminate in premature or unnecessary readmission to hospital, which is effectively a waste of resources. (Pound et al. 1995) Richards (et al 1998) has provided an exemplary tour de force of the issue with a randomised controlled trial of a large cohort of patients. Their main outcome markers were, excess mortality, quality of life, cost and patient acceptability. (Coast et al. 1998) The paper is actually both long and detailed but the main findings were that all of the parameters that were measured (with one exception), showed no adverse effect of an early discharge. The differences were that there was a greater expression of patient satisfaction with the Hospital at Home scheme. (Wilson et al 1997) 2. Anatomy and physiology of the ageing process should be briefly explained. The anatomy and physiology of aging are two subjects which are specialties in themselves and we do not presume to attempt to cover them in any detail in this essay. Russell points out that older adults are not simply a more aged version of a younger adult, they have distinct metabolic and anatomical differences that alter (for example) their nutritional requirements. As humans age their variability in nutritional need becomes greater rather than narrower. (Russell R M 2000). This type of change can be demonstrated in the fact that the older adult generally maintains their ability to absorb macronutrients well into advanced years but they loose the ability to absorb a wide variety of micronutrients. (van Asselt D Z et al. 1998) Other areas where the aging adult is demonstrably different from the young adult is in the state of their DNA which undergoes progressive oxidation from free radicals throughout life. This has repercussions with regard to a number of disease processes such as diabetes mellitus and many types of cancer. (Gilchrest B A et al. 1997) There appears to be a pre-programmed reduction in mitochondria content of tissues as they age. This is manifest in a number of clinical ways. Reduced strength and energy together with muscle wasting are frequent accompaniments of advancing years and may be one of the most significant factors in the rehabilitation of the elderly person. (Navarro A et al. 2007) 3. In this assignment it is important to define and discuss your understanding of ageism and ageist attitudes in relation to appropriate discharge planning. There are many studies which explore the subject of ageism in clinical practice. They reveal a stereotypical belief that older people are â€Å"dull, disagreeable, inactive, and economically burdensome† (Spence D L et al. 1998 These attitudes are still encountered in some healthcare professionals who may categorise lives into discrete stages as a means of charting progress. The expression â€Å"Act your age† suggests that one has to comply with the cultural (rather than biological) expectations of a stage in life. These stages are commonly associated with economic power with the 40s and 50s usually being considered to be the pinnacle of life as such people tend to have good health and are most likely to have robust financial resources. (Schroots J J F 1998) Engendering positive feelings about older people will help to produce a climate of better care for the elderly. (Puckett J M et al. 1999) In terms of the multidisciplinary discharge team, one should clearly be aware of the fact that the elderly have different needs, requirements and abilities. The belief that this equates with a lesser status and a lower level of expectation should be actively challenged. There is no rational reason to expect an 80 yr old to be less entitled to dignity and a good quality of life than a 30 yr old. If we consider the Rudd study (Rudd et al 1997) we can point to a hard evidence base to support the concept that active multidisciplinary discharge planning can actually produce an improvement in the quality of life indicators for the elderly if ageist stereotypes are actively challenged. It is fair to observe that this particular study utilised a particularly wide-ranging and apparently forward thinking multidisciplinary discharge team, but the results achieved are impressive by any analysis. 4. Explore the role of the nurse in relation to multi disciplinary team working in planning safe discharge. By its very nature, the multidisciplinary discharge team is made up of members from a number of clinical disciplines. The role of the nurse is multifactorial. Very often the nurse is the lead organiser in the team. (Lindley et al 1995). In addition to this, the professional role of the nurse often will allow a special insight into the dynamics of the caring and support networks outside of the hospital environment. It is part of the professional nursing requirement that the nurse should also act as the patient advocate (in common with other clinical disciplines) and as such should speak up for the patient if she believes that a clinical or social need is being unfulfilled. (Roper et al. 1983) 5. consider the psychological psychosocial impact that appropriate discharge planning could have on the older person and their family. Because of the increased likelihood of physical frailty, secondary morbidity and financial insecurity in this demographic group, increased dependence is more likely to be found in the elderly. This dependence is almost certain to be increased in the short term in the immediate aftermath of a hospitalisation. This will inevitably have a significant impact on the psychological well-being of both the patient and their carers. Depression is commonly seen (but less commonly recognised) in the elderly as they may struggle to cope with the demands of daily living which are also likely to be more acute after as in-patient spell. (Roper et al. 1983). Anxiety is another commonly experienced entity in both the patient and their carers as, to a degree, if planning has not been adequately carried out or inadequately explained, they may be concerned about how they are going to manage. Intuitively one can suggest that both of these factors can be significantly reduced with appropriate pre-discharge planning and intervention. (Drummond et al. 1995). 6. Appraise strategies in health promotion and rehabilitation with regard to discharge planning that can assist the older person and their family. This is potentially a vast area as there are a great many papers which have looked at the efficacy of the multidisciplinary discharge team in the discharge planning process. As illustrative examples we can consider some of them. The Mahoney paper suggests that the basic minimum input for a multidisciplinary discharge team should be a nurse and an occupational therapist and that these core workers should have the ability and discretion to co-opt additional specialists such as physiotherapists, geriatricians, social workers and psychologists as they feel appropriate. (Mahoney et al 1965) Specific types of patient discharge may require specific modifications of the basic plan. Ball produced a tour de force in his paper on discharge of the elderly from a coronary care unit, (Ball et al. 2003) where patients were allowed to go home earlier than they might normally have been allowed home but with the proviso that specific teams of specialist nurses were available to reassess the patient in their own home and consider direct readmission if required. The team referred to in this study was comparatively unusual insofar as it was comprised six nursing staff but with different skills and experience and they referred the patients to other members of the team only if they felt that more expert input was required. Many papers consider the role of the occupational therapist as a specific and vital entity in the discharge planning process. Gilbertson (et al. 2000) considered the various impacts that each individual professional had on the overall effectiveness of the eventual discharge and came to the conclusion that the impact of the discharge process (as measured by the Barthel quality of life indicator) was influenced by the input of the occupational therapist more than by any other individual category of healthcare professional. In making this statement, we should note that the authors were conducting a study into the discharge of stroke patients and therefore their findings may not be completely generalsable across the entire spectrum of patient discharge. We should also note that these benefits, which were detailed at some length in the analysis section of the trial, were only demonstrable on a comparatively short term basis. Their six month follow up after discharge showed that the patients had returned to the pre-admission status of quality of life. This, in itself, should not be considered as a negative finding as ultimately, it is one of the purposes of hospital admission to try to maintain or improve a patient’s quality of life In passing, we should also note that the Logan study (Logan P A et al. 1997) produced a similar trial structure and concluded that the Social Worker had an equally important part to play in the successful discharge of the patient. 7. your discussions should address inter disciplinary practice, relevant research and government policies (including the national service framework for older people). Discussion There are a great many studies that have been consulted in preparation for this essay. An overview would suggest that it is best practice to carefully assess, consider and then implement an appropriate discharge package for each patient. This has the advantage of minimising physical, psychological and practical trauma for the patient and their carers but also, (as Hensher observes) it can reduce the incidence of readmission in the immediate post-discharge period. (Hensher N et al. 1999) The National Service Framework for the elderly makes a number of good practice recommendations together with targets and goals that have a specific impact on the whole of the discharge process. (Rouse et al. 2001). Arguably one of the most significant recommendations is the implementation of the multidisciplinary discharge team process although there is no specific recommendation as to how the team should be comprised. A number of papers have examined the impact of the various differential structures of the teams and have come to differing conclusions. We have cited some of these already but some, such as the huge STUC trial suggest that, in specific consideration of the elderly, the prime determinant of whether a patient was going to eventually cope at home or not was their ability to transfer â€Å"successfully and reliably† from chair to chair and to a large extent, this was dependent on the availability of physiotherapy input. (STUC 1997) To conclude, we should perhaps detail the structure and facilities of the â€Å"ideal† discharge team as outlined by the STUC authors. A hospital based outpatient clinic, geriatric day hospital, generic domicillary physiotherapy and speech and language therapy, hospital outpatient physiotherapy, and the usual community resources. The maximum level of home care available in the study area to all patients was three one hour visits daily by a home help for personal care, meals on wheels, and community nurse visits for specific tasks. In addition this paper also quotes details of the additional measures that were also available for the patients:- Patients randomised to the community therapy team remained in hospital until the required package of social services care could be organised and any home adaptations undertaken whereas a store of commodes, high chairs, and toilet frames was kept by the team to expedite discharge. The patients were assessed for rehabilitation needs before discharge in conjunction with the hospital based therapists to set initial objectives and to ensure continuity of care. After discharge, patients were given a planned course of domiciliary physiotherapy, occupational therapy, and speech therapy, with visits as frequently as considered appropriate (maximum one daily visit from each therapist). In addition to all this input, the paper comments that each patient was assessed by the team on a weekly basis for up to three months to ensure optimum utilisation of resources The team’s input base was detailed as:- i) Senior physiotherapist grade 1 with neurological training, ii) Senior occupational therapist grade 1, iii) Speech and language therapist, iv) Therapy aide. v) Nurse vi) Consultant physician To conclude, we can consider a very valid point made by Haines (T P et al. 2004) who suggests that if proper multidisciplinary assessments take place in admission units as well as prior to patient discharge, it is quite possible that some cases may not actually need hospital admission in the first instance. References Ball, Kirkby Williams, (20030 Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. 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