Efficacy of Personal and Professional Communication Research Paper

Efficacy of Personal and Professional Communication - Research Paper Example Yet, application of its principles seems neglected in actual clinical set-ups. Although the efficacy of health care communications is disregarded by some, interpersonal and professional communication patterns play primary roles in enhancing quality services, connecting communication gaps, and preventing clinical practice errors. Interpersonal Health Communication Interpersonal communication functions as one of the main areas that need close scrutiny. In clinical settings, interpersonal contact means â€Å"provider-client communication,† which serves as the primary source of association (Schiavo, 2007). Accordingly, clients place their full trust on their clinical providers, in return, the medical staffs do their best to assure their clients’ condition--clients fully depend on health providers for support and treatment. Initially, clients seek health-related advice regarding their health status, establishing interpersonal contact between clients and health providers. In the process of medical consultation, health providers are accountable in exhibiting intellectual and psychological skills in handling their clients (Hubble, Trowbridge, Hubbard, Ahsens, & Ward-Smith, 2008). Part of basic function is forming personal relationship with clients during preliminary inquiry on physiological and psychological disposition. As this is a delicate matter, competent communication techniques must be exhibited by providers--draw out accurate and reliable information as chief basis for further management and treatment. In the assurance of therapeutic interpersonal communication, this augment client awareness and comprehension with suggested care plan, while being time-effective during assessment and examination period (Gordon, 2002). Evidently, the performance of efficient interpersonal strategy in health communication assumes that clients get quality medical attention they seek, and health staff gets to perform their obligatory functions more proficiently. Profes sional Health Communication In another communication area, professional communication serves as important aspect in the care of clients. Schiavo (2007) illustrates this communication classification as involving health providers in a â€Å"peer-to-peer approach...to promote the adoption of best medical and health practice.† In this statement, the professional category in health care communications indirectly affects the clients in the pursuance of standardized medical practice. Through cooperative relationship, each member assumes individual and team responsibilities during decision-making and resolving client-related management issues (O’Daniel, & Rosenstein, n.d.). Team collaboration elevates the features of care provided, in all phases of health process. Their expert exchange of medical information and active participation in the care of clients is critical in achieving holistic health care services and positive health outcomes. Excellent professional communication s erves as best defense against medical errors and neglect (Smith, & Mishra, 2010). Above all else, the professional health team can uphold their oath to ensure patient welfare in every action they perform.

Philosophy Essay Example | Topics and Well Written Essays - 1500 words - 12

Philosophy - Essay Example Thus, all knowledge of things comes to us by objects that are outside. In a way, Hobbes has put forward a mechanism of knowledge; we receive stimuli and our brain and heart interpret it and then they send us signals that help us interpret what that thing is. However, at least in Leviathan, Hobbes is not too clear on how the signals are sent from within us. Hobbes goes on to state that, thus, â€Å"when we would express the decay, and signify that the sense is fading, old and past, it is called memory† (Hobbes Chapter II). He says that memory is simply our old sensory perceptions that have faded enough for us to not be able to remember them clearly, likening it to the light of the stars which fades during daylight, but is there still. Thus, our experiences are the sum of our memories. For Hobbes, memory is at par with imagination, with one slight difference, memory must always be empirically possible, whereas imagination need not be so. However, what is interesting is that Hobbes does not lay down the condition that memory has to be true in the sense of it having actually occurred, it can be an untrue event when it comes to the veracity of its occurrence, but it will be considered a memory of it is empirically possible. So, according to Hobbes, all memory, just like our senses, are perceived from objects that are outside of us, which we interpret through our sensory perception. In turn, it is these memories that shape up our world-view and our beliefs about things that are around us. When it came to memory, Plato held the view that everything that we know, or will ever know, is actually present in our memory already, or anamnesis. Time, and its passing, are mere illusions, when what is actually happening is that our memory is unfolding, nothing more. We are not acquiring new knowledge, rather it is our old memories that are unfolding and the illusion of time makes us believe

Guidelines for Writing the Three Major Parts of the Literature Review Essay Example for Free

Guidelines for Writing the Three Major Parts of the Literature Review Essay The introductory section should describe the topic (problem area, guiding concept, theme or research question or problem) that is being reviewed. Aim for an â€Å"eye catching opening sentence†. Sometimes this is a dramatic expression of a number to catch the reader’s attention such as the prevalence of a disease, crime rate, school drop out rate, or sales volume. Be sure the topic is focused on the literature that will be reported. Briefly define the key concepts. Introduce these immediately. The topic should be sufficiently focused to permit an in-depth, substantial investigation, relevant to an area of advanced study/global leadership that guides a range of inquiry, results in an extensive search of scholarly literature, and generation of questions for further inquiry. The purpose of a literature review is presented in the introduction. Bourner (1996) reports the following Purposes – of a literature review – (reasons for a review of the literature) before embarking on a research project. These reasons include: †¢ to identify gaps in the literature  Ã¢â‚¬ ¢ to avoid reinventing the wheel (at the very least this will save time and it can stop you from making the same mistakes as others) †¢ to carry on from where others have already reached (reviewing the field allows you to build on the platform of existing knowledge and ideas) †¢ to identify other people working in the same fields (a researcher network is a valuable resource) †¢ to increase your breadth of knowledge of your subject area †¢ to identify seminal works in your area †¢ to provide the intellectual context for your own work, enabling you to position your project relative to other work †¢ to identify opposing views †¢ to put your work into perspective †¢ to demonstrate that you can access previous work in an area †¢ to identify information and ideas that may be relevant to your project †¢ to identify methods that could be relevant to your project Bourner, T. (1996). The research process: Four steps to success in T. Greenfield (Ed. ), Research methods: Guidance for postgraduates (pp. 7-11). London: Arnold. Retrieved 8-13-02 from Royal Melbourne Institute of Technology RMIT University http://www. lib. rmit. edu. au/tutorials/literature/litrev. html As you attempt to define concepts (variables) and their relationships to other variables, if applicable, identify causal (independent) variables and effects (dependent variables). You may also identify other variables that can be contextual, intervening, or mediating (see Creswell, pp. 94-95 or other texts). After you introduce the topic area properly (instructions follow), you will develop a succinct one-sentence purpose of the review. Three examples of a concluding purpose statement in the overview are: Example 1: The purpose of this review is to critically analyze the theoretical and empirical literature on web-based instruction as an instructional method in distance education, with an emphasis on effectiveness studies that focus on instructional effectiveness, student learning outcomes, retention, student perceptions of this method of course delivery, and to identify areas of future scholarly inquiry. In this example, the causal variable (independent) is â€Å"instructional method of web-based instruction† and the effects (dependent variable) are instructional effectiveness, student learning outcomes, retention, and student perceptions. Example 2: The purpose of this critical analysis of theoretical and empirical literature is to (a) examine historical and current literature to evaluate whether gender workplace bias exists; (b) explore the impact such a bias would have on women in the workplace, specifically women moving up the corporate ladder; and, (c) identify any theoretical or empirical gaps in the literature for the purpose of suggesting future areas of scholarly inquiry. In this example, the causal variable (independent) is â€Å"gender bias against women in the workplace† and the effect (dependent variable) is mobility up the corporate ladder. Example 3 (Review carefully): The purpose of this critical analysis of theoretical and empirical literature is explore the influence of organizational leadership and other factors on organizational performance, in for-profit and not-for profit service organizations, and to identify areas of future scholarly inquiry. In this example, the causal variables (independent) are â€Å"organizational leadership† and â€Å"other factors†, contextual (intervening or mediating) variables are the type of organization (product versus service) and profit/non-profit, and the effect (dependent variable) is organizational performance. Please note in developing your purpose statement, that the purpose statement begins with The purpose of †¦. and concludes with a statement related to identifying future areas of scholarly inquiry. 9 Instructions: Writing An Overview and Purpose (Follow precisely) *Review Blackboard Forum 5. Use your information and faculty comments for strengthening, as a guide to develop your Overview and Purpose (see items #1-9 below). *Draft 1 is due Week 3. Review Forum 6. You will get a great start if you develop this well. 1. Using the template: a. Develop a preliminary title for the Review and include on the title page. The title should include the main concepts and themes (and/or key theories) for this review. Remember this is a critical analysis of the literature NOT a research study!!!! In no area of this paper, should you refer to this Review of Literature as a research study!!!!!! b. For the Introduction to the Literature, insert a brief subtitle preceding the colon for the level heading: ___: Overview and Purpose. 2. Under the Overview and Purpose, introduce the paper with an â€Å"eye catching† opening sentence for the first paragraph. 3. After the â€Å"eye catching† opening sentence, briefly – describe the topic (problem area, guiding concept, theme). Get to the point – don’t let the reader guess what the review is about a few sentences. 4. Next include brief definitions of each of the major concepts and cite references for these definitions in appropriate APA format. BE BRIEF – this is not the literature but an introduction to it! Anything you present in the introduction is developed in depth in the Review of the Literature. 5. Next, very briefly, attempt to identify how the literature explains these variables and their relationships to other variables. Include as many as possible variables because this will help in constructing a literature map. The map will show relationships between the variables as you describe here. – Begin with the following: The causal variables (independent are) †¦ The effects (dependent/outcome variables are†¦ Contextual (intervening or mediating) variables that further impact the dependent or outcome variables are †¦. 6. Discuss how the topic area was identified and your reasons (point of view) for selecting the topic area to conduct your critical analysis of the literature. Review the Guidelines: How to Start Select a Topic and Overview and Purpose, including purposes identified by Bourner (1996). Begin with the following: The topic area of ____ was selected because___. 7. Explain what you want to know about the topic. Review Hart, 1999, p. 14 (Questions the Review Can Answer). Begin with the following: Some questions to be answered through this critical analysis of the literature are:†¦Ã¢â‚¬ ¦ 8. Answer the following: Is the topic about the problems in a discipline or field of study, the processes in a discipline or field of study, or the practices in a discipline or field of study? Processes can refer to various epistemologic processes to develop knowledge (also See Hart, 1999, p. 14). Introduce this clearly so the reader knows what you are speaking about. Begin with the following: The problem area of †¦ is about†¦Ã¢â‚¬ ¦ 9. Conclude the Overview and Purpose with a clearly formulated statement of purpose of the literature review. Use the examples in the guidelines, as a guide to develop this. Make this clear (see examples in the previous lecture note). Begin with the following and include the ending The purpose of this †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.., and to identify areas of future scholarly inquiry. Organization of the Review, Scope, and Library Research Plan Organization of the Review Lecture Collect appropriate articles, read critically, identify concepts, theories, and themes, and think about the best way to present your topic. Write these concepts, theories, and themes down (see your Blackboard forum 5 submission and instructor response. Develop a Literature Map. This is a Content Map (Concept Map or Mind Map): All students will have a literature map that will guide the organization of the review and literature search. Build (draw) a visual picture of the concepts and their relationships, which results in a literature map. These evolve from your topic, key concepts, ideas, theme, and/or purpose. Don’t introduce new information or concepts. It should first be introduced in the overview. The literature map is presented in-depth here. There are many methods to organize the review, which often change as you learn more about the topic. Concept Mapping Representing information in diagram form where key words are linked by lines. These lines are then labeled to express the relationship between the terms. The resulting map shows links between key ideas and can then be read through to clarify relationships between key terms. a. Definition and Purpose of a Literature Map. This map is a visual/graphic representation of concepts, ideas, and themes that serve to guide thinking. In this case, the purpose is to guide the search and organizational presentation of your review. This map serves to: i. Develop ideas for your review ii. Show relationships and interrelationships between the concepts, theories, and themes – and if so, what type of relationships iii. Assist in organizing old knowledge and integrating it with new knowledge iv. Guide your literature search plan/strategy v. Identify subtitles (subheadings) to organize your literature review so that you can communicate your ideas systematically. vi. A literature/content map is a creative, intuitive, and artistic endeavor to see how things fit – to generate alternatives. It is also analytical and critical, based on what you are finding in the literature. REVIEW THESE LINKS A simplified explanation of understanding of a Content map is described in the following URL – web link – http://users.edte. utwente. nl/lanzing/cm_home. htm b. Various types of Graphic or Visual Organizers (review this online. Click each box) (you need to have the syllabus downloaded and Internet connection on) |Chain of Events |Clustering |Compare/Contrast | |Continuum |Cycle |Family Tree | |Fishbone |Interaction Outline |Problem/Solution | |Spider |Storyboard |Venn Diagram | Source: http://www. sdcoe. k12. ca. us/score/actbank/sorganiz. htm Other Web sites: Graphic or Visual Organizers Graphic or Visual Organizers: A good site review this online by clicking link. http://edservices. aea7. k12. ia. us/edtech/classroom/workshops/organizers. html http://www. cast. org/ncac/index. cfm? i=3015 http://www. veale. com. au/phd/files/Lit_Map. pdf Some diagrams of content maps are depicted in the following URL web link http://trochim. human. cornell. edu/research/epp2/epp2. htm#Table1 Free Mind Mapping Software (Smart Draw) http://www. smartdraw. com/specials/mindmapping. asp? id=13054 Readings on Mapping Ideas: See Hart, 1999, pp. 142-162 Blackboard’s Assignments Toolbar: See example of literature maps in Assignments – Weeks 1-8 Literature Review (Critical Analysis) 50%. Within this folder is information on PowerPoint Presentation and Student Examples. Most of the student examples include literature maps for RES 702 (RES600) students. Organizing the review of the literature by themes, theories, or major concepts and related concepts provides a â€Å"frame for the central topic† to organize. In this case, you may proceed inductively or deductively. http://trochim. human. cornell. edu/kb/dedind. htm Exercise in Deductive/Inductive thinking: http://www2. sjsu. edu/depts/itl/graphics/induc/ind-ded. html#3b For example, a deductive approach might start with the broader view or concept(s) then move to the specific topic area. Example FOLLOWS: A literature map (Figure 1) is used to guide the library search for theoretical and empirical literature about distance learning. The map shows a deductive pattern of the major themes, using an â€Å"interaction line style† type of graphic organizer. Beginning with the broadest concept of distance education, web-based instruction interacts with student characteristics, which leads to evaluation of effectiveness of web-based instruction in distance education. . . . Other concepts and their relationships to guide the review are . . †¦Ã¢â‚¬ ¦. Other Organizational Methodologies for Reviews: While RES 702 students are asked to develop literature maps that serve to organize the review, with more scholarly experience and depending upon the topic, you could also present the Review using an â€Å"opposing view† or â€Å"methodological approach†. This is not expected now. c. The literature map generates an outline for the Review of the Literature Review â€Å"Why do an Outline, and Basic Outlining skills: http://www. und. edu/instruct/wstevens/PROPOSALCLASS/PATRAS. html http://www. mnstate. edu/wasson/ed603/ed603lesson5. htm An outline provides a blueprint, skeleton, or a roadmap for the final written review. An outline is an organizational process that is a logical description of the important components of the literature review. It provides a visual and conceptual design for writing. 1. Identify the main points in the order they should be presented. 2. Differentiate each main heading into logical subheadings. 3. Use further subdivisions if necessary. IT IS STRONGLY SUGGESTED THAT YOU INCLUDE A SECTION ON MEASUREMENT OF YOUR MAJOR VARIABLES. REPORT SOME OF THE MAJOR METHODS, TOOLS, OR INSTRUMENTS THAT HAVE BEEN USED IN PRIOR STUDIES TO MEASURE THE KEY CONCEPTS IN YOUR OUTLINE. Notice in the outline that follows, a sub-level heading is measurement of leadership and organizational performance. In the Review of the Literature section, you would then describe the tools whether qualitative or quantitative, and reliability, validity (quantitative tools), and trustworthiness of qualitative tools. Run a Proquest or Google search such as: â€Å"measurement leadership†. This saves you time in the QP and literature in the †dissertation† where you need to know how your variables have been studied and measured. It is best to have MORE detail in these themes. You can always change later. Example of an Outline: (Let us say that the following concepts are present in the literature map which could be Chain of Events, Clustering, or Interaction Outline. This is an example of an outline (quite detailed). It includes the major concepts that can be used for the literature search, and the outline is placed in the 2nd part of this Review (Review of the Literature) to organize how to present the literature. Leadership Classical, Progressive, Risk Leadership Theories Traits and Characteristics of Leaders; Leadership, Power and Influence; Gender and Equity Issues in Leadership Practice Cultural Issues and Leadership Developing Teams Leading Organizational Change Organizational Leadership Development; Strategic Leadership Leadership Measurement Organizational Performance Dimensions of Organizational Performance Organizational Climate Individual Performance Team Performance Supplier/Vendor Perspectives Customer Satisfaction Financial Performance Effectiveness Indicators Performance Driven Organizations Competency Modeling Managing Performance 360 Degree Feedback Collaborative Change Organizational Performance Measurement: Output (Activities) and Outcome (Results) Measures Factors Influencing Organizational Performance Leadership and Performance of Organizations Leadership Style and Team Performance Leadership Style and Organizational Outcomes Leadership Style and Vendor/Supplier and Customer Satisfaction Transformational Leadership, Organizational Culture, and Organizational Effectiveness 7 Instructions for Writing the Organization of the Review Do not present literature that you reviewed here. Just respond to questions 1-7. 1. After you design the literature map, begin with the statement: A literature map (Figure 1) is used to guide the library search for theoretical and empirical literature in this review about ___. 1. Next, describe the specific type of organizer that you used to design your map (for example, cluster, chain of events, cycle, etc). To do this, you need to review this syllabus on line, and click the different URL links of examples of visual or graphic organizers (review preceding lecture which provides several types). 2. Identify the specific the concepts, theories, and themes that are in your literature map. 3. Next, briefly, describe the relationships between these concepts, theories and themes (such as what leads to what? Which are the causal, outcome and/or intervening variables? Are the concepts organized inductively or deductively? This all refers to the concepts, theories, and themes in your literature map. 4. Next explain that in addition to guiding the literature search, the literature map serves to identify themes, theories, and concepts that will organize the Literature Review. Present these theories, concepts, and themes in outline form, differentiating each main heading into logical subheadings. (Keep it simple). 5. Due for draft 1, go to the next major section (Review of the Literature) – insert these themes/concepts as level headings/sublevel headings in outline form. They serve to organize the Review of the Literature. Use appropriate APA (see p. 113 of APA) level headings. An example using APA level headings, is shown in the next major section of these guidelines. The concepts and themes for the example, uses the outline of themes previously discussed (leadership and organizational performance). 6. Insert the Figure 1, Literature Map at the end of this discussion of the Organization of the Review (before Scope and Context). a. Make sure that you develop your literature map in a software application that can be copied and pasted into your Microsoft word document containing your paper. b. Make sure the map is an appropriate size and fits within the required paper margins. c. The Figure and #, and Title (Literature Map) belong at the bottom, centered: Figure 1 Literature Map Your goal is to have the map well-developed in draft 1 and finalized in (draft 2). It is expected that this map will change as you â€Å"tighten† and â€Å"organize your literature review in the next section† as well as well as in your qualifying paper. Refine this part with each new draft (and particularly as your literature map evolves). Scope and Context Lecture This section lets the reader know what is and is not included in your literature review (scope). The topic is described in such a way that an appropriate context for the review of the literature is established, in a meaningful, logical way. The key terms here are included/excluded. You can restate the theories, concepts and constructs that you will include and obvious theories, concepts and constructs you won’t include (Look at your problem and topic area). Identify what might be included in the search in terms of types of organizations (public/private; for-profit, not for profit; service/product; types of businesses, types of educational institutions); populations such as young versus old; gender; cultural groups; countries; or type of occupation. The major types of scholarly literature to review are: empirical studies, review articles (critical analysis), theoretical articles/books, methodological articles, and case studies. These types of literature may be in the form of a book, hard copy journal articles, and electronic journal articles. The following are different types and forms of literature: Periodical Abstract in a primary source, Abstract in a secondary source, Periodical (hard copy), Periodical (electronic), Non-periodical (Book), Non-periodical (chapter in a book), Proceeding of meetings or symposia, Doctoral Dissertations (including abstracts), Unpublished work, Audio-Visuals, Newspaper, Government documents, and Electronic Media. 5 Instructions for Writing the Scope and Context 1. As you write this, discuss what is and is not included. Regarding the topic or problem area, discuss what is and is not included in terms of concepts/theories, applications to different populations and settings. 1. Identify the forms (not types) of publications that are included. You don’t need to name specific articles, but identify the forms of literature to be included. 2. Identify the discipline(s) you are focusing in (e. g. , education, health, business, criminal justice, accounting, sociology)? Included specialized areas within these disciplines, such as: gender theories in sociology, accounting ethics, special education for specified populations, urban violence, etc. 3. Identify the scope in terms of the years (period of time) that your literature review covers and exclusions. 5. Discuss whether you are limiting your review to U. S. literature, and/or Global literature. For global literature, identify the â€Å"countries†. If seminal books are emphasized, include the titles. Refine this part with each new draft (and particularly as your literature expands). Library Research Plan and Strategy Lecture THIS IS THE PLAN, NOT THE REVIEW OF THE LITERATURE!! The review is presented in the second major section (Review of the Literature) Searching the Literature: A good review of the literature is dependent upon knowledge of the use of indexes and abstracts, the ability to conduct exhaustive bibliographic searches, and ability to organize the collected data meaningfully. Information literacy skills assist with information seeking and retrieval methods and scholarly communication. Recognize scholarly and peer reviewed journals (See Week 1 Lecture). The e-Learning tutorials about Lynn Library can assist research students with the development of literature reviews using electronic databases, abstracts, bibliographic software, Internet searching, Library catalogue searching, subject resources, off-campus searching, and research and writing skills. You need to complete the tutorials. Library Research Plan/Strategy: In reporting your library plan/strategy, identify concepts, themes (key words) or descriptors and search the relevant databases for research on your topic. Be consistent with the Literature map concepts and themes. Focus your search on primary scholarly works including: empirical, theoretical, critical/analytic, or methodological inquiry. Recognize the differences between these types of scholarly inquiry. Review dissertation abstracts. Did you do a Lynn Library catalog search on the topic (at Lynn)? Did you search selected journals? Did you limit the search to peer-review journals? Did you limit the search to certain years? If you are having difficulty in your library search, you may make an appointment with the Reference Librarian who may assist in building effective search strategies. When visiting the Library, you should come prepared with your search words. Requesting Materials: It is suggested that you read the abstracts before requesting the materials from the Librarian, because certain abstracts may provide enough information to help you make a decision on the material’s relevance. Expect that you will obtain more literature than you will need to include in your literature review. Quantity, however, is not as important as selecting appropriate literature, that is of value and relevant. While many published review articles may have more than 100 cited references, due to time constraints in the course, the expectation is a minimum of 20 â€Å"relevant†, scholarly citations in the text of your paper. Do not go overboard. Quality and relevance is what counts. Don’t use references from â€Å"consulting firms† or firms that are â€Å"promoting† their products or services. Look for scholarly publications. Types and Forms of Literature: Minimum Requirements i. The preference is that you review a variety of types and forms of literature so that you many learn to: ii. Search for and evaluate different types and forms information iii. Integrate a variety of types information in the text of your paper iv. Recognize classic (seminal) works as well as current literature Give yourself time to read the material; do not make a library request for everything at once. Readings: Search Strategy worksheet: http://library. humboldt. edu/infoservices/sstrawrksht. htm http://www. noodletools. com/debbie/literacies/information/5locate/adviceengine. html http://www. lynn. edu/clientuploads/Library/Graduatestudentsmanual. doc 11 Instructions for Writing the Library Research Plan and Strategy In a Review, a discussion of the plan or strategy you used to develop your literature search is presented. Don’t discuss what you â€Å"will† do, but rather â€Å"what you did†. 1. Identify the descriptors (concepts, themes, theories, phrases/key words) used to search the relevant databases for research on your topic. Include â€Å"themes† or groups of words used in the search plan. Add the terms â€Å"theory† or â€Å"research† to your themes when you are searching. You should uses many â€Å"themes† to limit the search. Example of a theme for a library search: â€Å"leadership organizational performance research†. Try to include several themes. 2. Report databases used in your library search. 3. Indicate which of the following types of primary scholarly works were reviewed: empirical, theoretical, critical/analytic, or methodological inquiry (aim to obtain all of these)? 4. Were secondary citations of references used in your paper? Explain Why? Review APA p. 247 to understand a secondary citation of a source. Remember that these need to be limited. In your dissertation, you need to mostly use primary sources of literature. Remember that if you report literature from secondary sources in your paper use (as cited in __). 5. Explain if you reviewed dissertation abstracts (yes/no). If so, on what topics, which abstracts? You should use these. 6. Explain if you did a Library catalog search on the topic (at Lynn or where? ) Yes/ or no 7. Provide the titles of the key journals reviewed. (Put these titles in Italics). 8. Indicated whether or not you limited the search to peer-reviewed journals? 9. Indicate if you limited the search to certain years? If so, which years? 10. Refer the reader to the example of a library Search Print-out that you will place in Appendix A. 11. Report any problems encountered in your library search and how these problems were managed. Refine this part with each new draft. Interest, Significance, and Rationale for the Critical Analysis Lecture In this last part of the introduction to the literature review, you explain the importance and significance of the Review that will follow. As you read more, you will find more rationale as to why this review is important. Provide a transition sentence from this Introduction to the Review of the Literature. Then end with a statement that explains how the Review will conclude in the Discussion section. Example of concluding statement: As an emerging method of instructional delivery in higher education, and one that continually evolves with the growth in technology, it is important to understand its impact on learning, retention, instruction, and students. This critical analysis of the literature concludes with a summary and interpretation of theoretical, empirical, and methodological literature, conclusions, and recommendations for future scholarly inquiry into web-based instruction in distance education. 4 Instructions for Writing the Interest, Significance, and Rationale for the Critical Analysis 1. Discuss if the topic is of limited interest, regional, national, or perhaps of global interest? Explain why? You can include personal interest based on experience and potential applications. 2. Describe why it is worth studying (or examining)? 3. Indicate that the presentation of the Review of the Literature follows 4. Develop a concluding statement (see example above, in lecture) to the effect that a synopsis and interpretations, conclusions, and recommendations are presented at the end of the review in the discussion section. Refine this part with each new draft. Review of the Literature About ___ (add your topic) Lecture This is the second major part of this critical analysis. This has a long lecture. Now is the time to write â€Å"your in-depth Literature Review†. You laid the foundations for this section in the Introduction to the Review, to organize your review according to those themes. Present the theoretical literature (theories, model, constructs, concepts) about those themes, and empirical literature (studies) regarding those themes, in a proper manner. Follow the instructions (see presenting theoretical literature, and presenting empirical literature) in this Review of the Literature section. If you present the literature appropriately in this body of the review, then you will have information to present in the Discussion of the Literature. If you don’t, this Review falls apart. Only literature presented in this Review of the Literature can be analyzed in the next section, Discussion of the Literature. You will save a stitch in time, if you follow instructions and learn how to present theories, and how to present studies, including the authors stated limitations and recommendations for future inquiry, in addition to your critique of those studies. †¢ General comments: The theoretical and empirical literature is summarized, analyzed, evaluated, and synthesized in a more in-depth â€Å"coherent† manner within organized headings and sublevel headings. Specifically, information pertaining to theoretical, empirical, methodological, critical review, and case studies about the topic is reported. As reported previously, expect that you will obtain more literature than you will need to include in your literature review. Quantity, however, is not as important as selecting appropriate literature to present, that is of value and relevant. While many published Review articles may have more than 100 cited references, due to time constraints in the course, the expectation is a minimum of 20 â€Å"relevant†, scholarly citations in the text of your paper. This will increase to 50 references in the qualifying paper. It certainly isn’t unusual to have over 100 references in a dissertation. Do not go overboard. Quality and relevance is what counts. Don’t use references from â€Å"consulting firms† or firms that are â€Å"promoting† their products or services. Look for scholarly publications. As you present literature in your â€Å"word† document, it is okay to talk to yourself. Make notes in the document to your self. You can use different font colors or highlights for these messages to yourself. o Perhaps you want to leave a message to yourself to review a particular article that you didn’t yet have the chance to review, or o you want to search another theme. o Or you read an article, but didn’t have a chance yet to write about it – jot down notes o Use the word file as a tool where you keep all information in one place. You will find this technique very helpful in developing the qualifying paper, and in developing the your dissertation. The instructor does not mind (and in fact encourages you do to this, even in final copies0. Just make the messages â€Å"neat† – and not to distracting) Of utmost importance, is that you present your review appropriately. Practice doing it correctly immediately or you will be WASTING time (having to redo it later). †¢ Your review must be organized within the headings/sublevel headings. Insert the outline developed in the Introduction to the Review. Make sure that the outline is consistent with the organization of themes, concepts add theories in your literature map. †¢ It is ok if you reorganize or rename the themes, but make the changes if the Organization of the R (and literature map, in the prior section). You want the Introduction to the Review, Review of the Literature, and the Discussion section all to be â€Å"internally consistent† with one another. †¢ Instructions follow on how to present CRITICALLY present, theoretical and empirical literature. FOLLOW THESE INSTRUCTIONS. Quotations and Paraphrasing and Critical Analysis †¢ This is a literature review, and not your opinion.

Survival Outcome Neonates Early Sepsis Health And Social Care Essay

Survival Outcome Neonates Early Sepsis Health And Social Care Essay A Retrospective Comparative Study on the Survival Outcome of Neoates with Early -Onset Sepsis with Sclerema Given Fresh Frozen Plasma at Davao Medical Centern Nursery-A One Year Review Objectives: To determine and compare the survival outcome of patients with early onset neonatal sepsis with sclerema given fresh frozen plasma plus standard therapy of neonatal sepsis to those who were only given standard therapy alone. Fresh Frozen plasma contains immunologic factors which is deficient in a neonate. This study would help us validate the role of FFP transfusion in a sick neonate with sclerema. Design: Cohort Study design Setting: Tertiary care hospital Participants:All neonates presenting with clinical signs of neonatal sepsis with sclerema admitteded at Davao Medical Center nursery for the year 2008. Results and Conclusion: INTRODUCTION Neonatal sepsis is a clinical syndrome of bacteremia characterized by systemic signs and symptoms of infection in the first month of life1. It has taken so many lives of newborn babies. The mortality rate continuously increases especially in the third world countries like the Philippines so that early recognition, diagnosis and treatment of infection is important because it is largely a preventable disease. Neonatal Sepsis can be divided into two main classes depending on the onset of symptoms related to sepsis- early-onset and late-onset neonatal sepsis2. Early onset is mainly due to antepartum infections vertically transmitted while late-onset is the combination of the former and nosocomial infection. The incidence of neonatal sepsis varies from one institution to another with higher rates in developing countries. In the United States , the incidence of a culture-proven sepsis is approximately 2 per 1000 livebirths and increases to 25 per 1000 livebirths in infants with birthweight less than 1500 grams3. It is considered to be a major cause of fatality during the first month of life contributing to 13-15% of all neonatal deaths with highest rates seen in premature infants and in small for gestational age infants. The mortality rate in neonatal sepsis may be as high as 50% for infants who are not treated3. A local study conducted at MCU-FDTMF Hospital nursery found the incidence of neonatal septicemia to be 9.6 %4 as compared to other studies at UP PGH which is 5.5%. At Davao Medical Center the incidence and the case fatality rate of neonatal sepsis for the year 2008 are about 5/1000 livebirths and 1.3% respectively5. Considering the nonspecificity of the early clinical signs of neonatal sepsis and the neonates relative state of immunosuppression, early diagnosis and treatment is of utmost important. The mainstay of treatment is antibiotic. Supportive management is geared towards thermoregulation to prevent hypothermia or hyperthermia, ensuring good ventilation/oxygenation to vital tissues, provision of optimal nutrition preferably with enteral feeding or TPN, prevention of hypoglycemia and electrolyte imbalance by administration of parenteral fluids and vasopressors for hypotension. Adjunctive therapy includes fresh frozen plasma transfusion, exchange transfusion, immunoglobulin therapy, granulocyte-macrophage colony stimulating factor, and granulocyte transfusion. Sclerema is the uniform hardening of the skin and subcutaneous tissues to the extent that the skin could not be pitted nor picked up or pinched into a fold6.It is considered as a sign of a potentially fatal underlying disease process like neonatal sepsis especially gram- negative sepsis. Neonatal septicemia is invariably fatal when associated with sclerema7. Its reported mortality rates range from 67-88% with death occurring hours to days after onset8. Although literature about the benefits of Fresh Frozen Plasma transfusion in septic neonates with sclerema is scarce, our experienced at SPMC nursery suggests improved outcome from neonatal sepsis with sclerema when given FFP. We do not give FFP to septic neonates without sclerema. We are doing this study to validate if indeed our perception is correct and if this practice is valid. The study will be limited to comparison of septic patients with sclerema only. This preselects the most seriously ill patients. By limiting the study to early onset neonatal sepsis, opportunistic infections from less virulent pathogens like candida and staphylococcus epidermides are likely to be excluded and infection is most likely vertically transmitted and not nosocomial. This is to limit the varaiables due to etiologic agents that may affect outcome and interpretation of the result. Review of Related Literature The defense system of the human body consists of three components: physical , cellular and humoral. Neonates are particularly deficient in all three so that a more aggressive management is mandatory to improve survival outcome when neonates develop septicemia. The physical and chemical barriers to infection in the human body are present in the newborn but are functionally deficient. The skin of a preterm infant is only a few cell-layers thick and is poorly cornified hence can easily be damaged paving the way for infection. The protective fatty acid production is also low making them more vulnerable. At 23 weeks gestational age the fetus possesses T and B lymphocytes, macrophages, monocytes, polymorphonuclear cells and the capacity to synthesize all known immune factors. The ability of the T and B lymphocytes to produce cytokines is less in comparison to adults, however neonates are capable of generating appropriate adaptive immune responses. Langerhans cells are important in local infection and are present in the neonate at 18 weeks gestation. Phagocytes from preterm neonates show normal activity when suspended in normal adult serum, however neonatal serum is deficient in immunoglobulin and complement so there is a marked reduction in adherence and chemotaxis. The neonatal neutrophil or polymorphonuclear (PMN) cell, which is vital for effective killing of bacteria is deficient in chemotaxis and killing capacity. Also neonatal PMNs are less deformable therefore they are less able to move through the extracellular matrix of tissues to reach the site of inflammation and infection. The limited ability of neonate for phagocytosis and killing of bacteria is further impaired when the infant is clinically ill. Lastly neutrophil reserves are easily depleted because of the diminished response of the bone marrow especially in the premature infant. The neonate is capable of synthesizing IgM in utero at 10 weeks gestation, however IgM levels are generally low at birth unless the infant was exposed to an infectious agent during the pregnancy, thereby stimulating increased IgM production. During pregnancy IgG is transported actively and passively across the placenta from about the 20th week of gestation and at full term the neonates IgG levels are higher than his mothers levels. The IgG in an infants plasma has a half-life of about three weeks.Until the infant is able to generate his own IgG, IgM and IgA there is a period of postnatal hypogammaglobulinemia. In a preterm neonate of 26 weeks gestation the plasma IgG levels are markedly lower and diminish to ineffective levels very quickly, increasing the risk of infection. Complement protein production can be detected as early as 6 weeks gestation; however the concentration of the various components of the complement system widely varies among individual neonates. While some infants have had complement levels comparable with those in adults, deficiencies appear to be greater in the alternative pathway than in the classic pathway. The terminal cytotoxic components of the complement cascade that leads to killing of organisms, especially gram-negative bacteria are deficient. The deficiency is more marked in preterm infants. Mature complement activity is not reached until infants are aged 6-10 months. Neonatal sera have reduced opsonic deficiency against GBS, E. coli, and S pneumoniae because of decreased levels of fibronectin, a serum protein that assists with neutrophil adherence and has opsonic properties. Most common organisms causing early- onset neonatal sepsis include group B streptococci, gram -negative enteric organisms like E. coli. Listeria monocytogenes and Klebsiella are also a common isolates. Less common organisms include staphylococcus, other streptococci, anaerobes, and Haemophilus influenza9. The host-defence mechanism of neonates are immature. They have a markedly decrease levels of C3, Cy properdin and factor B which are very important in the alternative pathway of complement. Levels of IgM and IgA are also low at birth. Although IgG levels may be normal in term neonates, it is low in preterm infants. These relative deficiency of the neonates immune system complicated by low birthweight and decreasing age of gestation makes them more susceptible to life threatening infections10. Sadana,et al mentioned that the incomplete development of the host defense system of the neonate is largely responsible for the high mortality in neonatal sepsis11.In his study an increase in the levels of IgG, IgM, IgA andC3 was noted after exchange transfusion.Exchange transfusion offers removal of bacteria and toxins, improves oxygenation and perfusion as well as decreases hemorrhagic complications. The relative immunodeficiency state and susceptibility to sepsis and complications is the impetus for exploring treatment modalities other than antibiotics. There was an increase in the levels of IgG antibodies in septicemia patients with coagulase negative staphylococcus after FFP administration in the study made by Krediet, et al12 The neonate being deficient in both humoral and cellular immunity is more vulnerable to infection. There are literature that suggests the usage of Fresh Frozen Plasma in patients with neonatal sepsis to compensate for the immunologic deficiencies. FFP improves neonatal chemotaxis, provides humoral or cellular factors13 and increases the levels of immunoglobulin such as IgG, IgA and IgM. FFP remains the only approved source of factors V,XI, protein C, protein S and plasminogen14 and basically all the clotting factors. Others would say that FFP transfusion in neonatal sepsis is good because it increases levels of IgG, IgA and IgM15 that will increase chances of survival. FFP contains immunoglobulins anc complement factors16. Fresh frozen plasma, the plasma separated from a unit of whole blood and frozen at -18 oC within 8 hours of collection. It is a platelet-poor plasma17.Each bag has a volume of 175 to 250 ml and contains between 1 and 2 units of each coagulation factor per ml and 400 to 800 mg fibrinogen. It contains fibrinolytic and complement factors. It carries the same risks of viral transmission as other blood components and can cause allergic reactions and fluid overload. Indications for fresh frozen plasma, once used routinely in the support of critically ill-infants and children, have become more specific as evolving evidence has confirmed or disproved the efficacy of plasma in various circumstances. Fresh frozen plasma is currently indicated to treat the coagulopathies of massive hemorrhage, liver failure, disseminated intravascular coagulation and sepsis18. In an infant the fat has a higher saturated- to-unsaturated fatty acid ratio compared to adult fat and thus a higher melting point. Prematurity, hypothermia and shock and anatomic abnormalities have been postulated to further increase this ratio,possibly as a result of enzymatic alteration allowing precipitation of fatty acid crystals within the lipocytes. This condition has been suggested to result in the dramatic clinical findings in the affected skin. Xray diffraction techniques have confirmed that infants with sclerema have an increase in saturated fats and that the crystals within the fat cells are composed of triglycerides. The exact incidence of sclerema neonatorum is unknown . All studies describe SN as extremely rare. The number of reported case in recent years have declined, probably as a result of a better neonatal care. Because sclerema neonatorum invariably is associated with serious underlying disease process, the mortality rate is high. In different series, the reported mortality rates range from 67-88%, with death occuring hours to days after onset. If the underlying disease is treated successfuly, the skin softens and returns to normal. Sclerema neonatorum shows a slight male preponderance, with an estimated male-to-female ratio of 1.5:1. Sclerema neonatorum is a disease confined to the newborn period. It can present at birth, but onset within the first week of life is more common. The oldest reported infant presented with Pseudomonas septicemia is 106 days old. According to literature one half of the affected infants are premature, , and the others are full term but have a serious underlying disease. They are often of low birth weight and have cyanosis and low apgar scores.In one series, 75% of the mothers were healthy, while 25% had preeclampsia, placenta previa, or infection. Labor is usually normal and the delivery is spontaneous and nontraumatic. Physical findings appear suddenly, first on the thighs and on the buttocks and then spreading rapidly often affecting all parts of the body except the palms and the soles and the genitalia. The involved skin is pale, waxy, and firm to palpation. The skin cannot be pitted or pinched up because it is bound to the underlying tissues. The affected infant often dispalys flexion contractures at the elbows, knees and hips, temperature instability, restricted respiration, difficulty in feeding and decrease in spontaneous movement.17 Recognition and the prompt institution of therapy specific to the underlying disease process are mandatory such as antibiotics, steroids, exchange transfusions and FFP transfusion. Definition of Terms Neonatal sepsis- It is a clinical syndrome of bacteremia characterized by systemic signs and symptoms of infection in the first month of life. Neonatal sepsis encompasses systemic infections of the newborn including septicemia, meningitis, pneumonia, arthritis, osteomyelitis and urinary tract infection of the newborn19. Associated factors for early onset neonatal sepsis include lowbirthweight, PROM, foul smelling liquor, multiple vaginal examinations and maternal fever20 Early onset neonatal sepsis- It usually presents within the first 48 hours of life. In severe cases, the neonate may be symptomatic in utero, (fetal tachycardia, poor beat to beat variability) or within the first few hours after birth. The source of the infection is generally in the maternal genital, gastrointestinal, urinary tract . Clinically neonates usually present with respiratory distress and pneumonia. Presence of some perinatal risk factors has been associated with an increased risk of early onset sepsis. Frozen Frozen Plasma It is the plasma removed from a unit of whole blood and frozen at or below 55 degrees Fahrenheit within 8 hours of collection. It contains all the coagulation factors in normal amounts and is free of red cells, leukocytes and platelets. It is not a concentrate of clotting factors. Sclerema Neonatorum- It is derived from the Greek word sclerosmeaning hard. It is considered best as a sign of a potentially fatal underlying disease process in the newborn period. Physical findings appear suddenly first on the thighs and buttocks and then spreading rapidly, often affecting all parts of the body except the palms, soles and genitalia. The involved skin is pale, waxy and firm to palpation. The skin cannot be pitted or pinched up because it is bound to the underlying tissues.It can present at birth but onset within the first week of life is more common. Associated underlying conditions include septicemia, pneumonia, hypothermia, metabolic acidosis, respiratory distress syndrome, congenital heart defects, gastroenteritis and intestinal obstruction. Clinical Signs of Neonatal Sepsis: (At least 2 clinical signs supported by laboratory findings) 1.sclerema 2.hypoglycemia/hyperglycemia 3.temperature instability 4.tachypnea/respiratory distress 5.Apnea 6.Poor perfusion Laboratory findings: 1..I/T ratio> 0.2 2.leukopenia 3.Neutropenia 4.Thrombocytopenia Research Question Will FFP transfusion improves the survival outcome of the sick neonates with early onset neonatal sepsis with sclerema given the standard therapy plus FFP? Is the use of FFP justifiable in the treatment of neonatal sepsis with sclerema in terms of cost and survival outcome? Significance of the study Many studies have been done to improve the survival outcome of neonates with septicemia. The progress in terms of the available adjuctive therapies in the treatment of neonatal sepsis entail a higher cost which is an issue to our marginalized patients who cannot afford such expensive add on treatment hence inspired the researcher to study fresh frozen plasma transfusion which is much more affordable and readily available to the neonates with septicemia particularly with sclerema. FFP contains immunologic factors helping the immunologically deficient neonate in fighting serious infections. This study aims to evaluate the effects of FFP transfusion in the subset of neonates with high case fatality rate. They are the candidates that would benefit from the terminal cytotoxic complement with the coagulation cascade that FFP may provide. OBJECTIVES OF THE STUDY General Objective: To determine and compare the survival outcome of patients with early- onset neonatal sepsis with sclerema given the standard therapy (antibiotic + supportive care ) plus fresh frozen plasma to those with early -onset neonatal sepsis given only the standard therapy (antibiotic + supportive care ) at Southern Philippines Medical Center- Nursery for the year 2008 . Specific Objectives: Determine the incidence of sclerema in early onset neonatal sepsis in SPMC. Determine the rate of early onset neonatal sepsis with sclerema in SPMC. Determine the mortality rate of neonates with early onset sepsis with sclerema. Identify the possible the maternal fetal/neonatal factors related to early neonatal sepsis with sclerema Compare the outcome 1.resolution of sclerema Chapter 2 METHODOLOGY Study Design This paper will be an observational descriptive and comparative study on the survival outcome of patients with neonatal sepsis with sclerema admitted at Southern Philippines Medical Center for the year 2008 using a Cohort study design. Population This study will include all neonates with early-onset neonatal sepsis with sclerema admitted at Southern Philippines Medical Center -Nursery for the year 2008. Inclusion criteria: All neonates admitted at Southern Philippines Medical Center -Nursery who presents with the clinical signs of early- onset neonatal sepsis with sclerema. Exclusion criteria: 1.All neonates presenting with clinical signs of neonatal sepsis with sclerema occurring beyond 48 hours of life. 2. All non-institutional deliveries presenting with early onset neonatal sepsis with sclerema. 3. All neonates admitted at the NICU with obvious congenital anomalies like syndromic features, cleft lip and palate etc. Data Collection Data will be collected by the researcher through a retrospective chart review. The researcher will scan and evaluate each chart of the patient with neonatal sepsis for the presence of sclerema in the progress notes. A data sheet will be use for each patient.Research consultant will be asked for validation of diagnosis. Independent variable -Fresh Frozen Plasma transfusion Dependent variable- survival outcome of neonates with early onset sepsis with sclerema Sample Size: All neonates admitted at Southern Philippines Medical Center-Nursery who fulfilled the inclusion criteria for the year 2008 will be used as a sample in this study. Data Analysis: correlation coefficient and odds ratio will be used to summarize the data for the comparative part. Means and standard deviation for the descriptive part and percentage and rates as per standard definition. Ethical Consideration The approval of the hospital research committee and the ethics committee will be sought before the conduct of the study. No identification data or marks will be placed in each patient included in the study. The data will be kept by the researcher for 5 years. Table 1.Patient clinical profile Name: AGA___SGA___LGA___ Age: Weight: AOG: Sex: Medical record number: length of stay in the hospital: Date of admission : Date of discharge: Diagnosis upon admission: Final diagnosis: OUTCOME: [ ] died [ ]survived [ ] HAMA [ ] transferred [ ]transout to blue area Cause of death: Age at onset of sepsis(hours) Age at onset of sclerema(hours) Antibiotics Ampicillin/Gentamycin Cefotaxime/Amikacin Piperacillin + Tazobactam/Amikacin Meropenem Cefepime Neonatal risk factors Birthweight 1.VLBW 2.LBW 3.normal weight 4.LGA APGAR SCORE (5 minute) 0-3 4-6 7-10 Ballard Scoring 34-37 >37 Comorbidities Neonatal pneumonia Meconium aspiration Intubation Pulmonary hypertension Pneumothorax Others (specify) MATERNAL RISK FACTORS Premature labor and delivery Prolong Rupture of membrane Antenatal Steroid Chorioamnionitis Manipulative Operative Delivery Maternal infection within 2 weeks of delivery UTI RTI Preeclampsia/eclampsia Placenta previa/ abruptio Others (specify) SCLEREMA Hours first noted FFP transfusion Yes /hours before transfusion No Resolution of sclerema post FFP Yes- number of hours first noted resolution No- OUTCOME Died Survived COMPLICATIONS NOTED Table 2. ANTIBIOTICS Standard care+FFP Standard care Total No. % No. % No. % Ampicillin+Gentamycin Cefotaxime +Amikacin Piptazo+Amikacin Meropenem Cefepime Total Table 2.BIRTHWEIGHT Standard care+FFP Standard care Total No. % No. % No. % VLBW LBW AGA LGA Total Table 3. APGAR SCORE(5 MINUTE) Standard care+FFP Standard care Total No. % No. % No. % 0-3 4-6 7-10 Total Table 4. BALLARDS SCORE Standard care+FFP Standard care Total No. % No. % No. % 34-37 weeks >37 weeks Total Table 5. Comorbidities Standard care+FFP Standard care Total No. % No. % No. % Neonatal pneumonia Meconium aspiration Intubation Pulmonary hypertension Pneumothorax Others (specify) Total Table 6. Maternal Risk Factors Antibiotic+Standard care+ FFP Antibiotic +Standard care Total No. % No. % No. % Preterm labor/delivery RBOW Antenatal Steroid Chorioamnionitis Operative Delivery Maternal infection UTI RTI Preeclampsia/eclampsia Placenta previa /abruptio Others (specify) Total Table 7. Onset and Resolution of Sclerema Antibiotic+Standard care+ FFP Antibiotic +Standard care only Onset resolution Total time of sclerema Table 8. Outcome Survived Dead Total No. % No. % No. % Antibiotic+Standard care+ FFP Antibiotic +Standard care Total Conceptual framework: Babies admitted at DMC nursery 2008 No sepsis Compare results Sepsis with sclerema Antibiotic+Standard care+ FFP Antibiotic +Standard care Sepsis without sclerema Early-onset neonatal sepsis COST/BUDGET: COUPON BOND.P.400.00 PRINTINGP700.00 RESEARCH MATERIALS ..1,000.00 ______________________ P 2,100.00 TIME TABLE (May 2009- December 2010) May PRESENTATION TO RESEARCH COMMITTEE AND ETHICS June -October DATA GATHERING November PRESENTATION OF RESULTS December SUBMISSION OF HARD COPIES

The Problems with Voting in America Essay -- Politics Political Essays

The Problems with Voting in America If one were to look at the voting history as of late in America you would surely find information on the Florida catastrophe in 2000. The problem with our voting system today is in the technology being used; many demographic groups find our current systems confusing and hard to use. As voters step into the polling places this election year many will be voting through new devices some even sporting â€Å"touch screen† technology and we can only hope that the new technology is understood and accepted. In the US each municipality selects their own voting equipment regardless of what other places are doing. According to this CPSR article the Vote-O-Matic system has been in place for over ten years in many US counties and while some may view this technology as acceptable the Vote-O-Matic was a major player in the 2000 recount. Many municipalities have the funding to adopt new technology but others either feel uncomfortable with this change or don’t have the funding. The problem with the Vote-O-Matic is it uses paper ballots that consist of many...

Sources of Finance for a Business Essay -- Papers

Sources of Finance for a Business For a business to successfully run, it must have sources of finance. These are methods of financing the running of the business, buying of stock and paying of workers. Small businesses and large businesses have different sources of finance. In this section, I will discuss the different sources of finance used by small and large businesses, and the advantages and disadvantages of each, starting with small businesses. Setting up a business costs money. For instance, setting up a bakery involves buying or renting a shop and buying stocks of flour and so on. One source of finance for a new business is equity or equity capital. This is money which is put into the business by its owners. The baker for instance, may have savings of  £20,000 which are used to buy a lease on a shop and start a sole proprietorship. They may also go into a partnership with another person, with each putting in  £10,000 of their own savings. The advantage of using equity capital is that, as it is the owner’s money, no extra cost or interest is charged when using it. The problem with equity capital is that it is difficult to gather in the first place. It is often difficult for small and medium sized businesses to find individuals to provide equity. Or, if the business is a sole proprietorship, the owner may be short of money to provide equity. Retained profit is also the most important source of finance for large businesses in the UK. Once the business has been set up, it will want to make a profit. This profit is owned by the owners of the business. Retained or undistributed profit is where these profits are kept back for us... ...ho set up their own businesses. They also provide training and support. Other grants are available to businesses which operate in areas of low income and high unemployment. Grants are good for businesses because they are given for free, with no interest or payment charges. However, they are fairly uncommon for everyday businesses and are only given to businesses which need the boost in funds. For a business to succeed, it needs to find the right balance of finance. It is important that it is well-placed to survive any financial problems it might go through. In my business, it is vital to carry out extensive research to ensure that I will have the right amount of funds to carry out everyday running of the business. If this does not happen and I do not find the correct sources of finance then my business will fail.

Night World : The Chosen Chapter 3

God, it stank. RashelJordan had seen a lot of vampire lairs in her seventeen years, but this was probably the most disgusting. She held her breath as she stirred the nest of tattered cloth with the toe of one boot. She could read the story of this collection of garbage as easily as if the inhabitant had written out a full confession, signed it, and posted it on the wall. One vampire. A rogue, an outcast who lived on the fringe of both the human world and the Night World. He probably moved to anew city every few weeks to avoid getting caught. And he undoubtedly looked like any other homeless guy, except that none of the human homeless would be hanging around aBoston dock on a Tuesday night in early March. He brings his victims here, Rashel thought. The pier's deserted, it's private, he can take his time with them. And of course he can't resist keeping a few trophies. Her foot stirred them gently. A pink-and-blue knit baby jacket, a plaid sash from a school uniform, a Spiderman tennis shoe. All bloodstained. All very small. There had been a rash of missing children lately. TheBoston police would never discover where they had gone-but now Rashel knew. She felt her lips draw back slightly from her teeth in something that wasn't really a smile. She was aware of everything around her: the soft plash of water against the wooden pier, the rank coppery smell that was almost a taste, the darkness of a night lit only by a half moon. Even the light moisture of the cold breeze against her skin. She was aware of all of it without being preoccupied with any of it-and when the tiny scratch sounded behind her, she moved as smoothly and gracefully as if she were taking her turn in a dance. She pivoted on her left foot, drawing her bokken in the same motion, and without a break in the movement, she stabbed straight to the vampire's chest. She drove the blow from her hips, exhaling in a hiss as she did it, putting all her strength behind it. â€Å"Gotta be faster than that,† she said. The vampire, skewered like a hot dog, waved his arms and gibbered. He was dressed in filthy clothing and his hair was a bushy tangle. His eyes were wide, full of surprise and hatred, shining as silver as an animal's in the faint light. His teeth weren't so much fangs as tusks: fully extended, they reached almost to his chin. â€Å"I know,† Rashel said. â€Å"You really, really wanted to kill me. Life's tough, isn't it?† The vampire snarled one more time and then the silver went out of his eyes, leaving only the look of astonishment. His body stiffened and slumped backward. It lay still on the ground. Grimacing, Rashel pulled her wooden sword out of the chest. She started to wipe the blade on the vampire's pants, then hesitated, peering at them more closely. Yes, those were definitely little crawly things. And the blankets were just as repulsive. Oh, well. Use your own jeans. It won't be the first time. She carefully wiped the bokken clean. It was two and a half feet long and just slightly, gracefully curved, with a narrow, sharp, angled tip. Designed to penetrate a body as efficiently as possible-if that body was susceptible to wood. The sword slipped back into its sheath with a papery whisper. Then Rashel glanced at the body again. Mr. Vampire was already going mummified. His skin was now yellow and tough; his staring eyes were dried up, his lips shrunken, his tusks collapsed. Rashel bent over him, reaching into her back pocket. What she pulled out looked like the snapped-off end of a bamboo backscratcher-which was exactly what it was. She'd had it for years. Very precisely, Rashel drew the five lacquered fingers of the scratcher down the vampire's forehead. On the yellow skin five brown marks appeared, like the marks of a cat's claws. Vampire skin was easy to mark tight after death. â€Å"This kitten has claws,† she murmured. It was a ritual sentence; she'd repeated it ever since the night she'd killed her first vampire at the age of twelve. In memory of her mother, who'd always called her kitten. In memory of herself at age five, and all the innocence she'd lost. She'd never be a helpless kitten again. Besides, it was a little joke. Vampires†¦ bats. Herself†¦ a cat. Anybody who'd grown up with Batman and Catwoman would get it. Well. All done. Whistling softly, she rolled the body over and over with her foot to the end of the pier. She didn't feel like carting the mummy all the way out to the fens, the salt marshes where bodies were traditionally left inBoston . With a mental apology to everybody who was trying to clean up the harbor, she gave the corpse a final push and listened for the splash. She was still whistling as she emerged from the pier onto the street. Hi-ho, hi-ho, it's off to work we go— She was in a very good mood. The only disappointment was the constant one, that it hadn't been the vampire, the one she'd been looking for ever since she'd been five years old. It had been a rogue, all right-a depraved monster who killed human kids foolishly close to human habitations. But it hadn't been the rogue. Rashel would never forget his face. And she knew that someday she would see it again. Meanwhile, there was nothing to do but shish-kebab as many of the parasites as possible. She scanned the streets as she walked, alert for any sign of Night People. All she saw were quiet brick buildings and streetlights shining pale gold. And that was a shame, because she was in terrific form tonight; she could feel it. She was every bloodsucking leech's worst enemy. She could stake six of them before breakfast and still be fresh for chemistry first period at Wassaguscus High. Rashel stopped suddenly, absent-mindedly melting into a shadow as a police car cruised silently down the cross-street ahead. I know, she thought. I'll go see what the Lancers are up to. If anybody knows where vampires are, they do. She headed for the North End. Half an hour later she was standing in front of a brownstone apartment building, ringing the buzzer. â€Å"Who's there?† Instead of answering, Rashel said, â€Å"The night has a thousand eyes.† â€Å"And the day only one,† came the reply from the intercom. â€Å"Hey there, girl. Come on up.† Inside, Rashel climbed a dark and narrow stairway to a scarred wooden door. There was a peephole in the door. Rashel faced it squarely, then pulled off the scarf she'd been wearing. It was black, silky, and very long. She wore it wrapped around her head and face like a veil, so that only her eyes showed, and even they were in shadow. She shook out her hair, knowing what the person on the other side could see. A tall girl dressed like a ninja, all hi black, with black hair falling loose around her shoulders and green eyes blazing. She hadn't changed much since she was five, except in height. Right now she made a barbaric face at the peephole and heard the sound of laughter behind the door as bolts were drawn. She waited until the door was shut behind her again before she said, â€Å"Hi, Elliot.† Elliot was a few years older than she was, and thin, with intense eyes and little shiny glasses that were always slipping off his nose. Some people would have dismissed him as a geek. But Rashel had once seen him stand up to two werewolves while she got a human girl out a window, and she knew that he had practically single-handedly started the Lancers-one of the most successful organizations of vampire hunters on the east coast. â€Å"What's up, Rashel? It's been a while.† â€Å"I've been busy. But now I'm bored. I came to see if you guys had anything going.† As Rashel spoke, she was looking at the other people in the room. A brown-haired girl was kneeling, loading objects from boxes into a dark green backpack. Another girl and a boy were sitting on the couch. Rashel recognized the boy from other Lancers meetings, but neither of the girls were familiar. â€Å"Lucky you,† Elliot said. â€Å"This is Vicky, my new second-in-command.† He nodded at the girl on the floor. â€Å"She just moved toBoston ; she was the leader of a group on the south shore. And tonight she's taking a little expedition out to some warehouses in Mission Hill. We got a lead that there's been some activity out there.† â€Å"What kind of activity? Leeches, puppies?† Elliot shrugged. â€Å"Vampires definitely. Werewolves maybe. There's been a rumor about teenage girls getting kidnapped and stashed somewhere around there. The problem is we don't know exactly where, or why.† He tilted his head, his eyes twinkling. â€Å"You want to go?† â€Å"Isn't anybody going to ask me?† Vicky said, straightening up from her backpack. Her pale blue eyes were fixed on Rashel. â€Å"I've never even seen this girl before. She could be one of them.† Elliot pushed his glasses higher on his nose. He looked amused. â€Å"You wouldn't say that if you knew, Vicky. Rashel's the best.† â€Å"At what?† â€Å"At everything. When you were going to your fancy prep school, she was out in theChicago slums staking vampires. She's been inL.A. ,New York ,New Orleans†¦ even Vegas. She's wiped out more parasites than the rest of us put together.† Elliot glanced mischievously at Rashel, then leaned toward Vicki. â€Å"Ever heard of the Cat?† he said. Vicki's head snapped up. She stared at Rashel. â€Å"The Cat? The one all the Night People are afraid of? The one they're offering a reward for? The one who leaves a mark-â€Å" Rashel shot Elliot a warning look. â€Å"Never mind,† she said. She wasn't sure she trusted these new people. Vicky was right about one thing: you couldn't be too careful. And she didn't like Vicky much, but she could hardly turn down such a good opportunity for vampire hunting. Not tonight, when she was in such terrific form. â€Å"I'll go with you-if you'll have me,† she said. Vicky's pale blue eyes bored into Rashel's a moment, then she nodded. â€Å"Just remember I'm in charge.† â€Å"Sure,† Rashel murmured. She could see Elliot's grin out of the corner of her eye. â€Å"You know Steve, and that's Nyala.† Elliot indicated the boy and girl on the couch. Steve had blond hair, muscular shoulders, and a steady expression; Nyala had skin like cocoa and a faraway look in her eyes, as if she were sleepwalking. â€Å"Nyala's new. She just lost her sister a month ago,† Elliot added in a gentle voice. He didn't need to say how the sister had been lost. Rashel nodded at the girl. She sympathized. There was nothing quite like the shock of first discovering the Night World, when you realized that things like vampires and witches and werewolves were real, and that they were everywhere, joined in one giant secret organization. That anybody could be one, and you'd never know until it was too late. â€Å"Everybody ready? Then let's go,† Vicky said, and Steve and Nyala got up. Elliot showed them to the door. â€Å"Good luck,† he said. Outside, Vicky led the way to a dark blue car with mud strategically caked on the license plates. â€Å"We'll drive to the warehouse area,† she said. Rashel was relieved. She was used to walking the city streets at night without being seen-important when you were carrying a rather unconcealable sword-but she wasn't sure that these other three could manage. It took practice. The drive was silent except for the murmur of Steve's voice occasionally helping Vicky with directions. They passed through respectable neighborhoods and venerable areas with handsome old buildings until they got to a street where everything changed suddenly. All at once, as if they had crossed some invisible dividing line, the gutters were full of soggy trash and the fences were topped with razor wire. The buildings were government housing projects, dark warehouses, or rowdy bars. Vicky pulled into a parking lot and stopped the car away from the security lights. Then she led them through the knee-high dead weeds of a vacant lot to a street that was poorly lighted and utterly silent. â€Å"This is the observation post,† Vicky whispered, as they reached a squat brick building, a part of the housing project that had been abandoned. Following her, they zigzagged through debris and scrap metal to get to a side door, and then they climbed a dark staircase covered with graffiti to the third floor. Their flashlights provided the only illumination. â€Å"Nice place,† Nyala whispered, looking around. She had obviously never seen anything like it before. â€Å"Don't you think-there may be other people here besides vampires?† Steve gave her a reassuring pat. â€Å"No, it's okay.† â€Å"Yeah, it looks like even the junkies have abandoned it,† Rashel said, grimly amused. â€Å"You can see the whole street from the window,† Vicky put in shortly. â€Å"Elliot and I were here yesterday watching those warehouses across the street. And last night we saw a guy at the end of the street who looked a lot like a vampire. You know the signs.† Nyala opened her mouth as if to say she didn't know the signs, but Rashel was already speaking. â€Å"Did you test him?† â€Å"We didn't want to get that close. We'll do it tonight if he shows up again.† â€Å"How do you test them?† Nyala asked. Vicky didn't answer. She and Steve had pushed aside a couple of rat-chewed mattresses and were unloading the bags and backpacks they'd brought. Rashel said, â€Å"One way is to shine a flashlight in their eyes. Usually you get eye-shine back-like an animal's.† â€Å"There are other ways, too,† Vicky said, setting the things she was unloading on the bare boards of the floor. There were ski masks, knives made of both metal and wood, a number of stakes of various sizes, and a mallet. Steve added two clubs made of white oak to the pile. â€Å"Wood hurts them more than metal,† Vicky said to Nyala. â€Å"If you cut them with a steel knife they heal right before your eyes-but cut them with wood and they keep bleeding.† Rashel didn't quite like the way she said it. And she didn't like the last thing Vicky was pulling out of her backpack. It was a wooden device that looked a bit like a miniature stock. Two hinged blocks of wood that fit snugly around a person's wrists and closed with a lock. â€Å"Vampire handcuffs,† Vicky said proudly, seeing her look. â€Å"Made of white oak. Guaranteed to hold any parasite. I brought them from down south.† â€Å"But hold them for what? And what do you need all those little knives and stakes for? It would take hours to kill a vampire with those.† Vicky smiled fiercely. â€Å"I know.† Oh. Rashel's heart seemed to thump and then sink, and she looked away to control her reaction. She understood what Vicky had in mind now. Torture. â€Å"A quick death's too good for them,† Vicky said, still smiling. â€Å"They deserve to suffer-the way they make our people suffer. Besides, we might get some information. We need to know where they're keeping the girls they kidnap, and what they're doing with them.† â€Å"Vicky.† Rashel spoke earnestly. â€Å"It's practically impossible to make vampires talk. They're stubborn. When they're hurt they just get angry-like animals.† Vicky smirked. â€Å"I've made some talk. It just depends on what you do, and how long you make it last. Anyway, there's no harm in trying.† â€Å"Does Elliot know about this?† Vicky lifted a shoulder defensively. â€Å"Elliot lets me do things my way. I don't have to tell him every little detail. I was a leader myself, you know.† Helplessly, Rashel looked at Nyala and Steve. And saw that for the first time Nyala's eyes had lost their sleepwalking expression. Now she looked awake- and savagely glad. â€Å"Yes,† she said. â€Å"We should try to make the vampire talk. And if he suffers-well, my sister suffered. When I found her, she was almost dead but she could still talk. She told me what it felt like, having all the blood drained out of her body while she was still conscious. She said it hurt. She said†¦Ã¢â‚¬  Nyala stopped, swallowed, and looked at Vicky. â€Å"I want to help do it,† she said thickly. Steve didn't say anything, but then from what Rashel knew of him, that was typical. He was a guy of few words. Anyway, he didn't protest. Rashel felt odd, as if she were seeing the very worst of herself reflected in a mirror. It made her†¦ ashamed. It left her shaken. But who am I to judge? she thought, turning away. It's true that the parasites are evil, all of them. The whole race needs to be wiped out. And Vicky's right, why should they have a clean death, when they usually don't give their victims one? Nyala deserves to avenge her sister. â€Å"Unless you object or something,† Vicky said heavily, and Rashel could feel those pale blue eyes on her. â€Å"Unless you're some kind of vampire sympathizer.† Rashel might have laughed at that, but she wasn't in a laughing mood. She took a breath, then said without turning around, â€Å"It's your show. I agreed that you were in charge.† â€Å"Good,† Vicky said, and returned to her work. But the sick feeling in the pit of Rashel's stomach didn't go away. She almost hoped that the vampire wouldn't come.