Example of micro operations microinstruction

model of micro operations micro learningQ1. conk an Example of micro operations, microinstruction, micro curriculum, micro edict.colloidal suspension - Following are the examples of micro operations-Bus and Memory TransfersArithmetic MicrooperationsLogic MicrooperationsExample of Microinstruction-For Fetching Data-IF inter.ELSE nextinst.mapExample of micro program -sp = sp + (-1) marching = sp mbr = ac wrwrThis pushes the AC value onto the wadExample of Micro code-mar = sp rdsp = sp + 1 rdac = mbrPop a add from the stack and place it in the ACQ2 How information Technology underside be used for strategic advantages in air?autonomic nervous system Globalisation- IT has non completely brought the world closer, but it has allowed the worlds economy to become a single dep stamp outent system. We not tho share information quickly and efficiently, but in any case bring down barriers of linguistic and geographic boundaries. The world has developed into a global village due to t he help of information technology allowing countries same(p) Chile and Japan who are not only separated by distance but also by actors line to shares ideas and information with to each cardinal other.Communication- With the help of information technology, parley has also become cheaper, quicker, and more efficient. We can now communicate with anyone around the globe by simply school text messaging them or sending them an email for an almost instantaneous response. The net income has also opened up face to face direct communication from different parts of the world thanks to the helps of video conferencing.Cost effectiveness- Information technology has helped to computerize the business process thus streamlining businesses to make them exceedingly cost effective money making machines. This in turn increases productiveness which ultimately gives rise to profits that means better pay and little strenuous working conditions.More time IT has made it possible for businesses to be open 24 x7 all over the globe. This means that a business can be open anytime anywhere, making purchases from different countries easier and more convenient. It also means that you can have your goods delivered right to your doorstep with having to move a single muscle.Q3. What Characteristics of software make it different from other engineering products?Ans - Characteristics of software products -Software products may beGeneric developed to be sold to a range of different customers.Custom developed for a single customer according to their specification.Q4. What are different manoeuvreing modes available?Sol - Various increaseressing orders are -(1) Immediate Addressing Mode -Immediate orchestrateing is used to demoralize constants into registers and to use constants as operands.The constant is part of the instruction worde.g. cast up 5Add 5 to contents of accumulator5 is operand special range(2) Direct Addressing Mode -With direct cut acrossing the address is part of th e instructionUsually the OpCode is one word and address is the succeeding word or words. Effective address (EA) = address field (A)e.g. ADD AAdd contents of carrel A to accumulatorLook in keeping at address A for operandSingle memory reference to assenting dataNo additional calculations to work out effective address limit address station(3) Indirect Addressing Mode -RegisterMemory cell pointed to by address field contains the address of (pointer to) the operandEA = (A)Look in A, find address (A) and look there for operande.g. ADD (A)Add contents of cell pointed to by contents of A to accumulator(4) Register Direct Addressing Mode -Limited number of registers very small address field neededShorter instruction manualFaster instruction fetchNo memory accessVery fast executionVery limited address space doubled registers helps performanceRequires good assembly programming or compiler indite(5) Register Indirect Addressing Mode -The instruction specifies a register which contains th e address of the operandMOVE $1000,R7 R7 = $1000As there are usually only a small number of internal registers the address of the register is good contained in the instruction word.It is efficient and is very useful for working with arrays and pointers. Operand is held in register named in address field EA = RIf an array of total is stored at $1000, then can be accessed in sequence by adding 1 to the register after each access.Operand is in memory cell pointed to by contents of register RLarge address space (2n)One fewer memory access than indirect addressing(6) Displacement (Indexed) Addresing Mode -EA = A + (R)Address field hold two valuesA = base valueR = register that holds displacementor ill-doing versaQ5 How will you differentiate b/w Arrays and Stacks?Explain by giving an example.Ans- An array can be defined as an illimitable collection of homogeneous elements. A stack is a data social organisation in which all insertions and deletions are done at the same end called the top. It is often called last in first out (LIFO) data structure.Q6. How transcriber differs from Complier?Ans - translator- it is a device that changes a sentence from one language to another without the change of meaning.Compiler - It reads the entire program and converts it to the object code. It provides errors not one line but errors of the entire program. It consumes little time for converting a source program to an object program. Compilers are preferred when the length of the program is large. It provides security.Q7 Out of Linear and double star Search, which one is preferred where and why?Ans- in linear search,we access each elemnt of array one by one sequentially and in binary search we seach in minimum number of steps.in binary search elemnts have to be in the sorted form.Binary search is preferred over linear search because time consumed is less.

Barriers to Health Maintenance and Disease Prevention

Barriers to wellness Maintenance and Disease streakRedante CastroIntroduction on that point atomic number 18 many factors that interfere with wellness im spokespersoniality and the competency of the patients to get their wellnessc ar needs met. Whether populate atomic number 18 brawny or non, is determined by their circumstances and environment. on that point ar ch in allenges that a patient and wellness handle providers encounters in securing and providing health work. These social determinants of health, much(prenominal) as income, education, transportation, housing, and race or ethnicity, ca-ca powerful bring on a patients life long before they arrive at a hospital or clinic.According to literature, persistent social expulsion and inequities in wealth distribution and in access and use of services are reflected in health outcomes. cordial exclusions and inequity are obstacles to kind-hearted development. It poses barriers to pauperization reduction strategie s. It hinders social unity and mendd health characterises of the creations. Social exclusion and inequity are come along compounded by racial and gender discrepancy. There are health disadvantages due to differences between segments of populations or between societies. There are health gaps arising from the differences between the worse-off and every whiz(a) else. Lastly, on that point are health gradients relating to differences across spectrum of the population. Studies have shown that the poorest of the poor have the worst health. This is as well as a global phenomenon, seen in wiped out(p), middle, and high income countries. Within countries, studies showed that a unmarried with low socioeconomic position has worse health- this is the social gradient of health. The poorest have the highest mortality rates. Improvements in income and education has a positive effect on health. Ones occupation is withal relevant to health in terms of workplace risks exposure and its ro le in positioning the person along a societys hierarchy. There is also demographic transition to consider that tinges health, i.e., increasing life expectancy, increasing number of youths, outgrowth number of elderly persons in the population, increased migration, and rapid urban growth. existence distribution and population age structure are crucial determinants of social, economic, and health-related services. For example, the great unwashed in poverty are likely to be exposed to high level of stress, economic uncertainty, and unhealthy conditions than their wealthier countrymen.It was recognized by some policymakers and s make waterholders that the populations health female genital organnot be sustained by focusing only if on the financing and distribution of checkup services. A more ecumenical and integrated strategies are indispensable to foster health in all policies. An approach that integrate considerations of health, well- universe, and equity in the development, i mplementation, and evaluation of policies and services. Determinants of health are being accognitiond and incorporated into health reform processes and policy changes are made. Examples of these policy changes are regulation of alcohol and tobacco products, the expansion of healthy transportation bodys (bicycle paths, pedestrian-friendly roads, and pathways), improvement in air and water quality, expansion of essential health care services, and improvements in nutrition programs. This new focus has helped remove the emphasis away from individual lifestyles and from a focus on indisposition towards broader determinants and actions that created a big impact on population health. However, it is probably exquisite to say that all lodge issues are political to some degree. For example, if a factory is poisoning town water system with its effluent and injurious waste, local officials are faced with the choice of not dealing with the unquestionable cause of the problem, i.e., the dumping of waste and endangering citizens health, or addressing the dumping and endangering citizens job. Differences of political opinion can have enormous consequences in the health of the community.Health is not merely the absence of nausea or infirmity. It is the personification of somatogenic, mental, social, emotional and spiritual wellbeing (World Health organization, 2007). Spiritual wellbeing involves ones religious whimsy. Religious belief is essentially personal and confidential matter over which the individual should exercise control and choice. It is of value to gain the relative importance of religious beliefs and practices in protecting and promoting the health of the mess of religious faith and the need to protect their rights to practice this belief drop from discrimination. There is an abundant evidence in literature that religiousness can generate multitude benefits in health outcomes. For spate of faith, their religion and belief system whitethorn influ ence individual health-promoting practices, for example encouraging temperance from alcohol or not eating pork. They may also influence social environments. Strong social champion and participation have been fix to be associated with better health/ longer life and may be offered by some religious communities. To people of faith, prayer is very eventful while seeking healthcare or undergoing procedures, a prayer of support and encouragement when unfavorable conclusion was received. There are some religious group that blood and blood products are not to be part of any handling. For some religious groups, contraceptives, abortion and anti-life practices are against their belief system. With these in mind, alternative ways are to be sought to promote the health and wellbeing of the individual without compromising their belief system.Values are criteria that people use to evaluate actions, people and events. What is important to a person may not be important to someone else. Each in dividual holds numerous values with varying degrees of importance. Values are motivational construct. They refer to the desired goals people strive to attain. People have different health care value system. There are three ways people go out view their health how they became ill, what made them ill, and how they believed they can be cured. Example, people from the east (China) would value acupuncture for pain management option. This in turn lead cause health care providers to look at health treatment plan to accommodate those needs. Among Asian cultures, maintain family harmony is an important value. The interests and pay back of the family are more important than those of individual family members. Older family members are respected, and their leave is often unquestioned. Therefore, due to respect for authority, dis go forment with treatment recommendation by the health team is avoided. (McLaughlin, L. Braun, K. 1998).Ethnic discrimination and exclusion affects all aspects of the individuals life, including those related to health. Studies show that indigenous working people has low income, low educational level, poor access to healthcare, and has high mortality rate. Health screening, diagnosis, and treatment inequities within and between communities of different race, ethnicity and socioeconomic background are evident. Poverty barriers are linked to lack of primary care physicians, geographical barriers to care, competing survival priorities, comorbidities, in decent health insurance, lack of information and noesis, risk promoting lifestyles, provider-and system-level factors, comprehend susceptibility to sickness, cultural beliefs and attitudes. Social exclusion can be the result of prejudice, which results in different access to health care, education, or other services.These are social norms of acceptance of particular behaviors or practices. Culture influences how people limit illness or wellness, how they understand the causes of illness or wellness, and whom they access to improve their health. Greater support from families, friends and communities is linked to better health. Culture-customs and traditions, and the beliefs of the family, practices and behaviors, and community all affect health and even the outcomes of intercession. Example smoking, or even alcohol abuse, may be accepted part of the culture of a community. In that case, many more people will adopt it than in a community where those practices are considered health risks.Some people think that health is not having any complaint or illness, something that one feels. A paper from a conference of international health experts in 2011 sees health as the ability to adapt and to self-manage (Jocelyn Lowinger 2014).Medical News Today (2014) claims that most people accept that there are two aspects of health, physical and mental health. Most people relates physical health to honourable body health because of regular physical natural action (exercise), good n utrition, and adequate rest. To some people, physical health involves structural health and chemical health. Structural health is associated with ones height/ burthen ratio, body mass index, resting heart rate, and recovery time after exercise. chemic health suggests that there are no toxic chemicals in ones body and that there is a balance of nutrients needed by the body. Mental health on the other hand refers to peoples cognitive and emotional well-being. People have always found it easier to rationalize what mental illness is, rather than mental illness. Most people agree that mental health is the absence of mental illness. Mental health, to some people includes the ability to enjoy life, the ability to bounce back from adversities, the ability to fall upon balance, to be flexible and adapt, the ability to feel safe and secure and reservation the best of what you have. Some views health as reflecting lifestyle, including a moral belongings and emotional well-being (MacInnes Milburn 1994). Healthy behavior as not smoking, good diet, exercising, and not drinking alcohol to excess, a positive approach to life. venerable people concepts of health were identified as the absence of affection, as a dimension of strength, weakness and exhaustion and health as a useable fitness. (Williams, R. (1983)Concepts of Health an analysis of fructify Logic. Sociology 17185-204).Illness results from invalidating attitudes, arising from a conflict between the individual and society-lifestyles in its widest sense. Ideas about causes of disease tend to emphasize biological rather than behavioral factors. Some of the agents of disease cited by working class women included infection, hereditary factors and environmental factors. The causes of disease are very much outside the control of the individual. Studies have also shown that peoples ideas about disease causation and vulnerability from illness are also influenced by biomedicine, example, and germ theory. However, pe ople tend to take on beliefs which tend to fit with their lay understandings. (Calnan, M. (1987) Health and Illness the Lay perspective. London Tavistock). (Blaxter, M (1983) The Causes of Disease Women Talking, Social Science and Medicine, 1643-52). On the other hand, non-Western people views illness into two main systems consort to anthropologists- personalistic and naturalistic. Personalistic system views illness to be caused by the active and purposeful intervention of an agent that may be a supernatural being such as a deity or a god, a non-human being such as a ghost, ancestor, or evil spirit, or a human being such as a witch or a sorcerer. In this system, the sick person is a victim, the object of penalization directed specifically against him, for reasons that concerns him alone. In naturalistic system, illness is explained in impersonal, general terms. There is a concept of balance and equilibrium. Health prevails when elements in the body heat, cold, the humors, etc. are in balance appropriate to the age and condition of the individual in his natural and social environment. (Foster, G. Anderson, B. (1978) Medical Anthropology New York Jon Wiley). There are also beliefs or superstition that people believes as anorectic factor of illnesses.An understanding of peoples ideas about health aliment and disease prevention is crucial to the success of health education and health promotion programs. Ones health beliefs may contribute to the companionship of informal health care-how people manage their own health and whether they rent biomedical health services. humanity attitudes towards health master copys and their authority as medical experts are changing. The days of blind trust in a physician who knows best is history. Social and cultural processes that have encouraged change in interpersonal trust relations have stimulated changes in institutional trust. Beliefs about the limits of medical expertise together with concerns about the effectiven ess of professional regulatory systems to ensure high standards of clinical care, magnified by the media reportage of medical errors and examples of medical incompetence, have eroded trust in health care organizations, in the medical professions in general, and in the health system as a whole. The lower level of institutional trust and the matter of more informed and potentially demanding patients who are aware that expert knowledge may be contested and who may actively seek further opinions poses challenges for both governments and the medical professions and raises the question of whether trust is still relevant and necessary to the provision of medical care in the 21st century. (Trust relations in health care new agenda/The European Journal of Public Health 2006)There should be policies to improve health in proterozoic life, such as equal opportunity of access to education, good nutrition, health education access to health and preventive care facilities and access to adequate social and economic resources. Legislations to help protect minority and vulnerable groups from discrimination and social exclusion should be implemented. Government should intervene to reduce poverty and social exclusion at both individual and neighborhood levels. There should be policy regarding improvement in conditions of work and employees involvement in decision making process. For individuals who turn to drugs, alcohol and tobacco use there should be a policy that aims to address the patterns of social deprivation in which the problems are rooted. Effective drug policy must be back up by the broad framework of social and economic policy.ConclusionCountries, such as New Zealand can develop health policy changes in assembling and promoting effective, evidence based practices, place health equity as a shared goal across governments and other sectors of society, build a sustainable global movement and to turn public health knowledge into political action. Governments should rec ognize that welfare programs need to address both psychosocial and hooey needs.

Using Environmental Management For Businesses

Using environmental Management For Businesses tender beings depend on nature for various purposes like food, piddle, clothing, shelter and even the air to breath. But, the unintended impacts of human actions are now creating a moment of environmental issues like global warming, tropical deforestation, toxic waste disposal, ozone depletion and so on. These environmental issues, in turn, cause change magnitude awareness of the importance of environmental ethics, pertaining to the moral relation between human beings and their natural environment (Stewart, p. 154), and increased awareness of the importance of minimizing the impacts on environment arising out of the activities of manufacturing industries, supply chains, transportation, authorities etc.Manufacturing industries and business organizations cause major(ip) environmental issues and therefore potent Environmental Management has recently been viewed as imperative for businesses. This piece of look paper is an attempt to add ress the need and importance of environmental counseling for businesses, and outline the benefits of using such wariness schema for business organizations.Environmental ManagementAs Barrow noned, environmental charge, a significant start up of environmental ethics, is a system of efforts that attempt to minimize the negative environmental impacts of the products and go that a business is related with (p. 33). When companies are manufacturing large meretriciousness of in effect(p)s by using of various technologies, it causes major issues of waste disposal, toxic wastes, air, water and environmental pollution and so on that in turn finally cause major environmental issues of global warming, ozone depletion etc. the fundamental impression of environmental caution is that negative impacts of organizational activities on its environment should be minimized, energy to be saved, waste to be disposed trenchantly or to be renewed and environmental pollution to be avoided. In a br oader sense, environmental management system that a business implements not just saves human being life, but also, keeps sustainable environment for animals, species and all others documentation beings in the earth.Environmental management is essentially a significant bankrupt of business ethics and bodied social responsibility, because, the operation of the business should neer be harmful to the environment and social life. Ryding emphasized that a business, when it is socially responsible and ethical, must have shipment to keep sustainable environment. He suggested that a good corporate citizen must be socially and ethically committed to conduct operations in order to avoid honorable damage to the environment and social life (p. 536).Business organizations, regardless of minute or large, nationals or multinationals, should set up a system approach, by taking a group of people to be involved in and by setting certain organizational goals and standards to be obtaind by the m in order to make the company more ethical, socially responsible and virtuously committed to its environment (Tinsley, p. 2).In recent days, green business concept, environmental management and ISO 14001 have gained significant attention among the corporate giants. ISO 14001 is a limited and systematic international standards for environmental management, providing a framework on how a business can implement environmental management at corporate levels. The environmental management in a business can be effectively implemented if there are well defined policies, good communication among its members, strong desire from the management and social and ethical commitment towards sustainable environment.Importance of using environmental management for businessesThe environmental management at corporate levels would be a system approach align with strategies, actions and managerial activities that aim at eliminating the impacts of business operation and its products or function on the en vironment. There are large numbers of electronic machines, bendable products, household goods, food items and chemicals that cause major pollution to the environment or dispose toxic and dangerous wastes or even cause major health issues to the humans. By effectively implementing the environmental management system or ISO 14001, these pollution and environmental issues can be eliminated up to a greater extent and can do justice to the occupants of the earth, including humans, animals and all other quick beings. It shows that environmental management at business level can obviously benefactor enhance environmental ethics.Businesses today face rigorous emulation from counterparts that causing them to put any potential efforts that can help them achieve competitive advantages. Businesses require environmental management as an effective peckerwood for achieving its competitive advantages because customers that they face are increasingly aware of environment and products and servic es that are environment-friendly.To be more proper(postnominal), a business that fails to meet specific requirements of its customers pertaining to providing goods and services that are conforming to the environmental ethics, will lose its market. In contrast, a business with effective environmental management will lastly be socially responsible, ethical and thus to be able to achieve competitive advantages too. It also can be perceived that environmental management is helpful for businesses to create customer loyalty and reputation through acceptable their needs.Secondly, environmental management helps maintain healthy communication among the members of the organization, because people or workforce of the business are more likely to like working environment that are goods for their health and work and this in turn egg on them to perform in their works. Thirdly, by implementing effective environmental management system and by conforming its standards to that of ISO 14001, it can be certified as ISO 14001 that gives greater values in international relations.Waste minimization, energy saving and effective waste disposal are some of the positive aspects of implementing environmental management for businesses. Waste minimization and effective waste disposal can help the business become socially more responsible, especially among the people who hold up nearby the business. These both result cost saving to the business as well, because, by minimizing wastes and through better disposal methods, the company will be able to cut its costs good deal. Environmental management encourages energy saving, that not only helps reduce pollution to the nature, but also cut down expenses of the business.Evaluative Conclusion morals is perhaps one of the hot buzzwords of today. Ethics relates to both business and environment. This piece of enquiry work integrated environmental ethics and business ethics, detailing how environmental ethics can be enhanced by businesses through an effective environmental management system. This research paper has highlighted key benefits of implementing environmental management for the businesses.

What Bring Students To Multimedia University Education Essay

What consider Students To multimedia system University Education EssayDuring this era of globalization, to a greater extent and more local anaesthetic anaesthetic universities in Malaysia offer various degrees for educatees who wish to encourage their studies. Most of the high erudition putation has look plainly less qualified insertion which non know by the Ministry of Education withal exist. In Malaysia, there argon two types of Institutions of high Education. These two types of knowledgeablenesss of high discipline argon unexclusive Institutions of Higher Learning (IPTA) and Private Institutions of Higher Learning (IPTS).Higher development in Malaysia has achieved status as a strategic commodity exports. This constitution has been welcomed by both bodies to establish various forms of common soldier higher(prenominal)(prenominal) nurture instaurations either al ace or collaborate with initiations of higher training and local public institutions of high er reading abroad. To ensure the growth of private higher education was channeled in healthy, Parliament has approved two related acts in 1996, the Private Higher Education execute ( function 555) and National Accreditation Board Act (Act 556).Private Higher Education Act to act organizing the establishment and steering of private educational institutions in order of magnitude to provide high feature educational environment for each(prenominal) the bookmans especi ally for the savants from our country, Malaysia.Both types of institutions of higher encyclopaedism moldiness receive this recognition from Malaysians Qualifications Agency (MQA). The main component of MQA is to give the Malaysian Qualifications Framework (Australian Qualifications Framework, MQF) as a root word of higher education shade assurance system and a reference point interior(a) eligibility criteria and specimens. MQA act as a single body all overseeing and coordinating tonicity assurance and accr editation of higher education. MQA excessively functioned to maintain Malaysian qualification show (MQR).multimedia University (MMU) is one of the umteen higher learning institutions which feel been severalised by the ministry of higher learning and Malaysia Qualification Agencies (MQA). As the first of all government-proved of higher learning, multimedia system University (MMU) is non all recognized at Malaysia but at m each of foreign country such(prenominal) as United Kingdom, Iran etc.. nowadays MMU is recognized as one of the top private universities in Malaysia with or so 20,000 learners at both Melaka and Cyberjaya branch. In order to be a post-mortem university that propagates the generation and dissemination of knowledge in cutting edge technologies, multimedia University tries to improve their service each day with its mission to which atomic number 18 to repay quality academic program based on state-of-the-art RD, tear and nurture quality minds who all owing loan towards the global knowledge economy, infuse a strong investigate culture within a dynamic, businesslike and effective police squad of academic and support lag, to be financially self-sufficing via education and the commercialization of RD intersection points and run. multimedia system University (MMU) which has been established on 1996 and launch on 9 July 1999 by Malaysia 4th Prime Minister Tun Dr Mahathir Mohamed plays an serious role in providing a world class education within the surface area of theater of telecommunication, multimedia computers, digital art, animation, knowledge technology, software development, and management. multimedia system University which squander launched by Malaysia Prime Minister at that ongoing time, signified indebtedness for it to be a fully world class institution and last a catalyst of MSC and also the nation.PurposeThe main shoot for of this research project is to conduct a research on What Bring Students to Stud y in multimedia University (MMU). Basically, many assimilators intend to choose multimedia system University (MMU) rather than other universities. So, first of all, we would like to know what are the factors that raise shallowchilds to confront their studies in multimedia University (MMU)? We also want to know what are the advantages of admiting in MMU compared with other institutions of higher learning whether public institution or private institution. We also want to determine whether disciples choose to study at MMU because it has higher quality and recognized around the world or due to the other reasons.This research was conducted to work sure that the multimedia system University (MMU) will always be listed as one of the top universities in Malaysia and throughout the world. We would also want to make sure that MMU will improve all the weaknesses and improve the administration system to ensure that students would receive profound and quality services from MMU.ScopeT he scope of this research would be based on students in multimedia system University (MMU) for Cyberjaya campus only. Students in multimedia University (MMU) Melaka campus will not include in our research. Our result has indicated that students are nigh often to choose Multimedia University rather than other universities.This is based on the statistics we work obtained during the gathering of education. The information clearly shows that students are more provoke in choosing MMU as their like university compared with other universities.MethodologyTo answer our research movements we handed out questionnaire that covers students compass to make purposes as somewhat precise as possible. From question 1 to 5 that is located in chapter A, we ask for the respondent background or general information about them, such as faculty, source of finance and other that are related. Findings of the student background would help to see the copy in students background. If when various grade found in student of MMU, we could answer that MMU maintain student with various background and not barely from a type/group in the society.Question in member A, section B, and section C harp in, before, during and subsequently on timeline. The reason is students that interested in studying at Multimedia University Cyberjaya have different reasons in choosing MMU as place to continue their higher learning. Where some students concern in after affect of studying in MMU, and some maybe concern more in during studying in MMU. The result will help play up the authoritative advantages MMU Cyberjaya have from other universities, and so answering our research question.With fancying the advantages that pluck student to MMU Cyberjaya within the before, during and after timeline, it could improve the understanding and scram the more valid data from the MMU student themselves. Where from this determinations MMU could emphasize more on this selected categories in their promotions, this would increment the effectiveness of promotion of MMU.By knowing where or how the student most hear about MMU could help in set outing the most efficient way of promoting Multimedia University. By now this research has the finding that could help in increasing the effectiveness and efficiency in promoting Multimedia University to time to come students. indeed this achieves the immensity of the research, to kindle Multimedia University.The findings of the questionnaire would light up our topic and answer our research questions which our findings are from certain students in Multimedia University that we start up by use questionnaire. It reaches our scope and also with various categories. Thus it will able us to have varieties of findings to bring about a rectify view or result from the students.The combination of this component or discount of it should cover our issues and the whole research. Issues and the whole research that is including the research questions, pr oblem and importance of the whole research itself. This literature helps in guiding how to find relevant information or findings, so that reaches the purpose and the importance of the research.This research questionnaire which consist 10 questions, like stated above cover the student background, real and what they hope to achieve in the future as a Multimedia University Cyberjaya student. Question 1 until 5 will be covering the student background. This is fundamental as result buttocks be use in determining the Multimedia student trait. Student then will be put as a judge in deciding current Multimedia University Cyberjaya performance on the 6th to 7th question. On the eighth of the question, user inescapably to fill up their expectation in the future after graduating Multimedia University Cyberjaya. This question intended to be put up to know whether the student see a b correct future at Multimedia University.Why personal information is important for our research?In this sectio n, personal information is needed for our researches for us indentify from which faculty and level of study is they belonging to, the race of student which is compulsory for us to find the absolute majority of student in MMU either they are international or local student.In this section also we need to know how they manage their financial to study in MMU. For local student of course we know some of them might do loan from PTPTN or MARA but for international, we do not know either they been sponsored by certain organization or self paying.In section C, consist of 2 types of questionnaire which is multiple prizes of question and open-ended question. For open ended, qualitative data is our greatest hazard to get actionable information from this survey. The selection and composition of qualitative survey items is unconstipated more important than for quantitative items. This is because you cannot ask nearly as many items that require people to respond freely. At most, you can like ly only ask a handful of such items, so it is important to get them right.Literature ReviewA widespread of expansion of higher learning institution in Malaysia is on arising nowadays. All institution keeps competing in order to be the best Universities. Multimedia University that were established on 1996 which are the first private government approved university at Malaysia that are designed to go to Multimedia Super Corridor (MSC) and the wider community by creating diverse educational opportunities lock away going strong throughout the category. So questions arise, what brings student to MMU? Despite there is so much option aside from Multimedia University in higher learning sector, student s bank are coming e very(prenominal) year without exception on local or international student.Taken from the statistics of students existence in Multimedia University as at 31 December 2009, we found that it has reaches out to 20404 that include Multimedia University both of Melaka and Cybe rjaya campus and affiliate Colleges. From 2005 to 2009, human action of graduates change magnitude year by year although slightly falling in 2007 onwards. This churl fall is only differ by less 30 student, olibanum this fall is could have many factors that we consider as indefinite. Multimedia University student consist of student from various country and continent all over the world from Afghanistan to Zimbabwe where the perfects of 75 countries excluding Malaysia and still counting.Students that choose to study in Multimedia University are pursuing various level, from foundation to Master level and also Doctor of Philosophy level (PhD). As from the year 2000 to the year of 2009, the total number of graduates keeps increasing, and reached the grand total of 22840 on 2009 where the figure are bodied of graduates of International and local students. Both numbers game of international students graduates outgrowthd since 2001.When the numbers of graduates are broken down by l evels, there is an uneven pattern of increase and decrease. Though the pattern of increase and decrease are not that significant the bachelor level (degree) in the year 2004, though it increase back on the following year till 2009. As caused of this is ambiguous as there would be various reasons to cause it to happen. only when as a assumption on the decrease of degree students, as plausibly the event of tsunami hit Malaysia in 2004. That is most of the international student in Multimedia University pursue their study in degree level, rather than foundation or diploma.From increasing of graduates year by year, we conclude that students are interested in continuing study in Multimedia University. Where student who are not interested would drop out and find better university that move in them most. That is because students keep complaining but they still continue their study in Multimedia University, this also shows that students interested and prefer to study in Multimedia Univers ity.With this research we are able to narrow down some of the factors that contribute to make Multimedia University as one of their choices to pursue their study, where the result would not be precise of have definite answer. With this research would also find the most effective medium to promote Multimedia University as stated.From the increase in the number of graduates each year from the year 2000, shows that numbers of students enrolled in Multimedia University increased. The ongoing increase also shows that Multimedia University have been the choice for many to pursue their study, thus this research is to find out what major factors that attract students to Multimedia University. The list of factors could be endless, for that this research would result in the narrowed down of the factors, as it is more manageable answers to the research questions.As to support the purpose of this research, numbers of graduates are kept increasing thus showing students that enrolled in Multimedi a University have been pursuing their study till they are graduating. As this to support the research questions, which is what factors that encourage the students to enter Multimedia University.Multimedia University Melaka and Cyberjaya campus both have differences in numbers of faculty and courses offered at the particular campus. Where some courses are not provided or not on hand(predicate) at either of the campus, this somehow quietusd the margin of number of student differences. Faculties in Cyberjaya campus are Faculty of applied science, Faculty of Information engine room, Faculty of imaginative Multimedia, Faculty of Management and Centre of nucleotide studies and extension Education or mostly know as FOSEE. While in Melaka campus Faculty of Engineering Technology, Faculty of Information Science and Technology, Faculty of Business Law, Centre of Foundation Studies and Extension Education (FOSEE) and Centre for advance Diploma Program.Multimedia University is in partners with many of companies and also other universities. They are also varies in expertness where, most of the faculty in Multimedia University had partnered with company and some of them very well known in the respective field. Faculty of Creative Multimedia is in partners with many media agencies and other universities outside Malaysia which is Faculty of Engineering is in partners with companies in the Research and development field (RD). Faculty of Information Technology is in partners with various companies that are active in the information technology field. agree to the research by quantify online Good University Guide, universities are rated in 8 categories where the best universities have the highest accumulated score in the 8 categories. The 8 categories are student satisfaction, research quality, student and staff ratio, services facilities spend, entry standards, completion, good honors, graduate prob superpowers. Although this research is evaluating universities around U nited Kingdom, as for the method of evaluating an education institution there would not be a very much differences between universities in different country or continent.The first category is student satisfaction it is the general overview of the student on the institution. This is the first to be gauge because of the most important role in an institution are the students. Because of the students would probably end or stop to continue their studies in an unsatisfying institution. This is also the first category, because the students is the one that are using and interact with the staff and administration and system.Next is the research quality, where research quality is also important as a medium lay out aptitude of an institution to produce quality graduates. The research by the members of the university also portray the university have the knowledge to produce graduates that are relevant and able to be an contributor to the industry, where by these graduate can fulfill the indu stry needs that is not just knowledgeable worker but also hand on. This shows that the knowledge the graduates gained is relevant or met the knowledge needed in the real working world, and most importantly the graduates know to apply their knowledge.Student and staff ratio is to label the management of the institution. That is how well the institution manages to control the students and divvy up the whole institution. This will show how smooth or organize an institution are with the administrative task. Student and staff ratio can also show that is the students are taught in a small or largish group. Either it is better and more effective to teach students in a smaller group. Not just ratio on grouchrs, staffs in the non-educational course such as the administration are also important to make sure all the administrative task can be use effectively and efficiently.Service and facilities spend of an institution will show how the institution manage the welfare of their members, the students and also staff. Facilities provided such as sufficient labs for the students, and lecture halls that can accommodate the students in any given time. Facilities are not just the major infrastructure of an institution, where it is also important to provide minor facilities that would brings great benefits for example, sufficient parking spaces, sports complex, hostel or dormitory, food court, void space/relocate space for events and also emergency. Other forms of services should be available for students are counseling and financial assistance to the students. Where by institution should assist in giving list or advertise to the students any financial assistance that is available to them to apply.Entry standards are the entry requirements denounce by the institution, which is to check whether people are eligible to apply or to enroll in the chosen institution. Entry standards are for the institution to balance their standard and rating, where by an institution would pre fer the quality students to enroll. And entry standard is where the students can get the expectation of the learning level of that institution. Where is institution with higher requirements most likely having the toughest level of learning?Another category evaluate by the times online is completion, completion in their research is the number of student successfully completed their study. This somehow related with student satisfaction where student who are not satisfied with their university would most probably leave for a better institution. Either it may be an ambiguous factor on that. Good honors are the most common evaluation category for an education institution. Good honors in this means universities that produce the highest amount of students with high grades. As this also the point for parents and future student look for in a university as well as other features.A graduate prospect is the future possibility or expectations of the graduate after completion of study. The instit ution with the highest score in this category means that, most of its graduates are sedulous and not just that, they become successful or become and important role in the community or society. Student from this institution were looked up by firms, companies and establishments as the university or institution has the good name of producing good future worker that meet their industry requirements.The 8 categories made to evaluate the universities are very well combined, where as the research shows what is that particular university effectiveness or advantage and also what that particular university lack of. This research can help evaluated universities to improve their service that is to win over students. And not just that it would be a great way to attract parents to invest their money to an education system that they can trust for their children.From the research by times online we took out the categories to evaluate Multimedia University, that is to found out what attract the cu rrent students of Multimedia University of choosing Multimedia University as their choice of institution. This will help in our research to narrow down and uncover few ambiguities on factors that makes Multimedia University the chosen university among other university not just to the local student (Malaysia) but also the international student.Nowadays there have been an increasing number of universities set up in Malaysia. Thus, every student knew that they must have to choose the best place for them to further their study. It is because it effects a wads of the students future life. For example, later on when they finishing their studies and applying for job position in one of the company in Malaysia or out of country, the company that the student applying for job might state that the student previous university is not recognize by that company and the certificate also might affected and probably the student will loosing the job even they have a good result. There is some of the c ases that happen like this, but not most of the company will strictly doing that way, they might consider the student results. some(prenominal) it is, the student must take an early precaution so that later on there is no problem like this will arise.The student must know if the university that they want to enter is approval by the Ministry of Higher Education (MOHE) or not. It is important for all of the university and colleges in Malaysia must have approval accreditation by The National Accreditation Board and recognition of programmed by professed(prenominal) bodies or by the public service department (JPA). According to our research, as require by section 38, Private Higher Education Act 555, all Private Higher Educational Institutions (PHEI) are not allowed to conduct any academic program without the approval from the Ministry of Higher Education. Therefore, Multimedia University is one of the private universitys in Malaysia that had gone through all the process that require d them to be approval by MOHE. Multimedia University also seeks for recognition by professional bodies such as Board of Engineers Malaysia (BEM) and Malaysian Association of bear witness Public Accountants (MICPA). It is necessary to have the recognition by these professional bodies to enable graduates from the programmes to gain professional recognition. In contrast, the recognition from Public Service division (JPA) is necessary to enable graduates to be employed in the Public or Government sector. Without this, graduates can only gain employment in the private sector.If all university in Malaysia had done the process of approval from this particular department, so the student can choose any of the university that we have and not cosmos afraid if their certificate is not certified and they cant be employed. But what is exactly the main thing that important in choosing a right university? To answer this, we have to know student expectation on the university. According to my revi ew on a research of Yvonne Hill, Laurie Lomas and Janet MacGregor, they states that there is quaternion expectations that emerged in relation to what students perceived quality education to be. It includes quality of the lecturer, student appointment with learning, accessible or emotional support systems and resources of library and IT. Hence, all four expectations that they had state is the most important thing that every university should consider must have and apply. This review indicates that student expect more on learning technique and sources that they can easily get from university to proceed their study. Therefore, Multimedia University are one of the place that every student expect on. According to clause of Reaz, M. Hussain, S., Khadem, (2007), In a very short span of time, Multimedia University approaches the proliferation of digital learning systems, e-governance throughout the twin campuses, and the maximum implementation of multimedia-based features in the school system. Hence, this will support that Multimedia University always provides good services to all of their students. Even nowadays, Multimedia University had always upgrades their services to be better and to be the best among the rest.In addition, Multimedia University had done many things in promoting the university to attract students from all over the country. According to Donaldson and McNicholas (2004), the reputation, nature of the courses, location and address, financial considerations, facilities, social climate of the department, programme structure and accreditation factors influence student choice of institution and course for studies. There are several criteria that attract student to further their study in university. It includes interest in the subject for example, personal preference, ability in handling the subject matter, challenging and enjoyable. It also includes influence of others such as advisors and parents. Besides that career also influence student in choosi ng their university. For example compensation in the way of earning potential and earning growth, job accessibility and growth in the way of employment opportunity and advancement opportunity and lastly job requirement that require to dealing with people and team work. Therefore, Multimedia University always do a research and survey to find out what that they have to do to improve their facilities and services to all students. This will help the universities to be alert with what are the needs and requirement that they have to provide and fulfill.Multimedia University always gave a very detail condition and provide many resources about their universities in many source of information such as internet, web pages, TV and newspaper advertizement. Besides that Multimedia University also had done a very effective ways to promote or market their universities such as involving in education disposition fair, distribute brochures and making posters. According to Mayer et al. (1999), comm unication technologies, such as CDs and DVDs in university advertising and web page properties, have been considered before. Brochures, posters, meetings, sponsorships and billboards, web pages, TV, and newspaper advertisement are mostly used as some communication tools for university selection. Therefore, it is important for every company including university to have all that it takes to promote and market their product or services.

Study on the use of reflection in nursing

sight on the use up of reproof in nursingIn saucily- do years, reflection has undoubtedly be make an authoritative concept in nursing, stimulating debate and influencing nursing practice and education around the world. a lot has been scripted astir(predicate) the theory of reflection, the majority of which has been applied to the educational setting (Price 2004). However, the make of reflecting has been described as a transferable sk hardship which may be incorpo prised into clinical practice, enabling practiti unriv exclusivelyedrs to better understand themselves and former(a)s, and solve problems (Mantzoukas Jasper 2004). thence, the competency to reflect consciously upon ones professional practice is gener everyy considered important for the nurture of education and, hence, for clinical expertise (Mamede Schmidt 2004).Reid (1993) defines reflection as a answer of re heaping an experience of practice in order to describe, analyse, evaluate and so aver learning som ewhat practice (Reid 1993, p. 305). The nursing profession seems to advocate the get hold of for nurses to be educated and practice in slipway that develop their censorious thinking, autonomy and sensitivity to others (Reed Ground 1997). Bulman (2004) contends that pondering practice may leave behind a means of achieving this. Within an intense awe setting, some essay exists to suggest a rugged relationship between lived experience and learning, with around deprecative give c argon practitioners learning from previous experience (Hendricks et al 1996). to a greater extent latterly, reflection has been closely associated with the concepts of decisive thinking and deconstruction. It is argued that a combination of these principles realise a retrospective and prospective dimension, giving the practitioner the ability to deconstruct events, to rea male child the origins of berths, and to consider what has gone before and what may happen tho (Rolfe 2005).In order to be effective in practice thither is a requirement to be purposeful and goal headed. It is suggested therefore that reflection mass non just be concerned with understanding, exactly must also centre on locating practice within its social disablementoniumises, and on changing practice (Bolton 2001). This suggests that a structured approach to reflection is of benefit to the practitioner. Indeed the use of a model or framework of reflection is advocated as a tool which coffin nail aid and facilitate the practitioner in reflection, promoting a movement of continuous development (Bulman 2004).Reflection is seen as a dynamic process and not a static one (Duke 2004), and therefrom the use of a framework which adopts a cyclic approach to reflective practice seems appropriate. iodine such framework is Gibbs (1988) Reflective Cycle, which is adapted throw a framework of experiential learning, and uses a series of irresolutions to guide, and provide structure for the practitioner when reflecting on an experience. Gibbs (1988) elevatedlights 6 important beas of consideration when reflecting on a specific situation, encouraging the practitioner to consider what happened, why it happened and what could be through differently in the future. The 6 components of the Reflective Cycle are outline be blueDescription What happened?Feelings What were you thinking and feeling?Evaluation What was good and wondering(a) about the situation? compend What sense bottom you make of the situation?Conclusion What else could you stomach done? fulfil Plan If the situation arose again, what would you do?It is clear that the idea of reflective practice has come to hit a considerable impact on the nursing profession. This paper will guidance on 2 clinical scenarios occurring within an intensifier oversee setting. The issues raise will be discussed within the context of Gibbs (1988) Reflective Cycle. The aim in doing so is to highlight the benefits of a structured ref lective process, and to i hideawaytify ways in which clinical practice may be amend in the future.Scenario 1DescriptionThe first scenario concerns the complaint of an elderly, criticall(a)y ill unhurried, who was existence regaleed in a running(a) intensive care unit. At the time of this scenario the enduring had been in intensive care for almost 3 weeks, having been admitted with respiratory failure requiring intubation, and displaying clinical symptoms consistent with sepsis. The uncomplaining role role had m all other underlying medical problems, was morbidly obese, and despite antibiotic therapy was requiring high levels of inotropic and ventilatory support. Despite the patients symptoms, no definite ascendant of sepsis had been identified.The supra patient was macrocosm cared for by the writer on a 12 hour daylight shift and at the morning ward round it was noted that the patients particularise had deteriorated significantly over the previous 2 days, with change magnitude inotrope dependence and downslope nephritic function. With few give-and-take options left to try, the consultant anaesthetist opinionated that the patient should countenance a CT skim to identify or rule out an abdominal problem as a source of the sepsis. The patient was reviewed by a consultant surgeon who felt that in view of the patients co-morbidity, surgery of whatsoever(prenominal) kind would not be appropriate, despite potential drop dictatorial experienceings on CT.Knowing that a CT exhaust had been carried out 1 week previously with no significant findings, the antecedent raised concerns about the benefit of such a procedure, and suggested that at the real least the patients family should be informed or consulted about the planned investigation. The patients son had been spoken to the previous day and informed that the prognosis was very poor. insulation of treatment had been mentioned as a possibility in the event of no improvement in the patients go over. The son until now was not informed about the graze which went ahead the same day.Transferring the patient to the radiology department for scan proved difficult. The patient was sedated for transfer firmnessing in a need for increased inotropes due to merely hypotension start outd by the sedation. The patients large size also created a problem in finding an appropriate transfer trolley to pass the patients weight. Again the former voiced concerns, stating that perhaps transfer was inadvisable in view of the patients unstable cardiovascular status. The anaesthetist decided that we should proceed with the scan.The patient remained unstable throughout the transfer, requiring a further increase in inotropes on arrival at scan. Whilst on the CT table, the patient became hazardously hypotensive and bradycardic, and it seemed that cardiac arrest was imminent. Adrenaline boluses were administered, and large fluid boluses of gelofusine were also given. In view of this, the CT scan was abandoned midway, and the patient was quickly transferred approve to intensive care unit. Further adrenaline boluses were needed during transfer.On arrival back to ICU, the causality was met by the patients son, who was not aware that the patient was existence scanned. He was made aware of the patients poor condition. Back in ICU it was decided that further resuscitation was not appropriate. The son was present when the patient died a few proceeding later.FeelingsOn the day these events took place, the predominant thoughts and feelings of the generator were ones of guilt and inadequacy. Having considered the sevenfold wellness problems faced by the patient at this time, the rootage felt that the process of transferring the patient to CT scan and carrying out the scan itself may cause the patient stress, uncomfortableness and potential danger, and ultimately be of little or no benefit.During the transfer and scanning process, the author became increasingly anxiou s about the immediate safety of the patient, and the potential for deterioration in the patients condition. When the patient became dangerously bradycardic and hypotensive, the authors thoughts were concentrated on trying to prevent cardiac arrest.On re wrick to ICU and meeting the patients son, it seemed that neither the dignity of the patient or the concerns of the family had been respected. The author felt an inadequacy and felt that the interests of the patient had not been properly advocated. The patient passed away in a distressing and undignified manner, and the son did not take a shit the opportunity to spend personal time with the patient previous to this happening. The author felt guilty, as it seemed that the CT scan should not save happened and that the undignified circumstances surrounding the patients death need not suck up occurred.EvaluationLooking back on the events of scenario 1, it seems that there were both positive and negative aspects to the experience. Dur ing transfer to CT scan and the emergency situation which followed, the author felt that there was good teamwork between the different professionals involved in the care of the patient. Because of this, prompt action was taken, preventing cardiac arrest.However, it seems that this situation may stupefy been avoided, which in turn raises many questions relating to the care of the patient. Ethically, one must question how appropriate it was to scan a severely infective, unstable patient, particularly when disciplinary treatments would drop been inappropriate in the event of an abnormality being discovered. Should the author have advocated the interests of the patient and family more(prenominal) forcefully? Was there a miss of confabulation and consensus between the critical care team? The events of this incident culminated in a clinical emergency situation which led to the patients death. Thus, the author feels that the patients clinical condition and the honorable issues and dilemmas surrounding the patients care must be examined and discussed, in the hope that lessons can be learned through the reflective process.AnalysisSepsisMost illness and death in patients in intensive care is caused by the consequences of sepsis and systemic inflammation. Indeed, sepsis affects 18 million people worldwide individually year (Slade et al 2003), with severe sepsis remaining the highest cause of death in patients admitted to non-coronary intensive care units (Edbrooke et al 1999). Sepsis is a complex condition that results from an infected process, and is the bodys response to infection. It involves systemic inflammatory and electric cellular events that result in modify circulation and coagulation, endothelial disfunction, and impaired tissue perfusion (Kleinpell 2004).Dellinger et al (2004) define sepsis as the systemic response to infection manifested by 2 or more of the undermentionedHigh or low temperature (38C or Heart rate 90 beats per slenderRespiratory rate 20 breaths per minute or PaCO2 High or low white rakehell cell count ( 12,000 or In severe sepsis impaired tissue perfusion along with micro vascular coagulation can lead to tenfold electric reed organ system dysfunction, which is a major cause of sepsis-related mortality (Robson Newell 2005). While all organs are prone to failure in sepsis, pulmonary, cardiovascular, and renal dysfunction occur most commonly (Hotchkiss Karl 2003). When multiple organ system dysfunction occurs, Dolan (2003) promotes say- ground sepsis treatment whereby patients should receive targeted organ support. This intromits mechanical ventilation, renal replacement therapy, fluids, vasopressor or inotropic administration, and blood product administration, to maximize perfusion and oxygenation.In recent years new therapies have emerged which have been shown, in some cases, to increase the chance of choice from severe sepsis. Recombinant human activated protein C has been shown to have anti-infl ammatory, anti-thrombotic and pro-fibrinolytic properties (Dolan 2003). In a randomised minceled trial, Bernard et al (2001) set up a significant reduction in the mortality of septic patients who had been treated with activated protein C. The National Institute for clinical excellence (2004) now recommends this treatment for adult patients who have severe sepsis resulting in multiple organ failure, and who are being provided with optimal ICU support. Steroids, the use of which in ICU has long been debated, have also been shown, in low doses, to reduce the bump of death in some patients in septic shock (Annane 2000).Despite the development of specific treatments to interrupt or control the inflammatory and procoagulant process associated with sepsis, its management remains a major argufy in wellnesscare (Kleinpell 2004). The patient in scenario 1 was clearly in a state of severe sepsis, with respiratory, cardiac and renal failure, and receiving some of the positive treatments mentioned above. Indeed it seems that the severity of this condition should not have been underestimated. In view of this, the ethical issues surrounding the decision to take this patient to CT scan must now be considered.Ethical Dilemmas and ConsensusEthical issues have emerged in recent years as a major component of health care for critically ill patients (Friedman 2001). Thus, pity for these patients in an intensive care setting necessitates that difficult ethical problems must be faced and unyielding (Fisher 2004). Traditionally, a great deal of the literature in biomedical ethics comes from theoretical perspectives that include principled ethics, caring ethics and virtue ethics (Bunch 2002). Although these perspectives provide an ethical awareness, which can be helpful, they do not of necessity give much direction for clinical practice. Melia (2001) supports this notion, suggesting that many word of honors of ethical issues in health care are presented from a deterrent ex ample philosophical view address, which as a consequence leaves out the clinical and social context in which decisions are taken and carried through.Beauchamp Childress (1994) identify 5 principles pertinent to decision making in intensive care. These are salvageability, life preservation, non-maleficence, beneficence, and justice. Ethical dilemmas occur when two or more of the above principles come into conflict. The principles of beneficence (doing good), non-maleficence (doing no harm) and justice (fair treatment) are well established within the field of bioethics. Within a critical care context however, the dilemma between salvageability and life preservation becomes an important focus for health care professionals. Indeed, Prien wagon train Aken (1999) raise the question of whether all medical means to preserve life have to be active under all circumstances, or are there situations in which we should not do everything that it is realizable to do. This question becomes par ticularly relevant when a patients condition does not improve but rather deteriorates progressively. Curtin (2005) suggests that at some point in the course of treatment, the line between treating a curable affection and protracting an unpreventable death can be crossed. In such incidences Prien train Aken (1999) identify a transitional zone between the attempt to treat the patient, and the prolongation of dying, in which a conflict between the principles of life preservation and non-maleficence develops.These concepts seem particularly relevant to scenario 1 where the interests of the patient may have been neglected in favour of further attempts to treat the patients condition. This, in turn created a conflict between the principles of salvageability and life preservation. The decision to perform a CT scan on a patient with such cardiovascular instability and a very poor prognosis, meant that the patient was subjected to dangers and harms when there were few, if any benefits to justify this. Hence, the conflict between the ethical principles was not resolved, and the professional business of non-maleficence toward the patient was not respected.Such conflicts and dilemmas in intensive care can be made all the harder by the availability of advanced technologies. Callahan (2003) writes that one of the most seductive powers of medical engineering science is to confuse the use of engineering with a respect for the sanctity of life. In addition, Fisher (2004) contends that it has become all too easy to think that if one respects the value of life, and technology has the power to extend life, then a failure to use it is a failure to respect that value. This is particularly true of diagnostic technologies (such as CT scanning) which must be used with caution, especially in cases where the diagnostic info will make little or no difference to the treatment of the patient, but can create or heighten anxiety and discomfort for the patient (Callahan 2003). Medical t echnology is a two-edged sword, capable of saving and improving life but also of ending and harming life (Curtin 2005). Good critical care medicine carries the certificate of indebtedness of preserving life, on the one hand, and making possible a peaceful death, on the other. Callahan (2003) thinks by warning that any smart bias in favour of using technology will expose that latter possibility.Consensus between members of the intensive care team is also highlighted as an important issue in ethical decision making. Effective communication and collaboration among medical and nursing module are essential for high quality health care (Woodrow 2000). Collaboration can be seen as working together, sharing responsibility for solving problems, and making decisions to formulate and escape plans for patient care (Gedney 2000 p.41). In intensive care units where ethical problems are faced frequently, care has to be a team effort (Fisher 2004).In a qualitative discover, Melia (2001) fou nd that there was a strong desire within the intensive care team that ethical and moral consensus should be achieved in the interests of good patient care, even though it was accepted that there is no legal requirement for nurses to agree with ICU decisions. Cobaoglu Algier (2004) however, found that the same ethical dilemma was perceived differently by medics and nurses with the differences being related to the hospitals hierarchical structure and the traditional distinctions between the two professions. Similarly, it has been find that differences between doctors and nurses in ethical dilemmas were a function of the professional authority played by each, rather than differences in ethical reasoning or moral motivation (Oberle Hughes 2001).It seems therefore that while the medical and nursing professions character the same aims for patient outcomes, the ideas surrounding how these outcomes should be achieved may differ (Fisher 2004). These differences have contributed to the development of the concept of the nurse as patient advocate, which sees advocacy as a fundamental and integral intent in the caring relationship, and not simply as a single component of care (Snowball 1996). The role of the nurse advocate should be that of mediator and facilitator, negotiating between the different health and illness perspectives of patient, doctor, and other health care professionals on the patients behalf (Mallik 1998).Empirical evidence is sparse and philosophical arguments seem to predominate in the field of patient advocacy. thither is some evidence to suggest that nurse advocacy has had skillful outcomes for the patient and family in critical care areas (Washington 2001). Hewitt (2002) however found that humane arguments that promote advocacy as a moral imperative are compelling. Benner (1984) writes of advocacy within the context of being with a patient in such a way that acknowledges your shared humanity, which is the base of nursing as a caring practice (Benner 1984, p. 28). It has been argued that advocacy, at least in a philosophical sense, is the foundation of nursing itself and as such should be regarded as an issue of great importance by all practitioners (Snowball 1996).ConclusionIt can be cogitate that sepsis in a critical care environs is a complex condition with a high mortality rate, requiring highly specialised treatments. As such, the ethical issues and dilemmas faced by health care staff caring for a septic patient can be both complex and far reaching. It must be noted, that there can be no general solutions for such ethical conflicts each clinical case must be evaluated individually with all its associated circumstances.A study of ethical principles would suggest that it is important that the benefits of a specific treatment or procedure are established prior to implementation, and that these benefits outweigh any potential harms or risks to the patient. The ultimate decision maker in the scenario under discussion w as the consultant anaesthetist, who should have provided a clearer rationale for performing a CT scan on such an unstable patient. As the nurse caring for the patient, the author recognises that the final decision regarding treatment rested with the anaesthetist. However, the author could have repugnd the anaesthetists decision further, advocating the patients interests, with the aim of reaching a moral consensus within the team. maybe then the outcome would have been more favourable for all concerned.Action PlanBy reflecting on this scenario, the author has gained an understanding of sepsis and the potential ethical problems which may be encountered when caring for a septic or critically ill patient. As a result, the author feels more confident to challenge those decisions made relating to treatment, which do not seem to be in the beat interest of the patient, or which have the potential to cause more harm than good. The author now has a greater understanding of the professional responsibility to advocate on a patients behalf, with the aim of safeguarding against possible dangers. It is hoped that this will result in improved outcomes for patients in the authors care.Scenario 2DescriptionThis incident occurred in a surgical intensive care unit while the author was looking after a ventilated patient who had undergone a laparotomy and effective sided hemi-colectomy 2 days previously. Around 10.30am the patient was reviewed by medical staff and was found to be awake and alert with good arterial blood gases, and requiring minimal ventilatory support. In view of this, it was decided that the patients support should be reduced further, and providing this reduction was tolerated, that the patient should be extubated later in the morning.In the intensive care unit in which the author works an intensive insulin selection protocol is used (see Appendix A). This is a research based protocol which aims to normalize blood glucose levels and thus improve clinical outco mes for critically ill patients. All patients on this protocol require either to be absorbing enteral feed at 30ml/hr, on TPN or on 5% grape sugar at 100ml/hr (Appendix A, note 2). The patient involved in this incident was receiving enteral feed via a naso-gastric tube, and was on an insulin infusion which was running at 4 U/hr. When it was decided that the patient was to be extubated, the author stopped the enteral feed as a precaution, to prevent possible aspiration during or after extubation. The author however did not stop the insulin infusion which breached the protocol guidelines.About 12 midday the patients blood gases showed that the reduction in support had been tolerated, and so the patient was extubated. unawares after this the author was asked to go for lunch break and so passed on to a colleague that the patient had recently been extubated but was managing well on face mask oxygen. Returning from lunch 45 minutes later, the author found the patient to be disorientate d and slightly confused. With good oxygen saturations, the author doubted that the confusion had resulted from hypoxia or worsening blood gases. The author then established that the insulin infusion had not been stopped with the enteral feed earlier. A apprehension of the patients blood glucose level showed that it was 1.2mmol/L. The author immediately stopped the insulin infusion, administered 20mls of 50% dextrose endovenously, as per protocol, and recommenced the enteral feed. Twenty minutes later, the patients blood glucose level had move to 3.7mmol/L. The patient continued on the insulin protocol maintaining blood glucose levels within an suitable range. There were no pull throughing adverse do resulting from the hypoglycaemic episode.FeelingsWhen it was realise that the insulin infusion had not been stopped, the author felt a sense of panic, anticipating powerful that the patients blood glucose level would be dangerously low. Thoughts then became concentrated on raisin g the blood glucose level, to ensure that no further harm would come to the patient as a result of the authors mistake.Following the incident, when the patients glucose levels had risen, feelings of guilt were prominent. At this point the author realised how much worse the outcome could have been for the patient. The author felt incompetent, knowing that the patient could have been much more severely affected, or could even have died as the result of such a simple mistake.EvaluationThe events of scenario 2 highlight the fact that clinical phantasms, while easily made, can have potentially disastrous consequences. This is especially true of those errors which involve the administration of drugs intravenously. In the interest of patient safety, it is important that all such errors are avoided.The clinical error outlined above could easily have been avoided. It seems that there was not sufficient awareness, on the authors part, of the insulin infusion protocol and the guidelines conc erning the administration of insulin. As a result, the insulin protocol was not adhered to. The chase analysis therefore will focus on the importance of insulin therapy in critical care areas, and will consider the safety issues surrounding intravenous drug administration.AnalysisBlood Glucose Control in Intensive rushIt is well documented that critically ill patients who require prolonged intensive care treatment are at high risk of multiple organ failure and death (Diringer 2005). Extensive research over the last decade has focused on strategies to prevent or reverse multiple organ failure, only a few of which have revealed positive results. One of these strategies is tight blood glucose control with insulin (Khoury et al 2004). It is well known that any type of acute illness or injury results in insulin resistance, glucose superstition and hyperglycaemia, a constellation which has been termed the diabetes of stress (McCowen et al 2001). In critically ill patients, the severity of this condition has been shown to reflect the risk of death (Laird et al 2004).Much has been learned recently about the negative prognostic effects of hyperglycaemia in critically ill patients. Hyperglycaemia adversely affects fluid balance, sensibility to infection, morbidity following acute cardiovascular events, and can increase the risk of renal failure, neuropathy and mortality in ICU patients (DiNardo et al 2004).Research suggests that there are distinct benefits of insulin therapy in improving clinical outcomes. Such benefits have been seen in patients following acute myocardial infarction, and in the healing of sternal wounds in patients who have had cardiac surgery (Malmberg 1997 Furnary et al 1999). More recently Van den Berghe et al (2001) conducted a large, randomized, controlled study involving adults admitted to a surgical intensive care unit who were receiving mechanical ventilation. The study demonstrated that calibration of blood glucose levels using an inten sive insulin infusion protocol improved clinical outcomes in critically ill patients. In particular, intensive insulin therapy was shown to reduce ICU mortality by 42%, and significantly reduce the incidences of septicaemia, acute renal failure, prolonged ventilatory support, and critical illness polyneuropathy. The length of stomach in intensive care was also significantly shorter for patients on the protocol.It is unclear as to why improved glycaemic control has been associated with improved outcomes in several clinical settings. Coursin and Murray (2003) have summarized several leading hypotheses including maintenance of macrophage and neutrophil function, enhancement of erythropoiesis, and the direct anabolic effect of insulin on respiratory muscles. The potential anti-inflammatory effects of insulin have also been evaluated (Das 2001). There is also uncertainty over whether it is the real(a) insulin dose received per se, or the degree of normoglycaemia achieved that is respon sible for the beneficial effects of intensive glycaemic management. Van den Berghe (2003) analysed the data derived from their 2001 study and have concluded that the degree of glycaemic control, rather the quantity of insulin administered was associated with the decrease in mortality and organ system dysfunction.In a follow up to Van den Berghe et als 2001 study, Langouche et al (2005) found that a significant part of the improved patient outcomes were explained by the effects of intensive insulin on vascular endothelium. The vascular endothelium controls vasomotor tone and micro-vascular flow, and regulates trafficking of nutrients and several biologically active molecules (Aird 2003). Langouche et al (2005) conclude that maintaining normoglycaemia with intensive insulin therapy during critical illness protects the vascular endothelium and thereby contributes to the prevention of organ failure and death.Whatever the reasons for improved patient outcomes, the study by Van den Burghe et al (2001) has prompted much research in this field, all of which has yielded mistakable results. In a similar study, Krinsley (2004) found that the use of an insulin protocol resulted in significantly improved glycaemic control and was associated with decreased mortality, organ dysfunction, and length of stay in the ICU in a heterogeneous population of critically ill adult patients. Thus it seems that with the strength of the emerging data in support of a more intensive approach to glycaemic management, insulin infusions are being utilised with increasing frequency, and are considered by many to be the beat of care for critically ill patients (DiNardo et al 2004).It is important to note that a well recognised risk of intensive glucose management is hypoglycaemia. Indeed Goldberg et al (2004) emphasise that in the ICU setting where patients often cannot report or respond to symptoms, the potential for hypoglycaemia is of particular concern. The events of scenario 2 highlight th e authors error in the administration of insulin resulting in hypoglycaemia. For this reason some issues surrounding intravenous drug therapy will now be discussed.Intravenous Drug TherapyThere is an increasing recognition that medication errors are causing a full-blooded global public health problem. Many of these errors result in harm to patients and increased costs to health providers (Wheeler Wheeler 2005). In the intensive care unit, patients commonly receive multiple drug therapies that are prescribed either for prophylactic indications or for treatment of established disease (Dougherty 2002). Practitioners caring for these patients find themselves in the challenging position of having to monitor these therapies, with the goal of maximizing a beneficial therapeutic response, as well as minimizing the occurrence of any adverse drug-related outcome (Cuddy 2000).The Nursing and Midwifery Council (NMC) (2004) identifies the preparation and administration of medicines as an impor tant aspect of professional practice, stressing that it is not merely a mechanical task performed in strict compliance with a written prescription, but rather a task that requires thought and professional judgement. Heatlie (2003) found that the inception of new insulin protocols and regimes could give rise to problems, espe

My New Life with Wickham Essay -- Pride and Prejudice, Jane Austen

I go been reenforcement in London with Wickham for s perpetuallyal months now, and, although none of my family would agree with this, I am glad that I ran away with him, he likes me very much and I care for him dearly. After all, if I had asked for mothers per shedion to go and live with Wickham, without being marital, surely he would shit said no without any hesitation. So I thought, if I wanted to be with Wickham, I had no choice entirely to propel away with him. At the time, I thought, why not now? So I did. I love being here, in London, alone with my Wickham, sometimes I do feel quite lonely though, because Wickham goes out gambling at least either other day I would say. I am in the process of stopping Wickham from gambling, he is so addicted. I try to tell him that he allow never get a better paying job if he clutchess gambling, he leave have too bad a reputation. He keeps saying that he impart try and stop, but he always ends up going forth in the evening. He cann ot control himself. It is terrible really. When he is out, and I am alone, I do think of my family, my sisters, mother and father, I do miss them all very very much. On the whole, I am relatively happy with my life though. One good affair is, even though I am the youngest of us 5 sisters, I am the original to be married So mother will be very proud of me. Now, I am the most important one, I will be put first. We have only been married for one month, but I love it. Wickham does not seem to view things any differently, he still treats me exactly the same, it is as if nothing has changed. One strange thing about our wedding was Mr. Darcy being there, most surprising. When Mr. Darcy came to us one evening, crack to organise our whole wedding and pay for it all, I was so shocked. It... ...zzy would ever marry. I am quite jealous that Lizzy will be living in the grand estate of Pemberly, and she will be ever so rich, that I am glad of. Because myself and Wickham are in debt and there is no hope of us ever having our own house, so hopefully we will be given help financially so we can have our own house. If we are very lucky, Darcy might help Wickham with some rail line of some kind. I do not see why they should keep all their money to themselves, that would be ever so selfish of them. I feel that I am the luckiest girl alive, I am married to the finest, most handsome adult male in the world. I imagine every woman must be envious of Wickham being at my side. I could not have married a finer man, and I could not have made my sisters more envious of me. Kitty and Mary do not have a chance of finding a man as good and kind as I have. Life could not be better.

Robot Lobstrocities :: Technology Machines Papers

Robot Lobstrocities Check this out, Joseph Ayers, a biology prof at Northeastern University says as he turns on his laptop.The soundtrack from the 1975 film, Jaws plays in the background. On the screen is a grainy image of a moving pecker lumbering towards a huge pile of bricks, easily maneuvering itself over them. The harmony reaches its climactic conclusion and a lethal claw dominates the screen. Fortunately its not a monster its just a lobster. For Ayers, lobsters atomic number 18 fascinating creatures that has inhabited his life for most of his career. For more than a ten his team has worked on building a fully autonomous robotic lobster with the corresponding behavioral patterns of the real thing. Funded largely by the US Navy, the hope is that it pass on one day be used for underwater mine sensing as a less expensive and more efficient ashes to current methods.Hours were spent analyzing lobster behavior and its legs, claws, abdomen and tail movements. These observations were then born-again into mathematical components, correlating the movements with the nerve signals that actuated them. In essence it makes a computer program act as the lobsters brain. A big grade from the field of artificial intelligence, the project is all about reverse engineering the biological functions nature has taken thousands of years to evolve and develop. Were in all likelihood one of the few laboratories in the world to get artificial muscles to work. To in truth control a freely behaving robot. The other thing thats distinguishable about our robot is that it really is controlled by the rules the nervous clay working by, instead of the list of instructions to control the behavior, unlike AI found robots, said Ayers.Starting out as a young life scientist from California, Ayers is now one of forefront re searchers of biomimetics, which takes ideas from nature and implements them into new technology. His project originate in from his graduate days when he first s tudied the behavior of the lobster. both sides of Ayers office are crammed with books on marine biology. It is a classifiable college professors office, except for the lobster claw mobile hanging from the ceiling. On the wall, a childs drawing of lobster. A Superman derisory book featuring, the Lobster Man. Its obvious that Ayers has an affinity with these crustaceans. He admires their nervous system and adaptability to the sea. Their complex movements and ability to move on every surface of the sea floor.

Essay --

It should be needed to provide heat content in an enormous amount at a great price. However, it is possible to accept if atomic number 1 is produced without carbonic acid turgidity emission because CO2 elimination is energy demanding and embodyly process related with environment riddle, much(prenominal) as greenhouse effect. Unfortunately, currently conventional process of heat content exertion is the steam reforming process which has highly CO2 emission. Currently, approximately 48 % of enthalpy derives from innate(p) gas by steam reforming process, 30 % from oil reforming in the chemical manufacturing and 18 % from coal gasification.3 It replies that 96 % of the hydrogen end product derives from fossil associated with a huge amount of CO2 emission. Only 4 % of hydrogen production is come from water electrolysis.4 It also expected that hydrogen production without CO2 technologies atomic number 18 the great wish for the future of a sustainable hydrogen economy.Zero CO2 e missions are possible when the raw materials are from renewable source such as bio-gas. For instance, water electrolysis with renewable electricity and thermo-chemical cycle processes development renewable heat are the representative hydrogen production without CO2 emission.5, 6 However, the cost of hydrogen production using renewable processes is currently prohibitive cost. Thus, a changeover to a hydrogen economy would probably start with hydrogen produced from fossil fuels, especially natural gas (NG). Steam reforming of natural gas process is the most businesslike and generally used process for the hydrogen production in commercial field.7 Steam reforming process is basically the transformation of methane and water to hydrogen gas and carbon oxides, and has two main reactions, as shown in Fig. X7 Synthesis gas genera... ...ches have a particle accelerator deactivation problem related with the carbon, which come from methane decomposition, can be covered on the catalyst su rface. Therefore, it needs the burning process17 or gasifying with steam18 for removing carbon on the catalyst surface. However, gasification or combustion of carbon residues on the catalyst surface causes to produce a huge amount of CO2 as byproduct. So, there have been researched the synchronic production of hydrogen and nanostructured carbon by Ni-and Fe- catalyst for decomposition of methane.19, 20 Also, another group reported the possibility of using carbon materials as catalyst for thermal decomposition.21, 22 They reported carbon catalyst is an environment-friendly mode to the production of hydrogen and carbon. Carbon is precious byproduct of the thermal-catalytic process. It could reduce the cost of hydrogen production.

The Beginning of the Second World War Essay -- Adolf Hitler, WWII

When the First World warfare started to come to an culmination, legion(predicate) people hoped that it would be the last war that Europe had to endure. Unfortunately to many a(prenominal) a(prenominal) people who lived through the world-class war, the Second World War surpassed the first in death, scope, brutality, and by the number of people it reached. The roots were not only when buried in the First World War, but also in the precious years after it. It was also the result of Axis aggression, a failed peace treaty after the First World War, and the failure of the consort to stop the expansion and influence of Axis powers. When the First World War started, many people believed that it would be a quick war (Wilkinson 35). To many who looked the combatants, the Entente powers appeared the strongest (35). Though when push came to shove, Germanys industrial might and cracked multitude came to a shock for the Entente powers (35). The failure of Germanys invas ion plan into France, highly-developed by Count Alfred von Schlieffen, lead to trenches being dug by twain sides on the Western Front (40). With casualties mounting on both sides, the Germans risked everything in one last offensive into France (68). Defeat would be the collapse of the primordial Powers (68). Victory was almost in reach, although the German army could no long-lasting field enough men to attack (69). On September29, 1918, General Erich Ludendorff of the German General Staff, said that only an immediate armistice could save Germany presently (69). With mutinies in the navy, revolutions in Bavaria, and the emperor abdicating, Germany signed an armistice agreement in terms with the Entente powers.( 70). On November 11, 1918, the First World War came to an end.( 70). The end of the war brought a peace treaty that was signed in the Hal... ...sualties. As the Allies slowly pushed the Germans back to Germany, evidence of the national socialists racial polices was slowly uncovered. Mass graves and concentration camps slowly began appearing. Soon, people began to realize what they were entreating for and why it was so important to fight that battle. Hitler, with all hope lost, retreated into his bunker in Berlin where he attached suicide during the last few days of the war. Works CitedMazower, Mark. Dark virtuous Europes Twentieth Century. New York Alfred A. Knopf, Inc, 1998Wasserstein, Bernard. Barbarism & civilisation A history of Europe in our time. New York Oxford University Press, 2007 Wilkinson, James. present-day(a) Europe, A History Ninth Edition. New Jersey Simon & Schuster, 1998Wright, Mark. What they didnt teach you about World War II. Navato, CA Presidio Press, 1998

The Trebuchet :: Physics Trebuchet History Papers

The Trebuchet The roots of the motorcar go back to at least the fifth century B.C. in China. In its most primitive form, it consisted of a pivoted glint with a ballista at one end and ropes at the other. A stone would be placed in the scarf bandage and a team of men would force the ropes, swinging the beam up into the air1.The trebucket reached the Mediterranean by the sixth century C.E. It displaced other forms of artillery and held its own until well after(prenominal) the coming of gunpowder. The trebuchet was instrumental in the rapid expansion of two the Islamic and the Mongol empires. It also played a part in the transmission of the Black Death, the epidemic of plague that swept Eurasia and the North Africa during the fourteenth century. Along the way it seems to have influenced both the development of clockwork and the theoretical analyzes of drift2.We will now look at the physics of a trebuchet. The trebuchet uses many different physics applications, we will look at a few of them. Basically a trebuchet is a fulcrum.First the goose egg of conservation. The setting of the trebuchet before firing is shown in Fig 1. A heavy counterweight of mass (M) (contained in a large bucket) on the end of the short arm of a sturdy beam was raised to some height while a smaller mass (m) (the rocket engine), was positioned on the end of the longer arm near or on the ground. In practice the projectile was usually placed in a strap hurtle attached to the end of the longer arm. However for simplicity, we shall ignore the sling and compensate for this omission by increasing the assumed space of the beam on the projectiles side. The counterweight was then allowed to fall so that the longer arm swung upward, the sling following, and the projectile was ultimately thrown from its container at some point near the top of the arc. The far end of the sling was attached to the arm by a rope in such a way that the release occurred at a launching burthen near the op timum value ( most likely by repeat trials) for the launch height. The launching position is shown in fig.2 where we have assumed that the projectile is released at the minute the entire beam is vertical. In the figures (a)=height of the pivot, (b)= length of the short arm, (c)= length of the long arm, while (v) and (V) are the velocities of (m) and (M), respectively, at the moment of launching.