There are some Christians who do know that the Believer...

There are some Christians who do know that the Believer has a â€Å"sin nature.† Because of that, they use such as an excuse to sin and keep sinning. In other words, they say, â€Å"I have a â€Å"sin nature,† so I can’t help but sin.† Most fall back on the Verse written by the Apostle Paul, â€Å"For that which I do, I allow (understand) not: for what I would, that do I not; but what I hate, that do I† (Rom. 7:15). Such people are guilty of the sin of â€Å"antinomianism.† The prefix â€Å"anti† comes from a Greek word that means exactly what it says, i.e., â€Å"to be opposed, to be against.† â€Å"Nomi† in the Greek means â€Å"law.† Such people, in other words, live a lawless existence, meaning that they look at sin very lightly. They also fall back on another statement†¦show more content†¦5:17). The sin and the debauchery they, as an unredeemed individual, once loved, they now hate. The thing they once hated, namely living for God, they now love. In fact, the â€Å"human nature† of such a person has changed, because they have been â€Å"born again† (Jn. 3:3, 16). But unfortunately, most Believers are little taught God’s Prescribed Order of Victory, so they set out to live for the Lord in all the wrong ways. If a person wants to sin, that person is not really saved. In respect to this, John the Beloved said, â€Å"Whosoever is born of God does not commit sin (does not practice sin); for His seed remains in him (refers to the Word of God): and he cannot sin (cannot continue to practice sin), because he is born of God† (1 Jn. 3:9). John also said, â€Å"And ye know that he was manifested to take away our sins; and in him is no sin† (Christ did so at the Cross; the Christian cannot practice what Christ came to take away and destroy.) â€Å" Whosoever abideth in him sinneth not (does not practice sin): whosoever sinneth (practices sin) hath not seen him, neither known him.† (1 Jn. 3:5-6). If we look to the Cross, â€Å"sin shall not have dominion over us† (Rom. 6:14). (Continued on next page†¦) The Friendly Messenger Page 9 Volume 6 Edition 1 (†¦Continued on from page 8) Most Christians, tragically, although saved, simply do not know how to live for God. This means that almost all the ways they areShow MoreRelatedCome, Follow Me Essay1069 Words   |  5 Pagesâ€Å"We are all seekers, people who are searching for some measure of happiness and fulfillment.† (Lamoureux, 1) Humans naturally have an appetite or hunger for things like food, drink and money. Humans also have desires that seek satisfaction. We want to be as satisfied as possible. Humans want to know their purposes in life and finally be able to reach that ultimate goal or obstacle and complete it. In this completion, a human finds their ultimate meaning or value. 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Historical Female Leaders Exhibiting Civil Disobedience

Historical Female Leaders exhibiting Civil Disobedience Susan B. Anthony lived in a time, 1820-1906, that lacked equality. Thus, She dedicated most of her life’s time to social issues (Susan B. Anthony†). Anthony was known in history as a suffragist and Women’s Rights activist and is recognized for her demonstration of nonviolent resistance also known as civil disobedience. Civil Disobedience is the refusal to obey governmental demands or commands especially as a nonviolent and usually collective means of forcing concessions from the government (â€Å"Civil Disobedience†). Anthony strived to achieve her goals through practical means, such as Antigone, the leading female character in Sophocles’ fictional play Antigone. Antigone defies the law set by Creon, the King of Thebes. Creon’s decree denies Antigone’s brother, Polyneices, the right to a proper burial which goes against a sacred law in the eyes of the Gods. Antigone’s act of defiance is an example of civil disobedience, which similarly relates to Susan B. Anthony’s actions. Both women are feminist heroes, who are not intimidated by the unjust laws. They fought for what was morally inequitable. Though, the path these two take is strenuous. In Antigone’s case of civil disobedience, Creon punishes her solely because she is a woman. Even more so, she is a woman defying man’s law. Creon close-mindedness fails him in the end, even though he had the time to think about the moral issue Antigone’s rebellion raised. However,Show MoreRelatedSSD2 Module 1 Notes31223 Words   |  125 Pagesthe SOP conveys a clear message and that it answers the questions who, what, when, and how. The next step is to submit the draft SOP for peer review and supervisory approval. Your SOP will normally be sent through squad leaders, the platoon sergeant, and platoon leader for review. You must always assign a suspense date on their review, so you can complete the SOP on time. The commander s approval makes this document a SOP After you receive suggestions and comments from the peer review and yourRead MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 PagesSelf-Assessment Library How Good Am I at Building and Leading a Team? 308 glOBalization! Group Cohesiveness across Cultures 314 An Ethical Choice Using Global Virtual Teams as an Environmental Choice 315 Myth or Science? â€Å"Teams Work Best Under Angry Leaders† 320 Self-Assessment Library What Is My Team Efficacy? 322 Point/Counterpoint We Can Learn Much About Work Teams from Studying Sports Teams 326 Questions for Review 327 Experiential Exercise Fixed versus Variable Flight Crews 327 Ethical Dilemma

Exotic Locales in Indian Cinema Free Essays

Cinema has always been a world of fantasy and grandeur. What a common man cannot do in the real world is done by the star in the reel world. The artistic eyes of the filmmaker always wants the frame to be outstanding or beyond normal. We will write a custom essay sample on Exotic Locales in Indian Cinema or any similar topic only for you Order Now How do you get it? The film is shot in exotic locations. Indian cinema has always fantasized about shooting in foreign locales. It was in the late 1970’s Indian cinema industry went abroad to film. They mostly frequented U. S. A, Singapore or the United Kingdom.In the early days mostly songs were shot in these foreign countries. They were received well by the audience which made more filmmakers to follow suit. The three major movie industries in Indian cinema go to foreign locations to shoot the most. They are Hindi, Tamil and Telugu industries respectively. Films in other languages are rarely shot in foreign countries. In the last few years Hindi films are shot entirely in foreign countries. This has given the audience a refreshing experience.Hindi films released recently like Race, Dhoom, Kabhi Alvida Naa Kehna, My Name Is Khan, Housefull , Kites, Prince, New York , Kambakth Ishqq, Blue, London dreams , Life partner, Dostana, Chandni Chowkh to China, Luck, etc, were filmed entirely in foreign locales. These films were well received by the Indian audience especially the locations. Many foreign countries encourage shooting of Indian films by providing very good support. There are countries which provide monetary help to films shot in their country. Countries like U. S. A, U.K, South Africa, France, Italy, Singapore, Malaysia, Thailand and Australia provide support to Indian film companies and are frequented mostly for shooting. Though shooting in foreign locations make the film look more grand,the cost of shooting is much cheaper when compared to shooting inside india. This sis because when shooting abroad the number of people in the crew is considerably less than in local shooting which infact makes hindi film producers to opt for filming in foreign countries. Songs in Tamil films were shot in foreign locations usually. But the trend has been changing lately with films shot entirely in foreign countries. Last year the film Asal was shot entirely in France which was a new location for the Tamil industry. Films like Billa,Thillalangadi, Thambiku intha ooru, vinnai thandi varuvaya were shot in foreign countries. Kamal Hassan starrer Manmadhan ambu is being shot entirely in a cruise liner in Greece. Poda Podi a film starring Silambarasan is being filmed entirely in and around London. But not only foreign countries are exotic locations.There are many extraordinary places in india which are more beautiful than those alps and the ports. Locations like Shimla,Kashmir, Coorg, Athirappaly, Hogennakal etc,. Are indeed exotic locales in India. These locations in fact are more adhering to the Indian culture and are beautiful too. There are legendary filmmakers who have shot their films entirely inside the subcontinent. Maniratnam, Mahendran, Balumahendra, Ram Gopal Varma are few brilliant filmmakers who have not wandered around the globe scouting for locations.They shot entirely inside India and showcased its beauty to the world. Recently released film Raavanan which was shot entirely around the southindian forest region was appreciated by the international audience. The audience found the jungle and the rivers more terrorizing than the amazon. So we can conclude that any location as such which adds to the beauty of the scene and supports the emotions and feelings of the characters can be justified as an exotic location. But the trend of shooting scenes and songs in foreign countries for no reason is rather a disturbing fact. How to cite Exotic Locales in Indian Cinema, Papers

Comparison Between Mercutio and Tybalt free essay sample

While some scholars have claimed that there is no such thing as society, this is rubbish. The immortal and indispensable phrase ‘honesty is the best policy’ [1] must have been referning to Comparison between Mercutio and Tybalt. Both tyranny and democracy are tried and questioned. Yet Comparison between Mercutio and Tybalt provides standards by which we may judge our selves. Special care must be taken when analysing such a delicate subject. On the other hand anyone that disagrees with me is an idiot. Society is powered by peer pressure, one of the most powerful forces in the world. As long as peer pressure uses its power for good, Comparison between Mercutio and Tybalt will have its place in society. Economic Factors The dictionary defines economics as the social science concerned with the production, distribution, exchange, and consumption of goods and services. We will primarily be focusing on the Fish-Out-Of-Water model, making allowances for recent changes in interest rates. We will write a custom essay sample on Comparison Between Mercutio and Tybalt or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Housing Prices Comparison between Mercutio and Tybalt There is no longer a need to argue the importance of Comparison between Mercutio and Tybalt, it is clear to see that the results speak for themselves. The question which surfaces now is, how? My personal view is that housing prices world wide are driven entirely by Comparison between Mercutio and Tybalt. A sharp down turn in middle class investment may lead to changes in the market. Political Factors Posturing as concerned patriarchs, many politicians guide the electorate herd to the inevitable cattle shed of equal opportunity. Contrasting the numerous political activists campaigning for the interests of Comparison between Mercutio and Tybalt can be like looking at the two sides of Comparison between Mercutio and Tybalt. One quote comes instantly to mind when examining this topic. I mean of course the words of style icon Achilles Tuigamala People in glass houses shouldnt through parties. [2] What a fantastic quote. Both spectacular failure and unequaled political accomplishment may be accredited to Comparison between Mercutio and Tybalt. While Comparison between Mercutio and Tybalt may be a giant amongst men, is it a dwarf amongst policy? I hope not. Conclusion We can say with certainty Comparison between Mercutio and Tybalt may not be the best thing since sliced bread, but its still important. It questions, literally plants seeds for harvest, and most importantly it perseveres.

The unitsed ates Fie fighter today Essay Example For Students

The unitsed ates Fie fighter today Essay FIREFIGHTER TODAYFirefighting is one of the worlds most honored but hazardous occupations. It is the duty of every fire department to practice life safety, incident stabilization, and property conservation. Whenever and wherever an emergency arises, the fire department is one of the first called and to respond. In todays fire service the fire department has an expanded roll that involves more than just fires. The emergencies involve accidents, aircraft crashes, water rescues, hazardous materials, civil disturbances, explosions, and medical emergencies. The list is never ending and always expanding. Firefighters are involved with all types of people and are appreciated by some and scorned by others. They are expected to calmly evaluate the problem and bring it to a successful conclusion. Firefighters are not extraordinary- they are ordinary people places in extraordinary situations. Bringing any emergency situation to a safe conclusion requires knowledge, ability, and skill. Because o f this fire fighters need to be trained to a higher standard today than they did in years past. Fire fighters enter into three categories: Career, Paid on call, or Volunteer. Career personnel are persons who are salaried. Paid-on-call firefighters receive reimbursement for each call they attend. Volunteer fire departments and their firefighters greatly outnumber career departments and their firefighters. Canandaigua Fire department is a hybrid between Career and Volunteer fire Fighters, and it has a very successful combination. We will write a custom essay on The unitsed ates Fie fighter today specifically for you for only $16.38 $13.9/page Order now Today almost a quarter of the United States population live in rural communities. For many of these Americans, fire protection is inadequate. Suburban communities such as Canandaigua whose political institutions and community services have not kept pace with the rapid population, Commercial and industrial growth. Rural and suburban areas often have many problems: insufficient water supply, lack of codes, to few inspectors to enforce them, insufficient funds to pay and hire firefighters and replace equipment. Even with strong volunteer fire departments, such as Canandaigua, they still have a delay for manpower to the scene and during the workday have a shortage of firefighters. According to the Department of Health, Education, and Welfare, the fire fatality rate for Americans in non-metropolitan areas if half again as great as the rate for Americans in metropolitan areas. Even the best fire equipment, properly placed, cannot function with out well-trained firefighters. While Canandaigua Fire department receives excellent training and is held to high standards we are the exception not the rule. There are other duties to firefighting that do not involve emergencies and that involve fire prevention and education. Deuel Richardson stated, A significant factor in contributing to the cause and spread of fire is human failure- failure to recognize hazards and take adequate preventive measures, failure to act intelligently at the outbreak of the fire, failure to take action which would limit damage.These failures can only be limited through education. Day in and day out firefighters out see the evidence of human failure. The prevention of fires due to human carelessness in not all that fire safety education can hope to accomplish. Many fires cased by faulty equipment rather than carelessness could be prevented if people were educated in how to recognize the hazards. Now the overview of the inherently dangerous job of firefighting is a broad spectrum, but how do you measure success. What is a successful fire department? What makes it successful? And what can be changed to make a fire department more successful. These are all obligatory questions asked by many town and city council members, but how do you measure fire protection. When does a fire department become most important to you, when you call 911. Most people assume that when they call 911 that they will no matter what the time have the highest trained firefighters and paramedics show up to their emergency. Well in most cases that is not true. Sit and listen to the scanner and you will here calls go unanswered during the day and calls get repeated. In Canandaigua we have a luxury of having firefighter/ EMTs that are in house most shifts and at the beginning of the year every shift. But does that make us successful as a fire department? Todays firefighter has to be better educated than yest erday. The fires and emergencies are different

Old and knew immigrants essays

Old and knew immigrants essays Old and New Immigrants, Birds of Passage, and True Immigrants Historians have divided immigration to the United States into two categories: old and new immigrants. With population increases in almost every European country due to advances in medicine and public health standards resulting in reduced infant mortality rates and increased life expectancies, land and food supplies did not increase to meet the new population demands. England, Ireland, France, Germany, and Scandinavia, defined the old immigrants who were mostly white Protestants. The majority of them were literate and had lived under constitutional forms of government. Greeks, Poles, Russians, Slavs, and Turks were the next wave of immigrants referred to as new immigrants. They emigrated from eastern and southern Europe only to find assimilation more difficult because they differed from earlier immigrants and native- born Americans politically, religiously, and culturally. Some reasons for the cause of these new immigrants to come to America was overpopulation in eastern and southern parts of Europe, and young men faced job, land, and food shortages. Between 1860 and 1890, more than ten million migrants arrived on Americas shores; between 1890 and 1920 over fifteen million more arrived. The United States did not only lure immigrants from Europe, millions emigrated from Australia, New Zealand, South Africa, Canada, Brazil, and Argentina and other areas of the globe. There were two types of immigrants living in America for different reasons. Permanent immigrants also known as true immigrants came to America because of Barroso 2 what it had to offer: political and religious freedom as well as economic opportunity. ...

Class Discussion Essay Example | Topics and Well Written Essays - 1250 words

Class Discussion - Essay Example There is no other better way that could explain of economic globalization that this. According to Mittelman (53), globalization goes through macroregionalism supported by economic and states forces that seek to open larger markets as a way towards greater competitiveness. This is certainly true. Others have referred to the process of continental globalization in line with North America indicating that regionalism is the force through which globalization is conveyed (Scholte 7). Likewise, Mittelman’s analysis points to the emergence of global regions as the key factor leading to globalization. Take Europe for instance. The continent houses a majority of the world’s economic giants because of its regionalism policy advocated by the European Court for Human Rights. This body advocates for a ‘Social Europe’, the proposal of a federalist post-national Europe, which a majority of European nations have embraced, (Scholte 7). In these, the countries see the likelih ood of a non-neoliberal, progressive regional system of authority in which the freeing of the markets for capital, goods, and labor occurs in the context of a rights-based, progressive, social system. These regional financial arrangements are rather different and range from foreign exchange reserve pooling and government financing to currency swap arrangements. What is widespread to all these schemes, in spite of their intrinsic variety, is that they all wish to promote regional integration along with financial and macroeconomic stability. Even though, there is a considerable stream of academic contributions on economic regionalism, people’s understanding of financial regionalism is fairly limited, despite its potentially wide-ranging effects in shaping the global financial structures (Veseth 40). Take for instance a continent like Europe, where the newly projected European Stability Mechanism is projected to be a legal tender union lending arrangement to offer direct assista nce to countries in Europe and other regions. In Europe, just after the Second World War, the interdependence of the continent’s economies led to the formation of the European Payments Union, a forerunner of a much advanced framework, which culminated with the creations of the currency union in 1999. The organizations have been able to influence globalization all through Europe (Scholte 7). Latin America, on the other hand, boasts the oldest, even though less renowned tradition of regional assimilation efforts among the developing nations. These economic relations, in South America, also go as far back as the 50s. Hoping to produce a regional common market for countries in South America, lawmakers, in the region, have succeeded in setting up clearing arrangements for intraregional expenses, FLAR and two development banks. FLAR refers to a small and cozy membership of seven small, as well as medium-sized, economies with strong traditional ties. They also portray a wide set of common interests (Veseth 50). In reality, FLAR offers a direct proof to the potential of regional associations to offer greater ownership to member countries that would otherwise put a lot of efforts to be heard in the international, 188-member IMF. The search for alternative futures for the region, in the Americas, in many ways, reflects the talks taking place within the broader "anti-globalization" movement. They perceive

In this assignment you will draw two primary sources and two secondary Research Paper

In this assignment you will draw two primary sources and two secondary sources written after 1990 to explore a topic addressed i - Research Paper Example There are several factors that played a key role in the collapse of one of the greatest empires in the world. According to Bauer (84), several factors that occurred within a span of approximately 500 years were instrumental in the collapse of a strong empire, the Roman Empire. Expansion of the Rome Empire can be referred to as one of the major causes of its collapse. Rome kept conquering many nations and therefore there was rapid growth in the land they owned. Consequently, there was great need to defend the borders and the territories of Rome. As they struggle to keep this under their control, emperors increased taxes on non-Romans and these created more enmity where frequent rebellions arose. Lack of enough solders to safeguard their territories forced them to employ foreigners who were against them resulting in the collapse of the empire. Since the empire was growing at a rapid rate, it needed more soldiers for it to remain a great conqueror. As such, militarism was adopted as a m ean of the emperor and his compatriots remaining in full control. In this case, constant fighting needed heavy military spending. This demand for the military was high since the Roman Empire became over stretched, and the need for more solders was proportional to its needs for expansion and protection of their overstretched territories. Due to this, there was overspending in the military body, hence other fundamental activities were left with few resources. Vital issues such as provision of houses to the public, quality roads and channel were left untouched. This also resulted in emperors raising taxes repeatedly resulting in increased levels of inflation. Roman Empire faced a failing economy and increased levels of inflation. Inflation is a state where prices increase and the purchasing power of currency declines. The Rome Empire was in this situation and the government was threatened of impoverishment as it did not have sufficient cash to cater for its needs. Overexpansion and eff orts to protect their territories resulted in this. For instance, the increased population required more militaries and the demand forced them to recruit and train more people. This process was demanding and more money was used in paying the large numbers of military personnel .The other factor is that after they diminished new lands conquering, the flow of gold to their economy decreased. This resulted to less use of coins and the coin become less valuable. Due to over-expansion of the territories, there were more merchants from the conquered places who raised the prices of the goods that they sold. Several persons changed their way of trading and butter trade erupted eventually. People stopped using coins and they began to undertake barter trade in order to get what they wanted from others. This went to as far as paying salaries in the form of food and clothing while tax collection also changed and vegetables and fruits were used to pay taxes. In this case, the expansion of territ ories shows how the economy was affected resulting to its decline. According to Goldsworthy(72) Over expanded Roman Empire territory had people from different ethnic groups and was over populated. As a result, the labor force was composed of slavery resulting in unemployment. Plebs in

Long-term Sources of Finance Essay Example | Topics and Well Written Essays - 3500 words

Long-term Sources of Finance - Essay Example Hence to meet the requirement of long-term capital, there are long-terms sources of finance which the business should seek for ensuring viability in their operations. Main sources are equity, debt and derivatives. While equity comes from share capital from the public and promoters, debt finance and derivatives can be procured in the form of debentures,, convertible notes, warrants etc. The share holders acquire right of ownership in the company by which they are entitled to share of profits, to vote in general meeting to elect and remove directors and pass or reject important resolutions concerning the company's management. In case of liquidation of company due to loss, the share holders may lose their money invested the shares of the company or in part in accordance with the company's liquidity position. Ordinary share form bulk of the company's capital having no special rights over the other shares. As already mentioned, in case of liquidation, the ordinary share will rank last for being paid after all other liabilities of the company are met. The management of the company may decide not to pay dividends in any one or more years for reasons of losses or any such reason. Most important feature of share form investment is that the share holders' liabilities are limited to the value of their shares and they will not be called upon to pay more than that in case of l osses incurred by the company... ThiPreference Shares This type of shares carries a right of dividend over ordinary share holders above discussed. The dividend is generally a fixed amount every year whether there is profit or not earned by the company. At the time of liquidation also, the preference share holders are paid before ordinary share holders. Preference share holders do not have voting rights but it may be exercised in case of failure to pay dividends to them. Several types of preference shares as follows. a) Participating preference shares. These share are entitled to additional dividends which may fluctuate as per profits earned by the company. b) Cumulative preference shares. If in any particular year, dividends are not paid, they are carried over and cumulative of such dividends is paid in subsequent years. c) Non-cumulative preference shares. They are so called as are not entitled to accumulate arrears of dividends. d) Redeemable preference shares. Company can redeem these shares and pay the owners a redemption price usua lly set above the par value in order to compensate them for untimely redemption. e) Convertible preference shares. Holders of theses shares have an option to convert them into other types of shares usually ordinary shares. This form of investment being less risky, carries lesser returns than ordinary shares which may be eligible for higher dividends in case of abnormal profits. Practical example of above said shares is taken from the Annual Report of M/S Reckittenkisser, Uk for 2004-05. The Annual Report says that parent company holds 4,500,000 nos 5% cumulative preference shares. The rights and restrictions of these shares are mentioned in note 16 to the report. Number of ordinary shares at the book price of m76 as at 31 December 2005, is mentioned as 722,160,934. as against

Effectiveness Of Electronic Medication Administration Record System Information Technology Essay

Effectiveness Of Electronic Medication Administration Record System Information Technology Essay The report will highlight that to enhance technology in clinical setting is not easy. It required lot of support and resources. In-addition technology cannot be successful without well organized plan. It requires long term planning. This report will provide the overview of pilot implementation of electronic medication administration record (eMAR) system. Health care providers need to understand the importance of eMAR its role in improving patient care safety. This system will help to increase patient safety and have extremely positive impact on hospital reputation. It also helps to decrease medication errors and adverse drug reaction via safe medication administration. It also helps to save printing cost. Pilot implementation of the system assist in identifying issues related to medication administration error in hospital setting. Thus, help to understand how IT processes help to enhance safety. It further helps to understand analyze benefits of the system and how IT facilitates can reduce the chances of error by having robust computerized system. This paper helps to identify users anxiety to accept the IT systems and little modification in programming helps to get positive outcome. This paper investigates why IT systems are unsuccessful and suggest computer literacy and simple modification and technical support to users will help to expedite the process to achieve everlasting solutions to provide quality and safe care to the patients Introduction: The quality of patient care and safety is one of the most significant aspects of health care sector. Nursing and medical professionals face increased need of using information technology in day to day operations with an overall aim of improving the quality of care by increasing patients safety. Currently, hospitals facing patient safety issue related to medication administration. Numerous studies conducted to identify number of medication administration error. Stoppler (2006) pointed it as Approximately 1.3 million people are injured annually in the United States following so-called medication errors. Chiang (2008) supported this issue as Medication errors have been a major concern of patient safety initiatives for all health care systems of the world. Internationally health care facilities are struggling hard to increase patient safety via safe medication administration, because existing paper base medication administration record process is not safe and presented with large number of errors. Russo, (2007) stated that, current paper based medication administration record (MAR) is an inefficient process with no decisive workflow, that places needless stress on nursing staff and lead to illegible entries can resulted in medication administration errors. Therefore, to maintain the quality of drug dose administration and to prevent medication administration errors, electronic medication administration record (eMAR) system, is found to be significant. Few studies suggested that eMAR is a bedside medication administration recording tool providing new levels of recording medication administration activities by dropping error rates and making the administration of medications safer for patients. This report aims to outline the background to implement eMAR system, process of implementation, strength weakness of newly developed system and potential benefits on complete implementation to develop insights about newly developed electronic system for medication administrat ion record. Background: At my institution in 2006 during Joint Commission International Accreditation (JCIA) survey, auditors were not able to find out the administration record of one of the drug of a patient. This generated a thought to have electronic records for all the care provides to the patients. Malloch (2007) highlighted the need of electronic record as: Three specific applications within the electronic record-computerized physician order entry (CPOE), electronic medication administration records (eMAR), and clinical documentation-are impacting patient safety in numerous ways by decreasing incorrect and unnecessary treatments and medications, as well as improving the timeliness of careà ¢Ã¢â€š ¬Ã‚ ¦.The benefits from these 3 applications vary, depending on the implementation sequence; some organizations implement each application as separate initiatives, while other organizations have implemented all 3 applications simultaneously. (p. 159) Consequently our organization decided to initiate each application separately. CPOE for medication prescription, dispensation and medication order review had already been implemented in July 2005. Therefore higher management decided to design and develop in-house system of eMAR for safe medication administration as an initial step towards electronic patient record. The purpose was to eradicate manual MAR and replace with eMAR since current paper based MAR sheets had following subsequent issues: Manual administration record are more prone to error Prone to being lost as difficult to manage paper Utilizes large amount of paper Not meeting the JCIA requirement Administration record not available after discharge Data retrieval is difficult from paper based MAR Sheet Paper records are frequently lost unorganized Sloppily written record lead to legibility issues Mekhjian et al (2002) found that manual medication administration charting resulted in a transcription error rate of 11.3 percent whereas transcription errors were completely eliminated via eMAR. Further literature supports that the most common errors reported were administering drugs at the wrong time or neglecting to administer drugs at all. eMAR provided the framework for improvements in patient safety and in the timeliness of care. (Mekhjian, 2002). Bates Cullen (1995) suggested that 78% of errors leading to drug errors are due to inadequate information management system of eMAR. Furthermore, eMAR has gained a foothold in inpatient settings to support medication administration safety. It prevents paper records prone to being lost, incomplete, or misread. California Institute for Health Systems Performance report highlighted that upto 38% of inpatient medication errors occur at the administration stage (Miller et.al, 2001) Solution: Electronic Medication Administration Record System Safe medication administration is one of the most important elements of care. During hospitalization nurses are responsible to administered medication safely to the patients. This activity is performed multiple times in a day for an individual patient. It is a complex process therefore accurate documentation of the medication administration is extremely important. Jylha Saranto (2008) cited: The complexity of the medication management process exposes it to errors, and medication errors can occur at any point in the medication management process. A survey recently conducted in a Finnish hospital showed that more than half of reported adverse events (66%) were medication errors, most of them relating to documentation (33.6%) However, manual MAR had lot of issues related to patient safety and could lead to adverse drug events. Thus, organization decided implement for eMAR because it allows nurses to manage medication administration efficiently as it has the potential to make the administration of medication safer for the patients by reducing error rates (Westbrook, 2007). Therefore following steps were taken: eMAR task force developed to explore the need of technology including hardware software Group reviewed current medication administration process and developed flow diagram for expected system Visited different hospitals in USA to develop understanding of the system and its flow Conducted regular meeting with ISD for system design and development After having vigorous exercise team identified that eMAR could not be implemented completely without right patient identification and right drug identification. This system is heavily dependent on admission and pharmacy system. Therefore bar-coded wrist band bar-coding unit dose system would be pre- requisite. Consequently sub-group was developed to explore bar-coding system for different applications. The purpose to incorporating bar-coding in health care setting is to improve the quality of care by reducing medical error and by decreasing the cost of care for the patient. Thus, admission and pharmacy departments had been involved for bar-coding implementation. After multiple sitting and cost analysis, group decided to break eMAR implementation in 3 different phases Phase 1) Implementation of Barcodes: Patients Armbands for right patient identification for all the inpatients on arrival from admission department Bar-coded medication labels for identification of 5 rights include right patient, right drug, right time, right dose right route. Further pharmacy system generates medication administration schedule; this schedule will be foundation stone for eMAR. Phase 2) Medication Trolley Purchase new medication trolleys with Laptop having wireless connectivity barcode reader to view active drug list due at specific time, to follow 5 rights Phase 3) Online MAR Develop software of eMAR to eliminate manual MAR and initiate online entry after administration in computer to eradicate paper How this will work Nurse will identify the patient by scanning wrist band Nurse will then scan the Medication Cassette Bin of respective patient First RIGHT will be identified at this point Right Patient Nurse will then scan the Medication Labels Remaining four RIGHTS will be identified at this point Right Drug Right Dose Right Time Right Route Nurse Administer the Dose to the Patient After Administration, Nurse will put her Signature electronically into the system Thus above requirements were communicated to the senior management. Consequently due to lack of resources implementation of all above requirement were not possible at once because huge amount of money is required for barcode implantation in admission and pharmacy department and sophisticated medication trolley with laptop barcode reader. Therefore, team determined to implement eMAR successfully, with good outcome and within the resources provided, all above phases need to be implemented step by step. Thats why 3 sub-groups have been developed to initiate the work for each activity. Group 1 will work on Bar-coding planning and implementation. Group 2 will be responsible for purchasing of sophisticated medication trolley and group 3 will work on software development for electronic administration entry for medication. However, phase 3 of aforementioned plan was to be implemented first as it only required in-house software developments with no extra cost involvement and further built on existing CPOE system. Therefore, group 3 comprises of nursing and information system department (ISD) team work together to design and develop the system. ISD developed first template of eMAR in December 2006 and presented to nursing management team for feedback, they suggested few modifications. Modified version presented to them again for re-evaluation in February 2007. Afterward, pilot implementation was done in 5 beded cardiac step down unit in April 2007. Same was replicated in other cardiac stopdown units. Subsequently it was replicated in other units depending upon the availability of computers. Therefore, 06 desktop computers, 20 wall mounted computers in intensive care units, 2 mobile trolleys without medication bins 2 laptop mounted medication trolleys were provided in nursing units to cover 153 beds out of 520 beds. This covers 30% of total admitting patients. This phase will help to overcome issues of legibility, decrease chances of data lost as not need to manage paper since no paper is required. It helps to meet the JCIA requirement as data retrieval is easy and able to find out administration record. In-addition this will help to have ontime administration record and nurse need to sign the medication after administration and system will capture administration time which will further help to indentify wrong time administration, delayed administration and miss dose administration. Through this phase patient safety issue is still not resolved as identification of 5 rights is achieved manually because bar-coding is yet to be implemented. However, further implementation discontinued after July 2008 due to resource limitation for computerized laptop based eMAR trolley barcode implementation. In-addition few reservation for further implementation related to multiple frequent system breakdown and users resistance for further implementation was also highlighted. Therefore, eMAR task force re-collected to discuss and resolve above concerns to promote further. They identified following issues: Issues related to system functionality System performance/ shutdown issue. Issues related to limited hardware availability Training issue and computer literacy issues Users resistance as system force them for ontime documentation whereas paper base MAR have provision to sign the administration record as per their own accord On other hand group 1, barcode team implemented bar-coded armbands for all the inpatient. Now only medication label to be bar-coded is pending, for that label has been designed and approval has been taken from nursing users and pharmacy. Bar-coded label printer is to be purchased and pilot testing of barcode label needs to be carried out. Group 2 representatives explored different eMAR trolleys available in the market to identify the most suitable for our working environment. Our requirement is light weighted small trolley with 10 medication bin as 1 nurse is assign to 10 patients. Finally it was decided to purchase Atromick Medication Trolley. Purchase order was generated to have sample trolley to pilot. Trolley has been piloted successfully and received positive feedback from nursing users. Therefore, it was decided to purchase 72 more trolleys as required by nursing units. 46 trolleys will be purchase by October 2010 and remaining will be purchased in 2011. System feedback after pilot implementation Information technology seems to be more proficient and provide transparent alternative to manage issues/concerns smoothly. After pilot implementation of in-house developed eMAR software and Atromick medication trolley few strength and weaknesses were identified. We identified that most of the users in our hospital are not well computer literate. This lead to increase resistance and they prefer to use manual system. Another most important issue is lack of interest from some of the nursing managers. They even not agreed to initiate the pilot project and the main reasons were lack of staff, lack of computer literacy, lack of hardware availability on nursing floor and they felt it would increase staff workload. Their concerns were well taken and computer training had been provided to nursing staff before initiation and on regular basis as well. Moreover, extra computers have been provided on nursing floor before pilot implementation. Nursing director is working hard to increase number of staff but its difficult as currently nurses turnover rate in our organization is 17%. Lastly management group was explained that it definitely increase some workload initially but it save nurses time currently utilize on maintaining paper record and data retrieval as it will be more transparent. It also increases safety of the patient and their record and have ontime documentation of drug administration. Thus, pilot project has been put into practice for 30% of hospital beds. The pilot project helped us to be acquainted with the weaknesses of the system which includes: Lack of material resources human resources Gaps in software programming i.e. initially all the stat orders and single dose order automatically disappeared from the screen with drug stop time. This created frustration among users as they were not able to mark administration for pre post transfusion drugs, chemo therapy drug, pre post operative drugs. Another gap is related to infusion screen as nurses have to sign infusion record every hourly which increase their workload. Multiple time system got stuck/ slowdown/ non functional endorse resentence of users as they feel whole process is very slow Users highlighted that system is not user friendly On multiple occasion users identified that same drug appears twice on the screen. On investigation it was find out that its because physician enter new order for same drug without discontinuing the previous one. Therefore, modification is required in CPOE system. Unsatisfactory technical support Lack of training System usually found to be slow which lead to increase administration recording time Beside, this one of the most important issues is resistance from users side as it increases their workload as well as their accountability, because paper base system has provision to sign the administration record as per their own accord. Whereas, electronic system increase obligation for ontime documentation. Another most important weakness is related to patient safety issue as bar-coding system has not been initiated yet and users relays on manual identification of 5 rights. However, in conjunction with above resistance, users satisfaction survey conducted in July 2008 showed 79.9% satisfaction of users with the system. The results appear with positive feedback but they highlighted area for improvement. Their feedback enclosed request for multiple modification, for instance separate screen for cyctotoxic drug administration as this required to mark start and stop administration time with comments as these drugs administration time last for hour. Demand to generate multiple reports to view administration record, miss dose administration record, administration record of discharge patient, administration report of particular drug etc. Primarily system starts with single screen for all type of administration i.e. intravenous infusion, PRN and routine medication which overcrowd administration screen and create confusion. Therefore, requested to develop separate option for each. In-addition modification was requested for infusion screen as current option requi res to sign infusion every hourly. Survey also highlighted some of the strength of the system pointed out by users which include: System helps users to easily identify numbers of doses administered to particular patient for specific drug as data retrial is extremely easy, though sometimes it takes time due to slowness of the system but its faster than manual process as data retrieval is difficult with paper base system. In addition it helps users to identify miss doses, delayed administration and skipped administration. It decreases utilization of paper and save printing cost. It helps to identify reason for delayed miss dose administration Administration screen appears with current drug only i.e. due for administration for next dose time. System frequently update with changes in CPOE system and has good interface with pharmacy and admission system System is easy to operate and output (Administration reports) data from system is reliable and accessible System appears with detail information regarding drug including drug name, ID, required dose, dose time, route, frequency, star time and stop time, drug comments if any for safe administration. System is provided with dictionary based comments column for nurses to enter administration comments if any, in case of delayed, missed early administration. Paper base system utilizes nurses time to print medication label on drug review and then need to paste them in MAR sheet. This system omits all above and reviewed order in CPOE system automatically appears on eMAR screen for administration. Thus, many nurses found this system very effective the only concern is related to more time required at entry level. We identified that nurses with good computer skills are more positive towards IT systems. Chiang (2008) cited that Studies have shown that, for instance, nurses found that the IT system was good in aiding prevention of medication errorsà ¢Ã¢â€š ¬Ã‚ ¦.but required a lot of time in operating the system. Potential benefits of the system after complete implementation eMAR system can improve the administration record and will able to provide accurate administration time of the drug. It advances patient safety by right patient and right drug identification via bar-coding system. To elevate further safety option has been developed in a manner to mark administration after actual drug administration to the patient as system is not provided with any go back to your old ways option, which will help to increase reliability. System has been provided with mandatory option to enter comments for delayed administration or miss administration which will help later to identify causes and corrective action can be taken to improve business. Besides the safety of patient and its data, other supplementary benefits are cost and saving of storage space. Currently our hospital utilize huge amount ($15857/annum) of money for storage space. Although, these potential benefits are currently not very visible but it will be apparent with complete computerization of patients record. In addition an electronic system gathers all at one wave length and has standardized practice. This will provide opportunity to have good interface with national and international systems later. To get most out of it nurses suggested to provide medication order review screen drug formulary on eMAR system to save nurses time for multiple login. Kuperman Gibson (2003) cited This technology can yield many significant benefits and is an important platform for future changes to the health care system. Conclusions Patient safety is our main objective while working in clinical setting. Therefore, technology needs to be adopted to enhance safety. This will help to progress further. We all need to work continue to enhance computerization and involve information communication technology in hospital setting. Our organization actually works hard to achieve eMAR to increase patient safety and by 2011 we will certainly achieve our target to reduce medication administration error. Above report shows that eMAR system helps to increase safety, decrease medication administration error and safe printing cost. On top of it system will avoid wrong time error and have ontime documentation.

big bang theory :: essays research papers

Big Bang Theory We certainly know that our universe exists, however, this knowledge alone has not satisfied mankind's quest for further understanding. Our curiosity has led us to question our place in this universe and furthermore, the place of the universe itself. Throughout time we have asked ourselves these questions: How did our universe begin? How old is our universe? How did matter come to exist? Obviously, these are not simple questions and throughout our brief history on this planet much time and effort has been spent looking for some clue. Yet, after all this energy has been expended, much of what we know is still only speculation. Yet in 1927 a man by the name of Georges Lemaitre from Belgium proposed that the universe began with a bang. â€Å"He proposed that a primeval atom exploded and that is how the universe formed itself. His proposal came after observing the red shift in distant nebulas by astronomers to a model of the universe based on relativity.† Before I was enrolled in S urvey of Astronomy I wasn’t sure what to believe. But after sitting through the class I started to realize that all the pieces are starting to fit together like, why the galaxies are increasing in velocity away from us and also explaining the cosmic background radiation.   Ã‚  Ã‚  Ã‚  Ã‚  About 15 billion years ago a tremendous explosion started the expansion of the universe. This explosion is known as the Big Bang. At the point of this event all of the matter and energy of space was contained at one point. What existed prior to this event is completely unknown and is a matter of pure speculation. This occurrence was not a conventional explosion but rather an event filling all of space with all of the particles of the embryonic universe rushing away from each other. The Big Bang actually consisted of an explosion of space within itself unlike an explosion of a bomb were fragments are thrown outward. The galaxies were not all clumped together, but rather the Big Bang lay the foundations for the universe. Even more recently, NASA’s COBE satellite was able to detect cosmic microwaves emanating from the outer reaches of the universe. These microwaves were remarkably uniform which illustrated the beginning of the early stages of the universe. How ever, the satellite also discovered that as the universe began to cool and was still expanding, small fluctuations began to exist due to temperature differences.