I.T. Project †Converting a Card Index System to a Database Essay

The present system is based on the manual card index system so most of the work is done by hand, however due to the ever increasing growth of technology, and the internet, a wide range of resources are now being made easily accessible. British Airways has recently introduced booking online, where customers can book a flight and accommodation all over the Internet. Being such a big company as British Airways, most of their bookings are made through travel agents who book the flights and pass the information on to them. Question 1 – Could you describe the current system being used by Question 2 – How are these cards stored? Question3 – What problems do you encounter at the moment? Software Available MICROSOFT OFFICE 2000 WORD PROCESSOR – MICROSOFT WORD 2000 A word processing package is a program or set of programs used to edit, format, store and print documents. Word processors have many important unique features: * Spelling and Grammar Checker Misspelt words, or grammatical errors can be identified and corrected by the words in the computers dictionary. Correct words, identified by the spell check as wrong can be added to the dictionary. * Automatic creation of index and table of contents Any word in the text can be marked for inclusion in an index. Headings and subheadings in a given style can be included automatically in a table of contents, which can be updated at any time. * Import Files Tables, photographs, graphics, video and sound files can be imported from other sources and inserted in a document. * Mail merge A document and a list of names and addresses can be merged to produce personalised letters. * Creation of templates with preset text styles. Margins, formatting, letterheading etc. * WYSIWYG This stands for ‘What You See Is What you Get’, and refers to the ability to display on the screen. And enables the user to see their work on the screen exactly as it will be printed. SPREADSHEET – MICROSOFT EXCEL 2000 Spreadsheet packages allow a user to create worksheets (spreadsheets) representing data in column and row form. Spreadsheets are used for any application that uses numerical data, such as budgets, cash flow forecasts, profit and loss statements, student marks or results of experiment. Spreadsheet features: * Format cells, rows and columns, specifying for example, the alignment of text, number of decimal points, height and width of cells. * Copy cell contents to other locations, with automatic adjustment of formulae from an area to another location. * Determine the effect of several different hypothetical changes of data; this facility is called ‘what-if’ calculation. * Insert, move or delete rows and columns. * Use functions such as sum, average, max, min in formulae * Create a simple database and sort or query the data to produce a report of, say for example, all males gaining over a ‘C’ grade, for a list of students. * Write macros to automate common procedures * Create templates – Spreadsheets with formats and formulae already entered, into which new figures may be inserted. * Create ‘multi dimensional’ spreadsheets using several sheets, and copy data from one sheet to another * Create many different types of chart and graphs DATABASE – MICROSOFT ACCESS 2000 A database is a collection of data. It may be something as simple as a list of names and addresses or details of the CDs in your personal collection, or it may contain details of all the customers, products, orders and payments in a large organisation. When made reference to, the word ‘database’ is assumed to be data held on a computer, but manual databases also exist. Some smaller business (a garage) may hold a card index file with details about a customer and their car. The main difference between a manual and computerised databases is the speed at which data can be accessed. PRESENTATION GRAPHICS – MICROSOFT POWERPOINT 2000 Presentation graphics software such as PowerPoint is useful for putting together a presentation which can be delivered using a computer attached to a projection device, using transparencies and an ordinary overhead projector or as a self-running presentation in, say a shopping centre or cinema. The software allows the user to quickly create ‘slides’ combining text, graphics and pictures and to create animation or sound effects and ‘transition’ effects between slides. OPERATING SYSTEM – MICROSOFT WINDOWS 98 Hardware Available These are the specifications of the PC I am using at Home: OPERATING SYSTEM WINDOWS(r) 98 PLUS! CPU INTEL(r) CELERONTM / 333MHZ RAM 64MB FOR WINDOWS(r) 98 SCREEN DISPLAY 800 BY 600 PIXELS TRUE COLOUR (32 BIT) CD-ROM SPEED 32-SPEED AVAILABLE SPACE ON HARD DRIVE 2.4GB AUDIO 16-BIT SOUND CARD OTHER LOUDSPEAKERS These are the system specifications for the systems at school: OPERATING SYSTEM WINDOWS(r) 98 CPU 433MHZ RAM 32MB FOR WINDOWS(r) 98 SCREEN DISPLAY 640 BY 480 PIXELS 256 COLOURS CD-ROM SPEED 24 SPEED AVAILABLE SPACE ON HARD DRIVE 10MB AUDIO 8-BIT SOUND CARD PRINTER HP LASERJET All systems should have Microsoft Office 97/2000. All systems must have Microsoft Excel 97/2000. End User’s IT Literacy The end user of my system will already have basic IT skills and will have already had experience with the Microsoft Office Package. As they are working for a big trans-national company, they would have already undergone training in the secretarial sector, of which IT skills are a key part. To even have the job, they would have to be able to type quickly, answer calls and transmit data efficiently. Therefore, training costs will be kept to a minimum. Final Choice Having looked at the current system and the software and hardware available, I have decided to use Microsoft Excel, a spreadsheet program to design my booking system. Spreadsheet packages allow a user to create worksheets (spreadsheets) representing data in column and row form. Spreadsheets are used for any application that uses numerical data, such as budgets, cash flow forecasts, profit and loss statements, student marks or results of experiments. Spreadsheets offer a wide range of facilities making the task easier to perform. SKILLS: Current/To be acquired I have a good understanding of the Microsoft Excel package. I have done quite a few calculations and performed basic macros. Having looked through the coursework of former students, and reading through the coursework guide, I realise that I need to improve my knowledge of Excel. Excel is a powerful package and can carry out many tasks easily if instructed correctly. I have already started to go through sample projects showing me how to go about certain tasks with a book titled ‘Successful I.T. Projects in Excel’, written by P.M Heathcote. End User Requirements > Provide detailed reports showing customer booking for every working day. > Produce summary reports for flight bookings in order of popularity. > Allow data entry for new customers. > Provide easy access for amendments to customer details and flight details. > Automatic backup for all centralised records daily and weekly. > Provide an exception report for outstanding customer debts or extreme bank credit limits. > The system should record financial details concerning money in/outstanding. > Allow queries on the current flight availability. Quantitative Criteria > Printed tickets are to be generated within 15 minutes. > Accessing and amending customer/Fight/Airport details should be instantaneous. > Queries are processed promptly on customer request. > Backup should occur automatically every 24 hours. > Flight details processed every Friday (1 hour max) > Exception reports are produced quickly on demand within a minute. Qualitative Criteria > The system should provide a workable Human Computer Interface system according to different users, i.e. simple menu selections or buttons > The company logo is consistent on all forms and reports. > Amount of available screen data is kept to a minimum (increase usability) > Help systems are easily accessible.

Egyptian art Essay

Egyptian art is one of the most fascinating topics in both ancient art and ancient history. As a culture, the Egyptians truly represented themselves through their art and as a result produced a body of work that is rivaled only by the Renaissance. In the two reliefs pictured, the Egyptian ideal is pictured. This compares to the palette of King Narmer and the tomb of Ti in Saqqara. One thing that we can say about Egyptian art is that it does not change much over time. This can clearly be seen in the overall style of both of the reliefs pictured. One was done during the Sixth Dynasty and the other was done during the First Intermediate Period. The similarities in style are marked. From the stylized view of the head to the way the arms and body are drawn, the similarities are striking. This is compared with the Palette of King Narmer, which is from the Predynastic period. The same stylized images are displayed in this palette as in the two reliefs. Even in the tomb painting of Ti at Saqqara, one sees the same stylized images in living color. When we look at the Portrait of Ni’Ankhesut, one sees a relief image of a male wearing a headdress of non-noble bearing. He is also wearing a necklace, though we cannot see much detail. Our subject is seated, and above him we see some Egyptian hieroglyphics. These are probably cartouche in nature, that is, they reflect the subject’s name and rank within Egyptian society. The relief is composed in limestone, which was the primary building material of the time. The Funerary Stele of Iamu is another typical work of Egyptian art. Like the portrait, it is also composed limestone, but in this case, it tells a story. The Egyptians took their afterlife traditions and rituals very seriously and to that end, made sure the story of the deceased’s life and afterlife was told in detail. In this case, the tale being told is that of death. This relief shows the funerary rites as they are performed as well as hieroglyphics that explain what exactly is going on. In this case, the relief shows the process involved in serving the master and in creating the facade that is the Egyptian afterlife. Both of these reliefs contrast to the Narmer Palette. This is a two-sided object that is arrowhead shaped. Many archeologists feel as though it shows the dominance of Upper Egypt over Lower Egypt. Narmer is presumed to be a mythical god-king who presumably united Upper and Lower Egypt. Narmer is displayed prominently on both sides of the palette, and while there are some themes that are common in Mesopotamian art, there are aspects that are uniquely Egyptian. The partial profiling of the figure with the front view of the hands is Egyptian in and of itself and shows that Egyptian art had a style all its own even at the early juncture of its history. This palette also tells a story, that is, it tells the bloody story of the unification of the two parts of Egypt. This is also a theme that is indicative to Egyptian art. The nature of the storytelling that each piece tells shows that the Egyptians are very much interested in showing their own story and history through their art. Even at this early juncture, they saw art as a means of cultural transmission, and used it effectively to create the story of their own beginnings. Finally, the last piece of art is the tomb of Ti at Saqqara. This piece of art is unlike the others, in the fact that it still retains its original color. In this scene, we see who we can presume is Ti sailing on the Nile that is overflowing with fish and other marine life. He is with other warriors and is presumably hunting hippopotami and birds in the marshes. Again, the relief is highly stylized with no variations in the human form. As with the other reliefs noticed, there are no variations in the human form. Each person looks almost identical to the last, and the only way that one would know the difference between the various people is by looking at their cartouche or knowing what tomb one is in. It is even difficult to tell who is who in the relief images without the help of the hieroglyphic writing. What are the ways we tell who is who in the various relief pictures that we are exposed to in Egyptian art? One of the major ways that we can tell is by looking at the size of the person that is displayed. What does this tell us? What it says is that the largest person in the picture is usually is the main subject of the tomb or the hieroglyphics. The smaller figures are usually minor players or servants. Even spouses are sometimes displayed smaller in respect to the main figures. The main protagonist of the painting or relief is prominently displayed with the accompanying cartouche and tomb writings more than capably tell who is who in the grand story. If we look at the portrait of Ni’Ankhesut, we see that he is the largest figure in the relief. In the Funerary Stele of Iamu, we see that Iamu is most prominently displayed. Again, both of these examples show the casual observer who is the prominent figure in the relief. Additionally, the cartouche and the tomb writings show us easily who is the main protagonist. In the Narmer palette, Narmer is prominently displayed on one side of the palette, taking up nearly the entire side. This is the most telling sign of Egyptian art and supremacy of the figure. By making King Narmer the largest figure in the palette, the artist is showing the supremacy and the importance of Narmer in the history of Egypt. What can we learn from Egyptian art? We can learn that this group created a fascinating body of work that has permeated the world in which not only they lived, but we live as well. Without the Egyptians, we would not have modern portrait art and the art of realism that exists today. Though Egyptian art is highly stylized, we see shades of ourselves in their work. All cultures can look to the Egyptians for their own inspiration for their own art and culture. Each culture took from the Egyptians to form their own unique art forms and their own stylizations and themes. As a modern culture, we can look to the Egyptians for inspiration for the future, and we can look for them to reinforce our past so we can continue to learn more about the fascinating culture that continues to affect us even today.

Sociology Definitions

Culture: All that human beings learn to do, to use, to produce, to know, and to believe as they grow to maturity and live out their lives in the social groups to which they belong. Culture Shock: The reaction people may have when encountering cultural traditions different from their own. Culture Universal: Forms or patterns for resolving the common, basic, human problems that are found in all cultures. Culture universals include the division of labor, the incest taboo, marriage, the family, rites of passage, and ideology. Material Culture: All the things human beings make and use, from small handheld tools to skyscrapers. Non-Material Culture: The totality of knowledge, beliefs, values, and rules for appropriate behavior that specifies how people should interact and how people may solve their problems. Norms: Specific rules of behavior that are agreed upon and shared within a culture to prescribe limits of acceptable behavior. Mores: Strongly held norms that usually have a moral connotation and are based on the central values of the culture. Folkways: Norms that permit a rather wide degree of individual interpretation as long as certain limits are not overstepped. Folkways change with time and vary from culture to culture. Ideal Norms: Expectations of what people should do under perfect conditions. The norm that marriage will last â€Å"until death do us part† is an ideal norm in American society. Real Norms: Norms that allow for differences in individual behavior. Real norms specify how people actually behave, not how they should behave under ideal circumstances. Value: A culture’s general orientations toward life; its notion of what is good and bad, what is desirable and undesirable. Sapir-Whorf Hypothesis: A hypothesis that argues that the language a person uses determines his or her perception of reality. Cultural Lag: A situation that develops when new patterns of behavior conflict with traditional values. Cultural lag can occur when technological change (material change) is more rapid than are changes in norms and values (nonmaterial cultural). Subculture: The distinctive lifestyles, values, norms, and beliefs of certain segments of the population within a society. Types of subcultures are religious, age, regional, deviant, occupational. Rites of Passage: Standardized rituals that mark the transition from one stage of life to another. Ways that Culture is transmitted- Mechanism of Cultural Change-Diffusion: The movement of cultural traits from one culture to another. Reformulation: A trait is modified in some way so that it fits better in its new context. Innovation: Any practice or tool that becomes widely accepted in a society. Selectivity: A process that defines some aspects of the world as important and others as unimportant. Selectivity is reflected in the vocabulary and grammar of language. Taboo: A sacred prohibition against touching, mentioning, of looking at certain objects, acts, or people. Symbol: Objects that represents other things. Unlike signs, symbols need not share ant of the qualities of whatever they represent. Ethnocentrism: The tendency to judge other cultures in terms of one’s own customs and values. Cultural Relativism: The positions that social scientists doing cross-cultural research should view and analyze behaviors and customs within the cultural context in which they occur. Ideology: A set or interrelated religious or secular beliefs, values, and norms justifying the pursuit of a given set of goals through a given set of means.

AnheuserBusch Companies, Inc. 2004 Case Analysis Essay

AnheuserBusch Companies, Inc. 2004 Case Analysis - Essay Example The aim of this analysis was to determine the standing of this company as of 2004. The company was found to be a leader in the market. It has sales exceeding double those of its close competitor in 2003. The profit margin of the company is large, despite the fact that the beer market in America is shrinking. The company was also found to have diversified its activities a great deal, and this is one of the reasons why it maintains such a profit margin. In addition to twelve breweries in the local market, the company also operates theme parks, packaging industries and real estate investment. Anheuser-Busch Companies Inc is one of the largest companies in America. It is also one of the leading breweries both in America and globally. It has its roots in St. Louis. On its conception, it was named Bavarian Brewery. This was back in 1852. Within the years, the company has grown in leaps and bounds, and along the way changed its name to the current one. For the past half a century, Anheuser-Busch has been the market leader in beer sales and production. In the year 2003, its position as the market leader was unaffected by various negative aspects that could have seen its sales decline. These included the declining of the stock market and corporate scandals that rocked it. There was also an increase in the amount of government regulation around this time. This was also the time that saw unprecedented levels of global instability, both economically and politically. Despite all these negative aspects, Anheuser-Busch continued to lead the market. A comparison between the numbers of barrel sales that Anheuser-Busch made in the year 1865 with those sold in 2003 will clearly indicate that the company has really come far. The sales have risen from 8,000 to 127.9 million. The company owned a single brewery at that time, but the number for 2003 was made with a capacity of twelve breweries. Anheuser-Busch has gone through a lot of transformation and other experiences since it was found. It was incorporated in the year 1919. It has become the leader around the world in the production of beer. It has also seen a great deal of technological advancement. This company was the first one that employed the use of

Critically evaluate equality of opportunity in (a) the teaching Essay

Critically evaluate equality of opportunity in (a) the teaching profession OR (b) the classroom - Essay Example It must be pointed out that the EO in teaching profession result to EO in education and hence any discussion for EO in the classroom must be taken to explain the effect of EO in the teaching profession. On the hand the inequality of opportunity (IEO) teaching profession result to IEO in education and hence, any discussion for IEO in the classroom must be taken to explain the effect of IEO in the teaching profession. The premise the teaching profession affects education is based on the premise that teachers bear great responsibility in moulding education of students who will become professionals and matured members of society. And hence good teachers produce good students in the classroom and good teachers and good students produce good education of UK citizens. "Let us stop tinkering with school structures, such as bringing back grammar schools, or promoting selection and the rest. Let us address the real problem, which is to recruit more teachers and better qualified teachers, with adequate resources for them to do the job of raising the general standard of basic education in our country." (Callaghan, 2001) Community Council of DevonïÆ'  (CCD) defines equal opportunities EO as that â€Å"about ensuring fair and equal treatment for everyone, and tackling discrimination wherever it exists in our society.† It says the fundamental principle is that employment opportunities and service provisions should be free from bias, and equally available to all. It posits as well that equal EO involves the breakdown and removal of discriminatory structures, biased policies and prejudicial practices in organisations and individuals. It further states that EO seeks to replace processes that perpetuate inequality with fairer and more effective ways of working. (Community Council of Devon, 2002, pages 1-4) (paraphrasing made) CCD summarized that EOP is about the elimination of discrimination, maximising potential, taking positive action, implementing change,

The impacts on the financial decision process of human elements Essay - 1

The impacts on the financial decision process of human elements - Essay Example Financial decisions are made in a systematic process. Organization factions are run by individuals who are entrusted with carrying on the vision and the mission of the company. As such, human elements is one the key components in the formula of financial decisions success. This paper will evaluate the impacts of the human elements in the process of making financial decisions. As preamble, the paper commences by reviewing types of financial decisions that are made in the organization. The financial decision making process is then assessed. The study then evaluates the types of human elements that characterize the contemporary organization. The impacts of the identified human elements are then analysed with the intent of revealing the extent to which they affect the whole process of making the financial decisions. The study then concludes the findings by giving a brief summary of all the main ideas given in the whole study. Strategic financial decisions are mainly made by the senior management of the organization after the approval by the shareholders. There are three main financial decisions that are made within the organizations, that is, investment, financing and dividend policy decisions. The investment decisions involve identifying the available opportunities for the investment and investing the shareholders funds in the best investment that has high returns and low risks. The financing decisions are the decisions that are made to identify the possible sources of fund to the organization and then selecting three best source of fund. The main sources of fund for the investment to the organization are commercial loans, organization has retained earnings, fund sourced from the capital market, the grants from other organizations and issuing of the corporate bonds (Cascio, John and Boudreau 2010, p.255) On the other hand, the dividend decisions are the decisions, which are made to determine how the

What impact has sustainable design had on the cosmetics industry in Essay

What impact has sustainable design had on the cosmetics industry in the UK - Essay Example The sheer amount of cosmetics spent during the year clearly indicates how the future design would impact this industry. The major purpose of this study is to analyse and understand how the sustainable design may have an impact on the cosmetic industry in UK. The intended objectives of this research is to understand and analyze the impact of design on the cosmetic industry in UK therefore from its basic orientation, this research study will be qualitative in nature. A qualitative research study is conducted when the research objectives include the understanding of the meanings, understanding the ideas, values and belief systems which are understood mostly through subjective study of different variable. The subject of sustainable design is relatively new in the cosmetics industry therefore it may be difficult to obtain latest information on the subject. Since, this research will be qualitative in nature therefore data will be gathered by surfing through the available literature on the subject. This would include studying the relevant available texts as well as case studies on the subjects including peer reviewed journals, surfing the websites of L’Oreal, Body Shop and The design Council etc. This study will also be base don the cross-sectional data from international firms in order to draw different parallels to UK’s cosmetic industry which will then be applied to the cosmetics industry of UK. Apart from this, the researcher also intends to conduct an interview with the marketing manager of the Body Shop. This interview will be based on development of a small open ended questionnaire which will be filled by the marketing manger. Apart from this interview and study and analyses of the available research on the topic, there will be no other methods of qualitative research will be applied. This research study will basically attempt to identify different parameters which can collectively produce and impact on the cosmetic industry in UK.

Geologic Volcano Tour Research Paper Example | Topics and Well Written Essays - 1250 words

Geologic Volcano Tour - Research Paper Example In addition, there are ice caves formed from the lava tubes. The eruption type occurring in Bandera is the passive kind that produces lava flows, cinder cones and small cones. The term Hawaiian eruption is used for this eruption, as it is similar to the one that formed the Hawaiian Islands and continues to form them. Moreover, the rocks formed are called basalts and are usually black in color. In the eruptions, highly explosive eruptions fragment the magma into small cinders that result in cinder cones and gas-rich alkalic basalts make foamy lava shoot very high in the air and cool as they fall, piling up to create cones of loose particles. It is after this that craters are formed from alkali basalt resulting in the Bandera crater, therefore, the volcano is currently dormant albeit with mild signs of life considering its young age. Tectonically, the Bandera Volcanic field is located along the Jemez Lineament, an area known for crustal weakness, moreover, the zone is characterized by a concentration of late-Cenozoic volcanism. The Bandera volcanic field is also located at a transition zone between the Colorado plateau with a thick crust of over 40km (New Mexico Bureau of Geology and Mineral Resources, 2012). In addition, the crust of the area experiences stretching from regional tectonic forces. It is from this stretching that that produces areas of weakness in the brittle little crust allowing magma to force its way upwards and onto the surface. It is on the same Jemez lineament that forms the intersection between the Rio Grande rift and the Jemez Lineament, creating more lines of weakness for volcanic activity to take place. The rift of weakness, Rio Grande rift runs from the North to the South and serves as a means of accommodating East-West stretching of the crust. It is because of this that the entire area is covered with volcanic activity like the Zuni-Bandera crater and Mount Taylor (New Mexico Earth Matters, 2006). Economically, the volcanic site is know n for tourism activities. This is due to geological areas of interest such as the ice caves and the Bandera volcano. The area is open for all to see and visit with the areas labeled as unique and historic landmarks. It spots hiking trails that tourist can climb for a fee around the mountain to the ice caves and the mountain (Icecaves.com, n.d). Other than this, there are not other economic resources or activities suitable in the area for commercial or personal purposes. As for hazards associated with the volcano, there are few signs of a likelihood of an eruption, which makes it a relatively safe area in which to be. This is because despite its youth, there have not been any eruptions in over a thousand years. Groundwater The Antlers sandstone occurs in the in a 4400 square mile area of southeastern Oklahoma and runs parallel to the red river (Morton, 1992). The sandstone comprising the Antlers aquifer is only exposed in the northern side where groundwater runs unconfined (Hart & Da vis, 1981). The sandstone is made up of sand, clay, conglomerate and limestone deposited on Paleozoic rocks. The Antlers sandstone and cretaceous rocks underlie the Gulf Coast Plain Physiographic Province in an area that is mostly plain and is drained by the Red River and some of its major tributaries. The sediments mentioned from the Antlers Sandstone are representative materials that originate from the shoreline sea that

Marketing managment Assignment Example | Topics and Well Written Essays - 1500 words

Marketing managment - Assignment Example Each and every organization, today, give huge importance to marketing. Marketing of a restaurant is basically nothing but the marketing of the service of that restaurant. However, restaurant marketing is little more difficult as compared to any other organization or product as the restaurant industry is extremely competitive in nature. This paper is all about a new restaurant called ‘London dining Experience’ and various issues regarding marketing of this restaurant. The paper includes an in depth analysis of the marketing environment of the restaurant, the process and the reasons of segmentation of the market of ‘London dining experience’. Generally there are two distinct marketing environments that influence an organization. These are micro and macro environment. It is very important for any organization to analyze its marketing environment because marketing environment comprises of all those factors that have either direct or indirect influence on the organization. As far as ‘London Dining Experience’ is concerned, the restaurant is about to launch. As a result it needs to have clear understanding about its marketing environment. Like any other organization microenvironment of this restaurant would include its suppliers, competitors, customers and marketing intermediaries. On the other hand the macro environment of this restaurant is comprised of economics, demographics, nature, politics, culture and technology (University of London, n.d.). So, it can be stated that the marketing environment of this restaurant is the combination of all these factors. Proper analysis of all these factors would enable the organization to create and maintain healthy and effective relation with its suppliers and customers, to have clear idea what its competitors are currently doing, to clearly understand the current tastes, needs and wants of the customers and

Problems Assignment Example | Topics and Well Written Essays - 750 words

Problems - Assignment Example Since the producers are producing Q3, their revenue will rise substantially since all their produce is sold off. On the other hand, consumers would only consume Q2; implying that they are in the same position as before. The loss experienced by taxpayers result from the fact that they are the one financing the purchase of the surplus cheese through payment of higher taxes (David, 2003). b) When the price floor is at $10, new market price will be 10 dollars. This is because the price floor is binding. Taking into consideration that the quantity demanded of Frisbees are only 2 million at a price floor of 10 dollars, 2 million is the quantity demanded. The imposition of tax drives a wedge of 2 dollars between the supply and demand. Consumers pay price P2 whereas producers pay P-$2. Due to increase in price, the quantity of beer sold decreases to Q2 (David, 2003). b) The demand curve for typewriters, substitute goods, will shift to the left as a result of decrease in the computer price (David, 2003). Thus increase in the supply of computers will decrease the demand of typewriters. Hence typewriters producers should be sad. Both quantity supplied and price will decrease. d) Yes, the analysis do explain why software producer Bill Gates is one of the richest men. With advancement in technology, cheaper computers are made making people want more user-friendly software and operating systems. Thus Bill Gates who produce most popular operating systems and software make a lot of money from

Public and Private Schools Essay Example for Free

Public and Private Schools Essay There are many advantages and disadvantages to both public and private schools. As a parent, both options must be explored and the choice must be based on what is right for each particular child.   Public schools often have a larger variety of subjects available, especially when it comes to electives. However, what is learned is somewhat decided by the state because public schools need to do well on standardized testing. Private schools, on the other hand, whether parochial or private have much more freedom of choice in curriculum and can choose to make their own assessments. Because of the individualized instruction, private schools tend to do generally better on standardized testing, that is, if they choose to use it. Private schools, many times, have more demanding curricula and have a higher rate of students who go on to attend college. Public schools are larger and also have larger class sizes. Public schools also have larger student-teacher ratios. According to a web site called Public School Review, â€Å"Private schools average 13 students per teacher, compared with an average of 16 students per teacher in public schools† (publicschoolreview). However, public schools have certified teachers. Private schools typically have teachers who are not state-certified and who may not have expertise in their subject matter.   The biggest difference between public and private schools probably is that public schools are required to educate all students. They cannot deny any student admission. On the other hand, private schools have complete control about who they accept and can kick students out much more easily.   Public schools are funded by tax revenue whereas private schools are funded privately. That means private schools cost money to attend called tuition. Taxpayers pay for public schools so the payment is included in what people pay. However in private schools, the payment is upfront for students to attend. Overall, there is no one right answer for which kind of school a student attends—public or private. The decision must be made for each individual student as there are advantages and disadvantages of both. Works Cited Public School Review. Public Versus Private Schools. Retrieved Nov. 15, 2007 at Web

Locke vs. Rousseau Essay Example for Free

Locke vs. Rousseau Essay ?According to Rousseau, the original condition of mankind was a peaceful and quixotic time in which people lived solitary, uncomplicated lives. This differs from Lockes concept of the state of nature in that, his natural condition of mankind was a state liberty in which one was able to conduct ones life as they saw fit. Like Rousseaus, it was a time of peace between the people, but Lockes was not necessarily a solitary life. ?The state of nature for Locke was a state wherein there were no civil authorities or governments to punish people for transgressions against laws, but was not a state without morality. It was pre-political, but was not pre-moral. In it, persons were assumed to be equal to one another, and therefore equally capable of realizing and being obliged by the law of nature. (The law of nature being one internal, which commanded that no one should harm another as concerning their life, health, liberty, or possessions [p. 4]). In Lockes pre-contract condition, one was not at absolute liberty to do whatever one chose to do; they were inherently bound by the law of nature. ?Rousseaus state of nature had no private property. Private property was something which arose from the stages leading up to the need for authority. Where Locke saw property as something which was naturally protected in the state of nature, Rousseau conceived of property ? the result of greed, competition and vanity- as humanities reason for abandoning such a time and entering into the contract. ?For Rousseau, the few needs of the people in the pre-contract condition were easily satisfied by nature. Because of the abundance of nature and the small size of the population, competition was non-existent, and persons rarely even saw one another, much less had reason for conflict or fear. ?Moreover, for Rousseau, the simple and morally pure persons in the pre-contract condition were naturally endowed with the capacity for pity, and therefore were not inclined to bring harm to one another. There were no inherent ? laws forbidding transgressions on another; it was an internal aptitude for pity. It was the division of labor (once families and communities had developed and leisure time had resulted) that led to value and property, whereas Locke saw property as something that was existent in the natural condition.

Study On The Anthrax Disease Biology Essay

Study On The Anthrax Disease Biology Essay In 2001, letters containing the virulent Ames strain of anthrax spores were mailed to several news media offices killing five people and infecting 17 others. I found this story and the use of anthrax as a bioterrorism weapon fascinating Anthrax is a life-threatening infectious disease that normally affects animals, especially goats, cattle, sheep, and horses. Anthrax can be transmitted to humans by contact with infected animals or their products. However, anthrax does not spread from person to person. Anthrax  is an  acute  disease caused by the bacterium  B. anthracis. Most forms of the disease are lethal, and it affects both humans and other animals. As a member of the genus  Bacillus,  B. anthracis  can form dormant  endospores  that are able to survive in harsh conditions for decades.  For example, spores have been known to have re-infected animals over 70 years after the burial sites of anthrax-infected animals were disturbed. When spores are inhaled, ingested, or come into contact with a skin lesion on a host, they may become reactivated and multiply rapidly. If the spores of anthrax are inhaled, they migrate to lymph glands in the chest where they proliferate, spread, and produce toxins that often cause death. The symptoms vary depending on whether the anthrax spores were inhaled, ingested or through the skin. Inhalation Anthrax The first symptoms are subtle, gradual and flu-like. However as the illness worsens there may be severe respiratory distress, shock and coma. Spores are transported in the lymph nodes where they multiply producing deadly toxins, resulting in severe haemorrhage and necrosis. Usually causing death as although prescribed antibiotics are effective in eradicating the bacteria they do not destroy the toxins already released by the anthrax bacteria. Gastrointestinal Anthrax This form of anthrax is the rarest form. Gastrointestinal infection in humans is most often caused by eating anthrax-infected meat and is characterized by serious gastrointestinal difficulty,  vomiting of blood, severe diarrhoea, acute inflammation of the intestinal tract, and loss of appetite. Some lesions have been found in the intestines and in the mouth and throat. After the bacterium invades the bowel system, it spreads through the bloodstream throughout the body, making even more toxins on the way. Gastrointestinal infections can be treated but usually result in fatality rates of 25% to 60%, depending upon how soon treatment commences. Cutaneous Anthrax Cutaneous anthrax is typically caused when  B. anthracis  spores enter through cuts on the skin. This form of Anthrax is found most commonly when humans handle infected animals and/or animal products. Cutaneous anthrax is rarely fatal if treated,  because the infection area is limited to the skin. The cutaneous form of anthrax starts as a red-brown raised spot that enlarges with redness around it, blistering, and hardening. There lymph nodes get swollen in this area. Symptoms include muscle aches and pain,  headache,  fever,  nausea, and vomiting. The illness usually resolves in about six weeks, but deaths may occur if patients do not receive appropriate antibiotics. The bacteria may be found in cultures or smears in cutaneous anthrax and in throat swabs and sputum in pulmonary anthrax.  Chest X-rays may also show characteristic changes in and between the lungs. Other than  Gram stain  of specimens, there are no specific direct identification techniques for identification of  Bacillus species  in clinical material. A specific feature of  Bacillus species that makes it unique from other aerobic microorganisms is its ability to produce spores. Although spores are not always evident on a Gram stain of this organism, the presence of spores confirms that the organism is of the genus  Bacillus. French scientist Louis Pasteur developed the first effective vaccine for anthrax in 1881. In most cases, early treatment can cure anthrax. The cutaneous form of anthrax can be treated with common antibiotics such as  penicillin,tetracycline,  erythromycin, and  ciprofloxacin.  The pulmonary form of anthrax is a medical emergency.  There are several vaccines in current use. The Russian vaccine, called STI is a  live-attenuated vaccine  based on spores from the  Stern strain  of  B. anthracis.  The STI vaccines serious side-effects restrict use to healthy adults. If a person is suspected as having died from anthrax, every precaution should be taken to avoid skin contact with the potentially contaminated body and fluids exuded through natural body openings. The body should be put in strict quarantine.  Full isolation of the body is important to prevent possible contamination of others. Protective, impermeable clothing and equipment such as  rubber gloves, rubber apron, and rubber boots with no perforations should be used when handling the body. No skin, especially if it has any wounds or scratches, should be exposed. Anthrax cannot be spread directly from person to person, but a persons clothing and body may be contaminated with anthrax spores. Effective decontamination of people can be accomplished by a thorough wash-down with  antimicrobial  effective soap and water. Burning clothing is very effective in destroying spores. After decontamination, there is no need to immunise, treat, or isolate contacts of persons ill with anthrax. Early antibiotic treatment of anthrax is essential, delay significantly lessens chances for survival. Treatment for anthrax infection and other bacterial infections includes large doses of intravenous and oral  antibiotics, such as  fluoroquinolones. In possible cases of inhalation anthrax, early  antibiotic prophylaxis  treatment is crucial to prevent possible death. Anthrax spores can survive for very long periods of time in the environment after release. Methods for cleaning anthrax-contaminated sites commonly use  oxidizing agents   and liquid bleach products containing sodium hypochlorite. These agents slowly destroy bacterial spores.   The pH of the solution should be tested with a paper test strip; and treated surfaces must remain in contact with the bleach solution for 60 minutes. Anthrax spores can and have been used as a  biological warfare  weapon. There is a long history of practical  bioweapons  research in this area. For example, in 1942, British bioweapons trials severely contaminated  Gruinard Island  in Scotland with anthrax spores of the Vollum-14578 strain, making it a no-go area until it was decontaminated in 1990. There are a number of economic impacts of a wide release of anthrax. These include loss of life and direct compensations to families. In addition healthcare, loss of property, decontamination, evacuation and return. After the 2001 attacks the cleanup of postal facilities and offices cost $130 million and took 26 months.

Comparison of the Chartres towers :: essays papers

Comparison of the Chartres towers The cathedral of Notre-Dame at Chartres must be one of the most beautiful and famous architectural specimens in the world today. The cathedral owns an exquisite silhouette against the sky of La Beauce. Two towers rise uncontested, to take watch over miles and miles of French countryside. Up close, the two towers, along with their spires, seem mismatched or unrelated. Yet, the two together provide for one of the most interesting juxtapositions in architecture. â‚ ¬Chartres cathedral has had a tumultuous history with both tragedies and triumphs. Charpentier notes that the site of the cathedral has also served various other purposes. The Romans had used the higher ground for a military camp, part of which still exists on the eastern side of the cathedral by the transition of apse to choir. In addition to the camp site, there was also the existance of a Gallo-Roman temple on the same site as Chartres cathedral. This temple is believed to have the same orientation as the cathedral and the cathedral's round apse uses the foundation of a Gallo-Roman defensive tower. This use of the Gallo-Roman defensive tower is also present at Bourges cathedral. The lower parts of the defensive tower formed a crypt which was incorporated into the ninth century Church of Gislebert, also known as Saint Lubin's chapel. On the night of September seventh 1020, the Church was completely razed by fire. â‚ ¬After the destruction of the church in Chartres, the bishop of Chartres, Saint Fulbert, spearheaded the campaign to build a church in Chartres. Only the crypt remained from the earlier Caroligian church and Fulbert built his Romanesque church around the enduring crypt. Fulbert's church lasted 200 years, but in 1134 the front faÅ“ade was damaged by another fire. It was at this time that a effort to update and restore the church was put into motion. The religious powers, along with the Crusaders longed for a greater monument. Thus, Chartres decided to beg in a separate tower.â‚ ¬This adding on to Romanesque churches was not unusual for the day. The abbey-church at Cluny, outside Italy, was given a new magnificent five-bay narthex and two bell-towers. A similar renovation was attempted at La CharitÅ’, but funds ran short and the upgrades could not be completed. â‚ ¬Hence, in 1134 the tower forming the north-west corner of the present-day cathedral, (the left tower of the west faÅ“ade elevation), underwent construction.

The Influence Of CAD On Society Essay -- essays research papers

Before computers there were hands and tools. Before hands and tools there were just hands. Humans have always been designing and throughout human history drafting is what became of it. With new technology in building during the earlier years drafting needed to be changed to accommodate it. Humans have always been able to find better ways to accomplish things. Drafting is no different.   Ã‚  Ã‚  Ã‚  Ã‚  Before people used tools to draw something they went to what we call now a â€Å"General Contractor† with an idea and he had to come up with the rest. After a while the contractors wanted more. Just an idea wasn’t enough for them. Their clients sometimes wouldn’t like what they had built for them. So eventually the contractors asked the clients to tell them exactly what they wanted. Since it was hard to sketch accurately, tools were developed to aid them in drawing. This enabled the client to show the contractor exactly what he wanted.   Ã‚  Ã‚  Ã‚  Ã‚  As the population grew rapidly the demands for faster and more accurate plans did also. Once again drafters looked for a new way to draw. They decided to turn to the computer. In the 1950s MIT discovered the capability to display a computer-generated image on the screen (Zandi, 5). Up until the mid to late 1970s drafters used this technology just for mathematical calculations (Goetsch, 23). Then they discovered that the computer could be used to display more than just numbers. They found that they could use it to draw on. It wasn’t until the early 1980s that this new technology caught on (Goetsch, 23). Drafters found that using computers was much quicker, more accurate, and much neater than hand drawn plans. They had found their solution, Computer Aided Drafting and Design or CADD.   Ã‚  Ã‚  Ã‚  Ã‚  Now that CADD has found it way into drafting it has been improving upon drafting greatly over the past 20 years. Today nearly all firms use CAD (Friedman). It has changed the way people go about their drawing and designing process. The variety of new programs has made everything more accurate, there are many more ways to think towards a problem, and the process of fast tracking has come about. It has changed the society in many ways.   Ã‚  Ã‚  Ã‚  Ã‚  Whether using CADD or drawing a project traditionally, drafters always start off with a sketch. When brainstorming ideas i... ... in the office (Friedman). People sometimes have conflicting ways to go about something but in the end it all looks the same (Friedman). The human beings’ inherent slowness and inaccuracy in performing manual drafting tasks such as lettering, line work, and scale work, coupled with the ever increasing demands for higher levels of productivity, led to the wide scaled development of CADD (Zandi, 4). Drafting has been influence by CADD over the years and so has technology. The more we can do by drafting the more we can accomplish technologically. CADD has allowed us to accomplish these things. It devises a different way of thinking. (Friedman) And like the railroad, electric light, or the car it will eventually alter our economic structures, our social systems, and our daily living. IBM’s best thinking on this matter is that the computer did not turn out to be primarily a computational mechanism but is for many different things (Zandi, 22). CADD allowed us to design something as complex as a skyscraper and it allows us to create many other complex things. (Grad, 17) Many things are still to come of CADD can we can only await to see how it will change or society and our drafters more.

Free Speech on the Internet v. United States Constitution

The internet became a very popular and huge way of getting millions of different kinds of materials and information for everyday use in the later 80's early 90's. It became easy for anyone to access millions of different kinds of materials ninety nine percent of which is decent according to our governments standards and one or less percent which is considered to be material the is indecent or harmful to minors.(ABC) These facts maybe deceiving however because there are millions of internet sites so the internet may only be one percent indecent but that means there are thousands upon thousands of sites that are indecent.(ABC) The biggest question is how can we protect our children from these indecent sites? The government believed that passing a bill banning indecent material from the internet would help in the protection of the children who use the internet. So in 1996 Congress passed the CDA (communications decency act) along with the TCA (tela communication act).(Lewis) The TCA wa s purposed and passed by congress in order to band indecent material from the radio and television and the CDA was a last minute add onto this bill.(Greenhouse) The CDA was never heard before congress and many of the members questioned its constitutionality. Clition did signed the bill however it was understood that he was hopping that the courts would declare the bill unconstitutional.(Greenhouse) It became obvious very quick that this bill was going to cause problems. In June of 96 the same year the bill was passed a New York internet based paper filed a law suite against the CDA saying â€Å"‘This bill is a violation of the rights of not only myself, but a violation of the rights of the American people. Long live the net,’ said Joe Shea, editor in chief of The American Reporter, the electronic newspaper that challenged the law.†(Lewis) This case however was not the first. In Philadelphia a group of some 50 organization filed a lawsuit against the CDA and the court also ruled in their favor. (Lewis) More and more cases began popping up in federal courts until December of 96 when it was finally brought before the Supreme Court in Reno v. American Civil Liberties Union.(ACLU v Janet Reno) The problem with the CDA was the fact that it didn’t clearly define indecent material. Many thought the broadness of the terminology used i... ...gle to â€Å"safely protect† the rights of the men and women of America. Works Cited "American Civil Liberties Union v. Janet Reno." 11 May 1996. 2 May 2005 Childs, Kelvin. "Problems Persist Despie CDA Ruling." . 05 July 1997: 19 Apr. 2005 "Communications Decency Act; Gina Smith, Charels Gibson." Good Morning America. ABC. 19 Mar. 1997. 19 Apr. 2005 Dlouhy, Jennifer A. "Ruling Suggest an Alternative For Online Pornography: Mandate Use of Internet Filters." 3 July 2004. 2 May 2005 Greenhouse, Lina. "Court,9-0, Upholds State Laws Prohibiting Assisted Suicide; Protects Speech on Internet." New York Times 27 June 1997. Kids and Civil Rights. Talk of The Nation NPR, Washington DC. 06 Apr. 1998. Lewis, Peter H. "Opponents of Indecency Rules on Internet Win Another Case." The New York Times 30 July 1996. eLibrary. 19 Apr. 2005 "Policing Cyberspace." Editorial. The Nation 1 Mar. 1999: n. pag. "Supreme Court Affirms Preliminary Injunction of Child Online Protection Act." . 01 Sept. 2004: eLibrary. 2 May 2005 "Supreme Court Rules on Child Online Protection Act." . 1 July 2002: eLibrary. 2 May 2005

7 Habits by Stephen R. Covey

Stephen R. Covey book is titled â€Å"The 7 habits of highly effective people† helps to develop individuals’ personality in relation with others. The author takes us on the journey thru becoming proactive. Than we learn to realize where are we going with our life. The next step is to set priorities in our life. What things are important and what things can wait. We also learn how to achieve compromise that is satisfactory to all parties involved in daily activities. The author teaches us how to practice empathetic communications and the importance of the team work. Once all of that is achieved we are reminded to renew ourselves thru elements of nature. The first habit is â€Å"Be Proactive†. It says to take control over your own future, and that every one of us is in control of their own future. The proactive people do not blame others for their misfortune. The first step to become proactive is to take initiative and to act or be act upon. When I was working in a plant, and wanted to advance to a supervisor’s, I took initiative. I have studied the blueprints; observed and learned from others, and then I became an assistant, and then a supervisor. There were several other employees that started their careers at the same time as I did, however, they did not take the initiative. When I was leaving the field they were still working at the same level when they have began. Listening to our language is another very important aspect of becoming proactive. My favorite phrase is Stephen R. Covey had mention in his book is – â€Å"Let’s look at our alternatives†. Many people like to say â€Å"There is nothing I can do†. Another very important aspect of becoming proactive is to look where we focus our energy. In his book, Covey refers to two circles: circle of concern and circle of influence. Proactive people focus on the circle of influence. This circle includes things one can do something about like, health, family or work related problems. Reactive people, on the other hand, focus their energy on the things that they have no control of, like terrorism; weather etc. â€Å"Gaining an awareness of the areas in which we expand our energies in is a giant step in becoming proactive†. (As cited in Stephenconvey. com, 2009 p. 1). Begin with the end in mind† is the second habit. Every creation, design or invention is first created on the paper before it is actually build. My next project is to build a shed. Before I will invest time and money on generating the material, first I will have to make a plan of that building. Once I will accomplish that I can began to build. According to the author we should always know where we are going with our lives. â€Å"To begin with the end in m ind means to start with a clear understanding of your destination. It means to know where you’re going so that you better understand where your are now and so the steps you take are always in the right direction† (Covey, 1989 p. 98). The best way to get there is by creating Personal Mission Statement. That statement concentrates on where you want to be, and how to get there (Covey, 1989). In the first habit you are a creator. In the second habit you have a vision and in the third habit you put all those things into a prospective. The third habit is called â€Å"Put first things first†. This habit helps us manage our lives. There are four quadrants to our time management. Based on those quadrants, it is more convenient to schedule future tasks. Daily or weekly plan can be made to focus on the priorities. That plan is never solid; it will most likely change as the daily tasks progress. It is really important to manage priorities based on those quadrants (Covey, 1989). The fourth habit called â€Å"Think Win/Win† moves us into interdependence phase. Our relationships with others depend on our mentality of thinking. Many people would like to receive the promotion or save their marriage but, they were not able to properly interact with others. There are six paradigms of human interaction (Covey, 1989). The fifth habit is to seek to understand, and then be understood. That means that the listener should not just hear the other person, but try to empathize with him. Most of the people can hear what others have to say; however they don’t listen to others, the message that other person is trying to relate goes by them (Covey, 1989). The sixth habit is to synergize. The author is relating to work in the teams. He states that the all team members are worth more that each of them separately put together. The group depends on each other. The differences between the people make the group stronger because of their differences. Every individual has a different prospective (Covey, 1989). The last of seven habits is to sharpen the saw. Most people tend to forget themselves and tend to stay in one place. Many of the people tend to focus on the activities that are not relevant to their goals or values. Every person should continue to grow using the four elements of nature. That involves staying fit in physical condition. That can be achieved by proper nutrition and daily exercises. Mental fit refers to reading and writing. Social element of nature refers to servicing to others. The last element is to stay spiritually fit by studying and meditation (Covey, 1989). In conclusion, the seven habits written by Stephen R. Covey, teach us how to become internally focused. They are the simple set of rules for successful life. That refers to both personal and private life. We go thru seven changes that will make ourselves more aware of the world and people that surround us. References Covey, Stephen R. (1989). The Seven Habits of Highly Effective People. New York, NY: Simon & Schuster.

Irony in Brave New World Essay

A society in the future can be very distinctive apart from a society in the modern day. Brave New World, written by Aldous Huxley, is a novel in regards to a utopian society. It takes place in the future where all is advanced and people are no longer born. Instead, reproductive technology is developed and futurology is emphasized. The majority of the population is divided into classes and no one is able to think for themselves. The novel is ironic at points and uses satire profoundly. Huxley uses irony to satirize religion, family, and sex. In the World State, religion is really satirized and depleted by its employment of religious rituals and its portrayal of God. Their God is Henry Ford, the inventor of the conveyor belt and the man responsible for, as they say â€Å"the introduction of [Their] Ford’s first T-Model† (52). Ford’s invention of the assembly line is one of the many reasons why he is an ideal God to society in the World State. The assembly line is an efficient line of productivity that creates items and in Brave New World, this is how people are born. This really exhibits his roll of God as God is believed, in modern religion, to have created people. People in the World State also use his name in vain similar to today’s society so when Bernard yells â€Å"†¦for Ford’s sake† (90) it reveals how they perceive Ford as their god. Another circumstance that depicts religion is their visits to the Solidarity Services. In the World State the community is told to attend solidarity services which somewhat corresponds to how people go to church in current times. At the solidarity services they await their dose of soma and have an orgy. It moderately mocks how people in church eat the bread and pray together. It is all basically a mimicry of religion in current society. Brave New World is really satire towards the average modern family. The words â€Å"mother† and â€Å"father† are considered obscene. It states that to say one is a mother â€Å"[is] an obscenity† (153) and reveals how they contemplate family. In the World State there are no mothers and fathers because people are not born naturally, where instead they are born artificially. This concept is revealed through John’s reference to the director as â€Å"[His] father!† (152). When John shouts â€Å"my father† to the director, laughter breaks out from everyone there. The word â€Å"father† is pretty much a joke in their society. It is just not intended to have family in the World State. One of the biggest reasons why family is not ideal in Brave New World is order. Family is completely banned so it can reduce the possibility of people caring for each other; therefore it will reduce the possibilities of them disrupting the order in which they a re expected to obtain. Sex in Brave New World is distinctive compared to modern society. Sex is glorified and is more of a responsibility, however, it is not for pleasure or emotion but more for entertainment. Sex is encouraged and promiscuity is celebrated in different ways. Many forms of entertainment in Brave New World relate to sex. For example the Feelies, pornographic movies, are attended by the citizens. When the Assistant Predestinator asks Henry if he is â€Å"going to the Feelies this evening† (35) he is sustaining this argument. The fact that the government allows these films to be shown publicly reveals how the government encourages sexual promiscuity. In the World State, if a person is not sexually promiscuous, they are pretty much considered outcasts. Sex is practiced and discussed openly even with children. This is exposed when the nurse claims that â€Å"[They] had Elementary Sex† (27). Even at a young age children learn about sex and are encouraged to have sex where as to mod ern society would not permit this. All of the information is evidence to prove that the World State commends sex. A utopian society that takes place in the future can really have many differences than the average modern society. One feature that can expose many facets of a society is irony. In Brave New World, irony is used to satire events and ideas and reveals that all societies have their own views and morals.

Electronic Health Record Essay

In the proposed scenario, a Clinical Nurse Specialist (CNS) with a Post-Masters Nursing Informatics Certificate has decided that the 100 bed hospital that she works in would benefit from transitioning from paper charting to using an electronic health record (EHR) system. She has done initial clinical research and has a solid foundation of best-patient-practice reasons that support this change. She has also researched and studied the information on the government’s websites HealthIT.gov, and CMS.gov pertaining to the American Recovery and Reinvestment Act and the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. HITECH is a stimulus package approved by the US government allowing $19 billion dollars to be divided between hospitals and doctors â€Å" who demonstrate â€Å"meaningful use† of electronic medical records†(ARRA HITECH Solutions, 2015). She knows that the best way to select and institute an EHR is to assemble a team of m embers with various specialties pertaining to the goals outlined in the stages of HITECH. Stage 1- Data capture and sharing, Stage 2- Advance clinical processes and Stage 3- Improved outcomes. Each of these stages has it’s own meaningful use criteria. As seen in the diagram to the  left. The CNS begins by choosing the members of her team from various disciplines in the hospital. Because this will mean corporate wide changes and adoption. Her list includes the following, from the IT department, a Clinical Nursing Informatacist- chosen for a specialty in how nurses interact with software and what is required for nurses to effectively care for patients, and the Director of Clinical Informatics- chosen for an overall knowledge base of the hospitals informatics resources and requirements including what software and hardware is currently available, what has worked or failed in the past and what changes will need to happen to keep the hospital compliant with patient privacy and safety regulations. She will also need a Corporate Project Manager to organize and disseminate information to the various off-site entities related to the facilities that will need to be on board with this change across the corporation. A Chief Medical Information Officer will be key in providing the perspective of the physicians and their particular needs and goals, and to be a liaison for the staff physicians when the EHR rollout occurs. A Chief Information Officer will bring knowledge about the hospital’s day to day functions that will need to integrate into the new EHR along with how those systems currently function. A Chief Nursing Information Officer will have their finger on the pulse of each nursing unit and be aware of the different user interface requirements that will be needed by different departments for the the specific type of flow and care given. Lastly, a Chief Financial Officer will be able to guide the team on topics concerning governmental funding and current assets along with helping to create and maintain a budget as required with the acquisition of new software and hardware, he will also be able to work with each department’s budget makers when the time comes for allocating training hours and equipment purchases. Along the way the team will need to bring in sub-specialists to give information and feedback as they hone the new system, but for now the assembled team will be responsible for researching, choosing and implementing the best EHR for their hospital. A.2 a-e) Choose 2 real-life computerized management systems and analyze them by comparing their advantages and disadvantages, recommend the best choice to meet the ‘MU’ requirements, describe how the features of the recommended system meet the guidelines outlined in the three stages of meaningful use, describe the impact on quality of patient care, documentation and outcomes. The team is aware that currently they have a computerized system that they use for reporting and tracking labs, radiology and scheduling, but all documentation is paper based. They consider the price point involved with adding modules to the existing McKesson software vs purchasing and implementing an entirely new EHR called EPIC. EPIC appears to be user friendly and able to seamlessly connect all of the facilities under the umbrella of their corporation. They make a list of some of the pros and cons associated with each system. McKesson has the upside of being a system they have already worked with and it has different programs that can be pieced together to meet some of the meaningful use (MU) criteria for compliance. They already have a working relationship with this vendor and some experience with the product. Once the discussion gets going, the team realizes that there are many more bad points than good with McKesson. In their experience, the software modules are connected in a piecemeal fashion that makes it difficult for programs to interface. Quite frequently data is just lost and not retrievable. There are different data entry systems for the different types of departments i.e. OR, ER, labor &  delivery, Med/Surge, radiology, and pharmacy. The different systems do not allow for across the board data harvesting and that makes it difficult and time consuming to track reportable nursing and CMS indicators. The aesthetics of McKesson are something that is frequently complained about by the staff, due to lack of distinctive color transition and eye fatigue. Lastly, the group is very reluctant to continue on building their EHR base with McKesson because the PCPs in the area will not be able to access hospital records, and office visit information will not be available to the hospital based staff. Due to the need for increased man hours in servicing McKesson, lack of discrete data sampling, and the poor continuity of care related to PCPs not having access to hospital data and vice versa, the team decides to choose Epic instead. Epic has the down side of being a system that will require a large initial outlay of funds. The hospital will have to purchase software, and related hardware. They will have to expand the IT and biomedical engineering departments to support and maintain the new system and equipment (something that would have been necessary to a smaller degree with McKesson). They will have to address some retrofitting needs related to wiring and computer instillation and lastly training will be a very big issue. Despite the potential down sides, the team comes up with a long list of reasons that EPIC is the right system to choose. To begin with EPIC is all one system. It allows for seamless interdepartmental interfacing. The PCPs in the area already use a version of EPIC and this will allow for easy data exchange and a patient’s information will follow them easily. The EPIC system has a medication reconciliation form that is easily viewable to all care givers and pharmacies in the area, keeping track of each patients reported medication dose and frequency. EPIC has a ‘my chart’ feature that allows patients see labs, after visit summaries , and to interact with physicians about scheduling, medications and lab results. EPIC has  many built in safe guards, including password protection, continuous backup and recovery programs so no dat a is lost, and the vendor provides continuing support as needed. EPIC comes in 3 pre-bundled, customizable templates, each already set up to meet the Meaningful Use (MU) criteria without having to alter the program. The team can look at the three available options and determine if one fits them perfectly, or find the closest one and alter it to fit their specific needs. Some examples of how EPIC will meet the Stage 1 MU criteria are computerized physician order entry, checking for drug interactions and allergies automatically, tracking demographics, keeping current diagnosis, medication and allergy lists, allowing patients to have electronic access to discharge summaries, and it gives patients electronic access to physicians. Once the hospital has used EPIC for at least two years, some examples of how EPIC will help meet the Stage 2 MU criteria are ongoing patient data entry and discreet sampling for report generation. The team will continue to develop the software that demonstrates interoperability in sharing of lab results with other providers and systems. Security risk assessment will be ongoing and built into the system. Smoking status will be tracked on all patients 13 and older and the EPIC software is designed to guide the facility from meeting the Stage 1 criteria to meeting the Stage 2 criteria. Stage 3 MU objectives are projected to improve outcomes. The team is waiting on the final ruling for what the Stage 3 guidelines will be and in the mean time they have a projected goal of focusing on primary prevention measures and improving overall population health. This will include recommended vaccination reminders, smoking cessation assistance, healthy lifestyle and meal planning recommendations, and yearly checkup reminders generated by primary physicians that will crossover to hospital patient charts. Some of the better benefits of EPIC include point and click tabs in the assessment fields, this allows for discrete sampling of information. EPIC utilizes a reporting workbench that will harvest requested, reportable data  and assemble it into a user friendly template. This will benefit the hospita l by reducing former man-hours required to find and collect data for clinical quality measures, public health reporting, and CMS indicators. Discrete data sampling from EPIC will make the hospital a benefit to the community as well by allowing it to track trends and provide information to community health nurses. EPIC comes with the ability to establish hard stops and reminders that allow real-time users to be aware of needs for care coordination and patient specific follow-ups or recommended testing related to treating chronic conditions. It will also allow for symptom driven order entry fields to be immediately available in emergent situations where time taken to look for those things could mean a worse outcome. This is especially important when people present with symptoms of stroke or heart attack. Another EPIC benefit is the different levels of bedside specific PHI protection related to sensitive care. EPIC has a ‘break the glass’ functionality pertaining to all sexual assault and psychiatric admits. This function only allows relevant staff to open and view these patients charts, any others are shown a pop-up warning and a notice is sent to start an investigation of any other person who logs in to theses charts. The team is impressed with the information provided by EPIC concerning scanning patients and medications at the bedside and the reduction in medication errors this causes. The scanners will integrate with the medication dispensing machines already in use at the hospital. One of the major benefits of EPIC is the order entry build. Each physician, with a minimal amount of training, can customize the order entry process to reflect their needs. Medication orders are instantly linked to a pharmacist to double check for allergies, and correct dosing information, and then the medication becomes available, via PYXIS machines on the unit for the RN to administer at the bedside. The bedside dosing requires the patient and medication to be scanned, further eliminating potential erro rs, and provides a pop-up warning if an emergency override is required during any of these steps. While the team acknowledges that training and time to become familiar with the new charting and bedside routine changes will initially impact patient care in a negative way, they have a plan in mind to keep the patients educated on the new system changes and the anticipated better care available to the patients across the board from instituting an EHR system. Having the patients ask questions and give real time feedback will help the team tweek their training and bedside routines to give better, more organized care that results in trackable outcomes. This is just an overview of some of the many functions EPIC has that persuaded the team to choose it as the new EHR system for the hospital. (EPIC and McKesson related information was culled from the authors own experience with the systems and personal interviews with multiple members of the informatics department at St Francis Hospital, Indianapolis campus). A.3 a) Use of Quality Improvement Data EPIC has point and click assessment tabs and a standardized documentation format that links related data. This allows for discrete data sampling related to things like CMS indicators. The hospital will be able to track compliance with things like ‘door to EKG’ times in the emergency department, Foley catheter use and resultant CAUTIs, and the time from when a patient presents with stroke symptoms until a cat scan is done and/or whether the patient receives antithrombolytics as a result. The hospital will also be able to generate reports on errors that occur the via the Risk Monitor Pro incident tracking software. This will allow them to continue researching and improving processes. A. 3 b) Security Standards and Methods EPIC has 24 hour monitoring of staff use while logged in, and the records they access. This is important because hundreds of staff members will be using the system and there has to be accountability if employees were to look up their own records, or the records of friends or family. This  information can be tracked and the employee interviewed and disciplined if needed. EPIC also comes equipped with incident reporting software called Risk Monitor Pro. All staff members are encouraged to use this format to report any incident that might warrant further investigation. It covers every location, type of employee, type of equipment, patient, visitor or vendor. Risk Monitor Pro forms are used to report potential or perceived injuries, faulty equipment, sentinel events and things that have the potential to cause harm or damage. This information can be followed up on by the risk management team, so that process improvement is an ongoing process. The team works with members from the IT department and plans for primary data storage with a redundant back up storage unit that simultaneously updates so if the primary server fails there is no loss of information. They have also planned for a second, off site data storage center that can be used in case of emergency to ensure continuity of services, and keep things up and running while the primary system is off line for upgrades. Lastly back up tapes will be kept at a third site in case both of these areas are compromised, and the system can be rebooted and running again within 72 hours. A. 3 c) Explain how the system will protect patient privacy and meet HIPAA requirements EPIC will protect patient privacy in a number of ways. End User access is limited to only being able to access the information needed to do their jobs. Making the accessible information different for nurses, physicians, registration clerks, radiology technicians, committee members etc. Personnel will only be granted access once they have completed security training and have signed documentation stating that they understand the legal risks and responsibilities when accessing protected health information (PHI). Individuals outside the hospital will have access to EPIC as well, for example nursing home physicians. They will have a read only access granted, but will require multiple patient identifiers to access the information. Also, as mentioned earlier, EPIC will employ security related  chart hard stops like ‘Break the Glass’. A. 3 d) Explain how the recommended system meets HIPAA requirements EPIC helps to meet HIPAA requirements with automated enforcing of access policies, and pro-active alerting that links directly to the risk management department, requiring strong password policies, and automatic logout at end user work stations. EPIC allows providers to protect the integrity of data and recover original data in the case of it being altered or damaged. EPIC users are required to have appropriate training to be able to access the system, and can be locked out in the case of termination. Portable devices carry encryption software that does not allow for third party data extraction or access. EPIC can also quickly generate reports with discrete sampling related to various forms of access. The majority of compliance will be the responsibility of the staff with written policies, documented sanction programs and investigation that is on-going, consistent and documented. A. 3 e) Describe how adopting the system will reduce costs to the organization Instituting this new system will initially generate more costs, but in the long run will save the hospital money in many ways. Meeting the ARRA/HITECH Act requirements will help to offset those cost with financial incentives and avoiding fines and penalties. Having readily available test results will decrease the costs and labor associated with repeating lost or illegible results. With superior organization and data summary tools, the cost for labor associated with studying charts individually and generating reports will be exponentially lower. The need for transcriptionists will be greatly reduced by utilizing dictation software. Facilities for storage of paper charting cost money for upkeep and staffing. An electronic database should make billing and insurance claims easier to process and thereby generate revenue faster. The time it takes for physicians to spend going over complicated medical histories with patients is greatly reduced by  having that information readily available in a database. â€Å"According to a recent study, when hospitals rely on advanced electronic health records they can save up to 10 percent per patient admission† (â€Å"Advanced EHR Cuts Hospital Costs By 10% Per Admission,† 2014). 4. A) Explain why active nursing involvement in the planning, selection, and implementation of the systems is important to the success of the implementation process and meeting meaningful use requirements Active nursing involvement is important to the success of implementing any process that affects care given at the bedside. For the system to be optimized for use, nursing suggestions and feedback are critical. EPIC knows this and has a team of nurses on staff to work with the facility  in developing end-user interface. ‘Nurses’ from the hospital include the advocates, CNS’s, NP’s, LPN’s, managers, and bedside care givers, each with a specific focus and experiences that are valuable when helping to decide how charting should work. Any thing that pulls a nurses attention away from the patient, or is distracting or difficult to work with decreases the perceived level of care and increases the potential for errors. The health care goals of meaningful use include improving efficiency, safety and quality while decreasing discrepancies, involving patients and their families in their care, improving public health outcomes, improving care coordination, and advancing security and privacy of PHI (Gregory & Klepfer, 2010). All of these things are the foundation of every interaction a nurse has with a patient. This is why nursing is one of the most trusted professions, according to the Gallup pole website, nurses come out on top at 80% when people were asked to rate â€Å"the honesty and ethical standards of people† in different given fields (â€Å"Honesty/Ethics in Professions | Gallup Historical Trends,† n.d.). Because standard nursing care already meets the goals outlined for meaningful use, the most important thing the average  nurse can do is to work hard to be competent utilizing the selected EHR software. Advanced users and nurse leaders are important to help guide the EHR selection process in the direction that will improve the bedside interactions and user interface. Clinical nurse specialists have advanced educations and bring the nursing philosophy to the selection and implementation process. All of these roles are vital to the success of any EHR implementation.

Nursing Pressure Sore

What are pressure sores? Pressure sores are areas of injured skin and tissue. They are usually caused by sitting or lying in one position for too long. This puts pressure on certain areas of the body. The pressure can reduce the blood supply to the skin and the tissues under the skin. When a change in position doesn't occur often enough and the blood supply gets too low, a sore may form. Pressure sores are also called bedsores, pressure ulcers and decubitus ulcers. What are the symptoms of a pressure sore? There are 4 stages of pressure sores. Symptoms at each stage include the following: Stage 1.The affected skin looks red and may feel warm to the touch. The area may also burn, hurt or itch. In people who have dark skin, the pressure sore may have a blue or purple tint. Stage 2. The affected skin is more damaged in a stage 2 pressure sore, which can result in an open sore that looks like an abrasion or a blister. The skin around the wound may discolored. The area is very painful. St age 3. These types of pressure sores usually have a crater-like appearance due to increased damage to the tissue below the skin's surface. This makes the wound deeper. Stage 4.This is most serious type of pressure sore. The skin and tissue is severely damaged, causing a large wound. Infection can occur at this stage. Muscles, bones, tendons and joints can be affected by stage 4 pressure sores. Who gets pressure sores? Anyone who sits or lies in one position for a long time might get pressure sores. You are more likely to get pressure sores if you are paralyzed, use a wheelchair or spend most of your time in bed. However, even people who are able to walk can develop pressure sores when they must stay in bed because of an illness or an injury.Some chronic diseases, such as diabetes and hardening of the arteries, make it hard for pressure sores to heal because of poor blood circulation. Peripheral vascular disease,MI, Stroke,Multiple trauma,Musculoskeletal disorders/fractures/contractu res,Gibleed , Spinal cord injury (e. g. , decreased sensory perception, muscle spasms),Neurological disorders (e. g. , Guillain-Barre', multiple sclerosis),Unstable and/or chronic medical conditions (e. g. , diabetes, renal disease, cancer, chronic obstructive pulmonary disease, congestive heart failure),History of previous ressure ulcer,Preterm neonates, Dementia, Recent surgical patient. Where on the body can you get pressure sores? Pressure sores usually develop over bony parts of the body that don't have much fat to pad them. Pressure sores are most common on the heels and on the hips. Other areas at risk for pressure sores include the base of the spine (tail bone), the shoulder blades, the backs and sides of the knees, and the back of the head. How are pressure sores treated? There are several things you can do to help pressure sores heal: * Relieving the pressure that caused the sore * Treating the sore itself Improving nutrition and other conditions to help the sore heal What can be done to reduce pressure on the sore? Don't lie on pressure sores. Use foam pads or pillows to take pressure off the sore. Special mattresses, mattress covers, foam wedges or seat cushions can help support you in bed or in a chair to reduce or relieve pressure. Try to avoid resting directly on your hip bone when you're lying on your side. Use pillows under one side so that your weight rests on the fleshy part of your buttock instead of on your hip bone. Also, use pillows to keep your knees and ankles apart.When lying on your back, place a pillow under your lower calves to lift your ankles slightly off the bed. When lying in bed, change your position at least every 2 hours. When sitting in a chair or wheelchair, sit upright and straight. An upright, straight position will allow you to move more easily and help prevent new sores. You should change positions every 15 minutes when sitting in a chair or wheelchair. If you cannot move by yourself, have your caregiver help you shift your position. How should the pressure sore be kept clean? In order to heal, pressure sores must be kept clean and free of dead tissue.Stage 1 sores can be cleaned with mild soap and water. You can clean stage 3 sores by rinsing the area with a salt and water solution. The saltwater removes extra fluid and loose material. Your doctor or nurse can show you how to clean your pressure sore. Pressure sores should be kept covered with a bandage or dressing. Sometimes gauze is used. The gauze is kept moist and must be changed at least once a day. Newer kinds of dressings include a see-through film and a hydrocolloid dressing. A hydrocolloid dressing is a bandage made of a gel that molds to the pressure sore and helps promote healing and skin growth.These dressings can stay on for several days at a time. Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from the pressure sore. Rinsing the sore e very time you change the bandage is helpful. Special dressings that help your body dissolve the dead tissue can also be used. They are left in place for several days. Another way to remove dead tissue is to put wet gauze bandages on the sore and allow them to dry. The dead tissue sticks to the gauze and is removed when the gauze is pulled off.For more severe pressure sores, dead tissue must be removed surgically. Removing dead tissue and cleaning the sore can hurt. Your doctor can suggest a pain reliever for you to take 30 to 60 minutes before your dressing is changed to help reduce pain. Why is good nutrition important for healing sores? Good nutrition is important because it helps your body heal the sore. If you don't get enough calories, protein and other nutrients (especially vitamin C and zinc, which can help heal wounds like pressure sores), your body won't be able to heal, no matter how well you care for the pressure sore.Your doctor, nurse or a dietitian can give you advice about a healthy diet. Be sure to tell your doctor if you have lost or gained weight recently. What if the sore gets infected? Pressure sores that become infected heal more slowly and can spread a dangerous infection to the rest of your body. If you notice any of the signs of infection listed below, call your doctor right away. Signs of an infected pressure sore include the following: * Thick yellow or green pus * A bad smell from the sore * Redness or warmth around the sore * Swelling around the sore * Tenderness around the soreSigns that the infection may have spread include the following: * Fever * Chills * Mental confusion or difficulty concentrating * Rapid heartbeat * Weakness How are infected pressure sores treated? The treatment of an infected pressure sore depends on how bad the infection is. If only the sore itself is infected, an antibiotic ointment can be put on the sore. When bone or deeper tissue is infected, antibiotics are often required. They can be given intravenous ly (through a needle put in a vein) or orally (by mouth). How can I tell if the sore is getting better? As a pressure sore heals, it slowly gets smaller.Less fluid drains from it. New, healthy tissue starts growing at the bottom of the sore. This new tissue is light red or pink and looks lumpy and shiny. It may take 2 to 4 weeks of treatment before you see these signs of healing. How can pressure sores be prevented? The most important step to prevent pressure sores is to avoid prolonged pressure on one part of your body, especially the pressure points mentioned previously. It's also important to keep your skin healthy. Keep your skin clean and dry. Use a mild soap and warm (not hot) water. Apply moisturizers so your skin doesn't get too dry.If you must spend a lot of time in bed or in a wheelchair, check your whole body every day for spots, color changes or other signs of sores. Pay special attention to the pressure points where sores are most likely to occur. If you smoke, you shou ld quit. People who smoke are more likely to develop pressure sores. Exercise can help improve blood flow, strengthen your muscles and improve your overall health. Talk to your doctor if physical activity is hard for you. He or she can suggest exercises that can work for you, or refer you to physical therapist that can help. Pressure Sore PreventionRelieving pressure: Position must be changed on a regular basis, at least every two hours, and in the very frail at least every hour. Good Diet: A good and balanced diet contributes to healing, as well as avoiding severe nutritional and weight loss Skin Care: Keep the skin clean. Moisture should be minimized. Skin care products should be used that moisturize the skin but do not make it wet or soggy. Use continence aids if a person is unable to control their bladder or bowels. Pads, diapers, convenes or catheterizing. Inspect the skin to see if any redness or breaks in the skin are developing.Use products to relieve and treat pressure sore s; airbeds, foam bed, bed and chair protectors, chair products, continence aids can all contribute to avoiding of bed sores. Clean skin with warm water and minimal friction. Apply lotion often. ————————————————- Avoid direct pressure to bony areas such as ankles and hips. Use pillows and padded protectors to support arms, legs and vulnerable areas. Change the position of a bed-bound person every two hours. Handle and move carefully to avoid skin tears and scrapes.Change the position of a chair-bound person hourly. Discourage the bed-bound or chair-bound person from sitting with the head elevated more than 30 degrees, except for short periods of time. Check and change bed linens as often as necessary Use continence management products if necessary to reduce exposure to moisture. Padded supports, such as doughnut cushions may, themselves, become a source of pressure. Do not massage bony areas of the body. Do not massage pressure sores. Do not use remedies such as iodine, peroxide and cornstarch that may further irritate the skin.Pressure sores (bedsores, decubitus ulcers, pressure ulcers) are areas of skin damage resulting from a lack of blood flow due to pressure. †¢ Sores often result from pressure but may also result from pulling on the skin or friction, particularly over bony areas. †¢ The diagnosis is usually based on a physical examination. †¢ Treatment includes cleansing, removal of pressure from the affected area, special dressings, and, sometimes, surgery. Pressure sores can occur in people of any age who are bedbound, chairbound, or unable to reposition themselves. They are more common among older people.They tend to occur over bony projections where pressure on skin can be concentrated, such as over the hip bones, tailbone, heels, ankles, and elbows. They occur where there is pressure on the skin from a bed, wheelchair, cast, splint, or other hard object . Pressure sores lengthen the time spent in hospitals or nursing homes and increase the cost of care. Pressure sores can be life threatening if they are untreated or if underlying health conditions prevent them from healing. Causes Causes that contribute to the development of pressure sores include: †¢ Pressure Traction †¢ Friction †¢ Moisture †¢ Inadequate nutrition Pressure on skin, especially when over bony areas, reduces or cuts off blood flow to the skin. If blood flow is cut off for more than 1 or 2 hours, the skin dies, beginning with its outer layer (epidermis). The dead skin breaks down and forms an open sore (ulcer). Most people do not develop pressure sores because they constantly shift position without thinking, even when they are asleep. However, some people cannot move normally and are therefore at greater risk of developing pressure sores.They include people who are paralyzed, comatose, very weak, sedated, or restrained . Paralyzed and comatose people are at particular risk because they also may be unable to move or feel pain (pain normally motivates people to move or to ask to be moved). Traction also reduces blood flow to the skin. Traction occurs when the skin is stretched by being wedged against something or when it sticks to something, often bed linens. When the skin is stretched, the effect is much like pressure. Friction can lead to or worsen pressure sores. Repeated friction may wear away the top layers of skin.Such skin friction may occur if people are pulled repeatedly across a bed. Moisture can increase skin friction and weaken or damage the protective outer layer of skin if the skin is exposed to it a long time. For example, the skin may be in prolonged contact with perspiration, urine, or feces. Inadequate nutrition increases the risk of developing pressure sores and slows the healing process of sores that do develop. Malnourished people may not have enough body fat to pad the skin and bones or to keep the blood vessels from being squeezed shut.Also, skin repair is impaired in people whose diets are deficient in protein, vitamin C, or zinc. Did You Know†¦? †¢ Inadequate nutrition increases the chances of developing pressure sores and slows the healing of sores that do develop. †¢ Repositioning people who cannot move themselves at least every 1 to 2 hours can help prevent pressure sores. Symptoms For most people, pressure sores cause some pain and itching. However, in people whose senses are dulled, even severe sores may be painless. Pressure sores are categorized into four stages according to the severity of damage: †¢ Stage I: Redness and inflammation Stage II: Some shallow skin loss, including abrasions, blisters or both †¢ Stage III: Full-thickness skin loss down to the layer of fat. †¢ Stage IV: Full-thickness skin loss with exposure of underlying muscle, tendon, or bone Pressure sores do not always progress from mild to severe s tages. Sometimes the first noticeable sign is a late-stage sore. If pressure sores become infected, they may have an unpleasant odor. Pus may be visible in or around the sore. The area around the pressure sore may become red or feel warm, and pain may worsen if the infection spreads to the surrounding skin (causing cellulitis).Infection delays healing of shallow sores and can be life threatening in deeper sores. Infection can even penetrate the bone (osteomyelitis), requiring weeks of treatment with antibiotics. In the most severe cases, infection can spread into the bloodstream (sepsis), causing fever or shaking chills. Spotlight on Aging Aging itself does not cause pressure sores. But it causes changes in tissues that make pressure sores more likely to develop. As people age, the outer layers of the skin thin. Many older people have less fat and muscle, which helps absorb pressure.The number of blood vessels decreases and blood vessels rupture more easily. All wounds, including pr essure sores, heal more slowly. Certain conditions make pressure sores more likely to develop: †¢ Being unable to move normally because of a disorder such as stroke †¢ Having to stay in bed for a long time, for example, because of surgery †¢ Being excessively sleepy (such people are less likely to change position or ask someone to reposition them) †¢ Losing sensation because of nerve damage (such people do not feel discomfort or pain, which would prompt them to change ositions) †¢ Becoming less responsive to what is happening in and around them, including their own discomfort or pain, because of a disorder such as dementia Diagnosis Doctors can usually diagnose pressure sores by doing a physical examination. A doctor or nurse usually measures the size and depth of a sore to determine its stage and plan treatment. If the damage is severe, radionuclide bone scanning or gadolinium-enhanced MRI (magnetic resonance imaging) may be done to check whether infection has spread from the sore to bone—a disorder called osteomyelitis.To diagnose osteomyelitis, doctors may need to take a small sample (biopsy) of bone to see if bacteria grow from it (culture). Prevention Prevention is the best strategy for dealing with pressure sores. In most cases, pressure sores can be prevented by meticulous attention from all caregivers, including nurses, nurses' aides, and family members. Close daily inspection of a bedridden or chairbound person's skin can detect early redness or discoloration. Any sign of redness or discoloration at pressure areas is a signal that the person needs to be repositioned and kept from lying or sitting on the discolored area until it returns to normal.Because shifting position is necessary to keep the blood flowing to the skin, oversedation should be avoided and activity encouraged. People who cannot move themselves should be repositioned every 2 hours if they are in bed and every hour if they are in a chair—more often if possible. The skin must be kept clean and dry because moisture increases the risk of developing pressure sores. Dry skin is less likely to stick to fabrics and cause friction or traction. For people confined to bed, sheets should be changed frequently to make sure they are clean and dry.Applying noncaking body powder to skin in areas where two parts of the body press against each other (such as the buttocks and groin) can help keep the skin in these areas dry. Bony projections (such as heels and elbows) can be protected with soft materials, such as foam wedges and heel protectors. Donut-shaped devices and sheepskins should be avoided as they only shift pressure or friction from one vulnerable site to another. Special beds, mattresses, and seat cushions can be used to reduce pressure in people who are wheelchair-bound or bedridden.These products can reduce pressure and offer extra relief. A doctor or nurse can recommend the most appropriate mattress surface or seat cushion. It is important to remember that none of these devices eliminate pressure completely or are a substitute for frequent repositioning. Treatment Treating a pressure sore is much more difficult than preventing one. The main goals of treatment are to relieve pressure on the sores, keep them clean and free of infection, and provide adequate nutrition. Adequate nutrition is important in helping pressure sores heal and in preventing new sores from forming.A well-balanced, high-protein diet is recommended as well as a daily high-potency vitamin and mineral supplement. Supplemental vitamin C and zinc may help with healing as well. Electrical stimulation, heat therapy, massage therapy, and hyperbaric O2 therapy have not proven helpful. In the earliest stage, pressure sores usually heal by themselves once pressure is removed. When the skin is broken, a doctor or nurse considers the location and condition of the pressure sore when recommending a dressing. Film (see-through) dressings help protect ea rly-stage pressure sores and allow them to heal more quickly.Hydrocolloid (oxygen- and moisture-retaining) patches protect, keep the skin appropriately moist, and provide a healthy environment for deep sores. Other types of dressings may be used for deeper sores, those that ooze a lot of fluids, and those that are infected. If the sore appears infected or oozes, rinsing with saline and dabbing gently with a gauze pad are helpful. A doctor may need to remove (debride) dead tissue with a scalpel or a chemical solution. Removal of dead tissue is usually painless, because pain is not felt in dead tissue. Some pain may be felt because healthy tissue is nearby.Health care practitioners may flood (irrigate) the sore, particularly its deep crevices, with a sterile solution to help clean away hidden debris. Sometimes a bed that circulates air (an air-fluidized bed) is used in hospitals and nursing homes. This special bed helps reduce or redistribute pressure on the body. ——â₠¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€- Deep pressure sores are difficult to treat. Sometimes they require skin and muscle flaps, in which healthy, thicker tissue with a good blood supply is surgically repositioned to cover the damaged area.This type of surgery is not always successful, however, especially for frail older people who are malnourished. Often, when infections develop deep within a sore, antibiotics are given. When bones beneath a sore become infected, the bone infection (osteomyelitis) is extremely difficult to cure and may spread through the bloodstream, requiring many weeks of treatment with an antibiotic (see Bone and Joint Infections: Osteomyelitis). ————————————————- The terms decubitus ulcer and pressure sore often are used interchangeably in the medical community.Decubitus, from the Latin decumbere, means â€Å"to lie down. † Decubitus ulcer, therefore, does not adequately describe ulceration that occurs in other positions, such as prolonged sitting (eg, the commonly encountered ischial tuberosity ulcer). Because the common denominator of all such ulcerations is pressure, pressure sore is the better term to describe this condition. Pressure is exerted on the skin, soft tissue, muscle, and bone by the weight of an individual against a surface beneath.These pressures are often in excess of capillary filling pressure, approximately 32 mm Hg. In patients with normal sensitivity, mobility, and mental faculty, pressure sores do not occur. Feedback, conscious and unconscious, from the areas of compression leads inIndividuals who are unable to avoid long periods of uninterrupted pressure over bony prominences—a group of patients that typically includes elderly individuals, persons who are neurologically impaired, and patients who are acutely hospitalizedà ¢â‚¬â€are at increased risk for the development of necrosis and ulceration.These individuals cannot protect themselves from the pressure exerted on their body unless they consciously change position or have assistance in doing so. Even the most conscientious patient with an extensive support group and unlimited financial resources may develop ulceration resulting from a brief lapse in avoidance of the ill effects of pressure. [2, 3] dividuals to change body position. These changes shift the pressure prior to any irreversible tissue damage. The inciting event for a pressure sore is compression of the tissues by an external force, such as a mattress, wheelchair pad, or bed rail.Other traumatic forces that may be present include shear forces and friction. These forces cause microcirculatory occlusion as pressures rise above capillary filling pressure, resulting in ischemia. Ischemia leads to inflammation and tissue anoxia. Tissue anoxia leads to cell death, necrosis, and ulceration. à ¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€- Irreversible changes may occur after as little as 2 hours of uninterrupted preSpecialized support surfaces are available for bedding and wheelchairs, which can maintain tissues at pressures below 30 mm Hgssure. urning and repositioning the patient remain the cornerstones of prevention and treatment. The wound and surrounding skin must be kept clean and free A new international guideline with regard to the prevention of pressure ulcers was released in 2009. [11] A collaboration between the National Pressure Ulcer Advisory Panel and the European Pressure Ulcer Advisory Panel, the guideline covers the latest evidence-based recommendations for all patients in all healthcare settings.Clinical practice recommendations in regard to prevention will include: * Current definitions and classification of pressure ulcers; * Risk assessment, including the role of nutrit ion; * Skin inspection and skin care; * Positioning and repositioning patients; * Evidence for use of various support surfaces (air-fluidized beds; alternating air mattresses and cushions; foam-, gel-, or fluid-filled mattresses; overlays for operating tables; turning beds; and other aids for pressure redistribution); * Protective devices used for pressure ulcer prevention; and * Education and training for healthcare providers.