Teen angst monologue Essay Example for Free

Teen angst monologue EssayI dont get it, why is it when you become a adolescent everything gets so complicated and baffling? I mean, why are we sibylline to know how to wear make up, get on diets, wear tight clothing, entertain our calorie intake and the list goes on and on and on. Is at that place some unwritten law that when you become a teenager you move into the realm of alienation? Well its as if Im on one crazy roller coaster ride thats taking forever to end. Think about it Youre supposed to party in enounce to be cool, listen to songs with lyrics fill up with one word repeated over and over again like the baby baby baby song and whats with Kesha, no one wakes up in the morning and feel like p diddy and you definitely dont brush your teeth with some jack daniels. Hold on, jack daniels is a person right? Huh? (break) Hang on let me google it.Oh jack daniels is brand of some hard liquor. How can you feel like a g6? Ugh and things dont stop there, Im supposed to wash my face BEFORE I exercise to prevent build-up. No, Im supposed to wash my face AFTER I exercise to prevent break-outs. Im NOT mantic to eat coffee tree because it causes pimples. Wait, Im SUPPOSED to eat chocolate before I take a test, because its great, brain food. Scratch that, I guess dark chocolate is an exception. Then again, Im SUPPOSED to have lots of foods hat are rich in iron to help my circulation. Hold on, now, Im NOT SUPPOSED to have a lot of iron because it prevents my body from absorbing calcium properly.When Im at schooling I feel like Im in dire need of more vacations scarcely by the time the school gives out one long summer vacation it feels like I cant wait to get back to school even with the reason of only pauperisming to go meet my friends. I love my parents but there are times when I just want to avoid them and lock myself inside my room for days. The dillemas that I face on a daily basis like what outfits to wear, yesterday it looked as if my closet was filled with clothes but today when I tried to find the right outfit, my closet looked emptyThere was that one quote that says the hardest part about cosmos a teenager is dealing with other teenagers the criticism and the ridicule, the gossip and rumors. That quote is so true because backstabbers are everywhere but if there werent any backstabbers indeed I wouldnt know who my real friends are. And real friends are really hard to find, its like a finding a needle inside a haystack. Boys boys boys, what else is there to say? Phewww how did we all deal with heartaches and heartbreaks? People avoid you for being too innocent and so that means theyre more attracted to dirtiness? Ew why is the orbit so upside down? Wow, if I can survive being a confused teenager I think I can attractive much survive anything

Enron Corporation Essay Example for Free

Enron Corporation EssayI The BeginningWhen Enron Corporation declared a Chapter 11 bankruptcy in December 2001, it left the public especially its investors and stockholders reeling from such monetary s hindquartersdal and collapse. Enron had allegedly overstated its profits by $586 million since 1997 in vagabond to protect the firms balance sheet and practice sessiond insider barter as tumesce snake oil and conspiracy.Enron had been the seventh largest family in the unify States and had been one of the largest financial contributors to the Presidential elections, especially the Bush family. To the outside world, Enron portrayed a picture of success. However, upon closure inspection on the inside, Enron was on the brink of collapse.When Enrons stock footing hit its highest at $90, the executives who allegedly knew of the offshore accounts of Enron started selling their respective shares and to encouraged the public to continue buying the said stocks. However, the execut ives knew that the stock prices would non increase anymore but still reassured the public and its investors that the prices of stock would reach a high $130-140 per share. By August 2001, Enrons stock prices had dropped from $90 to a measly $42. It became evident that the gild had fraudulently induced and fooled the public, investors and stockholders to buying the companys stocks and shares.Amidst all these, Enron founder and former chairman Kenneth point move to reassure the public to remain calm, and asked the investors to buy the companys shares as the company will regain its profits in the succeeding months. Nonetheless, in October of 2001, the stocks plunged to $15 but the investors saw this as an opportunity to buy Enron stocks at such low prices. But the truth almost the companys financial rest became public and the stock price finally hit rock bottom at $1 per share.II Basis of the ChargesStockholders and investors gathered and instituted a class-action suit against En ron and its officers in order to recover the millions of investment they made on Enron as result of the treacherously representation and fraud by the company. Enron top executives specifically its Chief administrator Officers, Kenneth Lay and Jeffrey Skilling were charged and convicted with the collapse of the might giant. Kenneth Lay faced seven counts of fraud and conspiracy while Skilling faced 31 counts of fraud, conspiracy, insider traffic and lying to auditors about Enrons financial position.In 1987, Enron auditors found out a billion-dollar oil trading scandal in its New York offices. Traders had been act in this kind of practice falsifying transactions in order to boost their volume and profit thereby fattening their bonuses as well. Although CEO Kenneth Lay knew of this, he did not perk up the traders nor contacted the authorities in order to cover up their problems. But this incident did not deter the traders and six months later, competitors began to grow suspiciou s because if word got out, Enrons trading sectionalizationners could have demanded that the company cover its positions with cash, which the company did not have (Fowler). Thus, the traders were fired and charged but not until they were capable to transfer million of dollars into their personal accounts. Enron for its part was able to get away by bluffing the securities industry and reported $85 million in loss but sources claim that the loss totalled to at least(prenominal) $135 million.CEO Jeffrey Skilling, who joined Enron in 1990, did not care much about the expenses incurred by the company as long as the margins looked good. He was overly more concerned with the receiptss increases and widening profit margins instead of the cash flows which was practiced by his predecessor. So enamoured were the top executives in increasing business profit that when a deal failed or fell apart, more effort was placed into hiding the consequences instead of rectifying and owning up to the p roblem. After taking over as captain direct officer, he renewed the almost non-existent post of chief financial officer and delegated many of the management responsibilities.In theory, Enron had mechanisms that would assess risk and accurately report financial numbers. These mechanisms required that deals should be strictly analyzed which included review by the legal department of the originating unit, the corporate legal department, chief risk officer and chief accounting officer. However, callable to the insidious practice of the company, auditors and accountants were bullied to over ride the system and departments were able to determine the total value of their proposals by manipulating the long-term price of any(prenominal) product was sold or bought. The company also used a mark-to-market accounting system pushed by Skilling which allows a company to report as electric current revenue the total value of a deal over its projected lifetime (Fowler). This system made earning a ppear good which in turn manage up the stock prices and increased the value of stocks which executives received as bonuses.III TrialAs the stunned investors witnessed Enrons stock prices plunged, the government began a commodious crackdown on the executives who were responsible for the collapse of the company, and would end up in the conclusion of convincing and proving to the jury that Lay and Skilling, the two top executives of the company, where guilty of massive fraud and were thus guilty.Government prosecutors were at first overwhelmed with the girth of the corporate fraud. Nevertheless, they began to take measures to respond to these kinds of crimes and a barrage of felon and civil investigations and prosecutions began to surface. Thus, in 2002, the Presidential incarnate Fraud Task Force filed criminal charges against more than 900 defendants, of which 60 are chief executive or president level and success richly prosecuted or convicted five hundred of them.The case again st Lay and Skilling were heard by US District Judge Sim Lake and lasted nearly four months while the jury deliberated for six days. The defense counsel initially attempted to persuade the judge to move the trial away from Houston, Enrons hometown as they were afraid that the jury might be influenced by anger due to the resulting loss of jobs and money and would see them as a way of revenge.Kenneth Lay faced seven counts of fraud and conspiracy fraud and conspiracy while Skilling on the other hand, faced 31 counts of fraud, conspiracy, insider trading and lying to auditors about Enrons financial position. Although both asserted their innocence of the charges against them, they were convicted for a total of 29 criminal counts as well as conspiracy to hide the failing health of the company by selling boosterich optimism to Wall Street and the public (MSNBC).Lay, who was convicted to 6 counts of conspiracy, securities and cable fraud in the corporate trial and 4 counts on separate pers onal banking trial, surrendered his passport and posted a $5 million bond secured by the family. His sentence also carried a maximum penalty of 45 years in prison for the corporate trial while 120 years in personal trial respectively. Skilling on the other hand, was convicted by 19 counts out of the 28 charged as well as one count of insider trading while being acquitted with the remaining charges.The charges against these Enron top executives prospered as other executives turned the table and plead guilty in their respective charges in order to receive lower sentences than that prescribed. Among the former employees who testified against Lay and Skilling was Ben Glisan who is now serving a 5-year prison sentence subsequently pleading guilty to a charge of conspiracy. fit to Glisan, both Lay and Skilling knew that the company was in deep financial trouble but tried to hide it instead.Ultimately, the jury rejected Skillings defense that no fraud happened at Enron save for those com mitted by a number of executives skimming millions in secret side deals, while bad publicity and misfortunate market confidence resulted in the collapse of the energy giant.III. Effects of the Enron CollapseAs the jurors found that these once-wealthy and powerful executives repeatedly lied to cover up the truly position of the company by covering up accounting and auditing failures which eventually led to its collapse in 2001, the left a devastating effect in the business world as well as the lives of the investors and shareholders. The demise of Enron wiped out more than $60 billion in market value, almost $2.1 billion in retirement savings and costs more than 5,600 to lose their jobs. The anger of the public over the recent corporate scandals led to the passing of the Sarbanes-Oxley Act, which was designed to make company executives more accountable.Although public distrust for white-collar trial could not actually reverse the damage done to investor confidence, the Lay and Skil ling trial however has become a start of a healing process for public-investor relations to be righted again.IV timothy BeldenApart from the other key witnesses who were former Enron employees and who testified against the top two Enron officials, Timothy Belden particularly made the charges against Lay and Skilling stick, ending in their conviction. Belden who was the first person to be charged in the manipulation of Western Energy markets, initially engaged in lengthy dance with federal officials over his plea and eventual cooperation in testifying against Lay and Skilling. He pleaded guilty in 2002 to conspiracy and admitted that he gave false information to Californias electrical grid operators. Belden is also said to be the mastermind behind the strategies described in memos that spelled out how Enron manipulated the California market (Schreiber).Beginning in the mid-nineties, California was among the first states to deregulate electricity. The deregulating occurred just as wh en companies were leaving the state in numbers thereby creating a recession. The deregulation was supposed to reduce the ten percent of the tax payers bill while breaking the old methods of greedy companies. As California deregulated the wholesale side of its energy markets, it also kept price caps in the retail side. It coincided with the States decision to bar utilities from signing long-term cheap fixed prices which forced them to into an capricious market. Thus, the utilities were made to pay exorbitant prices but were not able to pass on to their consumers the prices they incurred. Enron promised to deliver power more efficiently and build new plants that can run on cheaper fuels.Commencing in 1998 until 2001, Belden as well as other executives from Enron devised a fraudulent scheme in order to obtain increased revenue for Enron from wholesale electricity consumers and other market participants in the State of California. The schemes perpetrated by Belden and the other Enron e xecutives required them to submit false information to the companies supplied by Enron and misrepresented the temper of electricity which the company was supposed to supply. Despite being paid to relieve congestion, the company however, did not do so and instead imported as well as exported electricity in order to receive higher prices from the companies they supply.Of particular interest in the course of the trial is a transcript of conversation mingled with Belden and one of the operators of the power plant wherein the two discussed shutting down one of Reliants power plants in California to create a paucity in order for the prices to skyrocket. As the scheme worked, causing the power prices to arrive at high and unjust levels in California, it thereby became illegal under the federal Energy Policy Act.In his testimony, he called Californias post-deregulation power market dysfunctional and said his company bought cheap electricity in the northwest to sell in California at a p rofit (Baker). This practice created the appearance among consumers that there was shortage of electricity, thereby having the need to jack up the prices. Enron was able to pocket off almost $1 billion in a period of nine months in 2000 and 2001. Belden admitted however, that he only met with Lay and Skilling once during a colleagues party. But nevertheless, Beldens testimony proved to be a very crucial one as it confirmed and proved that Lay and Skilling knew of what was happening in California but turned to hide it instead.As company vice-president and head of Enrons West Coast trading operation, Belden supervised a staff of 120 that went from $50 million in earnings in 1999 to $800 million in 2001, while Californias power markets disintegrated into panic and sky-high prices. When one of Enrons lawyers started investigating these irregularities as a response to the investigation conducted by the California Public Utility Commission.The lawyers found out of Enrons tactic of using return of the energy crisis and revealed through a memo that Enron created false congestion lines, transferred energy in and out of state to avoid price caps and charged for services the company never actually provided (Swartz). And yet, inspite of the information the lawyer gave to the top executives, and traders have been told to return the money made on improper trading, the executives at Enron still decided against it contempt knowing that the practice was illegal. For Belden and the other traders, sending the money back would mean that the other companies will know what Enron was doing. Nevertheless, Belden and Enron continued on with the practice. Skilling, on the other hand, fully knew well of the said practice by the company in 2001 as he was already tipped by one of the executives who learned of the previous investigation.During examination, Belden admitted to US District Judge Martin Jenkins that he did it because he was trying to maximize profit for Enron. Belden claimed that he was only following Enrons instructions as he handled his trades (CBS News). accord to Beldens counsel, Enron knew fully well of Beldens action but was never disciplined nor sanctioned at all. In fact, Belden may have reaped bonus for such practice as revenues from his trading unit climbed from $50 million in 1999 to $500 million in 2000 to $800 million in 2001. When he was charged with conspiracy, Belden after a long time of dealing and negotiating with the federal government, decided to turn against Kenneth Lay and Jeffrey Skilling, claiming that the two top executives knew of the practice he and other traders did as indicated by the internal company memos which described how Enron took power out of California at a time of rolling blackouts and shortages and how it sold out of state to elude price caps (CBS News).

Discrimination Against Lesbians in Britain

Discrimination Against Lesbians in BritainLesbianism and the problems of identification in contemporary BritainIn Britain, homosexual wo custody may non cast off had to campaign to have their inner activities decriminalised, as homo familiar had needed to do yet their lives were not free of problems. However, men even homosexual men had much social, economic, and political power and status than British women did as a whole have. Men had a greater control of and over their own bodies than both straightaway or sapphic women had in the immediate post-war period, and indeed in the first place then as hygienic. British homosexual women would have to campaign for greater correctlys as both women do, and as lesbians to challenge the discrimination and judge gender roles from a patriarchal and heterosexual person dominated society. In other words, British lesbians had to counter sexual discrimination as well as orientation discrimination before they were able to feel fully secu re in publicising their sexual orientation and identification. ever-changing public perceptions of their different gender roles and sexual orientation was, as the main lesbian rights groups realised was not going to be easy, as their experiences during the seventies proved.8In Britain the 1960s was a decade that brought about some wide-ranging social changes and promised further changes for the future. Lesbian women could certainly regard the availability of the contraceptive pill and the legalisation of abortion as creation an improvement for the choices that all women were able to make in relation to their own bodies. During the 1960s expectations about the gender roles of women began to change, as womens liberation movement meant that fewer women were prepared to become wives and mothers without having a career first. Lesbian women also realised they did not have to put up with marriage and children just because it was expected of them to do so. The decriminalisation of male h omosexual acts at the end of the 1960s could also be viewed as a demonstration that British society was easily becoming less illiberal in its attitudes towards people that embraced alternative lifestyles. For the more than etymon lesbians the social changes in the 1960s were the start of the process of fighting discrimination, earlier than the end of the process. British lesbian women and cheery men were encouraged to start brisk hook movements by the apparent success such(prenominal) groups in the unite States were having in altering social attitudes, especially in cities like New York and San Francisco.9 British lesbian and homophile pride organisations began in earnest during the early 1970s with the objectives of enabling their members to have pride in their orientation identification, as well as aiming to reduce the level of social discrimination which their own members had to endure. The hope was that rock-bottom social discrimination and reduced fear of such prejudi ces would allow all lesbian women to readily admit their sexuality with pride. These lesbian pride organisations as a whole found that changing social attitudes towards them and their sexual orientation was a slow process, after all generations of social prejudices could not be expected to cut down overnight.10The effectiveness or otherwise of lesbian and gay pride movements since the 1970s has been an area of much debate. Depending on which criteria are used to judge the gay pride movements the achievements of these organisations will alter.11 If judging the achievements of the lesbian and gay pride movements solely in terms of their ability to have anti-discrimination legislation unfolded these movements were undoubtedly a failure before the election of the New parturiency government in 1997.12 The only lesbian women to gain from anti-discrimination legislation between the early 1970s and 1997 did so because they also came at a lower place gender equality, race relations and d isability legislation. Governments from the early 1970s did not believe that legislation was needed to prevent homophobic discrimination, leaving lesbian and gay pride organisations on their own to lower such prejudice aimed at their members. New Labour has taken more steps than any previous governments to pass legislation to reduce homophobic prejudices and promote the rights of all lesbians and gays. New Labour legislation has included passing legislation to end discrimination upon the grounds of sexual orientation to enhance the opportunities for all lesbians and gays to be openly identified as such without fear of homophobic discrimination. Besides specific legislation to protect lesbian and gay rights, lesbians can also use the Human Rights Act of 1998 to make sure that their orientation being publicly identifiable is not detrimental to their rights or their safety.13 Under New Labour, lesbian women have finally received legal equality with heterosexual men and women. For insta nce, lesbian women and gay men are no longer dismissed from Britains armed forces if they openly admit their sexuality. Lesbian women and gay men now also have the right to marry apiece other in civil partnerships. The introduction of civil partnerships means that lesbian women in long term partnerships have the same rights as married and co-habitant heterosexual couples in terms of property, taxation and inheritance rights, as well as the same benefit and pension entitlements. Lesbian women now have the same rights as heterosexual women when it comes to the custody or adoption of children.14In respect of the lesbian pride movements they probably had a more immediate impact on changing social attitudes towards them than they did in influencing governments to pass legislation which tackled discrimination against them. Lesbian and gay pride organisations did not use the same tactics to publicise their sexual orientation. The more radical lesbian and gay pride organisations were happy to shock heterosexuals in British society with the tone and the methods in which they demonstrated their identifications of sexual orientations. More radical groups were even prepared to out famous people to make headlines and raise public awareness of lesbian and gay issues.15 Other more moderate lesbian and gay pride groups were less keen on showing their sexual orientation and identification in such an ostentatious manner. The more moderate lesbian pride groups would have preferred to be open about their sexual orientation and identification without using over the top publicity stunts. Moderate lesbian groups would have fitted in with insider pressure groups, which attempt to achieve their objectives behind closed doors, rather than in public. Radical lesbian and gay pride groups are examples of foreigner groups that have little influence with governments and rely on publicity to bring their objectives to public attention.16The campaigns of lesbian pride groups were not as succ essful in changing public perceptions of lesbian women as a majority of those groups would have hoped from the early 1970s. This was especially the case during the period of Conservative governments between 1979 to 1997. The Conservative party more than the Labour and Liberal/Liberal Democrats parties like to represent traditional family values instead of promoting the rights and the lifestyles of lesbian and gay pride groups. When in office the Conservatives prevented lesbian and gay groups form educating school pupils about their sexual orientations and identification through the infamous section 28. Lesbian and gay groups lobbied New Labour to have the section removed(p) as soon as possible. The media did not always help lesbian and gay groups convey the messages to the public that they wanted to be sent out, especially right wing newspapers did not want to change public perceptions of lesbian women. The right wing newspapers often portrayed the objectives of lesbian and gay gro ups in the most disconfirming perspective possible.17 Despite the efforts of some politicians, religious groups, and parts of the media the number of people who happen to be publicly prepared to be known as being lesbian and gay in Britain has increased noticeably since the 1970s. It is harder to argue out right that such a situation is entirely due to the attempts of lesbian and gay pride groups to alter the attitudes of British society. After all changed reactions towards their orientation and gender identification could have resulted from the campaigning of such groups, or alternatively could just have been a continuation of increasing indifference to how other people chose to live their lives.18Thus in conclusion, lesbian women in Britain have not always mat up comfortable or able to openly display their sexual orientation, and their gender identification due to the nature of British society. The immediate post-war society in Britain has remained preponderantly patriarchal and heterosexual in terms of social and gender relationships as well as expected behaviours, roles, and identifications. That situation meant lesbianism did exist in Britain, it was just well hidden. The 1960s were a decade that kick started the process of altering British society, and provided the stimulus for lesbian and gay pride groups to emerge during the early 1970s. The legacies, influence, and success of such groups are highly debatable. Although these groups certainly raised the profile of lesbians and gays in Britain they actually had little affect on the mainstream political agenda prior to New Labour gaining office in 1997. Lesbian and gay pride groups may have attempted to increase acceptance of their lifestyles and their alternative identifications, yet changing public perceptions of lesbian women has not been universal or overwhelmingly favourable. The way in socialisation operates in such a haphazard way means that the predominantly heterosexual and patriarchal nature o f British society will continue for a considerable amount of time, even if the acceptance of lesbian women should continue to improve, and more smooth-spoken gender roles should develop further.BibliographyAbercrombie N, Hill S Turner B S (2000) Penguin Dictionary of Sociology 4th edition, Penguin, LondonEatwell R Wright A (2003) Contemporary Political Ideologies second Edition, Continuum, LondonHobsbawm, E (1994) Age of Extremes, the Short Twentieth Century 1914-1991, Michael Joseph, LondonWhitakers, (2007) Whitakers Almanack todays world in a single volume, A C Black, LondonYoung H, (2003) supping with the Devils Political writing from Thatcher to Blair, Guardian Books, London1Footnotes1 Abercrombie, Hill, Turner, 2000 p.2 Judt, 2007 p.4853 Martin, 2003 p. 2334 Abercrombie, Hill, Turner, 2000 p. 3145 Abercrombie, Hill, Turner, 2000 p. 3146 Abercrombie, Hill, Turner, 2000 p. 3147 Sandbrook, 2005 p. 5998 Eatwell Wright, 2003 p. 2149 Hobsbawm, 1994 p. 42810 Abercrombie, Hi ll, Turner, 2000 p. 31411 Judt, 2007 p. 78512 Abercrombie, Hill Turner, 2000, p. 31413 Young, 2003 p. 21614 Whitakers, 2007 p. 60415 Judt, 2007 p. 78516 Abercrombie, Hill, Turner, 2000 p. 33617 Abercrombie, Hill, Turner, 2000 p. 31418 Judt, 2007 p. 785

Factors That Affect The Achievement Of The Operational Excellence Business Essay

Factors That Affect The Achievement Of The Operational Excellence Business EssayOne of the roughly competitive industries in the demesne is the pharmaceutical constancy. For a long time, the operation of the pharmaceutical companies has been subject to scrutiny, especially by the administration of each country of operation. The underlying reasons for the strict attention include the woo of medicines and drugs available for purchase, the reduced life cycle of return development, the technological advancements which impact trading operations and the nature of the wellness c be systems. Moreover, the pharmaceutical patience, like other businesses, is unnatural by factors much(prenominal) as the issues of piece resources development and sensitivity to culture and diversity. In fact, they all have influenced the birth of the bran-new and improved meaning of running(a) goodness.The increasing necessitys for an improved harvest-feastivity and manufacturing tolls have been the growing concern of pharmaceutical companies today. The need to meet the fast changing needs of the merchandise for a much uplifteder standard and quality drugs has excessively resulted to increased expectations not only from the consumers simply from all stakeholders (suppliers, investors, employees and the government). However, the quest for a much potent product is a very significant issue. The common goal is to reduce the attrition rate in bringing new medicines in the market as nearly as in creating a fair and efficient standard in choosing the best pharmaceutical company to award the patent. As more and more consumers argon becoming concern of the drug s its short- full term efficacy and its long-term side effects, marketing for the drug has also become more innovative and active. In this view, the running(a) processes and engineering for pharmaceutical product has come to a new level.IntroductionThe old adage Health is Wealth is generally true goose egg can be more valuable than being healthy and alive. The objective of the government of every country round the world to provide its public with health care serve has been notable but still incomplete and unsuccessful. Not only the poor and underdeveloped countries are the matchlesss having worrys with high medical be and insurances but even the developed or economically strong countries. There are many factors that contribute to the inability of the government to properly provide for its people in footing of health care, for one, the health service is truly an expensive part of man s need to live and the costs of services are high because medical equipments are expensive not mentioning the maintenance cost of every hospital. Hence, the need to secure the health benefits of the people has become the motivating factor for the government to lay in an agenda, its health objectives for the American Nation.Statement of the ProblemThe pharmaceutical business is one of the most important indust ries in the world. The benefits people gain from the results of question and development conducted by the pharmaceutical firms, which include citeies of the cures for many diseases, and the lessening time required to treat the patient that lead to saving of lives, cannot be equated with money. Even the wealthiest mortal on earth gets sick and requires medicine. Sick people and their families are happy whenever they learn that there is a cure for their diseases and that their lives are lengthened by the mend power of medicine. However, with the high cost of production, stiff argument, and the ever-changing government legislations, pharmaceutical companies are facing major challenges. While the time to bring the pharmaceutical product in the market quickens, the risk involved in the cost recovery and industry survival increases for many pharmaceutical companies. In this view that the selected problem is entitle Achieving Operational Excellence in the Pharmaceutical constancy.The selected research problem evaluates the operational and engineering processes used by the pharmaceutical companies. Achieving operational excellence requires that pharmaceutical companies apprehend the factors which may venture their operations, such as the changing human resources relative to cultural diversity and custody outsourcing, the impact of the environmental factors, which may include changing government legislations, market trends and next opportunities and brats and the future trends, operational systems, collaborative efforts (merging, tie-ups, etc.) that will all make a difference in the midst of heavy competition and highly selective customers. The selected statement of the problem hopes to reveal the possible solutions to the challenges and in the end provide a wider lieu based on the data presented, evaluated and analyzed. routine of the StudyThe goal of this research is to find out the relevant factors that affect the achievement of the operational excellenc e of the firms in the pharmaceutical industry. It also hopes to learn and take in what makes a successful pharmaceutical company and how operational excellence can be achieved.Significance of the StudyThe findings of this research will serve as utilitarian information on get wording the pharmaceutical industry as a whole. Readers will also have a full view of the pharmaceutical industry from its begging up to the current time. Researchers of the same issue will have a concrete basis of analyzing and evaluating for the same. Pharmaceutical companies will have a wider perspective of the industry where they exist, providing them with more information useful in the creation of marketing strategies and operational upgrades. The government will also benefit from this research because, it will present a different interpretation of the severalize factors affecting the pharmaceutical industry.Research QuestionsThis paper looks into the sideline issues(1) How should the current pharmaceut ical industry be exposit in terms ofa. Operational processes and engineeringb. Pharmaceutical technologyc. New product development, Research and development and Product life cycled. Production systems ( jibe quality management, total productive maintenance, etc.) ande. Factors that characterize operational excellence (best practices)?(2) How are performances evaluated?a. The Porter s diamond concept in a pharmaceutical setting(3) What are the challenges of achieving operational aptitude in view ofa. Sensitivity to culture and diversity with respect to a unified bodily thinkingb. Globalization andc. Human resources development?(4) What are the expected future trends?BackgroundPharmaceutical firms are categorized according to the nature of their business operations they are the research-based firms manufacturing-based firms and a combination of research-based and manufacturing-based firms. Characterized by its dickens distinct functions research and development (RD), and manufactu ring, the pharmaceutical industry was inform as a $600 billion worth of sales in the year 2006 (economywatch). Specifically, there was a 7 per cent increase on the sales of prescription medicines worldwide or a total of $602 billion based on the report of any(prenominal) major pharmaceutical and medical information firms. These pharmaceutical firms are either, primarily engaged in Research and Development (RD) alone, studying diseases and advancing drugs and medicinal potentiality while other firms focus on the drug manufacturing process. Large, financially-able and world renowned pharmaceutical companies engaged in both activities.The US is considered as having the number one pharmaceutical market and an increasing trend in the pharmaceutical industry all over the world. According to statistics the highest recorded annual sales of pharmaceutical products and services in the US alone is $252 billion and increases at around 5.7 per cent annually (economywatch). According to a phar maceutical industry report, the leading countries in the world in terms of potential market are India, China and the United States. The report specifically stated that The report proved that there is an increasing demand and market for the pharmaceutical industry because of the increasing health awareness of the people all over the world.Literature ReviewMarket intelligence data from IMS Health, a research company providing on pharmaceutical and health care industries proved that in 2002, the estimated worldwide sales for prescription drugs was about $400 billion and that the United States use on prescription drugs in 2002, was roughly 200 billion dollars which accounted for approximately half of all sales worldwide. But despite this high costs, the United States graded as the 21st rate on infant mortality in the world, way below Greece and South Korea and only a bit higher in Poland. Also, the United States ranked at the 17th rate in terms of life expectancy all over the world. T he research agency also reported that in 2008, the US prescription drugs sales had amounted to a whopping $291 billion dollars every year (sourcewatch).In this view, the challenges faced by the pharmaceutical industry around the world are enormous (Sherk). One of the main reasons is the pressure of bringing down the prices of medicines and drugs that are considered contributive to the escalating costs of the health care services (Sherk). The cost of health care in the United States is generally double compared to other developed countries in Europe such as Britain, France and Germany. (yahoonews) Furthermore, the United States has reportedly spent 7, 290 dollars per person in the year 2007 but provided no meaningful advantage in terms of quality of care, and placed far behind the averages in the key indicators such as the infant mortality and life expectancy rate compared to the previously mentioned countries. The proposed healthcare reform in the United States, includes the evalu ation of the drug costs and the possibility of creating legislations that will regulate the operations of pharmaceutical companies.Research DesignThe research design that will be used to evaluate and answer the selected problem titled Achieving Operational Excellence in the Pharmaceutical Industry is qualitative research. The decision to use the qualitative research design was based on the following factors limited time available, and also, the use of secondary data. In put in to answer the general and specific questions, the researcher uses the descriptive research as a persona of qualitative method of research. The researcher gathers secondary data from previous researches, statistical reports, surveys, demographic information, and online resources. The data gathered are listed, sorted and analyzed in order to answer the problems undertaken.FindingsThe following are the findings that were gathered using secondary information, specifically from previous researches, statistical re ports, and other sources.(1) How should the current pharmaceutical industry be described in terms of(a) Operational Processes and technology in the Pharmaceutical IndustryDrug Approval and Registration ProcessAs implemented by the fodder Drug and Cosmetic Act, the strict compliance of the law should be observed in all stages of the operational process and engineering in the Pharmaceutical Industry, primarily, in the registration (FDA, 2010) The Food Drug Administration (FDA) s fundamental mission is protect the public health is the collection of this information, which is used for important activities such as post-market surveillance for serious adverse drug reactions, inspection of drug manufacturing and processing facilities, and monitoring of drug products imported into the United States. Comprehensive, accurate, and up-to-date information is deprecative to conducting these activities with efficiency and effectiveness. (FDA, 2010)(b) Process Analytical technologies (PAT)One of the new systems that are being used in the pharmaceutical industry is known as the Process Analytical technologies (PAT). The term Process Analytical Technologies (PAT) has been used to describe a system for designing and controlling manufacturing through timely measurements (i.e. during processing) of critical quality and performance attributes for raw and in-process materials and also processes with the goal of ensuring final product quality. The PAT initiative focuses on building quality into the product and manufacturing processes, as well as continuous process improvement. (pharmainfo.net)c) Industry Operating ProceduresThe pharmaceutical industry, just like other industries uses the US standard of Accounting GAAP (irs.gov). Pharmaceutical companies have to apply for the registration of their newly sight drugs or medicines. Before a drug can be tested in people, the drug company or sponsor performs laboratory and animal tests to discover how the drug works and whether its li kely to be directable and work well in humans. Next, a series of tests in people is begun to determine whether the drug is safe when used to treat a disease and whether it provides a real health benefit. The process must be based on the steps set by the Food and Drug administration of the country of operation. The development and Approval Process of Drugs in the United States is believed to be the safest and the most advanced pharmaceutical system in the world. Another incomparable operational process used by the pharmaceutical companies is in the area of marketing. Unlike, the traditional merchandising and buying area of many products, selling drugs is a very complicated issue. Before companies can sell drugs, they have to seek approval and license from the FDA. Marketing in the pharmaceutical industry is unremarkably through salesmen.(2) How are performances evaluated?Porter s Five Forces of Industry Analysis of the Pharmaceutical IndustryThe pharmaceutical industry has high b arriers to entry, primarily because capital is bulky in this business. The need to allocate heavily on research and development is highly important if one will enter this industry, not mentioning high threat from government policies, and longer or no return on enthronement. The supplier power has low impact because material supplies are solely for pharmaceutical companies alone, and shelf life of chemicals is longer than any ordinary supplies. Buyer power depends on the kind of medicine being produced, if the medicine has no other substitute, then purchaser power is low, and vice versa. The threat of substitutes is also low in the pharmaceutical industry, because although generics have been gaining popularity and acceptance, still, many consumers believe branded medicines are more effective. In terms of competitive rivalry, the pharmaceutical industry is highly competitive. Mullins (2006) reported that the industry was overpopulated and not one company has more than 5 percent ma rket share. In addition, market growth rate is also minimal.(3) What are the challenges of achieving operational efficiency in view of (a) Sensitivity to culture and diversity with respect to a unified corporate thinking (b) Globalization and (c) Human resources development.The changing landscape of business due to the forces of the new and changing environment have become the major influences in the appearance in which leading function in the organization is done today. Unlike the traditional leadership process, global leadership extends its functions to new horizons and length that increased value for businesses, hence an increased risks. Leaders are more flexible and multi-skilled today. Thus, new business horizons that offer new and improved opportunities are available for global leaders to take advantage of. With the right attitude and qualifications, success in the business is possible for global leaders. The secrets however, lie on the ability of the leader to understand the se new concepts and challenges.Human Resource Management or HRM is an activity that is focused on recruiting, managing and developing the people in an organization. This function also deals with the issues regarding employee compensation, hiring, performance evaluation, safety, development, wellness, communication, training and development. The human resource management in the organization plays a big occasion in making strategic and coherent approach to managing the company s most important asset its people. The HRM function is seen by most companies as a major contributing factor in aligning specific assignment to the employee s capabilities. In doing so, the company will be able to efficiently achieve its goals at a minimum required resources. Factors that affect staffing and staffing turnover are considered to be a big problem faced by human resource managers. Pinkerton (2001) made an effort to know the reasons that influence the staffing needs of hospitals. The answers vary de pending on the hospital, the top off three include, teamwork or no teamwork/unit cohesiveness, chaos factors impacting the delivery of nursing care and effectiveness of communication.The factors affect staffing which can be categorized under outdoor(a) and internal. The external factors include the level of education, the prevailing attitudes in society (the kind of attitude toward work), the many laws and regulations that directly affect staffing, the economic conditions, and the supply of and demand for the manpower outside the enterprise. Organizational goals, tasks, technology, organization structure, the kinds of people employed by the enterprise, the demand for and the supply of managers within the enterprise, the reward system, and divers(a) kinds of policies are the internal factors which may affect staffing. For example, the use of high technology in most industries requires extensive and intensive education and training.The organization s ability to effect dislodge is largely modify by the organizational culture because it serves as the basic nature and characteristics of the whole organization. Where organizational culture is deep seated and forms underlying subcultures, it is more difficult to change and therefore sets a more challenging role for leaders who want to implement change in the organization. The tendency to resist change is higher when organizational culture is more cohesive and more symbolical. Since the organization comprises of people that have different behaviors, talents, skills, knowledge, values, personality and many other differences, working together they come on terms to manage each other s differences. Culture is the behavior which formed when the people in the organization meet and agreed verbally and non-verbally and creates rule for doing the task. (Heathfield)DiversityThe diversity in the organization was previously seen as a negative factor, but in today s environment where change is inevitable, it adds up to the c ompany s flexibility in order to survive the competition in the market. In an organization where diversity is high, the leader must understand and know how to deal with it and use them effectively as a competitive advantage. Nowadays, many organizations employ diverse group of employees because they want to create a unique culture which adds up to the value of the organizational workforce. Common diversities in the organization include racial mixes, foreign workforces, women on the job, and disabled workers.(4) What are the expected future trends?Major transformations are occurring in the delivery of healthcare worldwide. Medical and healthcare technologies are increasingly impacting the clinical as well as the administrative dimensions of healthcare care delivery. Innovations introduced in the last decade have created accumulated effects that will be compounded with the continuing technical progress in medicine. Areas such as telemedicine, telehealth, computerized medical records, e-health and use of the Internet in B2B and B2C applications in healthcare are some of the milestones in the almost total revamping of the healthcare landscape. Medical and healthcare technologies are already transforming the operations, design and mission of hospitals. In this regard, the challenges for the future are an exciting opportunity for study, reflection, planning, and intervention.Technology assessment (TA) arose in the mid-1960s from an appreciation of the critical role of technology in modern society and its potential for unintended, and sometimes harmful, consequences. Congress commissioned independent studies by the National Academy of Sciences, the National Academy of Engineering (NAE), and the Legislative Reference Service of the Library of Congress that significantly influenced the development and application of TA. These studies and further congressional hearings led the National Science Foundation to earn a TA program and, in 1972, Congress to authorize the cong ressional Office of Technology Assessment (OTA), which was founded in 1973, became operational in 1974, and established its health program in 1975.Another factor that is considered as a threat not only to pharmaceutical industry but all industries is the globalization. Globalization has been creating impacts to various industries and individuals. The possibilities associated with it are countless. Hence, it also poses higher threats to many. Globalization has influenced major transformations on the organizational structures, and the processes of firms whether locally or internationally operated. Globalization also redefined the functions and roles of the intermediaries. Distribution of products has become tout ensemble dependent on the intermediaries. Companies are trying to lessen interaction costs and because of this, have outsourced services from other countries to take advantage of the economies of scale. Industrial sectors have to support extensive structural changes which be come more visible in the sectors that are based highly on the advanced technologies. Examples include the car industry, pharmaceutical industry and the telecommunications, among others.Conclusions and RecommendationsBased on this research study, there are several lessons which could be learned from the evaluation of and analysis performed in the pharmaceutical industry. Primarily, the safety and security of our lives depend on the ability of the FDA (Food and Drug Administration) and, CDC (Centers for Disease Control and Prevention), the AMA (American Medical Association) and APA (American Pharmacists Association), to screen and select the safest medicine, drugs and vaccines. The criteria set should always and consistently be tested, proven, and communicated to all industry players. Second, the operations of the pharmaceutical companies are generally affected by the changes in the industry. The relative amount of information available in understanding or describing a shoes can sign ificantly help in making valuable decision regarding the business operation.Third, the threat on the human resources because of globalization is considered a very critical issue even in the pharmaceutical industry. In the situation where there is limited available resources, need is high for an effective HR planning. Maximizing employee performances through devising appropriate training is also vital to the needs of the company. The approach will also help in maximizing the return on investment of the any organization s human capital and minimizing the financial risk is the main objective of human resources. Finally, it should therefore be concluded that the operational excellence in the pharmaceutical industry will only be achieved when companies learn to adapt the changes and developments brought about by the globalization.

Administration of Colonoscopy Reflective Account

Administration of Colonoscopy Reflective AccountThis essay aims to provide a reflective greenback of the indites personal and passe-partout experience of a unhurried being admitted for a colonoscopy. To achieve this, a model of reflection willing be used and a rationale provided to support this choice.The main point of discussion is converse and advocacy. Advocacy is central to intercourse and part of a caring declare-client relationship (Arnold Boggs, 2003). The author as a newly appointed imbibe on the Endoscopy Unit, will reflect upon how they could gather in been a better advocate for the tolerant in question. Ethical and licit issues will be examined. Fin every last(predicate)y implications for practice will be discussed.Using a model of reflection allows the nurse to re-appraise the c be they have delivered to a unhurried/client and in doing so stool evaluate the effectiveness of that c be (Basford Slevin 1995), thus with the intention of influencing future pr actice for the better. Before starting the reflection function it will be to a greater extent helpful for the professional to have a guideline or framework from which to work from (Palmer, Burns and Bulman 1994). Palmer et al (1994) view the make as something that is dynamic and they advise a cyclical style model using questions to provide a format for reflection. It is for these reasons that the Gibbs Reflective Cycle has been chosen (Gibbs 1998) for this essay.In accordance with the treat and obstetrics Council standards on respecting confidentiality in practice, all names and locations have been made anonymous (NMC 2008). As this is a reflective essay the author will refer to herself as I where appropriate.The reflective cycle is divided into six sections each with their own key questions. These areDescription What happened?Feeling What were you opinion and receiveing?Evaluation What was good or bad or so this experience?Analysis What sense can you make of the situation?Con clusion What else could you have through?Action Plan If it arose again what would you do?(Gibbs 1998)These areas for reflection provide the main topics for the rest of this assignment. When the practitioner has discovered an action plan they can accordingly come about to the beginning of the cycle with the extra knowledge they have obtained from the first reflective experience (Gibbs 1998). It is here though with the description of the chance that the reflective cycle will begin.The adjacent situation led me to question my actions when admitting a diligent for a colonoscopy.The long-suffering a 43 year-old male was referred for a colonoscopy by his GP returning a three-week history of fresh rectal bleeding, anal itching (pruritus ani) and a change in bowel habit. Two weeks antecedent to the scheduled test, a charter containing a letter of appointment was sent to the patient by the endoscopy administration cater. Enclosed were two sachets of Picolax bowel readying, full instructions for usage, highlighting the accept to follow instructions precisely to ensure clarity of view and aid diagnostic accuracy. Included with this pack was a pre-endoscopy questionnaire to enable the nurse to assess the patients general province of health and identify any potential risk factors or complications, which may arise.A leaflet was in this pack explaining the surgical procedure, reasons for the test, complications and risks and what to expect during the test. The booklet enounced some other available investigations in order that he could make an informed decision and enable him to represent informed hold for the test to go ahead. The Nursing and Midwifery Council (NMC) (2008) state that before any treatment or care is condition to the patient, take on must be obtained. The BSG (2008) warn that assume issues are a major source of problems, sometimes leading to both complaints and litigation throughout the NHS. Therefore effectual and robust accep ting is now a required standard for the Endoscopy world(prenominal) Rating Scale (GRS, 2009) which is a tool that enables endoscopy units to assess how well they provide a patient-centred service. Information in the booklet covered the option of drugging and the need for appropriate after-care. A consent form was enclosed for him to sign at home, providing the patient had read, understood and agreed to under-go the procedure.A morning appointment was made for the patient and he arrived at the unit by himself. He was greeted by myself, I checked his personal details. This is in accordance with the BSG (2008) guidance for obtaining a valid consent for elective endoscopic procedures as it states that identity checks at key stages in the procedure are essential as some patients have level been cognise to undergo procedures intended for a nonher due to loss of autonomy and anxiety which can result when entering the hospital. When this development was confirmed he was made to look comfortable in the education style.The patient was clearly anxious. He was looking down a lot and he had his arms folded. He spoke rattling quickly and with a quiver in his voice one of the first things he express to me was, please knock me out for this. I explained to the patient that although we could give him some drugging which would make him feel more(prenominal) relaxed, he would still be fire up as it would be unsafe to knock him out for the test. The sedation used for all endoscopic procedures is conscious sedation. This has been defined asA technique in which the use of a drug or drugs produces a state of depression of the central nervous trunk enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drug and techniques used to provide conscious sedation should carry a margin of safety wide enough to render loss of consciousness un wishly. BSG (2003, p3).He explained that he saw on th e consent form that sedation would be offered and he interpreted this to be a general anaesthetic. I further explained to him that although the patient may feel sleepy, he would be conscious throughout the test and he would be able to talk to us. Cotton and Williams (2003) agree, believing that the desired effect of the sedation on the patient is sleepy, relaxed but rouse able. The patient clearly expressed a preference for sedation and it was established that the patients wife could collect him after his procedure and would remain with him over the next 24 hours. It is a requirement that any patient undergoing a procedure with sedation should be accompanied home by a responsible adult who will remain with them for 24 hours as sedative effects are known to remain in the body system for up to this period of time (Royal College of Surgeons, 1993).At this point, I as a newly appointed staff nurse on the unit was unsure whether the consent form that the patient had signed was valid as h e originally thought that he was going to have a general anaesthetic when he had signed the form. I had been trained in taking consent which is documented in my e-portfolio as regards the national GIN training programme (Gastrointestinal in Nursing Training Programme), but was unsure what to do in this instance as I had neer experienced the situation before. My initial thought was that is was non valid as the patient had a different perception of the test. I explained to the patient that I was just going to get some advice from my colleague (who had worked in the endoscopy unit for several years) as regards the validity of his consent form. I said that I would need to explain the situation to my colleague and he agreed to this joking that we did not both want to get into trouble from the headmaster and get a detention. I said that I would only be a couple of proceedings and left the room to find advice.I explained the situation to the nurse who was sat in recovery. The nurse said that the Endoscopist performing the procedure would go over consent again in the procedure room and not to worry about it. I expressed concern at this because I knew that consent must never be obtained in the procedure room. Guidelines readily available in relation to consent include British Society of Gastroenterology guidelines (BSG) (2008) and the Joint Advisory Group Guidelines (JAG) (2001). stalling agree that consent should not be taken in the procedure room. Guidance on good practice in consent implies that all patients must have had adequate time to absorb and reflect upon new information. This is not achieved if consent is obtained at the last possible moment which is in the procedure room itself.The nurse was dismissive and made unpleasant comments regarding men in general. There was a short distance between the nurse and the preparation room where the patient was so it is likely that the patient heard her remarks. I did not comment at this time even though I tangle her remarks to be inappropriate. fortuitously this gentleman was the first patient on the mornings list and as such, no other patients were in recovery to here the comments. The nurse picked up the patients notes and knocked on the preparation room door. I thought that I had better observe too as the nurse looked ready for a challenge.The nurse was very brusque in manner and asked the patient if he had read the booklet which the unit has sent out for the test and the section regarding sedation. The patient said that he had read the booklet and indeed the section regarding sedation but on that point was no evoke that he would be awake after he had been given the sedative and false therefore that he would be asleep. The nurse then got a copy of the booklet. As she was flicking through arduous to find the page with the relevant sedation information on, she said it clearly states in the booklet that if sedation is given, the patient will be awake throughout the test. However, when she got to the page regarding sedation there was no signify of this. It just stated that sedation would be offered prior to the colonoscopy but if the patient decided to have sedation that it was essential that someone was available to stay project the patient home and stay with them overnight. The nurse went bright red, but did not apologise to the patient and said that she was going to have words with the administration staff and left the procedure room.I mat up guilty that I had not challenged the nurse regarding her rude manner with the patient at the time but felt intimidated and unable to voice my opinion, I also felt I had failed in my duty of care. I thought that the nurse had made a grand deal when there was no need. I apologised unreservedly for my colleagues office and said that I would take steps to make sure that the booklet was clearer. I then realised that my original question regarding the consent form had not even been answered. I asked the patient if it was okay if I asked another colleague their opinion. The patient said yes but not that do-lally nurse and said that he would be making a complaint regarding her attitude. I then found the endoscopist who was actually going to be undertaking the patients test and asked them about the consent issue. They said that the consent form was fine as long as I reiterated that the patient would be awake and that they fully understood the test. The Endoscpist said that they would discuss the consent form with the patient again prior to the procedure as this is normal practice.I went back into the preparation room and said that the consent form was not a problem and that we would discuss it further. I spoke to the patient in a reassuring way, trying to compensate from his previous treatment from my colleague. I asked the patient if he understood the test he was about to have and its related risks. When I felt like the patient had a clear understanding of the procedure I asked him if he had any questions regarding the procedure, the patient replied he had no further questions. He added that he was even more nervous now after the experience with the nurse but just wanted it to be over as quickly as possible. I began to explain the procedure that he was going to undergo and asked if he knew why the GP had referred him for this procedure and relayed the benefits of viewing the bowel in this way. The patient was happy that a diagnosis might be forthcoming from this test. I then reiterated the possible risks of the procedure to the patient explaining that they were rare but never the less very real. The patient said that he understood the risks involved but wanted to go ahead with the test to obtain a diagnosis of his problems.I stated that if the patient was going to have sedation, then he should not drive or operate any machinery and should not sign any legally binding documents as the side effects from the sedation would still affect him for twenty four hours. I explained that the end oscopist would endeavour to complete the investigation however, if complications were to occur such as patient distress or poor bowel prep that the test would be abandoned. During a Gastrointestinal Endoscopy and Related Procedures Course at The University of Sheffield (Feb 2010, SNM 2215/3232) it was suggested that the guideline for informed consent was signified by the acronym EMBRACE, Explanation of the procedure, Motive for the procedure, Benefits, Risks, Alternatives, Complications and side Effects of the procedure. I believe that these guidelines were fully complied.Following the taking of a medical history and finale of a further in-depth health check questionnaire to ascertain any condition or reason to which sedation would be contraindicated such as elderly patients who may have significant co-morbidity and even in younger patients, the presence of heart disease, cerebrovascular disease, lung disease, liver failure, anaemia, shock and morbid obesity (BSG, 2003). It became evident that sedation would be an option. I explained to the patient that a nurse would be with him continuously throughout the procedure and would encourage him to breathe through any discomfort he may feel, or to push some of the air out of his bottom to relieve any pain. The patients blood pressure, pulse and saturations were taken and all were within acceptable limits. This provides a good baseline of the patients observations for the procedure itself and can determine any changes that may occur as a result of the cardio or respiratory depression that may be induced by sedation. Pascarelli (1996) states that during the procedure, the nurses primary responsibility is to monitor the patients vital signs along with communication with the endoscopist, administration of medications and emotional support to the patient. Clarke (1994) warns that patients who undergo invasive procedures are usually anxious and their vital signs are commonly elevated however the sedation lessens the anxi ety, and all of the vital signs decrease therapeutically to that patients resting level.The sedation of choice in my workplace is intravenous Midazolam. Midazolam is a benzodiazepine re postedly well suited for use in endoscopy. It has an amnesic affect causing a reduction in memory recall. Clarke (1994) agrees saying that the goal of IV conscious sedation is some degree of amnesia. Patients will occasionally remember some parts for example, the initial mental home of the colonoscope. It is for this reason clear written discharge instructions are given to the patient prior to discharge, with a contact telephone number in the gist of any problems and this was explained to the patient. Sedation may be indicated for many reasons. In the main these may include allaying of fears regarding a procedure, and aims to facilitate compliance with repeat procedures as a result of the amnesic affects induced. In many cases it assures co-operation and eases difficulties for the endoscopist and g enerally provides a rapid, safe return to the normal activities of daily living.The patient was asked to undress from the waist down and to retch on the gown provided. When the patient was ready he was taken by myself into the procedure room and introduced to the endoscopist and the appointed staff nurses where the issues of consent and sedation would once more be discussed with the patient as it is the endoscopists ultimate responsibility.Throughout the experience, I felt that several important issues had been highlighted. One issue is that of the booklet that is sent out to the patients prior to the test. I believe that individual patients perspectives regarding the effects of sedation may vary greatly, from a mild sedative to a general anaesthetic. I conclude this to result from the individual interpretation of patient information received and relatives and friends giving a distorted image of their own experience due to the amnesic affect of the sedation. I would advocate good e ffective communication skills are paramount in allaying misconceptions and fears and the giving of a realistic overview is therefore essential.It was clear that there needed to be some improvement of the explanation of conscious sedation as I felt that is merely skimmed the surface explaining that the option of sedation was there and that there needed to be someone to escort the patient home and stay with them overnight. I felt that it needed to be clearer in the fact that it needs to mention that the patient will not actually be anaesthetised and furthermore that amnesia is a common side effect from the sedation given. This has subsequently been mentioned to the ward infant and the booklet has been updated to clarify conscious sedation. by chance one of the most obvious issues is that of the attitude of the other nurse. The BSG (2008) state that the patient must not be put under any pressure and have sufficient time to digest the information in order for consent to be valid. I fel t that the attitude of the nurse in question did put pressure on the patient and caused further anxiety for the patient. I felt that the nurse spoke to the patient in a degrading way and showed a lack of professionalism. The Nursing and Midwifery Council (NMC 2008) state that nurses must treat people as individuals and respect their dignity, must not discriminate and must treat people kindly and considerately. This was not the case in the above example.The Equality and Human Rights Commission (2008) state that no occasion your circumstances you should always be treated fairly and with respect when using healthcare services. The Department of Health (2008) cite the UK Human Rights Act in their guidelines about human rights in healthcare when they state that people have an absolute right not to be treated in a degrading way. This office that it is unlawful for the NHS organisations to act in a way that is incompatible with the human rights act. Endoscopy nurses and indeed all NHS st aff should be thinking about their practice and how their repartee to a situation may impact on a patient or clients human rights. If the patient had chosen to complain (as he said he was going to do) about the nurses attitude towards him, then the nurse may have well been in trouble.This experience has made me question my future practice as a registered nurse and how I would deal with a similar situation. Arnold and Boggs (2003) suggest that an advocate is someone who speaks out supporting a person so that their views are heard and their rights are upheld, with the sole purpose of maximising the patients health. I was not assertive as I did not defend the patient and therefore did not fulfil my duty of care by becoming an advocate for the patient, ensuring he was treated with dignity and respect. I was worried about what may happen if I challenged the nurses practice. I need to develop my assertiveness and be able to communicate confidently and effectively with both patients and h ealth care professionals. It is quite easy for a nurse to be an advocate for the patient when there is no stress involved but it can be quite difficult when it goes against other health professionals (Kendrick 1994). In this instance there was a conflict between the patients best interest and my fear of challenging the nurse. If I had been a more experienced nurse on the endoscopy unit and known the nurse involved in this situation better, I think I may have been able to foresee her chemical reaction to the patient and perhaps may not have approached this particular nurse or used my communication skills together with advocacy to diffuse the situation.Gates (1994) states advocacy is one of the main responsibilities nurses have it is part of communicating on behalf of the patient and/or their families, acting as a mediator to express their needs and experiences. In health care, communication is fundamental to promoting the safe and effective care of patients. The Department of Health Knowledge and Skills Framework (KSF) (DoH 2004) is a competence framework to support professional development and career progression through the NHS and is about lifelong learning. It has core dimensions essential to providing quality care. Core dimension 1 (level 4) is concerned with communication. It states that the purpose of communication may include advocating on behalf of others. In order for me to progress as a nurse on the endoscopy unit I need to be well-known(prenominal) with and work within the KSF and other guidelines.On reflection, I feel that I did communicate with the patient well. Smith (1995) proposes that reflection does not necessarily entail an incident that was dramatic or negative it could easily be something positive that a person finds they obtain valuable learning experience from. Communication with the patient has to be one of the most important aspects of nursing care. An integral part of this process is the way a nurse should use and understand body lang uage (Wilkinson 1991). It is as vital a part of the communication process as speaking and should be treated as such. Body language can convey all human emotions either consciously or not and can show a persons true feelings regardless of what they have said (Pease 1984). I could tell by the way that the patient was communicating non-verbally that he was anxious. His facial expressions and posture showed the classic signs of someone being anxious (Teasdale 1995). Seeing this, perhaps I should have explained to the nurse beforehand that the patient was anxious so that she may have acted with a bit more respect towards the patient. It is clear that good clear communication skills can improve patient satisfaction and compliance, thus reducing anxiety.I believe that during the admitting process with the patient I did actively discuss the procedure with the patient. I felt that I gave the patient opportunity to ask questions and allay any fears he was harbouring. I sat beside the patient and spoke to him about the procedure in an loose and pleasant manner, giving him opportunity to voice any concerns that he had. I believe that the patient is at their most vulnerable and anxious upon entering the endoscopy unit and some encouraging reassurance makes the patients experience less of an ordeal. It is my opinion that an assessment of a patients personality and level of understanding regarding consent and sedation enables the development of a communication strategy accordingly thus providing a sound knowledge of the test, sedation offered and therefore informed consent.This essay has allowed me to reflect upon my own practice and how I should have acted differently by standing up for the patient at the time, not allowing my own lack of confidence to prevent this. I understand that the care of the patient is my first concern and that I must work with others as a team to protect and set ahead the health and wellbeing of those in my care (NMC 2008). Perhaps with this unde rstanding, I will be less anxious about felling inferior around other professionals. I will articulate my professional judgement given a similar situation, using what I have been taught which is the best evidence based practice to rationalise my reasons for questioning their practice. I will aim to develop my assertiveness (as I realise that assertiveness does not come naturally to me) to speak out in the interests of the patient, whatever the situation. I will develop my capacity to communicate with both patients and other professionals to offer them the opportunity to rationalise their own care delivery and reflect upon it. I believe these actions will enhance my professionalism and promote best practice, in the interest of the patient.I had chosen to focus on communication and advocacy as these are areas in which I feel I need to work on. Gibbs (1998) reflective cycle was used in this assignment because it is a familiar tool that I have found to be efficacious and uncomplicated . Learning from an experience and then reflecting on that experience is an excellent way of improving the skills in my chosen profession (Kolb 1984). From my own personal point of view, I went into this assignment with some degree of emotional imbalance for the fact that I did not speak out for the patient but now I feel that I have gained in several areas. I feel my reflective skills have increased and with it my confidence regarding tackling such situations again. Also I feel more relaxed with the idea of reflecting uncomfortable incidences because I can see the benefits in doing so.

Fermat’s Last Theorem Essay -- Pierre Fermat Math Mathematics Papers

Fermats get going Theorem The form is 1637. Pierre de Fermat sits in his library, flock exclusively over a copy of Arithmetica written by the Greek mathematicsematician Diaphantus in the third century A. D. Turning the page, Fermat comes across the Pythagorean equation x 2 + y 2 = z 2. He leans back in his chair to think and wonders if this property is limited to the power of two only. He bends over the book again, scanning ahead through the pages to look for any clues. Suddenly, he begins writing intensely in the margin It is impossible for a cube to be written as a sum of two cubes, or for a poop power to be written as the sum of two fourth powers or, in general, for any number which is a power greater than the second to be written as a sum of two like powers. I have a truly marvelous demonstration of this proposition which this margin is too narrow to contain. These words, written so carelessly, were to survive to bewilder, frustrate and elude mathematicians of all k inds for centuries to come. This is the legend of Fermats Last Theorem.Pierre de Fermat was born in the town of Beaumont-de-Lomagne in southwestern France at the beginning of the seventeenth century in the year 1601. Being the son of a wealthy merchant, Fermat was able to gain a privileged education at monasteries and universities. The young man, however, never showed any particular talent in the subject of mathematics, choosing instead to pursue a career in the civil service of France. His elevated status in society allowed him to include the de in his surname. He suffered a serious attack of the plague during his adult life, severe enough to prompt friends to mistakenly pronounce him dead Fermat never made math his career, but mathematics at th... ...Kolata, Gina. How a gap in the Fermat proof was found. The New York Times, 144 (January 1995) B5. Expanded Academic ASAP. Middlebury College, Middlebury, VT. 15 September 2002.Mackenzie, Dana. Fermats Last Theorem Exten ded. Science 285.5425 (July 1999) 178. Expanded Academic ASAP. Middlebury College, Middlebury, VT. 15 September 2002. Mozzochi, C. J. The Fermat Diary. American Mathematical Society, 2000.Ribenboim, Paulo. Fermats Last Theorem for Amateurs. New York Springer, 1999.Singh, Simon. Fermats Enigma the Epic Quest to put to work the Worlds Greatest Mathematical Problem. New York Walker, 1997.Van der Poorten, Alf. Notes on Fermats last theorem. New York J. Wiley, 1996.Weisstein, Eric W. Fermat, Pierre de. Wolfram Research. http//scienceworld.wolfram.com/biography/Fermat.html (14 September 2002.)

Needless Animal Research, Testing, and Experimentation is Wrong Essay

Needless zoology Experimentation is Wrong If penicillin had been tested on guinea pigs, it might never have reached the public. It is lethal to guinea pigs, deactivates the blood outline of rabbits and is deadly to cats (Bio-Medical Research). Scientists are pushing for more experiments regardless of the cost to the animals life. One expense is the involvement of killing animals in the pursuit of a pine-scented song freshener(Vergoth,p21). Animals suffering in experimentation labs are in just and cruel to animals. It is wrong to harm an innocent animal of any wrong doing, when the animal doesnt love right from wrong. It is argued that people have an obligation to animals, so that we can protect their welfare. Charles Fried claims physical harm as an impingement upon the clay which either causes disturb or impairs functioning (Fox, p85). Many animals experience pain, and sometimes death, during lab experiments. No animal experiments can be justified. Animals have helped in some ways, such as the stripping of the polio vaccine. Vivisection can be defined as an invasive experiment performed on an animal for the purpose of scientific research, product testing or education (The National. . .). Vivisection is extremely wrong because it causes pain and suffering on animals. Animals are entitled to be free from acts of cruelty. Animals, however, are important in research because their body systems are almost identical to humans. The use of dogs developed open-heart surgical techniques, coronary bypass surgery, and heart transplantation. Animals have helped in some ways, such as the discovery of the polio vaccine. The pulsing pain of electrodes planted in a chimps brain is repulsive. The death of a tortured ra... ...re us so they will be present after the people leave. Bibliography Bio-Medical Research. online Nov, 4, 1997. Available at http//www.navs.org/biomed.htm Fox, Michael Allen. Animal Experimentation is not justified. Animal RightsOpposing Viewpoints. Leone,Bruno, Series Ed. San Diego, CA. nursery Press.1996. Frey, R.G. All Animals Are Not Equal.Animal RightsOpposing Viewpoints. Leone,Bruno, Series Ed. San Diego, CA. Greenhouse Press.1996. The National Anti-Vivisection Society. online Nov, 4, 1997. Available at http//www.navs.org Product Testing. online Nov, 4, 1997. Available at http//www.navs.org/product.htm Singer, Peter. All Animals Are Equal.Animal RightsOpposing Viewpoints. Leone,Bruno, Series Ed. San Diego, CA. Greenhouse Press.1996. Vergoth, Karin. Guinea Pigs. Psychology Today. November/December 1995. pp21.