Universal Health Care

Introduction The United States national health care is in need of reforms due to the spiraling cost of health care and around 46 million Americans are not insured, while several other millions are underinsured. During the 2008 presidential elections, the issue of health reforms was among the top priority issues in all campaigns.Advertising We will write a custom coursework sample on Universal Health Care specifically for you for only $16.05 $11/page Learn More The United States directs a lot of money to healthcare, although the life expectancy of women and the infant mortality are similar to those of other developed nations (Kaiser, 2009). Public Opinion After being elected as the president, Obama and the democrats came up with elaborate health reforms aimed at creating a universal healthcare system in United States. The program packaged as an economic stimuli entailed a public insurance modeled after Medicare, whereby all legal residents of the United S tates below 65 years lacking access to insurance coverage in their workplaces or any Medicare at all, would be in a position to buy a health plan from the National Health Insurance ran by the government (Gelman, Lee and Ghitza, 2010). The healthcare plan was to be financed by money collected from taxes meaning that citizens would be paying higher taxes to ensure all Americans have access to health insurance. A poll carried out by Associated Press running from September 2009 up to March 2010 found out that 40 to 50 percent of Americans whose opinion was sought, opposed the public health plan (Gelman, Lee and Ghitza, 2010). Most of those opposed to the healthcare plan were republicans and those with strong conservative views. The opposition to the health care reforms stems from the public opinion that the present medical industry is doing well as it is fuelled by consumer choice and competition. By implementing a universal health care, many people argue that the capitalistic and democ ratic foundation of the United States economy that has been in place ever since its establishment would be threatened.Advertising Looking for coursework on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Success of the universal health plan can only be achieved by a change in opinion at an individual, organization and community level. According to National Institutes of Cancer, health programs that are successful use strategic planning and deeply understand the health problem targeted and the environment in which they are found (Croyle, 2005). This means that those formulating the universal health plan should have educated the diverse American population on its complexities and its benefits, to win over the public opinion. Success of Canada and Germany Universal Health Unlike the US, Germany and Canada have successful universal health plans, with Germany using a multiple-payer plan. The Germany and Canadian governments pay h ealthcare cost for every person from the taxes collected and also set all fees charged by doctors and hospitals, making healthcare affordable. The success of the universal care in Canada can be attributed to the positive public opinion of the country’s citizens. A public opinion carried out in 2005 showed that 85 percent of Canadians were of the opinion that scrapping off the public health care would result in a fundamental change in Canada , than eliminating the other six policies stated such as concluding peacekeeping missions or abandoning the official languages of Canada; French and English (Soroka, 2007). During this survey, 87 percent of the respondents viewed the elimination of the universal health plan as negative, validating the strong public support of the Canadian health plan (Soroka, 2007). Apart from this, most Canadians cited healthcare as the most essential problem to the country. They also overwhelmingly voted health care as the most important policy issue to the country during the opinion poll, showing that Canadians have continuously showed interest in their health care. The Communications Canada polling report of 2002 that captured the responses of prioritized issues against the government performance showed that healthcare was the highest prioritized policy issue and the government got the lowest ratings on the same.Advertising We will write a custom coursework sample on Universal Health Care specifically for you for only $16.05 $11/page Learn More A thorough analysis on the public opinion of the healthcare system carried out in 2002 by Matthew Mendelssohn of Queens University and the report later on handed over to the Romanow commission, showed that Canadians tremendously supported the universal healthcare (Soroka, 2007). According to the report, Canadians also raised concerns about the sustainability and quality of healthcare and urged the government to put more effort so as to improve the system. The government responded to the public concerns raised in the Romanow commission report by implementing some reforms such as formulating the 10 Year Plan to Strengthen Health Care during a ministers meeting in 2003. The success of the Canadian universal plan can be attributed to the constant concerns raised by citizens, the positive public opinion, as well as their continued confidence with the health care system (Soroka, 2007). References Croyle, R. (2005). Theory at a glance: a guide for promotion (Second Edition). National Cancer Institute, Washington DC. Gelman, A., Lee, D., Ghitza, Y. (2010). Public opinion on health care reform. Columbia University, New York. Kaiser, H. (2009). National health insurance: a brief history of reform efforts in the U.S. Kaiser Family Foundation, California. Soroka, S. (2007). Canadian perceptions of the health care system. Health Council of Canada, Quebec.Advertising Looking for coursework on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More This coursework on Universal Health Care was written and submitted by user Ezra Burch to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

The eNotes Blog 7 Misunderstood Characters inLiterature

7 Misunderstood Characters inLiterature First impressions can be misleading- in life, but in fiction as well. Sometimes, a character may gain a reputation that’s not exactly true to the text. We owe it to ourselves and to the world of literature to give such characters a couple more chapters before drawing conclusions. That’s why we’ve rounded up a collection of commonly misunderstood characters. From Frankenstein’s monster to Mr. Darcy, here are some characters who deserve to be read between the lines. 1. Frankenstein by Mary Shelley The character: Frankenstein’s monster The misunderstanding: After Victor Frankenstein creates his so-called â€Å"monster† from various corpses, he flees from it. The monster, free to wander the world, is met with cruelty and fear. Everyone sees an eight-foot-tall, yellowish, shriveled beast of a man and immediately thinks that he means harm. The truth: He just wants to love, be loved, and discover the truth about his creation. (But he does kill some people, so maybe the folks in the book weren’t wrong to go running.) 2. The Yellow Wallpaper by Charlotte Perkins Gilman The character: Narrator The misunderstanding: The unnamed protagonist of this stream-of-consciousness short story is a young woman being treated for her â€Å"nervous condition† with forced bed rest and isolation. Though she protests, she is treated like a child until she literally goes insane, thanks to her husband John’s patronizing and misogynistic medical practices. The truth: The protagonist is more competent and capable than she’s given credit for and knows her health better than anyone. If her husband had listened to her and allowed her to do some work or get out of the house while depressed, she maybe wouldn’t have so thoroughly lost her grip on reality. 3. Pride and Prejudice by Jane Austen The character: Mr. Darcy The misunderstanding: Just about the richest character in the book, Mr. Darcy seems rude, standoffish, and stuck-up to just about everyone else in the novel. In Elizabeth Bennet’s eyes, he seems incapable of saying anything nice or enjoying anyone’s presence. The truth: On a second read-through, it begins to become clear that that he’s not so much stuck-up as he is adorably socially inept, especially after having been chastised by Elizabeth. He’s just doing his best. 4. A Christmas Carol by Charles Dickens The character: Ebenezer Scrooge The misunderstanding: He hates Christmas and, it seems, all things good and happy. To everyone in the town, he’s a Christmas-hating, little-boy-mistreating, downright-evil old humbug who only thinks about money. The truth: Admittedly he’s nasty, but once you peel back the layers of trauma, you’ll see he’s a complex person who has been hurt and is actually capable of doing nice things for other people. 5. The Metamorphosis by Franz Kafka The character: Gregor Samsa The misunderstanding: After Gregor Samsa mysteriously becomes a gigantic insect (literally), his entire family shuns him and treats him like, well, a giant disgusting bug. And in doing so, they seem to forget that he is still their beloved son and brother. The truth: Even though he’s developed a new fondness for music, as well as an appetite for rotten garbage, he’s still the same person- more or less. And, just like any person, he suffers when ostracized. 6. Hamlet by William Shakespeare The character: Ophelia The misunderstanding: For apparently no reason, Ophelia goes insane, then kills herself. The truth: A kind, obedient, and innocent person, Ophelia falls victim to the political intrigue of Claudius’s court. Her overbearing father and brother chastise her for the affection she has for Hamlet, and when she becomes distraught after Hamlet begins mistreating her, she kills herself, having had no one around who would listen to her. 7. Miss Brill by Katherine Mansfield The character: Miss Brill The misunderstanding: The titular Miss Brill spends a day in the park, people-watching and enjoying the sights. But to those around her, she seems out-of-place, sitting alone on a park bench wearing her over-the-top fur. All in all, she comes across as off-putting and maybe even a little crazy. The truth: She just wants to be included in the world around her, creating fantasies of how she’s connected to everyone. But she ends up realizing more than ever how much of an outcast she is, and in turn, she ends up getting a glimpse of how cruel people can be. So, which characters do you owe a second chance? Are there any other characters out there you feel get a bad rap? Let us know in the comments!

Module 6 DQ1 and 2 Article Example | Topics and Well Written Essays - 500 words

Module 6 DQ1 and 2 - Article Example Such things as antivirus software and password or smart card logons help facilitate this. Data redundancy is backing up necessary computerized information so that it is available elsewhere in the event of a disaster. Most use what is known as a COOP site, an offsite storage area that is reasonably safe from fire, flood, and a myriad of other problems. Because mechanical items fail, data redundancy also can refer to having extra servers and computer equipment available so that the facility can continue to operate (IAHSS 2012). After the devastating effects on healthcare caused by Hurricanes Sandy and Katrina, those administrators would probably agree with this author that redundancy is the most important of the three areas discussed in this paper. HIPAA 1996 and its successor, PPACA 2009 (Obama Care) do tend to place what appears to be a rather large burden on healthcare providers concerning privacy (HHS 2013). However, as described above, the laws as written attempt to help keep providers and patients alike comfortable in the knowledge that necessary personal information (such as social security numbers) is not released to the public, as was the case with the VA employee who lost thousands of SSN’s. The Health Insurance Portability and Accountability Act (HIPAA) provides a list of what it refers to as "identifiable patient information†. Although the law allows the use of the information for clinical use, the Act entails strict privacy rules that must be adhered to (HHS 2013). It specifically disallows release of such information, except in those particular circumstances as outlined. This includes what HIPAA refers to as â€Å"demographic† information as that is defined as those statistics or characteristics that define a certain segment of the population. Such items as name, address, Social Security Number, and date of birth are specified, as well as

Analysis of Research Articles Essay Example | Topics and Well Written Essays - 1500 words

Analysis of Research Articles - Essay Example The use of likert scale response questions makes it easier for the respondents to answer the questions in addition to improving the questionnaire response rate (Crotty 1998). The researcher employed the use of questionnaire in this study in that, respondents respond according to their own opinions and are not controlled as in interviews and observations. The researcher had the questionnaire tested for reliability and validity. According to Greenfield (2002), for any research findings to gain the required scientific rigor, the research tool should be test-retested through a pilot study or through an expert’s forum to harmonize issues. This practice is done to ensure that the results from the tool can be generalized to fit the whole population. However, in terms of sampling, the researcher failed in that, different companies’ employees should have participated in the study to ensure non-biasness and rigidity in the generalization of the survey findings. Further, the researcher should have allowed the staff members to make an informed decision on whether to participate or not according to Denzin’s (1997) arguments. This practice is highly recommended in research ethics as it protects the participant from coercion and ensures justice of the participants. Another important aspect left out in the methodology is the fact that the participants had to be informed that the data collected from them was to be used confidentially and for the sole purpose of the study. This would ensure tangible, valid and reliable data is collected since if assured of confidentiality, then they may be biased to avoid victimization by the company. Further, a lesser sample would have been more economical in terms of time and resource requirements (Kaplan 2004). In this case, an un-biased sample would have resulted into the same kind of results as a complete count. Further, the sample should have had the same or nearly the same number of males as females. In the

Should spanking young children be considered a form of child abuse Essay

Should spanking young children be considered a form of child abuse - Essay Example The grey area involved in spanking comes into play when deciding at what point spanking is actually no longer spanking but hitting or beating. Also, at what point is a spanking deemed necessary and appropriate. Statistically speaking, â€Å"more than 4 out of 5 American adults, who were spanked as children, felt that it was an effective form of discipline. (Spare the Rod, 2008) This statistic however, leaves room for the one out of five who felt that spanking was not effective or that it was a form of abuse. Many parents feel that the only affective means of discipline is in fact, spanking. Essentially, spanking is a physical way to let the child know that their actions are not acceptable. Children rely on their parents for protection, comfort, love and basic needs. When a child is being corrected by a parent and is then spanked, the level of praise or acceptance a child normally feels is diminished and there is then a threat of losing the acceptance that the child felt before the punishment. Still other parents and many experts are overtly opposed to spankings as they feel that any type of physical punishment is abusive. Certainly, a fine line exists between an appropriate disciplinary spanking and abuse, but a good parent can make that distinction. Many critics feel that spanking leads to adult dysfunction, but are unable to distinguish between appropriate and controlled spanking as loving discipline as opposed to hitting or punishing out of anger. It can be said that punishment of any form out of anger is in fact, abuse as opposed to discipline, which should be done out of love. It has been argued by some within many faiths, that parents that do not use spanking as a form or correction are doing a disservice to their children and to God. According to Christians, God’s law prescribes that corporal punishment is the appropriate form of punishment that parents should use. Many Christians feel that they

Hazard Identification in a Combined Cycle Power Plant

Hazard Identification in a Combined Cycle Power Plant Fire and Explosion Hazard Identification in a Combined Cycle Power Plant ABSTRACT INTRODUCTION Fire and Explosion are the most prevalent accidents at chemical and process industries which can cause serious damage to properties and loss of productions. Fire and explosion hazards are considered as the first and second major hazards in chemical industries [1]. Besides that, release of toxic materials are prevalent accidents in process industries too. Among these three, fire is the most common but explosion is more significant in terms of its damage potential, often leading to fatalities and damage to property [2]. Also, fire can cause human fatalities, serious injuries, financial losses due to damage of equipment and disruption of productive activity, loss of employment and sometimes irreparable damage to the environment and also other costs such as insurance premiums would increase. Hence, identification of danger factors and the ways of controlling fire and explosion accidents in such these industries are very important [3]. In this paper, the hazard of fire and explosion accid ents at processing sections of a combined cycle power plant using one of the well-known hazard index which is called Dow fire and explosion index, has been estimated. The under studying power plant is comprised process unites and facilities such as gas units, vapor units and hydrocarbon storage site. Natural gas and Gasoline are the main chemical materials that are used and stored in these facilities which consume in Turbine units as fuel to produce electrical energy. The Dow Fire and Explosion Index (hereafter called the DOW Index) is a common hazard index [4]. Hazard indices using the numerical values to classify the various sections of process industries in the terms of fire and explosion and identify process areas with a high risk and estimate the losses due to fire and explosion. However quantify risks in different sectors of the industry make it easy to interpret the results [5-7]. The Dow index has been used in many researches across the world. Among those are the studies of Gupta et al. (1997), Roy et al. (2003), Bernatik and Libisova (2004), and Suardin et al. (2007) [8-12]. These researches showed that this index has been used for different purposes such as rating and classifying the danger, determining the economic impacts, and designing safe processing industries too. Suardin et al. concluded that by applying the (FEI) index, it is possible to design safer and more economical reactor and distillation system [13]. This index has been also used in a number of studies in Iran, especially in the chemical industries. The research of Atrkar Roshan et al. (2013), Jafari et al. (2012) and also Ahmadi et al. (2008 2012) are some examples [13-16]. In this study, the fire and explosion hazards of some process units at a combined cycle power plant using Dow index has been estimated. MATERIALS AND METHODS Process Unit Selection The fire and explosion risk analysis system is a step-by-step objective evaluation of the realistic fire, explosion and reactivity potential of process equipment and its contents. The quantitative measurements used in the analysis are based on historic loss data, the energy potential of the material under study and the extent to which loss prevention practices are currently applied [5]. Dow index was developed by the Dow Chemical Company in the 1960s as a tool for plant engineers to give relative value to the risk of individual process unit losses due to fires and explosions and to communicate these risk to management in terms easily understood, i.e., potential of financial losses due to lost production and damage to plant facilities [17]. In fact, Dow index rates the potential occurrence of fire and explosion hazards in a process unit and estimates the costs in money due to fire and explosion accidents in chemical and/or process units. The latest version of Dow fire and explosion in dex guideline published in 1994 was applied to calculate the fire and explosion index at Turbine processes and Gasoline storage site. The general procedure of Dow index calculation is shown in Figure.1 Figure.1: Dow Index Procedure (Dow’s Guideline, 1994) Process Unit Hazards Factor The Dow FEI is calculated from equation (1): Equation (1): FEI = MF Ãâ€" F1 Ãâ€" F2 = MF Ãâ€" F3 Where MF (Material Factor) is a measure of the potential energy released from the fire or explosion produced by combustion or chemical reactions. It is determined by considering the flammability and reactivity of the materials that are exist at process unit and has a range of 1 ±40 [4, 5]. F1 (General process hazard factor) is a measure of reaction and process unit characteristics such as exothermic or endothermic reactions, handling or transfer of chemical materials, outdoor or indoor units, access condition in emergency situations, drainage and spill control at process unit. F2 (Special process hazard) is a measure of chemical material and operations specifications such as toxicity, amount of flammable materials in process or storage unit, use and distance to fired equipment, dust explosion, extreme pressure or sub-atmospheric pressure, equipment’s corrosion and erosion, leakage-joints and packing, rotating equipment and etc. Each item is represented in terms of â€Å"pen alties† and â€Å"credit factors† [14]. F3 (Process unit hazard factor) is derived from the multiplying the F1 and F2 values. According to the value of the calculated index, the fire and explosion hazard of a pertinent process unit is rated as light, moderate, intermediate, heavy or severe which are shown in Table.1 [5]. Table 1: Degree of Hazard for FEI (Dow’s Guideline, 1994) Degree of Hazard for FEI FEI Range Degree of Hazard 1-60 Light 61-96 Moderate 97-127 Intermediate 128-158 Heavy 159-up Severe After the calculation of Dow index, FEI will be able to determine the radius and area of exposure to fire and explosion incidents using equations (2) and (3): Equation (2): Radius of Exposure = 0.84 Ãâ€" Dow FEI Equation (3): Area of Exposure Where, R is the radius of exposure [5]. Loss Control Credit Factors The preventive and protective measures that have been incorporated in the process design to reduce the fire and explosion hazard are taken into account in the form of Loss Control Credit Factors (LCCF). There are three categories of loss control features including; C1 (process control) which is derived from the multiplying by factors such as emergency power, cooling, explosion control, emergency shutdown, computer control, inert gas, operation instructions and procedures, reactive chemical review and other process hazard analysis. C2 (material isolation) is comprised from remote control valves, dump / blowdown, drainage and interlock items and C3 (fire protection) which accounts for leak detection (alarm and shutdown), fireproofing for structural steel, fire water supply, special systems, sprinkler systems, water curtains, foam, portable fire extinguishers / fire monitors and cable fire protection (instrumentation and electrical cables) [5, 17, 18]. Loss control credit factor is calc ulated using equation (4): Equation (4): LCCF: C1Ãâ€"C2Ãâ€"C3 Loss Control features should be selected for the contribution they will actually make to reducing or controlling the unit hazards being evaluated [5]. As well as the Damage Factor is determined from the Process Unit Hazards Factor (F3) and the Material Factor (MF) and referring to Figure 2. Damage Factor represents the overall effect of fire and blast damage resulting from a release of fuel or reactive energy from a Process Unit [5]. MPPD and BI Calculations The replacement value of the equipment within the exposed area in combination with damage factor can be used to derive the Base maximum probable property damage (Base MPPD) [4]. The actual maximum probable property damage (Actual MPPD) is then calculated by multiplying the Base MPPD by loss credit control factor which is shown in equation (5). The Actual MPPD is used to predict the maximum number of days which is the time required to rebuild the plant to its original capacity, the Maximum probable days outage (MPDO). The MPDO is used to estimate the financial loss due to the lost production: the Business interruption (BI) [18]. BI is the lost profit to the company due to an incident and is calculated by the equation (6): Equation (5): Actual MPPD = Base MPPD Ãâ€" loss control credit factor Equation (6): BI ($US) = Ãâ€" VPM Ãâ€" 0.7 Where VPM is the value of production per month. Figure 2: Damage Factor Determination (Dow’s Guideline, 1994) RESULTS The results of Dow index calculations for under studying units are illustrated in Table 2. For all under studying units, radius of exposure, area of exposure, value of area of exposure, damage factor, Base maximum probable property damage (MPPD), loss control credit factor, Actual MPPD, Days outage and BI loss in terms of US dollar has been calculated which are shown in Table 2. Turbine Unit (Methane) Methane as fuel in Turbine unit with the material factor of 21 had a highest material factor among chemical materials that were presented in process units and subsequently based on the result of Dow index value of 321, it can be indicated that Turbine unit with Methane as fuel, had the highest degree of fire and explosion risk (as mentioned in Table 3 which is considered severe). For Turbine unit with Methane fuel, radius exposure and area of exposure were calculated which are 82.2 m and 21227 m2, respectively. Also for this unit, value of area of exposure was estimated 13.8 US million dollars and damage factor is gained 0.83. After that, Base MPPD by multiplying the value of area of exposure and damage factor is derived which is 11.45 US million dollars. Loss control credit factor is estimated 0.36 which by multiplying it into Base MPPD, Actual MMPD is derived 4.12 US million dollars. Maximum probable days outage for this unit is estimated 50 days and finally the loss due to unit pa uses (BI) is calculated 3.03 US million dollars. Turbine Unit (Gasoline) After that, when Turbine unit uses gasoline as fuel has the second risk ranking with Dow index value of 236 and Gasoline Storage Site Gasoline storage site with Dow index value of 56.8 was the least which is ranked as light fire and explosion risk. Table 2: Results of Dow Fire and Explosion Index Calculation Process Unit Turbine Unit Turbine Unit Storage Vessels Major Material Methane[1] Gasoline Gasoline Material Factor 21 16 16 FEI Index 321 236 56.8 Exposure Radius (m) 82.2 60.42 14.5 Area of Exposure (m2) 21227 11468 660 Value of Area of Exposure ($MM) 13.8 7.45 13.58 Damage Factor 0.83 0.68 0.42 Base MPPD ($MM) 11.45 5.07 5.70 Loss Control Credit Factors 0.36 0.36 0.65 Actual MPPD ($MM) 4.12 1.82 3.70 Days Outage (MPDO) 50 30 25 BI Loss ($MM) 3.03 1.82 8.26 Table 3: The Fire and Explosion Index Ranking at Under Studying Units Process Unit FEI Index Degree of Hazard for FEI Light Moderate Intermediate Heavy Severe Turbine Unit (Methane) 321 Turbine Unit (Gasoline) 236 Storage Vessels 56.8   Discussion According to the results of this study, Turbine unit with Methane fuel has the highest degree of fire and explosion risk. Therefore appropriate control and protective measures should be establish to reduce the fire and explosion risks in this unit. In the other hand, according to the gotten results, Turbine units have the sever ranking of fire and explosion risk and in spite of gasoline storage site is considered as lowest risk of fire and explosion, this unit constrains most losses in money due to business interruption. The reason of this matter is related to the great amount of gasoline fuel which is deposited in 4 vessels and it is about 17 million liters. Conclusion In the present study, the Dow FEI in process units of a combined cycle power plant were calculated. Based on the results, Turbine unit that uses Methane as fuel with Dow index value of 321 has the highest degree of fire and explosion risk. Another Turbine unit with gasoline fuel is ranked second with Dow index value of 236 and severe fire and explosion risk and finally, gasoline storage unit is recognized the least unit in consideration of fire and explosion risk. The findings of this study can be used to estimate the loss due to fire and explosion and also can be used as insurance premium. References 1.Ahmadi, S., J. Adl, and M. Ghalehnovi, Relative ranking of fire and explosion in a petrochemical industry by fire and explosion index. THE JOURNAL OF QAZVIN UNIVERSITY OF MEDICAL SCIENCES, 2011. 2.Khan, F.I. and S. Abbasi, Major accidents in process industries and an analysis of causes and consequences. Journal of Loss Prevention in the Process Industries, 1999. 12: p. 361-378. 3.Mahoney, D.G., Large property damage losses in the hydrocarbon-chemical industries: A thirty-year review. 1997: M M Protection Consultants. 4.Khan, F., T. Husain, and S. Abbasi, Safety Weighted Hazard Index (SWeHI): A New, User-friendly Tool for Swift yet Comprehensive Hazard Identification and Safety Evaluation in Chemical Process Industrie. Process Safety and Environmental Protection, 2001. 79(2): p. 65-80. 5.Chemicals, D., Dow’s fire explosion index hazard classification guide. AIChE Technical Manual, 1994. 6.Etowa, C., et al., Quantification of inherent safety aspects of the Dow indices. Journal of Loss Prevention in the process Industries, 2002. 15(6): p. 477-487. 7.Khan, F.I., R. Sadiq, and P.R. Amyotte, Evaluation of available indices for inherently safer design options. Process Safety Progress, 2003. 22(2): p. 83-97. 8.Gupta, J.P., Application of DOWs fire and explosion index hazard classification guide to process plants in the developing countries. Journal of Loss Prevention in the Process Industries, 1997. 10(1): p. 7-15. 9.Roy, P.K., A. Bhatt, and C. Rajagopal, Quantitative risk assessment for accidental release of titanium tetrachloride in a titanium sponge production plant. Journal of hazardous materials, 2003. 102(2): p. 167-186. 10.Bernatik, A. and M. Libisova, Loss prevention in heavy industry: risk assessment of large gasholders. Journal of Loss Prevention in the Process Industries, 2004. 17(4): p. 271-278. 11.Suardin, J., M. Sam Mannan, and M. El-Halwagi, The integration of Dows fire and explosion index (FEI) into process design and optimization to achieve inherently safer design. Journal of loss prevention in the process industries, 2007. 20(1): p. 79-90. 12.Suardin, J., The Integration of Dow’s Fire and Explosion Index into Process Design and Optimization to Achieve an Inherently Safer Design. 2005, Texas AM University. 13.Roshan, S.A. and M.J. Gharedagh, Economic Consequence Analysis of Fire and Explosion in Petrochemical Feed and Product Pipelines Network. 2013. 14.Jafari, M.J., M. Zarei, and M. Movahhedi, The Credit of Fire and Explosion Index for Risk Assessment of Iso-Max Unit in an Oil Refinery. International Journal of Occupational Hygiene, 2012. 4(1): p. 10-16. 15.Ahmadi, S., et al., Determination of fire and explosion loss in a chemical industry by fire and explosion index. The Journal of Qazvin University of Medical Sciences, 2012. 15(4): p. 68-76. 16.Ahmadi, S., J. Adl, and S. Varmazyar, Risk Quantitative Determination of Fire and Explosion in a Process Unit By Dow’s Fire and Explosion Index. Iran Occupational Health Journal, 2008. 5(1): p. 39-46. 17.Jensen, N. and S.B. Jà ¸rgensen, Taking credit for loss control measures in the plant with the likely loss fire and explosion index (LL-FEI). Process Safety and Environmental Protection, 2007. 85(1): p. 51-58. 18.Sinnott, R., Coulson Richardsons chemical engineering. 1996: Butterworth-Heinemann. [1] Methane is the major component by more than 96 % Concentration of Natural Gas which is consumed as fuel at Turbine Unit in hot seasons of year, alternatively. Hence the MF of natural gas was determined from Methane which has the highest MF value.

Traffic Signal/Road Marking Detection and Processing :: Driving Traffic Signals Argumentative Essays

Traffic Signal/Road Marking Detection and Processing Humans have visual cues that they naturally use to perceive their motion through the environment. There are numerous human factors that are associated with being able to navigate a vehicle safely while adhering to signal lights, signs and other traffic road markings. There needs to be vast improvement in the way that information is presented to drivers for many reasons. One example is that the placing of the sun during a particular part of the day prohibits one from distinguishing whether a traffic light is green or red. The elderly have difficulties reading certain signs or differentiating among the color of signal lights, even with their glasses on. Most everyone has less visual acuity at night and certain road markings or traffic lights are harder to perceive. Color blind people canÕt always tell the difference between a red light and a green light, and they may also have a hard time seeing brake lights, blinkers, etc. All of the situations mentioned above can lead to serious fatal accidents. Extensive research in this area has been conducted for many years and is still going on today. Driving is a complex task which involves a variety of interactive parallel and serial processes that depend on various visual functions. Vision plays a vital role in safe, proficient driving even though there are other sensory and motor systems that are used in driving. It has been estimated that 90% of the information used in driving is visual and that visual information alone might be sufficient for safe driving (Fox, 1997). Beyond these general statements, it has been difficult to determine what specific visual skills are used for driving that are important. Safe and efficient driving is Òa matter of perceptual-motor sensitivity to perceptual laws of locomotion in a spatiotemporal fieldÓ (Fox, 1997). Specifically, the driver must be aware of two fields: (1) the field of safe travel and (2) the minimum stopping zone. The field of safe travel refers to a field surrounded by actual and potential obstacles to locomotion. The minimum stopping zone refers to a field that is determined by variables like speed, visual/road conditions, etc. Car crashes occur when another car or stationary object is not perceived accurately. In order to guide a vehicle, the driver must (1) abstract important sensory information from the environment, (2) process this information accordingly to complete visuospatial tasks and (3) act accordingly to achieve task goals.

Marketing the X-Box

Introduction The main aim of this project is to help me understand the marketing process, which is required to launch a new successful product. The new product I will be marketing is the Microsoft X Box. Millions of new products are launched every year worldwide. Most are unsuccessful and are taken off the market after a while. Without marketing a new product is very likely to fail. Microsoft needs to market their products because there is so much choice in the market. Marketing will give Microsoft a better understanding of the market and customers needs and wants. I will be acting as the marketing director within this company. Marketing is basically the management process, which is responsible for identifying potentially profitable products and them selling them to customers. Microsoft is a multi-national successful company with substantial profits and is aiming at a mass market with the X Box rather than a niche market. Microsoft will want to sell to as many places as possible. A marketing plan would help improve the company's performance and increase sales. There's a lot more to marketing than just advertising, marketing involves†¦ > Researching the market and finding out what customers want. > Developing and designing a product that satisfies customers and consumers. > Producing the right amount and to the right quality of the product. > Making sure that the customer is aware of the product and what its about. > Getting the price right so that the product is affordable to customers, but also allows the business to be profitable. > Ensuring that the product is on sale in places convenient to the customers. This can be summed up using a term called the marketing mix or the 4P's, place, product, price and promotion. Place A product is unlikely to be successful if customers find it difficult to purchase. So place is a vital part of the marketing mix. Microsoft needs to consider how to get their products to the customer. Channels of distribution need to be efficient and effective. For a product to sell it must be in the right place at the right time for customers to buy. Microsoft needs to find out where it's convenient for customers to buy the X Box. The X Box is likely to sell more in Electronics Boutique rather than New Look because people go into New Look to buy clothes not games consoles, but people do go into Electronics Boutique to buy computer games or games consoles. I will need to look at: > Where to sell the X Box and why? > Channels of distribution. > Selling to places that wont tarnish the company's good reputation. > Where it's convenient to sell to customers. > Selling to as many places as possible (mass market). > Disadvantages and advantages of selling the X Box in certain places. Product Microsoft have to decide what product or range of products they are going to sell. They also have to decide what quality of product they wish to make and sell, what name to give the product and how it is to be packaged. Another decision is whether to attempt to brand the product. I will have to look at: > The product life cycle and how it could affect the X Box. > Why is the product is called the X Box. > Product range. > Does the product satisfy the needs and wants of the customers? > Research and development of the X Box. > Is Microsoft product orientated or market orientated? > Importance of quality. > Product differentiation. > Disadvantages and advantage of the X Box. Promotion Microsoft needs to decide how best to promote the products they make and sell. The decision involves weighing up the relative cost of each form or promotion and how best to target their customers. They also need to consider the use of advertising agencies. Promotion is all about communicating with potential customers, if the public isn't aware of the X Box then they are not likely to go out and buy it. Microsoft will also have to be careful not to offend potential customers with advertising that discriminates against certain people, e.g. race or gender. When looking at the promotion part of the marketing mix I will have to consider: > Different types of advertising, where to use them, why, the cost and will they be effective. > Different types of promotions, where to use them, why, the cost and will they be effective. > Stages of the product life cycle and how the affect the promotion of the X Box. > Disadvantage and advantage to promotion. Price Price is another element of the marketing mix. Microsoft must decide how to price its product. In making this decision Microsoft has to consider, what are the prices set by competitors, how price can be used to increase sales of the product, whether the price will cover costs of production, whether customers are willing to pay that set price and different pricing strategies such as skimming or penetration pricing. When looking at the price section of the marketing mix I will have to consider a number of things: > Prices set by competitors. > How price can increase or decrease sales. > Does that price cover cost of production? > Are the customers willing to pay that price? > Different pricing strategies such as skimming and penetration. > Disadvantages and advantages to setting that price. If the marketing mix is wrong, for example, the price of the X Box is too high and it is not selling in places convenient to customers, the X Box wont be as successful as it could be. The marketing mix is a vital part of ensuring a new products success, without it the product will fail. Market research is a major part of this project. It can help me to find out the customers needs and wants, which will enable me to create the right marketing mix. The product needs to be affordable, make a profit and to be promoted and sold in the right places. It is also very important that the X Box is aimed at the right segment of the market. The market can be split into different categories: Age Age can be separated into years or stages of life e.g. child, teenager, adult or pensioner. Microsoft mainly targets adults with their existing products. With the X Box Microsoft is likely to target younger people such as teenagers because they are more likely to buy the X Box rather than a pensioner. Gender Different products can be aimed at different genders e.g. make up is aimed at women and beer is aimed at men. Some people could say this is sexist but men are more likely to buy beer than make up. Businesses have to be very careful when advertising to certain genders as not to offend people. Microsoft are likely to aim the X Box more to males rather than females because boy tend to buy games consoles and computer games more than girls. Income/Occupation The population can be segmented according to their salary or occupation. Microsoft mainly targets people with above average income because their products can be slightly expensive, but they have to be careful not to advertise this because people could get offended. Microsoft also has to make sure their product is affordable to as many people as possible but not lower the price too much in case they lose profits. Area The area in which people live can divide the population. People in the northeast of England may have a different lifestyle to people the south of England, therefore their needs and wants will differ. Microsoft will need to promote the X Box in different ways according to location as to satisfy a mass market. Ethnic, cultural and religious groups Businesses need to be careful with the production and promotion of its products when it comes to different religions. If a business decides to produce its products in Asia because of cheap labour, people from Asia could refrain from buying that business' product because they are offended. Equally businesses have to be careful when advertising its products as not to offend people of certain ethnic, cultural or religious groups. Socio – economic groupings One of the most important ways of separating the population is the use of socio-economic groupings. Socio-economic groupings work like this: Social Grade Social Status Head of household's Occupation % of total UK population A Upper Middle Class Higher managerial, administrative or professional such as doctors, lawyers and company directors. 3.5% B Middle Intermediate managerial, administrative or professional such as teachers, nurses and managerial. 12-13% C1 Lower Middle Class Supervisory or clerical and junior managerial administrative or professional such as shop assistants, clerks and police constables. 22% C2 Skilled Working Class Skilled manual workers such as carpenters, cooks and train drivers. 32-33% D Working Class Semi – skilled and unskilled manual workers such as fitters and storekeepers. 19-20% E The Poorest In Society State pensioners or widows, casual or lower grade workers, or long-term unemployed. 10% The Product Life Cycle The Development Stage Products start life in the development stage. This is where the product is designed and also where the majority of the marketing is done. There are no profits at this stage, only costs. Microsoft will have to make up for the money lost in the growth stage of the product life cycle. The Introduction Stage This is the stage where the product is launched. Profits and sales are minimal in this stage, but it doesn't last too long if good advertising is used to make the customers aware of the product. The Growth Stage Sales and profits are increasing rapidly in this stage. Microsoft will have to consider what pricing strategies and promotions to use to keep the X Box in this stage as long as possible. Maturity In the maturity stage, the product reaches a peak in terms of sales. Research and development costs are likely to be paid off. The product could be profitable enough to be financing the development of new products. Saturation Towards the end of the maturity stage the market becomes saturated. Competitors bring out products to try and take sales away. It is likely that Microsoft will not be able to sell any more of the X Box at this point. Decline Eventually a product is likely to go into decline, sales will drop dramatically. Microsoft could try extension strategies at this stage to try and increase sales slightly or they could just withdraw the product from the market. The product life cycle can affect a lot of the marketing mix, for example, which promotions and pricing strategies to use at certain stages in the product life cycle. A Business would like to be in a sellers' market where customers have little choice but to buy from them. In a buyers' market though, business have to be market orientated and the greater is the need for effective marketing. I think Microsoft is in the buyers' market. Although they are a major company with substantial profits, Microsoft still have competition such as smaller software companies. The product ‘X Box' is a slightly different product from what Microsoft usually sells. Microsoft specialises in software and hardware for PC's, the ‘X Box' is a games consol, and so the main competition will be Sony and their Playstation. Although the Playstation is a very successful product it may be entering decline in the product life cycle because the Playstation has been around for a while. When the Sony Playstation started to enter the maturity stage Sony launched a new product the Playstation 2, this would be the ‘X box' main competition. I think Microsoft could afford a very large budget because the company's profits are very large, the fact that they have spent a lot of money developing the product could affect the budget for marketing the product. I estimate that the budget would be somewhere around à ¯Ã‚ ¿Ã‚ ½20 million. I'm going to cover various areas of marketing, which will include†¦ * Analysing the market, finding out what customers want, where best to sell it and find out about the competition and target market. * Market Research, desk research and field research. * The Product, product differentiation, ways of differentiating the product, branding and retailing. * The Product Life Cycle, look at what similar products have gone through in the five main stages. Development, introduction, growth, maturity and saturation, and decline. * Pricing, competition, costs of making, affordability and pricing strategies. * Demand and Supply, what people want, how much they want and what they are willing to pay. * Promotion, advertising packaging, direct mail etc†¦ * Place, channels of distribution. * Retailing, how retailing within the company would affect marketing. * Constraints on Marketing, the law, ethics and the market and pressure groups. They are many disadvantages and advantages of marketing. Disadvantages include things such as, cost and constraints on marketing. Constraints on marketing are ethical considerations, the law (Trade Descriptions Act 1968), codes of practice (Advertising Standards Authority) and pressure groups. Ethical considerations include things such as labour, many multinational companies have been criticised for using workers in the Far East because they are relatively cheap, and the business want to take advantage of the lower costs of production. Nike was once criticised by the press because of the high prices they charge for their goods and the low wages paid to workers and low costs of production. Microsoft will have to ensure that they don't put too much of a profit mark up on the X Box, and also make ensure their workers are treated fairly. Other ethical considerations are the use of promotions and advertising such as the use of images in adverts. Many companies have been attacked by pressure groups because of the content of the adverts they use, such as images of beautiful woman that lure men into buying the product and information included in the adverts. For instance should a washing powder manufacturer claim in an advert that its washing powder ‘washes whiter' than other powders on the market when there is no scientific proof that it does? Should tobacco companies promote their products when they damage peoples health? If people are really shocked by an advert they may consider not buy the products produced by that company, therefore Microsoft will have to be careful when choosing methods of promotion. The law ensures that advertising does not fool the public. The Trade Descriptions Act 1968 states that is illegal for products to be incorrectly described for example Microsoft couldn't advertise the X Box as if it comes with a free TV if it doesn't. The government has encouraged businesses to adopt a code of practice as an alternative to passing laws. Codes of practice are rules, which businesses voluntarily agree to keep, but have no legal status. Advantages of marketing include†¦ Helping the business to get a better understanding of the market, marketing also lets the business to know what price, to set where to sell the product what promotions to use and what the potential customers want from the product. Market research will also tell the company whether there is a demand for the product in question. Marketing will change across different countries because different countries have a different way of life. For instance people in America can afford to pay a lot more for the X Box than people in the poorer parts of Africa and Asia. Market Research Microsoft needs information if they are to make good decisions. They need information about their target market to help them create a successful marketing mix. One way of gaining that information is by carrying out market research. Market research is a cost-effective way of finding out what people believe, think, want, need or do. There are various types of market research. Microsoft needs to decide what market research methods are most likely to give them the information they need. Businesses, which are mainly product, orientated risk spending a large amount of resources launching a product, which proves to be a failure. Researching the market helps reduce the risk. Microsoft should focus research and design effort onto products, which have a chance of success in the market place. When the product is launched a carefully researched product stands less chance of failing. Stages of Market Research Market research will help Microsoft to find answers to questions about the market. * What is the target market for the X Box? * How can Microsoft use the X Box to increase market share? * What is the right price to set that will maximise profits and be affordable to as many people as possible? * What are the right promotions to use that will appeal to Microsoft's target market? * Where's the best place to sell the X Box? * What do customers want and need? * What is the demand for the X Box? * What are existing patterns of sales for other games consoles? I then need to decide what information might help answer the questions, then I need to decide how best to collect this information. The information is then collected and analysed. Finally Microsoft has to make a decision about what to do in the light of the information gained. Desk Research Desk research involves the use of secondary data. This is information that is already available both within and outside the business. Information within the business Microsoft collects information routinely. Invoices for instance will tell them how much they sell and who they are selling to. Information outside the business Businesses can also collect information, which is available from sources outside the business such as: * Internal sources – such as sales invoices, reports and accounts. * Government – published statistics such as consumer spending figures, reports such as monopolies and mergers commission reports. * The Media – reports in newspapers, magazines on radio and on TV. * Trade associations – statistics or reports published by national organisations such as the TUC, the CBI or chambers of commerce or industry associations such as the Engineering Employers Federation. * Research organisations – reports prepared by specialist market research organisations such as Mintel or Mori; articles published in academic journals such as university journals. Field Research Field research involves the collection of primary data, information that no one has yet collected. It is collected specially for the particular piece of research. Primary data is collected through direct investigation, usually through observation, survey or experiment. To help me create my marketing mix I used both secondary and primary research. I collected primary data in the form of a questionnaire that I asked 50 people. I used secondary data from the Internet. I used the Internet to find out about Video Game sales and I found a report by PC Data about home Internet users planing to purchase console or PC games during the 2000 holiday season, and that PC and console gaming is no longer a male-dominated domain. This was very useful research and it helped me a lot when putting together my marketing plan. I didn't find any information from the media or the government because of lack of time. Quantitative and Qualitative Research There are two main types of survey data – quantitative, and qualitative. Quantitative Quantitative research provides numerical data. At the completion of a quantitative project it is possible to say (for example) what proportion or percentage of the population fall into different groups – those that want something, those that would be likely to buy something, those that are in favour of a particular policy or plan, etc. The essence of quantitative research is that every respondent is asked the same series of questions. Quantitative research can be done in various ways: By face-to-face interviewing, either in the street or, for more complex projects, in people's homes. This was the traditional approach to data collection, and remains important. In-home work is particularly suitable for lengthy interviews, or for some sensitive subjects. The understanding that can be established between the interviewer and the person being interviewed (the respondent) can help to ensure that detailed and thorough information is obtained. By telephone. This is a fast-growing form of data collection, is somewhat less expensive per interview than face-to-face, and can provide data more quickly – in some cases, overnight. Telephone research would rarely be suitable for lengthy interviews, but it can be ideal for smaller-scale, fast turn-round projects both amongst the public and for business research. Both face-to-face and telephone research involve the most basic form of data gathering, talking to people. There is one other form of quantitative data collection that should be mentioned – postal and self-completion research, which is the cheapest form of quantitative research, though it can take a relatively long time to gather data by post. Self-completion questionnaires can be handed out, for example, at exhibitions, on aircraft, or in town centres, to get peopleà ¯Ã‚ ¿Ã‚ ½s views. Self-completion questionnaires must be kept simple and the researcher has little control over whom, or how many people, return the form. Another form of quantitative research is omnibus surveys. These are useful for those with small budgets and relatively few questions to ask. Qualitative Research Qualitative research, though it cannot provide numerical data, provides understanding of how or why things are as they are. It can be used on its own or to help in the development of a questionnaire for a quantitative study. There is no fixed set of questions and therefore no assumptions about what is, or is not, important. Instead there is a list of topics, problems, or possibilities to be explored. The form and nature of the discussion is heavily influenced by the informants' own concerns or assumptions. Qualitative research is the way in which typical or relevant peoples' attitudes and beliefs can be explored, and ideas can be generated. It can be used for everything from testing reaction to a potential new advertising campaign, to exploring staff attitudes to a new management structure or procedure. There are various sorts of qualitative research, including the following. * Unstructured interviews with a single informant, based on a framework of themes and topics. The interview is adapted to the individual, and the interviewer feeds off and responds to the respondents' replies. * Focus groups (or group discussions) involve a similar approach but bring together a number of relevant people – typically about eight – and therefore benefit from the interaction between the different personalities and experiences in the group. I used quantitative research because I needed to find information quickly and easily, I think qualitative research would have been a lot more time consuming and will have used a lot of resources. I decided the best way to collect information about the market was to use a survey. A survey can't ask customers for their opinion. Only a fraction or sample of customers can be surveyed. To be useful, the sample chosen must be a representation of all consumers. In a random sample, every potential respondent has an equal chance of being chosen. Random numbers can be used to do this or it could be done by ‘picking people out of a hat'. It is often quite difficult to construct a truly random sample. So a cheaper and quicker method is to use systematic sample. This is where every 100th or 1000th person on a list such as the telephone book is chosen. A systematic sample is not truly random though and therefore the results may be less reliable. In a quota sample, the sample is broken down or stratified. One problem with a quota sample is that any people who fit the description can be asked to complete the survey. So Microsoft wanting to find 50 people aged 13 – 30 to complete a survey could ask the first 50 13 – 30 year olds who came out of Electronics Boutique in Bedford. This may not be very representative of all 13 – 30 years olds nationally. A stratified random sample may get round this problem. It is a quota sample where all the respondents, the people being interviewed, must be chosen at random. Microsoft would have to find some way of selecting people aged 13 – 30 through pure chance. I used a quota sample, I asked 50 people in Electronics Boutique my questionnaire. I used Electronics Boutique because a lot of people go in there to buy game consoles and other computer related products, and asking this people would give me a good idea of the target market. I think my data is quite reliable because the people I asked my questionnaire to are the people that are most likely to buy Microsoft's products. Price Pricing Strategies The product should be launched in November ready for the Christmas rush. The pricing strategy skimming should be used in the introduction and the growth stage of the product life cycle. Skimming is setting a high price initially and then lowering it later on. This is almost always used for products that incorporate new technology such as new DVD players and PCs. Some people are willing to pay high prices for new technology, the price of the X Box will be set high at first to catch this end of the market. By doing this Microsoft can maximise their profits and cover the costs of developing the X Box. When sales start to slow down Microsoft should lower the price and use a different pricing strategy. To ensure sales keep increasing half way though the growth stage Microsoft should change the pricing strategy from skimming to market orientated. This is where the price charged is based on analysis of the market and its characteristics. Market research might need to be undertaken again at this point to ensure that Microsoft knows what the customers are willing to pay. Market orientated pricing should be used at this point because the top end of the market is likely to be saturated, Microsoft will need to lower the price of the X Box slightly to provide for the people that aren't willing to pay as much. Using market orientated pricing will therefore help keep sales rising and the X Box will appeal to a broader market. When the sales of the X Box are slowing down it could be because of competition. This is when Microsoft will need to use competition based pricing because new games consoles will be being launched and the X Box wont be new technology anymore. Microsoft will need to lower the price a lot to compete with the new technology and keep people interested. Psychological pricing could be used throughout the life cycle. This is when a product is priced at 99p instead of a pound so that the customers automatically think it's cheaper. I don't think Microsoft will need to use cost based pricing with the X Box because Microsoft makes so much money off existing products going into debt wont be a problem. The X Box will soon make up for the research and developing costs in the growth stage of the life cycle. Penetration pricing also isn't appropriate for the X Box because new technology doesn't rise in price as it becomes more popular it starts off at a high price because of the cost of development. Price to be Set In the introduction stage of the life cycle the X Box should be priced at 299, in the growth stage the price should be lowered to about 249, when the market has been saturated the price should be lowered again to 199 and when the product goes into decline it should be priced between 99 and 149. Factors Affecting the Price > Cost of promotions and advertising > Cost of research and development > Customer's needs and wants > Competitors > Demand > Costs of distribution

Prone Positioning On Critically Ill Health And Social Care Essay

In my nursing experience, I have worked in both the neonatal intensive attention unit ( NICU ) and the paediatric intensive attention unit ( PICU ) . When I worked in the NICU, our babies were positioned prone ( face down ) for comfort grounds for the bulk of a 24 hr period. Our neonatologists seldom used sedation or trouble direction resources for our automatically ventilated patients. In the PICU I presently work in, all of our automatically ventilated patients are given uninterrupted medicines for both sedation and hurting, nevertheless prone placement is about ne'er used. When I have positioned patients prone in the past, most nurses look cross-eyed at me as though I have done something incorrect. Past research has suggested that prone placement is a curative manoeuvre that improves oxygenation in both paediatric and big patient populations ( Curley et al. , 2006 ) . However, some clinical tests in both paediatric and big populations have demonstrated that there is no betterment in clinical results for the patient ( Curley et al. , 2006 ) . In other surveies, when a patient is placed in the prone place, it has been shown that there is an increased in terminal expiratory lung volume and improved ventilator-perfusion fiting taking to better oxygenation ( Gattinoni et al. , 2001 ) . As you can see, there is assorted informations from many surveies proposing prone positioning leads to break clinical results for patients. Besides, as I was researching, I truly could n't happen a survey or literature that was new within the last 5 old ages. There is a current demand for updated research surveies and information. Hopefully I can carry through and add to the research with my proposed survey.Purpose, Aims, and HypothesissThe intent of this research survey would be to bring forth informations to assist infirmaries develop a policy, process and protocol for prone placement in critically sick, paediatric patients. The informations collected from this survey can add to the literature and hopefully convey current evidence-based pattern to PICUs across the state. Harmonizing to Polit & A ; Beck ( 2008 ) , purposes can be defined as the particular accomplishments a research worker would trust to accomplish by carry oning a research survey. My proposed survey has two specific research purposes.Aim 1To prove the effectivity of prone placement in automatically ventilated, critically sick paediatric patients, related to betterments in oxygenation.Aim 2To analyze techniques in airway direction of a automatically ventilated, critically sick paediatric patient, to find the safest nursing pattern in prone placement.HypothesissFor Aim 1, the hypothesis is that paediatric patients, who are critically sick and automatically ventilated, will hold better positive clinical results related to betterment in oxygenation in prone placement than in supine placement. The void hypothesis is that there is no difference in prone or supine placement in patient clinical results. For Aim 2, the hypothesis is that there will be safe techniques in airway direction in prone placement for the automatically ventilated, critically sick paediatric patient. The void hypothesis is that there is no safe technique in airway direction in the prone place based on continued, critical inauspicious events.BackgroundThe reappraisal of literature on the effects of prone placement in automatically ventilated patients has mixed ideas. Surveies conducted by Dr. Martha Curley and her research squad from Boston Children ‘s Hospital have refuted and so accepted the usage of prone placement in automatically ventilated, critically sick paediatric patients. Curley et Al. ( 2000 ) researched the physiologic alterations of automatically ventilated paediatric patients and evaluated the safety of prone placement who experienced acute lung hurt. The information was collected from a single-center prospective instance series from October 1997 to March 1999. The sample was 25 paediatric patients with bilateral paranchymal disease necessitating mechanical airing with a partial force per unit area of arterial oxygenation ( PaO2 ) to the fraction of divine O ( FiO2 ) ratio of less than or equal to 300 millimetres of quicksilver ( mm Hg ) ( Curley et al. , 2000 ) . The patient ‘s ages ranged from 2 months to 17 old ages. The participants were placed prone for 20 hours a twenty-four hours â€Å" until clinical betterment or decease occurred † ( Curely et al. , 2000, p. 156 ) . After run intoing eligible standards, informations collected consisted of arterial blood gases, critical marks ( temperature, bosom rate and arterial blood force per unit area, and cardinal venous force per unit area. Ventilator scenes and the figure of staff utilized and the clip it took to turn a patient were besides collected. The research workers besides collected informations on the medicine profile, particularly comfort medicines such as morphia and diazepam, and assessed force per unit area ulcers and presenting. â€Å" Features of the survey population are expressed as frequences, mean ( +/- SEM ) , or average with interquartile scopes ( IRQs ; 25th and 75th percentile ) † ( Curley et al. , 2000, p. 158 ) . The survey revealed that when prone place informations measurings were compared to the patient ‘s supine measurings, there were immediate and cumulative betterments in oxygenation ( Curley et al. , 2000, p. 161 ) . The research workers conclude that their survey suggests informations that prone placement is both safe and effectual in paediatric patients with ALI. Dr. Curley and her co-workers believe that this survey provides a foundation for a hereafter randomized survey to look into early and repeated prone placement for this paediatric population. Dr. Curley and her co-workers took on a prospective, multi-center randomized survey from August 2001 to April 2004. The hypothesis of this survey was that kids with ague lung hurt treated with prone positioning would hold more ventilator-free yearss than those treated with supine placement. Patients were included if they were age 2 hebdomads to 18 old ages old, intubated and automatically ventilated with a ratio of a PaO2 to FiO2 of 300 or less, bilateral pneumonic infiltrates, and no clinical grounds of left atrial high blood pressure ( Curley et al. , 2005 ) . Exclusion standards included patients less than 2 hebdomads of age, less than 42 hebdomads post conceptual age, had relentless hypotension or intellectual high blood pressure, cardiac related respiratory failure, and a figure of other medical conditions listed by the writers in their article. Of 8017 patients screened, merely a sum of 102 participants were included in the survey. A information and safety supervising board stopped the test at the interim analysis based on the futility fillet regulation. Ninety-four patients had completes the 28-day survey period. Of these 94, 47 were in each of the groups. After statistical analysis had been done, it was determined that if the survey had reached the planned registration of 180 patients, the chance of showing a difference in ventilator-free yearss between intervention groups was less than one per centum ( Curley et al. , 2005, p. 232 ) . The survey found that there was no statistically important difference of ventilator-free yearss between supine and prone placement in paediatric patients with acute lung hurt. Dr. Curley and her co-workers do non back up the continued usage of prone placement of paediatric patients as a curative intercession to better results in acute lung hurt ( Curley et al. , 2005, p. 236 ) . This province counters the research decisions drawn from Curley et Al. ( 2000 ) . Interestingly, Dr. Curley continued her research by executing a secondary analysis on this information collected in 2006. The intent of this secondary analysis was to depict the effects of prone positioning on airway direction, mechanical airing, enteric nutrition, hurting and sedation direction and staff use in paediatric patients with acute lung hurt ( Curley et al. , 2006 ) . The research workers suggest that their informations really shows that prone placement can be accomplished safely in critically sick paediatric patients. The research workers besides province that they believe patients can be safely assess and managed piece maintained in the prone place for drawn-out periods of clip, every bit long as 20 back-to-back hours ( Curley et al. , 2006, p. 417 ) . In this article on secondary analysis performed by Dr. Curley and her co-workers ( 2006 ) , they province that prone placement should go on to be used in critically sick kids as a enlisting manoeuvre in acute lung hurt to better oxygenation, lessening force per unit area wounds, and decreased bronchopulmonary compaction. These research workers besides province that this is the first survey to clearly show that prone placement can be accomplished safely. After researching prone placement in critically sick, automatically ventilated paediatric patients, I wholeheartedly agree. I believe that this is why these surveies could be replicated to assist formalize the protocols developed by Dr. Curley and her co-workers.SignificanceThe significance of a research survey on prone placement in paediatric patients is overpowering. In my ain personal experience, there has ne'er been grounds presented to my nursing co-workers or myself on whether prone placement is really safe and effectual. As ant ecedently stated, in reexamining the literature, there are really few clinical surveies that would be considered good mentions as true province of the art, evidence-based nursing pattern. In fact, I can non believe that merely Dr. Martha Curley has taken this undertaking on for the paediatric population. This proposed survey will be able to place the effectivity of prone positioning on improved oxygenation in a automatically ventilated paediatric patient. From survey informations aggregation, techniques in safe air passage direction could assist ease the usage of prone placement in paediatric patients of all ages and sizes and possibly advance more positive clinical results. In my survey, I hope to retroflex Dr. Curley ‘s methods utilizing her protocols, with some minor tweaking. This proposed survey should add to the organic structure of literature. The significance of this survey could assist formalize Dr. Curley ‘s protocols from her past surveies and besides assist make a criterion of pattern for prone placement.Research MethodsSample, Setting and RecruitmentThe mark population to be studied would be critically sick, paediatric patients runing from ages 2 hebdomads to 18 old ages of age. Inclusion standards will besides include patients with acute respiratory hurt necessitating cannulation and mechanical airing. Exclusion standards will be patients with respiratory hurt or failure of cardiac nature. Patients will besides be excluded if they have spinal instability or hold had abdominal surgery, as it would non be safe for these patients to be prone positioned. Patients with tracheotomies will be excluded. I would trust to include patients on conventional airing and high frequence hovering airing. Patients will be excluded if they weigh over 200 lbs, as the protocol will merely utilize three staff members to turn the patient, and this may be insecure in a patient of this size. The survey participants will be recruited from paediatric intensive attention units from infirmary centres willing to take part. In day-to-day unit of ammunitions, we would allow the paediatric critical attention doctors determine if the patient ‘s medical position was stable plenty to be eligible for survey standard. Randomization of patients will be done between prone placement and supine placement by utilizing a consecutive figure system. Centers will be provided envelopes with cards denominating between prone and supine placement and assign as each new participant is eligible. A sample size that would mirror Dr. Curley ‘s would be ideal. I hope to obtain at least 100 participants, but purpose for 200 participants. With 200 participants, the hope is to duplicate the original sample size, duplicate the figure of prone-to-supine and supine-to-prone bends, and increase the cogency of the research.Data Collection and InstrumentationFor my research survey, I hope to develop a systematic extension reproduction of the old surveies done by Dr. Curley and her research squad ( Curley et al. , 2000 ; Curley et al. , 2005 ; Curley et al. , 2006 ) . Dr. Curley and her co-workers ( 2006 ) developed a prone placement protocol for bedside nurses to follow in respects to analyze participants. The protocol is attached in Appendix1, nevertheless a brief drumhead is provided to assist assistance in the shaping of informations aggregation and instrumentality. When a patient has been met standards and is designated as eligible for the survey, informations will be collected based on the Pediatric Risk for Mortality III ( PRISM III ) ( Pollack et al. , 1997 ) . Demographics such as age, race, and ethnicity will be categorized. An anteroposterior thorax radiogram, in the supine place, should be obtained to document and guarantee that the endotracheal tubing ( ETT ) is positioned decently in the deep windpipe. The security of the ETT shall be assessed every bit good, based on the establishments current protocols. The size of the ETT, whether it is cuffed or uncuffed, and arrangement shall be paperss as Ten centimetres ( centimeter ) at the gum, as in â€Å" the patient has a 4.5 cuffed ETT, taped firmly at 12 centimeter at the gum † . The turnup of an ETT should be inflated with the minimum leak technique: inflate turnup until an air leak is ascultated at end-inspiration while maintain turnup force per unit area & gt ; 25 millimeter Hg ( Curley et al. , 2006, p. 420 ) . Security of the ETT and arrangement at the gum will be documented after each bend from the supine-to-prone and prone-to-supine placement every bit good as every 4 hours while in the prone place. The nurse or respiratory healer will doc ument whether or non the patient had a nonelective extubation during the bend. In respects to soothe and clamber unity, the patient ‘s should hold separately sized caput, thorax, pelvic, and leg shock absorbers to place the patients while prone ( Curley et al. , 2006, p. 419 ) . The end is to hold the patient positioned prone, with their shoulders, hips and lower limbs supported while their venters has room to stick out ( towards the bed ) and custodies can be tucked under the venters. The existent shock absorber will be difficult to set up, as every infirmary uses different positioning devices, nevertheless, I will offer the thoughts of slackly rolled covers or the Eggcrate stuff cut to the appropriate size. It will be documented if the patient has developed a force per unit area ulcer, and the ulcer will be staged harmonizing to National Pressure Ulcer Advisory Panel ‘s ( NPUAP ) description. The NPUAP ( 2007 ) established four phases of force per unit area ulcers. The first phase includes force per unit area sores that include non-blanchable inflammation, with integral tegument, normally over a cadaverous prominence. Phase two includes shoal, unfastened ulcers with a ruddy or pink pigmentation, without sheding of the tegument. Stage three ulcers include a full thickness tissue loss. Hypodermic fat is normally seeable at this phase and shedding may be present. In a phase four ulcer, the ulcer is stage three with seeable bone, musculus or sinew. A patient will stay positioned prone for 20 hours of the twenty-four hours and supine for 4 hours a twenty-four hours. The length of clip a patient is prone and supine will be recorded. Ongoing measurement will be done on all organic structure systems, including pneumonic and circulatory. Arterial blood gases will be obtained 1 hr prior to a patient being positioned prone and 1 hr after the patient has been prone. To maximise safety, staff will use bedside nurses and respiratory healers during chances for turning. The respiratory healer should be responsible for the unity of the tubing and turning the patients head, bedside nurse 1 shall be responsible for the turning of the shoulders, thorax and weaponries, and beside nurse 3 shall be responsible for the turning of the hips and legs. The prone positioning protocol that is attached as Appendix 1 which will be at the bedside of every patient for the nurses and respiratory healers to follow consequently.Datas AnalysisHarmonizing to Polit & A ; Beck ( 2008 ) , there are two wide categories of statistical trials, parametric and nonparametric. Parametric trials normally involve the appraisal of parametric quantities, require measurings on an interval graduated table, and presume that the variables for distributed usually for a population. These trials are frequently considered the most power and are normally preferred by research workers ( Polit & A ; Beck, 2008, p. 591 ) . Nonparametric trials do non gauge parametric quantities, normally used when the sample size is little or the information is considered non-normal. Figure 22.5 in Polit & A ; Beck ( 2008, p. 592 ) is a speedy mention for choosing bivariate statistical trials. Harmonizing to Polit & A ; Beck ( 2008 ) , the Fisher ‘s exact trial will be used to prove the significance of the differences in the two interventions ( Polit & A ; Beck, 2008, p. 601 ) . Fisher ‘s exact trial or x2 trial will be used to compare prone and supine groups in their baseline features and results that will be calculated on an single patient footing. Based on the categorical informations, such as the oxygenation of the patient, related to the arterial blood gases, I think a Fisher ‘s exact trial will be the best trial. The accidental extubation rate during bends will be calculated utilizing an exact binomial trial for comparing the rates of two Poisson procedures. For prone patients, Wald ‘s statistic, distributed as a qi square, will be calculated based on results evaluated after alterations in placement. The figure of staff utilized and the length of clip involved in the place turns will be analyzed utilizing signed rank trials such as a Wilcoxon rank trial. Once all information has been collected, synthesized and analyzed, the research will be drafted into a manuscript and submitted to the Pediatric Critical Care diary. Before the survey begins, it will be reviewed, and hopefully approved, by the IRB. Before a patient becomes a participant of the survey, written informed consent will be obtained from a parent or legal defender. Both female and male patients will be utilized, and the exclusion standard is entirely based on patient safety. The participants will be allocated to the prone and supine placement groups reasonably by utilizing random assignment. Complete decrease of prejudice can non be established because it will be impossible for the clinicians to non cognize whether or non their patient is positioned prone or supine. With the assorted placement protocols and adjustments with pressure-reducing stuffs, I hope to diminish the incidence of compromised tegument unity and uncomfortableness. This survey does non object, and encourages the usage of sedation and hurting medicines while the participants are automatically ventilated.

Marbury v Madison essays

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