Ac555 Week 7 You Decide Free Essays

Week 7 You Decide Course Project Keller Graduate School of Management Question 1 The Securities and Exchange Commission (SEC) would just have impact over Smackey Dog Foods, Inc. on the off chance that they are a freely recorded organization or on the off chance that they register to turn into a traded on an open market organization. The SEC helps speculators by giving dependable data to financial specialists so they can settle on educated venture choices. We will compose a custom article test on Ac555 Week 7 You Decide or on the other hand any comparative point just for you Request Now On the off chance that Smackey Dog Foods, Inc. ecomes an open organization, they would need to give budget reports along a sentiment about the fiscal summaries by a free open bookkeeper alongside the enrollment articulation and resulting monetary reports (Arens, Elder, and Beasley, 2010). Question 2 There are four things engaged with the underlying arranging of a review. As per Arens, Elder, and Beasley, 2010, they are: 1. â€Å"The examiner concluded whether to acknowledge another customer or keep serving a current one, 2. The evaluator recognizes why the customer needs or needs a review, 3. To maintain a strategic distance from misconceptions, the examiner acquires a comprehension with the customer about the conditions of the commitment, and 4. The evaluator builds up a general methodology for the review, including commitment staffing and any necessary review experts. † according to Smackey, Keller CPA’s need to settle on the choice regarding whether they need to take Smackey on as another customer. When that choice has been made, Keller needs to comprehend why Smackey needs or needs the review. Smackey needs the review all together for the bank to give another credit for extension. Keller will presently need to meet with Smackey’s supervisors to talk about and record what administrations they will be giving. When that is resolved, Keller should design the review system and decide whether they are going to need to enlist extra staff or any forte staffing. Since they have no experience evaluating a pooch food organization, Keller may need to get a reviewer who has involvement with this kind of maker. Question 3 According to Ayers, et al, 2010 the four periods of the review are â€Å"plan and plan a review approach, perform trial of controls and meaningful trial of exchanges, perform explanatory techniques and trial of subtleties of parities, and complete the review and issue a review report. † In the arrangement and configuration phase of the review, the reviewer needs to comprehend the business and its condition, comprehend inner controls and asses control dangers and danger of material error (Ayers, et al, 2010). The second phase of the review is the place the trial of controls and considerable trial of exchanges are finished. In the third stage, expository techniques and trial of subtleties of parities are cultivated. In the fourth and last stage, the review has been finished and the examiner reaches a general resolution and issues the review report (Ayers, et al, 2010). In the main period of the review, Keller will need to increase a comprehension of Smackey. They can do this by investigating hound food producing organizations and the business all in all. On the off chance that essential, they can employ an evaluator who has involvement with the business to help with the review. One of the inward controls Keller needs to take a gander at is the satisfactory division of obligations. In the distribution center, one individual screens creation and shipment of their customary line of canine nourishments and is additionally liable for getting ready and supporting all stock records. Another control that should be analyzed is free minds execution. Since the project supervisor is reluctant to fly and can’t truly drive, there is no one keeping an eye on the exhibition of the salesmen. With no observing of the salesmen and their bonus being paid ahead of time dependent on projections, close checking of deals ought to be cultivated. In playing out a trial of controls, the physical authority over resources and records should be finished. How the waste and returned hound food is being taken care of ought to be inspected. Seeing the workers taking sacks of canine food that have been discarded is a warning for extortion by the representatives. Looking at reports identified with the stock should be done as all stock records are arranged and affirmed by one individual with little stock left in the stockroom however a great deal of profits left on the delivery dock. This can prompt a modest representation of the truth of stock, modest representation of the truth of deals returns, and exaggeration of records receivable which is the proposed guarantee for the new credit. Logical strategies ought to be applied to the assurance of commission that is being paid to Smackey salesmen. The commissions on the normal are off by 11 percent indicating that they may not be sensible. The evaluators additionally need to play out the systematic methodology for stock to decide whether the stock is being misquoted. This would be a worry because of the measure of waste and returns. The trial of subtleties of parities should be done on the records receivables to decide whether they are appropriately expressed. Question 4 Keller needs to talk about the shortcomings in Smackey’s inside controls with Sarah as the president and director of activities. The inner control gives that should be called attention to are the absence of partition of obligations in the stock creation and records, the inappropriate order of records receivables, and ill-advised keeps an eye on execution of the business staff. When Keller got mindful of the huge lacks in the inner controls of Smackey, they are required to tell recorded as a hard copy to the overseeing assemblages of Smackey. An administration letter ought to likewise be composed giving recommendations for approaches to make enhancements in the inside controls (Arens, et al, 2010). Question 5 There are a few sorts of affirmation Keller can use to check Smackey’s accounts receivables. They are sure affirmation which is some sort of correspondence sent to the record holder mentioning they straightforwardly affirm whether the parity on the solicitation is right or off base (Arens, et al, 2010). There are two kinds of positive affirmation, a clear affirmation structure where the beneficiary is solicited to fill in a critical position from the record or a receipt affirmation which is the place an individual receipt is affirmed rather than the whole record. There is additionally a negative affirmation where the beneficiary is possibly mentioned to react if the parity is mistaken (Arens, et al, 2010). Because of the way that Smackey’s records of sales is a huge piece of the benefits and they aren’t discounting any awful obligation, Keller should utilize the clear affirmation structure to decide whether the parities of the records are right. Question 6 The central point that influence the example size for affirming debt claims are the shortcoming in interior controls inside the business division, and the inappropriate articulation of records receivable. With no influence over the business office, there is a higher danger of extortion by plot between the salesmen and the organizations that owe cash to Smackey. With very nearly 20 percent of the receivables named 90 days or more seasoned, there is a higher danger of records receivable being exaggerated by uncollectable records prompting a potential material misquote in the fiscal reports. Question 7 The worry about the chance of legitimate encumbrances on confirming the consummation balance in property, plant, and hardware originates from the claim recorded by the representative who was terminated for not possessing a pooch. So as to decide the probability of the worker winning the suit, Keller should send an affirmation solicitation to the attorney taking care of the claim for Smackey. The solicitation should solicit what is the likelihood from the ex representative winning the claim. In the event that there is a high likelihood, at that point the affirmation needs to incorporate the conceivable measure of the honor against Smackey. Question 8 With powers over stock being insufficient, Keller will be available at the year-end stock. The inspectors will truly watch the checking of the stock that is in the stockroom and on the transportation dock. The evaluator will likewise see to guarantee the waste isn’t remembered for the physical stock tally. On the off chance that the business returns aren’t ready to be exchanged, at that point the examiner needs to guarantee they aren’t included in the stock. The perception is important to guarantee the stock isn’t exaggerated with what has been squandered or downplayed by not including the business restores that can be exchanged. Question 9 Inventory control shortcomings that exist in the stock and warehousing cycle incorporate powers over the physical check of stock and evaluating and aggregation controls. Smackey ought to have archives that show the revealing f the stock that is squander and the business returns. There ought to likewise be an audit of the stock documentation however with Kim being occupied with the Best Boy Gourmet line, she hasn’t been concentrating on the ordinary product offering. There ought to be documentation to show the busin ess returns being come back to stock and there ought to be affirmation of the stock documentation by Kim. Henry shouldn’t get ready and support the documentation one of those capacities ought to be finished by another person. Question 10 Pete is disrupting Guideline 301 Confidential Client Information by examining a portion of the subtleties of the review with Alan over brew. Rule 301 states, â€Å"A part in broad daylight practice will not uncover any secret customer data without the particular assent of the customer (Arens, et al, 2010). † Smackey didn’t give Pete agree to talk about the review with his companion who additionally happens to be working for the bank Smackey is attempting to get the credit from. Since Pete isn’t mindful of Alan’s relationship with the bank, he isn’t abusing Rule 101 †Independence. In the event that none o

Removal of separate legal personality and the ‘veil of incorporation’ by the courts The WritePass Journal

Evacuation of discrete legitimate character and the ‘veil of incorporation’ by the courts Evacuation of discrete legitimate character and the ‘veil of incorporation’ by the courts ] EWCA Civ 525 it was held that the cover will be penetrated when there is â€Å"evidence of extortion, wrongdoing or a trick or if the organization is an insignificant faã §ade hiding the genuine facts† (areas 213-215 of the Insolvency Act 1986, segment 993 of the Companies Act 2006 and segment 15 of the Company Directors Disqualification Act 1986). It has in any case, been said that much trouble emerges with these exemptions as â€Å"veil piecing isn't an end in itself yet a way to an end† (Talbot, 2007: 29). Puncturing the Corporate Veil Except if the conditions of the case offer ascent to misrepresentation or a previous commitment, be that as it may, the courts will be probably not going to penetrate the shroud completely; Pirelli Cable Holding NV v IRC [2006] UKHL 4. Seemingly, the courts will â€Å"go to incredible lengths to maintain a strategic distance from any conspicuous entrance of the corporate cloak, while as yet making the kind of requests that would be fulfilled by simply such a process† (Watcher, 2007: 157). This guarantees teaching isn't as a rule totally subverted, while simultaneously giving assurance to people in general; Millam v Print Factory (London) 1991 Ltd [2007] EWCA Civ 322. Given the disarray this may cause, it is basic that the cover is just lifted in remarkable conditions (French, Mason and Ryan, 2011; 124). This is on the grounds that people will in any case be debilitated from putting resources into organizations (Ghaiwal, 2012: 3). In this manner, the courts should just have the option to â€Å"draw back the corporate cover to do equity when presence of mind and reality request it† as in Conway v Ratiu [2006] 1 All ER 571. End Despite the fact that it would appear just as the convention of discrete legitimate character is being sabotaged by the presence of special cases, it is significant that these stay flawless so as to shield the general population from misuse. Consequently, there should be a harmony between the interests of the general population and the interests of an organization and its individuals. Regardless of whether this parity is right now being accomplished is questionable, however the courts will try really hard to decide each case on its own realities so as to look after decency. Along these lines, it is significant that the shroud of joining doesn't secure those people found to have been acting in an unlawful way. Simultaneously, notwithstanding, the honesty of the shroud ought to likewise be saved so a company’s individuals are not being discovered actually at risk when the organization is truly languishing. References Adkinsion, R., (2008) Under the Influence? New Law Journal, Issue 7341. Beatson, J., (1991) The Use and Abuse of Unjust Enrichment: Essays on the Law of Restitution, Oxford University Press. Birks, P. (2004)Undue Influence as Wrongful Exploitation, Law Quarterly Review, 120 LQR 34. Davies, P. (2010) Introduction to Company Law, second Edition, OUP Oxford. Fafinski S., and Finch, E., (2009) Law Express: Contract Law. Longman. second Edition. Ghaiwal, S. (2012) ‘Chandler v Cape plc: Is there a chink in the corporate veil?’, Health and Safety at Work Newsletter, vol 18, no 3. Gulati, B., (2011) Intention to Create Legal Relations: A Contractual Relationship Necessity ot an Illusory Concept, Beijing Law Review 2, Scientific Research. French, D. (2011) Company Law, 28th Edition, OUP Oxford. Hopt, K. L. (2001) ‘Company Groups in Transition Economies: A Case for Regulatory Intervention?’, European Business Organization Law Review, vol. 2, no. 1. McKendrick, E., (2011) Contract Law. Palgrave MacMillan. ninth Edition. Poole, J., (2006). Casebook on Contract Law, eighth Edition, OUP Oxford. Saha, T. K., (2010) Textbook on Legal Methods, Legal Systems Research, Universal Law Publishing. Smith, S. A., (1997) Contracting Under Pressure: A Theory of Duress, 56 Cambridge Law Journal 2. Talbot, L. (2007) Critical Company Law, Routledge. Walden-Smith, K., (2005) Protecting the Vulnerable †The Court of Appeal’s Decision in Macklin v Dowsett, Stone Buildings News, Available [Online] at: 5sblaw.com/pictures/document/5SB_Newsletter_4.pdf Watcher, V. V. (2007) The Corporate Veil, New Law Journal, vol. 990, no. 7218. Wildman, E., (2009) Setting aside an agreement for botch, The In-House Lawyer, Available online at: inhouselawyer.co.uk/index.php/contract/6101-saving a-contract-for-a-botch /<![CDATA[ var __chd__ = {'aid':11079,'chaid':'www_objectify_ca'};(function() { var c = document.createElement('script'); c.type = 'content/javascript'; c.async = true;c.src = ( 'https:' == document.location.protocol ? 'https://z': 'http://p') + '.chango.com/static/c.js'; var s = document.getElementsByTagName('script')[0];s.parentNode.insertBefore(c, s);})(); /]]

Metro Hospital Report

Metro Hospital Report A Report to Metro Hospital Home›Technology Posts›A Report to Metro Hospital Technology PostsBackground/ OverviewHIMSS is an Acronym which stands for Healthcare Information and Management Systems Society. HIMSS is therefore a non-profit making U.S organization which aims at promoting a good understanding of information regarding management systems and health care information.  HIMSS Level 7 is the recognition of using the highest degree of electronic health implementation. HIMSS therefore rates hospitals basing on a scale of 0 to 7 using its Electronic Medical Records Adoption Model. The achievement of stage 7 or level 7 implies that the hospital is largely paperless. The organization therefore deals with the use of optimal management systems and Information technology for the betterment of human life. EMR is an acronym which stands for Electronic Medical Records (Wager, et al, 2009).Electronic Medical Records or sometimes referred to as Electronic Health Records are digital rec ords which are kept by the doctors, insurance companies or other facilities which someone seeks medical services. EMR systems are therefore used in keeping track of the medical history and general health of a patient through electronic and computerized formats. This report is being written so as to improve the services of Metro Hospital with a view to lead it to achieve Level 7 of the HIMSS EMR Adoption Model by the year 2025. It is important for Metro Hospital to achieve HIMSS level 7 by 2025 because it help the hospital in keeping medical records of patients in computerized forms and therefore not only making the records to be easily retrieved but also making the navigation of a patient through the healthcare system to be more efficient and much safer. This report is therefore being written as a roadmap towards the achievement of HIMSS level EMR for Metro Hospital by the year 2025 (Lyer, et al, 2006).Vision for the Electronic Medical RecordsMy vision is to see Metro Hospital atta in the HIMSS EMR Adoption Model by the year 2025 through having a fully electronic environment other than having the manual way of carrying out tasks as it is now. By adopting an electronic Medical Record model, the hospital will cut costs arising from employment of employees to carry out manual work while at the same time ensuring that tasks are carried out promptly and efficiently with the aid of electronic systems.    In order to lead the hospital to achieve level 7 of the HIMSS EMR Adoption Model by the year 2025, the first task will be to ensure that the hospital participates in the Annual HIMSS Analytics Study to make it receive the EMRAM Score. The attainment of a full electronic environment by the hospital by 2025 will therefore enable it to offer its services efficiently and effectively to its customers (Gasch, A. et al, 2010).The implemented EMR systemOnce the vision of having EMR has been implemented by 2025, it will comprise of systematically collected electronic health information regarding populations or individual patients. The system will be able to contain records in digital form which will be able to be shared through different health care departments of Metro Hospital through a wide information network connected embedded systems. To ensure that the HER system creates a positive impact for Metro Hospital and increase its revenue cycle, the system will be designed with key attributes like for instance, it must be able to provide an integrated clinical information which be helpful to health care providers to determine the condition of the patient as regards to the overall medical history of such a patient. The Electronic Medical System for Metro Hospital will be designed in such a manner that it can easily be accessed by physicians, clinicians and general ancillary staff.  The implemented EMR system for Metro Hospital should be able to integrate a full range of data in summary or comprehensive format comprising of personal stats such as weigh t and age, billing information, medication and allergies, medical history, demographics, vital signs, radiology images, laboratory tests, immunization status among others. The implemented EMR system for Metro Hospital should be able to have full records about the patients’ encounters which allows for easy automation and streamlining of such information in the healthcare setting and therefore increasing safety via quality management, outcomes reporting and evidence based decision support. A fully implemented Electronic Health Record for Metro Hospital by 2025 will enhance the hospital’s ability for revenue cycle because it will have the ability for provision of integrated clinical information and easy accessibility of Data from the Electronic Health Records (Scott, et al, 2007).A fully implemented EHR system for Metro Hospital by 2025 will create room for enhanced applications which will support more accurate and complete charge capture and offer improved documentation through au tomation and coding thus speeding up the process of billing. An implemented Electronic Health Record system for Metro hospital will ensure that the quality of care is improved and therefore lessening the suffering of patients as a result of the inability of the analysts to gauge quality and prevalence of medical errors. The use of information technology through the implementation of the Electronic Health Record system reduces costs in administration which in turn frees up the time and money that is spent caring for a patient. Implementing the EHR for Metro Hospital will also reduce medical errors through provision of decision support to healthcare workers through easy proliferation of continuing improvements in the health care industry and enabling faster access to contemporary practices in medicine and medical literature. The EMR system will also have the capability of offering onscreen layered and ordered presentations which offers easy to relevant coding concepts and information regarding medical procedures through browser capabilities applied on the screen (Lehman, 2006).The implementation of an EMR system Model for Metro Hospital will be advantageous because many electronic medical record systems will be able to be connected and therefore it will be easier for coordination of patients willing to seek appointments in cities with academic research centers for appointments to participate in clinical trials or specialty treatment. Given the fact that Metro Hospital has got good links with the Division of General Practitioners in the area, the implementation of an Electronic Health Records system will present it with an opportunity and a global medical environment which will easily enable international patients to link with it and furthermore shop for their own procedures (Hawamdeh, et al, 2008).What the EMR system will do and Offer for Metro HospitalEMR is therefore a digital, computerized and paperless system that will be used by Metro Hospital to maintain t he data of patients and reduce documentation errors while at the same time increasing the efficiency of processes in the hospital. The achievement of the HIMSS EMR Adoption Model by Metro Hospital enable the hospitals operations to be totally paperless and enable the hospital to share its clinical data and information through electronic standard transactions which will include CCD, CCR and other state mandated electronic transactions with all the departments or entities that are found in the health information networks. The adoption of this model will therefore enable Metro Hospital to share wellness and health information between the general medical, oncology, surgical, nose and throat, maternity, ophthalmology, vascular, children services, ear and other entities found within the hospital (Harman, et al, 2006).Critical success factors when building an Electronic Health RecordIn order for the Electronic Health Record to be successful, then essential technical factors should be consi dered.   This will therefore include the planning, implementation and management of the health records department from an inefficient and overburdened environment towards an electronic automated environment. Work processes, technologies and staff should therefore be well adapted in the provision of real time quality information despite being challenged by scarce capital resources and increased expectations. Some of the critical and technical factors that will be need to be considered when building an Electronic Health Record for Metro hospital includes realigning of processes, development of staff capacity, renovation of the physical environment and implementation of new systems that support the strategic plan of Metro Hospital (Warren, 2007).Development of staff capacity is important because it will help Metro Hospital to manage the cultural changes that will emerge and meet the future needs of departments by provision of education and other opportunities aimed at career developmen t. Building of staff capacity is also essential because it helps in the measurement of customer and staff satisfaction. Te development of a qualified ad committed team for Metro Hospital is therefore a critical success factor that is crucial for the preparation of the Electronic Health Record.   Realignment of processes for Metro Hospital is essential because it helps the hospital to plan and execute efficiently the sustainable processes changes and process improvement methodologies. The realigning process is also vital because it helps in measuring changes of the Electronic Health Records. Process redesigning or alignment is also vital because it ensures that all departmental workflows and renovations are aligned for best practice processes. Renovation of the physical environment through decommissioning of the satellite area and remodeling of the physical environment in order to have an optimal workflow is important because it will lead to reduced time in filling charts and retriev ing them. There must be adequate space that can be able to accommodate the filling of active charts accurately and quickly. The security of patient information is important especially when physicians, hospital employees and other third parties are granted access to such information and this should therefore be part and parcel of the renovation process (Walker, 2006).In order to achieve optimal collection and general of information for Metro Hospital, the possession of successful applications that require successful processes is critical success factor that should be considered by Metro Hospital should be considered in the implementation of the new Electronic Health Records.Analyzing the Current SituationTo be able to review the current Status of informatics within the Metro Hospital, I need to be informed how the hospital carries out its operations when serving its clients and general hospital operations. Currently, Metro Hospital is expected to provide a high level of technological tools and academic demands through provision of information management solutions to enhance the quality of health care that is provided to its clients, something that is missing from the current environment of the hospital. To be able to achieve this, a new strategic electronic information management and technology is a major enabler to help Metro Hospital in the achievement of the HIMSS EMR Adoption Model by 2025. The hospital is overburdened by an inefficient preparation environment which makes it hard for it to properly serve the high number of patients. Delivery of health care services at Metro Hospital is solely based on the use of paper charts and therefore the introduction of Electronic Medical records for the hospital is one of the crucial aspects that must be reviewed to ensure that clinical information is easily shared through electronic transactions. The hospital as of current, is not fully utilizing its functionality in the provision of efficient, safe and effective hea lth care for its patients because of the ineffective ways of carrying out its operations manually (Conrick, 2006).To be able to review the contemporary status of Informatics in Metro Hospital, it is essential for me to evaluate and determine if the cost of meeting the Electronic Health Records system is worth the cost of meeting it and the costs that Metro Hospital will incur as a result of adopting electronic Medical records. For instance, I should be able to determine whether the requirements in Stage one will exceed the value of incentive check and ascertain the costs that will have to be incurred in meeting all the stages even after they have passed auditing. I should also review if the Electronic medical Records meet their meaningful use and ascertain the time frames (Steele, 2002).To be in a good position to evaluate or review the current status of Informatics in Metro Hospital, I should be able to assess the current status of the hospital’s component deployment, understand the corporate goals of the hospital and be able to appreciate the hospital’s short term needs. Currently, the hospital has got good links with the Division of General Practitioners in the local area but they are not electronically linked. One of the most important aspects that I will review in Metro Hospital is making sure that an electronic health record is put in place to link these physicians and practitioners with the Hospital’s electronic records. The delay exhibited when serving patients because of the use of manual processes should therefore be reviewed to ensure that the manual way of searching for records is replaced by the Electronic Health records to save the time and resources spent on such tasks. Another specific aspect that I will review is the amounts of time spend when attending to patients at Metro Hospital. This will help me to ascertain whether the introduction of an electronic health record system will be beneficial for Metro hospital (Huang, 2010)..Informati on Management Practices that must be implemented to ensure the Effectiveness of an EMRStaff of Metro Hospital should be well informed of the management practices that must be enforced in order to ensure the efficient running of the electronic Medical record. Employees of Metro Hospital should therefore become aware with the relevant regulatory authorities, regulations and requirements regarding the use of electronic records. Regulatory authorities determine the existing guidelines and regulations about creating, maintaining, retaining and destructing traditional paper records and EHRs and EMRs and therefore such issues should be well known. Privacy legislation concerning the collection, use and final disclosure of patient’s personal information should be upheld and respected. The EMR will also be effective if the hospital management and staff as a general consider patient consent and their rights to accessing their health information that is stored in EHRs/EMR’s (Tan, 2009).Crit ical functions of electronic signatures must be taken into consideration while at the same time putting into mind the 5 key principles of transition from the manual to electronic system which include: securing of patient information and maintaining of the privacy of the information for patents. Medical records should also be kept and maintained through integrity and the integrity of clinical workflow should be supported and maintained (Brazell, 2004).Analysis and planning of level 7 of the HIMSS EMR Adoption ModelIn order to lead Metro Hospital into achieving level 7 of the HIMSS EMR Adoption Model by the year 2025, I intend to carry out a proper analysis and planning of the whole model by being informed of all the stages the hospital has to undergo in order to achieve the Final level 7.    Initially, Metro Hospital has not implemented radiology, laboratory and pharmacy ancillary department systems despite the fact that some of the clinical automation are present. The first procedu re to embark on towards the achievement of Level 7 status by Metro Hospital will therefore be to install all the main three ancillary systems in the hospital which will include the radiology, laboratory and pharmacy department systems. The second stage is to ensure that all the major ancillary clinical systems deposit data into a CDR (Clinical data Repository) which allows the physicians to retrieve and view results (Ochs, 2010).The Clinical Data Repository will therefore comprise of clinical decision support or rules and a controlled medical vocabulary which gives room for checking of any rudimentary conflict. During this second stage, information obtained from document imaging systems can be able to be linked to the Clinical data Repository. During the third stage of the HIMSS EMR Adoption Model, the Metro Hospital’s clinical documentation like flow sheets, vital signs e.t.c will be required while the eMAR (electronic Medication Administration Record), care plan charting and nur sing notes are scored with extra points and are integrated and implemented with the Clinical data Repository for one of the services in the hospital. Clinical decision support is implemented during the first level to in order to check for errors with the order entry in the pharmacy like for instance drug/lab, drug/food, drug/drug that are common in the pharmacy.  At stage three, there must be some level of communication system which can allow physicians of Metro Hospital to gain access through the hospital’s intranet or other secure networks that are available outside the confines of the department of radiology (Robertson, et al, 2008).During the fourth stage, CPOE (Computerized Physician/Practitioner Order Entry) to be used by any Metro Hospital clinician will be added to the Clinical data repository and nursing environment together with the capabilities of the clinical decision support that are related to the medicine based evidence protocols. The completion of the previous sta ges will signify the achievement of stage four. Stage five will now include the implementation of the closed loop administration in one of the patient care service environments implementation and integration of the bar coding, eMAR and other technologies used in auto identification like the RFID (Radio Frequency Identification) in order to maximize safety of the point of care processes used in the administration of medication. Stage six will involve the total documentation of Metro hospital’s physician charting/documentation for at least one of the areas in the patient care service. All the clinician activities are guided through level three of the clinical decision support which is related to protocols and outcomes in form of compliance and variance alerts.  All the film based images are displaced by PACS radiology systems which provide physicians with medical images through an intranet (Felder, et al, 2008).The final stage known as level 7 or stage seven will ensure that Metro Hospital has achieved an electronic or paperless EMR environment in which clinical information will easily be shared through electronic transactions and all entities of the hospital will be able to exchange electronic records within a regional network. For instance, the Division of General Practitioners    in Metro’s local area, subacute environments, ambulatory clinics, patients, patients, employers and other hospitals will be able to share vital health information. As envisioned in the level 7 of the HIMSS EMR Adoption Model, it is this stage that will ensure that true electronic health records are supported by HCO (Andersen, 2008).Implementation PlanMy implementation plan will have a purpose, system overview, management overview which will include the description of implementation, the points of contact, the major tasks, the implementation schedule , security and privacy, system security features and security set up during the process of implementation. Apart from that, the im plementation plan will consist of the software, hardware, materials and facilities, documentation and personnel. Under personnel, it will involve of the training for the implementation staff and staffing requirements. The implementation plan will consist of the performance monitoring, implementation impact and configuration management interface.  Lastly, the implementation plan will consist of the implementation requirements by site requirement details (Skolnik, 2010).Resources required in implementing the project Some of the resources that will be required in order to implement the EMR project will among others include Citrix which is a technology that will be used to provide remote access from the office and home through utilization of wireless infrastructure, qualified personnel, hardware which in this case will include laptops, tablets, desktops, touch screens and carts. The allocation of the various administered and departmental funds together with all the budgetary allocation s should be highlighted. Being able to ascertain the relevant resources needed for implementation of the project will enable me to know early warning signs of under spending or overspending or even possible savings and therefore enabling me to effectively track down expenditure.   In general, resources needed can either be financial or non financial or both (Kiel, 2001).Specific goals and timelines for achieving a ‘fully digital’ status by 2025 by Metro HospitalImplementation of an HIMSS level 7 by 2025 for Metro Hospital is not one single project but rather, it is a series of initiatives which represent a journey more than a destination. The implementation process will therefore consist of challenges, solutions and the impacts that will have on the clinical process. Some of the critical goals towards the achievement of a full digital status for Metro Hospital will therefore include planning of the Electronic Health records and the acquisition of the ambulatory Electronic Health Records. Thereafter, the process of intake and assessment will follow after which the medication process will be clearly evaluated. Clinical support and documentation will be followed through the provision of E-communication patient providers and portals. The stage of finally implementing the ambulatory of the Electronic Health Records will make the electronic system for Metro Hospital to be its legal health records by the year 2025.    Although initially Metro Hospital had no plans of becoming a digital hospital, it has always been my goal to achieve this electronic status. There is need for us to use automation and Information technology in order to improve the care given to our patients (Finn, 2009).In order to achieve specific goals and timelines for achievement of a fully digital status for Metro Hospital by the year 2025,a vision, consensus and a strategic plan must be build at the board or executive level aimed at transforming care delivery through a business initiative. A governance structure should also be build in order to facilitate decision making, accountability, prioritization and management which include a user-focused comprehensive plan which deals with informing people how to deal with change. After that Information Technology infrastructure that deals supports the Electronic Medical Records together with a disaster business/recovery continuity plan for Metro Hospital must be build. Supplier/consulting decisions should be made and then the technologies should be implemented in the right order. Managing of change, measurements and achievement of the technology should be kept as an in day to day work.  A governance structure should be build in order to facilitate prioritization, management, accountability and decision making which includes a comprehensive functional steering committee.   Measurement of the business processes will need to stretch the goals and need to be balanced so as to embark on this long journey of achieving level 7 by 202 5 for Metro Hospital (Lorenzi, 2005).  Executive Engagement3 Years2011Process Measurement2 YearsIT Infrastructure2 YearGovernance4 YearsBenefits for achieving HIMSS level 7 by 2025 for Metro Hospital will also require that the benefits are quantifiable and the whole executive team should always be accountable for achieving the goals. The business value for the benefits should always outweigh the costs of IT increasing operational expenses and implementation costs. Metro Hospital should plan in using the EMR in demonstrating data agility during the whole implementation process. In order to avoid situations where the stakeholders of Metro Hospital might get disengaged before the whole project is rolled out, incremental benefits arising from the use of EMR data entry must be seen. In general, the roadmap for achievement of the HIMSS level for level 7 by 2025 for Metro Hospital will involve the following goals and timelines (Sharma, 2005).System selection1 YearsThe above processes shoul d therefore take 14 years for Metro Hospital to be fully digital. During the first stage above, all the ancillaries namely the laboratory, the Pharmacy and the RAD are not installed and this stage is referred to as stage 0. At stage one, all the three ancillaries are installed followed by stage two in which Controlled Medical Vocabulary Clinical Data Repository and the CDSS inference engine might have Document Imaging. Stage 3 will involve clinical documentation and error checking which will in turn be followed by stage four which will involve Clinical Decision Support protocols. Stage five will thereafter involve the administration of Closed Loop medication and then under stage six, physician Documentation and full variance and compliance of CDSS will be undertaken. Finally, stage seven will ensure that Metro hospital has a fully digital status by 2025.Governance:Governance is a very important part in the implementation of the HIMSS EMR Adoption Model by 2025 for Metro Hospital bec ause having unclear governance plans may pose as a big risk to the hospital in the implementation of other aspects. The governance for Metro Hospital will be under the responsibility of two committees which will oversee the implementation of the HIMSS. The two committees will be the IT Committee and the other one that represents the operational and clinical departments that are affected by EMR-EHR. The various people who will be involved in management of various implementation processes should be known together with their responsibilities and the people they are accountable to in Metro Hospital. Procedures and rules for decision making should always apply throughout the whole project and governance arrangements should include all the agency lines of accountability and reporting coupled with the relevant executive committees and agency boards in the hospital. The project should be governed in such a way as to include all the services that are supposed to be delivered as a result of a dopting electronic medical records. Clinical Staff and all Physicians for Metro Hospital should conduct a needs analysis in order to be sure that the implemented EMR-EHR system will serve as a proper decision making guide for the caregivers. The separate governing bodies for Metro Hospital should therefore work hand in hand to see that the project is implemented successfully. The committees should be able to meet as many times as possible to discuss any emerging issues and hear any updates about the whole project (Edgar, et al, 2010).Likelihood of Success and identification of riskI have high hopes that I will be able to achieve level 7 of the HIMSS EMR Adoption Model by 2025 because of the supportive and understanding Metro Hospital Staff.     However, there is a high concern that some of the practitioners linked with the Metro Hospital from the area will struggle in meeting some of the proposed rules for quality reporting requirements aimed at meaningfully using health information technology.   Some of the risks that may be faced with Metro hospital upon completion and final implementation of the Electronic Health Record will include incomplete or weak and lack of enough policy awareness and malicious misuse by insiders. The Metro Hospital’s Electronic Health Records may also be exposed to external attacks through either social engineering, defacement of the website, electronic mail phishing or through social engineering phone calls which may be detrimental to the hospital because vital information may be lost. Metro Hospital should also be concerned about weak incident response recovery policies and weak disaster recovery plans (Perezgonzalez, 2005).Benchmarks In order for usability ratings to give more than comparative information, it is necessary to use benchmark metrics to establish them. These benchmark metrics can be developed through measuring the actual clinical environment of clinician users for each scenario or task. The clinician panels will the n compare good actual performances against the perceived ideal performance by users so as to establish a target score which reflects better the needs of the users unlike the present state of the Electronic Medical Records performance (Gumpper,   et al, 2008).Conclusions/ RecommendationsIn order to make the adoption of level 7 of the HIMSS EMR Adoption Model by 2025 for Metro Hospital to be a success, it is vital for me to look at the benefits, barriers and risks. There is a significant relationship between the benefits and barriers of adopting HER systems by Metro Hospitals.  The transition by Metro Hospital from manual operations to electronic medical records is a significant change in the medical practice towards clinical processes. The ability of Metro Hospital to transform its medical records into electronic form will create further opportunities for the hospital to start clinical practice changes not only at individual levels but also at population levels. The success of the E MR-EHR for Metro Hospital will therefore largely depend on the input that will be derived from all the departments of the hospital what will use the system in improving the quality of care given to patients and increasing productivity. Committees dealing with governance in the implementation of the project should never be underestimated because it is through them that other stakeholders are able to give criticism, ideas, advice and suggestions.  Relevant approaches should always be approached in order to ensure that the EMR-EHR system is properly implemented to ensure that improved healthcare and regulatory practices are upheld (Jain, Et al, 2010).

Daniel OConnell - Biography of Irish Statesman

Daniel OConnell was an Irish patriot who came to exert enormous influence on the relationship between Ireland and its British rulers during the first half of the 19th century. OConnell, a gifted orator, and charismatic figure rallied the Irish people and helped secure some degree of civil rights for the long-oppressed Catholic population. Seeking reform and progress through legal means, OConnell was not really involved in the periodic Irish rebellions of the 19th century. Yet his arguments provided the inspiration for generations of Irish patriots. OConnells signature political achievement was the securing of Catholic Emancipation. His later Repeal Movement, which sought to repeal the Act of Union between Britain and Ireland, was ultimately unsuccessful. But his management of the campaign, which included Monster Meetings which drew hundreds of thousands of people, inspired Irish patriots for generations. It is impossible to overstate the importance of OConnell to Irish life in the 19th century. After his death, he became a venerated hero both in Ireland and among the Irish who had emigrated to America. In many Irish-American households of the 19th century, a lithograph of Daniel OConnell would hang in a prominent location. Childhood in Kerry O’Connell was born on August 6, 1775, in County Kerry, in the west of Ireland. His family was somewhat unusual in that while Catholic, they were considered members of the gentry, and they owned land. The family practiced an ancient tradition of â€Å"fosterage,† in which a child of wealthy parents would be raised in the household of a peasant family. This was said to make the child deal with hardships, and other advantages would be that the child would learn the Irish language as well as local traditions and folklore practices. In his later youth, an uncle nicknamed â€Å"Hunting Cap† O’Connell doted on young Daniel, and often took him hunting in the rough hills of Kerry. The hunters used hounds, but as the landscape was too rough for horses, the men and boys would have to run after the hounds. The sport was rough and could be dangerous, but young O’Connell loved it. Studies in Ireland and France Following classes taught by a local priest in Kerry, O’Connell was sent to a Catholic school in the city of Cork for two years. As a Catholic, he couldn’t enter the universities in England or Ireland at the time, so his family sent him and his younger brother Maurice to France for further studies. While in France, the French Revolution broke out. In 1793 O’Connell and his brother were forced to flee the violence. They made their way to London safely, but with little more than the clothes on their backs. The passing of Catholic Relief Acts in Ireland made it possible for O’Connell to study for the bar, and in the mid-1790s he studied at schools in London and Dublin. In 1798 O’Connell was admitted to the Irish bar. Radical Attitudes While a student, O’Connell read widely and absorbed current ideas of the Enlightenment, including such authors as Voltaire, Rousseau, and Thomas Paine. He later became friendly with the English philosopher Jeremy Bentham, an eccentric character known for advocating a philosophy of â€Å"utilitarianism.† While O’Connell remained a Catholic for the rest of his life, he also always thought of himself as a radical and a reformer. Revolution of 1798 A revolutionary fervor was sweeping Ireland in the late 1790s, and Irish intellectuals such as Wolfe Tone were dealing with the French in hopes that French involvement could lead to Ireland’s liberation from England. O’Connell, however, having escaped from France, was not inclined to align himself with groups seeking French aid. When the Irish countryside erupted in rebellions of the United Irishmen in the spring and summer of 1798, O’Connell was not directly involved. His allegiance was actually to the side of law and order, so in that sense, he sided with British rule. However, he later said that he wasn’t approving of the British rule of Ireland, but he felt that open revolt would be disastrous. The 1798 uprising was particularly bloody, and the butchery in Ireland hardened his opposition to violent revolution. Legal Career of Daniel OConnell Marrying a distant cousin in July 1802, O’Connell soon had a young family to support. And though his law practice was successful and constantly growing, he was also always in debt. As O’Connell became one of the most successful lawyers in Ireland, he was known for winning cases with his sharp wit and extensive knowledge of the law. In the 1820s O’Connell was deeply involved with the Catholic Association, which promoted the political interests of the Catholics in Ireland. The organization was funded by very small donations which any poor farmer could afford. Local priests often urged those in the peasant class to contribute and become involved, and the Catholic Association became a widespread political organization. Daniel OConnell Runs for Parliament In 1828, OConnell ran for a seat in the British Parliament as the member from County Clare, Ireland. This was controversial as he would be barred from taking his seat if he won, as he was Catholic and Members of Parliament were required to take a Protestant oath. OConnell, with the support of poor tenant farmers who often walked miles to vote for him, won the election. As a Catholic Emancipation bill had recently passed, due in large measure to agitation from the Catholic Association, OConnell was eventually able to take his seat. As might be expected, OConnell was a reformer in Parliament, and some called him by the nickname, The Agitator. His great goal was to repeal the Act of Union, the 1801 law which had dissolved the Irish Parliament and united Ireland with Great Britain. Much to his despair, he was never able to see Repeal become a reality. Monster Meetings In 1843, OConnell mounted a great campaign for Repeal of the Act of Union and held enormous gatherings, called Monster Meetings, across Ireland. Some of the rallies drew crowds of up to 100,000. The British authorities, of course, were greatly alarmed. In October 1843 OConnell planned a huge meeting in Dublin, which British troops were ordered to suppress. With his aversion to violence, OConnell canceled the meeting. Not only did he lose prestige with some followers, but the British arrested and jailed him for conspiracy against the government. Return to Parliament OConnell returned to his seat in Parliament just as the Great Famine ravaged Ireland. He gave a speech in the House of Commons urging aid for Ireland and was mocked by the British. In poor health, OConnell traveled to Europe in hopes of recuperating, and while en route to Rome he died in Genoa, Italy on May 15, 1847. He remained a great hero to the Irish people. A grand statue of OConnell was placed on the main street of Dublin, which was later renamed OConnell Street in his honor.

The Learning Styles Controversy - Arguments For and Against

Format for the Celebration Speech Free Essays

Format for the Celebration Speech Introduction: I. Attention GetterAn attention grabbing statement to get the audience interested in learning about your process II. Connection to the AudienceTell them why they should listen to you (i. We will write a custom essay sample on Format for the Celebration Speech or any similar topic only for you Order Now e. how does learning this process benefit them personally) III. Central Idea/ Thesis StatementA one sentence summary and preview of the entire speech, i. e. What are you teaching them? Body: * Transition Statement * I. Body Area Main IdeaA one sentence summary of the first body area A. Supporting MaterialInformation that confirms, illustrates, explains, etc. the main idea for the body area B. Supporting MaterialInformation that confirms, illustrates, explains, etc. the main idea for the body area * Transition Statement* II. Body Area Main IdeaA one sentence summary of the second body area A. Supporting MaterialInformation that confirms, illustrates, explains, etc. the main idea for the body area B. Supporting MaterialInformation that confirms, illustrates, explains, etc. he main idea for the body area * Transition Statement* III. Body Area Main IdeaA one sentence summary of the third body area A. Supporting MaterialInformation that confirms, illustrates, explains, etc. the main idea for the body area B. Supporting MaterialInformation that confirms, illustrates, explains, etc. the main idea for the body area * Transition Statement* Conclusion: I. Central IdeaRestate the central idea to review the main point of the speech II. Reconnect the Attention GetterReiterat e your attention getter. This makes your speech feel â€Å"complete†) Note: You have some leeway with how to format the body areas for this speech. A Celebration speech or an Informative speech is organized depending upon the information you are sharing about your topic. You should focus on interesting facts, uses, etc. about your topic and should NOT do a recounting of the chronological information about the topic. Audiences quickly become bored with this approach. How to cite Format for the Celebration Speech, Essay examples

Geology fo mars Essay Example For Students

Geology fo mars Essay Geology of Mars by Luke Justis Mars is the planet that is the closest geologically to our own. Still we know little about the planet. All the information that we have is from what we see. We can speculate about the geology of the planet but we will never know for sure what the planet is really made of until we physicallygo there. The information is all from NASA sites or NASA related sites. Mars red color leads us to believe that the planet has large amounts of iron. This red color is the only color that is on the surface besides the poles. There is also a darker area that runs along the equator. It goes around roughly one third of the planet. This is a giant canyon that makes our Grand Canyon look like a scratch. There are also what appear to be old stream channels. This implies that there could have been liquid water on the surface. The surface of Mars is varied greatly between north and south. This has been largely attributed to volcanism and erosion. Mars is similar to our moon in the southern hemisphere. This region is referred to as the Highlands of Mars. The area is pitted with numerous craters that reach between one to four km above the datum. Ejecta from the impact scatter around the crater making a rim like structure. The northern hemisphere is very low compared to the southern hemisphere. In the north the ground level rarely reaches above one km below the datum. This stark contrast between north and south is thought to have happened 3 Gyr ago. The south was continuously bombarded with meteors. The north would get hit but it would erode or volcanic flows would cover it. The north also has evidence of ancient stream channels and at the extreme north and south glaciers are still present in the form of an ice cap. Tharsis: The region known as Tharsis is at the center of a bulge in the planets surface. This giant volcano is 4000 km across and 10 km high. Another bulge is called Elysium and it is about 2000 km across and 5 km high. At the summit of Tharsis are three volcanoes the tallest of these is Olympus Mons. The peak of this volcano is 27 km above the place where Tharsis ends and Olympus Mons begins. The volcano itself was made by periodic eruption over a period of time. The lava is most likely very fluid and would have little pyroclastic activity. The large size of the volcano can be attributed the lack of tectonic activity. Few impact craters on the flank of the volcano suggest that the volcano is relatively young. It is possible though, that volcanism could have been occurring during much of Mars history. Mars volcanoes are very similar to those found on Earth specially those found on Hawaii. Their low shape and large flows are very similar to those in Hawaii. Ash deposits are also very common on Martian volcanoes. Evidence for hydrothermal activity is also another commonly found geologic feature on Mars suggesting even more that there is water on Mars. Water Erosion: The role of water erosion is the most mysterious this geologically about Mars. Large dry valleys and evidence Of ancient flood plains all add to the mystery. Old shore lines in the North suggest that there could have been huge lakes caused by massive floods. The floods could have been caused by the heating of the surface or a change of climate. All these bits and pieces add to the debate of whether or not Mars had large amounts of water like Earth at one time or another. The rate at which the water did carve the stream channels and large valleys is still uncertain. There is supple evidence to suggest that the water ran at a slow pace. The features of these valleys appear to be the product of slow erosion. Branch valley networks are commonly found in the southern hemisphere and some in younger areas. .ufb869a299a5f3ba93db0885e5f8361cf , .ufb869a299a5f3ba93db0885e5f8361cf .postImageUrl , .ufb869a299a5f3ba93db0885e5f8361cf .centered-text-area { min-height: 80px; position: relative; } .ufb869a299a5f3ba93db0885e5f8361cf , .ufb869a299a5f3ba93db0885e5f8361cf:hover , .ufb869a299a5f3ba93db0885e5f8361cf:visited , .ufb869a299a5f3ba93db0885e5f8361cf:active { border:0!important; } .ufb869a299a5f3ba93db0885e5f8361cf .clearfix:after { content: ""; display: table; clear: both; } .ufb869a299a5f3ba93db0885e5f8361cf { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .ufb869a299a5f3ba93db0885e5f8361cf:active , .ufb869a299a5f3ba93db0885e5f8361cf:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .ufb869a299a5f3ba93db0885e5f8361cf .centered-text-area { width: 100%; position: relative ; } .ufb869a299a5f3ba93db0885e5f8361cf .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .ufb869a299a5f3ba93db0885e5f8361cf .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .ufb869a299a5f3ba93db0885e5f8361cf .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .ufb869a299a5f3ba93db0885e5f8361cf:hover .ctaButton { background-color: #34495E!important; } .ufb869a299a5f3ba93db0885e5f8361cf .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .ufb869a299a5f3ba93db0885e5f8361cf .ufb869a299a5f3ba93db0885e5f8361cf-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .ufb869a299a5f3ba93db0885e5f8361cf:after { content: ""; display: block; clear: both; } READ: Gamelan - Music of Indonesia Essay The channels appear to have tributaries that increase the size of the main stream channel. 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Facts Hvdc Essay Example

Facts Hvdc Paper A Paper presented on â€Å"FACTS HVDC TRNAMISSION SYSTEMS† PRESENTED BY NITIN K. MOHURLE (T. E. ELECTRICAL) SHRAM SADHANA TRUST’S COLLEGE OF ENGINEERING TECHNOLOGY BAMBHORI, JALGAON E-mail:- nitin. [emailprotected] com FACTS AND HVDC TRNSMISSION SYSTEMS Nitin Mohurle Shram Sadhana Trust’s College of Engineering And Technology, Jalgaon nitin. [emailprotected] com Abstract — Development of electrical power supplies began more than one hundred years ago. At the beginning, there were only small DC networks within narrow local boundaries, which were able to cover the direct needs of industrial plants by means of hydro energy. With an increasing demand on energy and the construction of large generation units, typically built at remote locations from the load centres, the technology changed from DC to AC. Power to be transmitted, voltage levels and transmission distances increased. FACTS (Flexible AC Transmission System) and HVDC (High Voltage Direct Current) are controllable devices whose functions are to enhance the security, capacity and flexibility of power transmission systems. Application of these components in power systems implies an improvement of transient and voltage stability, power oscillation damping and optimal power flow. DC transmission and FACTS (Flexible AC Transmission Systems) has developed to a viable technique with high power ratings since the 60s. From the first small DC and AC mini networks, there are now systems transmitting 3 4 GW over large distances with only one bipolar DC transmission: 1. 000 2. 000 km or more are feasible with overhead lines. We will write a custom essay sample on Facts Hvdc specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Facts Hvdc specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Facts Hvdc specifically for you FOR ONLY $16.38 $13.9/page Hire Writer With submarine cables, transmission levels of up to 600 – 800 MW over distances of nearly 300 km have already been attained, and cable transmission lengths of up to 1. 300 km are in the planning stage. As a multiterminal system, HVDC can also be connected at several points with the surrounding three-phase network. FACTS is applicable in parallel connection or in series or in a combination of both. The rating of shunt connected FACTS controllers is up to 800 Mvar, series FACTS devices are implemented on 550 and 735 kV level to increase the line transmission capacity up to several GW. The fast development of power electronics based on new and powerful semiconductor devices has led to innovative technologies, such as high voltage dc transmission (HVDC) and flexible ac transmission system (FACTS), which can be applied in transmission and distribution systems. This paper has discussed the application of high voltage power electronics FACTS and HVDC controllers, needs of advance FACTS and HVDC based control for future power system and enhancing system stability and its development. HVDC and FACTS offer major advantages in meeting these requirements. Keywords—SVC Static Var Compensator SC Series Capacitor, VSC, STATCOM I. INTRODUCTION The development of Electric Power Industry follows closely the increase of the demand on electrical energy. Main driving factors for energy consumption are listed in Fig. 1. In the early years of power system developments this increase was extremely fast, also in industrialized countries, many decades with the doubling of energy consumption each 10 years. Such fast increase is nowadays still present in the emerging countries, especially in Far-East. In the industrialized countries the increase is, however, only about 1 to 2 % per year with an estimated doubling of the demand in 30 to 50 years. In next 20 years, power consumption in developing and emerging countries is expected to more than double, whereas in industrialized countries, it will increase only for about 40 %. Fast development and further extension of power systems can therefore be expected mainly in the areas of developing and emerging countries. However, because of a lack on available investments, the development of transmission systems in these countries does not follow the increase in power demand. Hence, there is a gap between transmission capacity and actual power demand, which leads to technical problems in the overloaded transmission systems. Interconnection of separated grids in the developed countries can solve some of these problems, however, when the interconnections are heavily loaded due to an increasing power exchange, the reliability and availability of the transmission will be reduced. A. POWER FACTOR To understand power factor, visualize a horse pulling a railroad car down a railroad track. Because the railroad ties are uneven, the horse must pull the car from the side of the track. The horse is pulling the railroad car at an angle to the direction of the car’s travel. The power required to move the car down the track is the working (real) power. The effort of the horse is the total (apparent) power. Because of the angle of the horse’s pull, not all of the horse’s effort is used to move the car down the track. The car will not move sideways; therefore, the sideways pull of the horse is wasted effort or nonworking (reactive) power. The angle of the horse’s pull is related to power factor, which is defined as the ratio of real (working) power to apparent (total) power. If the horse is led closer to the centre of the track, the angle of side pull decreases and the real power approaches the value of the apparent power. Therefore, the ratio of real power to apparent power (the power factor) approaches 1. As the power factor approaches 1, the reactive (nonworking) power approaches 0. Fig. 2 Reactive Power analogy B. REACTIVE POWER: Reactive power is a concept used by engineers to describe the background energy movement in an Alternating Current (AC) system arising from the production of electric and magnetic fields. These fields store energy which changes through each AC cycle. Devices which store energy by virtue of a magnetic field produced by a flow of current are said to absorb reactive power; those which store energy by virtue of electric fields are said to generate reactive power. Explanation for reactive power says that in an alternating current system, when the voltage and current go up and down at the same time, only real power is transmitted and when there is a time shift between voltage and current both active and reactive power are transmitted. But, when the average in time is calculated, he average active power exists causing a net flow of energy from one point to another, whereas average reactive power is zero, irrespective of the network or state of the system. In the case of reactive power, the amount of energy flowing in one direction is equal to the amount of energy flowing in the opposite direction (or different parts -capacitors, inductors, etc- of a network, exchange the rea ctive power). II. FACTS AND HVDC SYSTEM A. HVDC SYSTEM HVDC was first used commercially 50 years ago. Since then a growing number of transmission schemes have been constructed around the world. HVDC differs from high voltage alternating current, HVAC that the voltage is not alternating 50 or 60 cycles per second but is constant. The advantage of HVDC is that long distance transmission is more efficient as there is no need to charge the capacitance of a transmission line with the alternating voltage. The drawback of HVDC is that one needs more expensive terminals at the line ends. Fig. 3 Typical HVDC converter station using thyristor valves HVDC has a number of properties that makes it different from ac transmission. The most important are: The two stations can be connected to networks that are not synchronized or does not even have the same frequency * Power can be transmitted over very long distances without compensation for the reactive power. Reactive power is power that does not add to the transmitted power, but is a by-product at ac- transmission as the line or cable capacitances has to be charged 50 or 60 times per second. As HVDC has constant voltage it does not gene rate reactive power. See also figure 4. * Only two conductors are needed (or even one conductor if the ground or the sea is used as return) for HVDC compared to thre conductors for alternating current. Fig. 4 Shows the power that is possible to transmit as a function of the distance for ac- cables of various voltage stress compared to HVDC With ac high power can be transmitted short distances or low power long distances. HVDC cables can transmit high power over long distances. B. Flexible Alternating Current Transmission System The objective of incorporating FACTS is into the power system lines are similar to HVDC but greater flexibility are involved like improving real power transfer capability in the lines, prevention of sub synchronous resonance (SSR)oscillations and damping of power swings [1]. FACTS devices have four well-known types which are used in many power systems in the world. ‘Single’ type controller is the types of FACTS that installed in series or shunt in an AC transmission line, while ‘unified’ type controller are the combined converters type of FACTS controllers like UPFC and HVDC. The size of a controller is dependent on the requirements of the network and desired power transmission at loading point Voltage Source Controller (VSC) is sinusoidal voltage and is used in power system and other application. The quality of the sine wave is dependent on the size or amount of the power electronics installed. C. LIMITATIONS OF LARGE AC SYSTEMS In large AC Systems with long distance transmission and synchronous interconnections, technical problems can be expected, which are summarized in Fig. 2. Main problems occur regarding load flow, system oscillations and inter-area oscillations. If systems have a large geographic extension and have to transmit large power over long distances, additional voltage and stability problems can arise. Fig. Limitations of Large AC systems III. FACTS, HVDC AND REACTIVE POWER FACTS has a lot to do with reactive power compensation, and indeed, that used to be the term utilized for the technology in the old days. Reactive power appears in all electric power systems, due to the laws of nature. Contrary to active power, which is what we really want to transmit over our power system, and which performs real work, such as keeping a lamp lit or a motor running, reactive power does not perform any such work. Consequently, in a way one can say that the presence f reactive power in a grid makes it heavier for it to perform its task, i. e. transmit power from A to B (Figure 1), and consequently less efficient than would otherwise be possible. We can also refer to Lenz? law, formulated already in the nineteenth century: Every change in an electrical system induces a counter-reaction opposing its origin. So, as a consequence, if we can minimize the flow of reactive power over the transmission system, we can make the system more efficient and put it to better and more economical use. We cannot altogether do without reactive power, though, because it is intimately linked with grid voltage (500 kV, 400 kV, 220 kV, etc). To get the correct grid voltage, we need the right amount of reactive power in the system. If there is not enough reactive power, the voltage will sag. And vice versa, if there is too much of it, the voltage will be too high. So, to have it in the right amounts at all times, and in the right places of the grid, that is the task to be performed by means of Reactive Power Compensation. Reactive power balance is important also from another point of view: it ensures that valuable space in transmission lines and equipment such as transformers is not occupied by â€Å"idle† reactive power, but rather available for a maximum of useful, active power as in fig. This is particularly crucial in situations where some fault appears in the grid. In such a situation, it will often be a matter of milliseconds for the Reactive Power Compensator, i. e. the FACTS device, to go into action and help restore the stability, and the voltage of the grid, in order to prevent, or mitigate, a voltage collapse. IV. LOSSES Maintaining proper balance of reactive power in the grid is important also from another point of view: too much reactive power flowing in the grid also gives rise to losses, and losses cost money which is always, at the end, charged to the customer. To prevent such losses, it is important that reactive power is not permitted to flow over long distances, because losses grow with the distance that the reactive power is flowing over. Instead, reactive power should be inserted where it is needed, i. e. close to large cities and/or large industry enterprises. This, too, is a task for FACTS HVDC SYSTEM. V. NEED OF REACTIVE POWER COMPENSATION: In Figure , the representation of a capacitor inserted at the middle of the line for its compensation, is illustrated. Fig. 7 Distribution line with a capacitor for a given compensation The phasor diagram illustrated in Figure 8 it is illustrated the effect of the capacitor for a 50% of compensation. Once inserted the compensator, Figure 8, it can operate injecting a voltage in the line according to equation. VI. TECHNOLOGY UNDRRLYING FACTS AND HVDC A. VOLTAGE SOURCE CONVERTER: A new type of HVDC using transistors for the ac/dc conversion has been developed. By using components that can not only switch on the current but also switch it off, making it possible to build voltage source converters (VSC). This type of converters offers many advantages when it comes to transmission of power especially from sustainable energy systems. Fig. 9 VSC converter valve B. SERIES COMPENSATION: Fig. 10 In series compensation, the FACTS is connected in series with the power system. It works as a controllable voltage source. Series inductance occurs in long transmission lines, and when a large current flow causes a large voltage drop. To compensate, series capacitors are connected. C. SHUNT COMPENSATION: In shunt compensation, power system is connected in shunt (parallel) with the FACTS. It works as a controllable current source. Fig. 11 Shunt compensation is of two types: A] Shunt capacitive compensation: This method is used to improve the power factor. Whenever an inductive load is connected to the transmission line, power factor lags because of lagging load current. To compensate, a shunt capacitor is connected which draws current leading the source voltage. The net result is improvement in power factor. B] Shunt inductive compensation: This method is used either when charging the transmission line, or, when there is very low load at the receiving end. Due to very low, or no load  Ã¢â‚¬â€œ very low current flows through the transmission line. Shunt capacitance in the transmission line causes voltage amplification (Ferranti Effect). The receiving end voltage may become double the sending end voltage (generally in case of very long transmission lines). To compensate, shunt inductors are connected across the transmission line. Fig. 12 Use of Power Electronics foe Power Transmission VII. FACTS AND HVDC CONTROLLER A. SHUNT CONNECTED CONTROLLER FACTS controllers can be impedance type, based on thyristors without gate turn-off capability, which are called Static Var Compensator (SVC) for shunt-connected application. Another type of FACTS controllers is converter-based which is usually in the form of a Static Synchronous Compensator (STATCOM). B. STATIC VAR COMPENSATOR Static Var Compensator is â€Å"a shunt connected static Var generator or absorber whose output is adjusted to exchange capacitive or inductive current so as to maintain or control specific parameters of the electrical power system (typically bus voltage)†. SVC is based on thyristors without gate turn-off capability. The operating principal and characteristics of thyristors realize SVC variable reactive impedance. SVC includes two main components and their combination: (1) Thyristor-controlled and Thyristor-switched Reactor (TCR and TSR); and (2) Thyristor-switched capacitor (TSC). In Figure shows the diagram of SVC. C. CONVERTOR BASED COMPENSATOR Static Synchronous Compensator (STATCOM) is one of the key Converter-based Compensators which are usually based on the voltage source inverter (VSI) or current source inverter (CSI), as shown in Figure. Unlike SVC, STATCOM controls the output current independently of the AC system voltage, while the DC side voltage is automatically maintained to serve as a voltage source. Mostly, STATCOM is designed based on the VSI. D. SERIES CONNECTED CONTROLLLER As shunt-connected controllers, series-connected FACTS controllers can also be divided into either impedance type or converter type. The former includes Thyristor-Switched Series Capacitor (TSSC), Thyristor-Controlled Series Capacitor (TCSC), Thyristor-Switched Series Reactor, and Thyristor-Controlled Series Reactor. The latter, based on VSI, is usually in the form of a Static Synchronous Series Compensator (SSSC). The composition and operation of different types are similar to the operation of the shunt-connected peers. E. STATIC SYNCHRONOUS COMPENSATOR As discussed in the previous section, STATCOM is a very popular FACTS controller application effective in transmission system voltage control. Since 1980 when the first STATCOM (rated at 20 Mvar) using force-commutated thyristor inverters was put into operation in Japan , many examples have been installed and the ratings have been increased considerably. APPLYING FLEXIBILITY TO THE ELECTRIC POWER SYSTEM The power industry term FACTS (Flexible AC Transmission Systems) covers a number of technologies that enhance the security, capacity and flexibility of power transmission systems. FACTS solutions enable power grid owners to increase existing transmission network capacity while maintaining or improving the operating margins necessary for grid stability. As a result, more power can reach consumers with a minimum impact on the environment, after substantially shorter project implementation times, and at lower investment costs – all compared to the alternative of building new transmission lines or power generation facilities. The two main reasons for incorporating FACTS devices in electric power systems are: * Raising dynamic stability limits * Provide better power flow control. ADVANTAGES OF FACTS AND HVDC SYSTEMS When implemented on a broad-scale basis, FACTS HVDC technologies deliver the following benefits. * A Rapidly Implemented Installations: FACTS projects are installed at existing substations and avoid the taking of public or private lands. They can be completed in less than 12 to 18 months a substantially shorter timeframe than the process required for constructing new transmission lines. * Increased System Capacity: FACTS provide increased capacity on the existing electrical transmission system infrastructure by allowing maximum operational efficiency of existing transmission lines and other equipment. * Enhanced System Reliability: FACTS strengthen the operational integrity of transmission networks, allowing greater voltage stability and power flow control, which leads to enhanced system reliability and security. Improved System Controllability: FACTS allow improved system controllability by building â€Å"intelligence† into the transmission network via the ability to instantaneously respond to system disturbances and gridlock constraints and to enable redirection of power flows * Seamless System Interconnections: FACTS, in the form of BTB dc-link configurations, can establish â€Å"seamless† interconne ctions within and between regional and local networks, allowing controlled power transfer and an increase in grid stability. DISADVANTAGES OF FACTS * The amount of power that can be send over a transmission line is limited. Origin of the limits varies depending on the length of the line. For short line, the heating of the conductors due to line losses sets a â€Å"thermal† limit. * The power flowing over an AC line is proportional to the sine of the phase angle of the voltage at the receiving and transmitting ends and it never reaches 90 degrees. Hence series capacitors or phase-shifting transformers are used on long lines to improve stability. CONCLUSION Power supply industry is undergoing dramatic change as a result of deregulation and political and economical driving forces in many parts of the world. This new market environment puts growing demands for flexibility and power quality into focus. Also, trade of electric power between countries is gaining momentum, to the benefit of all involved. This calls for the right solutions as far as power transmission facilities between countries as well as between regions within countries are concerned. * As indicated by the acronym, FACTS stands for flexibility in AC power systems. Properly utilized, this offers benefits to users of a variety of kinds. Without the need to reinforce the grid by means of additional or upgraded existing lines and/or substations FACTS brings about: * An increase of synchronous stability of the grid; * Increased power transmission capability; * Increased voltage stability in the grid; * Decreased power wheeling between different power systems; * Improved load sharing between parallel circuits; * Decreased overall system transmission losses; * Improved power quality in grids. The choice of FACTS device in each given case may not be obvious but may need to be made the subject of system studies, taking all relevant requirements and prerequisites of the system into consideration, so as to arrive at the optimum technical and economical solution. In fact, the best solution may often be a combination of devices. Finally, a rough and quick guideline to the use of FACTS in various applications: REFRRENCE: [1] Zhang, B. M. ; Ding, Q. F â€Å"The development of FACTS and its control†, Advances in Power System Control, Operation and Management, APSCOM-97. Fourth International Conference, Vol. 1, Nov. 1997, pp: 48 – 53 [2] Paserba, J. J. ; â€Å"How FACTS controllers benefit AC transmission systems†, Power Engineering Society General Meeting, IEEE, Vol. 2, June 2004, pp:1257 1262 [3] Edris, A, â€Å"FACTS technology development: an update†, Power Engineering Review, IEEE, Vol. 20, Issue 3, March 2000, pp: 599 627 [4] L. Gyugyi, â€Å"Application characteristics of converter-based FACTS controllers†, IEEE Conference on Power System Technology, Vol. , pp. 391 396, Dec. 2000. [5] N. G. Hingorani, L. Gyugyi, Understanding FACTS, Concepts and Technology of Flexible AC Transmission systems, IEEE Press 2000 [6] N. G. Hingorani,â€Å"High power electronics and flexible AC transmission system†, IEEE Power Engineering Review, Vol. 8, No. 7, pp. 3-4, July 1988. [7] IEEE FACTS Terms Definitions Task Force of the FACTS Working Group of the DC and FACTS subcommittee, â€Å"Proposed terms and definitions for Flexible AC Transmission System (FACTS)†, IEEE Trans. on Power Delivery, Vol. 12, No. 4, pp. 1848-1853, Oct. 1997.

View From The Bridge Critique essays

View From The Bridge Critique essays Arthur Millers A View from the Bridge is a modern tragedy set in 1950s Brooklyn about a mans obsession with his niece, and what that obsession ultimately brings about. Eddie Carbone, the protagonist of the play also happens to be the antagonist, because he ultimately is fighting against himself with his desires for his niece. I believe that this play was very predictable from the start; this is why I really did not enjoy it all that much. A View from the Bridge had some interesting parts but to me it was really boring and just didnt go anywhere. To me this play did not go anywhere because I did care for any of the characters. The way that Arthur Miller wrote this play makes it hard for you to care about any of the characters; therefore I also do not care what happens to them. There is Eddie, who comes of as arrogant to me; he is the one that I disliked the most. I really saw no point to his behavior, if Miller had given us more of a reason as to why he had such strong feelings toward Catherine then at least we could have learned what made him tick, but as it is I can not see that. I see no purpose for Alfieri; I think that this play could go on just fine without him. I do see the need for a narrator, but I dont think that Alfieri should have been included in the play itself, I believe this cheapens his position as the narrator. Beatrice and Catherine are two characters that I did not like all that much. I saw no practical purpose for Beatrice in this play, she had no effect on this play at all. I would have liked the Beatrice character a little more had she had more of an impact in the play. The Catherine character was likeable but I believe that she is a big reason why Eddie self-destructs. The way that Rodolpho acted made me not care about his fate. I do believe that Eddie was at least part right when he said that Marco was just looking to get married to become a citizen. I thin...

Autophagy in cancer( colonic adenoma and adenocarcinoma) Literature review

Autophagy in cancer( colonic adenoma and adenocarcinoma) - Literature review Example From this point, it is evident that the microvasculature of the tumor tissue is actually structurally and functionally deficient and hence is unable to provide blood supply that is prerequisite for appropriate tissue growth. To support this fact, there is evidence that some tumors, like the pancreas cancers are actually hypovascular (Sato et al, 2007). These conditions contribute to hyponutrient state of the tumor. However, for hypoproliferation, excess nutrient supply is mandatory and hence tumor cells are likely to use alternative source of energy and nutrients or some alternative metabolic process for the purpose. One such metabolic process is autophagy. There is evidence that some cancers, like the colon cancer, are resistant to nutrition depletion state and continue to thrive because of this metabolic process (Sato et al, 2007). Autophagy is a catabolic process that is conserved in which the organelles of the cells are self-digested. The first step in autophagy is development of isolation membrane, a lipid bilayer structure. This membrane sequesters various materials of the cytoplasm like the organelles to form autophagosomes. This step involves activation of LC3, a mammalian homologue of yeast ATG8 through an ubiquitination-like reaction that is regulated by ATG3 and 7. During activation, the proform of LC3 is cleaved into LC3-I which is soluble unlike the proform. This is then further modified into LC3-II which is membrane-bound form. This form is finally recruited by the autophagosomes which engulf the organelles (Rosenfeldt and Ryan, 2009). The engulfed organelles further fuse with the lysosomes and then mature into autolysosomes. This step also causes autodigestion and diminision of LC3 and also various other components of autophagosome. Thus autophagy has an important role to play in the provision of nutrition to cells during shortage of external supply of nutrition. Following autodigestion, aminoacids are released from the organelles and they are th e alternative sources of energy to the proliferative and nutrient deficient cells. Though, theoretically, this explanation seems logical with reference to nutrition supply to cancer cells in unfavorable environment, several controversial arguments have arisen in this regard. Some researchers are of the opinion that autophagic machinery may not be activated in cancer tissue contexts (Sato et al, 2007). However, there is enough evidence to point the role of autophagy in the pathogenesis of colon cancers. In this literature review the role of autophagy in the proliferation and thriving of colon cancers will be discussed through suitable literature review. Pathogenesis of colon cancer Cancer of the colon (and rectum) is the third most common cancer in men and women. It has been estimated that 940,000 new cases of colorectal cancer and nearly 500,000 deaths are occur worldwide each year (El- Deiry, 2006). The frequency is same both in men and women. The risk of the disease increases afte r 40 years of age (El- Deiry, 2006). Colon cancer (colorectal cancer) is almost always adenocarcinoma. The most common predisposing condition leading to adenocarcinoma is adenomatous polyps. Alterations in the adenomatous polyposis or APC gene as a result of mutations is the beginning point of development of the cancer. This gene is mutated in individuals affected by familial

Business Assignment Example | Topics and Well Written Essays - 500 words - 3

Business - Assignment Example The academic journal by Orlando Behling (1998) titled â€Å"Employee selection: will intelligence and consciousness do the job† has put concerted effort to settle this challenge. According to Behling (1998), there seems to be commonalities among the employers during the recruitment of employees which attempt to match the best employee to the jobs. The interest of all employers is to recruit the best that they can select, however the method that they use does not lead to the wish that they have. On that account, a number of the managers now questions the succinct matching approach that can give the best from the group of job seekers. In that line, the managers now have an idea that top performers are those that can be successful in almost, if not all jobs. This is one of the yard stick that can be used. In further attempt to unknot this conundrum, an examination that was made at Gatewood and Fields Human resource selection, had footsteps that could establish the best matching approach of the best performer with the job. According to the examination, an emphasis was made on the imperativeness of the industrial psychologist and the human resource managers in in matching the best performers and the employment (Behling, 1998). The article goes ahead to explain the other modalities that are on the use to enhance the matching of the best performer to the employment. The use of intelligence is hinged on the idea that the smart people finish first. Using this mantra, most of the employers having been using this matching technique to have the recruitment work done. The explanation of the word has been used in getting into the core reason why it has been used weather consciously or unconsciously. It defined as the human talent to solve problem. There are ten intelligence that human being are endowed with. They include deductive, inductive, memory, mechanical, numerical, perpetual reasoning, spatial, verbal and vocabulary. Using this

The Role Of An Occupational Therapist

The Role Of An Occupational Therapist Health care like health itself is a dynamic process which can be subject to change over time. There are an increasing amount of tensions within medicine between various groups of health care practitioners, and between the evaluation of treatment and responding to patients views. This reflects the different strains and demands bearing down on medicine from numerous quarters. I am interested in exploring from the counsellors perspective, in this case the occupational therapist, what exactly they do in an effort to socialize people back into society. For example looking at the role of occupational therapist and the patients environment: physical access to buildings; availability of family and monetary support for living at home. To answer the above question I examined areas such as what is the doctor-patient relationship or in this case the occupational therapist-patient relationship, drawing on Goffmans (1969) work, who states we all play roles throughout our lives, we present ourselves to society, and we are socialized to these roles throughout our lives, especially in childhood. Society has given us our roles- doctor, patient, sick role, etc. and we as actors can perform the role. I also looked at Occupational therapies link to Functionalism, concentrating on Durkheim and Parsons and also drawing on the work of Marx and Weber and how Marx led to the acknowledgment in occupational therapy that labour is the collective creative activity of the people. Description of the research strategy For my research into how occupational therapy contributes to the promotion of health in society, I chose to use qualitative research and in this case qualitative Interviewing. Several researchers have argued that structured interviews are unnatural and restrictive. Informal interviews get deeper. Therefore I used semi-structures face to face interviews. I feel that using semi-structured in depth interviews allowed me use a more open framework, allowing a focus on the conversation and the topics that the interviewee brings up. I started with more general questions and topics to allow the conversation to build up a relationship so the participates felt comfortable and at ease so that they could talk about some sensitive issues if they arose. Semi structure interviews are less intrusive then other methods of research. They allow us to not only gather answers but also reason for the answers, therefore giving a more comprehensive analysis into this area. Therefore I found the major benefi ts of this type of interviewing where that: It is less intrusive to those being interviewed. This is because the semi-structured interview encourages two-way communication. Those being interviewed can also ask questions of the interviewer and feel as though they have their own input. Using this type of interviewing confirms what is already known but also allows the opportunity for learning other information outside of whats being asked. Conducting semi-structured interviews often will provide not just answers, but the reasons for the answers. When individuals are interviewed they tend to open up more and feel more at ease to talk about sensitive issues. (Silverman: 2001) Access I found access to interviewees a little difficult. Getting contacts was the first step, which was done through another occupational therapist I know who passed on a number of email address of willing participants. Once contacted it was difficult to arrange meeting points, days, and times that suited all, but all these issues where overcome and two interviews were successfully scheduled. Ethical considerations Mason (1996) puts forward ways to deal with ethical issues in qualitative which I tried to follow throughout this pilot. This included, deciding what is the purpose(s) of my research, e.g. self-advancement, examining which individuals or groups might be interested or affected by your research topic- in this case it would not be ethically sound to interview the patients themselves as there seen as a vulnerable group, and considering what are the implications for these parties of framing your research topic in the way you have done (1996:26-30). The main ethical considerations I took when interviewing the Occupational therapist, was that before the individual became a subject of research, he/she was notified of: à ¢-  My aims, my methods, my expected benefits and possible hazards of the research I was conducting. à ¢-  I made it clear to the interviewee of his/her right to abstain from participation in the research and his/her right to end at any time that they feel necessary to do so. à ¢-  The confidential nature of his/her answers. I also made it clear during my researching, that no individual would become a subject of research unless they have been given notice and that they freely consent that they would like to participate. No pressure of any kind was used to persuade an individual to become a subject of my research. I will make sure that the confidentiality of individuals from whom I gather my information, shall be kept strictly private. I also stated that at the end of my research any information that would reveal any person involved in the interviewing, will be destroyed, unless already consented that this precise information will be used. http://www.idrc.ca/eepsea/ev-65406-201-1-DO_TOPIC.html Evaluation of Research Process One important use that pilot studies have in qualitative research is to develop an understanding of the concepts and theories held by the people you are studying- what is often called interpretation. This is not simply a source of additional concepts for your own theory, ones that are drawn from language of participants; this is a type of concept that Strauss (1987, pp. 33-34) called in-vivo codes.2 More important, it provides you with an understanding of the meaning that these phenomena and events have for the people who are involved in them, and the perspectives that inform their actions. These meanings and perspectives are not theoretical abstractions; they are real, as real as peoples behaviour, though not as directly visible. Peoples ideas, meanings and values are essential parts of the situations and activities you study, and if you dont understand these, your theories about thats going on will often be incomplete or mistaken (Maxwell, 2004a: Menzel, 1978). Looking at my research questions, through my pilot study I found I had problems in developing the questions as I often got confused between intellectual issues- what I wanted to understand by doing the study- and practical issue- what I wanted to accomplish. According to LeCompte and Preissle, distinguishing between the purpose and the research question is the first problem in coming up with workable research questions (1993, p. 37) I decided to focus on three kinds of questions that are suited to process theory, rather then variance theory. For example I tried to base my research questions around (a) questions about the meaning for events and activities to the people involved in these, (b) questions about the influence of the physical and social context on these events and activities and (c) questions about the process by which these events and activities and their outcomes occurred. For example What does your typical working day involve? Because all of these types of questions involve situation-specific phenomena, they do not lend themselves to the kinds of comparison and control that variance theory requires. Instead, they generally involve an open-ended, inductive approach in order to discover what these meaning and influences are and how they are involved in these events and activities. Decisions about where to conduct my research and whom to include were an essential part of my research methods. I found sampling to be problematic for the qualitative research pilot, because it implies the purpose of representing the population sampled. It ignores the fact that, in qualitative research, the typical way of selecting settings and individuals is neither probability sampling nor convenience sampling. Instead it falls into a third category, known as purposeful sampling (Patton, 1990, p.169). This is a strategy in which particular settings, persons, or activities are selected deliberately in order to provide information that cant be gotten as well from other choices. For example, Weiss argued that any qualitative interview studies do not use samples at all, put panels people who are uniquely able to be informative because they are expert in an area or were privileged witnesses to an event (1994, p.17); I used this form of purposeful selection by choosing full trained Occup ational Therapists to interview. I think selecting those times, settings and individuals that can provide you with the information that you need in order to answer your research question is the most important consideration in qualitative selection decisions. On the negative side, I feel as though one of my interviews suffered slightly due to it been chosen because of its convenience of where and when the interview could take place. Although convenience and cost are real considerations, they should be the last factors to be taken into account after strategically deliberating on how to get the most information of the greatest utility from the limited number of cases to be sampled. Convenience sampling is neither purposeful nor strategic and I feel as though a different individual could have brought more information to light had I chosen more wisely (Patton, 1990, p. 181) If conducting this study again I think I would test out the use of participation observation. In this case it would be of that in an open setting, usually public and in this case a hospital. Gold (1958) states that, when using this technique the participant observer enters the setting without intending to limit the observation to particular process or people and adopts an unstructured approach. Occasionally certain foci crystallise early in the study, but usually observation progresses from the unstructured to the more focused until eventually specific actions and events become the main interest of the researcher. It is important to differentiate between significant and relatively unimportant data in the setting. I also feel several other valuable things were brought to my attention on conducting this pilot study. I found that I need to revise my interview guide, adding questions about issues I hadnt realised were important, such as asking respondent to go through a typical day. I also discovered additional useful questions, such as asking participants to describe specific medical terminology that would illustrate what they had been saying. For example, probing more around phrases such as sensory function, neuromusculoskeletal function, body structure, and client centred. I found that taking a step back and listening to participants experiences in new ways was very important to the collection of the data and feel as though in the future it will help me if I put everything know about Occupational Therapy to one side and do the interview as if I know nothing about this area. Codes Equipment Environment Medical language Patient Life Intervention Medical OT/Patient Academic Skills OT/Patient Social- Work Physical- Work Role of Occupational Therapy In qualitative research, the goal of coding is not to count things, but to fracture (Strauss, 1987, p. 29) the data and rearrange them into categories that facilitate comparison between things in the same category and that aid in the development of theoretical concepts. Above is a diagram of the codes produced after my interviews once the data had been worked through in a systematic manner. Through doing this, many connections were highlighted. For example, looking at the codes Medical Language and Medical OT/Patient. Basically, all patient information, evaluations, and interventions must be documented.(Interview 1, p.3) ..Help them overcome the effects of disability caused by physical or psychological illness, ageing, or accidents (Interview 2, p.2) Therefore this process of coding is the process of combing the data for themes, ideas and categories and then marking similar passages of text with a code label so that they can easily be retrieved at a later stage for further comparison and analysis. Coding the data makes it easier to search the data, to make comparisons and to identify any patterns that require further investigation. http://onlineqda.hud.ac.uk Main Findings After conducting this pilot study and fieldwork, I found that Occupational therapy and Sociology are two completely different sciences. While this is true they encompass a strong underlying relationship. According to Alice J. Punwar and Suzanne M. Peloguin, Occupational therapy is a diverse profession and is hard to define because it has undergone many changes since its beginnings. Early definitions emphasize the use of occupation as a remedial activity to help restore the individual to an improved state of physical and mental health. Now occupational therapy is defined as the use of purposeful activity or interventions designed to achieve functional outcomes which promote health, prevent injury or disability and which develop, improve, sustain, or restore the highest possible level of independence of any individual who has an injury, illness, cognitive impairment, psychosocial dysfunction, mental illness, developmental or learning disability, or other disorder or condition. It inclu des assessment by means of skilled observation or evaluation through the administration of interpretation of standardised or nonstandardised tests and measurements. On the other hand Sociology is understood as the study of human social life, groups and societies (Giddens: 2001) coalescing both of these definitions. Durkheim and Parsons are two of the main theorists whom contributed to the elements of functionalism. Each society has particular social needs or functional prerequisites that must be met in order for the society to strive and survive. Included in these prerequisites, is the need to reproduce new generations, meaning the need for food, clothing, control conflict and the maintenance of social order and of social solidarity. Societies achieve these social needs by developing structures and institutions that have valuable functions. The purpose of any activity or structure is the roll it has in the maintenance of society itself. Society can be viewed as one main structure wit many interrelated and inter-pendent parts. For example, the family, economy and education all work together in an effort to help society survive. Institutions can be seen as being beneficial to societies as the institutions exist for survival of societies. Most literature suggests that they shouldnt come under criticism and instead should be supported. Relating this back to occupational therapists, they should be seen as having a positive role in society. Within a functionalist perspective, roles and social roles are important. The belief is that individuals are socialised through these social roles into society, parent, student, occupational therapist. These social roles largely determine an individuals behaviour. Looking at Kavanagh Faves (1995), two occupational therapists working with homeless people, they stated that Roles are a source of identity and are the frame work of everyday life. Sociologists and Occupational therapists have put this view under criticism. They have argued against the determinism inherent in this view. Mocellin (1995) is an occupational therapist who believes the focus on roles to be stereotyping and that carrying out occupational roles, for example that of a housewife, may not always be therapeutic. Looking at Talcott Parsons model of roles and his theory of the Doctor-Patient relationship, in Bury, M. (2005), he began with the idea that being sick/ill was a type of dysfunctional deviance and that this required reintegration with the social organism. Being ill allows individuals to be excused from their occupation and other responsibilities such as looking after the family, cooking and cleaning. This was seen as potentially detrimental to social order if it wasnt controlled. The development of Parsons sick role was seen as being essential to controlling this deviance to make being ill a transitional state back to the individuals usual role. For Talcott Parsons, Physicians demonstrate Parsons the shift to affect-neutral relationships in contemporary society, with physician and patient being protected by emotional distance. Medical education and social role expectations teach normative socialization to Occupational therapist to act in the interests of the patient instead of their own material interests, and they are lead by an egalitarian universalism instead of a personalized particularism. Physicians have mastered a body of technical knowledge, it is seen as functional for social order to permit physicians professional autonomy and authority, controlled by their socialization and role expectations. Weber and Marx, look at how people exist within the world and are concerned with how that existence is shaped. Marx believes that the problems in society come from different social organisations instead of being a natural phenomenon. This is what is meant by people being constrained by circumstances, but it is important to remember the other element that stresses peoples ability to act. Drawing on earlier work of the philosopher Hegel, Marx identified that we create ourselves in a historical process, of which the motive force is human labour or the practical activity of men living in society (Bottomore Rubel 1963, p.18). Marx noted how the division on labour traps us into particular lifestyles or activities and the influence of Marx led to the acknowledgment in occupational therapy that labour is the collective creative activity of the people (Wilcox 1993) Conclusion After conducting this pilot study it is clear that my research question is still unanswered but it has provided me with ideas, approaches and clues I may not have foreseen before conducting this study. I feel this may increase the chances of getting clearer findings in my main study and has permitted a thorough check of my planned statistical and analytical procedures, giving me a chance to evaluate their usefulness for the data. I also feel it has greatly reduced the number of unanticipated problems as I now have an opportunity to redesign parts of my study to overcome these difficulties again. Overall, carrying out this smaller scaled study will hopefully lead to a rich and in-dept qualitative research project, and the end result being my research question being answered in great detail. The role of an Occupational Therapist The role of an Occupational Therapist The following essay will give a critical evaluation of the role of an Occupational Therapist (O.T) within vocational rehabilitation in the private mental health setting. Firstly the essay will describe a critical analysis of vocational rehabilitation and the added value of an O.T within this setting. Secondly it will analyse the trends within vocational rehabilitation and how these relate to O.T philosophy and core tenets, thirdly an examination of concepts of management that relate to vocational rehabilitation and finally a justification of the identification of a model relevant to vocational rehabilitation. Work can be seen as being an important part of health and wellbeing and also social inclusion. Waddell Burton (2006) suggest that work is therapeutic, helps promote recovery and rehabilitation. Leads to better health outcomes, minimises physical mental and social effects of long term sickness absence and worklessness, decrease the chances of chronic disability, long term incapacity from work and social exclusion. Also promotes full participation in society, independence and human rights, reduces poverty and improves quality of life and wellbeing. Work can be divided into four different areas: paid (contract, material reward), unpaid (housework, caring, volunteering), hidden (illegal, morally questionable) and substitute (sheltered workshop, work projects, day centres) (Ross 2007). The demand for work is extremely high due to the amount of people that are living. Compared to other countries, the United Kingdom employment figures are high with people being employed with a health related condition increasing (Department of Health 2008). It has been estimated that 175 million days were lost in 2008 due to illness with 600,00 people turning to incapacity benefit. (Department of Health 2008) It has been shown that 40% of medical certificates issued have been related to mental ill health with the average time off working being 15 weeks. (Department of Health 2008) Work has been shown to be good for your health and employers who adopt a good approach to health, by protecting and promoting it, are important in stopping illness from occurring. This is an area in which O.Ts can provide a key role in supporting and maintaining people back into work or who are already in work to stay there. Vocational rehabilitation is important. This has been shown in the governments new mental health strategy No Health Without Mental Health (Department of Health 2011). One of the aims is working to help people with mental health problems to enter, return to employment and stay in it. The application of O.T within this area is important as our core philosophy is to enable individuals to engage in meaningful occupations, therefore there is a key role for O.Ts to play within vocational rehabilitation. The following quote demonstrates that meaningful engagement in occupation can be important, which reflects O.Ts core ethics and philosophies. Not everyone wants to be employed but almost all want to work, that is to be engaged in some kind of valued activity that uses their skills and facilitates social inclusion (College of Occupational Therapist 2007 p9). Currently within vocational rehabilitation, employment specialists are trained in advice and guidance and REC level 3 advanced certificate in recruitment practice. Employment specialities tend not to be mental health professional but have skills in vocational rehabilitation or industry experience (Waghorn 2009). O.Ts already have these skills and also can add a holistic client centred approach from an occupational perspective. O.Ts can also add an educative approach, combine medical and occupational models and use activity analysis. They can assess occupational function/performance, build therapeutic relationships, carry out psychosocial assessments and interventions, cognitive evaluation and training, help with work life balance for the client and work with clients strengths. (Waghorn et al 2009, Devline et al 2006 Joss 2001, cited in College of Occupational Therapist 2007 p15) An O.T can bring seven core skills to vocational rehabilitation: collaboration with the client e.g. building therapeutic relationships, assessment e.g. Model of Human Occupation Screening Tool, enablement, problem solving, using activity as a therapeutic tool, group work and environmental adaptations e.g. graded return to work (Duncan 2006 p45) Current themes and drivers within mental health are social inclusion, return to work agenda, recovery. Social exclusion happens when people are unemployed have poor skills, low incomes, poor housing, high crime, bad health and family breakdown (social inclusion and co-production 2011) A report called Mental Health and Social Exclusion was published in June 2004 by the Office of the deputy Prime Minister. It aimed to improve the lives of people with mental health problems by getting rid of obstacles to employment and social participation. There are five main reasons why social exclusion occurs for people with mental health problems. Firstly stigma and discrimination, in which an O.T can help by activity speaking to employers about mental health and how reasonable adjustments, could be made. An O.T can help by increasing low expectations, help promote vocational and social outcomes, help provide ongoing support whilst in employment by regular outreach appointments and help access basic services e.g. dry runs on transport, membership to sports centres (Office of the deputy Prime Minister 2004). Overall an O.T can help people remain in their jobs longer and return to employment faster and manage the work environment better by grading work, breaking down activities and rebuilding them step by step and making adaptations to the work environment for example. Another trend is recovery. Recovery is building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems (Slade et al 2008). Recovery encourages people to develop relationships which give their life meaning. There are five stages of recovery: moratorium (withdrawal, loss, hopelessness), awareness (realisation), preparation (strengths and weakness regarding recovery), rebuilding (positive identity, goal and taking control), growth (living a meaningful life, self management of illness, resilience, positive sense of self) (Andresen, Caputi Oades, cited in Slade et al 2008). Satisfying work supports recovery and as such O.Ts can have a great impact here by ensuring clients are in jobs they really enjoy and able to cope with the work demands. By working in a client centred way, listening, help identify and prioritise personal goals for recovery; identify examples of own lived experience. Also pay attention t o goals which will enable the service user to get back into work, suggest non-mental health resources (friends, contacts, organisations), encourage self management of problems, discuss what the service user needs in terms of psychological treatment, convey an attitude of respect and continue to support, an O.T can help a service user to achieve their ideal job. The return to work agenda is about helping people in and/or return to work. O.Ts can aid this by grading work activities e.g. working hours to start with 16 hours per week and gradually increase by 5 hours per week until full time hours are achieved for example. Also by providing support whilst in job by light touch support, setting up group work activities and training the service user. A practice called place then train helps increase motivation and confidence by placing someone in work and then training them instead of the other way around. It improves employment outcomes and peoples mental and physical health over a long period of time (Centre for Mental Health 2011). Its philosophy emphases rapid job searching, individualised job placement in work followed by on-the-job training and ongoing support (Twamley et al 2008). Currently the concepts of management in vocational rehabilitation within the private mental health sector follows the following structure: Area manager Service lead Employment specialists Volunteers With the introduction of an O.T manager the following structure will be placed: O.T Manager Band 5/6 O.T Employment specialist/ Volunteers O.T.A Referrals will either come from people themselves or via the community e.g. mental health teams, doctor surgerys, job centres. With new referrals the degree of risk, impact of O.T on service user, consequences of service user not receiving treatment, length of waiting time and the appropriateness of skills and abilities will be considered. To get people on board for the change in management, people will be listened to for their points of views, concern will be shown, the manager must be approachable e.g. leaving door open and using positive body language, change will be promoting in a positive manner e.g. it will benefit the patients and questions will be encouraged, integrity and charisma will be shown, also have a good ability to communicate, set direction and unify and manage change. The Lewins stages of change (Mullins 2007) will be adopted where first unfreezing will take place followed by moving and then refreezing. Unfreezing is about getting ready to change by understanding that change is necessary and moving out of comfort zones. Its about weighing up benefits and negatives of the change. Moving or change is when people are unfrozen and decide to move toward a new way of working. This is often the hardest for people and support is needed. Refreezing is stability once the changes have been completed. These changes have been accepted and become the norm. People create new relationships and become comfortable with the new routines. The O.T manager will provide supervision to the band 5/6 O.T and have supervision from a paid outside O.T at that equivalent level. The Band 5/6 O.T will have supervision from the O.T manager and the Occupational therapy assistant (OTA) / employment specialist and volunteers will be supervised by the band 5/6 O.T. Volunteers will be looked after by the OTA. Management will be in a democratic style by listen to people opinions and having staff work with the manager, not against. Make sure that management set examples by dressing correctly, not being late for work; develop an image, project self confidence, influence others and establish personal authority (Martin et al 2010). Also address self management by managing time, self and case load e.g. size up task, knowing themselves (need for breaks, strengths and weakness), prioritising and planning control(keeping a dairy, decreasing interruptions). Bad management will be discouraged such as not resolving problems, criticising staff, poor decision making, disorganisation, failing to deal with staff issues, done give recognition, inflexibility, and have an uncaring attitude and poor communication skills (Moore et al 2006) Management will consider professional duties and responsibilities such as the code of ethics, continues professional development (competence), health and safety (risk assessments) and deal with the present. A number of factors may influence management style: confidence in staff e.g. their abilities, need for certainty (risks of handing over control), personal contribution and stress (overload, worry, pressure) (Martin et al 2010). The justification of a model relevant to vocational rehabilitation is the Model of Human Occupation (M.O.H.O). M.O.H.O looks at peoples motivation (volition), routine planning (Habituation) and the influence of environment on occupation (performance capacity). Some of these areas will be affected by the service user. Volition is the thought and feelings we adopt whilst doing things. This involved three areas: personal causation, value and interest. To change motivation these areas will need to be addressed. By looking at the service users present and potential abilities relating to work and how able they are to bring about work (what is good, right and important) e.g. security, accomplishment and interests, having positive feelings associated with working. Habituation looks at reoccurring patterns of behaviour that make up our daily routines. A service user can change their habits by learning new ways of doing occupations and by changing their perceived role to one of a worker/bread winner. Performance capacity is how the musculoskeletal, neurological, cardiopulmonary and other body systems are used during performance. If there is a problem in performance capacity, the environment must be addressed. Work is an increasing important aspect in our lifes. Some of us live and breath work spending the majority of our waking hours working. Work gives us a sense of identity, an occupation, money to spend. It also provides us with a role in the community helping others with our knowledge in a particular area. Work provides us with a purpose, includes us within society preventing social exclusion, increases self esteem and gives us a role/meaning within society. Definition Work can be seen as the idea of doing, either mental or physical, giving an economic reward, social interaction, the structuring and organisation of time, opportunity for social interaction, contribution to society and self identity (Baker Jacobs 2003) What can Occupational Therapy offer that is different? Occupational Therapy can offer an approach which looks at the whole of a person by putting the client at the centre of their treatment from an occupational perspective. Occupational therapists can also educate people, focusing on independence and ensuring participation in meaningful activities. Occupational Therapists are able to combine medical and occupations models. This means they can look at the impact that physical, social and cultural environments have on everyday activities. Patch Three The following patch will give a critical evaluation and analysis of social policy, legislation and ethical issues impacting on vocational rehabilitation in a report style. Legislation No Health without Mental Health (Department of Health 2011) The government is helping people with mental health problems to enter, stay in, and return to employment. This can by achieved by using light touch support, increase confidence in returning to and remaining in work, help manage conditions and help the interaction between appropriate work and well being. It consists of six main objectives: more people will have good mental health, more people with mental health problems will recover, more people with mental health problems will have good physical health, more people will have a positive experience of care and support, fewer people will suffer avoidable harm and fewer people will experience stigma and discrimination (Department of Health 2011 p6). Its outcome strategies is to focus on how people can be best empowered to lead the life they want to lead, to keep themselves and their families healthy, to learn and be able to work in safe and resilient communities and how practitioners can be supported to deliver what matters to service user. Occupational Therapists can provide high quality employment support which will include building confidence in returning to and retaining work, changing employers and service users beliefs, that they can perform the job and their condition is manageable. Support Interaction between appropriate work and wellbeing and help employees to make appropriate recruitment decisions and manage workplace health. New Horizons (Department of Health 2009) This mentions that work can be good for mental health and wellbeing and support recovery. Those who are unemployed are at an increased risk of developing mental illness and benefit from early support. Employment should be seen as an important outcome to the treatment of mental illness in health care settings. O.Ts can help change attitudes to mental health, can improve health and wellbeing in work, provide swift intervention when things go wrong, coordinate help tailored to individuals needs and build resilience from the early years and thought working lives. Health, Work and Wellbeing Caring for Our Future (Department of Health 2005) Suggests that work is recognised by all as important and barriers to starting, returning to or remaining in work are removed. For people to remain in and return to work, that healthcare services meet the needs of people of working age. That health is not affected by work and good quality advice and support is available. Ensure work offers opportunities to promote health and wellbeing and access to the retention of work promotes and improves population, people with health conditions and disabilities are able to optimise work opportunities and people make the right lifestyle choices from an early age. O.Ts already recognise the importance of work for their patients wellbeing and can provide the assistance necessary to fulfil their key roles in helping patients to remain in and return to work. O.Ts can help people return to work following and absence by employment advice and helping to find a suitable job by adapting the work place environment e.g. time flexibilities. National Skills Framework 5 years on (Department of Health 2004) Help to prevent social exclusion in people with mental health problems, improving their employment prospects and opposing stigma and discrimination. O.Ts can help prevent social exclusion by building confidence, motivation and skills, speak to employers about mental health and how reasonable adjustments could be made, help provide ongoing support whilst in employment and help reduce stigma and discrimination by educating people. Working for a healthier tomorrow (Department of Health 2008) Is concerned with the health of people of working age (females 16 to 59 and males 16 to 64). Identifies factors that prevent good health and changes in attitudes, behaviours and practices. Three main principal objectives: prevention of illness and promotion of health and wellbeing early intervention improvement in health of those out of work O.Ts can prevent illness and promote health and wellbeing by using activity as a therapeutic tool, ensuring early intervention and help those out of work by doing group work to build confidence, motivation and reduce anxieties. Ethics There are at least five potential ethical issues which may be encountered within vocational rehabilitation in a private mental health charity organisation. These are confidentiality, consent, autonomy and welfare, human rights, issues of power and control (College of Occupational Therapists 2005): Confidentiality Safeguarding of confidential information relating to clients, only disclose information when client has given consent, there is a legal justification or it is in public interest to prevent harm. Only disclose to third parties if there is a valid consent or legal justification to do so. Keep all records locked away securely and only make available to those who have a legitimate right or need to see them. Clients can see their records and prior to producing material, issues of confidentiality will be addressed. Use the confidentiality model: Protect (look after information), inform (ensure service user is aware), provide choice (allow service user to decide if information will be disclosed and improve (look for better ways to protect, inform and provide choice) (Department of health 2003) Consent Making sure the client has the capacity to consent. The 2005 Mental Capacity Act makes provision for people who are thought to lack capacity to make their own decisions. It has five key areas: a presumption of capacity every adult has the right to make choices and must be assumed to have capacity to do so unless it is proved otherwise; the right for individuals to be supported to make their own decisions appropriate help must be provided before anyone suggests that they cannot make their own decisions; that individuals must retain the right to make what might be seen as eccentric or unwise decisions; Best interests anything done must be in the best interest for the service user and Least restrictive intervention anything done should be the least restrictive of service users basic rights and freedoms. (Department of health 2007) Autonomy and welfare Respect clients autonomy and promote dignity, privacy and safety of client. Give patients the right to make choices and decisions about their own healthcare and independence. Provide sufficient information to enable them to give informed consent and in a language that can be understood. Make sure client understands the nature, purpose and likely effect of intervention and acknowledge refusal. Human rights A right not to be discriminated against regardless of persons religion, sex, race, colour or mental health A right to respect for private and family life e.g. medical record keeping, parental involvement, collection of data A right not to impact on the individuals freedom of thought, expression or conscience e.g. spoken language and access to interpreters Issues of power and control Respect individuals, enable client to take power and promote partnership Management of Quality Issues Quality assurance The service provided will ensure that it meets the needs and expectations of clients and communities, that there is an understanding of service delivery systems and its key services, that data is analysed, problems are identified, performance is measured and that a team approach to problem solving and quality improvement is used. Clinical Governance Involvement Make sure service users, carers and public are involved within the service by holding focus groups, open days, suggestion boxes, questionnaires, panels e.g. to find out opinions on waiting times, attitudes of staff and the physical environment Risk management Establish what could go wrong and rank this. Think how probable it is likely to occur, what can be done about it and what action should be taken if incident happens again (Health Safety executive 2006). E.g. service users deliberately harming herself in occupational therapy session or a spillage on the floor. The Healthy and Safety at Work Act (1974) states that it is the duty of the employer to ensure so far as is reasonable practical, the health, safety and welfare at work of all his employees (section 2 (1) Health and safety at work act 1974). Although it is the duty of the employee to take reasonable care for the health and safety of him/her and others who may be affected by his/her acts of omission and to co-operate with their employer in regard to any duty or requirements imposed (section7 Health and Safety at Work Act 1974) Clinical audit Identify topics relevant to vocational rehabilitation e.g. referral response times, set standard (3 days), collect data (computer package), analyse data (if standard not met then why) and implement change. Other examples may be how the service compares with standards set by other clinical governance activity. Clinical effectiveness Ensure that all treatment is up to date and based on evidence based practice, National Institute of Clinical Excellence and National Service Framework guidelines. Staffing and staff management All staff recruited have the skills and qualifications needed to do the job e.g. that they are Health Professional Council (HPC) registered, induct them, give supervision and appraisal and deal with poor performance. Also supervision on a regular basis and appraisal once a year. Use an indirect approach which is more centred around the person, talk less and listen more, provide a supportive relationship, ask questions, accept and use ideas, reflect and summaries ideas (Enthwistle 2000) Education, training and Continues Professional Development (CPD) Ensure mandatory training is given e.g. fire training, child protection, health and safety. Complete CPD portfolios and HPC audits; provide training and opportunities to enhance CPD such as visits to another vocational rehabilitation service. The HPC (2011) states five standards for the CPD. A registrant must maintain: an up-to-date and accurate record of their CPD activities demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice make sure that their CPD has contributed to the quality of their practice and service delivery ensure that their CPD benefits the service user present a written profile containing evidence of their CPD on request Use of information systems Use information systems to record treatment sessions that service users attend, time spent preparing treatment sessions, time spent on phone calls to service user and time spent in case discussions. Also handling patient identifiable information by applying the data protection act and locking information away. The data protection act implies that anyone collecting personal information must fairly and lawfully process it, process it for limited, specifically stated purposes, use the information in an adequate relevant and not excessive way, use information accurately, keep information on file no logger than necessary, process information in accordance with legal rights, keep information secure and never transfer information outside U.K without adequate protection (Direct Gov 2009) Patch Four The following patch will provide a reflective narrative of the learning experienced throughout the module utilising the Gibbs reflective cycle. This has been developed from Kolbs ideas and develops the features of the experience-reflection-action cycle (Jasper 2003): Description Action plan Feelings Reflective cycle Conclusion Evaluation Description The Gibbs cycle consists of six stages and asks a series of questions about the experience. Description stage is what happened, feelings stage is what where you thinking and feeling, evaluation stage summarises what is good and bad about the experience, description stage involves making sense of the situation, conclusion stage is what else could have been done and the action plan stage asks if the situation arose again, what would you do. To begin with the whole assignment seemed extremely daunting as I had never participated within a role emerging placement/role before. I had also never completed a patch work text and knew very little of both. As part of the assignment we were asked to discuss ideas with peers. I felt it was a good idea to share information with others and thought that this would be an ideal opportunity to reflect on things I was not sure about and where to go for more information. Whilst discussing ideas with my peers I was thinking how what we had discussed would fit into my assignment and in what patch. It made me feel a little more comfortable sharing with other as we could bounce ideas and thoughts off each other. I feel other peers also felt that group discussions were useful and helpful. From start to finish I felt good about discussing information and still feel that this was of great benefit to all of us. Exchanging views helped put things in some kind of order and others could help in areas where I had difficulties. I do not feel there was anything negative about this experience in general. Sharing ideas with others went well as we all had views to share. To contribute, I helped others to see what went in each patch and gave ideas about the assignment. Overall there is not much I would have done differently with this peer review work. The aim was to share and discuss information and this was done successfully. If I were to do peer review work again I would do the same by sharing ideas and information with others. During my visit to a vocational rehabilitation setting I got to see how the service was run, where referrals come from, meet staff and service users and view leaflets. Upon arrival I felt overwhelmed by information and was intrigued about the service. I was thinking how I could relate this to my assignment and what role an occupational therapist would play within such a service. The service manager, who showed me around, knew about occupational therapy as previously they had worked as an assistant in such a role. This made me feel happier as I could share some ideas with them. I felt the visit went extremely well and it was a positive learning experience. From the start I felt comfortable about visiting the service and knew I would collect lots of relevant information from it. Access to information and ideas was the most significant factor for me. Actually seeing a vocational rehabilitation service running was a great inspiration and thought provoking for me, as I could see where parts of my assignment would fit in. I feel the whole visit went well and managed to collect a lot of relevant information. To complete patch work two we were asked to produce a leaflet aimed at our intended service users. I found this patch difficult because selecting relevant information was not easy e.g. font, colours, headings, content, pictures. When I first started the leaflet I had previous knowledge from another module, so had an idea how to construct the framework. I was thinking what type of content would go into the framework of the leaflet and how. Others mentioned that the leaflet should be easy to read and with bullet points, pictures and a calming background. I felt this would be a good idea, by aiming the leaflet at my service user group in particular. I thought that the leaflet was starting to take shape and it was aimed at who it was intended for. To start with I felt a little lost as to what to so but with help from my peer review group I eventual found a way. The most significant thing to me was being able to reflect ideas with other people about the leaflet. I feel that putting the leaflet together was a good experience as it has taught me how to present information to a targeted audience by using easy to understand phrases rather than jargon. Also working in peer review groups was a good experience as we were able to share ideas with each other and share information. The only thing that didnt go so well was working out how to transfer the leaflet from publisher to a word document, also slimming down the content without vital information being lost. I feel the leaflet went well and managed to collect and produce the correct information. Others did help by offering encouragement and ideas which aided me in producing the leaflet. I realise now that I should have consulted my peer group earlier to starting the leaflet as their ideas helped and guided me. To complete patch three we were asked to critically evaluate and analyse social policy, legislation and ethical issues impacting vocational rehabilitation. I found writing this patch extremely difficult as I had no idea of legislation, ethical issues and quality issues relating to this subject. When I started this patch I felt very nervous and worried as to how I would find such information. I was wondering how I would go about doing this patch and what was involved. When I was looking for information I found a vast array. I had to sieve through relevant legislation and apply it to