Gender Equality Essay

Irrespective of the country and the cultures people live in, it is next to impossible to keep the question of gender equality hidden in the modern society. When the word gender equality was voiced in the 19th century what was been sought was political rights. Not only then but also today inequality between men and women has been evident in our society. Discrimination against women is an act that has had a lot of negative impact in our society and to the women themselves. This has been demonstrated through gender violence, economic discrimination, reproductive health inequalities and harmful traditional practices. It is a concern to the whole world to a point of making the affirmative action to fix this problem. Gender equality first and foremost is a human right; women are entitled to live in dignity and in freedom from fear and want (Tomasevski, 1993). Should men and women be equal in the modern society? Men and women are equal; only that women are victims of pervert social progress. Gender discrimination between men and women leads to unequal access to the resources and benefits of development. see more:gender discrimination short essay Gender inequality affects all people; sustainable gains in development and poverty reduction are only possible when men and women are full and equal participants in society. Men and women are different but they are equal in that whatever men can do their women counter parts can do it well. Men and women are equal what brings the discrimination is the socialization that men and women get. The notion that women are weak has denied many women with the ability to exploit the abilities they have (Tierney, 2007). Men and women are equal in so many aspects and should be equal. Politically, financially and academically no much difference that can be noted, it is insignificant. In the political realms there are women who are doing extemporal well. Taking the example of the just concluded US election Hillary Clinton had good support and motions that would be bought by the rest of the candidates. In the world of business we have Oprah Winfrey; an indicator of what women can do. She is competing among the men in that field and still her success is a threat to many. In the modern society women have been known to take responsibilities of raising the families. Women have come up so well in that their dependency level is going down even though they are discriminated in salaries. This is a proof enough that if women are given equal opportunity with men they can do much well. In the employment sector women are taking those opportunities which were thought to be for men (Kramarae & Spender, 2000). Women are managers of big companies and also owners just as men. They are also well represented in the government sectors and in the government. They have become career makers. Men have the initiative of sharing the household responsibilities. It is a common occurrence that couples can choose whether it is the woman or the man who will get a leave to take care of their new borne baby. Men and women are equal in the eyes of the law; they are subjected under the same law. Women are equal to men in all aspects hence in the modern society they should get the right to basic needs, education, job training and employment as men do. Empowering women is a great tool for reducing poverty and advancing development. Empowered women contribute to productivity and health in the families and communities and hence improved prospects for the next generation (Cross, 2001). The idea that men are stronger physically is just a preference of a few. If women are given similar opportunities as men they can perform equally well. Denial of opportunity has contributed to decreased performance of women in various areas. On the other hand both women and men should not forget their roles though sharing of responsibilities is taking root in the modern society. References: Cross, P. L. (2001): Women’s Rights are Human Rights; Human Rights are Women’s Rights. Retrieved on 29th Dec, 2008 from: http://www. pinn. net/~sunshine/essays/w_rights. html Kramarae, C. , Spender D, (2000): Routledge International Encyclopaedia of Women: Global Women’s Issues and Knowledge. ISBN 0415920906, 9780415920902, Routledge Tierney, J. (2007): Men and Women, Different but Equal: What’s the Problem? Retrieved on 29th Dec, 2008 from: http://tierneylab. blogs. nytimes. com/2007/09/09/men-and-women-different-but-equal-whats-the-problem/ Tomasevski, K. , (1993). Women and Human Rights. ISBN 185649120X, 9781856491204, Zed Books

How Are Syariah Laws Being Currently Applied in Malaysia Essay

Islam had been established in Malaya by the 14th century. Malacca, one of the Malay States in Malaya, emerged as a Muslim Kingdom under Sultan Iskandar Syah and his successors. By the early 15th century, it had become a power of great importance in South East Asia. This brought an end to the political control and cultural influence of the Hindu and Buddhist powers over the Malay Peninsula. This brought an end to the political control and cultural influence of the Hindu and Buddhist powers over the Malay Peninsula. Malay society and its laws were influences by thought and ideas from various Muslim countries. This because Islam itself came to this region from different countries, namely the Arab countries, India and even China. The law used in Malacca was Muslim law together with Malay customary law. Malay customary law may also referred as to as Adat Melayu. In 1511, Malacca was conquered by the Portuguese. However, it’s difficult to provide a satisfactory account of the legal development during that period. Although Malay customary law was preserved under Portuguese rule and later by the Dutch, during their conquest of Malacca in 1641, it was ultimately replaced by English law during the British colonization of Malaya beginning from 1786. Evidences and traces of Islamic legal thought and institutions are present in Malay law. Terminology and ideas from the Islamic legal system found their way into the numerous treatises on traditional Malay law. They are found in the Melaka Digest (Undang-undang Melaka or Risalah Hukum Kanun of 1523) and the Pahang Digest of 1596 with a later supplement, and in the Kedah Digest dated 1606 containing port rules. Further evidence is found in the 18th century, 99 Laws of Perak and in the Johor Digest of 1789. Finally the orthodox Muslim works of the Shafiee School of Islamic Law, such as the treatises on the law of marriage, divorce and legitimacy of children were translated in Malay. The Majalah al-Ahkam al- Adliyyah (The Mejelle), a set of Muslim civil laws of the Ottoman Empire, was also translated into Malay and recognized as the law to be followed by the Johor courts in 1914. Islamic law, being an imported law, evolved through a period of 6 centuries of development. Its impact on the country’s legal system was far reaching, even until the early part of the present century. This is well illustrated in the case of Laton v Ramah, where the Court of Appeal held that Islamic law in Peninsular Malaya was not foreign law but local law, the law of the land which every court must take judicial notice. But during the post British colonial period, Islamic law has been reduced in importance and its significance has further declined after the independence. The ninth Schedule of the Federal Constitution, Legislature Lists (List II- State List) states: ‘The Islamic Law is under state authority. Each state enacts its own enactment with jurisdiction over it. Every state has its own Council of Islamic Religion and Malay Custom and the Kadis Courts. These courts have limited jurisdiction on persons professing the Islamic religion, and only included in this list, but shall not have jurisdiction in respect of offences except insofar as centred by Federal Law’. The Muslim Courts (Criminal Jurisdiction ) Act 1965 [No. 23 of 1965] provides that the jurisdiction of the Shariah Courts : ‘ Shall not be exercised in respect of any offence punishable with imprisonment for a term exceeding 6 month or with any fine exceeding one thousand dollars or with both’. It’s been a questioned among the people about the application of Hudud law in Malaysia since there are different types of religious and beliefs the nations uphold. Many people agreed with the implementation whereas some disagreed with the issue. Basically, Hudud is the most severe and strict Islamic law for resorting to punish those offenders through physical means. The provisions of the Hudud law cause Malays feared the law and they are not ready for the implementation of Hudud laws as there are lack of understanding on the need of a proper model on the Islamic criminal law. According to Professor Dr. Mahmood Zuhdi Abdul Majid of IIUM, he said ‘If we do not politicize it, we Malays are definitely ready to implement hudud in Malaysia, but if we were look at Hudud as a political issue, then it becomes a problem’, He also stated that criminal laws should be imposed on all citizens because Islam does not discriminate on whether you are a Muslim or a non-Muslim. Besides, PAS had decided that it will seek constitutional amendment in the Parliament to apply the Hudud law once the Pakatan take over the federal administration. According to our Former President, Dr. Mahathir Mohammad, had stated his dissatisfaction on the implementation of Hudud laws in Malaysia which will create an injustice judiciary system. For an instance, a Muslim who committed an offence will be punished according to Hudud law, which is a severe punishment whereas the non-Muslims who committed the same offence will be punished according to civil law which is much lineal. He also commented that there is nothing mentions in the Quran about the severe punishments and he urged Muslims to follow the primary sources of Islam, Quran instead of the Sunnah or Hadith which are basically those interpretations of the Quran. Furthermore, Nibong Tebal MP, Tan Tee Beng said Kita president, Zaid Ibrahim confessed that non-Muslims can be punished under the Hudud criminal code enactments. He added that Shari’ah laws that being practiced in Malaysia are based on civil and family legislation, which governs individual Muslim matters. The issue is controversy as Hudud law can be applied if the Federal Constitution amended which requires majority votes from the members of Parliament. Based on UMNO Minister, Datuk Seri Jamil Khir Baharom view, he stated that Hudud Law will never give any impact on Non-Muslims. The government is alert that there are distinctions of views and thoughts on this issue among Islamic scholars and jurists and a research need to be done before the Hudud law implemented in Malaysia, so that the penal code is fair to all, complies with Allah’s conditions and is in accord with the Malaysia legal system. He also added that if Hudud law is to be applied in Malaysia, the Syari’ah Court would only have jurisdiction over those who practice Islam in accord with the Federal Constitution, the Supreme law of the Federation. Though the issue on the application of Hudud law in Malaysia is indecisive stage, the application of Shari’ah law does not lose its position. The Islamic law that is in force in Malaysia totally is not genuine Islamic law but may have been influenced by written laws judicial decisions and customary law. For an instance, the written laws, especially, those enacted before independence, may reject Islamic law. Thus in Ainan v Syed Abu Bakar, it was held that the legitimacy of a child should be determined by the Evidence Enactment (F. M. S. ) and not accordance with Islamic law.

Moby Dick Essay

Questions 1.The captain, Ahab wants revenge against the great white whale Moby Dick because he lost his leg to the whale. 2.Ishmael is the narrator. The first line is â€Å"Call me Ishmael.† 3.The two allusions are the names of Captain ahab and Ishmael. Referring to Captain Ahab: Ahab is a wicked king who goes against goes against God’s will, Like how captain Ahab goes against the white whale. Referring to Ishmael: Ishmael means â€Å"outcast† or â€Å"wanderer† like how he seams to be the only person who cares anything of the beauty of nature. 4.To Captain Ahab he all that is evil in the universe. To Starbuck, he is just an animal to be killed for oil. To Ishmael, he is nature and all it’s wonder, both beautiful and terrifing. 5.Melville wrote about whaling to create a cosmic allegory to show the unglamorous a whaling, he had a deep respect for nature and wanted to expose it. The industry was significant because it provided oil for lanterns, streetlamps, and machinery and was the main oil used. 6.Melville set sail for the south pacific when he was 21. 7.Melville befriended Nathaniel Hawthorne while writing Moby Dick. 8.The four harpooners represented different races and ethnic groups of the world bringing the Pequod to be like a symbol for the ship of state, a little democracy. 9.The Pequod is attacked by moby dick and is destroyed. Ahab was caught and shot out of the boat and vanished into the sea. Finally, Ishmael becomes the only survivor of the pequod, he floats around until he is rescued and picked up by another ship, The Rachel. 10.He was unemployed, desperately broke, and took a job as a customs inspector. He was forgotten by the public.Interview Questions to Ahab 1. What exactly did you do on the ship other than plot the death of Moby-Dick? 2. How did you keep up hope that you were actually going to encounter Moby-Dick again?3. How did you recognize and tell Moby Dick apart from all the the other whales in the world?4. Have you wanted to be the captain of a whaling ship your entire life? If not what profession did you aspire before?5. Avoiding sailor colloquial verbiage, can you describe the night of the incident with Moby Dick? Also, do you recommend anyone who is good at making ivory legs if this were to happen to anyone in the future?

Talent Essay Example | Topics and Well Written Essays - 250 words

Talent - Essay Example In business, a talent is also considered to be a recurring form of thought or conduct which can be exploited productively. To be able to perform a task outstandingly, one require having a recurring thought pattern. In business, different people perform different in different jobs depending on their talent. Additionally, talents require to be managed to enhance success (Sorensen and Crabtree Web). My talent is in management. I consider this to be my talent I have the natural ability to motivate other people which a crucial management skill. Since I was young, I have always been able to deal with people of different personalities and I often find myself playing the motivating role when working in a team. Additionally, am visionary, have apposite critical thinking skills, decisive and good team player. I believe management is my talent since having the above skills enables me to relate well with others, be organized, decisive, and be able to communicate effectively which is important in

Corporate Social Responsibility of McDonalds Assignment

Corporate Social Responsibility of McDonalds - Assignment Example The paper tells that corporate social responsibility includes a variety of tactics such as environmental, philanthropic and ethical. A new field of corporate social responsibility has emerged that encourages companies or organization to take steps and initiatives in the interest of all stakeholders. The public or consumers are also considered stakeholders and hence the organization should create a balance between the interests of both stake shareholders. McDonald's is the leading international fast food retailer which is spread over 36,000 locations and serves approximately 69 million customers in 100 countries daily. Most of the McDonalds branches are run by independent businessman and women. The success of the company’s success is the system which aligns the franchises and supplies. By the implementation of this system, McDonald's was able to satisfy the customers with what they wanted. This system also allows local customization of the product. McDonald's focuses on three p riorities for the optimization of its menu; to modernize the consumer’s experience, to increase accessibility to McDonald's with convenience and to optimize the menu. McDonald's plan to win strategy focuses on people, product, place, price, and promotion in order to increase the customers experience regarding McDonald's. McDonald's is considered to possess the largest framework when the subject of CSR is discussed. Their motto of CSR â€Å"responsible food for a sustainable future† outlines their social responsibilities. A board of directors is responsible for keeping McDonald's up to the standards that are being guaranteed to their stakeholders. The first step taken by this board of directors was to create a code of conduct in order to ensure that every supplier follows this code of conduct. This agreement is then signed by the suppliers. McDonald's also considers the three E’s that is ethical responsibility, environmental responsibility, and economic responsib ility. This serves as the vision for the supply chain management.

Analyze Thomas More's Utopia in terms of his purposes and Essay

Analyze Thomas More's Utopia in terms of his purposes and characteristics he assigns to the state of Utopia What does he have to - Essay Example Hythloday talks about Utopia’s history and geography and tells that Utopia was once Isthmus before General Utopus conquered it. Hythloday puts forth a very civilized image of the Utopian society. He says that Utopians are rational in their thinking and dealing with one another. Property is communal. People of utopia are highly productive and do not run after money or gold. They value human life and etiquettes more than power and money. Class distinction is non existent in Utopia and so is the poverty. People are tolerant in religious matters and crime and offence is negligible. The society is better than any society in Europe. Finally, (More) says that he would appreciate it if few of the Utopian policies were inculcated in the European system, though he sees little to no chance of it in reality. Works Cited: More, Thomas. Utopia. UK: Bibliolis Books Ltd, 2010. Print.

American Women Coursework Example | Topics and Well Written Essays - 500 words

American Women - Coursework Example As John Briggs says â€Å"education played a large role in the women’s rights movement of the 20th century because it was seen as a key to success in gaining social, economic and political equality.† The education mainly comprised of subjects such as mathematics and home economics as it was understood that these subjects will help them in running their houses and educating their children. Also, subjects like child birth, hygiene and first aid were preferred by many women. Poor women were educated by well to do women who had the finance to attend schools (Briggs, n.d). Christie Anne Farhaan (1994) argued that U.S needed an educated citizenry and this in turn required the nurturing of the young by more educated mothers and so women’s education was very important (pg 16). The seven sisters was one of the first all women college which encouraged women to study liberal arts and had high academic standards which could be compared to that of men’s colleges. Since education was limited to the white women, colleges for the black women also sprang after the civil war.

The Condition of U.S. Bridges Research Paper Example | Topics and Well Written Essays - 2500 words

The Condition of U.S. Bridges - Research Paper Example As a result of years of declining budgets with respect to bridge repair, it is estimated that only one in the ninth bridges are currently considered as â€Å"structurally deficient†. The underlying reason for the lack of funding that bridge repair has been able to affect over the past several years can be linked to various factors. One of the first factors that should be considered is with respect to declining overall revenue that gas taxes have been able to drive. As the cost of a gallon of gasoline has risen precipitously over the past 20 years the response by both federal and state government was to decrease the overall tax burden that was leveraged against this particular commodity. Naturally, the underlying goal for such an approach was to make the resource more affordable to the population; thereby increasing mobility and decreasing the overall rates of joblessness that the economy would otherwise experience. However, a downside to this approach was the fact that federal and state revenue that was earned on each and every gallon of fuel sold was not able to meet the same levels as it had during the 1980s and 1990s. As the reader can reasonably expect, the inability of revenue to keep up with the increased requirements of infrastructure repair created a situation in which a veritable avalanche of projects competed for repair by increasingly reduced levels of funding. Research into the current state of the nation’s bridges estimates that by 2025, fully  ¼ bridges will be over 65 years old.

Casa vicens Assignment Example | Topics and Well Written Essays - 500 words

Casa vicens - Assignment Example This was due to the underlying impressive beautification of the invention that was possessing captivating spaces such as smoking and dining rooms. Moreover, the explosion of pigments in regard to its decorative details was mainly influenced by Arabic and eastern art thus making Casa Vicens a strong forerunner Modernista association. Casa Vicens was originally surrounded by a convent on one side and a magnificent garden on the opposite side (Roe, 2012). The house was extended by Joan Baptisa I Serra in the year 1925 subsequent to the destruction of the initial work. The garden vanished steadily over the years due to the destruction of the underlying monumental fountain with parabolic arch that was designed by GaudI (Crippa & GaudiÃŒ , 2006). Nevertheless, Casa Vicens was restored by architect Ignacio Herreo Jover in the ranging from 2000 and 2005 by combining the underlying facedes finishing which is currently in the market. The plans for Casa Vicens-site main floor, faà §ade is dated back to the 15th January, 1883 and permit for construction was granted 8th march, 1883 (Crippa & GaudiÃŒ , 2006). The construction project provided initially was for a house and a garden. A meeting held on the 27th September presided by Mr. modesto Casals y Leonor, in the Ayuntamiento of Villa de Gracia granted permission to construct ground floor buildings, a water gallery and a corresponding wall on a piece of land situated on Calle Rincon de San Gervasio within Gracia. In the 1929 Jose Fracisco Rafols printed his first and very significant work in regard to Gaudi and the corresponding architecture subject. Architect Antonio Gaudi was in charge of the original project by Mr Manuel Vicens Y Montaner, who inherited the parcel of land from his mother (Crippa & GaudiÃŒ , 2006). Casa Vicens has been in the Jover family since the year 1899 when Dr Antonio Jover who is the grandfather of

Financial Management Master Case Study Example | Topics and Well Written Essays - 2250 words

Financial Management Master - Case Study Example It prides itself in the following retail brands: B&Q; Castorama; Brico Depot and Screwfix. Progressively, the company has been faring pretty well over the years, consequently scooping a pre-tax profit of three hundred and eighty six million pounds generated from a total sale of over nine billion pounds within the first quarter of the 2008 financial year (kingfisher.com). Investment will be reprioritized, targeting higher hurdle rates and faster payback periods. A key target is to stabilize debt at current levels, prior to reducing it in due course. A target of flat rate debt has been set for the current year. Greater focus will be placed on generating higher cash returns from the retail businesses. Stretching targets for sales growth, margin improvement and cost reduction will be drawn (http://www.ekingfisher.com/managed_content/files/downloads/2008ar.pdf ). With these key priorities it is evidenced that the management of kingfisher are committed to the survival profitability and sustenance of the company which is a very good indication of share prices increasing. The market for the product is very lucrative since home improvement is an attractive segment of retail, benefiting from natural long- term demand. Characteristics coupled with demand for more new housing and more frequent home renewal. The market also benefits from variety of products being common across international market, which gave rise to outsourcing and Economics of Scale; but within this market kingfisher is enjoying a large geographically diversified business. However, delivering these values to shareholders from this strong strategic position ill require the charges which have been talked about. The number of shares opened by the Company in various Countries will enhance the profitability base of kingfisher. This is enhanced by the management by the practice of decentralized management approach which gives power to their retail businesses largely operating independently but participating in group- wide programs for local advantage. This approach will enhance high turnover as local customers will adapt to the products. Operating Review of Kingfisher Plc With Retail profit growing rapidly for the past five years it has put the company in a good position to expand its operations in various sectors of the business. For example in 2007/2008 report of kingfisher retail profit grew 13.2% to 237million pounds with both businesses delivering a good profit growth. Gross margins were up90 basis points due to higher own- brand sales penetration, a 25% increase in direct sourcing and an improved sales and strong cost control. In France for instance kingfisher's total sales grew 7.2% and eight new shares were opened and in the year six were

Globalisation Essay Example | Topics and Well Written Essays - 2000 words - 4

Globalisation - Essay Example been broadly understood as a concept, policy and process casually used to describe a variety of phenomena that reflect increased economic interdependence of countries. It includes flows of goods and services across borders, reductions in policy and transport barriers to trade, international capital flows, multinational activity, foreign direct investment, outsourcing, increased exposure to exchange rate volatility, and immigration. These movements of goods, services, capital, firms, and people are believed to contribute to the spread of technology, knowledge, culture and information across borders (Fischer, 2003; Soros, 2002; Balakrishnan, 2003;Geriffi & Sturgeon, 2004). Thus, globalisation permeates the contemporary world. The paper aims to understand the positive impact of globalisation in India. As such, the focus question is how do changes brought about by globalisation have a positive impact in India? The paper will have the following structure: first part is the introduction where globalisation is defined, and the problem is presented. The second part is the presentation of the economic scenario of India. And the third part is about the positive impact of globalisation in India. India with a population of 1,139.96 million as of 2008 and a population growth of 1.3% annually is one of the emerging powers of the Third world (Harris, 2005). India’s 2008 GDP is $1,217.49 billion still higher by $40.60 billion than 2007despite the world economic crisis. Both the agricultural and industries sectors share 36% of GDP with 18% each respectively in 2008. The services sector comprises 53% of the GDP while India’s exports of goods and services for 2008 cover 24% of the GDP. There is a remarkable increase in workers’ remittances from $38666 million in 2007 to $51974 million in 2008. Foreign direct investments have tremendously increased from $6,677 million in 2005 to $22,950 million in 2007. Also, an increase in number of mobile phone subscribers from 21 per 100

Discussing Hamlets speach with Polonius Essay Example for Free

Discussing Hamlets speach with Polonius Essay Farewell, Ophelia, and remember well What I have said to you. Line 88,Act 1 Sc 111. Tis in my memory locked, And you yourself shall the keep the key of it. Line 90 Act 1 Sc 11. These were the last words Laertes and Ophelia exchanged before he left to France. It is when Polonius hears these words that he asks Ophelia what Laertes meant when he said, Remember well What I have said to you. Ophelia then tells her father that it was about her relationship with Hamlet. Polonius then questions Ophelia about this so-called relationship. Which then brings me to speech Polonius and Ophelia have Act 1 Scene 3 Lines 122-143 which I have based my essay own. I will go in depth and explain different characteristics of this speech. This whole speech between Polonius and Ophelia, though Polonius does most of the talking. I think it would be fairly accurate to say that he is actually lecturing Ophelia. Polonius is telling Ophelia that Hamlet is no good and also telling Ophelia that she shouldnt give in to Hamlet so easily. Polonius in this speech also reveals to the reader what his true feelings of Hamlet are. From this speech we can imply that Polonius is very concerned about Ophelias relationship with Hamlet. Shakespeare uses Metaphors, Similes, Alteration, and Personifications in Poloniusspeech s to stress Hamlets faults and Ophelias personality as well. The speech becomes more alive because of these devices. I will show exactly how these devices construct Poloniuss speech. It is obvious that Polonius is concerned about his daughters relationship with Hamlet this is shown throughout the speech in various ways. The speech also shows Polonius strongly disapproves of Hamlet he does this by criticizing every aspect of Hamlet. We can see this by looking at Poloniuss speech for example when Polonius says When the blood burns, how prodigal the soulAct1, Sc3, Lines125, Polonius is saying that when Hamlet has a sudden churning for a womens company that is when he goes to Ophelia. There is an alliteration here blood burns this put emphasis on these two words. When the blood burns is also a metaphor because we all now blood doesnt burn, these two devices make Hamlet seem like a monster. It seems as if Hamlet is only using Ophelia for his own selfish reasons. Then Polonius continues to say how prodigal the soul Lends the tongue vows Act1, Sc3, Lines123-124 Polonius here is saying that when Hamlet has a sudden churning his soul lends his tongue vows or promises. We can see the personification here because Shakespeares writes as if soul is a person and can actually lend the tongue vows. This personification shows the reader exactly how fake Hamlet is. Then Polonius says These blazes, daughter, Giving more light than heat, extinct in both Act1, Sc3, Lines124-125, Polonius is saying that the blazes contain light and heat but they die out soon after. Polonius is saying just like light and heat die out and so will Hamlets promises. This shows the reader that Hamlet is not going to keep his promises that soon they will be broken. Polonius again uses personification to show us exactly what he think of Hamlets promises in this quote Do not believe his vows for they are brokers,Act1, Sc3, Lines134-135, Polonius is talking about Hamlets vows as if they were alive and they could actually break promises. This shows Hamlets promises arent worth anything. Polonius goes on to say that Hamlet is a fake in this next quote Not of that dye which their investments shows Act1, Sc3, Lines135, Polonius is saying that Hamlet is not the way his clothing or covering make him look. In this line Hamlet may be seen as an imposter or a hypocrite. In this next quote Polonius show us exactly what kind of person Hamlet is Breathing like sanctified and pious bawds, Act1, Sc3, Lines 137 this metaphor means Hamlet is acting like a humble person so he can hide his obscene, vulgar personality. In other words Hamlet acts like someone else so he can hide his true self. At this point the reader can speculate from Poloniuss speech that Hamlet is a rather nasty character or that Polonius has some hidden issues against Hamlet and that is why he is intent on giving Hamlet a bad name. Throughout the speech Polonius doesnt give any reason as to why he feels this way towards Hamlet. In the previous paragraph I showed you how Polonius used comparisons and other literary devices to show his disapproval towards Hamlet. In this paragraph I will show you how Polonius makes Ophelia seem feeble and vulnerable. In the first line Ay springes to catch woodcocks! I do knowAct1, Sc3, Lines122 Polonius compares Ophelia to woodcocks, which are known to be witless and easily trapped. Polonius is saying that Ophelia is easily trapped by Hamlet words, gifts etc. The reader might think of Ophelia as a little vulnerable girl who can be easily fooled. Polonius then accuses Ophelia of not being able stand up for herself and saying no to Hamlet, in this next quote Set your entreatments at a higher rate. Than a command to parley. Act1, Sc2, Lines129 Polonius is saying dont automatically give in to Hamlets every request, have some self-respect and dignity. The reader may think that Ophelia cant really say no when it comes to Hamlet. Then Polonius wraps up his speech by saying I would not in plain terms from this time forth Have you slander any moment leisure As to give words or talk with Lord Hamlet. Look tot, I charge you. Act 1,Sc3, Lines138-142Polonius is ending his speech by telling Ophelia that she better not from this time on spend time or even talk with Hamlet anymore. Ophelia answers by saying I shall obey, my Lord. Act1, Sc3, Lines143 Ophelia doesnt complain to her father this shows a certain amount of feebleness on Ophelias side. The reader can obviously assume that Ophelia is a vulnerable, feeble and a nai ve girl in here nature. The overall effect of Poloniuss speech is concern for his daughter and disapproval towards Hamlet. Polonius is trying to protect Ophelia from getting hurt by Hamlet, which whom he doesnt particularly like. This makes Polonius seem like an overprotective father. The essence of Poloniuss speech is the concern mixed with extreme dislike toward Hamlet. He uses Metaphors, Similes, Alliteration and Personification this makes Poloniuss speech become more appealing. Polonius compares Hamlet to many things and says a lot about what Hamlet is and is not. Polonius does it so much that the audience is feels that the Polonius could have is own secret issues with Hamlet. The audience is hearing a lot of criticism directed at Hamlet and the audience might start to think that Poloniuss has other reasons for disapproving of Hamlet. This could mean that all the things said about Hamlet may not be true. How does the speech affect the rest of the play? This speech affects the rest of the play in the sense that Poloniuss disapproval of Hamlet causes for Ophelia to tell Hamlet that their relationship is over and Hamlet is not very pleased by this. After this episode when Hamlet starts acting weird, even a little mad. Polonius automatically suggests it is because Ophelia has dumped Hamlet, and therefore convinces Claudius and Gertrude that is what is causing Hamlets madness. Even though there is not direct evidence that implies Ophelia is the cause of Hamlets madness, in fact the reader know this is not even the reason for Hamlets madness further more Hamlet is not even mad. Polonius is simply playing devils advocate. I think Poloniuss extreme dislike of Hamlet that is revealed throughout the speech has affected the play in a number of ways.

Establishing Relationships in Support Work

Establishing Relationships in Support Work Haiyang Li There are many kinds of relationships in the world, for instance, parents and children, husband and wife, boyfriend and girlfriend, friends, neighbors and etc. Normally, people think the relationship between supporters and clients is the same as doctor and clients. However, there are a lot of differences. In this essay, I will demonstrate what a supporting relationship should be, identifying the key theoretical principles to establish a supporting relationship. In between, I will connect the theoretical principles with the case study, and demonstrate how the principles work in the real situation. To build a supporting relationship, the supporter needs to put his heart in the support work using all the helping skills and Personal-Certred Approach as a guide in the real work. The relationship between supporter and client was seen as someone who can talk to. It looks very simple. However, the supporter is the one who can be trust, the one who can understand the problems or the situation the clients in, the one can accept the fact of clients hold, and the one can be allowed to provide help for the client. In order to become that kind supporter, the helper need to prepare relevant knowledge to understand the situation, history, strength and worries the client has. the relationship is about building a rapport and trust with the supporter. The client may feel comfortable enough to open up and address their problems. This kind of relationship is built on confidentiality and reliability. In this case, ‘Spider’, he is a 19 years old boy. The situation of him is that he is sleeping in the nearby park. He is lack of education but he learned from street knowing how to survive on the street but poor living conditions. The history of him is that he has family abuse history and has been lived in foster homes for a few years and change foster home frequently in those years. He was not good at school study left school when he was 14. After he turned to 18, he lost government support and then he had to live in the street in the poor living condition and use street drugs for himself. The strength of him is that he identifies himself as a resourceful, determined and smart street dweller. He wants to start a new way of life which is moving out from the street, finding a job, requiring more knowledge and having his own living place. He hopes that he can have his own family. He has very strong desire to move on for his life to start working forward to his dream. The worries of him are homelessness, unemployment and reuse street drugs. From case study, I think the Person-Centred Approach is suitable and helpful for us to understand and care for him. The Person-Centred Approach developed from the work of Dr. Carl Rogers. The research (Richard, 1992) indicates that the Person-Centred Approach theory aim to develop or create a relationship that can allow the clients to be themselves. The relationship can be felt safe for the client and give them space to develop and grow. To achieve this goal, the supporter would be a person who was deeply understanding which is empathic in the theory; accepting which is having unconditional positive regard and genuine which is congruent in the principle. Using Person-Centred Approach theory, the supporter needs to understand what has happened to him. Firstly, when he was young, he was suffering from neglect and abuse in his family. The research (Smith Segal, 2012) shows that Negligence, on the part of parents or caretakers, can cause children both physical and mental health problems. Parents or caretakers carelessness can be seen as a kind of physicalabuse. Children’s fear is also from unpredictable environment change and behavior of their guardians. The guardians successfully manage to plunge fear in the hearts of the children. As a result children who suffered from family physical abuse always pay attention on the negative emotions of their caretakers or parents. So, when these children grow up, the childhood experience has impacted on their personalities and behavior as well. Research (Soomro, Abbasi Lalani, 2014) shows that they may encounter physical problems such as asthma, high blood pressure, ulcer, allergies, etc; p sychological problems such as personal disorders and aggressive demeanor and behavior problems such as felony, drug habits and poor academic performance. In this case, ‘Spider’ shows his behavior problems which are not successful in school and drug problems. And street drug problem still drag him back to the street. Secondly, he had been into the foster home but change frequent between foster homes. The foster care system seems another ideal choice for them; however, it is not always helpful when these young people need help. These adolescents have been impacted by the homeless issue and cause their social and health problem (Joanne Patricia, 2006). Children who have been put in the foster care home experienced about the relationship attached between them and their caretakers or their foster home parents. This link is very important for children’s development. Research (American Psychiatric Association, 1994) indicated that Disruptions in attachment relationships can lead to Reactive Attachment Disorder of infancy or early Childhood. In this case, ‘Spider’ has experienced the frequently changes in foster care homes. This impact may shows on him when he grows up. He may have difficulty trust or related with somebody else such as our supporters. So this may be a barrier in est ablishing supporting relationships. So from this case, as a supporter, I understand that the most problems of him have not controlled by himself. He has no choices that born from a family where abuse him when he was young. For rescuing him, he has been put into foster care. The child abuse experience makes his misbehavior in the foster home and school. He does not prepare enough for his independent life before he had been abandoned from foster care home. He has to live in the street in a rough condition so that he has the opportunity to connect with street drugs. I am also glad that he is still holding his hope on his future. He wants to be employed, educated and to have a living place. The internal motivation is the most important helper for him to reach his goal because an important part of this theory is that in a particular psychological environment, the fulfillment of personal potential is a desire to know and be known by other people (British Association for the Person Centred Approach, 2015). After understanding about the client, the supporter needs to preparing himself with communication skills, action skills, mind skills and using unconditional positive regard to start a conversation with the client. Richard (2012) indicates that the Communication and action skills are what people do and how they do it rather than what and how they feel and think. The skills include listening skills, questioning skills and challenging skills. Supporter and clients can use verbal messages, vocal messages, body messages, touch messages and taking action messages to communication with each other. In the Person-Centred Approach theory, supporter needs to use positively acceptant response to the client. Use warm and appropriate expression to send messages to build a different kind of relationships so the client may feel free to talk and express himself. Also, in genuine part, the supporter need to show client that client has been heard. It is important to show that the supporter is paying attention in the conversation they have. The supporter may use verbal messages to reflecting what the client said; may use face expression to let client know the support was thinking about what client said; or the supporter, may use taking action messages to make a note to show his listening. That is the main difference of the relationship with doctor, nurse or social worker. John and Julia (2011) research shows that these professional people tend to provide advices response rather than listening. They are looking for the solution rather than the process of helping people finding their own pro blems the helping relationship is focus on people. It is the way for people to rescue themselves. I understand of mind skills is the process to know yourself and your own experience in order to use your own experience to help the client. in this case, we can share the same experience when ourselves in the difficult situation. Out experience may difference with his abuse, foster care, homelessness history but we have our difficult time such as hard to find a job and do not know what to do next in life. The important that we share how we concur the difficulty, what effort we made and never lose the hope. To sum up, the support work is how you treat someone who needs help and how to provide help. The first to start a relationship, as the Person-Certred Approach suggested, understanding what the client is, such as who he is, what the situation he is in, what the problem he has and what worries he may have. Then before start a conversation, the supporter needs to provide a comfortable and safe environment for the client. One meaning of the environment is physical environment that may include the nice place to sit, comfortable and no interrupting noise. The other meaning of the environment is between supporter and the client. The supporter need to prepare an environment that the client can open his heart and willing to share his story. In order to do so, the supporter need to use the communication and action skills, use his voice, use positive unconditional regards, use acceptance attitude and use congruent skills to show that the supporter is ready and willing to accept the client. Also , the supporter needs to keep the confidentially of the conversation. So the client feels trustworthy and safe to talk to the supporter. References British Association for the Person Centred Approach, 2015. What is the Person-Centred Approach? Retrieved fromhttp://www.bapca.org.uk/about/what-is-it.html Joanne, O., Patricia, L. (2006). Adolescent Homelessness, Nursing, and Public Health Policy. Policy, Politics, Nursing Practice, 7(1), 73-77. doi: 10.1177/1527154406286663 John, M., Julia, M. (2011). Counseling Skills a practical guide for counselors and helping professionals. (2nd ed.). New York, USA: Open University Press Richard, N. (1992). Lifeskills Helping A text book of practical counseling and helping skills. (3nd ed.). NSW, Australia: Harcourt Brace Company. Richard, N. (2012). Basic counseling skills a helper’s manual. (3rd ed.). London, UK. Sage publications Ltd. Smith, M., Segal, J. (2012, July).Child Abuse and Neglect. Retrieved July 25, 2012, from Helpguide:http://www.helpguide.org/mental/child%5Fabuse%5Fphysical%5Femotional%5Fsexual%5Fneglect.htm Soomro, S., Abbasi,Z. Lalani, F. (2014). An Indepth Insight intoChildAbuseand itsImpacton Personality of Victims. International Research Journal of Art Humanities. 10 (40), 53-68. Retrieved from http://eds.a.ebscohost.com.ezproxy.massey.ac.nz/eds/detail/detail?vid=2sid=3dbcd49c-02aa-456b-9c1e-d379c403696f%40sessionmgr4002hid=4208bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=hlhAN=99236148

The role of human resource management (HRM) in Australian-Malaysian joint ventures

The role of human resource management (HRM) in Australian-Malaysian joint ventures As is stated in the article The role of human resource management (HRM) in Australian-Malaysian joint ventures by Gladys Cheah-Liaw, Stanley Petzall and Chris Selvarajah, the two human resource management issues that was agreed in the article are the staffing policies in term of compensation plan and the cultural differences issue thats mostly discussed in the article. Compensation gap has become the issue between the host country nationals and parent country nationals. Besides that, joint ventures between Australia and Malaysia have that gathering two differing cultures has be one of the challenge for human resource management to overcome if wanted to be success in joint ventures. Arguable issue always occur about the compensation gaps between host country nationals (HCNs) and parent country nationals (PCNs). As stated in the article, PCN on an international assignment would have a higher level of compensation then a HCN or a third-country nationals (TCNs) doing the same job and this cause HCN and TNC react negatively (Gladys et al., 2003). However, not adapting pay scales to local market can present human resource manager with more problems then it solve. The fact is that it can be extremely more expensive to live in some countries like UK than other like Malaysia, and if these cost of living differences arent considered, it may be most impossible to get managers to take high cost assignment. One international compensation trend of growing importance concerns the awarding of long-term incentive pay to overseas managers. Nowadays, a lot multinational are finding to formulate new long-term incentives specifically for overseas executives. Thus, joint ventures sh ould devising performance-based long term incentive plans that tied more closely to performance at the subsidiary level. These can help build a sense of ownership among key local managers while providing the financial incentives needed attract and keep the people we need overseas. The second issue as is agreed in the article is about the cultural differences. As joint ventures involve of employees from different background, human resource manager must be aware of cultural traditions and practices in the nations they are operating in. Unawareness of such things often causes offence to potential overseas business partners and customers. This is one of the factors needed to be attentive. Understanding the national culture can be vital. National culture refers to the attitude and perspectives shared by the people of a specific nation or cultural group that shape their behaviour and the way they see the world. There is wide ranging cultural and ethnic differences from country to country which demand corresponding differences in personnel practices among joint ventures. A high degree of sensitivity and empathy for cultural and attitudinal demand of employees is always important when selecting employees to staff overseas operations. However, such sensitivity is espec ially important when the job is human resource management and the work involves all labour force. Is important also for human resource department that shares the employees cultural background is most likely to be sensitive to the employees needs and expectation in the work place and its thus more likely to manage successful join venture. In summary, human resource management in joint ventures played an important role in overcoming all the issues that might cause failure to the joint ventures development. Question 5 What was the pattern of HRM practices for successful joint ventures? Explain it accordingly to the phase of join ventures development. The pattern of human resource management practices or successful joint ventures is whereby human resource management can fit with the organizations stage of development in joint venture. Each stage of development needs human resource management to adjust the firm accordingly with the different stage. The five organization stage was initiation, functional growth, controlled growth, functional integration and strategic integration. In the initiation stage, joint ventures should had operates for one to three years. In this stage, human resource practice was taken from the parent company. Employment in the initiation stage was said ethnocentric have been taken place which have their own management control and particularly use all capable managers for joint venture. By succeed in the initiation stage, human resource management need to lay emphasis on training, appraisals and aware of compensation for the employees to be in line with the host country. However, the cultural differences issue whereby human resource management need to attentive on it. In transition stage, joint ventures are mainly controlled by a parent country and focusing in the mechanized sector. Transition stage was said to be put up with local demand and is in polycentric perspective, like joint venture was managed by host country nationals. In this stage, training and development was intend to improve current and future employees performance by enlarge employees ability in achieve goal. Compensation was needed to be restructure to retain talented employees as if is due to the labour shortage. In this stage, cultural differences issue was not that critical as employees were monitored to work together and improve by communication. And lastly, joint ventures was said to be greatly successful if reached the maturation stage. They said to be aware of adopting the best practices and be competitive in the universal market. Employment was said to be geocentric which by using the best approach around the world and forces managers to take a wider, global view of operations. Training in this stage was still in improving their efficiency and effectiveness. And the compensation needs to be reorganizing by following the Hire Worldwide Remuneration Consultants (HAY) system for the organizational levels. Cultural differences challenge was said to be solve out and creating a successful diversity workforce. In short, every stage of the successful joint venture development is still on the purpose of getting the job done. As the joint venture development stage can be accomplish stage by stage, join ventures is said to be greatly successful. Question 6 Do you opine that your employers or the organization where you are familiar with has same HRM practices patterns as the organizations highlighted in the article? Discuss your answer. On year 1997, Malaysia Airlines (MAS) and General Electric Company of the United States (GE) have signed an agreement to shape a joint venture after a year of signed a Memorandum of Understanding for a joint venture which MAs and GE will joint together to form a Centre of Excellence in engine repair at Malaysia, The Aero Centre facility in Subang. The plan of joint ventures between GE and MAS in opening the Aero Centre of Excellence is to provide service and repair of to the aircraft engine to Asia Pacific customer which last time use to service in the United States and Europe. As stated in the Press Centre of GE, the joint venture is significant for the country, company and customers. GE is one of the world largest high-technological and blue chip company which joint venture with Malaysia Airlines. In this joint venture, Malaysia gain benefits in upgrading its present aerospace technological capacity, able Malaysia to develop indigenous technology and lead to becoming an aerospace hub. As stated by Tan Sri Tajudin Ramil, the chairman of MAS, this joint venture have bring advantages to MAS through upgrade the navy support and improved skill and productivity. MAS employees also gain benefits from the advance training in leading-edge technology for GE, the world class company. The president of GE Engine Services Inc. affirmed that through CE investment, and joint with MAS, they intend to make Kuala Lumpur the first-class shop operation that will drive future growth. In the joint venture, Malaysia Airlines able to carry to the undertaking a state-of-art facility and a trained workforce. As Aero Centre of Excellence in Malaysia which was the joint ventures between GE and MAS has gain profitability through growth, this joint ventures is to be said as successful just like stated in the article of The role of human resource management (HRM) in Australian-Malaysian joint ventures which involved with the pattern of human resource management practices for successful joint ventures. The successful joint venture development consists of 3 main stages which is initiation, transition and maturation. In the initiation stage, GE from U.S had started to assemble their own human resource policies and practices which included local demands. This was be said as ethnocentric whereby is the parochial belief that the best work practices and approaches are those of the home nation. The advantaged of ethnocentric are the organization will have simple structure and managers can implement closer control. However, theres still disadvantages in this view whereby that decision-making may be le ss effective. There is no flexibility for employees working in foreign locations and there will be difficulties in building good business relationships in the host nation. Due to the shortage of labor, they cant choose the people they want. So, training is needed in this stage and basic compensation was needed to be structured as the principle of the host country. In this stage, cultural issue will be the issue and challenges as human resource department needed to overcome the diversity problems. In the stage of transitional, human resource practices hold to local demand. This stage was polycentric perspective which , this is the view that managers in the overseas, host nation know the best work practices for running operations in that nation. The advantages are that the managers working in the overseas operation will have extensive knowledge of how best to run the workplace and meet market demand. Local managers are likely to be more committed and have higher morale than managers imported from the home country. Also the host government is more likely to provide support. The disadvantages are that duplication of work efforts and facilities in both the home nation and foreign host nation leads to inefficiencies and ineffective use of resources. It is also difficult to maintain a single focus on global objectives as operations in each nation concentrate on their own operations. In this stage, career development for staff is to be organized to improve the productivity. Compensat ion in this stage need to be restructured to retain the potential workers. However, the cultural differences issue has been reduced in this stage. And lastly, when reach the maturation stage, geocentric perspective was taken place whereby global-oriented view focusing on finding and using the best approaches from around the world. The advantages of this view are that it forces managers to take a wider, global view of operations. As in this stage, joint venture was said to be greatly successful which had managed cultural diversity. As GE and MAS was recently successful in the joint venture, they should have overcome all the stages and apply the human resource practice effectively and efficiently to be success in the diversity environment. GE and MAS was working greatly together with the profit that reached $ 1 billion last year. This is because, Aero Centre of Excellence in Malaysia which is joint venture between GE and MAS has overcome all the problems and challenges that occur on the joint venture development, especially the working environment that full of cultural differences. Question 7 Explain two human resource problems experienced by your employer of the organization where you are familiar with and to strategies for overcoming the problems. The two human resource problems experienced by my employer of the organization are the compensation and cultural differences. Compensation and retaining workers have always be the problems to human resource management because employees always not satisfy with the salary and benefits that been given by the employers. Developing a pay plan that is internally and externally equitable is no less important in a small firm or large firm. Besides the compensation problems, managing diversity workforce also be a problem to employer as Malaysia is a mixture country with different of race, religion and so on. Everyone have their own backgrounds which lead to the different thinking compare with others. To keep organization still that competitive, human resource problem needed to be solve out before it get worse. Employee compensation means all forms of pay or rewards going to employees and arising from their employment. Everyone knows that people have many needs, and some which can be satisfied directly with money. As every employee always as for a better life, they expect employers will provide them with satisfied salary just to retain them. Some employees always compare their salary with others. If salary was lower than their colleague, they will just go search for another job might increase the job turnover. In such case, employer should have policies on compensation-related method. Human resource manager need to ensure why the amount of salary among employees is is different and employees need to understand the reason to reduce conflict that might happen in organization. Employers should develop a workable pay plan by conducting a wage survey which collects the information about the job and set a base salary that deserve to receive by the employees. It can be easier also in structure the compensation plan if split employees into three group to managerial, clerical and plant personnel. For each of the three groups, determine the compensable factors to be evaluated and then rank or assign points to each job based on the job evaluation. For each class of jobs, employers should create a pay range. Besides this, employers also can provide reward to employees that attaining companys goal. This was not only can motivate employees but also keep them getting the job done, just to get the reward. Reward also can be a way in retaining potential worker. Capability workers will always surrounded by head-hunter and intellectual employees will just leave the organization if other company can provide better benefit package to them. Not all employees asking for money to satisfy their need but some may ask for achievement, affiliation, power or self-actualization. Yet, even with job enrichment can be a modern motivation technique. Besides that, to retain worker, non-monetary reward like vacations and holiday, sick leave, annual leave and so on can help in retaining potential workers. For employees that attaining organization goal, employers can reward them with promotion or paid vacation as a reward. Employees will somehow work hard just to get the reward offered by employers. Cultural factor have been generally be a problem to human resource. As Malaysia was known as rich of different cultural, most of the company in Malaysia was facing the same problem which is workforce diversity. To overcome this problem, employers can increase relationship between employees by regular meeting. Training also needs to be providing to employees in how to communicate efficiently to reduce conflict in the workforce. Besides that, employers can use teamwork to build relationship between employees while completing their task. In teamwork, sharing will be more to be occur and this can make employees understand each other more. Employers should encourage idea sharing among employees, just to make them discuss more and build relationship without knowing. This kind of method not only can help in diversity labor force but also can come up with new ideas and improve the productivity in the organization. In short, every company has their own human resource problem as is important for employers to apply strategies that is effectiveness and efficiency. Retaining workers has mostly been the problems faced by most of the organization and compensation needs to be structured carefully to avoid from any turnover. Cultural differences are something Malaysian companies can avoid from as Malaysia is a multi-cultural country. To cut down the problems in cultural differences, human resource need to solve out the diversity labor force by monitoring and liaison employees with each other.

Symbolism and Theme in William Faulkners A Rose for Emily Essay

Symbolism and Theme in William Faulkner's A Rose for Emily  Ã‚  Ã‚   In William Faulkner's short story "A Rose for Emily," a series of interconnected events collectively represent a single theme in the story. Symbolism is the integral factor involved in understanding the theme. "A Rose for Emily's" dominant theme is the search for love and security, a basic human need which can be met unfavorably in equivocal environments. Faulkner's use of symbolism profoundly develops the theme of the story, bringing to light the issues of morality that arise from a young woman's struggle to find love. Faulkner provides the necessary pieces of symbolism, speckled through out the action of the story, for the reader to assimilate and assemble. Curiously, it is a broken time line that Faulkner follows, that allows him to achieve maximum effect at the end of the story. The placement of the conclusion or denouement at the beginning of the story, allows the curiosity of the reader to become strongly engaged on the character of Emily Grierson. As the narration begins with the funeral of Emily, the juxtaposition of the image received in the opening paragraph, is sharply compared to that of the information found in the third paragraph. Where in the first the town has come to pay respects to a fallen monument, in the third it is learned that she was really, "...a duty, and a care; a sort of hereditary obligation upon the town..." (276). The story progresses through flashbacks, and Emily is heard speaking to the gentlemen representing the Board of Aldermen, and it is noticed that she is wearing a thin gold watch chain. It is not until a lull takes place after the spokesman announces the purpose of their visit, that they then,"... could hear the inv... ...uest for love and security, and Emily has provided this for herself. Whether she knew the process through which she gained it was moral or not remains a mystery whose answer died with her. She sought refuge from the cold, and inhospitable environment of abandonment. She sought to get away from the only life she ever knew. The strategic placement of symbolism in the action of this story, provides vast areas with depth of knowledge from which the theme comes forth. The reader is pulled into character early on, by placing the conclusion up front, and placing the falling action at the end of the story. This creates a greater sense of surprise or shock value, and may even evoke a sense of true pity for Emily from the reader. Work Cited Faulkner, William. â€Å"A Rose for Emily.† Literature for Composition. 4th ed. Ed. Sylvan Barnet, et al. New York: HarperCollins, 1996. Symbolism and Theme in William Faulkner's A Rose for Emily Essay Symbolism and Theme in William Faulkner's A Rose for Emily  Ã‚  Ã‚   In William Faulkner's short story "A Rose for Emily," a series of interconnected events collectively represent a single theme in the story. Symbolism is the integral factor involved in understanding the theme. "A Rose for Emily's" dominant theme is the search for love and security, a basic human need which can be met unfavorably in equivocal environments. Faulkner's use of symbolism profoundly develops the theme of the story, bringing to light the issues of morality that arise from a young woman's struggle to find love. Faulkner provides the necessary pieces of symbolism, speckled through out the action of the story, for the reader to assimilate and assemble. Curiously, it is a broken time line that Faulkner follows, that allows him to achieve maximum effect at the end of the story. The placement of the conclusion or denouement at the beginning of the story, allows the curiosity of the reader to become strongly engaged on the character of Emily Grierson. As the narration begins with the funeral of Emily, the juxtaposition of the image received in the opening paragraph, is sharply compared to that of the information found in the third paragraph. Where in the first the town has come to pay respects to a fallen monument, in the third it is learned that she was really, "...a duty, and a care; a sort of hereditary obligation upon the town..." (276). The story progresses through flashbacks, and Emily is heard speaking to the gentlemen representing the Board of Aldermen, and it is noticed that she is wearing a thin gold watch chain. It is not until a lull takes place after the spokesman announces the purpose of their visit, that they then,"... could hear the inv... ...uest for love and security, and Emily has provided this for herself. Whether she knew the process through which she gained it was moral or not remains a mystery whose answer died with her. She sought refuge from the cold, and inhospitable environment of abandonment. She sought to get away from the only life she ever knew. The strategic placement of symbolism in the action of this story, provides vast areas with depth of knowledge from which the theme comes forth. The reader is pulled into character early on, by placing the conclusion up front, and placing the falling action at the end of the story. This creates a greater sense of surprise or shock value, and may even evoke a sense of true pity for Emily from the reader. Work Cited Faulkner, William. â€Å"A Rose for Emily.† Literature for Composition. 4th ed. Ed. Sylvan Barnet, et al. New York: HarperCollins, 1996.

Benefits and Risks of Antibiotics Essay -- Antibiotics Pills Essays

Benefits and Risks of Antibiotics Introduction There are many issues that producers face in their practices today. One of these issues concerns the widely accepted use of antibiotics in livestock feeds. There are benefits and risks associated with this use. These issues impact not only the animal industry; the repercussions are seen on a much larger scale in the general public. This paper will give an overview of both the pros and cons of this issue. Background Antibiotics have been approved for use in livestock feed for over 30 years. This includes a variety of different antibiotics that are added to the feed at sub-therapeutic levels. There are strict guidelines that limit the amount of antibiotic to no more that 200 grams per ton of feed. Each antibiotic also has a minimum and/or maximum amount set. Antibiotics are widely used in all areas of the animal industry. They are most prevalent in swine, poultry and beef rations. PRO Antibiotics are invaluable to the producer. There have been numerous studies that show growth promotion and increased feed efficiency (a.k.a.: nutrient conversion) are achieved by using antibiotics in the feed. All industries can benefit from antibiotic use. For example, 100% of poultry producers add antibiotics to their rations for increased feed efficiency in growers and increased egg production in layer hens. Feedlot cattle are fed antibiotics to reduce the incidence of liver abscesses - a major money loss at slaughter. There are many who argue that the practice of including antibiotics in feed leads to drug resistant bacteria. The research done on this topic is inconclusive. Some producers are trying to get around this problem. These producers implement a gradient-feeding regime... ...uperbugs on the hoof? Science. 2000 May 5:288(5467):792-4 Hayes, D. J., H. H. Jensen, L. Backstrom, J. Fabiosa. Economic Impact of a Ban on the Use of Over-the-Counter Antibiotics in Swine Rations. 1999. Staff Report 99SR90 Center for Agriculture and Rural Development, Iowa State University, Ames, IA. Hoogkamp-Korstanje, JA. 1999. Ned Tijdschr. Geneeskd. (translation). PubMed abstract Houndt, T., H. Ochman. Long-Term Shifts in Patterns of Antibiotic Resistance in Enteric Bacteria. Appl.Environ. Microbiol. Dec 2000 V.66:5406 Jurgens, Marshall. 1997. Animal Feeding and Nutrition, 8th Edition. Dubuque, IA: Kendall/Hunt Pub. Co. Kamphues, J. 1999. Berl Munch Tierarztl Wonchensch. (translation). PubMed abstract. Tollefson, L., M. A. Miller, Antibiotic use in Food Animals: Controlling the Human Health Impact. J. AOAC Int. 2000 March/April; 83(2):245-254 Benefits and Risks of Antibiotics Essay -- Antibiotics Pills Essays Benefits and Risks of Antibiotics Introduction There are many issues that producers face in their practices today. One of these issues concerns the widely accepted use of antibiotics in livestock feeds. There are benefits and risks associated with this use. These issues impact not only the animal industry; the repercussions are seen on a much larger scale in the general public. This paper will give an overview of both the pros and cons of this issue. Background Antibiotics have been approved for use in livestock feed for over 30 years. This includes a variety of different antibiotics that are added to the feed at sub-therapeutic levels. There are strict guidelines that limit the amount of antibiotic to no more that 200 grams per ton of feed. Each antibiotic also has a minimum and/or maximum amount set. Antibiotics are widely used in all areas of the animal industry. They are most prevalent in swine, poultry and beef rations. PRO Antibiotics are invaluable to the producer. There have been numerous studies that show growth promotion and increased feed efficiency (a.k.a.: nutrient conversion) are achieved by using antibiotics in the feed. All industries can benefit from antibiotic use. For example, 100% of poultry producers add antibiotics to their rations for increased feed efficiency in growers and increased egg production in layer hens. Feedlot cattle are fed antibiotics to reduce the incidence of liver abscesses - a major money loss at slaughter. There are many who argue that the practice of including antibiotics in feed leads to drug resistant bacteria. The research done on this topic is inconclusive. Some producers are trying to get around this problem. These producers implement a gradient-feeding regime... ...uperbugs on the hoof? Science. 2000 May 5:288(5467):792-4 Hayes, D. J., H. H. Jensen, L. Backstrom, J. Fabiosa. Economic Impact of a Ban on the Use of Over-the-Counter Antibiotics in Swine Rations. 1999. Staff Report 99SR90 Center for Agriculture and Rural Development, Iowa State University, Ames, IA. Hoogkamp-Korstanje, JA. 1999. Ned Tijdschr. Geneeskd. (translation). PubMed abstract Houndt, T., H. Ochman. Long-Term Shifts in Patterns of Antibiotic Resistance in Enteric Bacteria. Appl.Environ. Microbiol. Dec 2000 V.66:5406 Jurgens, Marshall. 1997. Animal Feeding and Nutrition, 8th Edition. Dubuque, IA: Kendall/Hunt Pub. Co. Kamphues, J. 1999. Berl Munch Tierarztl Wonchensch. (translation). PubMed abstract. Tollefson, L., M. A. Miller, Antibiotic use in Food Animals: Controlling the Human Health Impact. J. AOAC Int. 2000 March/April; 83(2):245-254

Jai Ho

Assignment: Inverted Index October 19, 2012 1 Introduction Today, top search engines like Google and Yahoo use a data structure called Inverted Index for their matching of queries to the documents and give users the relevant documents according to their rank. Inverted Index is basically a mapping from a word to its position of occurence in the document. Since a word may appear more than once in the document, storing all the positions and the frequency of a word in the document gives an idea of relevance of this document for a particular word.If such an inverted index is build up for each document in the collection, then when a query is ? red, a search can be done for the query in these indexes and ranking is obtained according to the frequency. Mathematically, an inverted index for a document D and strings s1 , s2 , †¦ , sn is of the form s1 ? > a1 , a1 , †¦ 1 2 s2 ? > a2 , a2 , †¦ 1 2 . . . sn ? > an , an , †¦ 2 1 where ak denotes the lth position of k th word in the document D. l To build up this kind of data structure e? iently, Tries are used. Tries are a good data structure for strings as searching becomes very simple here with every leaf node describing one word. To build up an inverted index given a set of documents using trie, following steps are followed †¢ Traverse one document and insert words into a trie. As a leaf node is reached, assign it a number (in increasing order) representing its location in the index (staring from 0). Add the position of this word into the index. Now for a word which occur more than once in the document, when attempt for second insertion into the trie is made, a leaf node already containing that word would be found and its value would tell the location in the index. So simply go to this index and add another position for this word. †¢ Do this till end of document is reached. Now, you have a trie and an inverted index for the ? rst document. †¢ Repeat this procedure for the rest of the doc uments. 1 Now follow the below steps to search for a word from the inverted indexes and tries of all the documents †¢ For every document, ? st search for the word in the corresponding trie and get its location in the inverted index of that document. †¢ Then traverse through all the positions and see which document has most frequency and arrange the documents accordingly (in decreasing order). Also, in every document there are special words called â€Å"anchor texts† which have more importance than a normal text word. For example – a download link. So for the same word, its occurence as an anchor text increases the relevance of that document over its normal occurence. 2 Problem StatementFor this assignment, you need to create an inverted index for a collection C of documents from 1 to n. Every document will be a plain text ? le with ? rst line storing its id from 1 to n and next few lines containing space or new line separated words. The index should be an arr ay of lists with size of array equal to total number of distinct words in the array and the list for each word contains the locations of the word in the document. The trie used for this construction can be represented in any form (array/linked list/trees etc. ).So you would have n such tries and inverted indexes. Then you should ask user for the queries (single-word) and give the order of documents in decreasing order of relevance. For our case, the anchor texts are represented by following the word with a ?. So if you have something like – â€Å"Rats fear cats and cats* fear dogs. † then here 1st cat is a normal word whereas 2nd cat is an anchor text. So now your array size will be 2 ? totalnumberof distinctwords in the document as you would store positions of normal text and anchor text separately for a given word.And now relevance should ? rst be decided by the frequency of anchor texts and within them collision should be resolved by frequency of normal text. D1 D2 D3 1 it is what it is 2 what is it 3 it is a banana Below are the corresponding tries and inverted indexes for the 3 documents (? gure 1). 2 Figure 1: Trie and Inverted Index for Documents 1, 2 and 3 Now if query is â€Å"it† – then search in 1st index gives – 0, 3(f req = 2), 2nd index gives 2(f req = 1) and 3rd one gives 0(f req = 1).So, our output is – 1, 2, 3or1, 3, 2 (as document 2 and 3 have equal relevance). NOTE †¢ The names of the data ? les should be taken from command line. After 3 building the inverted index, you should ask for query again from command prompt and also give an option of quitting any time the user want. †¢ The inverted indexes should be written to ? les named as â€Å"1†¦ n. txt† with each line corresponding to one word in the document. †¢ You can ignore case-sensitive words i. e. , Cat and cat are same. †¢ Also ignore symbols in the text (if any) like . ,-? 4

Lowering the Drinking

The central plank of the debate is the determination of minimum age of drinking. The society will be happier where the states interference is less and where it allows the full freedom and liberty to the citizens with qualified restrictions. The actions taken and legislations passed by the governments are just for the welfare of the state with public policy. The heated discussion on Lowering the Drinking is not a new one and it came into spotlight with Jenna Bush’s arrest for consuming alcohol and buying it with fake identification. The social contract theory says that men have right to the sovereign to organize them in better way. The sovereign was not a party to the contract. The people authorized and give up the right of governing themselves to the sovereign who came into being as a result of the contract. [1] It is given the right of make laws. Law is the expression of general will. According to Rousseau â€Å"A law is a resolution of the whole people, for the whole people, touching a matter that concerns all†. Law must relate to general interest. It represents the general will. The enactments of the government are merely a corollary of the general will. So the laws framed regarding the drinking age also should go with the general will. The national minimum drinking age act, 1984 give 21 years as the minimum age of drinking in USA. In many countries there is no age restriction on the drinking and in countries like Indonesia, Malaysia it is 17 year. The present laws set the age of drinking as 21 [2] and it was 24 years back it came into force. And it is time look back with the resent development in social as well as technological development. There are several issues where the importance of age is taken into account. some of them are Marriage Adult franchise Capital Punishment Military Services The above mentioned are very important which are having affinity with the Society, Legislature, Judiciary and Executive (defense). They all prescribed the minimum age of their eligibility’s 18 years. But the age of drinking is declared as 21 years. The detailed discussion of them shows their importance and its relevance to the society. Marriage: According to Black law dictionary, â€Å"The legal union of a man and woman as husband and wife is called marriage.† It is regarded as civil contract by the common law. The essentials of the valid marriage are 1.  Ã‚  Ã‚  Ã‚  Ã‚   the parties are legally capable of contracting marriage 2.  Ã‚  Ã‚  Ã‚  Ã‚   mutual consent or agreement, and 3.  Ã‚  Ã‚  Ã‚  Ã‚   An actual contracting in the form prescribed by law. The essential ‘The parties are legally capable of contracting marriage’ goes with lot of interpretation. The legally capable to contracting marriage in regarding the age varies from religion to religion generally and with the uniform civil code it is given to the states to make laws on their own. For a marriage minimum age, license, proof, application, consent for underage applicant is required. ‘SEC. 3. (1) R. S. 1846, Chap. 83 (Amended by Act No. 44, P.A. 1956) Every person who becomes 18 years of age shall be capable by law of contracting marriage. Every person who becomes 16 years of age but is less than 18 years of age shall be capable of contracting marriage with the written consent of 1 of the parents of the person or the person's legal guardian, as provided in this section.’[3] So the eligible age for marriage is 18 and even 16 is allowed with the prescribed procedure. Marriage is one of the important institutions in the society. If the a person is allowed to go with that important responsibility and have the metal power, then why not a person is not allowed to drink at that age. Voting; The adult suffrage is the fullest implication of democracy and it is the most striking feature implication of democracy and it is most striking feature of the constitution. The ‘section 1, of the twenty-sixth amendment-reduction of voting age qualification gives the right of citizens of the United States, who are eighteen years age or older, to vote shall not be denied or abridged by the united states or by any state on account of age’.[4] If the person is eligible to decide which government he want and what will be the pros and cons of that government establishment, cant he think on the drinking and the limits of the drinking. With the development of mass media each and every point of manifesto are clearly analyzed and by taking that inputs only the people are voting. Now the leaders are also focusing on the youth issue which shows their importance in the elections. Being so important decision makers of a future government they can also decide on the level of drinking. So the age of drinking should be brought down to the age of voting right. Capital Punishment; Capital punishment is the highest punishment in the penology knows to man. It deprives the criminal’s life and existence. Modern Penologists, jurists, jurisprudents e.t.c preferred it for the grave and heinous crimes only. According to the reformative theory â€Å"No one is a born criminal. A criminal is the product of the social and economical circumstances.† Modern psycho-analysts, criminologists, sociologist’s e.t.c are  Ã‚   behind this modern theory. The one of the recent case Roper v. Simmons, 543 U.S 551(2005) the Supreme Court held that the minimum age at time of crime to be subject to the death penalty is 18. The judiciary is regarded as best institution for its reasoning on any issue. If the court itself is defending the decision and declared that at age of 18 the person is reasonably prudent and he have total knowledge about the society why cant it allow the person to drink at   the age of 18. Now almost 19 states and federal government had set a minimum age of 18 for capital punishment Military services The person having 18 years of age is eligible to enter into the military services and can serve the nation up to 49 years. Even a person of 17 years of age, with parental permission, can join the U.S. armed services.   There is a strong point that a person with 18 years is serving the nation with commitment, responsibility and attitude to serve the nation. If this is the case cant a person with 18 can’t have liberty drink. Conclusion: It is the time to re-look at the existing law with the advancement of the science and technology and improvement is the communication has enhanced the capabilities of a person.[5] The drinking problems can be reduced with alternative legislations. All people should not suffer due to few deterrents, so more though laws on the violators are a good measure.   Now the people are in a position to decide what is good and what is bad by 18 years itself. If the person is able to decide on the marriage, voting and joining into defense services, he can also think as a prudent person on the drinking also. So the minimum age of drinking should be brought down to 18 years. References: 1.VD. Mahajan, origin of state, Political theory,(1988), 4th edition , S. Chand and Company. 2. Radley Balko, Back to 18, A new chorus of critics says it's time to lower the drinking age, April 12, 2007 < Marriage Laws, 2008 Washtenaw County, MI http://www.reason.com/news/show/119618.html> 3. Selected Michigan    4.   Ã‚  Reduction Of Voting Age Qualification, 1995, United States Government Printing Office, http://www.gpoaccess.gov/constitution/html/amdt26.html 5. The Minimum Legal Drinking Age Debate, [1] VD. Mahajan, origin of state, Political theory,(1988), 4th edition , S. Chand and Company. [2]   Radley Balko, Back to 18, A new chorus of critics says it's time to lower the drinking age, April 12, 2007 ; http://www.reason.com/news/show/119618.html; [3] Selected Michigan Marriage Laws, 2008 Washtenaw County, MI ;http://ewashtenaw.org/government/clerk_register/cr_clklawsm.html [4]  Ã‚   Reduction Of Voting Age Qualification, 1995, United States Government Printing Office, ;http://www.gpoaccess.gov/constitution/html/amdt26.html; [5] The Minimum Legal Drinking Age Debate, ;http://ccat.sas.upenn.edu/~jordanlt/alctwo.html;

One of the Greatest American Sacrifices for WWII

The year is 1941 and the United States has managed to remain out of the 2nd World War. But on the morning of December 7th, history was changed for the American people. At 7:55am, Japanese militants dropped the first bombs on Pearl Harbor. This is â€Å"a date which will live in infamy. † Whether we liked it or not, America was now involved in World War II. Americans all across the country had to make many sacrifices to help out with the war efforts. There were restrictions placed on consumer goods such as automobiles, electronics, and nylons. Also, there were limitations placed on housing construction. But the greatest sacrifice of all was made by the Japanese Americans. In Mine Okubo’s book Citizen 13660, she describes as well as illustrates her experience as she, and approximately 110,000 other people, were evacuated from the west coast and sent to internment camps all across the country. The number 13660 in the book title comes from Okubo’s family number that was given to her when she registered for her brother and herself. It was to be used to identify their belongings and them as a family unit. On page 26, as she waits to load the bus to be taken to the camp, Okubo says, â€Å"At that moment I recalled some of the stories told on shipboard by European refugees bound for America. † In this quote, she is referring to the Jews who are escaping Germany. The stories that were being told are of the concentration camps that the Jews had been sent to. Okubo, along with all the other Japanese Americans, had no idea what was in store for them. Many feared that it would be something very similar to that of the concentration camps in Germany. When they arrived they soon learned that conditions were not as harsh as those the Jews were enduring. But still their experience differed immensely from the rest of the world. They lived in the internment camps and endured the lack of privacy and long lines to get food and to use the bathrooms. In the barracks, they had no choice but to sleep on mattresses filled with hay. â€Å"What hurt most I think was seeing those hay mattresses. We were used to a regular home atmosphere, and seeing those hay mattresses—so makeshift, with hay sticking out—a barren room with nothing but those hay mattresses. It was depressing, such a primitive feeling. † If the men wanted to join the service to show their loyalty to the ountry, they had to serve on the frontlines along with all the other Japanese Americans who chose to serve. The frontlines were extremely harsh conditions and the chance of survival was very low. â€Å"More than 50,000—the children of immigrants from China, Japan, Korea, and the Philippines—fought in the army, mostly in all-Asian units. † Some felt that these things were their way of helping with the war efforts and showing their loyalty to the country, and others felt that their civil rights had been stripped from them. Most of Mine Okubo’s wartime experience was spent in the internment camps. Through her illustrations and the text she shows us the reality of these harsh wartime conditions and how the Japanese Americans managed to make the most of the situation they were placed in. They managed to come together to create their own little community with schools, and visual arts, and even their own newspaper. Okubo’s illustrations allow us to see her emotions as we read her writings. Many of her emotions in the illustrations seem to lack any sort of anger and shed somewhat of a humorous light onto the text itself. I feel like her narrations would take on a more serious tone if her drawings were not present in the book. If I was placed in this same position as Okubo, I am not entirely sure how I would react. A part of me would love to take on the same perspective that Mine Okubo has taken, but as I read her book it is also hard for me to believe that anyone could remain so calm during such an intense time in their life. I would have such a hard time just packing up and leaving at any given moment and not knowing where I was going or what was going to happen to me. Okubo dealt with these undertakings very well and I am not sure I would be able to do the same if put in the same position. This portion in history tells us a lot about the â€Å"limits† of freedom in American history. Although the Japanese-Americans were citizens of the United States and residences within the country, they did not have equivalent rights during this time in history. â€Å"The Constitution makes him a citizen of the United States by nativity and a citizen of California by residence. No claim is made that he is not loyal to this country. † Many Japanese-Americans were being treated as if they had been disloyal to the US and even alienated because of how they looked. Also, the freedom to own land was taken from them as well. â€Å"The Federal Reserve Banks took charge of property owned by evacuees, while the Farm Security Administration took over the agricultural property. † Owning property is one of the greatest freedoms and American can uphold and as history has shown it can easily be taken away in an instant. Japanese-Americans were forced to sell everything because they were very limited in what they could take with them to the internment camps. As we can clearly see, Japanese-Americans had such limited freedom during World War II. Mine Okubo along with Yuri Tateishi gave us an inside look of what it was like for them during this crucial time in their lives and it allows us to see the rights and freedoms that were taken from these American citizens. I was able to more clearly see the actualization of their experiences through Mine Okubo’s illustrations because it allowed me to gain a greater respect for their emotions. Okubo and Tateishi, along with countless others, made some of the greatest sacrifices for the well being of our country during the war and for that they do not get nearly enough credit.

Importance of Criminal Justice Administration

Class: Criminal Justice Administration Date: 9/10/2012 Importance of Criminal Justice Administration The role of a Criminal Justice Administrator is to manage a criminal justice system. She/ He direct the administration of the day-to-day operations, participates in administrative decision making, enforce policies and procedures, and sets work flow priorities. Criminal justice administrators also oversee agencies’ budget, policies and program requirements. Each public agency, according to its primary function, has a support team.The criminal justice administrator is in charge of supervising all agency staff; which can include lawyers, judicial clerks, secretaries, investigators and line officers. He/ She review and approve their reports, as it is his responsibility to make sure all information is accurate and prepared in accordance with established policy and procedure. The United States criminal justice system is a system that acts to enforce the criminal laws of the country. In the United States, the criminal justice system is divided in three categories: federal, state and military.In addition to these three categories, each state has separate divisions that deal with adult and juvenile cases. Each of these systems is comprised of three major components. The first component of the criminal justice system and perhaps the most important and dangerous is law enforcement. This includes the local police department with all of its police officers and detectives. These people head the criminal justice system because they are the ones responsible for finding and capturing individuals who break the laws set forth by the state, federal government or the military.The second component is the court; the court system includes prosecution and defense lawyers, judges and juries. These individuals make sure offenders are given fair trails. Judges, also known as finders of facts, hear the cases and preside over the participants to make sure that all laws are followed wh ile the cases are being tried. Some cases are tried in front of a judge only, while others have a jury of 12 citizens who determine the guilt or innocence of a defendant based on facts brought forth during a trial.The last but not least is corrections. The correction system, which is tightly intertwined with the previous two components, is very important and quite large. The correction individuals ensure that a defendant’s punishment and all of its stipulations are carried out. Like any organization, state and local criminal justice agencies must deal with issues of organizational management and employ the management styles that best allow them to achieve their objectives of crime prevention, adjudication of criminal offenses, and punishment of offenders.In today’s world we have developed different styles of management that could apply to law enforcement agencies, criminal courts, and correctional facilities and departments. In my opinion managers are more important th an supervisor because they have more responsibilities under their shoulders. Systems management requires a complete approach to organizational leadership, which involves not only management of personnel, but also of organizational knowledge. A systems approach to management recognizes the complexity of modern organizational processes.In this perspective, organizations function based on the information and data that employees can access. A successful agency must properly manage all of these elements. Features of systems management include specialization within components of a large system and coordination among different components. System management could serve criminal justice agencies well, and some organizations exhibit elements of this approach. For example, many large law enforcement organizations have specialized divisions, such as homicide, gang enforcement, vice, and others, but with cooperation among these different units.In general Criminal Justice Administration it is imp ortant because in order for law enforcement agencies to work properly a Criminal Justice Administrator needs to be in charge. Law enforcement agencies and organizations devoted to research in the field of criminal justice administration sometimes need professional researchers to perform ongoing work. Examples might include research into the most effective ways to run criminal justice agencies and how budgets impact the administration of criminal justice.Administrators may have tasks that can include mathematical models and other methods in order to assess policies so those in the administrative side can make informed decisions. I personally believe that Criminal Justice Administration is not failing it just have its ups and downs. We have to keep in mind that in order for a criminal justice administrator to be successful he/she has to have a good working idea of the legal system and the role they play in it.

Electronic Medical Records

Electronic Medical Records Essay Cynthia Jones Grand Canyon University: HCA 450 November 11, 2012 Electronic Medical Records Essay Medical record keeping has change in the last couple of decades. In the past patients records were kept in a file on paper taking up excessive room. In the past, paper charts were the only means of keeping a patient’s medical diagnoses documented. Some of these charts are still used today in healthcare facilities, however they are slowly being replaced with a more advance method; electronic medical records (EMR’s).This virtual data–information center can serve as a vehicle to promote and to disseminate standardized data definitions and best practices to providers, consumers, and others interested in quality improvement efforts nationally and internationally (Varkey, 2010). The Electronic Medical Records is an advance computerizes medical record system that delivers medical data for physician’s office and hospitals within a matt er of seconds while offering care. This system allows the healthcare staff and physicians to modified, store and retrieves patient’s medical records.Electronic medical records are legible and organized. The Electronic Medical Record (EMR) has been around since the late 1960‘s, when Larry Weed introduced the concept of the Problem Oriented Medical Record into medical practice (NASBHC, 2012). Weeds innovation introduces the concept of the Problem Oriented Medical Record into the medical practice, which verifies the diagnosis (NASBHC, 2012). However, it wasn’t until 1972 when the Regenstreif Institute developed the first medical records system. Although it was a great invention, physicians didn’t seek to use it right away.This new system would help physicians improve patients care. Although, $19 billion in stimulus funds have been invested into the Electronic health record (EHRs) another name for EMRs; the Obama administration highly suggested that health car e and hospitals facilities start to digitize patient data and start making better use of the advance technology(Greenemeier, 2010). The health care industry has been slow to adapt to this new system. Although the EMR system is intended to make patients records more accessible for the physicians and staff, still many have not implemented it yet.Given the lack of EMR adoption throughout the health care industry, less than 10 percent of U. S. hospitals have adopted electronic medical records. Cost is the primary reason many have resisted or are unwilling to adopt the EMR system and shortage on staff as well. In a recent interview on November 9, Jessica in human resource at Vineville Internal Medicine, with Dr. Mary Bell Vaughn presiding as the physician over the practice. The practice has been using electronic medical records systems since the practice open in 2002. Dr.Vaughn thought patients and staff needed easy access to their records when needed. Some of her other reasons are as fo llow: †¢ Paperless, Less storage †¢ No physician running around ( Patient info available at finger tips) †¢ Saves time spent with patient †¢ Good for tracking information †¢ Financial Good This system is web based and uses an E-Clinical program through a portal. This system also allows prescriptions to be sent to the local pharmacy as well. Blood work results are also put into the patients charts as well.Recently, the practice took on new patients with paper charts, because their physician retired. In this cause their most recent charts were converted over to EMRs. However those paper charts still exist in a small storage area if further information is needed on the patient. Though the practice implements the EMRs system from the very beginning, the physician and staff are very happy with the system. Most patient information is put into the system via computer on the spot while the patient is telling the nurse or physician what is ailing them.Although there system is a web based system, it has two backup systems in two different locations just in case the systems go down or power outage. The EMR system has had great quality impact on the practice. The patients care has been improve by the system. It allows the physician to track and effectively treat the patient. In some cases if the patient is located at another healthcare facility this system allows them to send information to multiply people for care, no matter where they are. Dr.Vaughn’s practice is already looking into the future to implement sending out text message to patients to inform them of appointments. Patients have access to their care anytime. EMR adoption is slow to be implemented into some practices. Although there is some disapproval of the electronic medical records today, it is merely a digitized version of paper chart. This system will reduce medical errors and help put information in front of researchers This new form of technology is here to stay and the s ooner healthcare facilities start using it the more efficient results they will receive.References Prathibha Varkey (2010). Medical Quality Management, Sudbury, Massachusetts: Jones and Bartlett Publishers. History of the Electronic Medical Record system (2012) Retrieved November 8, 2012 www. nasbhc. org Will Electronic Medical Records Improve Health Care? (2009) Retrieved November 8 2012 http://www. scientificamerican. com/article. cfm? id=electronic-health-records Electronic Medical Records Engineering Management Field Project Electronic Medical Records: A Case Study to Improve Patient Safety at Royal Victoria Teaching Hospital By Annie Bittaye Spring Semester, 2009 An EMGT Field Project report submitted to the Engineering Management Program and the Faculty of the Graduate School of The University ofK. ansas in partial fulfillment of the requirements for the degree of Master's of Science )= †¢ , , Tom Bowlin Cotntnittee Member ‘~k Committee Member Date accepted: _ _&-4–_':'†/~,,,,,,†1_-. -Q:;,,.. r5c—-_ _ Table of ContentsTable of Contents †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 2 List of Figures †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 3 List of Tables †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 Acknowledgments†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Executive Summary †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 5 1. 1. 1. 2. 3. 3. 1. 3. 2. 3. 3. 3. 4. 4. 4. 1. 4. 2. 5. 6. 7. Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 Background of Royal Victoria Teaching Hospital †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 Literature Review †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 Procedure and Methodology †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 17 Exp erimental Design †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 17 Survey Procedure †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 18 Data Analysis †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 9 Limitations of the study †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 19 Resultsâ⠂¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 20 Reasons why EMR is not being used at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 23 Benefits and challenges of EMR†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 24 Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 0 Conclusion †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 30 Suggestions for Additional Work †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 32 References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 34 Glossary †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 Appendix †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 36 2 List of Figures Figure 1: Sources of funding, RVTH 2008 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 22 Figure 2: Averages ofEMR functions in order of relevance to work at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 29 List of Tables Table 1: Number of patients seen at RVTH in 2008 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 7 Table 2: List of Professionals, RVTH 2009 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 0 Table 3: Computer ownership and previous computer training received by the respondents at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 28 Acknowledgments My journey towards my Master's degree was a long and fruitful one. The Engineering Management (EMGT) program has not just exposed me to much information and ideas but also opened a way towards my career path. Thank you to my parents, Ebrima and Lucy who have always been a source of great inspiration and strength to me. They taught me the value ofeducation and their prayers has always been with me.Thanks to my brother, Baboucar who encouraged me to pursue my Master's degree and the never ending support I receive from him. Special thanks to my six year old son, Ebrima for his understanding that I'm at school when I'm not home to read him a bedtime story. I also want to thank all my EMGT instructors especially Professor Herb Tuttle, Dr Tom Bowlin and Ray Dick who worked with me recently, for the wonderful information and feedback they provided on this project. Thanks to Parveen Mozaffar for her extreme support and encouragement during the course of my studies.Thanks to the staff at Royal Victoria Teaching hospital for providing me with all the needed information for this project. Last but not least, my gratitude goes out to Dr Don Anthony Woods. It is because of his influence that brought me where I am today. He always had my best interest at heart and I want to thank him for that. May God bless you! Executive Summary Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) system to help improve healthcare quality. Unfortunately, The Gambia government faces a series of health crises including but not limited to HIVIAIDS, malaria, diabetes and tuberculosis.These diseases threaten the lives of thousands of people. Lack of infrastructure and trained, experienced staff are considered important barriers to scaling up treatment for these diseases. The contribution of this field proj ect outlines the benefits of an EMR system at Royal Victoria Teaching Hospital (RVTH) and how it will improve patient safety. This is a descriptive study using interview questionnaires from officials at the Royal Victoria Teaching Hospital. The study also looks into other facilities in similar developing countries with advanced systems, but not so advanced as to be at the level of state-of-the ­ art facilities in the U.S. Results from this study indicates the importance of an EMR system at RVTH to facilitate effective and efficient data collection, data entry, information retrieval and report generation. As a catalyst for development, the implementation of an EMR system at RVTH may make it one on the best hospitals in the West African region. 5 1. Introduction According to Dick and Steen, Electronic Medical Record (EMR) is the compilation of patient medical information in a computer-based format that allows the collection, storage, retrieval, and communication of this data.An electronic medical record replicates a paper chart and contains both clinical information (diagnoses, allergies, drug resistance and treatments) and demographic information about a patient; it provides a comprehensive medical picture and can be used by clinicians as a tool to determine appropriate treatment for patients. EMR is not only being welcomed by healthcare providers as a way to improve care delivery but also serves as a catalyst and gold standard for development (porter, Kohane, & Goldman; Reifsteck, Swanson, & Dallas).Unfortunately, Africa, a continent faced with many challenges ranging from epidemics, civil wars, and disasters, lacks robust healthcare infrastructure in the form of computerized h ealth care systems. For instance, Ghana has one the best health institutions in the region, Korle-Bu Teaching Hospital. This Hospital, for example, is currently the only institution in the West African sub-region which performs surgery. Due to the quality of outcome, it now receives referrals from most parts of the continent namely the Gambia, Sierra Leone, Liberia, Togo Benin, Tanzania, Nigeria, Cameroon, Cote d' Ivoire, and Ethiopia.Despite its exemplary performance, the hospital has no computerized information system which can help improve care delivery in the region. Therefore, the purpose of this study is to examine the potential benefits of EMR and its ultimate contribution to improving healthcare delivery development in less developed countries like The Gambia. 6 1. 1. Background of Royal Victoria Teaching Hospital The Gambia is a small country in West Africa, with a population of approximately 1. 5 million. RVTH has been in existence for over 100 years in The Gambia's capita l, Banjul.It used to be called Royal Victoria Hospital until in the late 1990s, when its name was changed to RVTH. The Gambian Government decided that it had to reduce its dependency on foreign doctors by establishing a medical school in the University of The Gambia (UTG). The UTG now uses RVTH to teach its clinical students. In recent years, The Gambia has been doing much on its own initiative to take to improve the healthcare of the nation. There are 540 beds in the hospital and the two largest Departments are Pediatrics and Maternity.The biggest â€Å"killer† disease in The Gambia is malaria, with young children and pregnant women being particularly vulnerable to this disease. Diabetes, high blood pressure, pneumonia and eye problems such as trachoma and cataracts are also major health problems. The following table provides an estimation of how many patients were seen at RVTH in the year 2008. Procedure Inpatient Admissions Children admitted to Pediatrics Patients treated in the Eye Center Out-Patient Appointments Out-Patients in the ER Number of Patients 25,281 9,352 986 over 184,365 24,334 Table 1: Number of patients seen at RVTH in 2008 7Unfortunately, RVTH does not have any EMR system in place to facilitate patient safety. As noted by participants, â€Å"EMR software is not used at RVTH because administration keeps complaining of money. It looks expensive to them and also they are more used to the paper folder†. Currently, information is very fragmented and therefore does very little to help patient safety and consistency in care. Another important issue here is that a large number of these patients are illiterates. To ensure they receive the appropriate treatment, they will have to explain to the physician current medications they are taking etc.This can be a very challenging and fatal to the patient sometimes. The typical paper medical record contains sections including information on demographics, admissions, discharge summaries, progre ss notes, protocols, laboratory results, radiology results, surgical and pathology reports, orders for, treatment and nursing notes. Most documentation regarding treatment of a patient is written directly in the patient's medical chart. On a given day a patient arrives at the hospital for care, sign in his name and waits anywhere from 30 minutes to six hours o get their records pulled depending on the day. Physicians, nurses, medical residents who need access the information in the medical record must wait till it's available. Typically, medical records are transported to the outpatient clinic where the patient would be seen, and then returned to storage center to be filed again. It is necessary for the medical record to follow the patient throughout their visit. If the patient was seen in one clinic where orders were written, it was necessary to physically transport the record when the patient moved to the medicine room for treatment. The purpose of this field project is to examine the potential benefits of an EMR system and its ultimate contribution to improving patient safety at the Royal Victoria Teaching Hospital in The Gambia. 9 2. Literature Review The first generation of EMRs was extensions of medical billing systems in large US hospitals. Over the last four decades, they have been used as tools to organize and store medical data. EMRs are widely accepted as important tools to support high quality health care in the US, Europe and other developed countries.Evidence shows that using EMRs that include decision support systems improves quality of care and both reduce medical errors and unnecessary medical investigations (Partners in Health), Experience with the use of EMRs in developing countries, if available, is much more limited than it is in the US and Europe. Now there is considerable interest in using medical information systems to support the treatment of HIV and TB in Africa, Latin America, and Asia. In most African countries, healthcare informati on systems have been driven mainly by the need to report aggregate statistics for government or funding agencies.Such data collection can be performed with simple paper forms at the clinic level, with all electronic data entry done centrally, but that approach tends to be difficult and time ­ consuming and may provide little or no feedback to the staff collecting data. Individual patient data that are collected and accessible at the point of care can support clinical management. Clinicians can easily access previous records, and simple tools can be incorporated to warn of potential problems such as incompatible drugs.Physicians or nurses can check on the outcomes of individuals or groups of patients and perform research studies. Many of these functions will work well on paper or with simple spreadsheets for up to 100 patients but become very time-consuming and potentially unreliable with more than 1,000 records, and virtually impossible with 10,000 or more. 10 Experience with the use ofEMRs in developing countries is much more limited than it is in the US and Europe, but there is now considerable interest in using medical information systems to support the treatment of HIV and TB in Africa.Some examples of EMR use in Africa include: †¢ The Regenstrief Institute in collaboration with Moi University in Kenya developed an EMR for general patient visits to clinics in western Kenya. This system was subsequently modified to support the care of several thousand HIV patients. †¢ Baobab Health Partnership in Malawi has developed an EMR system using innovative, low-power touch-screen PCs for data entry and display. This system is now used to support the care of more than 7,000 HIV patients in the Lighthouse clinic in Lilongwe and has been chosen by the national HIV program for use throughout the country. [email  protected], an HIV medical information system developed for US patients, has now been deployed in Uganda and is planned for use in other African c ountries and in Latin America. (Partners In Health) A wide-ranging literature review of electronic medical record implementation over the past decade reveals that clinical, workflow, administrative, and revenue enhancement benefits of the EMR outweigh barriers and challenges. Among other key efforts, organizations must train and motivate users to navigate EMR systems, as well as develop a common structured language.Clinicians who used CPRs found that electronic 11 access to clinical infonnation saves time and provides a thorough and efficient way to manage patient information To reap the full benefits of an EMR, organizations must redesign current workflows and practices to evolve into efficient providers of care. EMR systems are developed to meet the following goals: improve quality of care, reduce organizational expense, and produce a data stream for electronic billing. (Dassenko and Slowinski).The EMR meets these goals through workflow automation, connectivity, and data mining. ( Gaillour) The Computer-based Patient Record Institute's (CPRI) definition concurred with the other researchers, but added that the EMR provides protection of patient and provider confidentiality, has a defined vocabulary and standardized coding, produces documentation as a by-product of patient care, connects local and remote systems and provides electronic support for secondary users (payers, policymakers, researchers). Fromberg and Arnatayakul) Unfortunately, most EMR systems are unable to offer all of the components defined by the CPRI because †the technology is too complex and too expensive, doctors won't use computers, and standards don't exist. â€Å"(Gaillour) The advantages associated with implementing EMRs are well documented and are straightforward. The difficulty comes with placing a dollar figure to these advantages; consequently, few organizations have published studies describing the actual costs and benefits attained from implementing EMRs. Bingham) The benefit s associated with CPRs are organized into four categories: clinical, workflow, administrative, and revenue enhancement. Renner, states that measuring all the benefits associated with EMRs is 12 virtually impossible, and that it is probably safe to select those that can make the greatest financial difference, and incorporate them into a financial model.Clinical benefits seen after implementing an EMR include: better access to the chart, improved clinical decision making and disease management, enhanced documentation, simplified patient education, and increased free time to spend with patients, accompanied by improved perception of care and quality of work life. These benefits ultimately result in better delivery ofpatient care and safety. Despite all of these benefits, EMRs are not a standard in today's healthcare systems. It is evident that EMR technology is still a hot topic for discussion when browsing through current healthcare technology and management journals.The following bar riers have kept healthcare leaders discussing EMR technology instead of adopting it: cost, leadership, ROI, vendors keeping up with users' needs, and deficits in the following categories: public policy, standards, security, and a true definition. First of all, cost has kept organizations from implementing EMR systems. These costs can be organized into the following categories: software, hardware, infrastructure development and maintenance, implementation, education, planning, and administration.Software costs include development or purchase, maintenance, and upgrades over time, while hardware costs include purchase of workstations. (Mohr) Infrastructure development and maintenance costs include servers, interfaces, workstations, network cables, network maintenance, and help desk operations. Planning costs include development of an implementation plan, identifying measurable outcomes, and choosing meaningful metrics and goals, while implementation costs include training, overtime 13 ssociated with entering patient data, business disruption during transition, employee resistance to change, and lost productivity. Drazen, suggested that leadership was probably a more significant barrier than cost because, in the past, healthcare leaders have raised capital for essential business initiatives such as major building programs, acquiring a physician network, or starting up a managed care organization. This amount of capital is on the same scale as an EMR. Next, Drazen stated that a lack of government support is a major issue holding up EMR implementation.Unfortunately, the federal government does not contribute fmancially to EMR implementation projects. Without standards and structured data definitions, computer systems are not guaranteed to interface easily with each other, and databases are not easily developed. Most individual departments within a healthcare system have already invested in computerized patient information systems; however, these systems are isolated and do not communicate well with one another. Getting these systems to interface is one challenge facing EMRs. Data security continues to be an ongoing challenge.Bergman, found that politicians, consumer advocates, and the general public have voiced concerns about risks to the privacy and confidentiality of patient information. However, when compared with the security of the paper chart, the EMR's electronic audit trails and passwords actually improves internal security. The EMR may be more secure for internal breeches of confidentiality, but must also be protected from external breeches such as hackers, who could potentially enter the EMR from an off-site location and download volumes of 4 confidential information. Firewalls and encryption software are methods used to protect patient data from these violators. Clinicians who use EMRs recognize two benefits: First, electronic access to clinical information saves time. Second, electronic access provides a thorough and efficient way to manage patient information. With EMR systems, comprehensive information can be located and presented in a way that is relevant to the task at hand. Dassengko and Slowinski) The obstacles identified have thus far been insurmountable, but the considerable achievements identified in the benefits section of this discussion suggest that the advantages are well worth the effort. As Lenhart et al state, â€Å"Success comes at the price of considerable effort, persistence and optimism, as well as dedicated leadership. † (p. 114) some organizations that invested in early EMR systems are struggling to show the qualitative benefits promised by vendors because an electronic version of current work processes is not cost effective. Sandrick) â€Å"If the ROI were a function of the information tool itself, the financial benefits would be experienced universally. † (ROI: The White Paper. A Business Case for Electronic Medical Records) To get the most value out of an EMR, healthcare organizations must reengineer the following work processes to make full use of the system: Healthcare organizations must first train and motivate their users on how to navigate and operate the EMR tools. To optimally use the EMR, it must be implemented from registration through billing, thus allowing the organization to realize full potential benefits across the delivery system.These benefits include clear, concise, and comprehensive documentation, greater efficiency, care consistent with best practice guidelines and improved claims processing. 15 It is difficult to measure the economic value associated with less tangible benefits such as higher quality of care, patient service, provider and employee satisfaction, and competitive advantage. It is even more difficult to allocate necessary resources and commit to institutional change when the paper chart is â€Å"getting the job done,† even if it is not in the most efficient style.However, Carlon, suggests that all providers s hould embmce the EMR to deliver safe medical care. The information in the EMR can reduce medical errors to avoid dangerous, sometimes lethal, mistakes. If organizations can't show that EMRs have a positive ROI, they may decide that the EMR is just another expense of running a business. The expense is to improve patient safety and reduce medical errors. This review of literature emphasizes that the use of EMR systems contributes to the ultimate goal of delivering effective care while improving patient safety. 16 3.Procedure and Methodology The study is an exploratory study conducted in Banjul, The Gambia, to examine the potential benefits ofEMR and its contribution to improving patient safety. For the most part, this study is descriptive and categorized as a non-experimental qualitative study. Initial contacts were made with the Chief Medical Director, Development Officer and the Head of Medical Records at the RVTH to solicit participants for the study. 3. 1. Experimental Design Surv ey approach was used to gather data from healthcare professionals who are considered potential users of EMR.Copies of the questionnaires were sent through e-mail to participants. A total of 50 surveys containing 15 questions were sent out and 30 of them were returned. The content of the survey designed was open-ended questions based on the following areas: knowledge of EMR, benefits and challenges of EMR, transition from paper-based system to EMR, security issues associated with EMR use and assistance given to developing countries by developed nations to implement or use EMR. Other areas include, demographic details of respondents based on profession, length of practice, age and sex.The survey questions can be found in the Appendix. Participants were selected based on their level of healthcare training. The population set for the study was healthcare professionals from the RVTH, which includes physician consultants, surgeons, pharmacists, nurses, midwives, pathologists, radiologists , and laboratory technicians. Study participants were limited to these previously mentioned health professionals, since they would be the principle users of an EMRsystem. 17 RVTH has a total population of about 500 professionals and a sample size of 50 was chosen for the study.Since this was the first time such a study was being conducted in the country, there was limited knowledge of professionals on the subject as well as difficulty in getting volunteers to participate. 3. 2. Survey Procedure Survey questionnaires were converted into a PDF file and mailed electronically to all 50 participants on February 2, 2009. Unfortunately, five medical professionals who were initially contacted to participate in the study later declined to take part due to lack of understanding of the survey questions. As a result, different participants were contacted to replace the five individuals to make up the sample size.Since the researcher could not travel to Gambia to facilitate the survey, one of th e administrative officers at the hospital was contacted and helped to distribute hard copies of the questionnaire to all participants. Participants were requested to fill out the attached survey and return it in a sealed envelope to this person or the chief administrator. After three weeks, on February 23, 2009, a first reminder was mailed asking for their cooperation and the importance of returning the survey. A final reminder was sent out on March 9, 2009, to those who might have forgotten to return the survey. 8 3. 3. Data Analysis The 30 completed surveys were coded, sorted, and organized into themes. A spreadsheet was created in MS-Excel to enter all data for analysis. All responses were placed into themes and summarized. The survey responses and themes generated were used to determine result interpretation, recommendation, and future research direction. Despite initial difficulties to get volunteers to participate in the study, 30 out of the 50 surveys mailed were returned on March 16,2009, thus representing 60% response rate. 3. 4. Limitations of the studyDue to the difficulty of getting other hospitals in the area involved, the study was limited to RVTH only_ The findings represent views ofthat hospital alone. However, the research would have been more interesting and challenging if more professionals from other hospitals were involved in the study. Secondly, due to cost of air travel between the United States and Gambia, the researcher was not able to travel to Gambia to collect the necessary data for the study. The inability of participants to respond to some important questions on the survey skewed the data.Finally, due to the six hour time difference between Kansas and Gambia, it was hard to reach the participants at during business hours. Lack of high speed internet or sometimes no connection at all caused the delay in receiving all the responses on time. It was also really difficult to get people to cooperate because the survey was not on their l ist of priorities. 19 4. Results Based on the methodology, surveys were mailed to 50 participants at the RVTH in Banjul, The Gambia. Thirty completed surveys were received which included 15 questions.The results from all participants are as follows: The 30 respondents consisted of 17 males, 11 females and two people who did not indicate their gender. The age range of the group was 25-56. Table 2 presents the professional distribution of participants. No Response represents people who did not include their profession. The five students, however, included final year medical and dentistry students, as well as nursing, and medical laboratory students. Professional experience ranged between 1 and 20 years.Profession Surgeon Pharmacist Physician Radiologist Midwife Nurse Laboratory Technician Student No Response Total Table 2: List of Professiona is, RVTH 2009 Number 3 2 3 2 5 6 2 5 2 30 20 To analyze this result, key words such as computerized, storage and retrieval, were used to determi ne respondents' understanding of the concept of an EMR system. Subsequently, one-third of respondents (33. 3%) who included these three key words were marked as right. While nine people representing 20% who said it is a mechanism for storing patient medical record on a computer were classified as partially right and approximately half respondents (46. %) who just said the use of machine to keep patient medical data were classified as having an idea or understanding of the system. In addition, implementing and running a successful EMR system requires a number of key elements. Accordingly, 15 people identified technical elements such as (electricity, hardware, software, etc. ), 10 stated patient data, while four said adequate trained personnel, and one person indicated the need for money to train staff on EMR. Also availability of adequate infrastructure such as experts to support and train care providers on EMR is very crucial when implementing EMR system.However, more than half resp ondents agreed that enough infrastructures are not available in Gambia to support EMR implementation. On the other hand, 10 people believed that infrastructures are available, while four said available infrastructures are only few. Despite unavailability of infrastructures, 16 respondents reported there are enough computer experts in Gambia to train healthcare providers to use EMR. Seven reported experts are not available; six stated experts are available but too few to meet the demand and needed training requirement of the healthcare sector.Lastly, one person indicated he has no idea of the subject. Responses concerning how much developed nations are assisting less developed countries like Gambia with Health Information Management (HIM) system infrastructure 21 implementation showed diverse opinions. Nine people said developed countries are helping, 15 responded no. However, six indicated that â€Å"the help given from developed nations are not enough and sometimes electronic devi ces sent to less developed countries like the Gambia are inferior and lack quality†.Still others think â€Å"some form of assistance comes in to support the country on information management systems but not much is channeled towards the health sector†. Lastly, seven people reported they have no idea â€Å"if developed nations are helping† and one person did not respond to this question at all. This pie chart below shows the sources of funding and the amounts received for the year 2008. Sources of Funding 2% †¢ Gambia Government †¢ Patient User Charges †¢ Donation Fund †¢ Internally Generated Fund †¢ Global Fund Severe Malaria in African Children FundFigure 1: Sources of funding, RVTH 2008 22 The majority of funds come from the Gambia Government in the fonn of subvention received monthly or quarterly in advance. However, about 70% of the amount goes towards payment of salaries and allowances to approximately 1,200 staff. Other donations re ceived are in the fonn of drugs, equipment, supplies and services which made considerable contribution to the hospital. (RVTH) 4. 1. Reasons why EMR is not being used at RVTH Paper records are bulky and can take up costly space.Filing, retrieval of files, and the re-filing of paper records are very labor-intensive methods with which to store patient infonnation. Plus if a record is checked out for one department, another department cannot access the chart. The impact of not having immediate access to key infonnation in emergency situations can be serious. Paper medical charts also cannot be effectively searched and used to track, analyze, and/or chart voluminous clinical medical infonnation and processes. They cannot be easily copied or saved off-site.Also physician's orders and the corresponding results such as medications and labs can be issued and saved in a comprehensive EMR system. Our literature review and results have proven that paper records are costly, cumbersome, misinter preted, easily misplaced and cannot be used for any meaningful decision analysis. Unfortunately, RVTH does not have any EMR system in place to improve patient safety. As noted-by participants, â€Å"EMR software is not used at RVTH because administration keeps complaining of the lack of money. It looks expensive to them and also they are more used to the paper folder†.Nevertheless, four key issues were identified by participants as the main reasons why RVTH does not have an EMR system in use. 23 Overall, 36% of respondents attributed the problem to lack of resources in terms of personnel and infrastructure, 29% blamed it on lack ofleadership initiative and priority. While 18% reported cost in terms of equipment and training personnel, 15%, however, stated lack ofEMR importance or awareness and fear to change. Lastly, 2% respondents did not give any reason. 4. 2. Benefits and challenges of EMR There are both benefits and challenges to EMRs.Many argue that positive aspects of u sing an EMR system outweigh the challenges. Even though the investments in EMR systems are costly, most argue that over time this outset cost will result in greater savmgs. As well as cost saving, many agree that one advantage of EMR system is that they save space. Instead of keeping huge paper files on patients, all records are kept on computer files. Though someone must store these records in computers, this still represents a small percentage ofthe space required to store physical records. Along with saved space is reduction of paper used by hospitals.Although EMR systems do not render paper obsolete, but they certainly do reduce needed paper significantly. Another advantage of electronic medical records is the ability for all in a health care team to coordinate care in terms of monitoring and treating diseases. This helps avoid duplication of testing, prescribing medicines that in combination might be dangerous and the ability for anyone on the medical team to understand the app roaches taken to a condition. A person with complex health issues may see several specialists, and can easily become confused by overlapping or contrary advice.When specialists and primary care doctors use the same system for electronic medical records, then everyone on the team would be aware of all the other team members' actions and recommendations. Electronic medical records may save time as well. Though faxing and email may assist one doctor to get information from another doctor or a laboratory, there is generally a wait time to receive this information. When a doctor has instant access to all of a patient's information, including things like x-rays, lab tests, and information about prescriptions or allergies, he or she is ready to act right away, thus saving time.This may be particularly helpful in emergency situations where a patient cannot answer questions about medical history or allergies due to extreme illness or injury. Generally, doctors are often considered to have th e worst handwriting, though this is just a generalization, unclear writing can lead to misinterpretations and mistakes. Typed notes and prescriptions are more legible and less likely to create misunderstandings. However, electronic medical records do not rule out the occasional typo. One of the main disadvantages to EMR system is that start up costs is enormous.Not only must you buy equipment to record and store patient charts (much more expensive than paper and file cabinets), but efforts must be taken to convert all charts to electronic form. Patients may be in the transitional stage where old records haven't yet been converted and doctors don't always know this. Further, training on EMR software adds additional expense in paying people to take training, and in paying trainers to teach practitioners. In fact, one concern about the use of electronic medical records is that doctors may have a significant learning curve when these programs are first implemented.A poor 25 typist may a ctually take a long time to input information. Doctors often have to be their own medical clerks especially during an office visit, and a doctor distracted by confusing technology may not be as alert to a patient's symptoms or needs. There is no single electronic medical records source or system, so different hospitals and individual clinicians may not all be using the same program. This negates the possibility of instant information for all on the medical team, since one program may not communicate with another.Another concern is that electronic medical record systems might be hacked and exploited by others. Since one of the first considerations of medical treatment is confidentiality, it may remain a concern about how many people may have access to other medical records which they are not authorized to do so. Misuse of private medical information could create problems for people who have conditions they wish to keep private. Despite these concerns, it appears many hospitals are no w attempting to use EMR systems.It remains unclear how long it will take for hospitals to transition completely from the traditional paper-based systems to a complete paperless environment. As shown from the survey results, it is clear that many participants believe that implementation ofEMR will tremendously improve upon patient in the country. For instance, as noted by one respondent, â€Å"availability of patient past history in electronic format will enable health care workers have information about patients in seconds and with ease which will facilitate quick diagnosis and treatment hence reducing the rate of mortality. 26There is always some level of fear and resistance to change, especially in the healthcare industry. A question concerning the level of acceptability from the traditional paper-based system to EMR system shows that such change will be met with some difficulties. More than half of respondents said the process would be challenging initially, but eventually care providers will accept the system because it will improve patient safety and work performance. Although the majority may still prefer the paper-based system, â€Å"they will change when they see the importance or need for EMR† stated a participant.Others also believe it would be a â€Å"welcome idea†. The adequate protection of patient health record requires limitations at all levels, such as: collection, use, access, and disclosure. Therefore, development of privacy, confidentiality, and security principles is necessary to protect patients' interests against inappropriate access to their health data. Unfortunately, 14 respondents (47%) did not respond to this important question regarding measures necessary to maintain patients' privacy, security, and confidentiality at RVTH.However, 16 people representing (53%), did state that all health records must be securely protected by use of password, data encryption, and access restrictions to users. It is obvious from the surv ey results that effective implementation and utilization ofEMR can improve patient safety in developing countries. Considering training as one of the key elements to EMR success, a question was asked to determine length of time required to train care providers in Gambia on EMR.Almost 50% of respondents indicated it might take 6-18 months depending on â€Å"practitioners' ability to understand the concepts ofEMR as well as the user friendliness of the software†. Others believe â€Å"for 27 current medical students who are already computer literate may take about two weeks, but the older practitioners will take longer time (approximately over a year)†. Table 3, below shows the number of respondents that own a computer or has had some form of computer training in the past. Computer Training Profession Own a Computer 1 1 1 0 1 2 1 2 I Yes 1 1 1 0 2 3 1 7 16