Implementation of a Health Program

The â€Å"American Cancer Society† has come up with â€Å"Guidelines on Nutrition and Physical Activity for Cancer Prevention† (American Cancer Society, 2008, pp. 1 – 11). The purpose of the aforementioned is to â€Å"reduce the risk of cancer† through â€Å"healthy food choices†, as well as, â€Å"physical activity† (American Cancer Society, 2008, pp. 1 – 11).The guidelines provided addresses questions of countless individuals who are quite confused by â€Å"several studies or news reports† which are not usually peer-reviewed or not really â€Å"official† (American Cancer Society, 2008, pp. 1 – 11).Although answering the questions would help greatly, this program of the â€Å"American Cancer Society† should still undergo a process of implementation so that people will be motivated to look deeper into the guidelines, as well as, to practice them in order to â€Å"reduce the risk of cancer† (American C ancer Society, 2008, pp. 1 – 11).Before these guidelines are to be fully implemented, there are certain factors needed to be considered (American Cancer Society, 2008, pp. 1 – 11). Some of these factors are the following: 1) leading the implementation; 2) time frame; 3) staff qualifications; 4) staff responsibilities; 5) training; 6) supervision/support; 7) funds; and 8) advocacy (American Cancer Society, 2008, pp. 1 – 11).Leading the ImplementationIt is very important to assign an individual to â€Å"lead the implementation† (Illness Management and Recovery, 2003, pp. 1 – 6). The leader should be well aware of the program or guidelines and should have mastered all aspects of the guidelines (Illness Management and Recovery, 2003, pp. 1 – 6). He or she should also be supported by those in a higher position, as well as, respected by the subordinates (Illness Management and Recovery, 2003, pp. 1 – 6).Time FrameAfter a leader is chosen fo r the implementation, â€Å"time-frame† should also be settled (Illness Management and Recovery, 2003, pp. 1 – 6). This entails the time needed in training those who will play a role in the implementation of the program (Illness Management and Recovery, 2003, pp. 1 – 6). For instance, three months is required to extensively educate and motivate the individuals who will play a part in the implementation (Illness Management and Recovery, 2003, pp. 1 – 6).

Multicultural education Essay

From its early beginnings in the 1960s, multicultural education has since been in a constant state of evolution both in theory and in practice (Gorski & Covert 1996). In the last four decades, it has undergone repeated transformation, focusing and conceptualization as challenges emerge one after the other from a rapidly changing population demographics and a significant growth in diverse multicultural groups. The result is a multitude of conceptualizations reflecting different foci but which basically share the same ideals rooted upon the need for transformation or change. Gorski (2000) defines multicultural education as a â€Å"progressive approach for transforming education that holistically critiques and addresses current shortcomings, failings, and discriminatory practices in education†. These shared ideals that include social justice, equity in educational opportunities, and the dedication to help students reach their full potential as learners and as socially conscious and active individuals provide the basis for understanding multicultural education. It is a process of action, through which adults achieve clarity about their condition in this society and ways to change it (Phillips, 1988). Multicultural education acknowledges that schools, among all other institutions, play a pivotal role in building the foundation and acting as major influencing factor for the transformation of society and the elimination of oppression and injustice. The realities of the times clearly speak for the growing importance and relevance of multicultural education. Cultural diversity in schools is indeed one considerable challenge but like any other, it can be a most welcome opportunity. History has shown us that nations are enriched by the ethnic, cultural, and language diversity among its citizens (Banks, 2001). Schools play a significant part in finding ways to harness and redirect cultural diversity into creating unity and progress in schools and ultimately to society in general. References: Banks, J. A. (April 2001). Diversity within unity: Essential principles for teaching and learning in a multicultural society. New Horizons for Learning. Retrieved on May 28, 2009 from http://www. newhorizons. org/strategies/multicultural/banks. htm Gorski, P. & Covert, B. (1996; 2000). Defining multicultural education. Retrieved on May 28, 2009 from http://www. edchange. org/multicultural/define_old. html Phillips, C. B. (1988). Nurturing diversity for today’s children and tomorrow’s leaders. Young Children: 43(2).

Centers for Medicare and Medicaid Services (CMS) Essay

Procedure Until recently it was not uncommon for patients admitted to an acute care facility to have an indwelling catheter anchored for unnecessary reasons. Patients that came in thru the emergency department typically were sent to the units with unnecessary indwelling catheters in place and it was not unusual for a surgery patient to have an indwelling catheter anchored before or during a procedure. Once a patient was admitted and was transported to the units nursing would also anchor indwelling catheters for multiple unnecessary reasons. These Catheters could be anchored for many unnecessary days and in some cases until discharge. In 2008 the Centers for Medicare and Medicaid Services (CMS) initiated a policy change to no longer reimburse hospitals for additional cost that were incurred due to catheter associated urinary tract infections or in another term CAUT’Is (Palmer, 2013). The CMS recognized that CAUTI’s are the most common type of hospital acquired infection. The CMS also determined that when evidence based practices are initiated and followed they can be highly preventable, leading to a change in practice. Current Practice Up until 2012 there were no policies pertaining to the anchoring or removal of indwelling catheters in the facility I work for. Nursing would complete their assessment of the patients and per their discretion they would determine if an indwelling catheter by their standards is appropriate. An indwelling catheter could be deemed appropriate according to nursing for multiple reasons including; urinary incontinence, retention, convenience, pressure ulcers, strict output recordings and in some cases per patient request. The nurse was required to obtain an order from the physician in order to anchor a catheter and most cases the physician would comply. After the nurse anchored a catheter it would most likely stay anchored until discharge or until and order was given by the physician to discontinue it.  These procedures lead to the unnecessary length of times catheters were kept in place and the need for change. Rational and Explanation Even though in 2008 Medicare and Medicaid changed their reimbursement policies it wasn’t unit 2012 when the Joint Commission added guidelines for the prevention of CAUTI’s and the facility I work for initiated change. Prior to the Joint Commission’s new guidelines management relied on nursing to make the proper decisions for their patients and supported nursing when they deemed it necessary to anchor a catheter. In 2012 when the guidelines were initiated management chose to follow them when evidence based research supported CAUTI’s were preventable when the appropriate protocols were followed. Hospital management initiated evidence based practices that were supported by CMS and the Joint Commission that would assist nursing on when anchoring a catheter was necessary. The team responsible for these changes included the clinical manager in charge of all medical surgical units, each medical surgical unit manager where these changes were to take place and the medical surgical educator. This team reviewed evidence based research and practices on how to improve CAUTI’s and thru this research came up with a plan to implement nurse driven protocols that would be beneficial to our facility. These protocols instructed nursing, thru protocols on the patient’s EMR to guide nursing when anchoring a catheter would be appropriated and it also gave nursing the ability to remove a catheter when it was deemed unnecessary. After the protocols were initiated management began to notice a decrease in the use of catheters and a decrease in CAUTI’s resulting in cost effectiveness and higher patient satisfaction scores for the hospital. References Bernard, Michael S, Hunter, Kathleen F, Moore, Katherine N. (2012). A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of Catheter-Associated Urinary Tract Infections. Urologic Nursing, 32 (1): 29-37. Carter, Nina M, Reitmeier, Laura, Goodloe, Lauren R. (2014). An Evidence-Based Approach To the Prevention of Catheter-Associated Urinary Tract Infection. Urologic Nursing, 34 (5): 238-45. Hooton, T., Bradley, S., Cardenas, D., Colgan, R., Geerlings, S., Rice, J., Nicolle, L. (2010). Diagnosis, prevention, and treatment of catheter-associated urinary track infection in adults: 2009 international clinical practice guidelinges from the infectious diseases society of America. Clinical Infectious Diseases, 50(March): 625-663. Knoll, Bettina M.; Wright, Deborah; Ellingson, LeAnn; Kraemer, Linda; Patire, Ronald; Kuskowski, Michael A.; Johnson, James R. (2011). Reduction of Inappropriate Urinary Catheter Use at a Veterans Affairs Hospital Through a Multifaceted Quality Improvement Project. Clinical Infectious Diseases. Vol. 52 Issue 11, 1283-1290. DOI: 10.1093/cid/cir188. Mori, C. (2014). A-Voiding Catastrophe: Implementing a Nurse-Driven Protocol. MedSurg Nursing. 23 (1), 15-28. Clinical Implications An implemented change that would reduce the rates of CAUTI’s in acute health care facilities would be evidence based nurse lead protocols. The protocols would not only benefit the hospitals but they would also contribute to patient satisfaction scores. Approximately 80% of all nosocomial infections are contributed to CAUTI’s and are the most common form of nosocomial infections (Knoll, 2011). Some of the symptoms that contribute to the patients discomfort include hematuria, flank pain, fever and in some cases altered mental status. After a patient develops a CAUTI the patient receives the recommended treatment of antibiotic therapy. Antibiotic therapy could last up to 7 days which could result in an increase of stay (Hooton et al., 2010). Evidence supports that when nurse led or informatics led interventions are implemented CAUTI’s were decreased (Bernard, 2012). The interventions that assist in the prevention of  CAUTI’s are protocol bundles that include insertion policies, removal policies, maintenance policies and competency training (Carter, 2014). If the proper prevention measures are implemented patient satisfaction scores would improve, infection rates would improve leading to a decrease infection rate and shortening patient’s length of stay. Recommended Changes If the prevention protocols that are listed above were implemented changes would occur that would lead to multiple benefits for both the acute care facilities and the patients. Extended hospital days due to CAUTI’s has added to approximately 90,000 days per year and due to Medicaid and Medicare no longer paying the associated cost for CAUTI’s the hospitals out of pocket expenses are estimated at approximately 424 million dollars per year (Mori, 2014). The changes that are discussed and supported in this research paper would have a positive impact on decreasing this data. If the protocols are implemented not only would they benefit the patient’s but they would also benefit the hospitals. Patients would have a decrease risk in acquiring nosocomial infections and hospitals would have the opportunity to use the millions they are losing to benefit the patients. The hospitals could apply the money they are losing for research and/or other areas to improve overall satis faction, increasing hospital census. Stakeholders The stakeholders in implementing this change at the facility I work for would be the unit managers and the nurse educators in the units where these changes would take place. For the unit managers the increased costs that are acquired due to CAUTI’s would have a direct impact on them along with the patient’s overall satisfaction scores. The evidence based research that would be implemented would be presented to the unit managers and the nurse educators. The unit mangers would be the ones to determine if and when the new protocols would take effect. The nurse educators would be the ones educating staff on the new protocols and would be a vital part of evaluating the protocols along with suggesting and implementing changes if necessary. Change would happen in stages with the first stage being the unfreezing stage. This stage occurs when stakeholders receive the information on a change along with supporting evidence to why the change would be beneficial. The second step would be the moving stage. This is the stage when goals  and dates are set to when the change is to take place. The refreezing stage is the last stage. The refreezing stage is when the change is implemented and becomes hospital protocol. The end stage is when the nursing staff would need the most support until the change becomes the hospitals new standard (Cherry & Jacob, 2010). The steps listed will assist getting everyone on board with the change and complying with it. Barriers Anytime when new protocols or procedures are implemented barriers may occur. Not everyone is open to change and many may have a hard time adjusting. Many nurses have been following the same policies and procedures for many years and may be noncompliant due to habit. Another barrier may be the patients, â€Å"frequent fliers† or patients that frequent the hospital regularly have become accustomed to old protocols and may not be receptive to change. The frequent fliers are used to coming in and requesting catheters so they don’t have to get up to the bathroom or if they have incontinency issues. Management and the educators will have to work diligently with nursing to initiate change and nursing may have a difficult time adjusting to the change along with educating patients and enforcing the protocols. Strategies Strategies to overcome the barriers of change would include using Lewin’s Change Theory. This theory suggests that change should be initiated slowly and making the necessary changes with only the staff that would be involved (Cherry & Jacob, 2010). Management and the nursing educator should provide staff with the evidence based research as to why the change is being made so nursing can understand why the change is necessary. By following these strategies nursing may be more compliant with the change and can be better advocates for the patients. Application of Findings CDC guidelines recommend catheters to be inserted for necessary reasons which include urinary retention, strict intake and output, certain surgical procedures, healing for pressure ulcers in incontinent patients and in palliative care patients (Gray, 2010). As research has provided indwelling catheters should be placed only when deemed necessary and removed when they are unnecessary. The facility I work for along with quality control  and the nursing educator put together CAUTI prevention strategies using evidence based research practices. Protocols were initiated in the patient’s electronic medical record (EMR) that would assist nursing in making the right decision whether to cath or not and when it would be appropriate to remove an indwelling catheter. The charge nurses monitor the number of catheters each unit has and researches if they are deemed appropriate to keep anchored. All of these measures have decreased the occurrences of CAUTI’s in the facility I work for. Continued monitoring by quality control is still needed to insure assessments are completed properly and to monitor if the measure the protocols are working. References Bernard, Michael S, Hunter, Kathleen F, Moore, Katherine N. (2012). A Review of Strategies to Decrease the Duration of Indwelling Urethral Catheters and Potentially Reduce the Incidence of Catheter-Associated Urinary Tract Infections. Urologic Nursing, 32 (1): 29-37. Carter, Nina M, Reitmeier, Laura, Goodloe, Lauren R. (2014). An Evidence-Based Approach To the Prevention of Catheter-Associated Urinary Tract Infection. Urologic Nursing, 34 (5): 238-45. Cherry, B., & Jacob, S. (2010). Contemporary Nursing: Issues, Trends, and Management. (5th ed.) St. Louis, MO: Mosby Elsevier. Gray, M. (2010). Reducing catheter associated urinary tract infection in the critical care unit. AACN Advanced Critical Care, 20(3), 247-257. Hooton, T., Bradley, S., Cardenas, D., Colgan, R., Geerlings, S., Rice, J., Nicolle, L. (2010). Diagnosis, prevention, and treatment of catheter-associated urinary track infection in adults: 2009 international clinical practice guidelinges from the infectious diseases society of America. Clinical Infectious Diseases, 50(March): 625-663. Knoll, Bettina M.; Wright, Deborah; Ellingson, LeAnn; Kraemer, Linda; Patire, Ronald; Kuskowski, Michael A.; Johnson, James R. (2011). Reduction of Inappropriate Urinary Catheter Use at a Veterans Affairs Hospital Through a Multifaceted Quality Improvement Project. Clinical Infectious Diseases. Vol. 52 Issue 11, 1283-1290. DOI: 10.1093/cid/cir188. Mori, C. (2014). A-Voiding Catastrophe: Implementing a Nurse-Driven Protocol. MedSurg Nursing. 23 (1), 15-28.

Cap task 3 step#1 Term Paper Example | Topics and Well Written Essays - 500 words - 1

Cap task 3 step#1 - Term Paper Example The duty of New York Downtown hospital is to have a positive influence on existence and health of persons and population through issuing quality services directed by Christian values. This hospital employs the best physicians and nurses who issue patients with splendid health care in state-of-the-art skills. The only problem it is facing is the fact that it has a lot more clients than it can serve. The customer service seems inefficient not because the doctors and nurses are not skilled, but because of the excess number of patients being received on a daily basis. This problem is affecting the efficiency and of operation of the New York Downtown Hospital in many ways. First, the organization is receiving large numbers of patients with related problems that sometimes are unable to handle. Second, several people in the region are losing their lives due to this poor attendance by the doctors and nurses who are forced to rush on their services in order to attend almost all patients. This is a major challenge that requires a quick solution to save the lives of the Manhattan residents. The problem also causes distrust among the Manhattan patients who feel they do not receive effective treatment they deserve (Preston, 2010). New York Downtown hospital has been conscious about this challenge for some time and has put into practice some measures to lessen the prevalence and if possible, curb the problem. The problem has brought fourth other effects like poor customer service and poor sanitation which lead to other complications. The broad problem statement is how to curb the effects related to this problem. People are losing their lives which can be saved if correct measures are put in place (Preston, 2010). Individuals in the Manhattan region are still dying of poor sanitation, and related diseases. Most of them also lose their lives from poor services they receive due to the haste employed by the doctors and nurses in the

Grounded theory approach Research Paper Example | Topics and Well Written Essays - 250 words

Grounded theory approach - Research Paper Example Lost potential to manage muscles in the hand is an example and has many effects on the individuals. A person with Fine Motor Skill Disability may for example not be able to hold a pen firmly and write with it or even function effectively in physical activities that engage the affected muscles (Nicholls and Jones, 2012). Emerging trends in technology can however empower this population and this paper explores the population’s experience with technology to develop a theory on empowerment effect of technology on the population’s ability to participate in graphic design. In order to explore the research questions, the study will use a list of students with Fine Motor Skill Disability, from an academic institution, to generate a corresponding list of the students’ parents and teachers. Stratified random sampling will then generate a sample of 25 participants from the three groups with 11 participants being students with the disability. Interviews and observations will be used in data collection. The students will be interviewed on their experiences and opinion over derived benefits of technology in graphic design and their successful implementation of technology in design observed. Interviews will however be used in collecting data from the parents and teachers regarding effects of technology on the disabled students’ attitude and success in graphic design (Johnson and Chrisensen,

Discuss the female action heroine in 2-3 Hong Kong films. To what Essay

Discuss the female action heroine in 2-3 Hong Kong films. To what extent does she transgress conventional gender roles and to w - Essay Example Besides, the unique socio-cultural and political setting of Honk Kong deeply influences the foretold difference in gender roles. Thesis statement: The female action heroine in Hong Kong films transgresses conventional gender roles and does not simply conform to male fantasies (Special references to the star Brigitte Lin in the Hong Kong films: Swordsman II, Ashes of Time, Bride with White Hair). Prominence of women actors in Hong Kong action cinema The prominence of women actors in Hong Kong action cinema challenges the conventional mode of masculine power vested upon male actors. Kar, Bren and Ho (2004, p.109) state that ‘Historians of early Chinese cinema often regard Hong Kong as a cultural â€Å"branch† of the more sophisticated Shanghai’. An alternative version of masculinity can be seen among women actors in Hong Kong action cinema. Pang and Wong (2005, p. 137) state that ‘The ideological implications of masculinity can be radically re-examined by not simply looking at men exclusively but also mapping and recognizing the culture of a certain female type’. Within this perspective, masculinity is not fully vested upon male. Instead, masculinity is expressed through the search for one’s identity, especially by the female heroine. 1. Transvestite/Cross-dressing in Chinese (Hong Kong) films Transvestite/Cross-dressing in Chinese (Hong Kong) films creates sexual ambiguity and transforms gender identity from hero to heroine and vice versa. One can easily identify that cross-dressing in Chinese Operas deeply influenced the same process in films, especially the Hong Kong films. Vojkovic (2009, p. 43) states that ‘Here, we also have to consider the fact that Kung fu comedy as a genre makes much less of an appeal to authenticity, reminding us also that Kung fu comedy draws its origins from Beijing Opera’. Besides, cross-dressing indirectly challenges male primacy and patriarchy in the Chinese society. Generally, c ross-dressing helps the female heroine to hide her biological gender but the same will be exposed in front of the audience in the final unmasking scene. Garber (1997, p.45) makes clear that ‘Women who cross-dress must fall into two categories: the occasional, recreational cross-dresser who does not wish or try to pass and the transsexual’. Within the context of Chinese (Hong Kong) films, cross-dressing (assuming gender codes) lead to transvestism (transformation to opposite sex). In short, the Chinese (Hong Kong) films make use of cross-dressing as an innovative tool to challenge the hierarchy of power. 2. Transsexual/ Swordswomen in Chinese (Hong Kong) films The transsexual/ swordswomen in Chinese (Hong Kong) films are capable to demonstrate skill similar to their counterparts. But these transsexual/ swordswomen are not portrayed as independent warriors because they are attached to their male counterparts. Hunt (2003, pp.117-118) states that ‘But as Asian audienc es and critics were well aware, women warriors are nothing new in Chinese storytelling and have a much longer history than their western counterparts’. The unique socio-cultural and political setting within China, especially in Hong Kong unveils the feminine side of transsexual/ swordswomen. For instance, womenfolk in Chinese society uphold traditional

Safety and Security in the Gas and Oilfield Industry Research Paper

Safety and Security in the Gas and Oilfield Industry - Research Paper Example To reckon, there were a hundred of foreign hostages at Nigeria working for an oil company in its four rigs when labor disputes heightened in a May 2003 election. The war between Israelites and Palestine, albeit dealt for peaceful negotiation by the United Nations have also security implications for multinational oil companies operating in the region. In some regions inhabited by rebel and extremist groups, oil and gas companies are the target of terroristic attacks and exaction of money by rebel groups with the aim of weakening its operation. Trim and Caravelli (2009) explained that strategizing for security management will help develop resiliency and reduce vulnerabilities in gas and oil industry. This can be undertaken by developing a blueprint of national and corporate security, intelligence effort, and disaster/emergency planning enforcement. Trim and Caravelli (2009) professed that there are wide range of perspectives, disciplines, and mechanism that can be optimized by security managers but these certainly require human resources composed of security and intelligence experts, law enforcers, disaster and emergency managers, good relation with policymakers, networking with police and military enforcers, and good correlation with civil society and the academe. The strategy will also include counter-terrorism strategies and hence require national security strategists, security management reform and comprehensive security evaluation and planning which is also attuned to disaster and emergency management policies and practices (Trim and Caravelli, 2009). It is presupposed that oil and gas development is a major contribution to the economic boom in a country. Oil and gas companies must partner with a domestic government for disarmament and demobilization in the country where there are active extremist and rebel groups fighting against the government (Trim and Caravelli, 2009).

You Tube as a Cultural Form Essay Example | Topics and Well Written Essays - 2000 words

You Tube as a Cultural Form - Essay Example Understanding effects of media in the changing world and engaging in media study require â€Å"illustrating the dynamic symmetries† of various media like the press, radio, or television. (McLuhan 172). It is relevant to understand the repercussions of the Internet as a new form of a public sphere and to understand how the networked future might be different from what we have known about the new mode of public interaction and opinion making. YouTube remains an interesting study in marketing a consumer internet service in the changing scenario of mass media. Its reach, ubiquity, and sheer volume of content, everything from dumb home movies to glossy commercial calling cards, make it â€Å"easily dismissible as merely the latest purveyor of trivial, banal, repetitious distractions for an eagerly narcotized booboisie† (Cloud). In this context, it is essential to examine whether YouTube, as a socio-cultural medium, appropriates and exploits other media or not. All social changes contain elements of continuity and assertion of novelty is always a tricky enterprise. Our speech, print, and audio-visual media have always constituted the structures and frameworks for the objective of social setup, as these media act as a powerful instrument capable of imposing its assumptions on our modes of perception. In the electronic age understanding the effect of media in social change involve shaping and transfer of opinion and illustrating the dynamic symmetries of their operation on man and society.

Understanding Best Methods in Evidence-Based Practices in Healthcare Research Paper

Understanding Best Methods in Evidence-Based Practices in Healthcare and for Nurses - Research Paper Example In today’s medical world, electronic clinical information systems (ECIS) are now found in every hospital and clinic setting, allowing for nurses and doctors to quickly access information electronically and apply solutions immediately at the patient’s bedside. When medical staff are able to complete forms and search for information electronically using national standard code terms (or SNLs) on hand-held devices, this eliminates the older practices of having to return to one’s desk to look up information in books and office folders and then notate everything on paper. Eliminating excess time by having portable access to electronic medical information databases on the go, provides the environment in all clinics and hospitals of quickly and accurately providing efficient solutions and operations for all concerned (Allread et al., 2004). The ability for nurses to conduct research also provides the development needed for gaining experience in addressing clinical questi ons about cases and confronting ethical issues (Webb, 2011). Clinical research also provides opportunities to build a strong foundation of scientific information and knowledge, particularly applicable to clinical settings. Research in evidence-based systems also provides opportunities in developing processes within the nursing management sector as part of delivering better information and infrastructure in hospitals and clinics, between management and staff and between management, staff, and patients (Webb, 2011).

Poured Fire Analysis Essay Example for Free

Poured Fire Analysis Essay In the novel They Poured Fire on Us From the Sky, by Benson Deng, Alephonsion Deng, and Benjamin Ajak; Benson communicates a strong will to survive by using the device description. In the middle of the chapter â€Å"The Skulls Tree†, Benson describes the difficult experience he faced in the desert of Ajakageer. On his journey to Ethiopia, traveling through the desert of Ajakageer was the most dangerous part of his journey. Many of the thousands traveling to the camp in Ethiopia were ill and needed help. There was nothing they could, the only option they had was keep moving forward. Benson states, â€Å"At night, I was desperate for to have a good sleep and gain strength for the walking but I couldn’t because it was cold in the desert.† (78) This helps the reader understand the pain and misery of a Sudanese child that experienced this crucial journey. In the beginning of the chapter â€Å"The Gilo†, Benson describes what they had to do when the EPLA took over the camp. In the summer of 1991 the Ethiopian government was overthrown by some guerrilla fighters. The war once again reached them. They had to face the same problems they had. To survive, they must leave. Benson states, â€Å"The Sudan war had grown worse and spread farther. I longed to go home, but not like this-not running again, not back into battles. My beautiful homeland wasn’t a home in wartime. But to avoid conflict we agreed to leave their land and our lovely crops behind us.† This demonstrates that they were in serious danger. No matter where they went more problems caught up to them. They were lucky to get help. In order for them to survive they had to get rid and abandon there hope.

The relationship marketing

The relationship marketing Introduction Relationship marketing has become a widely applied and recognised way in which the hotel industry has been able to sell itself to guests. Prior to the start of the essay, the definition of relationship marketing must be addressed. Kotler et al. (2007) defines relationship marketing as the process in which the construction, cultivation and strengthening of strong value laden relationships with customers and other stakeholders occur. Another way relationship marketing can be defined is as with Dwyer et al. (1987, p. 12) both business marketing and consumer marketing benefit from attention to conditions that foster relational bonds leading to reliable repeat purchase. With this in mind, the idea that relationship marketing is a marketing strategy used in the context of the hotel industry for increased benefits both financial and otherwise via repeated purchases will be applied to within the scope of this essay. Recent shifts from the traditional side of transactional marketing to the inception of relationship marketing in recent times has seen a softer approach rather than a dominant approach to making sales transactions, and thus increases the relevance of the application of relationship marketing to the hotel industry. (Gummesson, 1999) While there are many perceptions as well as views to the notion of relationship marketing, this essay intends to focus on the advantages as well as the drawbacks of relationship marketing within the hotel industry, recommendations as well as propositions with regards its future directions will too be discussed with relevance to the question. Pros of Relationship Marketing Customer Loyalty A significant benefit that can be derived from successful relationship marketing (RM) in a business is the development of loyalty in customers. Hennig-Thurau, Gwinner Gremler (2002) mentioned that customer loyalty and positive word-of-mouth recommendations are usually the two outcomes of effective RM. Furthermore, it is further emphasised by Reynold Beatty (1999) that RM can provide exclusive benefits for customers, consequently reducing competition from other businesses that offer the same product which can thus assist in the achievement of consumer loyalty. Oliver (1997) defines loyalty as a close bonding between the consumer and the seller which results in frequent purchase of a certain product or service from the same supplier, despite the influence from other competitors which has the potential to evoke switching behaviour in consumers. The concept of customer loyalty has long been regarded as an important aspect of the integral operations occurring in organisations nowadays, as companies are becoming increasingly aware of the rewards to be reaped in the form of superior financial performance in the long run. This is further supported by Dowling Uncles (1997) purporting that loyal customers are more likely to spend additionally and often make favourable recommendations to other potential customers. In addition, McMullan Gilmore (2008) noted that greater knowledge and understanding of customer loyalty may allow companies to align their management strategies to meet the different needs of its customers in a more effective manner and hence, resulting in a more profitable business. Therefore, many hotels in todays world have implemented their own customer relationship management (CRM) system in order to offer their customers a unique and satisfying experience by accurately identifying the various needs of customers. Lo, Stalcup Lee (2010) stated that the concept of CRM has evolved over the past decades into a strategy employed by many organisations to integrate the different aspects present in the company, so that a greater understanding of their customers can be attained and ultimately, resulting in a long-term profitable relationship between the customers and themselves. However, it is crucial for hotels not to overlook other areas that are closely related to the concept of customer loyalty, instead of just merely focusing on the establishment of an effective CRM system. Customer loyalty is often linked to other service management concepts such as customer satisfaction and customer centricity. Businesses including the hotel industry should be mindful and take into consideration these other concepts that might affect the development of customer loyalty the ultimate aim of successful RM. It is also critical for hotels to recognise the obstacles impeding them from instilling loyalty in customers. One of the more noteworthy obstacles includes unresolved areas of dissatisfaction in consumers which, if left unattended, can result in dropping sales and profitability (McMullan Gilmore 2008). Therefore, a two-way communication becomes all the more essential for businesses to understand what customers want and knowing how to deal with dissatisfaction Lastly, managers should always assess the pros and cons of a loyalty program before implementing them, so that resources get measured and managed. Focus on Customer Retention Another advantage derived from relationship marketing is the increased profitability that stems from the retention as opposed to capturing new customers. Firstly, customer retention can be defined as the ability of a firms offer for a customer to purchase or patronage its product over a specific time period. (Shajahan, S, 2004. p.109) This occurs when, in the context of this essay, a hotel adopts a customer management orientation where it seeks to apply RM to retain its customers. Customer retention reduces marketing costs and as such benefits the hotel financially. This means that hotels need to spend potentially less money to attract customers they have lost as a result of the defection of its existing ones. This was exemplified in a study showing increase in profit by 25% to 125% in a company when it retained 5% more of its customers. (Reichheld, F Sasser, WE, 1990) This can be done by the hotel developing a customer retention strategy and thus focussing its energies on particular customers in which they would like to retain. This is as not all customers are worth the additional effort as well as cost to retain, certain customers are with more important with regards to their perceived value to the company as well as potential for development in the future (Buttle F, 2009). In the context of a hotel for example, a hotel might want to centre its attention on the higher spending, more affluent members of its clientele, as they represent more profits for the c ompany as compared to the ordinary spending customer that patronises the hotel. With these measures and understanding of customer retention in place, hotels can reap increased profits as an advantage of relationship marketing. Word-of-mouth (WOM) Advertising As mentioned earlier in this paper, one of the desired outcomes of successful RM is the positive word-of-mouth recommendations by satisfied customers. WOM has been regarded as a powerful tool of communication which can influence consumers purchasing behaviour and judgements (John 1994). Sweeney, Soutar Mazzarol (2008) further elaborated that WOM behaviour plays an influential role in promotion and it is very important especially in businesses that provide services such as hotels. Zeithaml (1981) reinstated that WOM creates significant impacts in service organisations because the intangibility of service made it impossible for consumers to pre-trial the product before purchasing it. Hence, it is paramount that hotel operators are aware that WOM behaviour can affect them to a large extent. Though significant repercussions may prove to be an issue if negative words about the company were to spread around, operators of hotels should be forewarned of the positives that WOM marketing can provide for them. For instance, WOM can reduce geographical boundaries that used to exist in traditional marketing, especially true with the increased affluence of internet in our modern society today. This is supported by Trusov, Bucklin Pauwels (2009) stating that the use of Internet can provide many various platforms and avenues for users to share their views and opinions with one another. In addition, it also serves as an advertising channel which can lower costs and ensure that consumers receive the message in the shortest possible time. Costs Savings for Businesses As most organisations face difficulties in nurturing and maintaining long-term relationships with their customers (1999), the advancement of information technology (IT) has significantly improved efficiency and decreased the costs associated with RM. For customers, RM through the use of IT will ensure a better understanding and better fit for marketing efforts (Xu, Yen, Lin Chou 2002). For hotels, RM through the use of IT means moving from general market segmentation to a more definitive segmentation while enhancing the level of intimacy between the hotel and her guests (Gummesson 1994). Barlow (1992) concurs that generally, guests desires to be communicated with on a one-on-one basis. Based on past data collected through the use of information systems and property management systems, hotels are able to utilise sequential data in RM (Grà ¶nroos 1995). Berry (1995) perceives that the use of IT in customer RM will facilitate information exchange, allow possible tracking of buying patterns, and the personalisation of service experience. This translates into cost-savings for the hotel for their marketing efforts. Understanding the Market Relationship marketing can be taken advantage to narrow the demand gap for accommodation rooms caused by seasonality of tourism demand. As mentioned by Butler (2001), seasonality in tourism exacerbates problems relating to capital access, retention of skilled labour and the under-utilisation of resources such as hotel rooms. Generally, the two main causes of seasonality in tourism has been identified as natural causes and institutionalised causes (Hartmann 1986). Weather conditions can often lead to the seasonality of demand in tourism (Kozak Rimmington 2000). As such, the ski industry has a large turnover rate of employees and often, ski resorts are vacant during the summer (Ismert Petrick 2004). Based on the geographical environment that it is in, hotels can actually sell nature tourism to potential guests during the off peak seasons. By having leisure activities at the destination, it creates a compelling justification for travellers to stay over. This form of marketing would be best communicated via the use of relationship marketing as hotels will have a better understand of guests preferences. Similarly, hotels can utilise existing guest records to target those that do not have work obligations for instance, and those that they deem as potential guests. During the low-peak seasons, hotels can make use of that as a selling advantage. A different group of guests may be attracted as a result of marketing the hotel to be quiet and peaceful. For example, by creating special packages that addresses accessibility issues, and includes a wide variety of leisure options and accommodation standards for the elderly, the hotel is able to tap on the retired greying population and boost room occupancy rates even during these periods. Cons of Relationship Marketing Importance of Recognising Cultural Differences One of the disadvantages of RM, and especially so for global hotel businesses, is that cultural differences are not being recognized when a single approach is being implemented for different societies. Culture must be first defined in this essay as an integrated system of learned behaviour patterns that are distinguishing characteristics of the members of any given society (Czinkota, MR Ronkainen, IA, 2007 p.54) This would mean that different cultures adopt different mindsets on various issues, attitudes and feelings. In the context of this essay this means various cultures respond differently with respect to RM in hotels. For example, Chinese tourists attach great significance to ritualistic behaviour such as a smile, greeting or a hand-shake as part of a service orientated experience which represents respect and importance of the guests. In the UK, however, ritual greetings by hotel employees are rare; furthermore interactions with guests from Chinese cultures are inclined to be h indered by language barriers. (Wang,Y. Vela,MR. Tyler, K.2008) This means that tourists from a Chinese culture would be affected in ways that guests from for example, a western culture would not be. Hotels therefore are faced with the constant challenge of providing a positive service experience for a variety of visitors with different expectations and needs. It is also noted that RM in the Chinese cultural setting is approached in a different manner than how it is done in western cultures. In the former, it is custom to establish kuan-hsi (networking/relationship) first followed by the business dealing. However in western cultures, a closer relationship is fostered only after the business dealing, with the view of acquiring further business opportunities. (Gilbert, DTsao, J,2000) In the hotels context this would mean that international hotel chains such as Starwood would have to deal with local suppliers or partners in different ways with regards to business dealings. A deal in China would not be approached in the same way as a deal in New York, lest offending or putting off potential suppliers. Hence the challenges faced by global hotel brands in RM with regards to different cultures. Involvement of High Costs for Training and Software Because of the different approaches to RM and a need to recognise these different cultural elements, hotel employees are required to undergo a stringent training process. As Zelkowitz (2005) advocates, the high costs related to relationship marketing generally spawns from the recruitment and training of staff. Thus, it contributes to the additional costs of the hotel. Furthermore, managing relationships have now been rarely limited to just the customer and the business, but also relationships with other stakeholders such as agencies and other suppliers which have different levels of integration and ways of operating. As a result of these complexities identified, many hotels are utilising integrated RM software to simplify their business operations process and effectively manage these multiple relationships. As such, this technology acquisition contributes to ongoing operating costs for the hotel and can be viewed as a form of maintenance (Little Marandi 2003). Counter Productivity of Relationship Marketing While trying to meet the needs of existing loyal guests, RM may have an adverse impact on customer loyalty. Sending unsolicited promotional materials such as mass customised emails to guests may risk jeopardising the relationship the hotel has with the guest (Brown Muchira 2004; Prasad, Ramamurthy Naidu 2001). At the same time, RM can result in guests being bombarded with promotional messages from various hotels that they have previously lived in. Bowie and Buttle (2004) believe that customer loyalty can only be dedicated to a small number of brands. Thus, overloading of information via marketing might be counterproductive and will eventually result in less benefits for both the hotel and the customers (Jayachandran, Sharma, Kaufman Raman 2005). Although RM might be able to anticipate guests needs and wants by accessing sequential records in the information system, it is important to remember that individual guests may not always desire for the same product and service even when b eing at the same property (Bowie Buttle 2004). Negligence of Existing Customers RM can be detrimental to any business if used in an improper manner. For instance, certain hotels may tend to use RM or tailor their strategies toward acquiring new markets whilst at the same time, lesser emphasis is placed on managing existing guest relationships. As previously established, the cost of attaining a new customer is five to six times more than retaining a loyal guest (Ndubisi, Malhotra Wah 2009), meaning some hotels suffer from the leaky bucket syndrome as they seem more interested in attracting new customers rather than retaining existing ones (Dowling Uncles 1997; Gummesson 1994). Limitations and Recommendations It has been widely accepted that the main objectives of relationship marketing and management is to establish long lasting relationships between the hotel and its guests through the increase in consumer knowledge and also establishing a two way relationship which is mutual and beneficial for both parties (Llamas-Alonso, Jimenez-Zarco, Martinez-Ruiz Dawson, 2009). The aforementioned points suggest that sound relationship management can lead to several benefits that increase the value of the hotel, provide competitive advantages, and enhance its competitive market positioning, which is then translated to the improvement in the hotels financial performance (Ryals, 2005; Boulding, Staelin, Ehret, Johnston, 2005). However, evidence also points out that effective relationship marketing requires heavy investment in information and communication technologies (ICTs) and also much effort in order to maintain these long-term relationships (Little Marandi 2003). Henceforth, this section aims t o explore existing limitations pertinent in the implementation of a relationship marketing strategy in hotels and subsequently, propose recommendations to address some of these issues identified. A plethora of research have been done in the area of CRM and they all seem to concur that the CRM framework no longer refers to just relationships between the business and the consumer, but also other organisations and parties interconnected within the framework, one where Gummesson (2004) has termed as a complex network of relationships. Several authors continue to expound on this, stating that these relationships frequently involve different mechanisms of governance, instruments of authority and control, levels of integration, and purposes which thus contributes to this complexity (Achrol Kotler, 1999; Rindfleisch Moorman, 2001), making CRM difficult to implement successfully. According to the Gartner Group ( 2002) and authors Srinivasan Moorman (2005), this complexity also mean certain aspects have not been addressed and thus constitutes to one of the reasons why a high percentage of CRM projects have failed and not liven up to the expectations of it. Hence, it is now understoo d that while these challenges are difficult to address, overcoming the complexity is integral for relationship marketing strategies to be successful within any hotel business. The multidimensional nature of relationship marketing entails proper foundations be established by the hotel management before the implementation of any CRM strategies. It is therefore recommended that the strategic objectives to be achieved by implementing CRM be defined clearly in the early in the planning stages. This ensures that it is clearly aligned to the overall hotel objectives and will thus be able to contribute strongly to hotel operations. As managing multiple relationships become more complex, it is also recommended that a performance management tool specifically catered toward CRM should be established in order to evaluate the success of the CRM strategy. This proposal builds upon the works of Sin, Tse Yim (2005), which proposes a potential tool for measuring performances in relationship marketing, defining the concept as a multidimensional construct consisting of four broad areas strategy, people, technology and processes. Therefore, this approach of recognising other dimensions will enable the hotel to take on a more holistic approach toward relationship marketing and CRM. Furthermore, with technology being increasingly relied on in managing these relationships, these evaluative tools will be able to measure the success of these information systems to ensure it delivers its intended outcomes. As mentioned earlier in this paper, relationship marketing not only refer to creating strong and long-lasting relationships with hotel guests, but also extends to other stakeholders such as suppliers and potential and existing employees (Christopher, Payne Ballatyne, 1991). Employees play a decisive role in managing relationships with guests since they become partners and co-producers in the customer experience (Llamas-Alonso et al., 2009). While most CRM strategies have tended to focus on guest satisfaction, guest loyalty and other areas relation to customer attitudes toward the hotel brand, it is then recommended that equal emphasis be placed on managing employee relationships and suppliers alike in order to increase the probability of successfully delivering the intended outcomes of the overall relationship marketing strategy. Benefits of Recommendations The development of measurement systems will allow hotel managers to anticipate how CRM will work and determine the way CRM will influence the achievement of the hotels strategic objectives. By designing and implementing a balanced, complex, and multi-dimensional measurement system, hotels will then be able to anticipate the future ability of CRM to achieve its objectives through a predictive performance measurement system or establish the level of real success achieved by CRM through an evaluative performance measurement system (Llamas-Alonso et al., 2009). Additionally, the implementation of evaluative measures in hotels will be able to provide important information to key decision-makers, allowing them to determine whether their efforts are on track with the overall relationship marketing strategy. Also, it will help managers to understand whether their programs are succeeding or failing by signalling potential managerial problems when the performance indicators are not able to track in the desired function (Llamas-Alonso et al., 2009). Above all, these measures will encourage hotel managers to take initiative and be accountable, at the same time, clarifying the process for the expectations and requirements of policy makers. The implementation of Performance Management and Control Systems (PMCS) with a predictive orientation will essentially help to minimise the risks of decision making and pave the way for hotel strategies to be executed, consequently improving the return on investments associated with the implementation of relationship marketing programs (Argyres, 1999). Furthermore, as Llamas-Alonso et al. (2009) purports, comparing the predictive and achieved objectives in the hotel will be able to establish the divergences between the expected results and the achieved results, thus improving efficiency and efficacy of the relationship marketing strategy as well. Conclusion After a thorough analysis of the relationship marketing concept within the of hotel industry, it is evident that relationship marketing if utilised appropriately, can lead to significant potential benefits for the hotel business. Such benefits include positive word of mouth recommendations to future customers as a direct result of customer loyalty, greater cost savings for business, increasing occupancy rate during off-seasons and also, customer retention all of which translates into higher profits and improving the overall functionality of the hotel. Despite the benefits gained, relationship marketing can also present several drawbacks to hotel operators. In todays world, globalisation has allowed the interactions between people of different ethnicity and cultural practice to take place more frequently. This means that understanding different cultures and learning to deal with different people becomes all the more relevant and could potentially sap large amount of time and effort. In addition to this, the costs required to establish a CRM system and training employees to be proficient in it can be exorbitant. It should be noted however, that these are investments that need to be made in order for relationship marketing to be implemented successfully and thus entail proper planning and objectives setting. Furthermore, the multidimensional nature of relationship marketing means hotels face much complexity. Hence, it is imperative that performance measures with an evaluative focus should be utilised in order to ensure the success of a relationship marketing strategy. It was also noted in this paper that relationships with suppliers and especially employees need to be managed as well, since the latter contribute to delivering the overall guest satisfaction. The adoption of a relationship marketing approach involves a great challenge for the firm, since it means a different way of understanding the marketing strategy, the market and the approach to the guest. Above all, hotel businesses need to be able to communicate this strategy to its staff, and ensure that the relationship marketing strategy is fully embraced and the organisation fully aligned to it in order for the business to face the multitude of challenges for the future. List of References Achrol, R. S. Kotler, P. 1999, Marketing in the network economy [special issue], Journal of Marketing, vol. 63, pp. 146-163. Argyres, N. S. 1999, The impact of information technology on coordination: Evidence from the b-stealth bomber, Organisation Science, vol. 10, no. 2, pp. 162. 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The Symptoms Of Dementia Health And Social Care Essay

The Symptoms Of Dementia Health And Social Care Essay Dementia is a group of symptoms affecting intellectual and social abilities, severely enough to interfere with daily functioning. It is caused by conditions or changes in the brain. Dementia is the loss of mental functions such as thinking, memory, and reasoning that interferes with a persons daily life and activities, Different types of dementia exist, depending on the cause. Alzheimers disease is the most common type. Dementia is a loss of the mind, it could be static which results from global brain injury or it could be progressive which results in long term decline in cognitive function (Hopkins). Dementia indicates problems with at least two brain functions, such as memory loss along with impaired judgment or language. Dementia has never been known to be a disease but a group of symptoms that causes diseases and conditions, some symptoms are changes in personality, mood, and behavior. Dementia can make someone confused and unable to remember the names and important people in the ir lives like the name of children, husband, sisters and brothers. Some cases of dementia can be treated or cured because the cause is treatable, like dementia caused by substance abuse e.g. street drugs, alcohol, controlled substances, dementia caused by severe depression. This is known as pseudo-dementia (false dementia) and is treatable. In most cases, a true dementia cannot be cured, because of some causes that are curable and partially treated; doctors must be thorough in making the decisions so as not to miss potentially treatable conditions. The frequency of treatable causes of dementia is believed to be about 10 % (WebMD 2010). Dementia is classified as cortical or sub cortical depending on the area that is affected. Cortical dementia affects the cerebral cortex or the outer layer of the brain; the cortex is a sheet of neural tissue that is outermost to the cerebrum of the mammalian brain. It plays a key role in memory, attention, thinking, awareness, consciousness and langu age.it could lead to problems with memory, thinking, and language, difficulty comprehending written or spoken material. Subcortical dementia results from dysfunction in the other brain areas below the cortex; it is the portion of the brain immediately below the cerebral cortex, this is a categorized dementia which can also bring about memory loss, degradation in thinking ability as well as changes in movement and emotions (Hopkins 2010). There are some related Dementia; Mild cognitive impairment is a transition stage between the cognitive decline of normal aging and the more serious problems caused by Alzheimers disease. This disorder can affect the language, writing and reading and could probably cause memory loss. Vascular dementia is the form of dementia that the condition is more than one; it is a group of syndromes relating to different vascular mechanisms. It is preventable and the early detection and an accurate diagnosis are important. Mixed dementia is a condition in which Alzheimers disease and vascular dementia occur at the same time, Dementia with Lewy body is a progressive declined disease or syndrome of the brain with several diseases, especially with two common diseases of older adults, Alzheimers and Parkinsons. Parkinson disease is a degenerative disorder of the central nervous system that often impairs the sufferers motor skills, speech, and other functions, Huntington disease, it is a genetically p rogrammed degeneration of nerve cells in certain areas of the brain. This degeneration causes uncontrolled movements, loss of intellectual faculties, and emotional disturbance. Creutzfeldt-jacob disease Creutzfeldt-Jakob disease is a rare, degenerative, neurological disorder that is invariably fatal and incurable. Normal pressure hydrocephalus is a condition in which there is too much cerebrospinal fluid in the ventricles. This occurs when the natural system for draining and absorbing extra cerebrospinal fluid does not work right. Wernicke-korsakoff syndrome is a neurological disorder that could be acute or chronic which is caused by the deficiency in the B vitamin thiamine, Frontotemporal dementia is a degenerative condition of the part of the brain it is a clinical syndrome caused by degeneration of the frontal lobe of the brain and may extend back to the temporal lobe, It is one of three syndromes caused by frontotemporal lobar degeneration. Dementia has lots of symptoms and all varies depending on the cause, the common ones are memory loss, difficulty in performing activities of daily living, inappropriate behavior, aggitation, personality changes, difficulty with coordination and motor function. Dementia can be diagnoses in different ways; the doctor determines the kind of test, it is important for the doctors to rule out the curable dementia, like depression, normal pressure hydrocephalus, or vitamin B12 deficiency which can cause the same symptoms. Early diagnosis and treatment is important for the patient. The different ways of diagnosing is autopsy to confirm or refine the clinical diagnosis of Alzheimer disease, the patient history so as to help the doctor rule out some conditions, physical examination to help the doctor rule out the treatable and curable cause of dementia and identify some other illness in the body which and coincide with dementia, neurological examination to assess the sensory neuron and motor neuron, especially reflexes to determi ne if the nervous system is functioning and to determine a movement disorder or stroke that may affect the patients diagnosis, lab test to rule out some symptoms like kidney failure that could contribute to the cause of dementia, the test includes complete blood count, urinalysis, blood glucose test, cerebrospinal fluid analysis etc. Brain scan to detect abnormalities of the brain the size of 5 mm and larger, it can also be used by doctors to identify stroke, tumor or other problems that causes dementia, there are different kinds of brain scan which are, computed tomography (CT) which combines special x-ray equipment with complicated computers to produce multiple images or pictures of the inside of the brain. These images of the area being studied can then be examined on a computer monitor, printed or transferred to a CD and magnetic resonance imaging (MRI) used in radiology to visualize detailed internal structure and limited function of the body. Psychiatric evaluation used to det ermine there is depression including sad, hopeless or worthless, or another form of psychiatric disorder which may be contributing to the symptoms of dementia, and presymptomatic testing is used when no treatment available stands in contrast to genetic testing done for the diagnosis of the dementia (White). There is no specific treatment for dementia; the treatment is to treat the cause. Patient with dementia needs to be under the supervision of medical care to focus on the quality care, medication and treatments such as therapy, and family members to help in activities of daily living, and to help the patient cope with many challenges. The goal of treatment is to control the symptoms of the disease; some patient might be hospitalized for a short period of time. The available drugs that the Food and Drug Administration (FDA) approved to determine the treatment of behavioral disorder in patient with dementia is antipsychotic medication which includes, Risperdal, Seroquel, Zyprexa and Abilify, they are used to reduce the psychotic symptoms of dementia and allow the patient to function effective and appropriately (FDA 2005). Drugs for treatment of dementia should be avoided unless they are really necessary, before any of these drugs are prescribed doctors make sure the patient is physicall y healthy, comfortable and well taken care of. Some symptoms that also be treated is when patient is pain, have problems with sight and have difficulty hearing, all this can make patient more confused and increase their vulnerability. It is essential for patients to take the drugs exactly as prescribed to make it effective, but if the symptoms are not controlled the doctor may refer the patient to a specialist for further advice. There are some possible side effects of these drugs that may worsen the symptoms which are muscle stiffness, tremor, anemia, depression, heart failure, infection, nutritional disorder, hypoxia and abnormal movements, which must be listed on the drug guide. The doctor usually starts the medication with low dose and gradually increase the dose until the desired outcome is achieved. It is important to inform the doctor about any other drug that the patient is taking to avoid contraindications and once treatment is established it is important to review it regul arly. In most cases these drugs should not be prescribed for more than three months and patient should not assume that if the has been proved to be effective does not mean it is going to be effective on them. There are some more drugs that can be prescribed which are mood stabilizer (citalopram, fluoxetine, and imipramine), stimulant (methylphenidate) and serotonin affecting drugs (trazodone, buspirone), information on how to take this drugs must be provided by the doctor or pharmacist. What is Alzheimer? Alzheimers disease is a brain disorder named after German physician Alois Alzheimer, who first described it in 1906 Alzheimers, it is irreversible, slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, perception memory and thinking skills, and even the ability to carry out the simplest tasks. It is cited as number one mental health among people age 60 and the risk goes up as you get older. The risk is also higher if a family member has had the disease. Alzheimer is a progressive disorder that starts in the brain in the area that involves thought, memory and language. It is characterized by the stage of increasing impairment and dependency (alz.org2010). People with Alzheimer disease may have trouble remembering things that happened recently or names of people. The earliest sign of Alzheimer disease is behavior such as suspiciousness and a thought process heavily influenced by anxiety or fear, often to the point of irrationality and delusion, angry, outburst, withdrawal. Over the time the symptoms of Alzheimer gets worse, they tends to forget how to speak, write, read, brush their teeth, comb their hair and even forget family members this might make them aggressive, wander around, and get stressed. The cause of Alzheimer disease is unknown but lots of factors have been explored. There is no single test that can detect Alzheimer but the disease is diagnosed by some symptoms, some findings on neurological examination and some result from diagnostic test. The tests show the possible sign and symptoms. The pathological hallmark associated with Alzheimers disease is amyloid plaque and neurofibrillary tangles, amyloid is found between nerve cells in the brain. Amyloids are insoluble fibrous protein aggregates sharing specific structural traits that the body produces normally, in an healthy brain the amyloid are broken and diminishes but in an Alzheimers disease the amyloi d form hard and insoluble plaques. Neurofibrillary tangles are also found in the brain of Alzheimer disease patients, this is the accumulation of twisted protein filaments within neurons of the cerebral cortex; a characteristic pathological feature found in the brains of Alzheimers disease patients. In Alzheimers disease, there is an overall shrinkage of brain tissue and theories have proved that there is no cure for it. The part of the brain called sulci are widened while the part called gyri shrunk. The ventricle that contains the cerebrospinal fluid is enlarged. The disease Alzheimer is affecting over 5.3 millions of Americans; it cost over $148 billion annually to take care of an Alzheimers patient (Alazraki). In the early stages of Alzheimers disease, the short-term memory begins to fade, when the cells in the brain begins to diminishes, the ability to perform routine tasks declines. As Alzheimers disease spreads through the cerebral cortex judgment declines, emotional outbursts may occur and language is impaired. As the disease progresses, more nerve cells die, leading to changes in behavior, such as wandering and agitation. In the final stages of the disease, people may lose the ability to recognize faces and communicate; they normally cannot control bodily functions and require constant care. Physicians discuss with the patient and family which tests are most appropriate to establish the correct diagnosis but there is no test that diagnose Alzheimer disease, but the disease is diagnosed by the symptoms, firstly patients have to complete a physical examination to rule out some symptoms, the patient the patient mental status and neuropsychological will be assessed to determine which thinking and memory function may be affected. The patient may have a psychiatric assessment to rule out some mental illness and depression. The patient may be asked to do a brain scan (MRI, CT scan, and PET scan) to help detect signs and symptoms of stroke that can bring changes to the structure of brain associated with thinking. Blood test may be ordered to check for infection, kidney and liver function, electrolyte level, thyroid disorder and other factors that can cause memory loss. Other tests that sometimes provide important diagnostic information include electroencephalogram (EEG), urine t ests, and tests on cerebrospinal fluid (CSF) obtained by a lumbar puncture. The possible drugs approved by the Food and Drug Administration (FDA) are tacrine which should be taken on an empty stomach, one hour before, or two hours after meals. If stomach upset occurs, it may be taken with meals; however, food can decrease tacrine blood levels significantly. The possible side effect of this drug is diarrhea, nausea, vomiting, muscle ache and loss of appetite. Donepezil is expected to delay the onset of Alzheimer disease for about one year in people suffering from mild cognitive impairment; it belongs to a class of drugs called cholinesterase inhibitors, it inhibits acetylcholinesterase, an enzyme responsible for the destruction of one neurotransmitter, acetylcholine. The possible side effects associated with this drug include headache, generalized pain, fatigue, nausea, vomiting, loss of appetite, weight loss, dizziness, muscle cramping, joint pain, diarrhea, insomnia, and increased frequency of urination. Namenda was actually prescribed for moderate to severe stage Alzheimer disease but now is being prescribed even in earlier stages of the disease, Namenda is an orally active receptor antagonist that regulates the activity of glumate in the brain. Cholinesterase inhibitors are used to treat cognitive functions and behavioral symptoms in Lewy body disease. Clonazepam is a benzodiazepine derivative with anticonvulsant and muscle relaxant, it is generally considered to be among the long-acting benzodiazepines and Opiate drugs used to relieve pain. Antipsychotic drugs not approved by FDA are sometimes used to treat agitation include, Risperidone Benzodiazepines and drugs such as Olanzapine , Quetiapine , Ziprasadone .The drugs increase the risk of death in elderly patients and the side effects include sedation, confusion and increased muscle tone. CITATION Charles L. White, Autopsy for dementia 2010 Croft, Harry. Psychiatric medication medication for mental illness http://www.healthplace.com/otherinfo/psychiatric-disorder-definations/medication. 5 may 2010 Alazraki, Melly. Nothing you can do will help daily finance 5/01/10. 11.00am http://www.dailyfinance.com/story/nih-on-alzheimer-much/19460466/mellyalazraki Hopkins, John. Special Report. 7thth ed. New York: new York Times, 2009. Print. Kesner, Julian. Three new dementia fighters. Prevention Jan. 2009: 104. Professional Collection. Web. 04 May, 2010 Webmd.com 2010

review potter3 chapter 1 :: essays research papers

The Characters in Chapter One â€Å"Owl Post† of â€Å"Harry Potter and the Prisoner of Azkaban† by J.K.Rowling In class, we listened to the first chapter of â€Å"Harry Potter and the Prisoner of Azkaban†. This is indeed an extremely interesting chapter since it contains all the basic information you have to get to understand the â€Å"Potter Universe†. It gives quite detailed information about most of the important characters. The chapter starts with very important information about Harry. It says:† Harry Potter was a highly unusual boy in many ways. [†¦] And he also happened to be a wizard.† As the story unfolds, you get to know Harry as a boy of thirteen years with untidy jet black hair who is quite small and skinny for his age. His eyes are bright green and he wears round glasses. The most important feature, though, in the description of his appearance is the scar on his forehead, shaped like a bolt of lightning. The book explains that Harry got the scar when his parents, James and Lily Potter, wizard and witch themselves, were murdered by the dark wizard Voldemort, the most vicious of his kind for a hundred years. This explains why Harry has to live with his only living relatives, whom he obviously dislikes. It is also made clear that Harry only spends the summer with his relatives to go back to Hogwarts School of Witchcraft and Wizardry for the rest of the year, which he has attended for the last two years. His relatives are his uncle Vernon Dursley, aunt Petunia Dursley and his cousin Dudley Dursley. They are non-magic folk, so-called Muggles, and they are extremely scared of anything that has to do with magic. This shows when Harry’s uncle roars at one of his wizard friends on the phone:† DON’T YOU COME NEAR MY FAMILY!†. To the Dursleys it is very important to make a good impression on their neighbours and so they are terrified of anyone finding out that Harry is a wizard and goes to Hogwarts. They think that magic people belong to some kind of a lower class, which shows clearly when Uncle Vernon screams at Harry:† HOW DARE YOU GIVE THIS NUMBER TO PEOPLE LIKE- PEOPLE LIKE YOU!† Magic people seem to be dirty and worthless and even dangerous in his eyes. Three of the magicians closest to Harry are characterized in chapter one in detail. First, there is Ron Weasley, one of Harry’s best friends at Hogwarts.

Essay --

Potato across Countries The cultivation of Potato has increased in the last fifty years all around the world. However, its consumption has decreased considerably for the past twenty years because in the developed countries. This is because these some of these developed countries have more abundant proteinous foods rather than depend on starchy food for survival. In the subsequent parts of this paper, the comparative analysis of potato in the China and France will be explored. It is believed that the Dutch introduced Potato in China around 1600. It has since been grown in the mountainous areas of western and northern China. It was not perceived with much vitality and its cultivation in China was not so important until the early years of the twentieth century. New varieties of exceedingly-yielding Potatoes and new technologies for harvesting and processing of the crop has substantially increased. The government of China began experimenting with Potato in the year 1914. Since then, improved varieties of Potato and advanced breeding methods have been discovered and put in to practice in China. Potato finally became of a highly important crop in China around the Second World War. This was a time when the nationalists and communists parties of the country and also the invading army of Japan discovered the advantages of a crop that can be grown easily, stored for considerable months and more easy to be transported. After the war ended, Potato cultivation exceed ingly increased all around China; most especially in â€Å"Ganzu, Guizhou, Inner part of Mongolia, Yunnan and Sichuan†. The crop could be cultivated over the winter even in the warmer region of the southern part of China. Consequently, in 1950 the production of Potato had the attained... ...rop became more abundant and relatively nutritious causing it to be grown by more sections of the French society. Potato helped support large families and population explosion in France just like in China. The French have their own Potato which differs from that of the Chinese and they are namely; White Wine Smashed Potatoes, Three-Cheese Potato Gratin and Potatoes Fondantes. Today, Potato is still grown mainly in the Southern region of France. New varieties are being planted with modernized farming equipment just like in China. Work Cited Smith, Andrew F. Potato: A Global History. London: Reaktion, 2011. Print. â€Å"Early History of the Potato in France.† The American Farmer; Devoted to Agriculture, Horticulture etc.(1881-1897) Jan 15 1893: 7. ProQuest. Web. 10 Nov. 2013. Reader, John. Potato: A History of the Propitious Esculent. New Haven: Yale UP, 2009. Print.

Diary of A Baby by Daniel Stern

Diary of a Baby by Daniel N. Stern focuses on 3 key points in Child Development. What your child sees, what they feels and what are the experiences during infantry. The author tries to relate from a baby’s point of view from one chapter to another. Reading this book is really an enjoyable experience where you ought to learn and tries to bring you back to the time where you are still young. The main character Joey gives us a clearer picture of what we were during this period. It clearly narrates how a young’s consciousness was penetrated by the environment and the people that they deal with everyday.Newborns can see clearly approximately 10 to 12 inches away, about the distance between a nursing infant and his mother’s face. Fortunately, infants tend to be more interested in the human face than everything else. This is where parents tends to take advantage of it and must spend time gazing into the baby’s eyes. As per the term what they see is more important because from total darkness in their mother’s womb, they were enlightened to the world and what they see gives them a clearer view and understanding of what the real world is all about.What a baby feels is like a human weatherscape where there is a unique moment of feelings in motion. Unlike photographs which are static, it has duration and changes depending on a child’s point of view. Dependability is one great word to describe what a child feels where it can last from a split second to many seconds. In the book, Joey’s feeling and perceptions change together. Each moment has its sequence and continuously adds up to the characters experiences in life. Interaction from the people around him is what drives his sights, feelings and experiences.What links the book to child development is that it gives guidance for parents in raising a child base on the scenario of everyday interaction. From coping up with the environment and dealing with the surroundings to the ex pectations in guidance and caring process to each Joey in a parent’s life. The optimal development of children is vital in our society. Therefore the social, cognitive, emotional and educational development of children is important to understand. Joey’s milestone mirrors child development in the book Diary of a Baby.Because it specifies physical and mental abilities like walking, seeing and understanding language according to a child’s age. Milestones can be described as what a child accomplishes throughout the different stages in their life. Increased knowledge of age specific areas in child development allows parents and other caring adults to keep track of appropriate child development which includes patience, problem solving, social skills and creativity in child rearing. What could possibly conflict the book and Child development is that not all that can be read may be applied.It varies depending on the knowledge and understanding of the reader and at the s ame time the stereotypical notion for them in racing their own child based on how they were raised by their parents. One strength of the book is that the reader sees a clearer view on a baby’s phase. It makes the reader feel as if they were young just like Joey once again. From the first six weeks where feelings are really great factors in child care. Why a warm hug and a sweet lullaby expresses deep love and care in every baby.World of feelings in this stage is extremely induced to the readers knowledge for them to be able to comply and have a better understanding how feelings is important during this stage. When a baby is hungry and wants to be fed up immediately it is like shots in a movie one maybe continuous with the next, or fade into it, or cut abruptly against it. Or be separated by a blank pause. It is not clear to babies how they move from one moment to the next or what. If anything happens between those experiences, the one who takes care of them are the mere respo nsible ones in the scenario.Because for Joey all his senses are focused on each one activity that he sees, feels and is experiencing at that very moment. And he lives and deals with each one intensely. Many are the prototypes of the moment that will or may recur over and over throughout his life. What could weaken the scenario is the conflicting ideas between the reader and the author’s concept for not all people may understand that all that is written in the book is the same in a parent-child scenario. One good example is unexpected pregnancy which may greatly affect the reader’s point of view on child development.It could provide both positive and negative impact once it was read. Positive in a way that a mother may become more excited into being a mother to her child or it could possibly frighten her in dealing with her baby because she is not really prepared to have one. Surprising Discoveries that was learned in the book is that I was fascinated how the author ent husiastically explained in details what a baby sees, feels and experiences during his childhood days where the only person they depend upon and look up to is their parents.This book can be utilized in the truest sense of the word parenting and child development process. It is a great instrument for mothers, expecting mothers and parents who desperately wants to know what the infant’s experience is really like Stern draws on his readers different findings and cutes on experiences of a baby in order to re-create the baby’s world and make it more fun, exciting and enjoyable

Religion in Ancient China Essay

The earliest information found about religion in ancient China is during the Shang Dynasty and so religion in the Xia dynasty remains unknown. Religious beliefs and rituals were prominent during the Shang Dynasty. The most significant deity was Shang Ti, Ti meaning ‘Deity Above’ or the ‘Lord on High’. He ruled as a supreme god over all the other gods and spirits. The gods and spirits were believed to symbolize objects found in nature; the sun, the moon, the wind, the rain, everything from mountains and rivers to the stars in the night sky. Ti is believed to have punished those who disobeyed or offended him and rewarded those who pleased him. It is said that Ti formed a noble court in heaven consisting of all deceased worthy ancestors. The Chinese’s belief in family harmony was associated to belief in the afterlife. The ancestors who were considered commendable served Ti, helping him govern the world. Ancestors were also worshipped and were said to act a mediators between the gods and humankind. It was thought that if ancestors were appropriately honoured, respected, and provided for, they would promote the family’s prosperity. A favour or grievance to a member of the family was considered a favour or grievance to the ancestors; consequently, people were reluctant to offense or harm descendants of a powerful family. It was believed that in the afterlife they would live in a celestial court in many ways similar to their earthly courts. Each Chinese family was expected to have an ancestral shrine in the centre of their home to honour and venerate their ancestors. Sacrifice to the gods and the ancestors were also a major part of the Shang religion. When a ruler died, slaves and officials were sacrificed with them in order to guarantee that their afterlife would be the same or similar as their life on earth. People were also sacrificed in smaller numbers when significant events, such as the founding of a palace or temple, took place. Along with their deceased ancestors, the Chinese had people on earth who acted as mediators between the celestials and the human race. Priests were among these intermediates and were responsible for a number of tasks including reading prayers and overseeing sacrifices and funerals. An augur is another type of mediator, responsible for asking gods questions on behalf of humans using various practices of foretelling to unearth the answers. The use of oracle bones was the most notable form of divination. The augur would ask the question, punching holes into the bone, usually the shoulder-bone from an ox, and in some cases the shell of a tortoise. The bone would then be held over a fire, until cracks appeared. These cracks would be made more evident by rubbing ink over the bone. The augur could now read the cracks and determine the answer of the god. Records of the questions and answers of readings were engraved on the bone. Questions on these oracle bones included issues of weather, warfare, agriculture, hunting, childbirth, and sacrifice. In reflection with their agricultural nature, the ancient Chinese use to honour the local deities of soil in order to increase the fertility of earth and to promote the growth of crops. Over time, this practice of earth worship began to dwindle and the veneration of Heaven increased. Divination was considered the only way to determine the requests and future actions of the ruler of Heaven who was also seen as a kind of ancestral figure. The Chinese were animistic and so believed that nature had many spirits. Good spirits, referred to as shen, and bad spirits, referred to as gui, were both thought to dwell in Heaven and Earth. The sun and the rooster were believed to have authority over the gui. This concept of shen and gui later influenced the formation of the yin and yang concept. The people of ancient China believed that there were two contrasting forces abiding in everything in nature; that is yin and yang. This concept was thought to be formed with the influence of the shen and gui concept from earlier ancient China. Yin is characterized as slow, soft, yielding, diffuse, cold, wet, or tranquil; and is associated with water, earth, the moon, femininity and nighttime. Yang, on the other hand, is fast, hard, solid, focused, hot, dry, or aggressive; and is associated with fire, sky, the sun, masculinity and daytime. During the time of the Eastern Zhou, religion in China underwent an evolution. The early gods were forgotten and replaced with ideologies that worked as both philosophies and religions. A phenomenon called the ‘Contention of a Hundred Schools of Thought’ took place in ancient China. Schools and philosophers flourished around this time and it was dubbed an era of great cultural and intellectual expansion in China. The four most prominent schools of thought that evolved during this epoch were Confucianism, Taoism, Mohism, and Legalism. Confucius was born 551 BC and grew up to become one of the most influential philosophers in Chinese history. Confucianism is a composite philosophy of moral, social, political, philosophical, and quasi-religious thought. He built his philosophy around five virtues: compassion, morality, decorum, wisdom and honesty. Compassion was considered the cornerstone, symbolizing loyalty, filial piety, patience and benevolence. He also believed that everyone should be in harmony with one another and establish a society ruled by standard etiquette and conduct. A legendary philosopher by the name of Laozi is believed to have established the religious philosophy of Taoism. The ‘forces of nature’ is the central belief behind the concept of Tao, which is literally translated as â€Å"the path† or â€Å"the way. † Taoism is in many ways the contrary of Confucianism, focusing on the individual within the natural realm rather than the individual within society. It also focuses on the affiliation between humanity and the cosmos, vigour and long life, and wu wei, that is action through inaction, which is said to create harmony with the Universe. Mo Di or Mozi was another Chinese philosopher form the Eastern Zhou period. He was strongly opposed to the teachings of Confucianism and Taoism. Mohism was based on the idea of universal love, ‘everyone is equal before heaven’. Mozi believed that everyone should practice communal love in order to create a heaven on earth. He also believed that an individual’s perception should be the basis of human cognition and not imagination or logic. Mozi advocated abstinence, and therefore opposed music, regarding it as excessive and a waste of resources which could instead be used to help those in need of basic necessities such as food, water and shelter. He even opposed elaborate funerals also regarding it as a waste of money which could be used in more useful matters. He also advocated pacifism thus disapproving of offensive war, only accepting aggressive action to defend the weak. Legalism, while the term itself was invented in the Han dynasty, was one of the major doctrines followed during the Contention of a Hundred Schools of Thought. It was established by Han Feizi and Li Si and theorizes that the human race is evil and in order to prevent this evil causing chaos, laws need to be put in place. Legalism wasn’t concerned with the nature or purpose of life, not even the welfare of the public; rather it sought the states prosperity and military aptitude. Out of these four philosophies, only Confucianism and Taoism are considered religions by scholars, as only they contain spiritual elements. Confucianism and Taoism both became part of what is now known as The Three Doctrine. Buddhism is the third doctrine however it was imported from India and flourished during Imperial China.

Mount Everest Disaster: The PRINCE2 Perspective

our site – FREE ESSAYS – DISSERTATION EXAMPLES Introduction The Mount Everest Disaster of 1996was one of the greatest expedition failures in the history of climbing. Young, Hailey, and Neame (2010) focused on the leadership failures of the expedition, and found that a situational analysis should have been carried out. However, there were multiple errors in planning and strategy that led to the death of eight people that could have been avoided. Sullivan (2007) approaches the failures from the risk-assessment perspective, stating that judgements were not made based on the basis of risk assessment, and there were no calculations performed before the dangerous expedition started. The below review of the disaster will highlight additional issues: lack of flexibility, performance and quality monitoring, and the inability to focus on the objectives of the project. The author of the current review will argue that using PRINCE2 project management approaches would have improved the feasibility of the project, allowing the team to succeed, eliminate o r minimise risks, and remain focused on the desired outcomes. 2. Situational Analysis According to Young et al. (2010: 1), â€Å"climbing teams pre-determine turnaround times to signal descent or abandon summit efforts†. However, these turnaround times were estimates, and did not take into consideration weather conditions, the training level of climbers, etc. There were no calculations made regarding to major risks, such as performance reduction due to the lower oxygen level at high altitudes, dehydration, lack of sleep, and – most importantly – reduced decision-making abilities of leaders (Young et al., 2010). Further risks were not assessed, such as the surprise snowstorm that occurred between 4 and 5 in the afternoon. There were other risk factors that could have been addressed before the trip, such as the problems with radio communication. For example, the leaders assumed that two people were dead, and abandoned them, however, they were alive. By the time they returned to rescue them, they could not be saved. Leadership errors are also noted by Sullivan (2007), who concludes that the two leading guides were unable to make decisions about turning back without Fisher, with whom they could not communicate with. If they took the clients back to camp on time, noting that the turnaround time has passed, they could have saved their lives. 3. Why and How the Expedition Failed According to Sullivan (2007), several people believe that the severe weather conditions caused the death of mountaineers on the Everest in 1996. He, however, notes that â€Å"the weather was a risk that should have been considered more carefully by both leaders† (Sullivan 2007: 38). Based on that statement, it is clear that no risk assessment was completed, and no real-time situation monitoring was implemented. The other reason why the project failed is the lack of clear role definition in the leadership team. There was already a rivalry between Hall and Fischer (Sullivan 2007), and it was not clear who was responsible for supervising the Sherpas, waiting for clients, providing medical emergency services, or even tying the ropes. This confusion about ropes resulted in a lack of action and delay. Delay – in a mountaineering world – means more oxygen used, and less time to turn around. Therefore, the lack of planning and clear roles was also responsible for the disaster. As Sullivan (2007: 42) puts it: â€Å"commercial high-altitude mountaineering must be recognized as an activity of risk, not one of risk-taking†. Analysing the bad decisions made by Hall and Fischer, Roberto (2002) introduces the idea of the â€Å"sunk cost effect†. He provides a clear definition for this effect as: â€Å"the tendency for people to escalate commitment to a course of action in which they have made substantial prior investments of time, money, or other resources†. This, translated to the world of climbers and commercial mountaineers means that they carry on, despite they know they are failing at the task, in other words: they are overcommitted, and make irrational decisions. This was the reason why they did not turn the climbers around, and let them carry on against the odds. Even though they had a â€Å"two o’ clock rule†, as a latest turnaround time, they did not communicate this clearly with the team. 4. How PRINCE2 Could Have Improved Project Management4.1. Process FundamentalsThere were several failures regarding the project fundamentals. In PRINCE2, these are described as starting up a project, directing a project, initiating the project, controlling stage, managing product delivery, managing stage boundaries, and closing a project. Each of these fundamentals can be applied to a project of climbing the Everest. In the starting up phase, the leaders should have clearly identified the objective of the project: completing the climb and getting all climbers back to the base safely. In the directing phase, they should have ensured that all infrastructure and resources were available, in good working condition, and accessible. In the project initiation stage, the leaders should have communicated the rules and objectives clearly with the climber and the Sherpas. They should have created a common understanding of the project (CIPFA 2012). The main failures, however, occurred on the co ntrolling and product delivery stages. Resource commitments were not agreed, and this meant that some climbers had to attempt reaching the camp without enough oxygen. There was simply no project manager who could have controlled the activities and created a stage plan. If there were controlling stages introduced, for example times when teams would communicate and provide updates, it would have been noticed on time that there were serious problems that needed solving. In the controlling stage, tolerances are also agreed (Murray 2010). If PRINCE2 was applied to the project, the different participants could have agreed on the acceptable deviance from the turnaround time, and many of the problems and communication errors could have been prevented. Similarly, if the framework was used in the development of the project, the product (expedition quality and safety) delivery would have been more controlled and better managed in the Managing Product Delivery stage. Finally, it is important to note that in the Managing Stage Boundaries stage. According to CIPFA (2012), this is the stage where â€Å"at each stage end, the continuing viability of the project should be confirmed†. If stage boundaries were created by the leaders, â€Å"reality checks† could have been completed, and it would have been clear that there was no chance to get all the participants safely home without oxygen. Based on benchmarking and evaluation, the project could have been abandoned (turning back), or redirected, modified. In the closing stage, the leaders should have identified lessons learned. More importantly, however, they should have learned from experience before starting the project, as they had many expeditions behind them, already. Reflecting on past and potential problems could have improved the overall project’s outcome and design.4.2. Theme FundamentalsBased on the theme fundamentals of PRINCE2, it is clear that the weakest aspect of proj ect design was risk. Managing uncertainties, such as weather, the physical condition of participants, communication systems’ reliability could have helped avoid risks that led to the death of climbers. There was no clear understanding and consensus on quality attributes the project wanted to achieve, and the plans were clearly not matched to the needs of participants (Plans Theme Fundamental). It is also necessary to highlight the fact that there was no clearly defined plan on dealing with changes, such as weather conditions, lateness. All the conditions, such as slow pace, not meeting deadlines had a negative impact on the project’s baseline aspects (CIPFA 2012). Continuous assessment of the viability of plans should have been carried out, such as performance monitoring, and the escalation of intervention plans if the project does not go according to plans. This control is in place to help the project manager determine whether or not the project should go on or be aba ndoned.4.3. Further ConsiderationsAs the TSO (2009a) guidance states, the key features of PRINCE2 for project managers are the clear definition of roles, authorities, and processes. If this framework was applied to the Everest expedition, all participants would have known what was expected from them in order to help achieve the acceptable quality product (outcome) (TSO 2009b). Marsh (1996) further explains the benefits of PRINCE2 for complicated projects: according to the summary provided by the authors, this system allows the clear definition of the requirements related to the organization itself, users, project managers, the operation team, and other stakeholders. If Hall and Fischer determined what was the desired outcome of the expedition, and identified processes that were needed to achieve them, assigning each individual with tasks, an advanced business system could have been developed. They could have agreed on set time-scales and project boundaries.4.4. Application of PRINCE2 PrinciplesThe Oracle (2011) White Paper further explains the main principles of PRINCE2, and they can all be applied to the case examined in this study. The first principle is continued business justification. This relates to regular reviews of the progress of the project, and decisions made whether or not it meets the needs of the organization. If this principle was applied in the Everest expedition of 1996, it would have been found that – because of the lack of oxygen, severe weather, and lack of adherence to timescales – carrying on with the trip was not serving the interest of the stakeholders, and would not result in the outcomes planned by the team. Learning from experience is another principle that would have helped the leaders prevent risks. It is evident from Sullivan’s (2007) account that the two experienced leaders have experienced problems previously. If these problems and potential risks of their recurrence were assessed before the expedition, plans could have been made to address the issues. For example, both Hall and Fischer have taken inexperienced climbers on the same route, and knew that the lack of planning would result in groups breaking up. Hall did know about the lack of reliable radio communication, and decided not to address the issue. There were no managed roles and responsibilities; another principle of PRINCE2. Sullivan (2007) writes that one of the guides, Anatoli Bourkeev did not act as a guide at all. He was hours ahead of clients. This clearly shows that responsibilities and roles were defined, he would have stayed with the clients and carried supplementary oxygen. Managing by stages was also not applied, as the leaders and guides were too focused on delivering the service clients paid for (Roberto, 2002). Even though another principle of the system is â€Å"Focus on Products†, it refers to fulfilling the product descriptions: in this case the product’s description would have been safe delivery of expedition, preserving the health and safety of participants, leaders, and Sherpas. However, several members fell ill, including Hall who had a previously developed chronic condition, and many people had to be rescued. Managing by exceptions was another principle that – followed – would have made the expedition safer and more successful. No alerts were made when problems occurred. As Roberto (2002: 145) writes: â€Å"The guides as well felt uncomfortable speaking up. Neil Beidleman, a guide on the Mountain Madness expedition, has indicated that he had serious reservations about people climbing well past midday. However, he did not feel comfortable telling Fischer and other team members that they should turn around†. In PRINCE2, risk registers are created (London South Bank University 2016), and they are accessed and updated by all participants. If this procedure was followed, the identified risk could have been dealt with appropriately: by management, rejection, elimination, or minimisation. Finally, PRINCE2 could have been tailored to the project environment, taking into consideration the challenges, the training level and health of participants, and the resources available. 5. Lessons Learned for Project Managers Several lessons can be learned from the Everest disaster of 1999. The main cause of the failure of leaders to keep participants, leaders, and Sherpas safe was the lack of clear quality measures, roles, and risk assessment. The project was not managed and monitored by stages, and communication was poor. The project owners did not ensure that all the resources needed for delivering a quality product (outcome) were in place (initiating a project). Based on the above assessment, it is clear that applying PRINCE2 principles, themes, and processes would have created better outcomes for the Everest expedition project. Bibliography CIPFA. 2012. PRINCE2 Quick Reference Guide. Ferguson, C. 2011. PRINCE2 for Small-scale Projects. Novare Consulting. London South Bank University. 2016. PRINCE2 Presentations and Lectures. Marsh, D., 1996. Project management and PRINCE. Health Informatics, 2(1), pp.21-27. Murray, A. 2010. White-paper: PRINCE2 AND Governance. Outperform. Document Number: 1042-01-01 Version Number: 1v0 Oracle. 2011. PeopleSoft Projects (ESA) Support for PRINCE2. An Oracle White Paper June 2011 Roberto, M.A., 2002. Lessons from Everest: The interaction of cognitive bias, psychological safety, and system complexity. California Management Review, 45(1), pp.136-158. Sullivan, P., Failure of Risk Management in the 1996 Everest Disaster. Discoveries. TSO. 2009a. Managing and Directing Successful Projects with PRINCE2. The Stationary Office. TSO. 2009b. The Executive Guide to Directing Projects: within a PRINCE2â„ ¢ and MSP ® Environment, TSO 2009 Young, S., Healey, K. and Neame, V., The Everest Disaster.