Mustard Gas Is A Group Of Chemical Compounds Used In Chemical Warfare,

Mustard Gas is a group of chemical compounds used in chemical warfare, so called because of its mustard-like smell. Mustard gas contains carbon, hydrogen, and chlorine, with either sulfur or nitrogen. When it comes in contact with skin, mustard gas causes severe blisters. Clothing can be worn to protect the skin, but breathing it produces extreme damage to the lungs and other internal tissues. These compounds are particularly harmful to moist areas of the human body, such as the eyes, armpits, and groin, and concentrated exposure may be fatal. Mustard gas is generally a solid or liquid, but can also be sprayed as an aerosol. Modern gas warfare began during World War I (1914-1918). In April 1915, after several experiments using tear gas, German forces used chlorine gas against British and French troops in Ieper, Belgium. The Germans set up a series of cylinders filled with chlorine gas along their front line. Opening the cylinders, they released a cloud of chlorine gas that the wind c arried to their enemy's front line. Thousands of Allied troops succumbed to the effects of the gas, and because of this devastation, the gas became an instrument of psychological as well as physical warfare. Protective equipment such as gas masks was soon issued to troops. This solved the problem mainly, but still did not give complete protection. In September 1915 the British initiated a gas attack against the Germans. Some of the British troops were inadvertently exposed, and this led to the rapid development of projectiles filled with gas that could be fired into the enemy's trenches from a safer distance. German chemist Fritz Haber supervised the first use of chlorine gas by the German military in 1915. Later, he directed the production of a deadlier form of gas, phosgene, as well as mustard gas. Mustard gas, first used in 1917, proved more stable than chlorine gas and phosgene, and could contaminate an area for days after its release. (Apparently those military scientists and leaders think more destruction is better. This just shows how sick the world is.) I am really against mostly all forms of violance, so spraying mustard gas on fighting soldiers would not get my support. I think it is ridiculous that military scientists and military leaders think that more harm is better. For all those sick, violant military people, I suppose mustard gas could be a useful tool of destruction. After all, it hurts and kills, and that's what the military is all about. In closing, I just want to say that instead of bombing countries and using chemical warefare, we should be spend more time trying to unite countries, work out disagreements and avoid war. I know I was supposed to mainly talk about my opinion on mustard gas, but mustard gas has to do with violance and war, and violance and war have to do with my opinion above.

Free Essays on Sexuality In Our Society

, â€Å"Little boys don’t cry†, issue forth. Children internalize paternal messages regarding gender at an early age, with awareness of adult sex role differences being found in two-year-old children. One study found ... Free Essays on Sexuality In Our Society Free Essays on Sexuality In Our Society Sexuality is a topic that has been debated in our society extensively, through research as well as in informal settings. Many wonder what it means to be masculine or feminine and if we can really assign a definition to such subjective terms. After all, shouldn’t one’s own perception be the determinant of what constitutes masculinity or femininity? This self-construction would be the ideal in our society, but unfortunately, it represents a false belief. Masculinity has certain characteristics assigned to it by our culture. In this paper I will explore the many facets of masculinity and demonstrate how certain beliefs pertaining to it are perpetuated in our society. I will also uncover many of the contradictions between society’s view of masculine and feminine roles. Men are primarily and secondarily socialized into believing certain characteristics are definitive in determining their manliness and masculinity (Nilsen). These characteristics range from not crying when they get hurt to being and playing violently. The socialization of masculinity in our society begins as early as the first stages of infancy. A child’s increasing sense of self – concept is a result of the multitude of ideas, attitudes, behaviors, and beliefs, which he is exposed (August 245). Later in this paper the question of whether there are genetic?, will be discussed. However, to further my argument at this point, I will discuss masculinity, as it is socially defined through the essays I have previously read. From the outset of a boy’s life he is socialized into the belief that he should be ‘tough’. Often when boys get hurt, ‘scrape their knee’, or come whimpering to their mother or father, the fated words, â€Å"Little b oys don’t cry†, issue forth. Children internalize paternal messages regarding gender at an early age, with awareness of adult sex role differences being found in two-year-old children. One study found ...

Rubics Essay Example | Topics and Well Written Essays - 750 words

Rubics - Essay Example Rubrics have a wider range of applications; so its importance of teaching sector cannot be ignored. The first and foremost fact about the usage of rubric connected to number assessment criteria used. Usual assessment based on single standard gets replaced with multiple measures. For example when a paper is evaluated to give scores, it will be better if various skills and inclusions are scored separately to get a resultant overall valuation. â€Å"Scoring rubrics are especially useful in assessment for learning because they contain qualitative descriptions of performance criteria that work well within the process of formative evaluation† (Tierney & Simon, 2004, para.1). The fragmented analysis helps in developing a better evaluation procedure supporting both sections of people. The person being assessed will have idea about factors and features being considered for giving him his scores while the examiner will have an easier task as he knows what have to be considered for scori ng. The method of rubrics provides a comfortable and additional branched explanation for estimation. Also, a provision for analysis by different persons is posed through this approach of valuation. The same objectives of a single person valued by more than judges create a competitive and efficient assessment result. Another purpose with rubric is to educe decisive criticism prior to final scoring judgment. The numerical scoring given for each criterion will help the examined individual to understand his flaws and benefits. The most noted use of rubric in academics is regarding the curriculum and syllabus objectives. The scoring, for each expected development through a course, given will help in reaching on effectual learning and teaching criticism. The rubric constructed below is used for the evaluation of special education website. A website with scores for all criteria as 3 will be the best

Business data analysis Essay Example | Topics and Well Written Essays - 1000 words

Business data analysis - Essay Example They try to elaborate the rate at which the stock values are found to be varying over time. Seasonal variations Seasonal variations have very important implications for the policies which define the functioning of a company. Rise and fall in stock prices often classify the boom and recessive periods of a company respectively. When stock prices rise, the companies generally are found to increase their employee wages and hire more employees as the production rises. They are generally predicted through figuring out the differences between the predicted trend line and the actual observations, for each individual period. Averaging over the differences throughout an entire year leads to the calculation of seasonal variations for each month in any year (Hargreaves, 1994, p. 154). Stock prices for Deutsche Bank are estimated to be reaching a peak during the fourth month of every year while it faces a recession during the tenth month of every year. Hence, the company might be regarded to be u ndergoing a period of boom during the second quarter of every year and a depression during the fourth quarter. However, when these seasonal variation statistics are compared with the actual monthly differences in the trend calculations and actual observations, the readings were found to be much different. The following graph depicts the comparative readings of differences between actual and trend observations. ... On the other hand, recession is actually experienced during the beginning of second quarter as against the seasonal variations calculated. However, it is not repeated for each and every year, as is found for the year 2002. In the year 2002, the actual seasonal variations are found to be coinciding with the calculated ones even though the readings do not match each other. The only factor which seems to correspond with each other is the direction of trend. If actual stock price values are being counted for, as the diagram alongside depicts, it would show that the correspondence between actual trend and estimated one is rarely found for the span of 10 years. In fact, the diagram suggests the absence of any hard-core seasonal fluctuation as such. The actual detrended line indicates the period between 2002 and 2004 as well as that between 2009 and 2010 to be under recession while that between 2006 and 2008 to be a period of boom. On the other hand, seasonal variation statistics show that regular cycle of booms and recessions are found to characterise every year. However, a point to be taken a note of in this regard is that even when the company, i.e., Deutsche Bank undergoes a whole period of boom or recession as such, there exists small fluctuations during the same. Hence, predictions about seasonal variations are likely to match during some years. Even when a company is experiencing a period of boom or recession, there could be ups and downs in business which symbolise seasonal variations, which actually is a short run phenomenon. However, there might also be another reason behind the lack of compatibility between the estimated trends and the actual adjusted closing price of the stocks of Deutsche Bank. As the diagram produced

Empire of the Wolves (2002) Term Paper Example | Topics and Well Written Essays - 1250 words

Empire of the Wolves (2002) - Term Paper Example This movie is based on a novel by Jean Christophe Grange and tells a story of young idealistic police captain Paul Nerteaux (Jocelyn Quirin) who has just taken over the case of three Turkish women seamstresses in Paris’ Turkish community. Paul decides to get help from retired cop Jean Louis Schiffer (Jean Reno), as he had patrolled the area for over 20 years but is known for his unorthodox methods.            The movie is an investigation about the murders of three women being subjected to an experiment. Though Paul tried to get with Schiffer about the crime he was torn between the judgments of the people about his collaboration on the retired cop who practice the unorthodox way of investigating the crime. Even the doctor in charge of the autopsy has given him warnings about the Schiffer.          The crime was projected in the movie is actually a crime about experimenting with human bodies for new treatment discoveries. It is a form of murder, which is a violation of the law and also a form of violation to medical, or bioethics. What’s so real about this movie is the implementation of the violation of bioethics. In Bioethics, humans should not be part of any technological or any experiments. Experiments should only be limited to a few forms of animals (like mice).   In real life, scientists are truly imprisoned and the license is taken from them if they practice experiments with humans just like in this movie where they use surgeries and implants. In real life, so far, there has been no news about scientists totally doing experiments on humans due to the imposed law about ethics. They are only practicing their findings limited to lab rats, sheep, and other animals. This media product though is not far from impossible to happen in the near future. I say it’s a little bit of advancement of science that violates the law. The investigation by the two cops was a mixture of the orthodox and unorthodox way of doing it. It happens, especially when the officers assigned in such cases are of different principles.

Study On The Changes Of The Nhs Nursing Essay

Study On The Changes Of The Nhs Nursing Essay In the last five years, United Kingdom has experienced a significant change in its national health services (NHS). This paper therefore focuses on that change. The first section is a detailed description and the main objective of the change. Using appropriate models and frame works, the second section identifies the key drivers to the change and how their interaction has affected the issues addressed by management. Drawing upon the examples of best management practices, the third section assesses the appropriateness of the approach taken by management in effecting the change and how effective management implemented the change strategy. The final section examines the extent to which the change has been successful in meeting its objective and assesses the need for any further related change. 2. Organisational change overview 2.1 The National Health Service The National Health Service (NHS) is the public funded health care system in the United Kingdom (UK) that provides the majority of health care to the UK residents. Its areas of health care coverage are the primary health care, in-patient care, long term health care, ophthalmology and dentistry. The Department of Health (DOH) headed by the Secretary of State of Health is the UK government department that is responsible for the NHS (Department of Health 2007). 2.2 Major change in the NHS Since 2005, the United Kingdoms NHS (UK NHS) has been implementing an innovative technology that will help patients stay healthy and maintain their independence. This technology is targeted at terminally ill patients with long term health condition that require regular monitoring. It also covers elderly people suffering from dementia and individuals with Down syndrome who may be at risk of injury. Thus, with this new technology, patients emergency room visits as well as unnecessary nurse visits to patients homes are reduced. Furthermore, this technology increases clinical efficiency and reduces the mounting financial cost of institutional health care in the UK. The implementation is said to be the worlds biggest trial of remote monitoring of chronically ill patients in their homes. Patients in New Ham, East London and Hull Yorkshire have benefited from this programme. This programme, funded by the department of health is been implemented by Philips, the worlds leading electronic companies. Philips electronics is hoping to prove to the NHS that it can immensely reduce the financial burden of institutional health care by implementing ultra-modern diagnostic equipment that uses internet technology to link patients from their homes to care providers in the hospitals. Since over 14.5 Million people in Britain have long term health conditions, it is expected that they will require regular monitoring (Department of Health 2007). I am a trained Electrical Engineer and have been providing tele-health equipment installation consultancy for Philips UK since 2008. I am directly involved in the implementation going on presently in Hull and New Ham. Patients in New Ham and Hull are been monitored at Home using diagnostic equipments linked via broadband internet connected to local hospitals and clinics. These patients are able to use the diagnostic equipments to take their vital signs and blood sugar level. Subsequently, the information is wirelessly uploaded to patients TV for their own monitoring and electronically sent via broad band to staff at the primary health trust. Further implementation is underway in Cornwell and Kent and will gradually expand to all cities in the UK as the department of health targets technology efficiency that could save the NHS Millions of pounds. Although the technology enables people to live independently in their homes, it is not intended to replace hospitals and care homes but to make better use of recourses and reduce financial burden on the system. 3. Drivers for NHS change Force field analysis by Lewin (1951) is a diagnostic tool used in looking at the variables involved in determining whether organisational change will occur. Once change priority has been agreed, a force field analysis can be used to identify actions that will enhance or deter their successful implementation. Applying Lewins force field analysis as shown in figure 1 below, it can be seen that the NHS Tele health technological implementation has some internal and external driving and forces. 3.1 Internal Drivers Among the strongest internal driving forces as can be seen in figure 1 below are; strong leadership and the need for accurate and consistent patients information availability. Strong leadership and commitment of top management are often cited as the most important factor for implementing a successful change programme (Bashein et al, 1994). NHS leadership is effective, strong and was able to provide a clear vision of the change programme. Other internal driving forces are the fact that the technology will aid patients to be independent and free up nurses and doctors to concentrate on other important task. This motivated medical practitioners in looking forward for the change. 3.2 External Drivers The identified external driving forces as can be seen in figure 1 are Governments desire to reduce the cost of administering health care in the UK, New European Union legislation in support of tele-montoring and the recent economic recession. Since 2005 the UK government has been researching on ways of bringing down the cost of instructional health care. Limited resources availability as a result of the recent economic down turn and an increasing UK population has necessitated the need for a cost effective alternative as the status quo is unsustainable. Another external driver is the new European Union legislation in support of tele-monitoring. Figure 1: Lewins Force Field Analysis of health care change in the NHS DRIVING FORCES INTERNAL Strong leadership and shared goal across the NHS Accurate and consistent information availability Patients independency Free up nurses and doctors to concentrate on other important task. EXTERNAL Governments desire to reduce the cost of administering health care in the UK European Union legislation in support of tele-monitoring The recent economic down turn necessitating the need for fiscal responsibility Adapted from Lewin (1951 4. Main objectives in making the change 4.1 Reduce cost of administering health care in the UK As the case load in primary care in the UK is increasing in size and complexity and the number of people with multiple long term disease is also increasing, there is increasing financial burden of administering primary care in the UK. The tele-health technology will in the long run help to reduce the mounting financial burden of institutional care. 4.2 Reduce nurse visits to patients house. Prior to the implementation of the tele-health technology in the NHS, each patient with long term condition is assigned a care taker nurse whos duty includes regular house visit. The nurses are required to take patients vital signs, blood sugar level and other related data that are necessary in monitoring the patients health condition. Upon implementation of the tele-health technology, the required data are taken by patients and are automatically sent via the internet from patients house to the hospital through the diagnostic equipment. As a result, nurse visit to patients house is considerably reduced. 4.3 Maintain patients independent. The technology ensures that nurses only visits when it is necessary and as a result allows patients to leave more independently. From a medical point of view, it is usually helpful for patients to be independent as it can give them the agility they may need to remain healthy. 4.4 Reduce patients emergency room visits. As patients health situation is monitored on a daily base, doctors and nurses are able to know when a patients condition is deteriorating and therefore avoid emergency situation. In Hull and New Ham it has been noticed that emergency room visits by monitored patients is much reduced. 4.5 Increase in clinical efficiency The diagnostic equipment interacts with the patient through a user friendly interface. It provides reminders, collects vital data and asks questions that help assess the condition of the patients. It also gives warning when a patients condition is changing. This in general allows doctors and nurses to intervene more quickly and accurately and as a result increases the overall clinical efficiency. 6.0 How action required was planned Management tools for problem analysis are very crucial for success in change management. One of such tools is the Cause and Effect analysis. Cause and Effect analysis is also referred to as the Fishbone diagram because the diagram has a fish bone appearance. The technique was proposed by Ishikawa in the 1960s and as a result called the Ishikawa diagram. The diagram is used to determine the root cause of a problem and identify areas that changes can be made. (Ishikawa 1985) In applying the Cause and Effect analysis to the NHS in determining what change is required and what action is to be taken. The first step is to get a clarity and consensus on what the problem is. Among many others, the focused problem statement identified in the NHS is the mounting financial burden of institutional health care in the UK. The economic recession and increasing overseas debt is forcing the UK government to look for ways of cutting cost and saving money. This necessitated the need for fiscal accountability and cost cutting in the NHS (NHS Centre for Reviews and Dissemination 2008). In constructing the Fishbone diagram for the NHS, the problem statement forms the head of the fish bone alone with the fish backbone as illustrated in the figure 5 below. The next step is to brainstorm potential causes of the problem. The major causes are laid out as large bones connected to the backbone. In the NHS, the major causes identified as responsible for the increasing financial burden are staffs people, technology, procedures, and policy. The fish bone diagram is then developed based on the identified causes. The final step is to probe deeper into each cause. A question asking-technique included in Senge et al (1994) Five Ways model can be used. It involves asking repeated why does this happen until it is clear that the root cause have been found. The answers are then added as sub-bones to the cause as shown in figure 5 below. Fig. 5 Fishbone Diagram stage three Too many admin staffs Increased number of nurses Too many Doctors Increased ageing population More sick patients More hospital admissions Expensive bureaucracy Productivity failure Expensive medical equipment Increased drug prescriptions Pay increase by government Increasing fixed cost Inflation policy Staffs People Procedure Policy Equipments/Materials Mounting Financial Burden of Institutional Health Care. There is increased spending in the NHS as there are now more people been treated in the hospitals than ever before. This is the direct consequence of increase in population and immigration over the years. Increase in the number of sick people and the ageing population has also contributed to increase spending. These increases in people requiring attention have necessitated an increase in Nurses, GP consultations and a large increase in drugs prescriptions. (Slywotzky and Morrison 1997) Furthermore, pay increases offered by the government to medical practitioners were in many cases over generous. Economic inflation and increased cost of fix asses has in no little way affected NHS budget. The office of the national statistics (ONS) has shown that NHS productivity is falling as spending is increasing. As output has not kept pace with rise in spending it is important to implement an efficient and cost effective way of administering health care. As the tele-health technology will ensure that the increasing number of people requiring health care is efficiently covered with little resources, it will therefore provide an efficient and cost effective way of administering health care in the UK. Looking at it critically, it is important to know that cause and effective relationship may not be easily apparent and that an intervention in any part of a health care organisation will have outcomes in many others, not all of them anticipated, and not all of them desirable. Smith (1995a; 1995b) in his work on response to performance indicator highlighted that change can lead to unanticipated and indeed dysfunctional consequence. Additional technigues that was used. The NHS employed process modelling technique in order to gain understanding of how the current process works and provide a clear articulation of how the new process is to be different. The process modelling technique provided clarification of the expected process so that the NHS is able to plan the required action. Fig. 6 Current and expected process flow Current process flow Expected process flow Is he in the clinic? Doctor decides that a patient needs monitoring No Yes Specialist nurse visits patient for information and counselling Vital information register created for patient and care nurse assigned to patient Care nurse visits patient and takes vital readings Vital readings recorded in patients information register Doctor assesses patients register Necessary actions take for abnormal readings Process repeated daily Action suspended Is he in the clinic? Doctor decides that a patient needs monitoring No Yes Specialist nurse visits patient for information and counselling Tele-Monitoring equipment is install and doctors assesses patients information remotely Necessary actions take for abnormal readings The process flow in fig.6.0 above is a diagrammatical representation of all the staged involved in a patents monitoring task. It shows both the current and process and what the process is expected to be after the implementing the tele-health system. The current process requires 9 steps and would take between 12 to 24 hours to complete a cycle while the expected process will require 5 steps and would take 10 minutes to complete a cycle. With the process modelling technique, the NHS identified that in order to successfully implement the change; it must fundamentally re-think the way work is done and adequately prepare the organisation for change. How management implemented change Having understood the situation, knowing why change is needed in the NHS, who and what needed to change, it is important to examine how these insights and what framework can be used to deliver the results that are needed. The technique of Business Process Re-engineering (BPR) is employed in the NHS in order to implement the change that is needed. Davenport and Short (1990) defines BPR as a technique for redesigning the way work is done. They also stated that it enables organizations to rethink work process so as to improve customers satisfaction, reduce operation cost and become more competitive. In addition, Hammer and Champy (1993, p32) stated that BPR is the fundamental rethinking and redesigning of business process to achieve dramatic improvement in cost quality service and speed. In the health sector, Walston and Kimberley (1997) observes that over 60% of hospitals are involved in re-engineering initiatives. In the NHS, the re-engineering initiative of the tele-health system is focused on optimizing productive work time, automating process to increase productivity and quality and resource management. The steps that were employed to implement BPR in the NHS are show in the model below. Fig.6 Change process model Communication the need for change Effective communication is considered a major key to successful BPR change implementation (Jackson 1997). The NHS implementation process began with series of meetings between the NHS management and stake holders inside and outside the HNS that would be involved in the change process. The purpose is to communicate the need of the change and the technology that would be implemented to effect the change. The meeting also helped to ensure patience and understanding of the structural and cultural change that are needed. Cooper and Markus (1995) suggest that communication should be open, honest, clear and in both direction between those in charge of the change initiative and those affected by them. Effective communication continued in the NHS throughout the change process. This formed the base that prepared the entire organization for change. Preparing the organization for change Hammer and Champy (1993) stated that organizational culture is a major factor to consider in preparing for a successful BPR implementation. Organizational culture influences the organizations ability to adopt to change. In the NHS, management ensured that the organization can understand and can conform to the new values and management process that are created by the newly re-designed process. This is so that a culture which upholds the change is established. Benjamin and Levinson (1993) argue that preparing the organization to respond positively to BPR related change is critical to success. In preparing for change, the NHS ensured that adequate trainings were given to staff that are involved in the change process. The New Ham University in conjunction with tele-health engineers from Philips UK provided the required trainings to staff. This is in line with the suggestion made by Tower (1994) that training and education is an important component in preparing an organization for change. Bruss and Roos (1993) also state that IT skills and techniques are important dimension of training for BPR. Fundamentally rethinking the way work is done After identifying and analyzing core business process, the NHS was able to define key performance objectives and design new processes to achieve the objectives. Davenport and Short (1990) define a process as a set of logically related tasks that are performed to achieve a defined outcome. Patient monitoring involves process with a great number of intermediate steps. The objective of the NHS is to reduce the processes involved in to single process that takes part directly to the final outcome. The single process designed with the needs and wants of patients in mind will allow the NHS to gain important advantages in the following ways; It reduces process steps and the time it takes to accomplish task; Improving the accuracy of patients medical information; Eliminate human mistake inherent with complex and repetitive task; Improve NHS efficiency and effectiveness and drastically cut down the overall cost of health care Implementing new technology to achieve change In order to make changes, certain known elements are required Harrington (1991). These are elements that act as variables for processes to change. Thus, , adequate IT infrastructure is considered as a vital factor in successful BPR implementation Moad (1993). Also, identification of enabling technology for redesigning business process and proper installation of IT components contributes to building an effective infrastructure for business process Barrett (1994) . In the HNS, the IT based tele-health system aimed at people with long term condition is the enabler for achieving change. The equipment connected to users television allows user to measure their vital signs. The results are automatically sent over the internet to monitoring centre. The results are monitored daily by health care professionals who can take immediate and appropriate action if there is any abnormality in the result. The system is designed to be user friendly, clear and straight forward. After installation, the technician will go through the system with the user to explain how it works and how to use it. Users are also able to call the monitoring centre at any time should they have any issue with the system. Extent to which change was successful Despite the significant benefits gained from the successful implementation of BPR, it is noted that not all organization embarking on BPR projects achieve their intended result. Hammer and Champy (1993) estimate that as many as 70 percent do not achieve the dramatic result they seek. This in most cases is attributed to poor implementation of BPR rather than a problem with the concept itself. Implementation process is complex and needs to be checked against several factors to ensure successful implementation (Alter 1994). However, it is important to note that the process re-engineering change initiative in the NHS can be said to be successful as it has implemented a modern technology which can be the way of the future for in-home patient care in the UK. It has helped increase productivity through reduced process time and has also drastically reduced cost. It has also improved quality and greater patient satisfaction in the NHS. Comparing the periods before and after implementation of the tele-health technology in the NHS, there has been a reduction in GP and Nurse Visits to patient and also a reduction in hospital admission of patients with long term condition. General satisfaction with the tele-health technology and the use of the equipments is high for all groups of patients. Patients felt comfortable using the technology and did not find it difficult. They also felt it helped improved the awareness of their condition (Department of Health 2009). To the 1.75 Millions who now rely on the tele-health service in the UK, it offers peace of mind and the certainty that there is always someone to help them in times of difficulty. Resistant to change in the NHS Cultural Issue Johnson (1992) in his cultural web model shown in fig 6 below suggests that until the paradigm at the heart of culture is changed, there will be no lasting change. Based on Drennan (1992) definition that culture is how things are done around here it is a general believe that organizational culture is a very strong resistant to any change implementation program. Figure 6. Garry Johnson Cultural Web In the NHS, evaluation has shown that the central principles of BPR radical, revolutionary approach to change is fundamentally incompatible with the traditions, culture and politics of the NHS. This in no small measure is a major resistant to change in the NHS (Buchanan 1997). Threat to Status One of the resistant to change in the NHS is that many of its staff perceived the change as a threat to their personal position. This is in agreement with Hanner and Champy (1993) who argued that the fear of job loss by employees is a major resisting factor to the success of management change program. Dawe (1996) added that, change moves the whole organization as well as every single employee out of their comfort zone and as a result, there are always going to be some people who would try to resist the change process. This is true for the NHS as some of both its management and medical staff try to stop or ignore the process of change. This is because the management failed to make a compelling case for change to its staff. Some NHS employees believed that the change was initiated only for the sole aim of saving money and cutting cost, that there is nothing in it for them. As a result they were not motivated to support the change process. This is supported by Kotter (1998) when he suggests that failure to create a win over hearts and minds will reduce the impact of a change program. Privacy issue Another major resistant experience in the implementation of tele-health change program in the NHS is fact that some people for personal reasons do not like to be watched over. They did not welcome the idea of been monitored on a daily base as they felt it violate their privacy right. The NHS management was able to resolve some of this problem by identifying patients who has indicated such fears and assuring them that only authorized medical officials would have asses to their information and that monitoring was mainly for their own good. Patients who were still skeptical and would rather not want to be monitored were all together exempted from the program. Recommendation for future improvement The overall improvement in patient health condition and reduction in hospital admission observed after implementing the tele-health system in the NHS supports continuation and further improvement of the scheme. A recommendation for further improvement is that the NHS could develop an assessment and measurement system that would help to register the build-up of momentum and identify early victories. Success in management is of little value unless they are supported by best practices and hence Senge (2003) suggest that success depends on the application of best practice. Nelson et al (1998) argues that although measurement is essential if change are to be sustained, the measurement them self must be defined practically. In the light of this, the NHS could adopt outcome and cost measurement, qualitative and quantitative measurement and a balances set of process to build measurement into the daily work routine and display it so that it tell a story of where they are, where they should be and where they are going in the change process. Furthermore, the management of the NHS should be aware that resistant is part of the change program and that anticipation and planning for resistant is important in implementing a successful change program (Clemons 1995). It is observed that the NHS management communicated change information only to stakeholder that was directly involved in the change program. This was only able to disfranchise the other stakeholders and strengthened the resistant. It is important that communication with a wide range of stakeholders directly or not directly involved in the change program be made so that they become involved and motivated (Stanton et al. 1993). The major future challenge that the NHS may encounter is how to engender a culture of continuous change in which change is on-going, evolving and cumulative. It would require a major shift in assumptions made by the organization and its members. Many of the individuals and groups whose assumptions and behaviors must change if this cultural shift is to be achieved are perceived to be of high status and are used to the exercise of individual and professional autonomy. Conclusion As people are living longer and there are more and more people who are unwell, going into residential and nursing home and living with long term conditions, the NHS which is the public service most valued by the British people must be able to keep pace with these change in society. The Remote monitoring tele-health technology will enable the NHS to effectively cope these increases in demand for health care. It would also help to reduce the overall cost of administering institutional health care in the UK. Although there are still pockets of issues and resistant, the program is generally termed as successful as it is already yielding the desired objective of improving life and saving cost. This paper presented an analysis of the approach take by management to effect the change and how effective management implemented the change strategy. It also demonstrated the extent to which change was successful and made recommendations for future development.

House On Mango Street :: essays research papers

In Sandra Cisneros book, The House On Mango Street , the theme is of how fantasizing keeps you going. In the story there are many different quotes and stories explaining how Esperanza and her friends would daydream about life in the future. Explaining how Esperanza’s friends are waiting for the perfect husband to come and marry them and take them off out of Mango street. Almost every story has someone daydreaming about how much better life is going to be when they get older. Explaining how there house is going to be big and about how they are going to be much happier then how they are now. The quote from the book that Esperanza wrote was â€Å"I want to be like the waves on the sea, like the clouds in the wind, but I’m me. One day ill jump out of my skin. I’ll shake the sky like a hundred violins.† This poem explains to us that Esperanza wants to be somebody. It tells us that Esperanza wants to make a change in this world and wants to be remembered when she dies. This is where Esperanza tries to reach out and explains her feelings with everyone but can’t. A quote of Esperanza’s dream house was â€Å"Not a flat. Not an apartment in back. Not a man’s house. Not a daddy’s a house all my own. With my porch and my pillows, my pretty purple petunias. My books and my stories. My two shoes waiting beside thee bed. Nobody to shake a stick at. Nobody’s garbage to pick up after. Only a house quiet as snow, a space for myself to go, clean as paper before the poem.† This tells us what Esperanza is looking forward to in her life. What she thinks her future is going to be like. Another quote from Esperanza is â€Å"One day I will pack my bags of books and paper. One day I will say goodbye to Mango. I am too strong for her to keep me forever. One day I will go away.† This quote explains to us the need to Esperanza to get out of Mango Street. The need for her to get away from all of this which she dislikes.

Bloodsucking Fiends: A Love Story Chapter 7

Chapter 7 Suitors After enduring a reasonable amount of bitterness from the crew over using his position to make a move on the girl in the parking lot, Tommy was able to persuade them to get back to work. Simon, Drew, and Jeff performed some mechanical magic on the meat case with a hammer, some jumper cables, and a can of Bondo, and by morning everything was running as if greased by the gods. Tommy met the manager at the front door with a smile and a report that his first night had gone great. The best crew he had ever seen, he said. He rode to Chinatown with Troy Lee. They found a parking place a few blocks from Tommy's room and walked the rest of the way. The sun was up only an hour, but already the merchants were open and the sidewalks crowded. Delivery trucks blocked the streets as they dropped off their loads of fresh fish, meat, and vegetables. Walking through Chinatown with Troy Lee at his side, Tommy felt as if he were carrying a secret weapon. â€Å"What's that stuff?† Tommy asked, pointing to a stack of celerylike stuff on a produce table. â€Å"Bok choy – Chinese cabbage.† â€Å"And that?† â€Å"Ginseng root. They say it's good for the wood.† Tommy stopped and pointed in the window of a herbalist. â€Å"That looks like hunks of deer antler.† â€Å"It is,† Troy said. â€Å"It's used to make medicine.† As they passed the fish market Tommy pointed to the huge spiny turtles trying to escape their milk crates. â€Å"Do people eat those?† â€Å"Sure, people who can afford them.† â€Å"This is like a foreign country.† â€Å"It is,† Troy said. â€Å"Chinatown is a very closed community. I can't believe you live here. I'm Chinese and I've never even lived here.† â€Å"This is it,† Tommy said, stopping at the door. â€Å"So you want me to ask them about the flowers, and what else?† â€Å"Well, about vampires.† â€Å"Give me a break.† â€Å"No, this guy I met, the Emperor, he said it could be vampires.† Tommy led the way up the steps. â€Å"He's bullshitting you, Tommy.† â€Å"He was the one that told me about the job at your store, and that turned out to be true.† Tommy opened the door and the five Wongs looked up from their bunks. â€Å"Bye-bye,† they said. â€Å"Bye-bye,† Tommy said. â€Å"Nice place,† Troy said. â€Å"I'll bet the rent is a killer.† â€Å"Fifty bucks a week,† Tommy said. â€Å"Fifty bucks,† the five Wongs said. Troy motioned Tommy out of the room. â€Å"Give me a minute here.† Troy closed the door. Tommy waited in the hall, listening to the nasal, banjo sounds of the conversation between Troy and the five Wongs. After a few minutes Troy emerged from the room and motioned for Tommy to follow him back down to the street. â€Å"What goes?† Tommy asked when they reached the sidewalk. Troy turned to him; he seemed as if he was trying to keep from laughing. â€Å"These guys are just off the boat, man. It was kind of hard to understand them, they speak some regional dialect.† â€Å"So?† â€Å"So, they're here illegally, smuggled over by pirates. They owe the pirates like thirty grand for the trip, and if they get caught and sent back to China, they still owe the money. That's like twenty years' wages in the provinces.† â€Å"So?† Tommy asked. â€Å"What's that got to do with the flowers?† Troy snickered. â€Å"I'm getting to that. You see, they want to be citizens. If they become citizens, they can get better jobs and pay off the pirates faster. And they can't be sent back.† â€Å"And the flowers?† â€Å"The Wongs are leaving the flowers. They're courting you.† â€Å"What!† â€Å"They heard somewhere that in San Francisco men marry men. They figure that if they can get you to marry them, then they can be citizens and stay here. You've got secret admirers, dude.† Tommy was indignant. â€Å"They think I'm gay?† â€Å"They don't know. I really don't think they care. They asked me to ask you for your hand in marriage.† Troy finally lost control and started laughing. â€Å"What did you tell them?† â€Å"I told them I'd ask.† â€Å"You fucker.† â€Å"Well, I didn't want to tell them no without asking you. They said that they'd take good care of you.† â€Å"Go tell them I said no.† â€Å"You got something against Asians? Too good for us?† â€Å"No, it's not that. I – â€Å" â€Å"I'll tell them that you'll think about it. Look, I've got to get home and get some sleep. I'll see you at work tonight.† Troy walked away. â€Å"You're cleaning garbage cans tonight, Troy. I'm in charge, you know? You better not tell Simon and the guys.† â€Å"Whatever you say, Fearless Leader,† Troy called over his shoulder. Tommy stood on the sidewalk trying to think of a better threat. A half block away Troy turned and yelled, â€Å"Hey, Tommy!† â€Å"What?† â€Å"You'll make a lovely bride.† Tommy, murder in his eyes, broke into a run after Troy Lee. Sunset. Consciousness hit Jody like a bucket of cold water. She thought, I miss waking up groggy and waiting for the coffee to brew. Waking up with your worries already in full stride just sucks. What was I thinking? Giving myself only a half hour to get ready for a date? I have nothing to wear. I can't show up in a sweatshirt and jeans and ask this guy to move in with me. I don't even know anything about him. What if he's a drunk, or a woman beater, or a psycho killer? Don't those guys always work nights in grocery stores? The neighbors always say that: â€Å"He worked nights and kept to himself. Who would have thought that he stir-fried the paperboy?† He did say I was beautiful, though, and everybody has their faults. Who am I to judge? I'm a†¦ She didn't want to think about what she was. Jody had thrown on her jeans and was furiously trying to put on what little make-up she had with her. She thought, I can read small print in the dark, I can see heat coming off a hiding rat from a hundred yards, and I still can't put on mascara without poking myself in the eye. She stepped back from the mirror and tried to fight the self-criticism – tried to look at herself objectively. I look like a late-night TV plea for the fashion-impaired, she thought. This won't work. She broke away from the mirror, then took one last look and primped her hair, then started out the door, then took one last look, then started out the door, then paused for a last look†¦ â€Å"No!† she said aloud. She ran out the door, down the steps, and to the bus stop on the corner, where she bounced from foot to foot as if waiting for the bathroom at a beer-drinking contest. Tommy had spent the day trying to avoid the five Wongs. He watched the room until he was sure they had all left, then he sneaked in and grabbed some clean clothes, showered, dressed, and sneaked out. He took a bus to Levis Plaza, where he napped on a park bench while pigeons and seagulls scavenged around him. Late afternoon brought a cold wind off the bay that chilled him awake. He walked up Sansome toward North Beach, trying to rub the crease out of the back of his head left by the bench slats. As he passed a group of teenagers who were posturing and panhandling at the curb, one pudgy boy shouted, â€Å"Sir, can you spare a quarter for some eyeliner?† Tommy dug in the pocket of his jeans and handed the kid all of his change. No one had ever called him ;sir; before. â€Å"Oh, thank you, sir!† the kid gushed in a high feminine voice. He held the fistful of change up to the others as if he had just been handed the cure for cancer. Tommy smiled and walked on. He figured that panhandlers had cost him about ten dollars a day since he had come to the City – ten dollars that he really couldn't afford. He didn't seem to be able to look away and walk on like everyone else. Maybe it was something you developed after a while. Maybe the constant assault of despair callused your compassion. A plea for money for food always made his stomach growl, and a quarter was a small price to pay to quiet it. The plea for eyeliner appealed to the writer part of him, the part that believed that creative thought was worth something. Yesterday he had heard a tourist tell a homeless man to get a job. â€Å"Pushing a shopping cart up and down these hills is a fucking job,† the homeless guy had said. Tommy gave him a buck. It was still light when Tommy reached Enrico's on Broadway. He paused momentarily and looked over the few customers who were eating on the patio by the street. Jody wasn't there. He stopped at the host's station and reserved a table outside for a half hour later. â€Å"Is there a bookstore around here?† he asked. The host, a thin, bearded man in his forties, with perfect anchorman-gray hair, raised an eyebrow, and with that small gesture made Tommy feel like scum. â€Å"City Lights is one block up on the corner of Columbus,† the host said. â€Å"Oh, that's right,† Tommy said, batting himself on the forehead as if he'd just remembered. â€Å"I'll be back.† â€Å"We are giddy with anticipation,† the host said. He spun curtly on one heel and walked away. Tommy turned and started up Broadway until he was accosted by a barker outside a strip joint, a man in a red tailcoat with a top hat. â€Å"Tits, slits, and clits. Come on in, sir. The show starts in five minutes.† â€Å"No, thanks. I have a dinner date in a few minutes.† â€Å"Bring the little lady back with you. This show can turn a maybe into a sure thing, son. We'll have her sitting in a puddle before you leave.† Tommy squirmed. â€Å"Maybe,† he said. He hurried along until the barker two doors up, this one a buxom woman wearing leather and a ring in her nose, stopped him. â€Å"The most beautiful girls in town, sir. All nude. All hot. Come on in.† â€Å"No, thanks. I have a dinner date in a few minutes.† â€Å"Bring her – â€Å" â€Å"Maybe,† Tommy said, walking on. He was stopped three more times before he reached the end of the block, and each time he declined politely. He noticed that he was the only one who stopped. The other pedestrians just walked on, ignoring the barkers. Back home, he thought, it's impolite to ignore someone who is speaking to you, especially if they call you â€Å"sir.† I guess I'm going to have to learn City manners. She had fifteen minutes before she was supposed to meet Tommy at Enrico's. Allowing for another bus ride and a short walk, she had about seven minutes to find an outfit. She walked into the Gap on the corner of Van Ness and Vallejo with a stack of hundred-dollar bills in her hand and announced, â€Å"I need help. Now!† Ten salespeople, all young, all dressed in generic cotton casual, looked up from their conversations, spotted the money in her hand, and simultaneously stopped breathing – their brains shutting down bodily functions and rerouting the needed energy to calculate the projected commissions contained in Jody's cash. One by one they resumed breathing and marched toward her, a look of dazed hunger in their eyes: a pack of zombies from the perky, youthful version of The Night of the Living Dead. â€Å"I wear a size four and I've got a date in fifteen minutes,† Jody said. â€Å"Dress me.† They descended on her like an evil khaki wave. Tommy sat at a patio table with only a low brick planter box between him and the sidewalk. To avoid the titty bar barkers, he had crossed the street eight times in the half block from City Lights Bookstore to Enrico's and he was a little jangled from dodging traffic. He ordered a cappuccino from a waiter who fawned over him like a mother hen, then stared in amazement when the waiter returned with a cup the size of a large soup bowl and a plate of brown crystalline cubes. â€Å"These are raw sugar cubes, honey. So much better for you than that white poison.† Tommy picked up the soup spoon and reached for a sugar cube. â€Å"No, no, no,† the waiter scolded. â€Å"We use our demitasse spoon for our cappuccino.† He pointed to a tiny spoon that rested in the saucer. â€Å"Demitasse,† Tommy repeated, feeling reckless. In Indiana the use of the word ;demitasse; was tantamount to leaping out of the closet in scandalous flames. San Francisco was a great city! A great place to be a writer! And gay guys seemed like pretty nice people, once you got past their seeming obsession with Barbra Streisand music. Tommy smiled at the waiter. â€Å"Thanks, I may need a little help with the forks.† â€Å"Is she special?† the waiter asked. â€Å"I think she's going to break my heart.† â€Å"How exciting!† the waiter gushed. â€Å"Then we'll make you look marvelous. Just remember, use from the outside first on the forks. The big spoon is for winding pasta. Is this your first date?† Tommy nodded. â€Å"Then order the raviolis – bite-size – no muss, no fuss. You'll look good eating them. And order for her, the rosemary chicken with roasted bell peppers and wild mushrooms in cream sauce – a beautiful dish. Tastes horrid, but on a first date she won't eat it anyway. You don't have time to run home and change, do you?† The waiter looked at Tommy's flannel shirt as if it were a foul, dead animal. â€Å"No, this is all I have clean.† â€Å"Oh well, it does have a certain Mr. Green Jeans charm, I guess.† Tommy caught a flash of red hair out of the corner of his eye and looked up to see Jody walking into the cafe. The waiter followed his gaze. â€Å"Is that her?† â€Å"Yes,† Tommy said, waving to catch her attention. She spotted him, smiled, and approached the table. Jody was dressed in a khaki skirt, a light-blue chambray blouse, light-blue leggings, and tan suede flats. She wore a woven leather belt, a green tartan scarf tied around her shoulders, silver earrings, bracelet, and necklace, and carried a suede backpack in place of her airline flight bag. The waiter, keeping his gaze fixed on Jody, bent and whispered in Tommy's ear, â€Å"The flannel is fine, honey. I haven't seen anyone that over-accessorized since Batman.† He stood and pulled the chair out for Jody. â€Å"Hi, we've been waiting for you.† Jody sat. â€Å"My name is Frederick,† the waiter said with a slight bow. â€Å"I'll be serving you this evening.† He pinched the fabric of Jody's scarf. â€Å"Lovely tartan, dear. Sets off your eyes. I'll be back with some menus.† â€Å"Hi,† Jody said to Tommy. â€Å"Have you been waiting long?† â€Å"A little while, I wasn't sure of the time. I brought you something.† He reached under the table and pulled a book out of a City Lights bag. â€Å"It's an almanac. You said you needed one.† â€Å"That's very sweet.† Tommy looked down and mimed an â€Å"Aw, shucks, it was nothing.† â€Å"So, do you live around here?† Jody asked. â€Å"I'm sort of looking for a place.† â€Å"Really? Have you been in town long?† â€Å"Less than a week. I came here to write. The grocery store is just a†¦ just a†¦Ã¢â‚¬  â€Å"Job,† Jody finished for him. â€Å"Right, just a job. What do you do?† â€Å"I used to be a claims clerk at Transamerica. I'm looking for something else, now.† Frederick appeared at the table and opened two menus in front of them. â€Å"If you don't mind me saying,† he said, â€Å"you two are just darling together. There's a Raggedy-Ann-and-Andy energy going between you two that is simply electric.† Frederick walked away. Jody eyed Tommy over the menu. â€Å"Have we just been insulted?† â€Å"I hear the rosemary chicken breast is wonderful,† Tommy said.

Discovery Museum Gold Rush History Center

The visit I made to the Discovery Museum Gold Rush History Center in Sacramento, California, proved to be highly informative, entertaining, and a two-hour well spent. The experience afforded me a lot of learnings from the Gold Rush period that I didn't know before. Before I made the tour of the four galleries inside the building, I first went to the visitors' information center, wherein an introduction regarding the building's construction has been shown in a nine-minute film clip.Based on the clip shown, I learned that the museum is a replica of the original building that was built in 1854 that previously housed the City of Sacramento's city hall, dormitory for the fire department, jail, police station, and court. The original structure had suffered from structural problems and was declared unsafe many years later. It was finally demolished about sixty years later in 1913.The replica building has been modified on some sides in line with its being a museum showcasing history, science and technology. The Gold Rush Center's exhibits are in The Lure of Gold gallery. The museum's arrangement of events is well organized and unique. From there, I was able to see gold nuggets on display and artifacts and implements used by miners from the Gold Rush era. The Gold Rush in California was a defining moment in history that changed Sacramento forever.Sacramento became the center of that event in 1849. People from all over the world went to this city hoping to make themselves rich. Previously, this gallery has showcased a typical miner's travel and lifestyle. Aside from the exhibits, there are also hands-on activities for children and interactive programs to help the present generation get a better understanding of the past.

Study Skills for Intermediate Level Language Learners

Study Skills for Intermediate Level Language Learners Learning any language takes practice - lots of practice! Often, its difficult to know what you should practice. Should you watch a video? Perhaps, it would be a good idea to do a few quizzes. Of course, you should try to speak English with your friends. All of these are great ideas, but its also important to build a routine. A routine will help you make studying English a habit. Thats the best way to improve your English! Make Learning a Habit Its important to be exposed to many different areas every day. However, you shouldnt try to study too many different subjects. These suggestions take a short listening and reading as the basis for daily practice. You are trying to learn many new things, so dont try to learn too much in any one area too quickly! Practice Routine Listen - 15 minutes: You can enhance your listening skills through specific strategies.Read - 15 minutes: Choose a subject you like to read about and read for fun.Improve your vocabulary - 10 minutes: Take five minutes to write down all the new words you find in your listening and reading exercises. Keep a notebook, and write in the translation in your native language.Grammar - 10 minutes: Think about what you are studying in English class (if you are taking it). Or, if you are studying by yourself, take out your grammar book and find one grammar point to review. Take a quick look at the grammar and then think about the listening and your reading. Did you hear or read these forms? How were they used?Speaking - 5 minutes: It is very important to move your mouth and speak! Even if you only speak to yourself. Take five minutes and speak out loud (not silently). Try to quickly summarize what you listened to and what you read. Can you do it? Of course, its better if you can do this with a friend. Find a friend and study together a few times a week. You can practice together. Thats it! Approximately 45 minutes a day, every day - or at least four times a week! If you continue to do this, you will be surprised at how quickly your English improves!

Managerial Accounting 2014 Assignment Essay Example | Topics and Well Written Essays - 2500 words

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HW #18 Essay Example | Topics and Well Written Essays - 500 words

HW #18 - Essay Example These standards are legally enforceable standards and must be adhered to. Secondary drinking water standards on the other hand are non mandatory water quality standards for up to 15 contaminants and outlines secondary maximum contaminant levels. Unlike Primary Drinking water Standards, these standards are established by EPA to provide guidelines to help in managing the aesthetic quality of public water systems and are not enforceable and include guidelines for aspects of water quality such as taste, odor and color. Unlike Primary Drinking Water standards, Secondary Drinking Water contaminants are considered to present no risk to human health. The effects of these contaminants are grouped in three categories; aesthetic effects, technical effects and cosmetic effects and include: aluminum, color, chloride, fluoride, Iron, Copper, corrosivity, pH, manganese, sulfate, zinc, silver, forming agents and total dissolved solids (Johnson, 1521). Secondary drinking water standards therefore provide guidance to the public water systems on removing these chemicals to levels below which people will not notice. The federal law regulating tap water in United States of America has been in use for the past 35 years without review with respect to emerging contaminants thus poses serious health risks. While more than 60,000 chemicals are used within US, only 91 contaminants are regulated despite the fear that many chemicals are carcinogenic even at low concentrations. This has resulted into the exposure of over 62 million Americans to drinking water that did not meet guidelines. Research has also shown that some contaminants that are regulated pose lesser risk than those that are not regulated by EPA (Duhigg, 1). Officials such as Dr. Pankaj Parekh, the director of water quality division for the city of Los Angeles have also faced criticism from the