Spirit Bound Chapter Twenty-Three

I DIDN'T NEED THE BOND to find Lissa. The crowd tipped me off to where she–and Dimitri–were. My first thought was that some kind of stoning or medieval mobbing was going on. Then I realized that the people standing around were simply watching something. I pushed through them, heedless of the dirty looks I got, until I stood in the front row of the onlookers. What I found brought me to a halt. Lissa and Dimitri sat side by side on a bench while three Moroi and–yikes–Hans sat opposite them. Guardians stood scattered around them, tense and ready to jump in if things went bad, apparently. Before I even heard a word, I knew exactly what was going on. This was an interrogation, an investigation to determine what Dimitri was exactly. Under most circumstances, this would be a weird place for a formal investigation. It was, ironically, one of the courtyards Eddie and I had worked on, the one that stood in the shadow of the statue of the young queen. The Court's church stood nearby. This grassy area wasn't exactly holy ground, but it was close enough to the church that people could run to it in an emergency. Crucifixes didn't hurt Strigoi, but they couldn't cross over into a church, mosque, or any other sacred place. Between that and the morning sun, this was probably as safe a location and time as officials could muster up to question Dimitri. I recognized one of the Moroi questioners, Reece Tarus. He was related to Adrian on his mom's side but had also spoken in favor of the age decree. So I took an instant dislike to him, particularly considering the haughty tone he used toward Dimitri. â€Å"Do you find the sun blinding?† asked Reece. He had a clipboard in front of him and appeared to be going down a checklist. â€Å"No,† said Dimitri, voice smooth and controlled. His attention was totally on his questioners. He had no clue I was there, and I kind of liked it that way. I wanted to just gaze at him for a moment and admire his features. â€Å"What if you stare into the sun?† Dimitri hesitated, and I'm not sure anyone but me caught the sudden glint in his eyes–or knew what it meant. The question was stupid, and I think Dimitri–maybe, just maybe–wanted to laugh. With his normal skill, he maintained his composure. â€Å"Anyone would go blind staring into the sun long enough,† he replied. â€Å"I'd go through what anyone else here would.† Reece didn't seem to like the answer, but there was no fault in the logic. He pursed his lips together and moved on to the next question. â€Å"Does it scald your skin?† â€Å"Not at the moment.† Lissa glanced over at the crowd and noticed me. She couldn't feel me the way I could through our bond, but sometimes it seemed she had an uncanny sense of when I was around. I think she sensed my aura if I was close enough, since all spirit users claimed the field of light around shadow-kissed people was very distinct. She gave me a small smile before turning back to the questioning. Dimitri, ever vigilant, noticed her tiny movement. He looked over to see what had distracted her, caught sight of me, and faltered a little on Reece's next question, which was, â€Å"Have you noticed whether your eyes occasionally turn red?† â€Å"I†¦Ã¢â‚¬  Dimitri stared at me for several moments and then jerked his head back toward Reece. â€Å"I haven't been around many mirrors. But I think my guards would have noticed, and none of them have said anything.† Nearby, one of the guardians made a small noise. He barely managed to keep a straight face, but I think he too had wanted to snicker at the ridiculous line of questioning. I couldn't recall his name, but when I'd been at Court long ago, he and Dimitri had chatted and laughed quite a bit when together. If an old friend was starting to believe Dimitri was a dhampir again, then that had to be a good sign. The Moroi next to Reece glared around, trying to figure out where the noise had come from, but discovered nothing. The questioning continued, this time having to do with whether Dimitri would step into the church if they asked him to. â€Å"I can go right now,† he told them. â€Å"I'll go to services tomorrow if you want.† Reece made another note, no doubt wondering if he could get the priest to douse Dimitri in holy water. â€Å"This is all a distraction,† a familiar voice said in my ear. â€Å"Smoke and mirrors. That's what Aunt Tasha says.† Christian now stood beside me. â€Å"It needs to be done,† I murmured back. â€Å"They have to see that he isn't Strigoi anymore.† â€Å"Yeah, but they've barely signed the age law. The queen gave the go-ahead for this as soon as the Council's session let out because it's sensational and will make people pay attention to something new. It was how they finally got the hall cleared. ‘Hey, go look at the sideshow!'† I could almost hear Tasha saying that word for word. Regardless, there was truth to it. I felt conflicted. I wanted Dimitri to be free. I wanted him to be the way he used to be. Yet I didn't appreciate Tatiana doing this for her own political gain and not because she actually cared about what was right. This was possibly the most monumental thing to happen in our history. It needed to be treated as such. Dimitri's fate shouldn't be a convenient â€Å"sideshow† to distract everyone from an unfair law. Reece was now asking both Lissa and Dimitri to describe exactly what they'd experienced the night of the raid. I had a feeling this was something they'd recounted quite a bit. Although Dimitri had been the picture of nonthreatening composure so far, I still sensed that gray feel to him, the guilt and torment he felt over what he had done as a Strigoi. Yet, when he turned to listen to Lissa tell her version of the story, his face lit up with wonder. Awe. Worship. Jealousy flashed through me. His feelings weren't romantic, but it didn't matter. What mattered was that he had rejected me but regarded her as the greatest thing in the world. He'd told me never to talk to him again and sworn he'd do anything for her. Again I felt that petulant sense of being wronged. I refused to believe that he couldn't love me anymore. It wasn't possible, not after all he and I had been through together. Not after everything we'd felt for each other. â€Å"They sure seem close,† Christian noted, a suspicious note in his voice. I had no time to tell him his worries were unfounded because I wanted to hear what Dimitri had to say. The story of his change was hard for others to follow, largely because spirit was still so misunderstood. Reece got as much out of it as he could and then turned the questioning over to Hans. Hans, ever practical, had no need for extensive interrogation. He was a man of action, not words. Gripping a stake in his hand, he asked Dimitri to touch it. The standing guardians tensed, probably in case Dimitri tried to grab the stake and go on a rampage. Instead, Dimitri calmly reached out and held the top of the stake for a few moments. There was a collective intake of breath as everyone waited for him to scream in pain since Strigoi couldn't touch charmed silver. Instead, Dimitri looked bored. Then he astonished them all. Drawing his hand back, he held out the bottom of his muscled forearm toward Hans. With the sunny weather, Dimitri was wearing a T-shirt, leaving the skin there bare. â€Å"Cut me with it,† he told Hans. Hans arched an eyebrow. â€Å"Cutting you with this will hurt no matter what you are.† â€Å"It would be unbearable if I were a Strigoi,† Dimitri pointed out. His face was hard and determined. He was the Dimitri I'd seen in battle, the Dimitri who never backed down. â€Å"Do it. Don't go easy on me.† Hans didn't react at first. Clearly, this was an unexpected course of action. Decision finally flashed across his features, and he struck out, swiping the stake's point against Dimitri's skin. As Dimitri had requested, Hans didn't hold back. The point dug deep, and blood welled up. Several Moroi, not used to seeing blood (unless they were drinking it), gasped at the violence. As one, we all leaned forward. Dimitri's face showed he definitely felt pain, but charmed silver on a Strigoi wouldn't just hurt–it would burn. I'd cut a lot of Strigoi with stakes and heard them scream in agony. Dimitri grimaced and bit his lip as the blood flowed over his arm. I swear, there was pride in his eyes at his ability to stay strong through that. When it became obvious he wouldn't start flailing, Lissa reached toward him. I sensed her intentions; she wanted to heal him. â€Å"Wait,† said Hans. â€Å"A Strigoi would heal from this in minutes.† I had to give Hans credit. He'd worked two tests into one. Dimitri shot him a grateful look, and Hans gave a small nod of acknowledgment. Hans believed, I realized. Whatever his faults, Hans truly thought Dimitri was a dhampir again. I would love him forever for that, no matter how much filing he made me do. So, we all stood there watching poor Dimitri bleed. It was kind of sick, really, but the test worked. It was obvious to everyone that the cut wasn't going anywhere. Lissa was finally given leave to heal it, and that caused a bigger reaction among the crowd. Murmurs of wonder surrounded me, and those enraptured goddess-worshipping looks showed on people's faces. Reece glanced at the crowd. â€Å"Does anyone have any questions to add to ours?† No one spoke. They were all dumbfounded by the sights before them. Well, someone had to step forward. Literally. â€Å"I do,† I said, striding toward them. No, Rose, begged Lissa. Dimitri wore an equally displeased look. Actually, so did almost everyone sitting near him. When Reece's gaze fell on me, I had a feeling he was seeing me in the Council room all over again, calling Tatiana a sanctimonious bitch. I put my hands on my hips, not caring what they thought. This was my chance to force Dimitri to acknowledge me. â€Å"When you used to be Strigoi,† I began, making it clear that I believed that was in the past, â€Å"you were very well connected. You knew about the whereabouts of lots of Strigoi in Russia and the U.S., right?† Dimitri eyed me carefully, trying to figure out where I was going. â€Å"Yes.† â€Å"Do you still know them?† Lissa frowned. She thought I was going to inadvertently implicate Dimitri as still being in contact with other Strigoi. â€Å"Yes,† he said. â€Å"So long as none of them have moved.† The answer came more swiftly this time. I wasn't sure if he'd guessed my tactic or if he just trusted that my Rose-logic would go somewhere useful. â€Å"Would you share that information with the guardians?† I asked. â€Å"Would you tell us all the Strigoi hideouts so that we could strike out against them?† That got a reaction. Proactively seeking Strigoi was as hotly debated as the other issues going around right now, with strong opinions on all sides. I heard those opinions reiterated behind me in the crowd, some people saying I was suggesting suicide while others acknowledged we had a valuable tool. Dimitri's eyes lit up. It wasn't the adoring look he often gave Lissa, but I didn't care. It was similar to the ones we used to share, in those moments where we understood each other so perfectly, we didn't even need to vocalize what we were thinking. That connection flashed between us, as did his approval–and gratitude. â€Å"Yes,† he replied, voice strong and loud. â€Å"I can tell you everything I know about Strigoi plans and locations. I'd face them with you or stay behind–whichever you wanted.† Hans leaned forward in his chair, expression eager. â€Å"That could be invaluable.† More points for Hans. He was on the side of hitting out at Strigoi before they came to us. Reece flushed–or maybe he was just feeling the sun. In their efforts to see if Dimitri would burn up in the light, the Moroi were exposing themselves to discomfort. â€Å"Now hold on,† Reece exclaimed over the increasing noise. â€Å"That has never been a tactic we endorse. Besides, he could always lie–â€Å" His protests were cut off by a feminine scream. A small Moroi boy, no more than six, had suddenly broken from the crowd and run toward us. It was his mother who had screamed. I moved in to stop him, grabbing his arm. I wasn't afraid that Dimitri would hurt him, only that the boy's mother would have a heart attack. She came forward, face grateful. â€Å"I have questions,† the boy, obviously trying to be brave, said in a small voice. His mother reached for him, but I held up my hand. â€Å"Hang on a sec.† I smiled down at him. â€Å"What do you want to ask? Go ahead.† Behind him, fear flashed over his mother's face, and she cast an anxious look at Dimitri. â€Å"I won't let anything happen to him,† I whispered, though she had no way of knowing I could back that up. Nonetheless, she stayed where she was. Reece rolled his eyes. â€Å"This is ridic–â€Å" â€Å"If you're Strigoi,† the boy interrupted loudly, â€Å"then why don't you have horns? My friend Jeffrey said Strigoi have horns.† Dimitri's eyes fell not on the boy but on me for a moment. Again, that spark of knowing shot between us. Then, face smooth and serious, Dimitri turned to the boy and answered, â€Å"Strigoi don't have horns. And even if they did, it wouldn't matter because I'm not Strigoi.† â€Å"Strigoi have red eyes,† I explained. â€Å"Do his eyes look red?† The boy leaned forward. â€Å"No. They're brown.† â€Å"What else do you know about Strigoi?† I asked. â€Å"They have fangs like us,† the boy replied. â€Å"Do you have fangs?† I asked Dimitri in a singsong voice. I had a feeling this was already-covered territory, but it took on a new feel when asked from a child's perspective. Dimitri smiled–a full, wonderful smile that caught me off guard. Those kinds of smiles were so rare from him. Even when happy or amused, he usually only gave half smiles. This was genuine, showing all his teeth, which were as flat as those of any human or dhampir. No fangs. The boy looked impressed. â€Å"Okay, Jonathan,† said his mother anxiously. â€Å"You asked. Let's go now.† â€Å"Strigoi are super strong,† continued Jonathan, who possibly aspired to be a future lawyer. â€Å"Nothing can hurt them.† I didn't bother correcting him, for fear he'd want to see a stake shoved through Dimitri's heart. In fact, it was kind of amazing that Reece hadn't already requested that. Jonathan fixed Dimitri with a piercing gaze. â€Å"Are you super strong? Can you be hurt?† â€Å"Of course I can,† replied Dimitri. â€Å"I'm strong, but all sorts of things can still hurt me.† And then, being Rose Hathaway, I said something I really shouldn't have to the boy. â€Å"You should go punch him and find out.† Jonathan's mother screamed again, but he was a fast little bastard, eluding her grasp. He ran up to Dimitri before anyone could stop him–well, I could have–and pounded his tiny fist against Dimitri's knee. Then, with the same reflexes that allowed him to dodge enemy attacks, Dimitri immediately feinted falling backward, as though Jonathan had knocked him over. Clutching his knee, Dimitri groaned as though he were in terrible pain. Several people laughed, and by then, one of the other guardians had caught hold of Jonathan and returned him to his near-hysterical mother. As he was being dragged away, Jonathan glanced over his shoulder at Dimitri. â€Å"He doesn't seem very strong to me. I don't think he's a Strigoi.† This caused more laughter, and the third Moroi interrogator, who'd been quiet, snorted and rose from his seat. â€Å"I've seen all I need to. I don't think he should walk around unguarded, but he's no Strigoi. Give him a real place to stay and just keep guards on him until further decisions are made.† Reece shot up. â€Å"But–â€Å" The other man waved him off. â€Å"Don't waste any more time. It's hot, and I want to go to bed. I'm not saying I understand what happened, but this is the least of our problems right now, not with half the Council wanting to rip the other half's heads off over the age decree. If anything, what we've seen today is a good thing–miraculous, even. It could alter the way we've lived. I'll report back to Her Majesty.† And like that, the group began dispersing, but there was wonder on some of their faces. They too were beginning to realize that if what had happened to Dimitri was real, then everything we'd ever known about Strigoi was about to change. The guardians stayed with Dimitri, of course, as he and Lissa rose. I immediately moved toward them, eager to bask in our victory. When he'd been â€Å"knocked over† by Jonathan's tiny punch, Dimitri had given me a small smile, and my heart had leapt. I'd known then that I'd been right. He did still have feelings for me. But now, in the blink of an eye, that rapport was gone. Seeing me walk toward them, Dimitri's face grew cold and guarded again. Rose, said Lissa through the bond. Go away now. Leave him alone. â€Å"The hell I will,† I said, both answering her aloud and addressing him. â€Å"I just furthered your case.† â€Å"We were doing fine without you,† said Dimitri stiffly. â€Å"Oh yeah?† I couldn't believe what I was hearing. â€Å"You seemed pretty grateful a couple minutes ago when I thought up the idea of you helping us against Strigoi.† Dimitri turned to Lissa. His voice was low, but it carried to me. â€Å"I don't want to see her.† â€Å"You have to!† I exclaimed. A few of the departing people paused to see what the racket was about. â€Å"You can't ignore me.† â€Å"Make her go away,† Dimitri growled. â€Å"I'm not–â€Å" ROSE! Lissa shouted in my head, shutting me up. Those piercing jade eyes stared me down. Do you want to help him or not? Standing here and yelling at him is going to make him even more upset! Is that what you want? Do you want people to see that? See him get mad and yell back at you just so you don't feel invisible? They need to see him calm. They need to see him†¦ normal. It's true–you did just help. But if you don't walk away right now, you could ruin everything. I stared at them both aghast, my heart pounding. Her words had all been in my mind, but Lissa might as well have strode up to me and chewed me out aloud. My temper shot up even more. I wanted to go rant at both of them, but the truth of her words penetrated through my anger. Starting a scene would not help Dimitri. Was it fair that they were sending me away? Was it fair that the two of them were teaming up and ignoring what I'd just done? No. But I wasn't going to let my hurt pride screw up what I'd just achieved. People had to accept Dimitri. I shot them both looks that made my feelings clear and then stormed away. Lissa's feelings immediately changed to sympathy through the bond, but I blocked them out. I didn't want to hear it. I'd barely cleared the church's grounds when I ran into Daniella Ivashkov. Sweat was starting to smudge her beautifully applied makeup, making me think she'd been out here for a while watching the Dimitri-spectacle too. She appeared to have a couple friends with her, but they kept their distance and chatted amongst themselves when she stopped in front of me. Swallowing my anger, I reminded myself she'd done nothing to piss me off. I forced a smile. â€Å"Hi, Lady Ivashkov.† â€Å"Daniella,† she said kindly. â€Å"No titles.† â€Å"Sorry. It's still a weird thing.† She nodded toward where Dimitri and Lissa were departing with his guards. â€Å"I saw you there, just now. You helped his case, I think. Poor Reece was pretty flustered.† I recalled that Reece was related to her. â€Å"Oh†¦ I'm sorry. I didn't mean to–â€Å" â€Å"Don't apologize. Reece is my uncle, but in this case, I believe in what Vasilisa and Mr. Belikov are saying.† Despite how angry Dimitri had just made me, my gut instinct resented the dropping of his â€Å"guardian† title. Yet I could forgive her, considering her attitude. â€Å"You†¦ you believe Lissa healed him? That Strigoi can be restored?† I was realizing there were lots of people who believed. The crowd had just demonstrated as much, and Lissa was still building her following of devotees. Somehow, my line of thinking always tended to assume all royals were against me. Daniella's smile turned wry. â€Å"My own son is a spirit user. Since accepting that, I've had to accept a lot of other things I didn't believe were possible.† â€Å"I suppose you would,† I admitted. Beyond her, I noticed a Moroi man standing near some trees. His eyes occasionally fell on us, and I could have sworn I'd seen him before. Daniella's next words turned my attention back to her. â€Å"Speaking of Adrian†¦ he was looking for you earlier. It's short notice now, but some of Nathan's relatives are having a late cocktail party in about an hour, and Adrian wanted you to go.† Another party. Was that all anyone ever did here at Court? Massacres, miracles†¦ it didn't matter. Everything was cause for a party, I thought bitterly. I'd probably been with Ambrose and Rhonda when Adrian went searching. It was interesting. In passing on the invitation, Daniella was also saying that she wanted me to go. Unfortunately, I had a hard time being as open to it. Nathan's family meant the Ivashkovs, and they wouldn't be so friendly. â€Å"Will the queen be there?† I asked suspiciously. â€Å"No, she has other engagements.† â€Å"Are you sure? No unexpected visits?† She laughed. â€Å"No, I'm certain of it. Rumor has it that you two being in the same room together†¦ isn't such a good idea.† I could only imagine the stories going around about my Council performance, particularly since Adrian's father had been there to witness it. â€Å"No, not after that ruling. What she did†¦Ã¢â‚¬  The anger I'd felt earlier began to blaze again. â€Å"It was unforgivable.† That weird guy by the tree was still waiting around. Why? Daniella didn't confirm or deny my statement, and I wondered where she stood on the issue. â€Å"She's still quite fond of you.† I scoffed. â€Å"I have a hard time believing that.† Usually, people who yelled at you in public weren't too â€Å"fond† of you, and even Tatiana's cool composure had cracked near the end of our spat. â€Å"It's true. This will blow over, and there might even be a chance for you to be assigned to Vasilisa.† â€Å"You can't be serious,† I exclaimed. I should have known better. Daniella Ivashkov didn't really seem like the joking type, but I really did believe I'd crossed the line with Tatiana. â€Å"After everything that's happened, they don't want to waste good guardians. Besides, she doesn't want there to be animosity between you.† â€Å"Yeah? Well, I don't want her bribery! If she thinks putting Dimitri out there and dangling a royal job is going to change my mind, she's wrong. She's a lying, scheming–â€Å" I stopped abruptly. My voice had gone loud enough that Daniella's nearby friends were now staring. And I really didn't want to say the names I thought Tatiana deserved in front of Daniella. â€Å"Sorry,† I said. I attempted civility. â€Å"Tell Adrian I'll come to the party†¦ but do you really want me to go? After I crashed the ceremony the other night? And after, um, other things I've done?† She shook her head. â€Å"What happened at the ceremony is as much Adrian's fault as it is yours. It's done, and Tatiana let it go. This party's a much more lighthearted event, and if he wants you there, then I want him to be happy.† â€Å"I'll go shower and change now and meet him at your place in an hour.† She was tactful enough to ignore my earlier outburst. â€Å"Wonderful. I know he'll be happy to hear that.† I declined to tell her that I was actually happy about the thought of flaunting myself in front of some Ivashkovs in the hopes that it would get back to Tatiana. I no longer believed for an instant that she accepted what was going on with Adrian and me or that she would let my outburst blow over. And truthfully, I did want to see him. We hadn't had much time to talk recently. After Daniella and her friends left, I figured it was time to get to the bottom of things. I headed straight over to the Moroi who'd been lurking around, hands on my hips. â€Å"Okay,† I demanded. â€Å"Who are you, and what do you want?† He was only a few years older than me and didn't seem at all fazed by my tough-girl attitude. He crooked me a smile, and I again pondered where I'd seen him. â€Å"I've got a message for you,† he said. â€Å"And some gifts.† He handed over a tote bag. I looked inside and found a laptop, some cords, and several pieces of paper. I stared up at him in disbelief. â€Å"What's this?† â€Å"Something you need to get a move on–and not let anyone else know about. The note will explain everything.† â€Å"Don't play spy movie with me! I'm not doing anything until you–† His face clicked. I'd seen him back at St. Vladimir's, around the time of my graduation–always hovering in the background. I groaned, suddenly understanding the secretive nature–and cocky attitude. â€Å"You work for Abe.†

Caferoma Case Study

Caferoma is a well known brand of coffee, promoted as an exclusive product with a strong and slightly bitter taste. The main problem is Caferoma's market share has declined by almost 30%. Let me Summarise the reasons for this change †¢ Consumers have become less loyal to the brand †¢ supermarkets are producing the similar products under their own label are selling at much lover prices †¢ Competing products have lower prices (30 to 40 %) †¢ Caferoma becoming less fashionable Brand image: not up to date s we can see from the chart 2 years ago Caferoma’s sales in Hotels was 30% but last year it was 25% in restaurants 2 years ago Caferoma’s sales was 10% but last year it was 15% In supemarkets 2 years ago their sales was 45% but last year it was 30% In specialist shops 2 years ago Caferoma’s sales was 10% but last year it was 25% Conducting the market survey we have the following results: Majority [m d r? t? ] people suppose Caferoma is old-fashio ned 70% of people think Caferoma has a good quality 60% of people consider that Caferoma is expensive little bit more than half of the respondents believe Caferoma is exclusive a less than half of people said Caferoma is value for money and almost a third of respondents think Caferoma is ecxiting. I can propose the following solution: Create a new coffee with a new taste and a new name for example „Cafferissimaâ€Å". To introduce the new coffee it will be good to have a limited edition (maybe coffee with taste of chilli). It is necessary to create a new package with an exclusive design for example in gold. Furthermore we give special introduction prices for both coffees.Most people want to try out new brands just to know how it tastes – this is our advantage. In order to bring the old brand back to life, will be a good idea to give small additional samples on the new coffee package of „Cafferissimaâ€Å". Moreover we need a new design of the logo, as the old on e is boring. There is no relation between this logo and the exclusive taste of the coffee. Maybe it could be similar to the package of Caferoma (golden, italic type). The next step will be a change of advertising. It is necessary to find the typical Italian style for old and young people.I think it would be great to have two different ads. One ad with an old woman, dressed very exclusively and the other one with a group of young people who are having fun, laughing and so on. But both ads will be made at the same place for example a typically Italien square. E-Mail To: From: Subject: RE:Caferoma decaffeinated; Premium Blend Date: 9th September Dear Mario, the first thing I have to mention is, that the „decaffeinated productâ€Å" is available in all supermarkets, but placed on botton shelves! Customers won't find the product as easy as other products.Most supermarkets sell their own brands because they make more money with it. I think that we can raise our profit by offering t he managers cash for displaying our product in a better position. Here some measures to improve the premium blend sales: As far as I can see, the price for the premium blend is too high and the packaging looks old-fashioned. Therefore we should reduce the price and launch a new packaging design. We should also start a new advertising campaign with focus on the brand's qualities. For instance some tasting sessions in big stores. Best regards

The importance of developing management skills Essay

The importance of developing management skills - Essay Example Secondly, managerial skills can be described as being controllable since the execution of these behaviours is normally under the individual’s control. Unlike institutional practices such as cognitive activities like â€Å"transcending fear† or â€Å"selectively hiring† skills can be deliberately improved, practiced, restrained or even demonstrated by people themselves. Furthermore, skills may definitely engage other individuals and need cognitive work; nevertheless, they are behaviours that can be controlled by people themselves. Thirdly, management skills can be developed leading to enhanced performance. Unlike definite temperament or personality aspects or IQ that remain comparatively invariable throughout life, people can improve their proficiency in skill performance via feedback and practice. People can advance from being less competent to more competent in management skills-with this being the fundamental goal of this paper.Fourthly management skills can be said to be overlapping or interrelated and it is hard to display just one skill in isolation from the rest. Thus skills are not repetitive, simplistic behaviors, but instead are integrated sets of complicated responses. Efficient managers must particularly depend on skills combination so as to accomplish desired outcomes. For instance, so as to efficiently inspire others, such skills as supportive communicating, self-awareness, influence, as well as empowerment may be needed. Efficient managers, therefore, institute a collection of skills.

Case Study Example | Topics and Well Written Essays - 250 words - 19

Case Study Example Carnival Cruise Lines had established an office in Boston that concentrated on advertising the fun aspects of the company’s cruise ships. However, the new advertisements will focus mainly on showcasing the safety precautions that the company has installed in its cruise ships for example, the fire safety technologies and a vacation program that grants one hundred and ten percent refund for disgruntled customers (Levere). This reassures the passengers that they are safe. The advertisement will also showcase the fun aspect of cruise by airing videos and photographs taken by former passengers and employees to display the experience on the cruise ships. They will also invite a number of celebrities who will discuss food and other family related topics (Levere). The new marketing strategy will attract new customer after considering the safety measures provided, hence assuring passengers a safe cruise. The segment focusing on the fun part of the cruise ship will help attract passengers as they will want to experience some of the moments that other passengers have experienced aboard the cruise ships (Levere). Levere, Jane. "Spot Shares Moments of Better Cruise Memories." The New York Times. Web. 13 Feb. 2014.

Db 5 Essay Example | Topics and Well Written Essays - 750 words

Db 5 - Essay Example The given case study reflects an ethical dilemma that organizations normally face during employee selection processes. This paper will critically analyze the given issue and suggest the most possible solution. Case analysis The two candidates, Martin and Joy apply for job in a computer technology company for the position of software trainer. The candidates are from two different countries and both of them possess certain unpleasant backgrounds. Martin has a scar on the right side of his face which indicates an extensive employment injury record. At the same time, Joe has a criminal background. In my opinion, the case does not fall under the category of diversity. To illustrate, â€Å"the concept of diversity refers to the number or the proportion of people within a community or social environment that hold different and various roles.† (Diversity Categories). This concept is against all forms of discrimination and it tries to promote social equality. Martin is from China and J oe is from United States. Here, the firm does not consider the nationality of the candidates in its selection criteria; on the other hand, the firm only takes the previous work history of the candidates into account. ... In the final decision regarding employee hiring, I would consider the candidates’ work history and morals as the most determinant factors. Since the company would not have knowledge regarding candidates’ qualification, experience, efficiency, professionalism, and dedication, The candidate’s background information would be the only criterion to take final decision. The extensive employment injury record found to be the major weak-point of Martin. However, it is precise that a software trainer does not need to engage in physically demanding jobs that cause injuries. Similarly, the scar on Martin’s face does not raise any further interruption to his work. In contrast, Joe’s criminal background seems to be a potential issue that disqualifies him for the proposed employment opportunity. It is not advisable for the firm to employ a candidate with criminal background since he may hurt the overall cohesion and interests of the organization in future. The em ployment of a person with criminal background would promote unfair practices in the company. Moreover, the presence of employees having criminal background would adversely affect the repute of the whole organizational unit. In addition, Joe has body odor which would cause inconveniences to his co-workers. Hence, it is advisable to hire Martin for the offered post since he possesses better qualities and personal integrity required as compared to Joe. In this case study, there are no elements that constitute a legal issue because the hiring process does not include any religious, racial, or political discrimination. Law clearly states that an employer can refuse the job application of a candidate if the employer has sufficient reasons to prove that candidate would

History Essay Example | Topics and Well Written Essays - 250 words - 36

History - Essay Example Hence, this admirable character enhances the effectiveness of the results in activities Germans engage in. Hence, Germans are viewed as thinkers while Americans are action oriented (Nees). Germans often pass as individuals who do not have a â€Å"can-do† attitude. In this case, they tend to take caution when approaching issues and accept that there are some challenging situations. Therefore, Americans view this as a typical negative attitude in Germans since Americans believe everything is possible. In fact, Americans instill the â€Å"everything is possible† attitude to their children when young. Case in point, any American child would say that they would want to become anything in life, even being the president of the United States. However, the cautious character in Germans is admirable since it represents practicality in life although Americans associate it as with a lack of creativity amongst the Germans (Nees). Germans’ listening style during communication is very different from the Americans. In this regard, Germans listen keenly to a conversation waiting for pauses in order to respond. On the other hand, Americans tend to nod, gesture, or even make a comment when the other party is talking during a conversation. Therefore, Americans stereotypically view the Germans’ listening style wondering whether they listening to a conversation. However, the Germans’ listening style is crucial since they pay attention to every detail put forward in a conversation and hence put forward a calculated response (Nees). It is evident from the foregoing discussion that Americans and other nationalities may view some characters in Germans stereotypically. However, some of these characteristics viewed stereotypically are admirable and can be a learning lesson not only to Americans but also to other nationalities. Overall, it is part

Reflections on Experience with Second Life Essay

Reflections on Experience with Second Life - Essay Example Being a downloadable client programme created by Linden Lab, San Francisco, United States gives the participants known as 'avatars' an opportunity to socialize and interact with other people of the virtual community, exchange views, buy or sell land and present their talents to the community. As per the website of 'Second Life', presently more than three million people have registered themselves with the community. With the growth of the broadband internet connections especially in the United States, where there is an increase from 30 percent (2005) of the Americans having a high-speed connection at home to 42 percent in 2006 has enhanced the passion for participation in this virtual world. This paper attempts to narrate the experience on the environments encountered in 'Second Life', the potential social and political implications of this virtual medium and also the possible future uses. As is being claimed by 'Second Life' this unique digital world offers a lot of opportunities to develop one's own skills by exhibiting what they are capable of creating. Especially people who are introverts and shy of meeting the other people in the real world can improve their socializing behaviour by interacting freely with other 'avatars' of this virtual world. People can give concerts, draw pictures; build houses and hotels and trade in any other commodities. All the trading transactions will be just like as happening in the real world. Because of the three dimensional effect of the site, one gets a feeling that he is interacting with the fellow community member in real life. This gives ample scope for the development of specialized skills of public speaking or playing musical instruments in front of an invited audience. People can shed their inhibitions. In 'Showcase'-one of the environment of 'second life' one can bring out his or her real talent to be appreciated by the fellow avatars. Second Life provides another opportunity of real time sales meetings with the customers and it is possible to make customer presentations through this media. Distance learning is another possibility which would be a very useful feature for the students to acquire a quality education. There are much more environments like business, property development and community interaction available in this virtual world which are distinguishably rare phenomena that need to be evaluated by one's own personal encounter and experience. 3.0 Social Variables Influencing Participation in 'Second Life': The social variables generally influencing any issue of importance are the Family Structure, Ethnicity, Language, Demography, Educational standards. Employment Status, Crime rates, Cultural Factors, Action by community based organsiations, Lifestyle issues, Recreational factors, Psychological factors and Historical dependence. This part of the paper analyses the influence of some of these social factors on the participation in 'Second Life. Of all these variables, recreational and psychological factors may have more impact on the participation than other variables. The people who feel shy and having inhibitions to present themselves to others in the real world may be more susceptible to participation in this virtual world. Similarly people who have more time at their disposal for recreation may well be influenced by this engrossing multimedia interaction and may see this as a

Patient Satisfaction Compared in 5 Rural and 5 Urban Hospitals in Research Paper

Patient Satisfaction Compared in 5 Rural and 5 Urban Hospitals in Illinois - Research Paper Example Majority concentrates on delivery of primary health care services. As portrayed by recent research, most rural patients’ by-pass rural hospitals to seek medical attention from urban- based hospitals. Due to under utilization of rural hospitals, these hospitals continue facing financial challenges due to reduced occupancy rates and declining government assistance (Dent & Haslam, 2006). The issue of lower occupancy rates has substantially increased costs, hindering efforts to introduce new services and technology. As such, the rural population continue to raise alarm of limited access to quality health care while at the same time they under- utilize rural hospitals leading to their closure The survey conducted in regard to satisfaction derived by patients generally rated the quality of rural care lower than that of urban care. In the figure below, the study was centered on two samples each consisting five hospitals selected from both rural and urban settings. The study found tha t, most patients were satisfied with services rendered by urban hospitals than those offered by their rural counter parts. Many patients from the rural setting either expressed dissatisfaction or were not sure of the quality of local services. Graphs Fig 1.0 Patients response on level of service satisfaction at rural hospitals Source: UnitedHealth Group/Harris Interactive Survey of patient response to quality of services in rural hospitals, May 2011 Results From the research carried out, it was learnt that 15% were strongly satisfied, 33% satisfied, 9% were not sure, 28% dissatisfied while 15% were strongly dissatisfied. Patient’s response on level of service satisfaction at urban hospitals Source: UnitedHealth Group/Harris Interactive Survey of patient response to quality of services in urban hospitals, May 2011 Results From the research undertaken, it was learnt that 37% of all the patients examined were strongly satisfied, 47% satisfied, 5% was not sure, 9% was dissatisfie d while 2% expressed strong dissatisfaction. Discussion Patients perceive rural hospital care to be more personal as they can identify themselves with the caregivers. There may be a chance of caregivers to interact with their patients after discharge. Therefore, they tend to be more attentive and courteous in their job (Chern & Wan, 2000). On the other hand, the anonymity of urban areas endangers the staff attitude of â€Å"who cares,† â€Å"I’ll never see the patient again.† Patients may have lower expectations of rural hospitals when they know that they lack necessary technology or experience high patient to staff ratio. As such, they may evaluate their preferred care against a lower set of expectations. In rural setting, there could be lesser chances of error due to the simpler care processes and simple technology being in use. From the previous studies, it was established that patients discharged from teaching hospitals derived more satisfaction. More so, pa tients want to receive care from hospitals with cutting -edge care, physicians who are the best in their field or those using state of art technology. Perhaps, patients viewed Medicare derived from such modern urban hospitals to be worth the cost associated rather than being prodded and poked by trainees in institutions that train practitioners and conducts research. Patient’s hospital choice between the rural and urban was found to depend on the ability of the patient to evaluate available options and their

Homeostasis and Pain Management in Patient with Multisystem Failure Essay

Homeostasis and Pain Management in Patient with Multisystem Failure - Essay Example Consequently, obtaining the blood pressure, respiration rate, pulse rate and temperature will reveal the vital symptoms of whatever ailments that the patient is suffering from. Determining the oxygenation of Mrs. Baker is extremely essential; this can be executed by the use of the pulse oximeter. Place the pulse oximeter on the index finger and observe the patient’s skin color, the beds of the finger nails, and also the skin around the lips (Poitout, 2004). The time intervals for capillary refills should be noted while also assessing the beds of the fingernails. Current level of consciousness should be determined by assessing the reactivity of pupils, orientation to person, time and place; ask the patient questions to estabish the state of the mind. Symptoms and signs of dehydration together with skin turgor, decreased blood pressure, lethargy, sunken eyes, confusion, dizziness, and dry mucous membranes must be investigated (Poitout, 2004). The pain levels of the patient can b e assessed successfully when the patient is in a conscious state and when he/she can still speak; for instance, the pain of the patient can be rated on a scale of 1 to 10. ... Furthermore, there is a standard standing order for intravenous medication in such situations, in this regard it important and a must to start an IV. The lab personnel must be ordered to be drawn off of the IV. Technological tools used, why they are used, and importance of the tools in determining the patient’s status Tools and technology to be used in the diagnosis include, pulse oximeter, stethoscope, glucose meter, Sphygmomanometer, Laryngoscopes, Stylets, and tracheal tubes The pulse oximeter is a medical device essential for measuring or monitoring indirectly the patient’s blood oxygen saturation, and blood volume changes in the skin. The pulse oximeter is also useful as it displays the patient’s pulse rate (Niles, 2010). The pulse oximeter is a vital tool especially in the event where patient’s oxygenation is unstable or compromised like in the intensive care unit, operating, emergency and in ward settings. As already mentioned, the tool helps in ass essing the patient’s need for oxygen and determining if there is any need for supplemental oxygen (Niles, 2010). The oxygenation levels of Mrs. Baker will be evaluated and recorded by the pulse oximeter. A stethoscope is an acoustic device used in hospitals for listening to sounds produced from within a human body or animal (Niles, 2010). In this regard, the instrument is indispensable in listening to sounds produced by lungs, heart, intestines together with blood flow in the veins and arteries. In this case scenario, the stethoscope will be used to determine the heartbeat rate, and the pulse rate of Mrs. Baker. The sphygmomanometer is vital in measuring the blood pressure by

Thesis Statements Essay Example for Free

Thesis Statements Essay There are two aspects that must be present in any thesis statement that is worthy of being written: 1. Textual Evidence 2. Specific Argument Your thesis should include both textual evidence (some description of the text and what you think is important or interesting in it) and a specific argument (the argumentative context in which you are making some claim about what you have seen). The argument should always answer the question â€Å"So what?† regarding the textual evidence. Do not just offer some facts about the text, or statements that cannot be debated. For example, â€Å"Elie Wiesel from Night struggles to survive† is self-evident and does not warrant an argumentative essay. No critical reader would bother to read such an essay since its central claim provokes no argumentative thought, which equates to little to no interest. If you do merely state a fact about the text, I will ask you â€Å"So what?† or, â€Å"What is important ABOUT the fact?† For instance: if your thesis statement is something along the lines of: William Shakespeare’s Romeo and Juliet depicts opposing characters like Benvolio and Tybalt. I will point out that this is merely a factual plot reference, not a claim about the text; basically, no one who has read the story could reasonably conclude otherwise. You’re just telling me that Benvolio and Tybalt are contrasting characters, not what is important or interesting ABOUT the fact that they are opposing. (So what?) But do not abandon this sort of sentence; after all, you have to begin by noticing something. Just make it the first part of your thesis: The opposition of Benvolio and Tybalt in Shakespeare’s Romeo and Juliet. . . becomes the subordinate clause (the textual evidence) in your thesis statement.

Sepsis Infection Causes and Effects

Sepsis Infection Causes and Effects Sepsis affects 18 million people worldwide each year (Slade et al 2003). Sepsis remains life threatening and mortality rate remains high approximately 40-50 % (Opport et al2005). We, nurses in all areas of practice, will care for septic patients during our professional carreer.Many nurses receive little training in how to identify sepsis or how important early and aggressive treatment to help prevent the condition. I am very interested to discuss about sepsis, because I have looked after many patients with sepsis. The aim of this essay is to raise awareness of sepsis, so that nurses will have a greater understanding of this condition and feel more confident in the identification and treatment. The definition of sepsis is the presence of Systemic Inflammatory Response Syndrome (SIRS) criteria in the patients with a new infection. Once sepsis becomes complicated by a dysfunction in one or more organs, this defines severe sepsis. Bacteria cause 90% cases of sepsis. They are two types, gram negative and gram positive. Escherichia coli, Klebsiella, Enterobactor, Pseudomonas aeruginosa, Serratia, Proteus and Bacteroides fragilis are the gram-negative bacteria. Staphylococcus aureus, Streptococcus pneumonia, Alpha and beta-hemolytic streptococci are the gram-positive bacteria (Edwards 2001). Gram-negative bacterial infection causes most cases of sepsis. Viruses or fungi can also cause sepsis, particularly Candida spp (Cohen et al 2004). The surviving sepsis campaign (formed in2002) is an international collaboration to improve the diagnosis, management and treatment of sepsis. The main aims of the campaign are: To increase the awareness of sepsis, severe sepsis and septic shock among health care staff and the public. Develop evidence-based guidelines for the management of severe sepsis. Ensure that the guidelines put into practice to create a global standard of care for patients with sepsis. Reduce the mortality from sepsis worldwide by 25 percent in the five years following the publication of evidence-based guidelines in 2004 (Dellinger et al 2004). It is essential that nurses are aware of the evidence-based guidelines as our role is crucial to the success of the campaign. Nurses are in an ideal position to identify the first signs of a patient developing sepsis, and the sooner treatment begins the less likely the condition is to spread and result in organ dysfunction or failure (Ahrens and Tuggle 2004). Infection is a major reason for patients admitted to hospitals and some patients may develop infections while in hospital (DH2003). Infection can found in any system of the body. The most common sources of infection that can lead to sepsis are: Respiratory tract: community-acquired pneumonia or health care-associated pneumonia. Intra-abdominal-cavity: infection might result from diverticulitis, appendicitis, perforated bowel, and ischemic or necrotic bowel. Central nervous system-such as meningitis. Genitourinary system: urosepsis is an infection, which might result from an obstruction in the urinary system, or catheter related infection. Skin: wound infections, cellulitis or necrotizing infections of the skin and soft tissues with rapid destruction of tissue, such as necrotizing fasciitis. Intravascular Catheters: any invasive catheters (central venous catheter or peripheral canulae. Many organ systems may affect during the sepsis syndrome. Respiratory system: As the effects of of sepsis progress, acute respiratory distress syndrome (ARDS) may occur. During sepsis, there is a decrease in the performance of the ventillatory muscles, which leads to hypercapneic ventillatory failure and respiratory arrest These happens when metabolic demands on the ventillatory muscles. Tachypnoea,hypoxia and respiratory alkalosis are associated with the early onset of ARDS, followed after 48 hours by pulmonary infiltrates and respiratory failure (Mortelliti Manning). Sepsis leads to an increase in lung permeability, the sequestration of polymorphonuclear neutrophils and respiratory failure. These affect the function of respiratory system (Nagase, Uzumi Ishii). Cardio vascular system: The dysfunction of cardio vascular system is also observed in patients with sepsis, where both the heart and blood vessels show hypersensitivity. An increased amount of pro-inflammatory cytokines and vasoactive substances is present during sepsis. Following the increase in pro-inflammatory cytokines, production of nitric oxide is increase in both the vascular endothelium and smooth muscle. This leads to a fall in systemic vascular resistance, thereby hypotension (Patterson Webster). Renal Dysfunction: Normally, the kidney regulates perfusion and glomerular filtration via autoregulation, which is dependent on the afferent and efferent arterioles. Autoregulation of the kidney, is affected during sepsis. Coagulation system: Sepsis often associated with a disorder of coagulation secondary to the cytokine-mediated activation of the coagulation pathway. This secondary disorder, known as disseminated intravascular coagulation (DIC). It causes bleeding and micro vascular thrombi, both implicated in multiple organ failure and soft-tissue damage (Meijers Bouma). Diagnosis can base on the presence of fever and other abnormalities of vital signs, as well as the presence of one or more organ dysfunctions that are not the original site of infection or trauma (Ahamed). Sepsis syndrome is characterized by; alteration in body temperature regulation, tachycardia, lowered systemic vascular resistance, respiratory alkalosis, leococytosis, leucopenia and some form of organ dysfunction(Chistman, Holden and Blackhell).It does not discriminate between different ages, underlying disease, genetic background, infecting micro-organisms or sites of infection. Sepsis can occur in people who were previously healthy. The infecting organism may be a temporary defect in the hosts defense. Defects may be located in specific or non-specific cellular barriers, humoral immunity barriers and physical barriers such as the skin or mucous membranes and reflexes such as cough and peristalsis (Maskin, Fountain and Spinedi et al). In understanding the changes that happen to the body in severe sepsis, it is helpful to remind ourselves of the changes that occur during the normal immune response. Cells damaged by infection from bacteria, viruses, chemical agents or trauma produce the same non-specific defensive response of inflammation. Regardless of the cause, inflammation has three basic phases; vasodialatation and increased permeability of blood vessels; emigration of phagocytes; and tissue repair (Tortora and Grabowski, 2000). Vasodilatation brings more blood to the damaged area, and the increased permeability allows phagocytes and antibodies to pass out from the circulation. The clotting cascade is also activated. Clot formation is part of the normal immune response, and may be the bodys attempt to confine any invading organism to one area of body (Ahrens and Vollman, 2003). This inflammatory response and activation of the clotting system is to repair damaged tissues and prevent further damage. Clinical assessment is important in patients with sepsis. Any patients who triggers early warning score, should be assessed initially using the ABCDE approach. This systemic approach ensures that the life threatening problems are assessed and managed in order of importance. The Resuscitation Council 2006 also recommends that clinical staff should follow ABCDE approach when assessing and treating critically ill patients. It is sensible to adopt this systemic approach to the assessment of sepsis patient (ABC of sepsis). Airway: An assessment should be made of the patency of airway. If patient is alert and talking, there is less chance of an airway problem. Breathing: The bodys demand for oxygen rises in sepsis. As demand outstrips supply, lactic acidosis occurs. These processes combine to elevate the respiratory rate. The depth and pattern of respiratory rate should evaluate in addition to any asymmetry of chest movement. Listen for abnormal sounds include expiratory wheeze, suggesting obstruction of the lower airway and crepitating suggest the secretion, pulmonary oedema or consolidation. If a respiratory problem is identified, attention should be given to oxygen therapy and to the possible need for bronchodilators and physiotherapy. The response to therapy should be assessing repeatedly. Pulse oximetry is mandatory, and ABG and chest X-ray is helpful. Circulation: Attention should pay to the colour of the skin, particularly peripherally. Pallor is suggestive of hypo perfusion and may suggest a low cardiac output. Heart sound should auscultate to seek murmur. Feel for the peripheral skin temperature. In decompensated sepsis, where the cardiac output begins to fall, the peripheries may appear cool. Capillary refill time is useful test of perfusion. The heart rate and rhythm should asses by palpitation of peripheral pulses. Disability: Sepsis can produce confusion, agitation and reduced conscious level due to reduced cerebral perfusion. Fluid resuscitation can restore cerebral function. It is important to check blood sugar because; hypoglycemia can also produce these signs and is readily correctable. The conscious level can quickly asses and communicate using the AVPU scale.( A-Alert,V-responds to voice,P-responds to pain,U-unresponsive). Exposure: The patient should be examined from head to toe seeking the source of sepsis. Consideration should be given to the patients dignity during this assessment, and it should be recognized that exposure can cause rapid temperature loss. Therefore, it is essential to check peripheral temperature. When treating patients with sepsis, the first hour known as the golden hour because the treatment given or not given during that time can have significant impact on the survival (ACS 1997).To be able to treat patients in the `golden hour` we must first be able to recognize it confidently. Studies have shown that patients admitted to intensive care unit from the wards are often not referred early enough. Sometimes receive suboptimal care, which can increase patients mortality (McQuillan et al1998).Vincent et al 2002 suggest that some patients with sepsis are recognized late and are not treated appropriately before transfer to ICU. In March 2004, the Surviving Sepsis Campaign produced comprehensive guidelines on the management of patients with severe sepsis. Initial treatment within one hour of diagnosis is, Give supplemental oxygen therapy, via facemask, to achieve SpO2>94%. Obtain blood specimen lactate, full blood count, urea and electrolytes, glucose, liver function tests, coagulation screen and blood culture two sets. Samples from sputum, urine, wound swab etc as appropriate. Blood cultures should be taken before antibiotics are given to identify any microorganisms that may be in the blood and it should from a peripheral vein and from any invasive catheters that the patient may have in situ.Blood cultures are not always positive in patient with sepsis. Cohen et al (2004) suggest that care should take when obtaining blood cultures to prevent them becoming contaminated and giving a false positive result. Administer intravenous broad-spectrum antibiotics. In severe sepsis antibiotics should be given within one hour of diagnosis (Dellinger et al, 2004). Giving prompt antibiotic therapy may reduce mortality by 10-15 percent, compared with patients in whom antibiotic therapy is delayed (Wheeler Bernard, 1999). Any septic patient who has a lactate level above 4mmol/L should be considered to have severe sepsis even if the blood pressure is within the normal range. If patient is hypotensive, fluid resuscitate up to 3boluses of 500ml normal saline to maintain MAP>65/systolic 100mmhg (Trusts sepsis care pathway). Consider catheterization to maintain fluid balance. If the patient have signs of severe sepsis, needs referral to ICU. Signs of severe sepsis are; Systolic blood pressure below 90mmHg or MAP below 65mmHg, lactate above 2mmol/L, urine output below 0.5ml/kg/hr for 2 hours, INR above1.5, bilirubin above 34mol/L, platelets below 100mol/L, creatinine above 177mmol/L. Some patients develop severe sepsis from infections they acquire while in hospital. One in ten NHS hospital patients are affected by healthcare associated infections(HCAIs) each year(DH2003).The most common of these infections are urinary infections as a result of indwelling urinary catheters and pneumonia.Therefore,nurses must make continued efforts to play an active part in reducing the number of HCAIs as this can potentially lead to fewer patients developing sepsis . Ahrens and Tuggle (2004) suggest that it may also be beneficial to raise the publics awareness of the Surviving Sepsis Campaign and the warning signs of developing sepsis. This may help to achieve the main aim of the campaign, which is to reduce mortality.Sepsis, is a common condition and can be fatal. A good knowledge of the signs and symptoms of sepsis is the key to prompt recognition. Every patient suspected having sepsis should have blood taken for a serum lactate level. In patients with severe sepsis, early aggressive treatment and adherence to evidence-based guidelines can help to save lives. In addition, efforts to reduce HCAIs can aid in the reduction of the incidence of sepsis.

Goodman Brown’s Loss of Faith in Hawthornes Young Goodman Brown Essay

Nathaniel Hawthorne wrote Young Goodman Brown based on morals and what Easterly in "Lachrymal Imagery in Hawthorne's 'Young Goodman Brown' " calls "spiritual maturity" (Easterly 339). In the short story, Goodman Brown, a young Puritan leaves his wife of three months to watch a witch ceremony in the forest. During this point in time, Puritans based their lives on teachings of religion and morality; therefore, witch-meetings were surely immoral, and they betrayed the commitment of God. Dwelling in the forest throughout the night, Goodman Brown experiences an event that changes his entire perspective of life. In one night, the event destroys "his relationship with his wife Faith, isolates him from his neighbors, and destroys his ability to worship God"(Easterly 339). Eventually, Goodman Brown dies without his faith, and "they carved no hopeful verse upon his tombstone; for his dying hour was gloom"(Easterly 339). Â   Before Brown leaves the house, Faith begs him to stay saying, "...put off your journey until sunrise, and sleep in your own bed to-night" (Hawthorne 298), but of course, Brown ignores her plea and continues his journey anyhow. In the forest, he meets a man with a staff "which bore the likeness of a great black snake" (Hawthorne 299), an ultimate representation of evil. Surely, Goodman Brown knows that the witch meeting appears to be his destination. Walking through the forest, he pays close attention to every tree and every rock. As he proceeds his journey, Brown sights Faith and his moral and spiritual adviser, along with Deacon Gookin and the minister. He then notices Goody Cloyse, an old "Christian woman" (Hawthorne 300), rushing through the woods. Surely Brown's suspicion begins to take over, now curious about... ... and spiritual maturity because he could not handle the fact that others worshiped the devil (those he certainly did not expect). In this, Hawthorne tells us that the man who sheds no tears lives the rest of his life a sad man, whose "dying hour was gloom" (Easterly 339). Â   Works Cited Easterly, Joan Elizabeth. "Lachrymal Imagery in Hawthorne's 'Young Goodman Brown.' " Studies in Short Fiction. 28 (1991): 339 Hawthorne, Nathaniel. "Young Goodman Brown." Literature: Reading, Reacting, Writing. Ed. Laurie G. Kirszner and Stephen R. Mandell. Fort Worth: Harcourt, 1997. 298-308. Â  Mikosh, Bert A. "The Allegorical Goodman Brown." An American Literature Survey Site. September 1996. Â  Segura, Giberto. "The View of 'Young Goodman Brown.' " An American Literature Survey Site. September 1996. (31 March 1999)

Essay --

Juliette Gordon Low is the founder of girl scouts and she led a long and prosperous journey for strengthening and empowering young women; Even though she became deaf she was not deterred and she continued on with her job as the founder of girl scouts. Juliette Low was a leader all throughout her life as a child and an adult. Along her journey of girl scouting she achieved many of her goals and had many different hobbies and interests. After she passed away she was remembered for all the impacts she made on the world. The cause for Juliette’s deafness isn’t the most obvious to be sure, But it is pretty ironic how it happened. When she was young she had many ear infections which made her lose most of her hearing in one ear. But in the other ear was a more Bizarre happening. On her Wedding day, Many people showed up for the event. After the wedding was done and Juliette and her fiance’ were walking down the church steps to start their life together. All of this happened while being showered upon by rice being thrown by well-wishers. But what they didn’t know is that one piece of rice became lodged in her ear causing an ear infection in that ear. Later on, it caused deafness in both ears. Juliette Gordon Low was born in Savannah Georgia in October 31, 1860 to William Washington Gordon and Eleanor Lytle. Her maiden name is Juliette Magill Kinzie Gordon. Shortly after she was born; she was given the nickname â€Å"daisy†. This later changes to â€Å"Crazy Daisy† due to personality change, positive energy, and openness. She was born into a split opinion Family with her Dad’s side of the family for succession and her Mother’s side of the family for abolition. Many neighbors were irritated that the Low family had differi... ...eginning stage of development, Low wanted them to be inclusive and independent. They started out by working on merit badges like: first aid, cooking, map reading, and knot tying. They were also known to spend a majority of their time in the outdoors participating in activities such as: swimming, camping, basketball, ect. They Introduced the idea of selling cookies as a fundraiser in 1917; This idea flew high and is still a major source of revenue for today’s girl scouts. Low decided it was enough and resigned presidency in 1920. and by 1925, the number of girl scouts grew to 90,000 girls in girl scouts. Low lead a legacy that will be remembered for a long time to come. With her outgoing personality she changed many girls lives as she met her goals and achieved many things. Becoming deaf had little effect on her, for she remained in girl scouting until the very end.

George Orwells 1984 :: essays research papers

GEORGE ORWELL'S 1984 THE BOOK 1984 BY GEORGE ORWELL IS ABOUT A MAN NAMED WINSTON SMITH. HE LIVES IN THE COUNTRY OF OCEANIA. IN THIS COUNTRY EVERY THING IS CONTROLLED BY A PARTY NAMED THE BIG BROTHER. THIS PARTY CONTROLLS EVERY THING FROM FOOD RATIONS TO WHAT PEOPLE CAN THINK. THEY EVEN HAVE TELLASCREANS EVERY WHERE SO THEY CAN WATCH PEOPLE AT ALL TIMES. WINSTON WORKS IN NEWSPEAK. NEWSPEAK IS WERE THEY EVENT SIMPILAR WORDS SO THEY CAN ELEMINATE OTHER WORDS TO MAKE THE LANGUAGE SIMPILIAR. WINSTON LIVES A PRETTY NORMAL LIVE UNTILL HE JOINS A UNDERGROUND PARTY CALLED THE BROTHERHOOD. HE JOINS THIS BECAUSE HE DOES NOT BELIEVE IN WHAT THE BIG BROTHER IS DOING AND HE THINKS IT IS WRONG. THE BROTHERHOOD IS AGAINST THE BIG BROTHER AND IS TRYING TO END ITS POWER. IN THIS PARTY THEY TELL WINSTON EVERY THING THE BIG BROTHER IS NOT TELLING THEM THINGS LIKE WHO OCEANIA IS REALLY AT WAR WITH AND EVERY THING THAT THE BIG BROTHER HAD BEEN LYING TO THEM ABOUT. IN THIS PARTY WINSTON MEETS A GIRL NAMED JULIA. OVER A PERIOD OF TIME THEY FALL IN LOVE. THEY HAVE SEX FOR A LONG TIME BUT HAVING SEX IS ILLEGAL IN OCEANIA. SO THEY HAVE TO HIDE.THEY FIND A SPOT IN THE FORREST WHERE NO ONE KNOWS ABOUT SO THEY WONT GET CAUGHT. AFTER A FEW MONTHS THEY FIND A BETTER SPOT THAT THEY RENTED FROM A FREIND. THEY USED THIS PLACE FOR A FEW MONTHS. UNTILL ONE NIGHT WHEN THEY FELL A SLEEP AND IN THE MORNING THEY WOKE UP TO THE POLICE TAKING THE TO JAIL. THEY TAKE THEM TO A PLACE WHERE THEY ARE QUESTIONED AND INNTERRIAGATED UNTILL THEY BREAK DOWN AND CONFESS. THEY ARE TAKING THERE AND TORRTURED AND BRAIN WASHED UNTILL THEY BELIVE WHAT THE PARTY TELLS THEM. THEY USED THE THING WINSTON WAS MOST AFRAID OF AND THATS RATS. SEEING THE RATS MADE HIM YELL OUT DONT

The Impact of Transnational Corporations on Less Economically Developed Countries

A transnational (TNC) corporation is simply a large business organisation which operates and has ownership of assets in more than one country. Most TNCs operate in just a few countries, are involved in manufacturing and services and have their head offices in more developed countries. TNCs are responsible for employing over 40 million people worldwide, indirectly influence an even greater number, and to control over 75 per cent of world trade. At first, many branches of TNCs were located in economically less developed countries, but there has been an increasing global shift to the affluent markets of Europe, North America and Japan. The reason why TNCs originally decided to locate in less developed countries was due to the existence of valuable resources, but the most important reason was the level of incentives offered by the home government. Also read this  Cheating in a Bottom Line Economy If a TNC decides to settle in an LEDC, there will be huge benefits. Many new jobs will be created, which will be filled by local labour. The jobs will probably be better paid than other jobs supplied by industry which developed within the country. On the other hand, the wages will be much lower than the wages given for the same job in an MEDC. This is another reason why TNCs choose to create branches in LEDCs. The jobs supplied by the TNC will probably require some basic skills, especially if it involves the manufacture of a good. The education will be supplied by the TNC, and will probably be of a fairly high standard if they want the branch to be very productive. The employees will benefit from these skills, because they would be able to use them in other aspects of their lives. The TNC will supply the expensive machinery used in manufacturing for the employees, which may also introduce new technologies as well. This will enable the country to progress and allow companies to use the new technology to develop. Because worker wages is increasing, demand for consumer goods will increase as well, another reason why new companies will be tempted to develop. Mineral wealth and new energy resources will develop, Because there is more trade in the country, there will be more reason for roads to be built, as well as railways and airports. The TNC may help fund the development of these because it will improve the importing and exporting ability of that country. The government will probably supply money for the transport links as well, due to the increasing amount of money coming into the country. The increased amount of money made by the country can also be used for many other things. Health control could be introduced, which means workers will be given improved working conditions and health plans. This could also help to improve output further because workers will be in a better environment and mood to work. Money can also be used for environmental control, which could include developing ways of minimizing the amount of pollution certain industries create and even developing new production methods. Although the advantages to the country are numerous, there is a negative side which includes many disadvantages. Although the new TNC will supply many jobs, the cost of investment will be high. The new TNC will know that wages in the target country are very poor and so they will not have to pay workers as nearly as much as they pay employees in MEDCs. This is quite unfair, because the TNC is taking advantage of the people in the LEDC. Furthermore, employees will be made to work very long hours with little or no breaks. The TNC will most likely choose not to employ local highly skilled workers, because they will expect higher salaries and better working conditions. This will mean that low skilled people will be given jobs, but higher skilled workers will remain unemployed. As previously mentioned, the TNC will most probably enjoy large profits if they set up branches in LEDCs. The problem is most of this money will not stay within the country because the main branch of the TNC will be situated in an MEDC. This means money will not stay in the LEDC; there will be an outflow of wealth. If money is going abroad, the GNP of the TNC will increase rapidly. The GNP of the LEDC used will increase as well, but at a slower rate. This means that development speed of the MEDC will far exceed that of the LEDC. This defeats one of the main reasons why TNCs setup branches overseas; they want the country to catch up with the growth rate of other countries. Technological advancements in the LEDC can eventually cause problems. Mechanisation will mean that fewer workers are needed because robots can do the jobs that the workers once did. The only workers needed will those used to maintain the machinery, which means the work force will be decreased substantially. The raw materials which are located in the LEDC will most probably be exported instead of manufactured locally. If the country is using as lot of energy to develop, then this can cause a national debt. Therefore, the rate of development will be stunted and the country will have been taken advantage of. This could cause upset within the workforce, creating strikes. This can cause further problems because the firm is not located within the country. They could choose to pull out when ether they like, meaning many jobs would be lost. This would not be a great loss to the TNC though, as they have many other branches they can rely on. The money created by these TNCs would probably be better off spent on improving housing, diet and sanitation than roads and airports for trade. The problem is that the TNC would not benefit as much from these improvements so it does not concern them. The development of new firms can damage the environment because land must cleared for factories to be built. This could destroy the natural homes of species of animals, which is very difficult to correct. Because the target country will not be aware of the amount of pollution produced by industry, the laws on pollution control will not be as tight as the country where the firm is located. This could cause health problems, especially if a lot of waste is produced and dumped into the local water supply, for example. It is clear that there are many advantages and disadvantages in terms of TNCs creating branches in other countries. The real problem is that the disadvantages mostly affect the target country, not the TNC. So until LEDCs are aware of the problems caused by firms settling in their country, the chance of the growth of TNCs slowing down is very small. This could cause the gap between the levels of development in LEDCs and MEDCs to become even wider in the future.

Assessments in a care environment Essay

Although there are many hazards that could be potential risks in the food environment in a hospital, there are a few which have the highest risk of  occurring and could then cause the most harm to both the service users and service providers. Whilst preparing and cutting vegetables, there is a risk that someone could cut themselves with a sharp knife or cutting equipment. Although the likelihood of this happening could be quite high when there is a lack of training involved, the severity of the injury or damage to health would be quite low considering many injuries that occur this way would be easily seen to and treated by the first aider or the person in charge. However, to prevent this risk occurring at all, all staff should be supplied with the appropriate equipment they should use and training so they are aware of how to handle the equipment in the right manor. A low level of sanitation in a food environment could cause there to be a wider and much quicker spread of bacteria through the food and surfaces which could prove to be harmful, especially in a hospital environment. Due to health and safety regulations being followed by all caring establishments, the likelihood of this happening would be a 2. However if there weren’t regulations being followed by the hospital and this was to occur then the severity could potentially be a 4/5 as the spread of bacteria in a hospital setting would be made worse when considering the weaker people in the hospital and those whose immune systems wouldn’t be able to fight off bad bacteria as well as other and could get sick or their condition could worsen if they already are sick. To prevent this all supervisors should ensure legislations, policies and procedures are being followed at all times to ensure maximum sanitation and cleanliness. Due to the wide variety of people consuming the food in the hospital, it would be vital to take into consideration allergies some people may have and to ensure they are not given food that contains or has been made in the same area as the food they are allergic to. Although the likelihood of this happening is just a 3 due to the fact all staff should adhere to procedures and take into consideration peoples allergies anyway, the severity of this if it occurs could be a 4/5 due to the fact allergic reactions could potentially severe and some cases could even lead to death. To ensure all precautions are taken with these activities and to minimise the risks which could occur from the hazards there are many things that can be done or put into place and thus prevent patients, staff or visitors from  harm. Firstly, to prevent somebody cutting themselves while they are preparing food they should be given training before hand to ensure they are aware of how to use the equipment appropriately and make sure they know which piece of equipment is the most appropriate for the type of food they are preparing. Under the Personal Protective Equipment (PPE) policy it states that all employers have duties concerning the provisions and use of PPE at work and should provide safety training to ensure no members of staff come to any harm (hse.gov.uk, 2015). To prevent the spread of bacteria and ensure the safety of everyone who is to consume the food available, all staff should also be given training on the appropriate ways and places to store food at the right temperatures to ensure the risk of bacteria growth is minimised. Managers of businesses or areas dealing with food have a duty to ensure all food is safe to eat, all harmful or out of date food is removed and unable to be consumed and records should be kept of where the food was bought from to provide evidence if needed. This emphasises the importance of how the Food safety act 1990 should be put into place to ensure the employers and employees stick to their duties to ensure maximum safety for service users. Also hand sanitiser should be provided and available around the hospital including the kitchen to prevent cross contamination that way (legislation.gov.uk, 2015). Finally, to ensure the safety of patients and minimise the risk of something fatal happening to them, all allergies they have to foods should be recorded down and available to all kitchen staff who will be preparing food. These records should be checked regularly and all food should be prepared on separate work surfaces or chopping boards to reduce the risk of cross contamination and any allergic reactions occurring. Physical exercise class Although many form of exercise and physical movement for many patients would be greatly beneficial to their health and wellbeing, it could also prove to provide more harm to health than good if precautions are not taken. Spilt water on the floor where someone may be exercising could prove to be harmful and cause damage to their health if it isn’t seen and cleaned up by someone. Although there is just a likelihood of just 2, the severity could potentially be 3 as an injury to someone in a hospital who could be elderly  could be fatal and cause serious damage to their weak bones and skin. To minimise to risk you could put control measures into place including not allowing any food or drink to be consumed in the exercise area and to have a separate room for them to be stored. Too much exercise for some patients could over work them and cause an injury to their health if it is repeated. Exercise can cause a vast increase in both heart rate and blood pressure and could lead to ma ny serious problems if an elderly patient is doing too much. The likelihood of this causing harm to patients is 1 as both patients and staff should be aware of when too much exercise is being done and if they’re working too hard. However, if this was to occur, the severity would be 5 as weaker elderly patients could suffer from a heart attack or stroke over time if they aren’t being monitored on what exercise they’re doing and the effect it is having on their health. To control this all service providers involved in the physical activities and wellbeing of the patients should know and keep records of any conditions the patients may have which could lead to adverse effects or weaken them. All patient files should have records of what exercise patients have done to ensure they do enough to stay health but not too much that they cause themselves harm or injury. There should also be multiple members of staff observing exercise sessions to keep an eye on those more likely to over work themselves. If patients are showed how to warm up and down properly then they could injure themselves more then what they would if they warmed up. Also, if the exercise is too harsh and causes patients to have to put a lot of effort in just to complete tasks then the severity should be decreased to allow them better health. This would also help prevent a majority of excess aches and pains that would come from treating their body too harshly. Because of possible high severity of an incident is water was spilt during an exercise class, precautions should be put into place to minimise this risk and decrease the likelihood of it ever happening and injuring a patient. If drinks are restricted to one particular area or room away from where the exercise is taking place then there would be a decrease in the risk of anything being spilt in certain areas. Also if patients doing the exercise were given regular breaks to have a drink and a rest they would prevent spillages as well as prevent any pains occurring by doing too much exercise.  Secondly, the amount of exercise each individual patient is able to do would be subjective on the individual and therefore not all the patients should be forced into doing as much as others may do if they are less capable. Each patients amount of exercise should be monitored and recorded to ensure they get the right amount but are not getting too much. Also by monitoring them it would be easier to identify if any of the patients are struggling with any of the exercise methods or are in too much pain to carry on. This also applies to the third point made. The patients shouldn’t be doing exercise which is too harsh for them to carry out or if they don’t completely understand what they are doing because they could do it wrong and injure themselves severely. By allowing them to warm up and down before and after they carry out exercises and by showing them how to carry it out appropriately would lower the risk of injury and allow them to enjoy it instead of being in pain. Visiting Times Visiting hours are the busiest times in a hospital and so could potentially have many hazards involved in allowing people in and out of the hospital without appropriate precautions taken. Poor sanitation from new visitors could potentially be a big problem in a hospital as bacteria will be being bought into the wards and could enhance the spread of infections or diseases. Due to the fact a hospital has a wide variety of patients including elderly and those who have recently had surgery (meaning they may also have open wounds) the spread of bacteria could be hazardous to their health and the healing process of their injuries/wounds. The Likelihood of this happening would be 2 which is significantly low considering the change of law in 1995 which ‘provided specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings’ (Cdn.gov,2014). However the severity of a lack of sanitation would potentially be a 4/5 as the spread of bacteria and therefore infections and diseases could be harmful to people’s health and if unable to fight it off, it could possibly even shut down some peoples immune systems. To minimise the risks of this there should be hand sanitizer and hand was stations placed all around the hospital with signs so the visitors remember to clean their hands and kill off unwanted  bacteria. Security is a vital party of a hospital to ensure the safety of everyone in the building. Without a high level of security around the hospital anyone would have access into and out of the building that may not be authorised. This could mean unwanted visitors may come in and read documents they are unauthorised to, or even confused elderly patients may get out without realising it and end up injuring themselves outside without anyone there to help. This hazard would have a likelihood of 1 and a severity of a potential 4/5 because, although it is very unlikely to happen in a hospital, if a patient were to get out they could get themselves into all sorts of trouble and not realise the danger of traffic outside causing fatal injuries or maybe even death. CCTV should be in place to monitor people in the hospital and all wards should be locked so only authorised people are able to enter and exit. Damage to property could occur during visiting hours as the hospital will be crowded with a variety of people, patients and staff which could cause some things to be damaged or broken, especially when there are a large number of visitors at one time. Although this would not directly affect the health of service users or service providers, it is a hazard to the hospital and would cost a lot of money in repairs each year if there are no control measures in place. CCTV would help monitor any damage that would occur and the person behind the damage; however there should also be signs around the hospital reminding visitors to stay orderly and respectful at all times on the wards and around the building. Due to the fact that so many different people will be entering and leaving the hospital, they could be carrying many different types of bacteria into the hospital which could cause a higher risk of the spread of infection. By providing hand sanitiser and making it widely available around the hospital and wards, all visitors and people who enter the hospital will be able to reduce the amount of bacteria they are bringing in and reduce the risk of infection. There is a hand hygiene policy which should be put into place in the hospital to ensure the safety of patients and visitors. It is well known that hand hygiene is one of the most important factors in preventing the spread of infection and the unwashed hands of all healthcare professionals and visitors is the most important route of cross-infection in the  healthcare environment (Ayliffe at al, 2000). Secondly, there should be an appropriate amount of security in and around the hospital to ensure only authorised people are getting in and out of the building. CCTV cameras should be working and placed all around the building and there should be security systems put in places at all of the entrances and exits to ensure the risk of unwanted visitors or patients getting out is minimised. This would also lower the risk of any property being damaged and if it does occur it would allow the staff to look back over the footage and identify who was at fault for any damages that occur. Although the likelihood of these occurring is predictably low, it would decrease the severity of incidents which occur as it would allow people to be identified and things could be managed before they get out of hand. Dispensing of medicines Prescribing and dispensing medicine is a vital role in hospitals to ensure all patients get the medication they need to help them recover, however there could be many possible hazards involved with dispensing medicines that could cause harm to patients and their health. Prescribing patients with the wrong dosage of medication is a possible hazard as it could lead to the patient having an overdose or having serious health problems afterwards. Although the likelihood is low the severity if this does occur is high as the health effects would be very negative and put patients health into a decline. To prevent this all patients records should be checked beforehand to ensure they are being prescribed the right amount, also the medication should be double checked before being handed to the patient to ensure no mistakes have been made. If medication is left on the side it could be consumed by someone who doesn’t need it, by a visitor not knowing what it is or even by a child who mista kes them for sweets. This could cause great harm as someone who takes them could overdose and it would have negative effects on their health if taken in large quantities, especially to a child. All medication should be locked away in a cupboard or be handled/observed by a nurse or doctor at all times to ensure no one can take them when they don’t need to or accidently. Needles could be a hazard in a hospital if not used correctly or if a nurse slips while holding one. If found left lying around someone could use one and pierce their skin injecting themselves with  something they don’t know about, or even risking infection by finding a dirty needle and using that. Also if a nurse slips whilst holding on they could injure themselves or the patient by accidently stabbing the skin. This isn’t very likely to happen as all nurses should be provided the appropriate training on how to handle needles and dangerous equipment so they don’t make a mistake. Also, all needles should be di sposed of immediately after use so they cannot be used again and cause cross-contamination. The severity for all hazards which could occur for dispensing medicines are all high and so to reduce the risk of anything serious happening or anyone being injured, policies and procedures must be put into place to ensure people’s safety in the hospital. All patient records must be checked before they are prescribed with a medicine to ensure they are provided with the right type of medicine and the right dosage. If this is done wrong it could potentially eventually lead to death for an unfortunate patient and so the dispensing of medicines policy should be put into place. The policy states that all medication should be stored, administered and disposed of appropriately to ensure minimum harm and training must be given to staff to make sure they understand how vital and critical their role could be (oxfordshireccg.nhs, 2013). All medication must be locked away and not left lying around the hospital to ensure only the appropriate staff members who have had training are able to access it and no children or vulnerable people are able to pick it up off the side and take medication which could make them sick. Finally, it is evident that needles are dangerous pieces of equipment if mishandled or in the wrong hands and so the dispensing of medicines policy should be ensured and put into place because of this fact also. All used and unwanted needles should be disposed of immediately instead of being left lying around and all staff should have training before they start in their role to ensure they know how to handle a needle and to make sure they don’t injure themselves or anyone else with one (goshospital, 2015). Moving patients between wards Naturally there would be many risks involved with carrying out this activity as there are a lot of precautions that would needed to be adhered to to make  it successful. There could also be many complications to consider if you were moving an elderly, weak or disorientated patient. The likelihood of any of the hazards occurring is low due to training the staff have and regulations they follow to ensure safety. Using the appropriate equipment is vital when moving a patient between wards as it would assist to lift and transport the patient without causing any harm to the health of either the patient or the member of staff. If a nurse is moving a patient on their own without a hoist or any help, they could injure their back by not lifting properly or injure the patient if they’re lifted in the wrong way. According to the manual handling regulations 1992 all staff should be provided with PPE and training on how to carry out tasks like these to avoid injuries or harm. The likelihood of any harm occurring is low if the regulation is followed however the severity could be 3 as the damage it could cause may need special attention. Dropping patients would be a risk if they are heavy or awkward to lift between one place to another. The severity of this if it happens would be quite high depending on the state of the patient, especially if the patient being moved is elderly or fragile, they could easily break a bone or more damage would be caused if they are dropped. Busy corridors during visiting hours could cause complications when moving a patient as it would make it a lot harder. If some of the corridors or lifts are busy you would not be able to move the patient as quickly and efficiently as liked/needed. Also, if there are people milling about the corridors it would be easier for the patient to be knocked over or injured by accident. The severity of something happening while a patient is being moved between the hospital is on average 2.5 which could be severe in the wrong situations and so staff must be provided with the right equipment and training to prevent the risk of injury or the likelihood of anything happening. Under the personal protective equipment policy it states that all staff members should be provided with the correct equipment to carry out tasks to prevent injury to themselves and the other person involved (hse.gov.uk, 2015). This could include someone like a hoist to prevent injury to the staff members back and to ensure that the patient is being lifted properly. Although dropping a patient has a low likelihood and may not happen easily, if it  does it could be severely fatal to the patient and cause them a lot of injuries. The risk of this happening would also be minimised if the correct equipment was provided to ensure the staff member doesn’t assert strain on their back/ body and it ensure that there is enough power to lift the patient, especially if the member of staff isn’t very strong. Finally to make it easier to move patients it should be done when the hospital isn’t busy so there are no visitors mulling around and getting in the way. References Hse.gov.uk, (2015). Personal Protective Equipment (PPE). [online] Available at: http://www.hse.gov.uk/toolbox/ppe.htm [Accessed 15 Jan. 2015]. Gov.uk, (2015). Food safety – your responsibilities – GOV.UK. [online] Available at: https://www.gov.uk/food-safety-your-responsibilities/food-safety [Accessed 15 Jan. 2015]. Legislation.gov.uk, (2015). Food Safety Act 1990. [online] Available at: http://www.legislation.gov.uk/ukpga/1990/16/contents [Accessed 15 Jan. 2015]. Hospital, G. (2015). Sharps: disposal of used sharps – Clinical guidelines – Health professionals – Great Ormond Street Hospital. [online] Gosh.nhs.uk. Available at: http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/sharps-disposal-of-used-sharps/ [Accessed 15 Jan. 2015].

AB Thorsten Case Study Analysis

In my view, manufacture of XL-4 in Sweden is a well laid out plan and Mr. Ekstrom and his team has done good research and analysis of the project. However, I would not authorize the investment. To start with, the investment in Sweden will cost the company heavily as it will involve setting up a new factory at a whooping cost of Skr. 76.385 million.In making investments decisions, we must always consider all possible alternatives then come up with the most viable one. In this case for example, we have an option of expanding the Canadian plant which supplies the Swedish market to provide for the proposed increase in market share at a cost of only Skr. 7.183.The expansion would not only ensure minimal rise in the fixed costs but also save the company due to the economies of scale enjoyed by the Canadian plant. As compared to the five years that the company will take to recover its investments for the Swedish plant, upgrading the Canadian plant will only take 2.5 years to give the compan y a return on its investments.In addition, the company stands to benefit form the high internal rates of return in Canada which are set at 60% as opposed to the Canadian 15.7% rate of return (Torre, 1999). Incorporating the production of more XL-4 to supply the 400 tons demand in the Swedish market would therefore prove more viable as it will save more resources.The resources saved could actually be used for other purposes or be invested in projects that will bring forth higher returns within a shorter time such as investing in bonds and bank certificates. The investment in Sweden should therefore not be undertaken.According to Ekstrom and his team, the proposed project was going to be a major breakthrough for the company with a potential market of 800 tons of XL-4 in Sweden. Customer trial conducted using three major companies have revealed that indeed the technology of XL-4 can save the companies a great deal in terms of costs, material handling and fuel.Ekstrom and his team are c alling to the management to help in setting up a plant producing 400 tons of XL-4 each year at a cost of about Skr. 76.385 million in plant and machinery.Working capital of about Skr. 5.6 million will be required as working capital. Ekstrom states that the plant can recover 60% of its inventory costs from the taxable income as the Swedish law permits it. The plant's life after which it will have to be renovated to suit advancement in technology is given as seven years.By the end of the seven years, the Swedish plant should have reached a net present value of Skr. 15 million after taxes. The analysis is well performed using modern management tools and they are highly optimistic of all the figures presented.The analysis however does not include the sales projects in case the company may decide to expand to Europe and the rest of Scandinavia. On the question as to where the funds would come from, Ekstrom explained that funding could be obtained from borrowing in Swedish banks if the de mand surpassed 400 tons.The Canadian divisional management is against the investments. They give several reasons to support their arguments. Gichoud, the director of sales argues that the sales of 400 tons per year were far too optimistic citing from his experience in marketing (Torre, 1999).According to him, there is no way they can make 400 tons sales in Sweden alone while Roget's overall world market is only 600 tons. Director of manufacturing, Levanchy is also not very keen on the project saying that the manufacturing processes is very complicated for Sweden to undertake even with the presence of trained workers.The Canadian management insists that this is an expensive undertaking for the company taking up a lot of money which could have been saved if the production was done in Canada.They compare the returns and number of years taken to get a return on the investments. As opposed to Sweden which will use initial costs of Skr. 76.385, Canada would spend Skr. 7.183; get returns i n 2.5 years as opposed to Sweden's five years; get a higher rate of return on capital of 60% as compared to Sweden's 15%.The issues of uncertainty and market trends are ignored in estimating the demand of XL-4. Customer choice resulting from competition, increase in technology and changes in the markets is an important consideration before making an investment.In the event that a new product comes to the market before the seven years proposed by Ekstrom and his team are over, the division is likely to suffer losses from the huge investments. Take for example that the target 400 tons per year falls due to the changes in market or emergence of a competitor.The predicted plant's net value would be lower than Skr. 15 million. A 15% return cannot also be achieved. The management therefore ought to give an allowance for any changes in the market. This proposal takes the market as a constant playing ground which according to them will only change after seven years.