Sister Carrie :: essays research papers

In August of 1889, Carrie Meeber leaves her small town to find employment in the city of Chicago. Theodore Dreiser, the author of Sister Carrie, informs the reader that, "Self-interest with her was high, but not strong. It was nevertheless her guiding characteristic.". With her youth and innocence she hopes to seek employment so that she can get and buy all the nice things that she wants. Carrie does not have any idea how hard this is going to be. When she tries to find a job, she is scared. Carrie has no skills to offer an employer, no job experience, and her clothing was of poor quality. Chicago was a large city, but society at that time did not have many job opportunities for working women. The only jobs that Carrie could possibly get were in the factories that, paid low wages, had poor working conditions, and long hours. She knew that after she paid rent to her brother-in-law, she would have very little left to buy all the beautiful things that she longed for. When Carrie took the job at the shoe factory, she did not like the hard work and considered the other women who worked there to be common. When winter arrived, Carrie got sick and stayed home from work which caused her to lose her job. On the train to Chicago, Carrie had met a traveling salesman, Charlie H. Drouet. She is impressed by the way he talks and dresses. When they meet again, Drouet is aware of her beauty and innocence and he hopes to charm and seduce her. He "lends" Carrie money to buy nice winter clothes, treats her to fine meals, takes her to the theater, and shows her the sights of Chicago. Because Carrie is young and inexperienced in the world of men, she is not wise enough to understand where all Drouet's attention is leading toward. Although she senses that the money should be given back, her desire and longing for the good things in life are so powerful that she ignores her beliefs in what is right and wrong. Unable to find another job, Carries is forced to make a decision, returning to Wisconsin or letting Drouet keep her as his mistress. Choosing to remain with Drouet was an extraordinary decision. This went against everything society taught. It was unthinkable for any decent woman to live with a man without marriage.

Wordsworth: Tintern Abbey And Lyrical Ballads :: essays research papers

Born in 1770 at Cockermouth in the heart of the Lakes District in England. William Wordsworth grew up in a rustic society and his beautiful and ageless poetry often reflect this. Wordsworth’s mother died in 1778 and in 1779 he was sent to grammar school in Hawkshead. Wordsworth’s father died in 1783, leaving his uncles as guardians. They tried to guide him towards a career in law or in the church and he was accepted into Cambridge in 1787. Wordsworth was uninspired to work towards a career he had little interest in and subsequently his grades, which bordered on the average, reflected this. Before completing his final term of college Wordsworth went for a walking tour of Europe and finally received his degree in 1791 but had no direct plans for his future. He returned to France in 1791 and stayed a full year, during this time became an enthusiastic advocate of the French Revolution. Money concerns forced him to return to England and he was unable to return to France unt il 1802 due to war breaking out between the two countries. In 1795 two things happened that ultimately changed the course of Wordsworth’s life. In August of 1795 a young friend whom Wordsworth had been nursing died of tuberculosis and left him a grant of 900 pounds. His friend had hoped that with this money Wordsworth would be able to devote his life to poetry, and in August of 1795 Wordsworth met Samuel Taylor Coleridge. Over the next two years their friendship would grow and in 1797 William Wordsworth and his sister Dorothy moved to Alfoxden House, which was only a few miles from Coleridge’s home. The creative partnership between these two young poets would eventuate in the first publishing of Lyrical Ballads. The publication of Lyrical Ballads represented a turning point for English poetry. It was released anonymously on October 4th, 1798 and the learned old guard of literary England was mostly unaware that a form of â€Å"literary revolution† had taken place. Previous ages had considered the aim of poetry to be used as a tool to change people’s behaviour or as a learning mechanism. Wordsworth launched the Romantic Era of poetry and paved the way for many of the romantic poets that came after him. John Keats and Percy Bysshe Shelley to name but two. Coleridge encouraged Wordsworth to write a preface to Lyrical Ballads. A preface that would explain the work contained within the collection.

Subsistence Agriculture

How is intensive subsistence agriculture distinguished from extensive subsistence cropping? Why, in your opinion, have such different land use forms developed in separate areas of the warm, moist tropics? Intensive agriculture is the primary subsistence pattern of large-scale, populous societies. It results in much more food being produced per acre compared to other subsistence patterns. Beginning about 5,000 years ago, the development of intensive farming methods became necessary as the human population grew in some major river valleys to levels beyond the carrying capacity of the environment using horticulture and pastoralism.The transition to intensive agriculture was originally made possible by water management systems and the domestication of large animals for pulling plows. This allowed farmers to get below the top soil to bring buried nutrients up to the surface. It also allowed farmers to maintain much larger fields of crops. Subsistence agriculture is performed by one family , typically. Enough food is generated for that one family to subsist or survive.This is different than agriculture practiced in western capitalist countries, wherein the product is economically profitable, and not just limited to an amount of food produced that allows one family to subsist. Humid tropic conditions are found over nearly 50 per cent of the tropical land mass and 20 per cent of the earth's total land surface an area of about 3 billion hectares. Tropical Central and South America contain about 45 per cent of the world's humid tropics, Africa about 30 percent, and Asia about 25 per cent.As many as 62 countries are located partly or entirely within the humid tropics. Agricultural systems and techniques that have evolved from ancient times to meet the special environmental conditions of the humid tropics include the paddy rice of South-East Asia, terrace, mound, and drained field systems, raised bed systems (such as the chinampas of Mexico and Central America), and a varie ty of agroforestry, shifting cultivation, home garden, and natural forest systems.These systems share common elements, such as high retention of essential nutrients, maintenance of vegetative cover, high diversity of crops and crop varieties, complex spatial and temporal cropping patterns, and the integration of domestic and wild animals into the system. Changes and land transformation in the tropics are occurring at a much faster rate; in some cases, areas are completely transformed and often degraded beyond economically feasible restoration within one generation.Many of the traditional and ancient systems have been deeply modified or abandoned owing to economic, cultural, and social pressures. Question #2 What economic or ecological problems can you cite that do or might affect the gathering industries of forestry and fishing in North America? What is the maximum sustainable yield? Is that concept related to the problems you discerned? The agriculture, forestry, and fishing sector s are the cornerstone of industries that produce and market food, fiber, and fuel.Collectively, the three sectors make up a huge component of the U. S. economy and are a major employer in the United States. Annually, these industries generate more than $1 trillion and create exports exceeding $68 billion. The National Institute for Occupational Safety and Health (NIOSH) estimates that more than 5. 5 million workers are employed in agriculture, forestry, and fishing. These sectors also consistently rank in the top six most hazardous occupations; fishermen and loggers have the highest fatality rates.Collectively, the three sectors consistently have the highest injury and fatality rates of any U. S. industries, so the overall effect on the safety and health of exposed populations in agricultural, forestry, and fishing worksites is enormous. In population ecology and economics, the maximum sustainable yield or MSY is, theoretically, the largest catch that can be taken from a fishery sto ck over an indefinite period. Under the assumption of logistic growth, the MSY will be exactly at half the carrying capacity of a species, as this is the stage at when population growth is highest.The maximum sustainable yield is usually higher than the optimum sustainable yield. This logistic model of growth is produced by a population introduced to a new habitat or with very poor numbers going through a lag phase of slow growth at first. Once it reaches a foothold population it will go through a rapid growth rate that will start to level off once the species approaches carrying capacity. The idea of maximum sustained yield is to decrease population density to the point of highest growth rate possible.This changes the number of the population, but the new number can be maintained indefinitely, ideally. MSY is extensively used for fisheries management. MSY in most modern fisheries models occurs at around 30% of the unexploited population size. This fraction differs among populations depending on the life history of the species and the age-specific selectivity of the fishing method. However, the approach has been widely criticized as ignoring several key factors involved in fisheries management and has led to the devastating collapse of many fisheries.As a simple calculation, it ignores the size and age of the animal being taken, its reproductive status, and it focuses solely on the species in question, ignoring the damage to the ecosystem caused by the designated level of exploitation and the issue of by catch. Question #3 How, in your opinion, do the concepts or practices of comparative advantage and outsources affect the industrial structure of advanced and developing countries? In economics, the theory of comparative advantage refers to the ability of a person or a country to produce a particular good or service at a lower marginal and opportunity cost over another.Even if one country is more efficient in the production of all goods than the other, both cou ntries will still gain by trading with each other, as long as they have different relative efficiencies. The outsourcing of U. S. jobs overseas is part of an economic movement that promises a better life — indeed, a new beginning — for many people in developing countries. It gives technologically savvy young people in countries like India livelihoods that move them into the ranks of the middle class. On the other hand, workers in industrialized nations are being displaced in large numbers.Comparably well-paying jobs are not being created fast enough to make up for the positions headed offshore. Outsourcing has gained notoriety in recent months because of the accelerating volume of job transfers overseas and the sudden vulnerability of high-tech and service occupations that were once thought immune to trade displacement. Services that used to be nontradable (back-office operations, call centers, data management and accounting sectors) have now been made fully tradable b ecause of advances in communications and computational technologies.Location is increasingly insignificant in the provision of these services. Moreover, the ready availability of large pools of technically capable and computer-savvy workers overseas has eroded what traditionally had been considered the distinct preserve of the U. S. and other developed countries: sophisticated, high-end technologies. Developed countries, too, have been major beneficiaries, since their comparative advantage lies in the trade of manufactures, services, intellectual property and capital. Industrialized countries have been vocal in promoting trade openness in these areas and have fiercely defended the need to respect and enforce intellectual property rights (e. g. , pharmaceutical patents and software).There are, of course, adjustment costs that accompany trade, since segments of local populations are hurt by open markets. Despite these costs, poor countries have subscribed to international trade rules and have slowly but steadily opened their markets in those economic sectors (especially manufactures and services) where industrialized countries have much to gain.Having reaped enormous profits from free trade in those areas where they enjoy a distinct comparative advantage, developed countries violate procedural justice whenever they curtail or suppress the liberalization of markets in which they have a comparative disadvantage. This is exactly what the European Union, Japan and the U. S. have done in food markets, making poor countries unable fully to reap the gains of their comparative advantage (agricultural crops). The industrialized nations have steadfastly refused to open up trade in farm goods in an effort to protect farmers from being displaced by global trade. Works Cited:* Jorge, Niosi & Majlinda, Zhequ. â€Å"Aerospace Clusters: Local or Global Knowledge Spillovers? † March 2005. . * Virgin, Bill. â€Å"Global Economy Complicates Outsourcing. † Seattlepi. com. 24 January 2006. . * Lee, Dwight R. â€Å"Comparative Advantage Continued† The Freeman: Ideas on Liberty – October 1999. http://www. fee. org/publications/the-freeman/article. asp? aid=4962. * Wikipedia.

Neanderthals and Human Evolution Essay

The Neanderthals are an extinct species in the homo genus. They lived during the Pleistocene age. The Neanderthals are believed to have lived in most of Eurasia from 120,000 years ago to about 30,000 years ago. They were a more advanced pre-modern variation of the homo genus. The reason they are viewed as more advanced than other Pre-modern hominids is because they made tools, buried their dead they also lived to around forty years of age. This is quite long compared to their contemporaries. Their tools and artifacts characterize what is known as the Mousterian. To be precise the Neanderthals created flake tools. Tools made by the breakage of flakes of stone off of a larger rock. One example of these are the hand axes and smaller tools with a sharp cutting edge. They were large game hunters who were specially adapted to thrive in the frigid conditions of the middle Pleistocene in Europe. They seem to have originally evolved in Europe at around 250,000 years ago, but latter expanded into southwest Asia. The Neanderthals appear to have been the first hominids who deliberately buried their dead. The graves sometimes included flowers, tools, and food. This could possibly signify a belief in an afterlife. There is also some evidence that they would as a group care for injured or deficient members of their community showing that they had likely had the capacity for compassion. The first Neanderthal remains were discovered in the Neander valley in Germany. The remains show that the Neanderthals were about five feet tall with a stocky and powerful build. While they did have prominent brow ridges and an occipital bun their brain size is comparable to modern day human size. Their population went in to decline and eventually became extinct when the Homo sapiens began to move in to their territory. There are a couple theories on what occurred at this point. One theory is that Homo sapiens either killed off the Neanderthals or took over so much of the land that the Neanderthals couldn’t survive on what was left to them.

Acute Care: Care Implementation and Evaluation.

Acute Care: Care Implementation and Evaluation. This assignment will be based around the care that is implemented and evaluated, within a National Health Service (NHS) Foundation Trust (FT). The focus of the assignment will be to discuss two health problems that a selected patient has and has been admitted to the FT with. The selected patient had been admitted into FT with breathing difficulties and also suffering from dehydration. The assignment will focus upon the goals that are set for the patient whilst in FT and the reasons why the goals are set. The patho-physiology of the two problems will also be discussed and also the care that had been implemented to achieve the goals. Throughout the assignment, the patient will be known as Terry with the permission from the patients parents, according to the Nursing and Midwifery Council (NMC, 2008) confidentiality guidelines. The assignment will also aim to discuss the role of the Health Care Professional (HCP) in planning appropriate care for the patient, in particular, using the assessment technique of goal setting by using Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T) target planning technique (Roper et al, 1996). The reasons for planning care can involve the HCP assisting in preventing potential health problems, for example, breathing difficulties for the patient becoming worse and to also assist in solving problems where possible. Care planning can also assist in alleviating possible health problems that cannot be solved by HCP’ s and so will need the assistance of Multi Disciplinary Team (MDT) , for example, consultant, physiotherapists to further improve an develop the care plan. Terry is a 42 year old single man, who lives with his parents, and has suffered from a number of illnesses throughout his life, for example, optical glyoma, Deep Vein Thrombosis (DVT), epilepsy, and also learning difficulties. Terry has difficulty with breathing, and this appears to have been caused by respiratory rhythmicity centre in the medulla and the pons (areas of the brain which can control breathing) and these appeared to not be working in the correct way (MacKenzie, 1996; Waugh et al 2006). Terry’s reduced neurological status was due to trauma that had been suffered in the motor pathways, and the peripheral nerves, in the brain (Iggulden, 2006). Terry was admitted to the Intensive Care Unit (ICU), within the NHS FT, suffering from numerous problems that were mainly neurological. Terry's admission to ICU was due to the increased breathing difficulties that he was experiencing. Due to the breathing difficulties, the nursing team, and Terry's consultant, agreed that it would be best for Terry to have a percutaneous tracheostomy inserted. Due to Terry suffering from a probable cerebellar lesion, severe learning difficulties and poor communication skills; it did appear that Terry could not understand what the nursing team were informing him of, the medication that he needed and the care that was being delivered (NMC, 2008). Due to the fact that Terry appeared not to be able to understand or communicate with the nursing team, and that his parents and family members were with him, the nursing team, and myself, ensured that the parents, and family members, were informed of what was happening regarding the care that had given to Terry. The fact that Terry could not understand the instructions given to him, due to learning difficulties, consent to insert a percutaneous tracheostomy had to be given from Terry’s parents, to the Consultant (NMC, 2008). The tracheostomy that had been inserted into Terry helped the nursing team in the ICU and on the ward, to oxygenate Terry to the optimum level of 98%. The tracheostomy, also ensured that Terry was able to maintain a breathing rate of between 35 and 50 breathes per minute (Bailey, 2008). Although Terry was able to maintain a respiration rate, the normal respiration rate for an adult is normally between 14 and 18 breathes per minute (Bailey, 2008). The nursing care that had been implemented included ensuring that oxygen was flowing through the tracheostomy and this ensured that Terry had enough oxygen in his body for his heart and lungs to function, and that the heart pumped the oxygenated blood around the body (Machin et al 1996; Roper et al, 1996; Bailey et al 2008). Due to Terry’s respiration centre not working properly, and suffering from breathing problems, this meant that gaseous exchange was impaired, and led to a risk of respiratory acidosis. Gaseous exchange is where the oxygen goes into the alveoli capillaries, and the carbon dioxide is moved out of these capillaries (Bailey, 2008). The respiration centre is made up of a group of nerve cells, which are in the reticular endothelial system of the medulla oblongata. These cells send impulses to the motor neurones, via the spinal cord, and are then sent to the intercostal muscles (Bailey, 2008). The trauma that Terry had suffered with, was a possible cerebella lesion when he was a child. When Terry was admitted, his oxygen level was 82% (Bailey, 2008). The goal for this problem was to keep Terry's respiration and oxygenation at a level that was suitable. A suitable level of respiration for an adult is between 14 and 18 breaths per minute, and an oxygen level of around 97 to 98% (Bailey, 2008). The patho-physiology of breathing difficulties includes a lack of oxygen to the tissues of the body, including the brain, and even death (MacKenzie, 1996; Waugh et al 2006). Due to Terry haiving an oxygen saturation level of 82%, we set the goal that we would aim for and set this goal with his parents. The goal that the nurses had set with Terry's parents, due to the fact that Terry had learning difficulties and could not set the goal with the nurses. The goal was set as the nurses aimed to have his oxygen saturation level between 95% and 98% within two hours. The goal had to fit in with the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T) target planning technique (Roper et al, 1996; Faulkner, 2000). Terry's sitting and lying position had to be carefully planned around him, this ensured that we as a nursing team where able to ensure that his lungs would expand to their optimum and to maintain a satisfactory oxygen saturation levels within his body (Roper et al 1996; Machin et al 1996; Hackman, 2008). The normal oxygen saturation level is between 95% and 98% (Woodrow, 1999). The fact that Terry had an oxygen saturation level of just 82%, the Consultant had to prescribe oxygen for Terry. The oxygen that had been prescribed for Terry, had been increased from 24% to 40% (NMC, 2002). The consultant advised us to ensure that the oxygen was to be humidified. Due to Terry having the tracheostomy, we were able to deliver the oxygen with the use of a tracheostomy mask and what is called a T-piece circuit (Machin et al 1996; Dolan, 2008; Soady, 2008). The consultant also advised the nursing team to ensure that neurological observation's were undertaken, especially the oxygen saturation levels, every 15 minutes until Terry's oxygen saturation levels had risen to 96% (Machin et al 1996; Dolan, 2008; Soady, 2008) The neurological observations with regards to the goal, meant that the nurses were able to deliver oxygen, which would enable the oxygen saturation level to be maintained (Machin et al 1996; Dolan, 2008; Soady, 2008). Once the nursing team had ensured that the oxygen had been delivered to Terry at 40% and was humidified, they then ensured that 15 minute observations were maintained. The Consultant had to ensure that the 40% oxygen that he had verbally prescribed, was documented and written clearly in Terry's medical notes and on his prescription sheet (NMC, 2002; NMC, 2004). The fact that Terry had been prescribed the higher rate of oxygen, this needed to be clearly documented within Terry’s nursing notes (NMC, 2004). The documentation was needed, so that the other nurses were aware of the change. Although the observations had been maintained every 15 minutes, with regards to Terry's oxygen saturation levels, this ensured that the nursing team maintained Terry's neurological observation's (Machin et al 1996; Dolan, 2008; Soady, 2008). The goal that had been set by the nursing team and Terry's parent's, for his oxygenation levels did fit into the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T) target planning technique. The goal was specific, measurable and realistic for Terry and the nursing team caring for him, as well as being achievable in the time frame that had been set by Terry's Consultant (Faulkner, 2000). Due to the fact that the nursing team had achieved this goal for Terry, proved that the nursing care and interventions made by the nursing team, were effective. The nursing care and interventions were effective enough, for this goal to have been met (Roper et al 1996). The goal that had been set for Terry with regards to his oxygen saturation level, had to be documented. The goal had to be documented within the nursing notes, which the nursing team had to document clearly. The nursing team were able to hand over the information about Terry, to the nursing staff that would have been caring for him on the next shift. (NMC, 2004) The second of Terry's problem's is that he was at risk of dehydration, this was due to the fact that Terry could not swallow as he had a reduced neurological status. The fact that Terry could not swallow was due to the motor area of cerebral cortex of his brain, did not work in the way that it should (Waugh et al 2006). The motor area of the cerebral cortex of Terry's brain, was damaged due to the increase in epileptic seizures. Dehydration can cause the cells to deplete, due to not having enough fluids for them to replenish. The cells replenish in the sense that the fluids help the cells to regenerate, regulate the body temperature, to dilute the waste products within the body, and to maintain the level of fluids within the tissue fluid and blood (Waugh et al 2006). The patho-physiology of dehydration includes thirst, the mouth being dry, the tongue would look leathery, and fluid from within the tissues and skin would be withdrawn (Roper et al 1996; Brown, 1997; Day, 1997). Due to Terry not being able to drink fluids, he was not able to regulate his own body temperature, nor was his body able to dilute the poisonous substances in his body (Waugh et al 2006). Due to fluid being withdrawn from the body, this would mean that the body would not be able to maintain its own volume in blood (Roper et al 1996). The patho-physiology of not having enough fluids also includes the kidneys would excrete less than they normally would; a person would be lethargic; the skin would lose its elasticity and would appear to be more wrinkled (Roper et al 1996; Brown, 1997; Day, 1997). If Terry had been suffering from dehydration, his would have looked sunken and his urine output would be reduced as well as being more concentrated. If Terry had been suffering from a severe case of dehydration, his blood volume would be reduced. If the blood volume was to cause a circulation deficiency, this would cause his kidneys to fail to excrete the waste products that they normally excrete (Roper et al 1996; Brown, 1997; Day, 1997). Due to Terry not drinking the recommended two litres of fluids per day, we had to set a goal. The goal that had to be set, had to be set with Terry's parents (Roper et al 1996). The goal for the second problem, was to prevent dehydration during Terry's stay in hospital, through ensuring that Intravenous Saline was delivered through venous access (Dougherty et al 2008). The Intravenous Saline had to be delivered through venous access, due to the fact that this was the most effective way in which to infuse fluids. The fluids had to be infused over a period of 24 hours, due to the volume of the fluids. The Consultant prescribed two litres of Intravenous Saline, and the nursing team ensured that it was delivered (NMC, 2002; NMC, 2004; Dougherty et al 2008). Due to the fact that the fluids needed to be infused, the nursing team ensured that the fluids were delivered through the venous access, by using an infusion pump. The pump that was used by the nursing team, was the volumetric pump. The volumetric pumps allow health care professionals to administer large amounts of infusions, and this is why were used this type of pump to deliver the fluids that Terry needed over a 24 hour period (Sarpal, 2008). Due to the fact that the nursing team were delivering Intravenous Saline to Terry, it was important that this was documented by the nursing team within his nursing notes. The fact that this was documented in Terry's notes, ensured that the information was handed over to the nursing team on the next shift (NMC, 2004). It was important hat a fluid balance chart was also documented, as this would help the nursing team to ensure that the amount of input from fluids, was similar to Terry's urine output. The fact that the nursing team were able to monitor Terry's fluid input and output, ensured that his body was not retaining any of those fluids within a 24 hour period (Hunt et al 2008). The goal for dehydrat ion by providing two litres of Intravenous Saline over a 24 hour period, did fit into the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T) target planning technique. This was due to the fact that the goal was specific, measurable and time set. The goal was achievable and realistic, but only while Terry's venous access was as good as it was. When Terry's venous access for the Intravenous Saline to be delivered was poor, this meant that the nursing team had to find another route to deliver these fluids. The nursing team had to re-set the goal for delivering the Intravenous Saline. (Faulkner, 2000) Due to the fact that the nursing team could not deliver the Intravenous Saline through the venous route, had to be documented. The nursing team had to document the fact that Terry had poor venous access, and that they had asked his Consultant to review Terry (NMC, 2004). When Terry's Consultant had been to review him, the Consultant advised the nursing team to deliver the Saline through Terry's PEG tube. Terry's Consultant had to document the fact, that he had advised the nursing team to deliver the Saline through Terry's PEG tube. The Consultant also had to document that his advice was due to Terry's poor venous access in Terry's medical notes, and he had to document this on the prescription chart (NMC, 2004). Due to Terry having a Percutaneous Endoscopic Gastrostomy (PEG), the nursing team and Terry's parents re-set the goal to deliver the fluids that Terry needed (Faulkner, 2000). The new goal that had been set, was to deliver one litre of Intravenous Saline through Terry's PEG tube. The litre of Saline was delivered to Terry through his PEG tube, over an 8 hour period rather than a 24 hour period. Even though the nursing team had to deliver the fluids through the PEG tube, they had to ensure that the goal did fit into the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique. This goal was specific, measurable, achievable, realistic and time set for Terry and the nursing team (Faulkner, 2000). Before the nursing team could deliver the Saline through Terry's Percutaneous Endoscopic Gastrostomy, the Saline had to be prescribed by his Consultant. The Consultant had to document the Saline on Terry's prescription chart, and also had to document the route that the nursing team were to deliver the Saline (NMC, 2004). The Saline that had been prescribed by Terry's Consultant, also had to document in Terry's medical notes, that he had prescribed this and also document the route that he had advised to the nursing team (NMC, 2002; NMC, 2004). When the nursing staff had commenced the delivery of the Saline through the Percutaneous Endoscopic Gastrostomy (PEG) tube, they themselves had to document this. The nursing team had to document the Saline running through the PEG tube, to enable the nursing notes for Terry to be up-to-date. The nursing team to document the amount of Saline that was to run through Terry's PEG tube, and what time the Saline infusion began. The nursing team also had to document how much of the Saline was to be infused in any one hour, when the Saline was due to finish, as well as document the lot number and expiry date that were on the bag of Saline. NMC, 2002; NMC, 2004) The documentation of the infusion of the Saline running through Terry's Percutaneous Endoscopic Gastrostomy (PEG) tube, ensured that the nursing team could hand over the information to the nursing team that were due to care for Terry on the next shift (NMC, 2004). The goal that had been re-set by the nursing team, and Terry's parents, fitted in with the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique (Faulkner, 2000). The fact that the goal had to be re-set, ensured that the nursing team had been able to deliver the Saline through the Percutaneous Endoscopic Grastrostomy (PEG) tube. The goal to deliver the Saline through the PEG tube, had been specific, measurable, realistic and time set for Terry and the nursing team. This goal had been achieved, due to the fact that the care that the nursing team had been able to deliver the Saline in the time that they had set with Terry's parents (Faulkner, 2000). Due to the goal being achieved in the time frame that had been set by the nursing team, and Terry's parents, meant that the nursing team had been able to deliver the care that had been needed to achieve this goal (Faulkner, 2000). I am now at the point in this assignment when I can reflect. For my reflection, I will be using the Gibb's Reflective Cycle to reflect upon this assignment, which is documented within his book that was published in 1988 and entitled Learning by Doing: A Guide To Teaching and Learning Methods (Gibb's, 1998). Due to the fact that Terry ad a number of health problems, I had a hard task of choosing which two that I would use. I did have to think long and hard about which two health problems that I would use, but I was given permission from his parents to enable me to write this assignment (NMC, 2008). The two health problems that I had chosen, were breathing difficulties and dehydration. Due to the breathing difficulties that Terry suffered with, meant that his oxygen saturation levels were low. Due to Terry's breathing difficulties, this is why the nursing team, and his Consultant, had to gain consent from Terry's parents, to insert a percutaneous tracheostomy. The fact that the tracheostomy was inserted soon after Terry's admission, enabled the nursing staff within the ITU and the ward of the NHS FT, to ensure that Terry's oxygen saturation levels were maintained. Therefore, this is the reason why a goal was set. Due to a goal being set for Terry's oxygen saturation levels to be maintained, provides evidence to show that the nursing interventions were effective. The effectiveness of these nursing interventions, proves that goals that are set for an individual patient can also be met. The second goal that had been set for Terry by the nursing team, and his parents, had fitted in with the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique. Due to the fact that this goal was only partially met, did not necessarily mean that the care that had been delivered to Terry, had been ineffective. The care that had been delivered to Terry had been effective, but the goal could no longer be achieved through the venous route, due to the fact that Terry's venous access was poor. Due to Terry's poor venous access, this is why the nursing team had to re-set the goal with his parents. The goal that had to be re-set, fitted in with the Specific, Measurable, Achievable, Realistic and Time Set (S. M. A. R. T. ) target planning technique. The goal had been re-set, and had also been achieved in the time frame that had been set with Terry's parents. The goal that had been re-set, had been achieved in the time frame that had been set. The goal had been achieved due to the fact that, the nursing team were able to deliver the Intravenous Saline through the Percutaneous Endoscopic Gastrostomy (PEG) that Terry had in place. The fact that the nursing team could not achieve this goal when it had first been set, was not an issue that could have been anticipated. Even though nursing teams can not anticipate why the goals are not met, they can re-set the goal and in time, meet the new goal. Therefore, the nursing care and interventions that are delivered, do make nursing care effective. Documentation of all care from the nursing team was important, due to the fact that the nursing team on one shift, were able to inform the nursing team of the next shift. Documentation also ensures that if the nursing team were unsure of any test results, that they were able to look over the nursing notes to ensure they knew where we were up to with the patient. The Consultants documentation in the patients medical notes, ensured that other doctors or Consultants were also aware of the patients condition and any tests that may have been ordered. Bibliography. Bailey, M. , Crossen, S. , Holland, J. , & Hollis, V. (2008) Observation's in Dougherty, L & Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 25, Pages 496-544. Oxford: Wiley-Blackwell Publishing. Brown, A. (1997) Caring for the Patient Undergoing Surgery in Walsh, M. (ed) (1997) Watson's Clinical Nursing and Related Sciences. 5th ed. Chapter 10, Pages 232-259. Edinburgh, Bailliere Tindall. Day, S. (1997) Caring for the Patient with a Nutritional Disorder in Walsh, M. (ed) (1997) Watson's Clinical Nursing and Related Sciences. 5th ed. Chapter 16, Pages 552-570. Edinburgh, Bailliere Tindall. Dolan, S. (2008) Respiratory Therapy in Dougherty, L & Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 38, Pages 749-765. Oxford: Wiley-Blackwell Publishing. Dougherty, L. , Farley, A. , Hopwood, L. & Sarpal, N. (2008) Drug Administration: General Principles in Dougherty, L & Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 11, Pages 202-251. Oxford: Wiley-Blackwell Publishing. Faulkner, A. (2000) Nursing: The Reflective Approach to Adult Nursing Practice. 2nd ed. Gloucestershire: Stanley Thornes Publishers Limited. Gibb's, G (1988) Learning by Doing: A Guide To Teaching and Learning Methods. Oxford: Further Education Unit, Oxford Polytechnic. Hackman, D. 2008) Positioning in Dougherty, L & Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 34, Pages 668-689. Oxford: Wiley-Blackwell Publishing. Hunt, P. , Kelynack, J. & Stevens, A. M. (2008) The Unconscious Patient in Dougherty, L & Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 44, Pages 849-853. Oxford: Wiley-Blackwell Publishing. Iggulden, H. (2006) Care Of The Neurological Patient. Oxford: Blackwell Publishing Limited. Local NHS Trust (2004) NHS Trust – Recommended Protocol for Care of the Patient with a PEG. Liverpool: Local NHS Trust. Machin, J. , Rhys-Evans, F. (1996) Tracheostomy Care and Laryngectomy Voice Rehabilitation in Mallet, J. , Bailey, C. (eds) (1996) The Royal Marsden NHS Trust – Manual of Clinical Nursing Procedures. Chapter 41, Pages 550-565. London: Blackwell Science Limited. MacKenzie, E. (1996) Respiratory Therapy in Mallet, J. , Bailey, C. (eds) (1996) The Royal Marsden NHS Trust – Manual of Clinical Nursing Procedures. Chapter 35, Pages 474-480. London: Blackwell Science Limited. Nursing and Midwifery Council (2002) Guidelines for the Administration of Medicines. London: NMC. Nursing and Midwifery Council (2004) Guidelines for Records and Record Keeping. London: NMC. Nursing and Midwifery Council (2008) The Code – Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: Nursing and Midwifery Council. Roper, N. , Logan, W. W. , Tierney, A. J. (1996) The Elements of Nursing. 4th ed. America: Churchill Livingstone. Sarpal, N. (2008) Drug Administration: Delivery (Infusion Devices) in Dougherty, L & Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 13, Pages 290-309. Oxford: Wiley-Blackwell Publishing. Soady, C. (2008) Tracheostomy Care and Laryngectomy Care in Dougherty, L & Lister, S. (eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Chapter 42, Pages 809-829. Oxford: Wiley-Blackwell Publishing. Waugh, A. , Grant, A. (2006) Ross and Wilson Anatomy and Physiology in Health and Illness. 10th ed. Philadelphia: Churchill Livingstone. Woodrow, P. (1999) Pulse Oximetry. Nursing Standard. Volume 13, Number 42. Pages 42-46. Woodrow, P. (2006) Intensive Care Nursing – A Framework for Practice. 2nd ed. Oxon: Rouledge.

Case Scenario: Grocery, Inc. Essay

Scenario: Grocery, Inc. is a retail grocery store chain based in Any State; U.S.A. Grocery has stores throughout the United States. Grocery has written contracts with many different vendors to purchase the products they sell in their stores. Vendors range from individuals to international corporations. Tom Green works as the produce manager for the store in My Town, U.S.A. Jeff Fresh, 17 years old, is spending his summer vacation working for Tom in the produce department. Assignment: Using the scenario above, give detailed answers to the following questions: 1. Does Article 2 of the Uniform Commercial Code (UCC) apply to the contracts between Grocery and its vendors? Do common law contracts apply? Explain, in detail, why or why not. Your answer should compare and contrast common law contracts and UCC Article 2 contracts. Article 2 of the Code applies only to transactions in goods. The sale of goods is the transfer of ownership to tangible personal property in exchange for money, other goods or the performance of services. The law of sales of goods is codified in Article 2 of the Uniform Commercial Code While the law of sales is based on the fundamental principles of contract and personal property it has been modified to accommodate current practices of merchants. Therefore, the situation depends on whether or not a contract is for the sale of goods. If it is not, then the principles of common law that were discussed in Part 3, Contracts, apply. If the contract is one for the sale of goods, then the Code applies. 2. Grocery contracted with Masterpiece Construction to renovate the store on Main Street in My Town. Masterpiece, unable to complete the renovation within the six-month time limit due to a sudden increase in jobs, sub-contracted the entire job to Build Them To Fall. Grocery was unaware of the sub-contract. When Grocery realized (due to the poor quality of work) that Build, not Masterpiece, was handling the renovation, Grocery petitioned the court for an injunction and then sued Masterpiece for breach of contract and specific performance. Masterpiece argued that it had a right to delegate  the duties of the contract, or in the alternative, to discharge the contract due to commercial impracticability. Who wins? Explain your answer. In such a case as this one, Grocery would win a suit for specific performance but not necessarily for breach of contract. The only situation that would restrict Masterpiece from delegating the duties to another company is if the actual contract specified that Masterpiece had to perform the work. If the contract did specify that Masterpiece had to perform the work, they would be responsible for breach of contract; otherwise, they would have the right to delegate the work to a third party without penalty. Though Masterpiece might have had the right to sub-contract the renovation to another company, it does not release Masterpiece from liability. When a delegatee (Build) accepts an assignment from a delegator (Masterpiece), the delegatee assumes responsibility for performance. This assumption does not release the delegator from liability but instead, creates a situation where both the delegator and delegatee owe duties to the obligee. If a situation arise, such as this one, and the delegatee refuses to pay, the delegator can still be held responsible. The only way Masterpiece can lose the title of obligor and not be considered liable for specific performance is to be discharged from performance by novation. A novation is â€Å"a particular type of substituted contract in which the obligee agrees to discharge the original obligor and to substitute a new obligor in his place† (Mallor, Barnes, Bowers, & Langvardt, 2003). If Build and Grocery both agree to the novation, Masterpiece would have no further obligation under the contract and Grocery would have to hold Build responsible for performance. 3. At the end of the summer, Jeff Fresh had earned enough money to put a down payment on a car. He decided to continue working part time during school to earn money for the car payments. Jeff purchased a car from Smooth Sales Used Cars. Smooth did not ask Jeff how old he was; the salesman assumed he had reached the age of majority. Jeff paid the down payment and signed the contract stating that he would make payments of $200 each month. Six months later Jeff lost his job and could no longer make the payments. Jeff took the car back to Smooth and said he wanted to cancel the contract and that he wanted his money back. What are the possible outcomes? Explain your answers. As a minor, Jeff is entitled cancel the contract by disaffirming it and receiving the amount he paid for the car in exchange for returning the car back to Smooth Sales Used Cars. As per the textbook, â€Å"Upon disaffirmance, each party has the duty to return to the other any consideration that the other has given. This means that the minor must return any consideration given to him by the adult that remains in his possession.† Jeff should receive his down payment and $1200 back from Smooth Sales Used Cars. Since the car is not considered a necessary, the following law for minor does not apply. â€Å"The minor’s recovery of the full purchase price is subject to a deduction for the minor’s use of the consideration he or she received under the contract, or the depreciation or deterioration of the consideration in his or her possession.† Necessaries are basics things needed for survival and not supplied by the minor’s parents. Examples of necessaries a re food, clothing, shelter, medical care, tools of the minor’s trade, and basic education or vocational training. 4. Grocery has a written contract with Cereal, Inc. to purchase 20 cases of cereal per month at $22 per case. The contract does not state the types of cereal or how the 20 cases will be divided up between Grocery’s 20 stores in Any State. After a flood, Cereal suffers severe water damage in its warehouse. With the exception of Soggy Flakes, Cereal does not have enough undamaged cereal to comply with its Grocery contract. On the day delivery was due; Grocery receives 10 cases of Soggy Flakes at the three stores located in My Town and two stores in Your Town. Twelve days before delivery was due, Grocery had requested, by facsimile, that 15 cases containing a variety of cereals be delivered to the five stores listed above with the remaining five cases going to Grocery’s warehouse in Corp Town. Grocery wants to reject the shipments of Soggy Flakes and cancel its contract with Cereal. Discuss Grocery’s rights under contract law. Cereal argues that based on the gap-fil ling rule, it had the right to modify the terms of the contract. Analyze the gap filling provisions of UCC Article 2 as they pertain to the terms of this contract. What rights and/or defenses, if any, does Cereal have under contract law? Analyze the remedies available to Grocery and/or Cereal. Explain all answers in detail. There are two sides to this scenario in which both parties have a valid reason to alter as well as even terminate the contract. From the Cereal, Inc perspective, if unforeseen conditions cause a delay or the inability to make delivery of the goods and thus make performance impracticable, the seller is excused from making delivery. However, if a seller’s capacity to deliver is only partially affected the seller must allocate production in any fair and reasonable manner among his customers. Cereal did abide by it and delivered the 10 cases of Soggy Flakes due to the fact that those cases were not destroyed, leaving them deliverable. However, the seller (Cereal, Inc) has the option of including any regular customer not then under contract in his allocation scheme. When the seller allocates production, he must notify the buyers [2-615]. When a buyer receives this notice, the buyer may either terminate the contract or agree to accept the allocation [2-616]. The Code recognizes the fact that parties to sales contracts frequently omit terms from their agreements or state terms in an indefinite or unclear manner. The Code deals with these situations by filling in the blanks with common trade practices. In this case, no length of time was addressed in the contract for Grocery to continue purchase products from Cereal. With this, Grocery did have a right to terminate at any given point of time. 5. Tom Green spent his time away from work on his hobby, model trains. His train set was very large and consisted of rare and one-of-a-kind trains. One day, while visiting with a fellow train hobbyist Harry, Tom said, â€Å"When I retire in two years from Grocery, I’m going to sell my trains and spend the rest of my years traveling on real trains.† Tom then told Harry that he was the only person he planned to offer his trains to because he knew Harry would take good care of them. Harry said he looked forward to the day when he could buy the trains. Harry then spent the next two years and most of his savings building a new 2,000 sq. ft. room onto his house to make room for the trains. When Harry told Tom that he was building the new room, Tom just smiled. Tom also heard that Harry had borrowed money from his aunt to buy the trains. When Tom retired, he sold his trains to David. Harry sued Tom claiming breach of contract, or in the alternative, for promissory estoppel. Wh o wins? Explain your answer. Promissory estoppel is when a person relies on a promise made by another even though the promise may not be sufficient to be considered a contract. The elements of promissory estoppel are a promise, reliance on that promise, and injustice that comes from that promise. These elements are apparent in this situation. Tom told Harry that he was the only person that he wanted to leave his trains to, that was the promise. Harry saying that he looked forward to buying the trains and then building a room for them was the reliance on the promise. Finally, Tom selling the trains to someone else is the injustice and the breaking of the promise. Harry should not be suing for breach of contract, but rather for promissory estoppel. There is no official breach of contract in this situation, but it is a clear example of promissory estoppel. If the lawsuit were for promissory estoppel, then Harry would win. The lawsuit being for breach of contract might cause Harry to lose because it is not complete breach of contract. 6. Organic Farms shipped a truckload of peaches to Grocery using an independent trucker. In route, the truck broke down and the shipment was delayed three days. The peaches were spoiled when they arrived. The terms of the contract were F.O.B. Who bears the risk? Explain your answer. Under F.O.B. terms, the seller is responsible for the costs and the risks associated with transporting the goods to the designated area assigned by the buyer. Once the shipment arrives at the designated area, the buyer assumes responsibility for the goods and any shipping of the goods that might occur afterwards. Since the goods were still in route to the destination (Grocery), Organic Farms is responsible for the loss and Grocery is not obligated to pay anything. Organic Farms might be able to recover the loss from the independent tucking company but this does not affect the destination contract that places the risk of loss on Organic Farms. Organic Farms would still be required to compensate Grocery for the loss, while they potentially seek reimbursement from the independent trucking company. 7. Discuss the different warranties that apply to Grocery’s business. Explain your answer in detail. There are several different warranties present in Grocery’s business. The first is express warranties. Express warranties are present because the goods conform to the description and because oftentimes, samples are available of the goods. Implied warranty is also present in this situation because the goods in Grocery’s business are merchantable. Finally, implied warranty of fitness is present here. This is apparent because the seller, Grocery’s store, knows that there is a purpose for the buyer to buy the goods. Grocery’s store also knows that the buyer is relying on the goods that are being sold and that the buyer is relying on Grocery’s for the goods. 8. Supplier, Inc., a large wholesaler, had a contract with Grocery. Supplier sued Grocery for breach of contract when Grocery failed to place an order for goods by a specific date as specified in the contract. Each order was to be worth at least $550. Grocery contended that the contract Bill Green signed was a standard preprinted supply contract without specifics regarding time of order and quantity. Green had authority to sign a standard supply contract, but could not authorize specific terms. This was unknown to Supplier. Supplier argued that the terms were â€Å"boilerplate† and could therefore be modified by acceptance. Supplier offered oral testimony at trial to prove that Green agreed to the modifications. Is there a contract? If so, what are the terms? Explain your answers. Also, discuss the use of Supplier’s oral testimony at trial. In this case, there is no contract since the quantity is not specified. When there is indefinite quantity, the buyer does not have to buy from the seller even if there if a minimum purchase amount required and therefore, the quantity required is illusory and unenforceable. As per the textbook, â€Å"it is fundamental that a contract is unenforceable if it fails to obligate the parties to do anything.† The oral testimony from Supplier Inc. cannot be used. Any modifications to a sales contract needs to be in writing. Verbal modifications will not be enforceable. References: Business Law: The Ethical, Global, and E-commerce Environment (12th ed.). Jane P. Mallor, A. James Barnes, L. Thomas Bowers, & Arlen W. Langvardt McGraw Hill, 2004 Burr Ridge, IL University of Phoenix Material: Case Scenario: Grocery, Inc, Susan Brown Parker. Retrieved from http://www.phoenix.edu

Abstract Health Care

MIS 6324 Business Intelligence Dr. Syam Menon Term Project SUBMITTED BY : Group 6 Swetha, Priya, Ram, Vishal, Madan Business Intelligence in Health Care Management The  health  care system is more complex than most people know. Its business model is different from most  businesses  in that its consumers dont usually come willingly. That, plus not getting paid what they bill, hurts cash flow makes health care a shaky business. With uncertain revenue, costs not entirely within their control, and regulatory issues, health care management problems arent always easy to fix. Forward-thinking healthcare organizations realize that data and, thus, business intelligence (BI) is at the center of informed and precise decision-making that will improve patient and service outcomes in addition to ensuring their organizations’ future. This paper gives an insight into which business intelligence tools are currently being used in healthcare and their effectiveness in terms of sustaining the businesses of those organizations that use these tools. The paper also deals with common problems faced while implementing these techniques to patients’ data and ways to overcome problems. Outdated information management strategies and invalid statistics cause serious problems in investigating health outcomes and negotiating reimbursements. Predictive modeling, however, goes beyond standard regression techniques, expanding advanced analytical options for better, faster decision making. Predictive models use a variety of tools to deliver more accurate, long-range views of treatments and costs. Also there are many new reporting technologies designed to improve the productivity of business analysts and preserve information consistency throughout an organization. These analytical tools, the advantages vs. problems during implementation and their ability to shape the future of healthcare industry are focus of this paper.