L. E. Fouraker & J. M. Stopford †Organizational Structure and the Multinational Strategy Essay

Organizations constitute an important part of society. Parsons (1960) said that with organizations it is possible to â€Å"get things done†, and â€Å"achieve goals beyond the reach of the individual†. However, organizations may face continuous structural change, as A. D. Chandler’s â€Å"Strategy and Structure† (1966) suggest. Lawrence E. Fouraker, a Business Administration lecturer, and John M. Stopford, a research associate at the Harvard Graduate School of Business Administration analyze this work in their paper titled â€Å"Organizational Structure and the Multinational Strategy†. The following is a brief synopsis of the same. To begin with, a historical outline is given of how company resources were acquired and used. According to Chandler, there was an â€Å"initial expansion and accumulation of resources† (qtd. in Fouraker and Stopford 1968: 48), then followed by a reduction of these utilized resources, an opening out into new markets, and eventually the development of an entirely new structure. These four stages in time, according to Fouraker and Stopford lead to distinctive organizational structures. The so called Type I – organization is a basic organization that is seen to be the extension of the head of the company, and hence reflects the same â€Å"interests, abilities, and limitations† (qtd. in Fouraker and Stopford 1968: 48) of the chief and/or founder. It is characterized by its focus on the production of a single product only, and furthermore, stresses a single task, leaving little or no flexibility in terms of adaptation to new market developments. The problem solving or decision-making always leads to one individual who carries all burdens. This might also be explained by the philosophy or mind-set of the management (â€Å"command and control†). Having a very basic organizational design, the marketing orientation (as per Kotler and Armstrong 2006) that describes the Type I – organization best, may be the product concept. Although no actual product innovations are implemented, it does apply to a certain extent since this model assumes that the organization’s core business is to target a high sale in volumes of the product that is marked by its quality, and that is manufactured by the smaller-sized company. A simple example for such an organizational type may be a company that produces plain mousetraps. Since a Type I – organization would believe in its single product most intensively, it is important that the organization does not get trapped in marketing myopia, i.e. by thinking that their product (the mousetrap) is the only and best built product, ignoring better solutions (for instance chemical spray or exterminating services) (Kotler and Armstrong 2006: 10). The Type II – organization on the other hand is defined by efficiency and the â€Å"rational use of resources† (qtd. in Fouraker and Stopford 1968: 49). Being based on the structure of a Type I – organization, one still stays within a single functional activity (qtd. in Fouraker and Stopford 1968: 49), but simultaneously expands to a few more related products, or diversified product-lines. This development mainly took place, according to Fouraker and Stopford, in order to avoid risks, ensure that the organization continues to function once the core product has reached its expiration, and to make an efficient use of the equipment and plant (i.e. to use it to its full capacity). One now also has a vertically integrated style of management, which, however, still excludes research and development. It is further highlighted by Fouraker and Stopford, that although various products are being produced efficiently, so far no actual management or professional administratio n is applied. On the contrary, the same type of management philosophy predominates. However, the better co-ordination in functions allows for the move within the marketing framework; One shifted to the production concept. This becomes obvious since, according to Kotler and Armstrong (2006: 9), consumers are in need of affordable and available products, which on the other hand makes more efficiency in the production-process necessary. An historical example is given by Henry Ford and his development of the Model T car. It had been his aim that every family could afford such a car, hence he efficiently reduced the production time from 12 hours to 96 minutes by means of the moving assembly line (Ali and Gomez 2006: 14). The subsequently developing organization, Type III, builds up in its complexity, which also brings about the need for professional management and a general change in management’s approach towards the components within the value chain. It allows for general managers to be trained and tested and also to be instituted in unrelated divisions (which are separated on the basis of the nature of the products). Specifically, one now has a multi-divisional product structure (i.e. the divisions are separated on the product basis) with more functional responsibility being delegated to the division general managers. For the first time, organizations now also carry out research and development to a large degree. Product innovation hence plays a role, and the need for better marketing arises, that means the marketing concept (as per Kotler and Armstrong 2006) is practiced. By focusing on consumer needs, one uses integrated marketing perfectly on both, the external and the internal level, and achieves profits through customer satisfaction (Kotler and Armstrong 2006: 10). Ericsson and Sony might be examples for companies who follow this organizational and marketing design. The authors then go into the fact that from research and development, product innovation, and the new organizational structure, a development of investments into foreign markets emerges. Among others, that is the case because the products produced locally, are unique and will not be found abroad. There are different types however, of how the set-up may look like (i.e. there might be a separate international division, world-wide production divisions, a geographic division, or a mixed form). Lastly, there is an illustration of the modern organization, or â€Å"matrix organization†, where there are many more products and product departments, along with different managers and different geographical registrations. In terms of a three-dimensional design it typically would see the managers on an x-axis, the product range on the y-axis, and the locations on the z-axis (although this may vary). It is also very likely that a manager in such a structure carries responsibility for more th an one product, attached to different regional focuses. This clearly suggests more flexibility (managers are automatically more skilled and can adopt different tasks), but also brings about the problem of a divided responsibility or a weak accountability (for instance difficulties when questioning which manager would be liable for the success or failure of a particular product launch in any region). Both the product as well as the marketing concept can be implemented by a company that has this structure. The product concept may be applicable since product differentiation takes place, and it is the organization’s aim to create higher value added by exploring different product ranges (most likely by the use of R&D). At the same time, relationship marketing might be applied (i.e. satisfying customers for the long-term), when considering that managers will opt for recurring purchases. All in all, the above has been an outline of Chandler’s â€Å"Strategy and Structure† (1966), re-studied by Lawrence E. Fouraker and John M. Stopford. Although the evolution of different organizational designs is illustrated to a great extent, it is evident that virtually all of these are still having importance today as they are wittingly or unwittingly implemented by corporations.

Theseus’ Ship

The Ancient Identity Crises The transitivity of identity is a question often contemplated by philosophers through philosophical puzzles of change. A popular version of the puzzle includes a man named Theseus and his ship. A ship in which has undergone a gradual change where all of the lumber was replaced by the new cargo of lumber it carried. The question then remains, is this still the original ship of Theseus? Philosopher John Locke attempts to answer this question by stating that identity is a subjective matter rather than objective.He begins by separating the idea of a substance, organism, and a person and the different criteria used to determine each type of identity. Naturally we would agree with Locke that a ship is a not a living thing capable of thought and assume that it can only be talked about in reference to matter. However, Locke proposes that a substance like the Ship of Theseus can be talked about with reference to a conscious subject’s beliefs towards it.This is based off the fact that a concept of the ship’s identity could not exist without human consciousness. Locke also provides a further suggestion that two things should not be questioned as whether or not they’re simply the same. The reason for this being that criteria differs among concepts so we must be careful in specifying â€Å"the same what† when making comparisons. Therefore, Locke concludes that the idea belonging with the ship is the identity of the ship itself.In other words, identity is a relative aspect rather than absolute, one that heavily depends on context. Identity can be defined as the distinct characteristics by which something is recognized. In other words, identity is an idea created by and for people and does not exist without them. This directly links with Locke’s idea of relative identity, as the perception of an idea is a relative concept depending on what, where, when, and whom you are asking.We must also keep in mind that just b ecause things are qualitatively identical in sharing similar properties, it may not mean they are numerically identical as one and vice versa. It is ultimately up to whomever is answering the question from what angle to declare an objects identity. In this case, I will present a variety of explanations to the identity of Theseus’ ship through different contexts. In the context of defining a ship, the change in lumber does not interfere with the necessary criterion of the preconceived notion of a ship.Though Theseus’ ship has undergone a qualitative change through the replacement of lumber, it still remains the same ship by definition of a large vessel that carries goods or people over sea. So the ship may not be qualitatively identical to the old one but numerically the same because it serves the same purpose as Theseus’ ship over time. Now, consider another context where after Theseus ceases to exist, somebody purchases and moves this ship onto land to serve an d sell dinner on deck.It’s then safe to say that the object does not meet the conditions of a ship, despite being qualitatively identical. Instead, the object now serves the purpose of a restaurant, causing it to retain a new identity without losing any parts at all. However, the context changes once again when we begin to consider the identity of the ship in relation to Theseus. Despite the gradual changes, there has only ever been one beginning to Theseus’ ship, so we can assume that he has no problem claiming it as his own.But what happens when the old, original lumber is collected and used to build a qualitatively similar ship? There are now two ships that share similar properties instead of one ship that is qualitatively different, yet numerically the same over time. Theseus must then claim one ship to be the original based on the criteria he has of how his vessel should be constituted. His predetermined opinion on what conditions must be met in order for either o f the ships to be the original is what essentially establishes the identity of the old ship.In this situation, I can agree with Locke that though the old lumber is being used, the ship is still being created from a new beginning, rendering it a new ship. Though it can then be argued that if both ships match Theseus’ criteria of the original ship, this does not make it possible for them to be one numerical identity as they are clearly two. By analyzing the various contexts above, it causes us to consider identity as grey matter rather than just a simple black and white answer.It also begins to make it clear that identity is an issue of semantics and epistemology, rather than a metaphysical one. However, while the belief of an idea within a specific circumstance is important in constituting an identity, it becomes difficult to say what is true in a world of many different perceptions. That’s when semantics might be able to step in to sort out the problem of subjectivity. Still, it’s visible that identity is a relative concept that relies on perception and context rather than something that is absolute.

Microsoft Office Word, Excel, and Powerpoint in the Business Enviornment.

In most work environments, Microsoft Office Word, Excel, and PowerPoint are being used on a daily basis. From being a Loan officer to a front desk cashier these three apps are very helpful in our work place. Microsoft Word is good with writing business letters and business cards, Excel is good with making spreadsheets or charts for your business, and lastly, PowerPoint is good with making presentation audio and visually. In the following paragraphs below I will explain why these three are most helpful and useful in the work place. For one, Microsoft Office Word is mostly used to writing business letters to their clients. From one paragraph or 4 pages it’s where they will have their letter written up and printed. There are also different tools like spell check and grammar, formatting tab, paragraph selection and etc. that also become useful. Business cards can also be used on Microsoft Word and then printed out which also is being used in the work place environment. (office Microsoft) Secondly, Microsoft Excel is mostly used because of its layout and widespread availability, it is often used as a tool to create and maintain a list. More users use it to store database records, create charts or graphs. A lot of organization uses excel to manage their budgets, business planning, customers records, business intelligence, analysis of sales data, customer data, performance dashboard, etc. (advanced excel) Lastly, Microsoft PowerPoint presentations utilize both audio and visual techniques, making for easier understanding. Normal teaching and training is interactive and more effective by using PowerPoint presentations instead of simple lectures. Many executives and managers use PowerPoint for this reason. Executives use this as a strategy to increase sales. Using PowerPoint in front of a potential client shows that you are up with the time. Plus, projecting charts that all can see also makes the presentation more interactive for the client. (powerpoints and apps) So all in all I hope you find Microsoft Word, Excel, and PowerPoint useful in the work place. Not only will it help you and your business be successful but also have that professionalism. ? Reference Microsoft office np November 1, 2011< http://www. baycongroup. com/powerpoint> Baptiste, Jason np November 1, 2011 < http://jasonlbaptiste. com/startups/microsoft-excel>

The Usefulness of Websites for Historical Research Essay

The Usefulness of Websites for Historical Research - Essay Example A website may be the work of an individual, a business, or any other type of organization for that matter, which is typically dedicated to some particular topic or purpose. Websites are extremely useful in the studying of various research topics. However when it comes to historical research, there are certain values and limitations of websites for studying this history. The aim of this paper is to examine and assess these values and limitations, in order to come to a clearer and more knowledgeable understanding on how accurate and useful websites truly are for studying history. By examining six websites in particular, we can base our results on how successful the average website is when used for studying history. Basing our historical research around the Civil War, the websites which will be used in this study will be as follows: By thoroughly examining these six websites, we can come to a critical assessment of how accessible and resourceful the average website is in historical research. This is what will be dissertated in the following. The immediate content of this website was professional and direct, with the home page offering separate corresponding timelines to choose from. Information such as: Civil War experience, Civil War timeline, Civil War battles, and Civil War people were also available to choose from on the home page; giving the visitor a vast array of options to choose from. In terms of visual presentation, it was accurately appropriate for the topic, and good design allowed for easy access through this site. There was in fact even a design labeled as the 'best graphic on site' in the 'Civil War Experience' page.1 Thinkquest offered a vast exhibition of useful information in regards to the Civil War, and even offered a 'Fun Fact of the day'; random factual occurrences which relate to the Civil War. The corresponding timelines offered accurate and incredibly informational timelines on the Civil War, and were significantly useful directional tools in terms of accessing around the website. In terms of what was negative about this site, or what more could have been done, the only true factor would be in regards to the actual design layout of the page. Although all the information was easily accessible, the visible attractiveness of it could certainly be updated and laid out more efficiently. However, as a website for allocating and using resourceful information on the Civil War, it can certainly be considered overall as positive. The Civil War Home Page This website was easily the most informational, graphically pleasing, and overall positive out of the six. The home page itself contained more educational and resourceful information that might even be expected; while still remaining to be pleasing to the eye. The layout and content of the site was done so in a way most certainly methodologically in order to allow visitors an easily accessible and highly information tour through the site. The immediate presentation of the website was not the only positive element; after selecting any of the numerous offered links to

Modern Workplace Essay Example | Topics and Well Written Essays - 500 words

Modern Workplace - Essay Example (Take from presentation and paper work on work stress and health. Scheduled in 2003 in Toronto) We have now more racially diverse work force, older and has larger number of women. More over the workforce is being reshaped by new ways of dependent work , contract labor, and employment practices. But we haven't understood yet that what will be the effect of this on the worker health and safety in today's changing workplace. Another major problem is sexual harassment. The women's lobby in Europe states that around 40 to 50% of the women have experienced some form of sexual harassment or unwanted sexual behavior in the workplace.( Taken from Dziech et al 1990, Boland 2002). In United States Of America around 15000 cases of sexual harrasment have been brought to U.S Equal Employment Opportunity Commision (EEOC) each year. Where as a study from Hong Kong states that one third of sexual harassment victims are males who are being targeted by female supervisors at the work place. The chair person of Equal Opportunity Commission, Jenny Watson, says that: ' it affects both women and men, causing stress, health problems and financial penalties when they leave their jobs to avoid it'. (Dziech, 1990) and (Dziech et al 1990, Boland 2002) Technology is the commanding force in todays work place , technologically literate people uses tools, materials, systems,

Computer security Essay Example | Topics and Well Written Essays - 1500 words - 3

Computer security - Essay Example Software licensing refers to all legal measures that govern the dispersion of software. The licensing is undertaken to help protect and prevent the computers information and data from loss and fraud. Computer software licensing is essential in preventing the loss of data and thus should be an area of great concern. In addition, computer licensing is vital for the protection of others work from those who would want to benefit from it without undergoing the costs. Coming up with a software involves a lot to do with the brain, and it would be unfair if someone would just enjoy the use of such without paying for the same. Using this approach, we would say that computer licensing may or may not be antisocial. Software licensing is antisocial given the fact that it can terribly damage social cohesion. A proposal to permit only one individual or only a group to use the program, while locking out the others, is divisive and should be unacceptable in a social community (Stallman 2010). Software is used to share information among others, but if they are licensed, then only a few people can get the rights to use them. As a result, the licensing of this software prevents information sharing that is largely reclusive. Software engineers and developers are also of the idea that personalities that do not exist in their inner cycles ought not to benefit from their hard earned sweat, and this further divides the society (Stallman 2010). Therefore, computer licensing in the computer savvy world is not so conducive for the development of a social setting in as much as computers are necessary. Yes, it is ethical and widely acknowledged learning the solutions to computer problems. People should be trained and taught about the computer problems so as to know what it is they should anticipate when using the devices (Tompsett 2009). Similarly,

Just War Doctrine Essay Example | Topics and Well Written Essays - 250 words

Just War Doctrine - Essay Example In this direction, Orend, Brian (2008) argues that â€Å"just war theory is probably the most influential perspective on the ethics of war and peace.† This means that the talk of just war raises a lot of questions on ethics and morality. Many researchers and theorist have therefore propounded a lot of ideas and theories on just war. One of such is the ‘consequentialist’ moral dynamic for intelligence operations introduced by Arrigo. The Arrigo Paper and believers of it thereof raise a lot of issues of when human source intelligence, counterintelligence, or covert operations pass the â€Å"moral divide† and violate the Just War doctrine. As an expectation of civilians from the military, wars should be started by causes and causes should be found through intelligence. For this reason, a justified war comes with a justifiable cause and for that matter, a justifiable intelligence. It is therefore important that â€Å"a doctrine of just war should coordinate wi th a doctrine of just intelligence, especially for human source intelligence, counterintelligence, and covert operations† (Arrigo, 2001).

Causes of World War I Research Paper Example | Topics and Well Written Essays - 1000 words

Causes of World War I - Research Paper Example The second industrial revolution also resulted in unprecedented horrors of war just because this was an industrial war that saw for the first time weapons like machine gun, barbed wire, heavy artillery, tanks, airplanes and zeppelins, bombs and grenades, poisonous gas, submarines and gunboats (Junger, 1920). The   steam   engine   and development of rail lines meant   that   more   artillery   could   be   deployed   to   the   armies, and   the   armies   could   be   kept   clothed, fed, and   armed   indefinitely   (Junger, 1920; Best et al., 2004). The result was unprecedented volume of casualties. For example, in 1916 alone, the Germans lost 850,000 men, French lost 700,000 and the British lost 400,000 men (Merriman, ---year, 907).  Q2: The   nature   of   the   â€Å"The   Great   War†.  The   nature   of   WWI   was   grim and not even closer to what was anticipated   by   the   countries   when    they   decided   to   stage   it. Two of the elements that made it really grim were that it was a â€Å"total war† and also an industrial war. A â€Å"total war† in this context means that it was a global war involving nations across the world, secondly, it was a war in which the nations were totally equipped in terms of weapons and technology to wage an unprecedented war, and thirdly, it actually brought into the battle field, all the social, political and economical resources available for all nations involved. It could be called a global war just because the European states collected the resources needed for war from its Asian and African colonies, and troupes and laborers were imported into Britain and France from these colonies. The Middle East, Japan and the USA were also participants in the war in one way or other. The role of industrialization in deciding the nature of the war was also manifold. As â€Å"mechanized production† replaced the à ¢â‚¬Å"primacy of agriculture†, international trade grew resulting in the emergence of a more influential public (Best et al., 2004).5 Another consequence of this was that the public â€Å"

COFFEE DIRECT UK SOCIAL ENTERPRISE Essay Example | Topics and Well Written Essays - 2750 words

COFFEE DIRECT UK SOCIAL ENTERPRISE - Essay Example Due to the factors like technological advancements, developments in the communication process and globalisation, the terms of the trade are fast changing. The traditional beliefs and the conventional ways are being replaced by newer methodologies and tricks. The massive competition in the industry has helped the processes to become sharper and efficient. Traditionally, it was all about those companies that would have sold coffee powder and the coffees would specifically be prepared at home. But with time, the concept changed and new shops and organisations came up that claimed themselves to be professionally ran in order to sale various preparations of the celebrated drink. Coffee Direct is a front line organisation in that respect and claims itself to stock comprehensive selection of coffees. Established in 1990, Coffee Direct has been primarily a family run business. The group stocks wide range of coffees and teas and take pleasure to supply those to cafes, hotels, offices and also to home. The organisation also deals in the coffee machines all across the United Kingdom. Not only, it supplies but also it installs as well as commissions along with the add-on services like testing and maintenance of such machines. The Coffee Direct also provide free on-site training on the various of arts of coffee as it believe that without the knowledge of operating such machines, there is no point for the buyers to possess a high performance device. The training that the company provides is quite elaborate and includes the basic procedures of extracting the coffee in the proper and scientific way and also the organisation provides training on the various preparations of coffee like that of lattes, cappuccinos and various forms of espresso. The company makes it a point to carry out all the illustrations through adequately trained engineers (Coffee Direct, n.d.). The company acknowledges the fact that the two driving forces behind

Protecting Human Research Participants Coursework

Protecting Human Research Participants - Coursework Example Within these research areas, there is a robust Research Ethics Review Board (ERB). The team is tasked with approving research proposals in line with National Institute of Health (NIH) requirement (NIH Office of Extramural Reserach, 2010). It is a multi-disciplinary body made up of four members including a doctor, pharmacist, nurse, and case manager. Together, they review aspect of the proposal and ensure that they provide minimum protection under the ethical principles laid down in Belmont Report. In line with ERBs requirements, this body meet the minimum requirements as stipulated in the NIH provisions. Three aspects of their ethics works prove that they are in line with requirements. Firstly, these members are from medical professionals, thus knowledgeable in health and health research. They also meet twice every week to review proposals; the frequent meeting is an important part of work that all ERBs should meet. Lastly, this ERB has members with a myriad experience in health research.

Computer information Essay Example | Topics and Well Written Essays - 500 words

Computer information - Essay Example Both outlook express and MSN messenger support electronic messaging and the sending of electronic documents. The advantage of MSN messenger is that communication is faster rather than having to walk across the staff room to the person whom you wish to talk to. Documents can be sent via MSN messenger too. The disadvantage is that communication has to be real-time. If the person to whom you wish to communicate to is teaching classes, communication is impossible. Fortunately, there's always outlook express. The advantage of outlook express makes up for the disadvantage of MSN messenger. Communication is possible at different times from different places, in addition to the capability of sending documents. The disadvantage of outlook express is that verbal and non-verbal cues such as tone, inflection, and facial expression are missing (Montoya, 2003). Office automation systems include the electronic office such as computers, fax, and computerized telephone systems, as well as office automation applications such as word processing, electronic mails, desktop publishing, fax, image processing, and teleconferencing. The trend is to integrate these applications (Williams, Sawyer, & Hutchinson, 1997). In the school where I am teaching, we use computers, Microsoft office applications such as w

Gantt chart Essay Example for Free

Gantt chart Essay The phenomena of calendar effects in stock markets seem to be a center of curiosity for many researchers across the world. Following many studies about the significance of calendar anomalies, testing the presence of Monday effect and January effect appears to be an area of interest. The aim of this study is to discuss about calendar anomalies and its significance. It should be noted that the study will focus mainly on Monday effect and January effect on the stock returns of companies listed on SEM-7. The research proposal will consist mainly of the literature review part and the methodology part. 2.LITERATURE REVIEW 2.1DEFINITON OF BASIC CONCEPTS Calendar anomalies are effects which include apparently different behavior of stock markets on different days of the week, month and year. Calendar effect may also be defined as a collection of theories that state that certain days or month are subject to above price changes in stock market and can therefore represent good or bad times to invest. Brooks and Persand (2001) defined calendar effects as the tendency of stock returns â€Å"to display systematic patterns at certain times of the day, week, month or year †. As mentioned above, the study will discuss mainly on Monday effect and January effect. The day of the week effect also called Monday effect indicates that the average daily return of the market is not the same for all days of the week as we would expect on basis of Efficient Market theory. Monday effect is a theory which states that return of the last trading day is the highest and return on the first trading day is the lowest across the days of the week. January effect is a phenomenon whereby stocks claim higher rates of returns during January compared to any other month. Smaller stocks tend to beat bigger stocks during this period. The January effect also known as â€Å"year-end effect† indicates rise in price during the period starting on the last day of December and ending on the fifth trading day of January . The Stock Exchange of Mauritius was incorporated in Mauritius on March 30, 1989 as a private limited company responsible for the operation and promotion of an efficient and regulated securities market in Mauritius. The SEM operates two markets namely the official market and the Development Enterprise Market (DEM). The study will focus only on the official market. On 31 March 1998, the Stock Exchange of Mauritius launched the index SEM-7, comprising companies listed on its official market. The SEM-7 comprises the seven largest qualified companies of the official market measured in terms of market capitalization, liquidity and investibility criteria. Therefore, the study will be based on the 7 companies in the SEM-7. 2.2Theoretical Explanation on Calendar effects EFFICIENT MARKET THEORY The growing number of studies proving the significance of calendar anomalies has led to doubts on â€Å"Efficient Market Hypothesis†. According to Fama (1970), â€Å"a capital market is efficient if all the information set is fully reflected in securities prices†. Efficient market hypothesis is one of the theories which states that, in whichever form, all the information is completely integrated in the share prices and therefore no one can beat the market. There are three form of market efficiency; weak form, semi-strong form and strong form based on set of information. The weak form efficiency states that no one can outperform the market based on past information while in the semi-strong form, despite using public information, the market cannot be beaten. The strong form efficiency states that no one can beat the market despite using past, public and private information. As a result, according to the efficient market theory, the calendar anomalies have no effect on the share prices and that no one can use this anomaly to gain abnormal returns. MONDAY EFFECT As already mentioned above, Monday effect, also known as weekend effect, is a theory according to which returns on Monday is less than the other trading days. Two hypotheses that have been formulated to explain Monday effect are Calendar Time Hypothesis and Trading Time Hypothesis. According to the Calendar Time Hypothesis, Monday’s average return will be different from the other days’ average returns. A reason for this difference is that Monday’s average return will be three times higher than the average returns of the other working days. According to Trading Time Hypothesis, the returns on stock are generated during a transaction. This indicates that average returns will be the same for all weekdays including Monday. JANUARY EFFECT January effect occurs when there is a general rise in stock prices during the month of January. January effect is also known as small firm in January effect because it is most frequently observed in small cap stocks . The nature of this anomaly suggests that the market is not efficient as market efficiency would suggest that this effect would disappear. The theories which explain January effect are: †¢Tax-Loss Selling Hypothesis This hypothesis was first suggested by Branch (1997) . In order to reduce tax liabilities, investors sell their loser stocks in December and create capital losses which they offset with the capital gain. Due to excessive selling of shares in December, stock prices are decreased and then investors purchase it again in early January which forces stock prices to rise. However, it is noteworthy of the fact that since in Mauritius, capital gains is not liable for tax purposes, this hypothesis cannot be used to explain January effect. †¢Window-dressing Hypothesis Some portfolio managers also do window dressing to their portfolio by creating January effect. Since they have to report their portfolio holding as at 31 December, they just sell riskier stocks before 31 December in order to make their portfolio look less risky on Annual Report. Later on, they just purchase the risky securities again in a view to earn high profits. †¢Information Release Hypothesis According to this hypothesis, also known as differential information effect, the excess January returns are the effect of significant information releases that occur in the first few days of January. This hypothesis relies on how discrepancy in the quantity of information available for different companies may result in different returns. According to Rozeff and Kinney (1976), distribution of year-end information may have a greater effect on the prices of small firms’ securities relative to large firms because the market for small firm stock is less efficient . 2.3Empirical evidences on Calendar effects In order to investigate on the existence of calendar anomalies, there have been several studies conducted obtaining different results. In a recent paper by Haug and Hirshcey (2005) on January effect, evidence is found that the anomaly is significant for small cap stocks and continues to be consistent over time . Moreover, Fountas and Segredakis (2002) investigate about the significance of the monthly seasonality in the Amman Stock Exchange and find very significant January effects in this market.

Handwashing Practices among Health Workers

Handwashing Practices among Health Workers BACKGROUND Hand washing or hand hygiene is the process of cleaning ones hands with or without the use of water or another liquid, or with the use of soap for the purpose of removing soil, dirt, and/or microorganisms. Handwashing involves five simple and effective steps; Wet, Lather, Scrub, Rinse and Dry. Regular handwashing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others. Its simple, its quick, and it can keep us all from getting infected (CDC, 2016). The provision of healthcare worldwide is always associated with a potential range of safety problems. Yet, despite advances in healthcare systems, patients remain vulnerable to unintentional harm in hospitals (Devnani et al. 2011; Mani et al. 2010). One of the most significant, current discussions in healthcare delivery in hospitals is healthcare associated infection (HAI), sometimes called hospital acquired infection (Mani et al. 2010; Momen Fernie 2010) or nosocomial infection, which is any infection that a person develops as a result of treatment in hospital (Minnaar 2008, 2). Nosocomial infection is a global public health problem with an estimated 1.5 million suffering consequences at any given time [WHO,2009] noted that at least 25% of all hospital infections in the developing world are nosocomially acquired. The hands of health care providers are major agents of infection transmission in hospitals leading to the campaign to improve hand hygiene, Clean Care is Safer Care [WHO, 2005]. Two types of hand colonizing flora are predominant in hand skins. These are the Resident flora that are not easily removed by the simple friction associated hand washing and the Transient microorganisms which are not usually hand colonizers but they are most likely associated with infection [ Grayson, 2009]. Various types of such microbes are found on patients, instruments and other items and are important in infection transmission  [Hubner, 2006]. Improper hand washing practices serve as means of infection transmission in hospital wards (Duckro, 2005). Hand hygiene was thought to be a key factor in reducing hospital acquired infection during the initial development of healthcare systems (Akyol 2007; Ott French 2009). The battle with HAI started when the Hungarian obstetrician, Semmelweis (1847), observed that puerperal fever was more common on a maternity ward, where physicians and medical students provided care to women in labour, than it was on the ward where midwives assisted deliveries. He noted that physicians and medical students were contaminating their hands while performing autopsies and later attending the examination of women without hand washing. Arguably, he was the first to recognise the importance of hand washing in controlling the transmission of infection (Akyol 2007; Meers et al. 1992; Trampuz Widmer 2004). Equally important was the work of Florence Nightingale during the Crimean war, when she called for basic public health in a military hospital in Scutari in 1854. PROBLEM STATEMENT Hospital acquired infections has resulted in many negative impacts on health workers, patients and families over the world (WHO2012). The working environment, health workers and patients are the main reservoirs of hospital acquired related infection (weber, 2013). The transmission of infection from patient to patient mainly occurs at the hands of health workers (Ellingson K, 2014). The hands of health professionals are contaminated during patient care on a daily bases despite wearing gloves (Kendal A, 2012). Handwashing is critical in the prevention of hospital acquired infections. It is a very simple procedure and work well in the prevention of diseases as people are the carriers of pathogenic microbes. The practice is however unacceptably low among health workers (Takahashi Turale 2010; Trampuz Widmer 2004). Hand hygiene compliance rates in different developed countries rarely exceed 50% (Mani et al. 2010; Maxfield Dull 2011; Ott French 2009). For instance, figures show that in the USA it is 50%, in Switzerland 42% and in the UK 32% (Takahashi Turale 2010). Hence, poor compliance has resulted in high morbidity and mortality. In the USA, there are between 1.7 and 2 million people who contract HAI and 88 to 99 thousand deaths are attributed to HAI annually. Furthermore, HAI affects nearly 10% of hospitalised patients and presents major challenges in healthcare facilities. Consequently, annual medical expenses have increased in the USA to approximately $ 4.5 billion (Maxfield Dull 2011; Smith Lokhorst 2009; Trampuz Widmer 2004). Hand hygiene practice among HCWs is considered to be the single most clinical and cost effective measure to prevent HAI, a view recognised internationally (Momen Fernie 2010; Ott French 2009; Takahashi Turale 2010).The World Health Organisation (WHO) strongly emphasise the essential need for hand hygiene during healthcare delivery, to avoid possible infection and subsequent complications; hence, the Clean Care is Safe Care programme, launched by WHO in 2005 as part of the First Global Patient Safety Challenge. This programme offers new guidelines on hand hygiene training, observation and performance reporting in healthcare settings. Out of every 100 hospitalized patients, at least 7 in high-income and 10 in low-/middle-income countries will acquire a healthcare-associated infection. Among critically ill and vulnerable patients in intensive care units, that figure rises to around 30 per 100 (who,2014). Factors that contribute to poor hand washing compliance include absence of hand washing sinks, time required to perform hand hygiene, patients condition, effect of hand-hygiene products on the skin and inadequate knowledge of the guidelines(Larson and Kretzer, 1995; Simmons et al., 1999;Meengs et al., 1994; Doebbeling et al., 1992; Voss and Widmer, 1997). PURPOSE OF THE STUDY The purpose of this study is to determine the knowledge, attitude, and practices of healthworkers and also compare between healthworkers regarding their knowledge, attitude, and practices on hand washing. MAIN OBJECTIVE To determine hand washing practices among health workers in the Tamale West Hospital. SPECIFIC OBJECTIVES Assess the knowledge, practices and attitudes of healthworkers on handwashing Assess the differences across age groups, gender and experience regarding KAP of handwashing Compare between healthworkers regarding KAP of handwashing Assess the availability of resources for handwashing RESEARCH QUESTIONS What is the knowledge, practices and attitudes of healthworkers concerning handwashing? Are there differences across age groups, gender and experience regarding KAP of handwashing? Can KAP between healthworkers regarding handwashing be compared? Are there available resources for handwashing? SIGNIFICANCE OF THE STUDY Hand washing is considered the most important single and simple practice for preventing hospital acquired infection. An intricate problem may be caused by a number of factors if there is failure to practice effective hand washing. Understanding the factors that influence this behavior is key to change the behavior of poor effective hand washing practices. More studies are needed to identify, which of the factors contribute significantly to the problem of poor compliance with hand washing recommendation. OPERATIONAL DEFINITION OF TERMS Hand washing Hand washing is the process of cleaning ones hands with or without the use of water or another liquid, or with the use of soap for the purpose of removing soil, dirt, and/or microorganisms. Health care workers Professional personnel working in clinical setting of a health facility Veronica buckets Buckets used to store water for washing of hands Nosocomial infection/hospital acquired infection are infections gotten from the hospital setting. LITERATURE REVIEW KNOWLEDGE, PRACTICES AND ATTITUDES OF HEALTHWORKERS ON HANDWASHING Hand hygiene practice among HCWs is considered to be the single most clinical and cost effective measure to prevent HAI, a view recognized globally. Despite the relative simplicity of this procedure, adherence to hand washing recommendations is unacceptably low, usually well below 50% (Ekwere Okafor, 2013). Most nosocomial infections are thought to be transmitted by the hands of health care workers. It has long been known that hand hygiene among health care workers plays a central role in preventing the transmission of infectious agents. Hand-washing (HW) is the most effectiveway of preventing the spread of infectious diseases But despite a Joint Commission requirementthat Centers for Disease Control and Prevention hand hygiene guidelines be implemented in hospitals, compliance among health care workers remains low The reasons for low compliance to hand hygiene have not been defined in developing countries probably due to limited studies on hand hygiene. Factors that contribute to n oncompliance to HW among health careworkers are: lack of awareness and knowledge among health care workers as regard the importance, techniques, methods and quality of hand hygiene (Abd El Aziz Bakr, 2009). Alex-Hart and Opara, (2011) study on hand washing revealed that, more than halve (55.4%) of the health workers lacked the knowledge of good hand washing technique as most believed it involved the use of soapy water in a basin. This may be due to the fact that running water is not readily available, so the use of soapy water in a basin may have been the available alternative. With its repeated use over time, most health workers may have come to perceive it as the ideal hand washing technique. The NMCS Code of Standards and Conduct requires nurses and midwifes to provide a highstandard of practical care all the time. Yet, the momentum for hand hygiene, some nurses are still presenting with low compliance because they perceive it as not their problem, that it is something to do with infection control staff and they have to deal with it . Furthermore, Nazarko (2009) indicates that nurses often fail to practise hand hygiene because they are busy and they feel hand hygiene takes up precious time. In addition, nurses often perceive that gloves can be used as an alternative to hand hygiene. They usually tend to remove the gloves without washing their hands or use the same gloves to deliver intended care to multiple patients. Even when they remove their gloves, only 20% of nurses actually clean their hands (Ott French 2009). According to Canham, (2011) nurses avoid hand hygiene because they are frightened that skin problems such as dermatitis could develop, especially with alcoh ol hand-rubs. DIFFERENCES ACROSS AGE GROUPS, GENDER AND EXPERIENCE REGARDING KAP OF HANDWASHING Nurses tend to wash their hands more often than doctors and among non-health care workers, females tend to wash their hands more often than males. This study examined the influence of gender on the hand washing rates of health care workers (HCWs). The null hypotheses were that, there would be no inter-gender difference in either hand washing rates in healthcare workers across professions, or within professional groups. Although increased compliance with hand washing protocols has been shown to decrease infection rates, hand washing compliance remains poor, particularly among some professional groups. Studies of hand washing frequency have recorded hand washing rates following patient contact ranging from 10.6% to 61%, and significant differences have long been noted in hand washing frequency between professional groups such as nurses and doctors. (Van de Mortel, 2001) Van de Mortel, (2001) studies again found out found that, registered nurses (RNs) washed their hands following patient contact significantly more often than doctors in the Intensive Care Unit (ICU). The RNs washed their hands 71% percent of the time, whilst junior and senior resident doctors (RMOs) washed their hands 50% of the time and specialists washed only 25% of the time. He postulated that, failure to wash hands may be a gender-related phenomenon. The proportion of female nurses is considerably higher than the proportion of female doctors. In the above study, 90% of the nurses were female; 45% of RMOs and 6% of specialists were female. (Van de Mortel, 2001). Several studies have examined, among other variables, the influence of gender on hand washing frequency in health care workers however; these studies arrived at conflicting conclusions. Van de Mortel, (2001) found that hand washing frequency in the emergency department was lower among female nurses, RMOs and specialists tha n among males within each of those groups, however, the sample size of the study was small (n = 13 nurses, 11 RMOs, and 11 specialists). In contrast, in an extensive study of hand washing practices in two countries, it revealed that female health care workers were washing their hands more frequently than males, regardless of occupational group. However, this study was based on self-reported practices collected by questionnaire, and a degree of bias may have been introduced due to the fact that non-responders may have exhibited different behavior than responders. There is also a tendency for people to overestimate socially desirable behavior when answering questionnaires. To illustrate the latter point, Van de Mortel, collected data on hand washing frequency among doctors, both by means of questionnaires and by covert observation. He found that doctors estimated that they washed their hands 73% of the time, but the data collected by covert observation showed the percentage of doctors washing their hands following patient contact was in fact only 10.8%. METHODOLOGY This chapter describes the study area, the study design, the study population and the sampling procedure as well as the recruitment of respondents and the data collection procedure. The data entry and analysis is also outlined in this chapter. RESEARCH DESIGN This study is a cross-sectional study method designed to assess the knowledge, attitude and practices of health workers in TTH towards handwashing. Including assessing the differences across age groups, gender and experience regarding knowledge, attitude and practices of handwashing, and also, compare between healthworkers regarding KAP of handwashing RESEARCH SETTING The study will be conducted at the Tamale Teaching Hospital (TTH). It is a foremost tertiary referral centre providing patient care to residents of Tamale and neighboring towns and cities. There are 30 wards in Tamale Teaching Hospital. There are 74 doctors and 655nurses at the hospital. Hand-washing facilities are located in all the wards and clinics in the hospitals. Each ward is provided with at least a Veronica bucket for hand washing, running tap water, soap (liquid or cake) and sometimes, a towel for hand drying. TARGET POPULATION This study targets the clinical staff of the Tamale Teaching Hospital with a total population of 729. There are 31 wards in Tamale Teaching Hospital SAMPLE, SAMPLE SIZE, AND SAMPLING TECHNIQUE The sample size is 360 respondents this was arrived at by the using Cochran formula. Sample Size = [z2 * p(1-p)] / e2 / 1 + [z2 * p(1-p)] / e2 * N] N = population size z = z-score e = margin of error p = standard of deviation N= 729 Z= 1.96 (using 95% confidence interval) E=0.05 P= 0.5 Sample size = [(1.96)2*0.5(1-0.5)]/0.052 / 1 + [1.962*0.5(1-0.5)]/0.052* N Sample size = 384.16/1.076 Sample size= 357 An extra 3 was added to make it a total of 360 respondents. There are 30 wards in the hospital. 12 respondents would be sampled from each ward if they are eligible for the study. INCLUSION CRITERIA Respondents must be registered healthcare workers in the Tamale Teaching Hospital. EXCLUSION CRITERIA Medical, nursing and other clinician students are excluded from this study. DATA COLLECTION TOOL A well-structured questionnaire will be used to collect socio-demographic data, knowledge on handwashing from the respondents. PROCEDURE FOR DATA COLLECTION Probability sampling technique will be used. This is to help get an equal proportion of participants from the various wards used. The data collection will employ the use of structured questionnaire which respondents will check and will also give short answers to some questions to solicit data from respondents. All the wards will be successfully visited on a daily basis to get eligible participants for the study. These wards will be visited on a daily bases recruiting respondents until the last questionnaire is administered. The wards in the Tamale Teaching Hospital include; Purposive sampling will be used to select clinicians from the hospital who will be available during the data collection from Tamale Teaching Hospital. The study data will be collected based on the socio-demographic characteristics of respondents, general knowledge about handwashing, assess the differences across age groups, gender and their experiences regarding handwashing through the use of a structured questionnaire administered by the research assistants with minimal clarification from the research assistants. Primary data will be collected and used in the analysis. DATA ANALYSIS The data will be coded in excel and then entered into SPSS V.16 for analysis. Responses will be assigned codes in the form of numbers, which will make it easy for keying in the responses into a computer format. Univariate analysis will be done for socio-demographic characteristics of respondents and also for areas that require only descriptive statistics. Bivariate analysis will be performed to find associations or relationships between socio-demographic characteristics and level of knowledge, attitudes and practices of clinicians on handwashing. Likert item was rated on a 1-5 response scale; where strongly agree=5, agree-4, neutral=3, disagree=2, strongly disagree=1. The scores were graded into positive, neutral or negative. ETHICAL CONSIDERATIONS Ethical approval to use the hospital was from the Ethics and Research Committee of the hospital. Formal consent will also be obtained from the respondents prior to administration of questionnaire. Individual participants will be told that the study is purely for academic purpose and names as well as addresses will not be and also needed assuring them of their privacy and confidentiality. Respondents were also told that they had the right not to participate in the study. LIMITATIONS OF THE STUDY The cost and inexperience of researchers in conducting this study will be a challenge. Also, bias in the sampling procedure can also occur. REFERENCES Abd Elaziz, K.M. Bakr, I.M (2009) . Assessment of knowledge, attitude and practice of hand washing among health care workers in Ain Shams University hospitals, Cairo, Egypt J PREV MED HYG 2009; 50: 19-25 Alex-Hart A. B. and Opara, P. I. (2011). Handwashing Practices amongst Health Workers in a Teaching Hospital. American Journal of Infectious Diseases 7 (1): 8-15, 2011 Ekwere, T. A Okafor P. I (2013) Hand hygiene knowledge and practices among healthcare providers in a tertiary hospital, South West Nigeria Nazarko, L. 2009. Potential pitfalls in adherence to hand washing in the community, British Journal of Community Nursing 14:2, 64-68. Ott, M. French, R. 2009. Hand hygiene compliance among healthcare staff and student nurses in a mental health setting, Mental Health Nursing 30, 702-704. Van de Mortel, T. F. (2001) Gender Influences Hand washing Rates In the CriticalCare Unit. American Journal of Infection Control, vol. 29, no. 6, pp. 395-399.

Incorporating Telemedicine into a Surgical Practice

Incorporating Telemedicine into a Surgical Practice Kristen Harkey Complex wounds can create a challenge for the patient as well as the surgeon. The challenges faced include operative management, cosmesis, long-term management, effects on lifestyle for patient and caregiver, and self-image (Park, Copeland, Henry Barbul, 2010). Hospitalized patients will have the surgical team, the wound care specialist, and a bedside nurse to assist them in their daily care. When these patients are ready to leave the hospital they can feel anxiety about providing care for themselves, especially if they have a complex wound present. This anxiety can decrease once they learn how to care for themselves at home while having the readily available supplies, but then they must leave their homes to travel to come to the surgical office for a wound check. This can be a burden to not only the patient but their primary caregiver. The purpose of this paper is to introduce an evidence-based change project that focuses on providing patients with the option of telemedicine office visits. Background In 2010, approximately 51.4 million inpatient surgeries were performed in the US according to the National Center for Health Statistics (CDC/NCHS, 2010). Wound complications can be an important cause of postoperative morbidity following a laparotomy (Mizeell, Sanfrey, Collins, 2014). Acute wound care is needed in all patients with surgical and traumatic wounds, when an incision is made this creates a wound which will need further attention. There are a multitude of ways to address these wounds such as wet to dry dressings, dry packing strips, wound vac systems, and if needed further surgery such as a skin graft. These wounds can then become chronic when they have failed to proceed through the reparative process to produce anatomic and functional integrity in 12 weeks (Sen, 2009). Both acute and chronic wounds can become a significant financial burden on both the healthcare system and the patient’s themselves. Significance With the sheer number of surgeries listed above, this will create wounds that need to be managed appropriately. Not only are wounds created by surgery, they can also be created by trauma or massive soft tissue infections (Park, Copeland, Henry Barbul, 2010). Part of this management may be further surgical interventions to restore the fascia or possibly watchful waiting. In our facility in 2014, 3349 patients were evaluated by our wound care specialist. Of these 695 patients had surgically created wounds and approximately 656 were managed with wound vacs (G. Caldwell, personal communication, January 20, 2015). These patients will need to be followed in the outpatient setting for ongoing wound assessments, possible change in wound management, or further surgical intervention if indicated. The outpatient care to these patients will include discussions on proper nutrition to promote wound healing, activity levels, timing of dressing changes, and ongoing assessments of the wounds. It can create a significant burden to patient and caregiver to travel to office visits for ongoing assessment of the wounds which can take as little as ten to fifteen minutes to examine once they have arrived back to the exam room. This short office visit can create a significant burden to the patient and their caregiver, this burden can include ability to keep themselves clean throughout the trip, financial, and time-strain. PICO Question and Components Evidence-based practice (EBP) can be described as a â€Å"life-long problem solving approach to clinical decision-making that involves the conscientious use of the best available evidence with one’s own clinical expertise and patient values and preferences to improve outcomes for individuals, groups, communities, and systems† (Melnyk Fineout-Overholt, 2011). EBP will help to ensure high quality, safe, relevant, and up-to-date care while at the same time improving patient outcomes (Robb Shellenbarger, 2014). One of the ways to create EBP in a way that will yield the most relevant information from a search is to form a question in the PICOT format. The PICOT format is composed of the following: â€Å"P† will describe the patient population, â€Å"I† will reveal the intervention or issue of interest, â€Å"C† will reveal the comparison intervention or status, â€Å"O† will reveal the outcome, and â€Å"T† will reveal the time frame in w hich the intervention/issue of interest will accomplish the outcome (Melnyk Fineout-Overholt, 2011). For the purpose of this paper, the author will include all components listed except for time which will be addressed at another juncture. Population The population of focus will be outpatient postoperative patients in the home health setting. The patient population will be those with acute/chronic wounds, ages eighteen and up, both male and female patients with no restrictions on ethnicity. The wounds will likely be compromised of complex abdominal wounds, however no limit will be placed on the type/cause of the wound. The patient’s will live in North Carolina or South Carolina and reside within a 4 hour drive from Charlotte, NC. No restrictions will be placed on the agency providing home health services to the patient. Intervention Telemedicine is defined by the World Health Organization (WHO) to be the practice of healthcare using video, interactive audio, and/or data communications (Chanussot-Deprez Contreras-Ruiz, 2008). With the use of telemedicine the patients will be able to stay in their own home. This will also provide an enhanced team based approach because we will have both the patient, patient’s caregiver if applicable, and the home health nurse. This will provide accurate documentation of wound measurements. The appropriate wound care will then be provided by the home health nurse, and if applicable the wound vac will be re-applied. Comparison The comparison group will be a standard office visit. The standard office visit will consist of the patient and their caregiver coming to our surgical practice, in one of our two locations. The patient will be required to wait for their appointment time and wait as required for the provider to see them. If a wound vac is present, this will be removed in the office and will not be re-applied per standard operating procedures. The patient will have a temporary dressing replaced and will then need the home health nurse to come to their home upon their arrival to re-apply the wound vac. This consists of a standard office visit in our practice. Outcome The anticipated outcome, will be no effect on wound healing when using telemedicine. For the practitioner, one important aspect of examination of the wound is not only using your sense of sight but also your sense of smell. The smell of a wound can be indicative of necrotic tissue that requires further debridement or possibly a wound infection. This sense will be missing with telemedicine and the practitioner will need to rely heavily on the home health nurse for this aspect of assessment. Another outcome for this study will be increased patient satisfaction. The patient with a complex abdominal wound may have difficulty at baseline maintaining adequate coverage for the drainage, this is more of a challenge when you add frequent position changes associated with traveling to a health care provider’s office. In summary, a postoperative surgical patient will require care for the surgical wound in an outpatient setting. This care can be frustrating for the patient, the patient’s caregiver, and the home health nurse. With the addition of telemedicine to a surgical practice this will decrease the burden of traveling to a standard office visit as well as enhance multi-disciplinary care for the patient. It is the hope of the author that for complex wounds that remain difficult to manage in the outpatient setting, the inpatient wound ostomy nurses who provided care inpatient will be able to assist more in the outpatient setting by providing continuity of care. Conclusion With every surgery performed a resultant wound is created. Wounds can also be created by trauma or massive necrotizing soft tissue infections (Park, Copeland, Henry Barbul, 2010). The surgical wound can heal without difficulty and the patient returns to his activities of daily living, however a multitude of wound complications can occur delaying wound healing. Some wound complications will require further surgery, however due to the nature of these wounds surgery may need to be delayed for up to one year or longer. This can cause caregiver strain and for the patient can take away many of the freedoms we enjoy on a daily basis. As part of a standard office visit the patient is expected to arrange transportation to our office, wait for his/her appointment time, have their wound examined, and then if a wound vac is used they are expected to have this re-applied when they get back to their home by the home health nurse. With the addition of telemedicine to the patient’s postopera tive care, they would be able to have a multidisciplinary team visit them in the home using telemedicine resources. This would significantly decrease the burden travel can create for these patients with complex wounds. References CDC/NCHS National Hospital Discharge Survey (2010). Retrieved from  http://www.cdc.gov/nchs/data/nhds/4procedures/2010pro4_numberprocedureage.pdf Chanussot-Deprez, C. Contreras-Ruiz, J. (2008). Telemedicine in wound care. International  Wound Journal, 5(5), 651-654. Melnyk, B. Fineout-Overholt, E. (2011). Evidence-based practice in nursing healthcare: A  guide to best practice (2nd ed.). Philadelphia, PA: Wolters Kluwer|Lippincott Williams   Wilkins. Mizell, J., Sanfrey, H., Collins, K. (2014). Complications of abdominal surgery. Retrieved  from http://www.uptodate.com. Park, H., Copeland, C., Henry, S., Barbul, A. (2010). Complex wounds and their  management. The Surgical Clinics of North America, 90(6), 1181-1194.  doi: 10.1016/j.suc.2010.08.001 Rob, M., Shellenbarger, T. (2014). Strategies for searching and managing evidence-based  practice resources. The Journal of Continuing Education in Nursing, 45(10), 461-466. Sen, C. K., Gordillo, G. M., Roy, S., Kirsner, R., Lambert, L., Hunt, T. K., Longaker, M. T.  (2009). Human skin wounds: A major and snowballing threat to public health and the  economy. Wound Repair Regeneration, 17(6), 763-771. doi:10.1111/j.1524-475X.2009.00543.x Incorporating Telemedicine into a Surgical Practice Incorporating Telemedicine into a Surgical Practice Kristen Harkey Imagine presenting to the hospital for your planned cesarean section, a time of great anxiety and joy. During the procedure you unfortunately have a complication and an enterotomy (cut into the intestines) is made, but missed at the time. Hours later you develop increasing abdominal pain and a rash spreads quickly across your abdomen. Your healthcare providers explain you have an infection called necrotizing fasciitis and this requires further surgery to treat the condition. The individual then wakes up possibly weeks later with most of their abdominal wall, upper thigh skin, some muscle layers missing of both the abdomen and thigh, as well as stool draining from the middle of the wound. The individual is informed they have an enterocutaneous fistula that will likely not be able to be repaired for several months to a year. This person is finally able to transition home with their newborn, a gaping abdominal wound, stool draining from the wound, not allowed to have anything to eat or drink, and are attached to intravenous nutrition twenty-four hours a day. This would be overwhelming for the most health literate patient, much less an individual with limited resources and low health literacy. Our health can change quickly with an unexpected surgery that causes a complex surgical wound. This wound must be monitored closely in the outpatient setting to prevent further complications including loss of limb or possibly life. Typically the patient’s wound care has been provided in the home by a home health nurse. Subsequently the patient and family caregiver are then expected to travel to the doctor’s office for intermittent follow-up examinations of the wound over a weekly to monthly schedule which could last up to one year or more postoperatively. Leaving the patient’s home with these complex wounds can be a burden due to factors such as increased pain, time-consumption, financial costs, and possible embarrassment if the wound or ostomy appliance leaks. Some of this burden could be relieved with virtual visits. Overview of Problem of Interest In the United States 6.5 million individuals are affected with chronic wounds that require ongoing care (Sen et al., 2009). Patients are expected to travel to their healthcare provider’s office for follow-up examinations and sometimes this requires a long care ride, wait in the office, and then travel home. It is difficult to maintain a dressing on the wound in the most basic of circumstances, such as during times of everyday activity in their home. With the addition of traveling this can become an overwhelming and untidy endeavor while the healthcare provider will likely only spend minutes examining you. Due to this some patients will not come to their follow-up appointment and this can be detrimental to their health by prolonging wound healing, increasing risk for infection, and delay future surgical repairs. When the individual is at home, they require home health services for ongoing wound care as well as provision of supplies. The home health nurse sees the patient on a m ore regular basis than the healthcare provider and will call the providers’ office with important changes they note. Unfortunately this process may take several phone calls which takes valuable time for the home health nurse and increases wait time for care of the patient. Most patients have an expectation that surgery will help them heal or cure their disease. Unfortunately approximately 22% of patients may experience moderate to complete postoperative disability (Shulman et al., 2015). Home health nursing will provide some relief for the patient and a multidisciplinary approach is necessary to manage complex treatment modalities (Wilkins, Lowery, Goldfarb, 2007). In Carolinas Medical Center Main in 2014, 3229 patients had wound care provided by our wound ostomy care nurse team and of those 820 were surgical patients (G. Caldwell, personal communication, January 25, 2015). These are many of the patients that require ongoing care in the outpatient setting to prevent further complications. In the United States (US) in 2000, forty million inpatient surgical procedures were performed and at that time the need for post-surgical wound care was sharply on the rise (Chittoria, 2012). In the US the amount of money spent on wound care, diminished quality of life, and the loss of productivity for the individual and caregiver comes at a great cost to our society (Sen et al., 2009). Therefore it is in our best interest as providers to provide safe and effective care to our patients in the most convenient format for both the patient, caregiver, home health nurse, and the healthcare provider. Review of Literature One of the first steps to address a problem is reviewing evidence available to support the proposed intervention. Virtual care is currently being used in many different platforms such as urgent care, psychiatric care provided in ER’s, preventing readmissions in heart failure patients, and many other venues. The examination of acute and chronic wounds is one venue that has found success. In the plastic surgery population where visual exam is heavily relied upon for decision-making, telemedicine has been shown to have great potential. Gardiner and Hartzell (2012) performed a systematic review of twenty-nine articles. Twenty-eight of the articles noted a benefit including improved access to expertise and cost reduction through conserving hospital resources and avoiding unnecessary transfers (Gardiner Hartzell, 2012). Wallace, Hussain, Khan and Wilson (2012) had similar findings in the burn population where they noted improved assessment and triage, avoidance of unnecessary trans fers and a potential for health care savings when using virtual care. In the trauma population a 90% accuracy was noted in assessing traumatic plastic surgery injuries whether the practitioner was using bedside visual exam or transmitted digital images (Gardiner Hartzell, 2012). Wilkins, Lowery, and Goldfarb (2007) used their initial investigation to determine the feasibility of virtual wound care and then moved forward with performing a pilot study using a store and forward technique. At the time of initial referral the mean wound surface area was noted to be 5.85 cm2. Using virtual care the authors noted in 58.2% of the wounds, the diagnosis or treatment plan was changed. This change in diagnosis or treatment plan resulted in an average decrease of 58% from the initial wound size over an average time period of 40.2 days. The authors went on to note 95.5% of patients found telemedicine consultation more convenient than traveling and 98.2% of patients were either satisfied or very satisfied with the care they received (Wilkins, Lowery, Goldfarb, 2007). An article published in 2014 by Kidholm, Dineseen, Dyrvig, Rasmussen, and Yderstraede was noted to be the largest and most comprehensive research project to evaluate telemedicine effectiveness and costs for patients with chronic diseases. The results revealed telehealth reduced mortality with an odds ratio of 0.54. Mortality in the control group was noted to be 8.3% while the intervention group was 4.6%. The authors also noted a 10.8% lower hospital admission rates in the intervention group with an odds ratio of 0.82 (Kidholm, Dinessen, Dyrvig, Rasmussen, Yderstraede, 2014). Telemedicine may be applied to many different aspects of medicine, but a benefit has been shown in the examination and long-term treatment of wounds (Wilkins, Lowery, Goldfarb, 2007). Telemedicine has been shown to satisfy both the clinician as well as the patient, while continuing to provide quality care. Therefore a solution to the burden of traveling to the doctor’s office, decreasing financial strain, decreasing caregiver strain, and improving access to care are all potential benefits of providing care using virtual visits. Purpose of Project The purpose of incorporating telemedicine into our surgical practice is to provide our patients with the most efficient high quality care in the most appropriate setting for the patient. A standard office visit consists of the patient traveling to our office, being evaluated by the medical team, and then having to travel back to their home. This evidenced based project will allow the patient to stay in their own home and have the providers visit them via a virtual visit. Upon discharge from the hospital the patient will be evaluated for inclusion into the virtual visit program. If the patient is determined to meet the criteria including living in NC, using Healthy at Home to provide home health services and have a complex surgical wound; then an appointment will be made for the virtual visit. The home health nurse will proceed to the patient’s home at the assigned appointment time and use their tablet for the visit. The provider will then join the home health nurse in the virt ual setting and the patient’s wound will be evaluated. Appropriate changes in the treatment plan for the wound will occur and the provider will assure all questions/concerns are addressed with the patient, caregiver, and home health nurse. One desired outcome for this project will be to maintain a high level of patient satisfaction, as we do in our office. As providers, we would like to provide more efficient care and this may be possible by having one provider performing postop visits virtually while another provider evaluates new consults in the office. It will be important for this project to provide the same level of care that we provide in the brick and mortar office, as well as following all current standards of care. Project Management The facility where this project takes place is a Magnet facility. To receive this designation an organization must prove they have several key characteristics including empirical outcomes as well as integrating evidenced based practice and research into operational and clinical processes (American Nurses Credentialing Center, 2014). An important goal for our organization this year will be to provide care in new ways, one of which will be providing more opportunities for our patients to experience virtual care. This innovative project is meant to assure that we are improving quality, enhancing value and dealing with the complexity of health care today (Harris, Roussel, Walters, Dearman, 2011). Implementation Team The backbone of quality improvement work is the team and their teamwork (Ogrinc et al., 212). The team for this project will include individuals from different disciplines to ensure success. The author of this paper will serve as the operational lead on the project, assuring all aspects of the project are coordinated. Our administrative lead will be the practice manager for our outpatient sliding scale clinic. He will be able to assist the project in assuring we meet meaningful use standards as we do in the office, as well as building templates in our scheduling software, and facilitate changes in the organization. A management associate with the virtual care division will remain part of the team, as she has had past experience with implementing similar projects and has provided invaluable support. The next member of the team will be a member of the IT department and will assist the team in choosing the right technology/platform for this project. He will not only assist in the beginn ing stages of this project but will be a constant resource for ongoing IT support. The administrator for the home health agency will be a member of this team, she will provide information regarding her organization and provide us with establishing workflow for the home health nurse. This will be an important step as this project is meant to provide multidisciplinary care, however it will not be beneficial for it to provide more efficiency for our team but not the home health team. The chairman of surgery who also serves as the interim lead of the acute care surgery team, as well as the two surgeons who practice on the same service. This team will serve to bring virtual care visits to our surgical practice. Risk Management Strategy It is important to examine every project to identify external and internal items that either positively or negatively affect the project. One type of assessment that can be performed is the strengths, weaknesses, opportunities, and threats analysis (SWOT analysis). During the SWOT analysis the system is fully examined from the clinical micro to the macrosystem perspective (Harris, Roussel, Walters, Dearman, 2011). For this project some strengths noted include other departments within the facility using virtual visits and a department dedicated to assisting new groups to use this technology. Another strength is the patients included in this project will remain in the global ninety day postoperative fee which will not require reimbursement from insurance companies and keep the cost incurred limited. It is important to then examine some of the weaknesses which include removing a provider from an already overbooked clinic to participate in this project, the additional cost of the techno logy, and surgical postoperative care has not been provided in this manner in our facility prior to this. When further evaluating opportunities associated with this project, the ability to be the only surgical providers providing care virtually will set this team apart and appeal to more consumers and home health agencies. Another opportunity would be to include all home health care providers in our area and obtain licensure to be able to provide virtual visits in South Carolina. Some threats to this project include newer technology that hasn’t been tested, a good working relationship with the home health agency must be in place, and is it possible for the team to provide confidential care to our patients using virtual visit technology. Organizational Approval Process Initially this project was approved at the departmental level after multiple discussions with the chairman of surgery for the metro division of our healthcare system. Prior to proceeding to the IRB process, the facility requires submission of your proposal to the Nursing Scientific Advisory Council (NSAC). Once NSAC has evaluated a proposal fully and any revisions have been completed you may move forward with your submission to the IRB. Role of Information Technology in this Project Information technology will play an integral part of this project. Although virtual visits are used throughout the hospital system, they have not been incorporated into the surgical practices within our system. This project will include an IT tech to assist in choosing the best platform to serve our patient population while being user friendly for our home health nursing colleagues. It will be important for our platform to work well with the technology available to the home health nursing team. This will assure we are able to provide the best quality visit and address not only the provider’s needs, but also the home health team, patient, and caregiver. The project needs IT support for both the onsite provider as well as the home health team in the patient’s home. Plans for IRB Approval An institutional review board (IRB) is a committee that is mandated by the National Research Act, Public Law 93-948 and is required in institutions that conduct biomedical or behavioral research that involves human subjects (Harris, Roussel, Walters, Dearman, 2011). IRB approval will be sought for this project using the Carolinas Healthcare System’s IRB. The submission type will be expedited. This approach was chosen because it is evidenced based research and poses minimal human risk to the participants (Chatham University). Prior to approval by the IRB this project must be submitted to the NSAC therefore this will be performed in September 2015. Once approval has been obtained by the NSAC the information will then be submitted to the IRB for approval, likely in November 2015. This letter can be reviewed in Appendix A of this paper. References American Nurses Credentialing Center. (2014). Magnet model. Retrieved  fromhttp://www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-Model Chatham University. (n.d.). Institutional Review Board (IRB). Retrieved from  http://my.chatham.edu/tools/irb/ Chittoria, R. (2012). Telemedicine for wound management. Indian Journal of Plastic Surgery,  45(2), 412-417. Gardiner, S., Hartzell, T. L. (2012). Telemedicine and plastic surgery: A review of its  applications, limitations and legal pitfalls. Journal of Plastic, Reconstructive   Aesthetic Surgery: JPRAS, 65(3), 47–53. doi:10.1016/j.bjps.2011.11.048 Harris, J., Roussel, L., Walters, S., Dearman, C. (2011). Project planning and management:  A guide for CNLs, DNPs, and nurse executives. Sandbury, MA: Jones Bartlett  Learning. Kidholm, K., Dinesen, B., Dyrving., A, Rasmussen, B., Yderstraede, K. (2014). Results from  the worlds largest telemedicine project-The whole system demonstrator. EWMA journal,  14(1), 43-48. Ogrinc, G., Headrick, L., Moore, S., Barton, A., Dolansky, M., Madigosky,  W. (2012).Fundamentals of health care improvement: A guide to improving your  patients’ care(2nded.). Oakbrook Terrace, IL: The Joint Commission and the Institute  for Healthcare Improvement. Sen, C. K., Gordillo, G. M., Roy, S., Kirsner, R., Lambert, L., Hunt, T., . . . Longaker, M. T.  (2009). Human skin wounds: A major and snowballing threat to public health and the  economy. Wound Repair and Regeneration, 17, 763-771. Shulman, M. A., Myles, P. S., Chan, M. V., McIlroy, D. R., Wallace, S., Ponsford, J. (2015).  Measurement of Disability-free Survival after Surgery.Anesthesiology,122(3), 524-536.  doi:10.1097/ALN.0000000000000586 Wallace, D., Hussain, A., Khan, N., Wilson, Y. (2012). A systematic review of the evidence  for telemedicine in burn care: With a UK perspective. Burns, 38, 465-480. Wilkins, E., Lowery, J, Goldfarb, S. (2007). Feasibility of virtual wound care: A pilot study.  Advances in Skin Wound Care, 20(5), 275-278.

Aspects of Breast Cancer :: essays papers

Aspects of Breast Cancer According to the American Cancer Society, in the United States in 1997 alone, 180,000 people were diagnosed with a horrible disease. Of all types of cancer breast cancer ranks second and is the number one cancer which is fatal in women between ages of 15 to 54. This cancer is within the top three cancers of all women above the age of 15. This awful disease is breast cancer. Breast cancer is a group of rapidly growing reproducing, undifferentiated cells in the area of the breast in a woman. The earliest stages occur in the epithelial cells of the terminal end buds (TEB) of the breast milk ductal system. While the causes of breast cancer are unknown, the cells in the breast trigger a reaction of cell reproduction. These new cancer cells form tumors. If cancer cells are active or are considered malignate, the tumor grows at tremendous speeds, and may end up in metastasis. Metastasis is a process in which cells break away from their primary tumors and is carried through the blood supply or through the lymph system and relocate into other organs, thus spreading cancer throughout the body if left untreated. Generally, if a lump is less than one centimeter, it is considered benign, although every woman should consult her doctor about any unusual bumps or feeling in the chest. One sign of breast cancer results from ductal cancer in the breast. A once hollow open tube could be completely clogged up with cancerous cells thus leaving an awkward feeling in the chest area. The body is forced to supply nutrition for itself, but also for the large tumors that clog and cram the system. Although there are many different types of breast cancer, these are the most common. The first one is adenocarcinoma. It starts in the glandular tissues in any part of the body. Even though that it is a commonly diagnosed cancer the prognosis can vary greatly due to when the cancer is found. This accounts for nearly all breast cancer. Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer. It starts in ducts but doesn^Ã’t spread through the duct walls. The best way to detect this kind of cancer is by a mammogram. This may change into an invasive cancer if not caught in time. If it changes then it is called an infiltrating ductal carcinoma (IDC). This form of invasive cancer invades the fatty tissue of the breast. IDC invades to other parts of Aspects of Breast Cancer :: essays papers Aspects of Breast Cancer According to the American Cancer Society, in the United States in 1997 alone, 180,000 people were diagnosed with a horrible disease. Of all types of cancer breast cancer ranks second and is the number one cancer which is fatal in women between ages of 15 to 54. This cancer is within the top three cancers of all women above the age of 15. This awful disease is breast cancer. Breast cancer is a group of rapidly growing reproducing, undifferentiated cells in the area of the breast in a woman. The earliest stages occur in the epithelial cells of the terminal end buds (TEB) of the breast milk ductal system. While the causes of breast cancer are unknown, the cells in the breast trigger a reaction of cell reproduction. These new cancer cells form tumors. If cancer cells are active or are considered malignate, the tumor grows at tremendous speeds, and may end up in metastasis. Metastasis is a process in which cells break away from their primary tumors and is carried through the blood supply or through the lymph system and relocate into other organs, thus spreading cancer throughout the body if left untreated. Generally, if a lump is less than one centimeter, it is considered benign, although every woman should consult her doctor about any unusual bumps or feeling in the chest. One sign of breast cancer results from ductal cancer in the breast. A once hollow open tube could be completely clogged up with cancerous cells thus leaving an awkward feeling in the chest area. The body is forced to supply nutrition for itself, but also for the large tumors that clog and cram the system. Although there are many different types of breast cancer, these are the most common. The first one is adenocarcinoma. It starts in the glandular tissues in any part of the body. Even though that it is a commonly diagnosed cancer the prognosis can vary greatly due to when the cancer is found. This accounts for nearly all breast cancer. Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer. It starts in ducts but doesn^Ã’t spread through the duct walls. The best way to detect this kind of cancer is by a mammogram. This may change into an invasive cancer if not caught in time. If it changes then it is called an infiltrating ductal carcinoma (IDC). This form of invasive cancer invades the fatty tissue of the breast. IDC invades to other parts of

Engrave New Footprints In The Sand :: essays research papers

There were two strolling hearts that reposed on a huge rock at a near shore. As the sunset revealed its passion, they watched over the two sets of footprints they engraved in the sand. The scene had made them thought of eternity..two becoming one. There was heaven in their hearts and each step engraved a zeal of an endless love. But such heart-felt scene ended when the waves of the sea rushed towards the shore and washed the sand, leaving the sets of footprints unseen. Suddenly, the lovely sunset was covered with dark clouds and the soft breeze altered into a fierce wind. Heaven, then, became an illusion; the dream ended into a nightmare. And the rock were both of them once dreamt was left alone, all alone... When we fall in love, it is our great desire to let the feeling remain in hearts. Often, we feed this feeling by clinging to the other. Sometimes the demand for satisfaction is needed because of the fear of starving the heart. As we marvel towards the odyssey of our lives, we may pass to the point wherein our hearts become empty and longing. We feel the need to quench ourselves by seeking the oasis of love. Still, there are hearts that remain at lost and leave themselves to die and wither. Many of us find it easy to play the melodies of love, but when things get rough and out of tune, we would actually avoid it and sometimes, go silent. There is also a tendency to give up and escape from the reality. We must remember that the more we unravel the wonders of love, the more challenges we have to take. The sweetness of life's bitter can be achieved if we accept the challenges of love. This acceptance motivates us to grow.

The Carb-Cutting Atkins Diet Essay -- Health Nutrition Diet Exercise E

The Carb-Cutting Atkins Diet America is getting fatter. Recent statistics have shown large leaps in percentage the overweight in our country. As the obesity epidemic continues to grow, companies and nutritionists around the country work at a fanatical pace to develop new techniques which they claim can help prevent the emergence of an overweight America. Often, these techniques include diets – ranging from the highly sensible to the highly controversial. One such meal plan, which has recently been in the center stage of the media, is the carb-cutting Atkins Diet. Started in 1972 by the late Dr. Atkins, the diet of his namesake has had books, TV programs and even energy bars dedicated to it. One of these bars, the Atkins Advantage ® claims to be able to help with weight loss by lowering sugar levels in the blood, which in turn will aid in fat burning. One important question remains though: Is this claim supported? However, before answering this problem, we must first understand how the diet in question works.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  While many diets attempt to limit the number of calories consumed per meal, the Atkins diet instead tries to lower the carbohydrate content of these meals. The reasoning comes from the theory that carbohydrates - complex sugars found in bread and starchy foods, will lead to an increase in levels of another chemical, insulin. Insulin is a chemical that regulates several important factors in the human body, including that of weight and hunger. Nutritionists supporting the Atkins plan believe that high levels of insulin in the bloodstream actually slow down the body’s process of burning fat, known as lypolysis. In addition, Atkins supporters claim that because of the che... ...   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Despite the recent success and initial positive results of the Atkins diet, the bar does not seem to share the same qualities. Unfortunately for its creators, the Atkins Advantage ® bar contradicts the entire framework and basis of the Atkins Diet. While the goal of the energy bar was to reduce insulin levels, laboratory tests have suggested otherwise. Such would almost completely impair any benefits to the body from a low blood sugar level. It is quite possible that the excess insulin would store what little blood sugar there was in the body, and make consumers hungrier, faster. It appears that while many aspects of the Atkins diet do work on the premise of lowering blood insulin levels, the energy bar fails miserably. More tests would need to be performed, however, before a truly clear view of this bar and its effects can be formed.

Information System in Global Business Today Essay

1. What are the inputs, processing, and outputs of UPS’s package tracking system? Inputs: firstly, the scannable bar-coded should be pasted to the package, there are some information on the scannable bar-coded, like the sender, the destination, and the time of the package arrive. And then, customer could get own labels by UPS. For example, people could go to the UPS web site and use special software to download this information. The data off labels would be delivered to the UPS’s computer centre that nearest final destination, before the package pick up. Furthermore, workers should download these labels information by using UPS software and establish some special delivery route for every driver; people should consider some factors that affect package transmission, like traffic, weather conditions, and the location of every stop. Processing: there are some points that through from the sender and the receiver. Bar code equipment could scan labels to get some package information and send these data to the centre computer. By this way, customer also could check package information from web site, customer could check the data that extreme detailed, it contains delivery routes, calculates hipping route, determining time in transit, and so on. Outputs: first of all, the data that collected from web site are transported to the centre computer and back to the customers. Moreover, UPS also provides some tools that convenient customer to visit own web site, like Cisco system, it can be embed UPS function.

King v Cogdon

King v Cogdon, was an Australian cuticle heard in 1950. Ms. Cogdon who suffers from minor psych mavenurotic conditions is believed to be her daughters murderer. She had on an occasion visiont spiders were attacking her daughter ( sick). That darkness Ms. Cogdon had slept walked into her room and began to violently brush the spiders withdraw her daughters face in her sleep. On the night of the murder, Ms. Cogdon dreamt of soldiers attacking Pat. though Ms. Cogdon did not recall the incident, she remembered telling her babe that she thought she had hurt Pat.Unconscious Crime Sleepwalkers exclude in a state of dispirited consciousness, but are able to work out activities that would early(a)wise be performed in a state of full consciousness.These activities can regurgitate anywhere from Cleaning, hazardous cooking, driving, grabbing at hallucinated objects, or even homicide. Usually sleep walk of life in adults is a sign of drug wickedness or just about sort of disorder. somnambulate is less common in adults than children. Although, sleepwalkers concur their eyes open, they have very circumstantial or no memory of the incident.Sleepwalkers draw bystanders of their own crimes. With this said, should Ms Cogdon be held answerable for the death of her daughter while sleepwalking? Was the Killing of Pat Involuntary? Ms. Cogdon and Pats relationship was a beside one. Ms. Cogdon always worried about her 19 year old daughter Pat, who had for some time been receiving psychiatric treatment for a minor neurotic condition. Although doctors had said she was cured, Ms Cogdon often worried that she was okay.The night onward Pats death, they had both at peace(p) to the cinema.During their outing they had engaged in a conversation having to do with the war in Korea. This war troubled Ms. Cogdon. She was worried it would one day reach her door steps. Because of her sleepwalking, and other difficulties she had reported to her doctor, he had prescribed her a sed ative. There had also been talk of the possible action of psychiatric treatment. That night that Ms. Cogdon fell asleep, she began to dream of the war, and that one of the soldiers was attacking Pat in her bed.It was then when Ms Cogdon in her sleepwalking state, grabbed an axe and struck Pat on the head twice with it killing her. somnambulate is one form of automatism, and does not inhabit of free will. Because sleepwalking is a phenomenon in its own, courts are not properly fit to evaluate such claims. During the trial Ms. Cogdon maintain not guilty, but refused to plea insanity. Experts agree Ms. Cogdon was not psychotic. Acquitted of Murder Ms.Cogdon was currently released of the murder charges with the defense of automatism. It was believed that Ms. Cogdon had been sleep walking when she wandered into Pats room, and her bodily motions were beyond her control. Her story was also supported when her doctors gave tribute that she indeed suffered from mental and physical stre sses. At the trial there was enough exhibit to believe Ms Cogdons acts were involuntary, and thus convincing the jury of her innocence. Ms. Cogdon was then label of the crime.