The Remuneration of the Chief Executive Essay Example | Topics and Well Written Essays - 2000 words

The Remuneration of the Chief Executive - Essay Example Although target remuneration levels are aligned to the market, excellent performance by both the company and by the individual executive director is rewarded with higher bonus levels and share awards, taking potential total remuneration to the upper quartile or higher of the company’s key international competitors. Base salaries of employees are determined in a similar way to those of executive directors. The company’s approach is to ensure that target total compensation is benchmarked to the relevant market in which the individual is employed. The objective of this study is to analyze whether the CEO’s remuneration is in some way related to the performance of the firm or results from the position and power of the chief executive. Most of the studies conducted earlier consider whether CEO pay is determined by the performance of the company they manage or whether it simply relates to the influence which the CEO has over the board of directors. Several other factors such as the size of the company, number of executive directors on the board, sales growth of the company have also been considered in this study to understand the significant factor that decides the remuneration of the CEO. Some studies conducted indicate that if the CEO is also the Chairman of the company, this person has an undeniable influence on the decisions of the board. Hence the influence of the position of the executive director is also studied in this analysis. From the above analysis, it is concluded that the salary of the CEO is much higher when he is the Chairman of the company. The position and power of the CEO play a significant role in determining the salary despite the poor performance of the company. The higher the proportion of executive directors on the board, the higher is the salary of the CEO. Â  

A Statistical Analysis of AIDS Research Paper Example | Topics and Well Written Essays - 2500 words

A Statistical Analysis of AIDS - Research Paper Example The number of individuals acquiring the disease is also increasing. The growing concern today however, lies on the mounting difference in the number of African Americans and their White counterparts being infected or even dying from the disease. Women in particular, have constantly become the subject of people’s concerns regarding the matter of AIDS. This paper aims to present and discuss the statistics regarding the disparity between Blacks and Whites being diagnosed with AIDS. Moreover, the factors affecting this disparity will be presented. The importance of the role of the government in addressing this issue will be discussed and finally, a conclusion will be provided. The Statistics of AIDS in the United States In past statistics, African Americans were found to constitute the majority of individuals infected with AIDS1, 2. In the Black population, males comprised two-thirds or about 65% of new infections3. Furthermore, the rate at which Black men acquire new HIV infectio n is 6 times higher than White men and 2 times higher than black women4. On the other hand, the rate at which Black women acquire new HIV infection is 15 times higher than White women.5As such, the rate of death is also expected to be higher among Black women. Black females have a lower rate of infection in comparison to Black males. However, Black females are more affected by the disease in comparison to women from other races.6The large scale of Black womenbeing infected with, as well as dyingfrom AIDS has attracted attention from different areas and departments of the society. More so since there is yet to be a clear decline in the mortality rates of AIDS-infected African-American womenwhereas mortality rates of AIDS-infected White women have continually decreased. Ethnic disparities concerning HIV/AIDS infection and mortality are consistent in all states.7Figure 1 below presents a comparison of HIV/AIDS mortalities between Black and White populations in the United States. The hu ge difference between the races is evident except perhaps among the 15- to 24-year-old age group where the statistics were almost the same if not, slightly different. Figure 2 below presents the gender and racial comparisons with regards to new cases of HIV infectionin Massachusetts. The large disparity between Black females and White females as well as the large difference between the number of White males and Black males getting infected with AIDS are evident. According to Cole, Church, Fukuda et al.,8the percentage of Black women who have acquired HIV in the year 2006 – 2008 is 51% as compared to 20% of White women. This shows that Black women have almost twice the risk of acquiring the disease as compared to White women. However, it is also shown that from 2006 – 2008, White men have a higher percentage of new infections compared to Black malesin Massachusetts.This could be attributed to gay activities; however, not well-defined. In 2007, it has been reported that HIV was the third leading cause of mortality for black men and women aged 35-44.9 HIV also became the ninth leading cause of mortality for all blacks.10 In fact, about 233,624 Blacks who were diagnosed with AIDS had died in the United States.11 Moreover, African American women were known to be 22 times more likely to die

The Influence of Culture on Tuscan Families Essay Example for Free

The Influence of Culture on Tuscan Families Essay For many, the word Tuscany conjures up images of olive trees, vineyards, Chianti and remarkable works of art. It’s a romantic place with picture perfect landscapes and ancient churches and villages. Tourists from all over the world visit Tuscany each year to take in the sights, tastes and sounds of its glorious culture. Their visit is enhanced if they are familiar with the area’s colorful history, which reaches far into the past and continues throughout many, many cultural changes that make up its present. This essay employs political, religious, judicial and class stories from the region’s vivid history to help us form a picture of what family life in Tuscany may have been like from 1250 to 1500. It was, by all accounts, a great time to live in Tuscany. The region developed its own status after the Roman empire fell, when a series of rulers emerged to take control. By the twelfth century the Tuscan cities were gradually gaining their independence as republics and forcing the nobility to live in the cities (Van Helden 2). The land was fertile and the opportunity for various businesses was great. Most importantly, a class system developed that valued hard work over noble birth. Those high in the hierarchy lived within the same communities as the working class. The elite families that did control the power over the next few hundred years made decisions that would ultimately dictate everything from family tradition to fine art and literature. In the late Middle Ages, just around the fourteenth century, a simple political system was in place. In Italy, there was no political union, but the country was divided into many different town councils (www. greatdante. net, 2) As with many democratic societies of past and present, there were various political parties. Here in Italy, these were called the Guelfi and the Ghibellini. The Guelfi, a group held in favor of the Pope rather than the Emperor, held the majority of the power in the country. This party was especially popular in Florence, where it was separated into two subgroups: the whites (bianchi, in favor of the emperor) and the blacks (neri, in favor of the Pope). The years around 1300 were the ones in which political fights between whites and blacks became stronger and more dramatic (www. greatdante. net 4). At this time, Italy was not culturally or politically unified, which led to a variety of subcultures within Tuscany. There were many different Italian dialects to choose from. A family’s language might have been based on their geographic location, their religion and their political views. For the most part, this diversity did not lead to violence. Instead, it seemed to benefit the region. In addition to the renowned artwork of the time, some of the world’s best writers such as Dante, Petrarch, and Macchiavelli found inspiration in the conflicting viewpoints of the Tuscan communities. In a space of fifty years, during the lifetime of Dante, 1265-1321, Florence transformed itself from a political and economic backwaterscarcely keeping pace with its Tuscan neighborsto one of the richest and most influential places on the continent (Dameron 12). It was one of the world’s most prominent cities for two industries that were necessary for civilized societies: wool and banking. This was the beginning of the Florentine Renaissance that led to such legendary works by Michelangelo, Leonardo and Donatello, among others. We may be familiar with these names, but what about the cultural backdrop from which they prospered? What factors allowed them to flourish during this time period? Business people who were high in government made many decisions, but the Church was -2- also a major influence in the design of the times. In fact, religion, community and business often merged in the minds of Tuscans who placed emphasis in all three throughout their lives. As one author describes it: A busy grain market on a site where a church once stood, for instance, remained a sacred place where many gathered to sing and pray before a painted image of the Virgin Mary, as well as to conduct business. At the same time, religious communities contributed directly to the economic development of the diocese in the areas of food production, fiscal affairs, and urban development, while they also provided institutional leadership and spiritual guidance during a time of profound uncertainty (Dameron 75). Of course, diverse belief systems aren’t always the perfect utopia that history books make them out to be. There was some conflict throughout this age of historic prosperity. Many times community disputes over such things as property and status were settled in a court setting to help eliminate the use of violence. The court systems were relatively new to the Tuscan region in the twelfth century and procedures were quite experimental. Whereas early medieval placita had become largely formulaic by the tenth century, twelfth-century courts and arbitrations generated a variety of documents, including sworn testimony of witnesses, the claims and counter-claims of the litigants, and the judgment of the arbitrators (Radding 3). The documents that remain from some of these cases help paint a picture of what life was like inside courtroom and out. By studying these conflicts, we are able to gain a new vision for the strategies used by families and communities to assert and defend claims. Hearing their voices allows us -3- clues into their personalities, what was acceptable or offensive in that day and age. The documents sometimes provide enough direct speech to reveal how these often humble Tuscans saw the issues between them – the arguments offered by the opposing parties in support of their claims (Radding 4). While we must assume some of the holes in the story, one thing is for certain: the courtrooms of Tuscany were just as diverse as the beliefs of its people. The judicial process evolved over the years between 1250-1500. Private courts, which handled complex arbitrations between parties, spawned more efficient communal courts. Different cities in Tuscany had their own particular systems to handle disputes, as Radding summarizes here: Pisa, a neighbour and traditional rival of Lucca, was quicker to develop urban institutions (starting in the 1080s) and to adopt Roman law, which appears rather suddenly in 1159. Florence was smaller than either Lucca or Pisa in the twelfth century and its institutions were less developed, leaving disputes in the contado largely outside the control of the citys courts. Ecclesiastical institutions, finally, had the option of recourse to church courts, including the papal courts, even for cases whose legal substance was no different from those that secular courts routinely dealt with (8). Despite these distinctive variations, a series of uniformities grew to help define the character of the culture and the communities. Documents could be used a proof, but in societies where land was not surveyed or registered and social relations often were undocumented, public behaviors could be almost as important (Radding 10). Perhaps one -4- reason Tuscany prospered in the medieval times was because they had a civilized process in place to work out their disputes. Sometimes these conflicts were simpler than others; the reasoning by which a solution was reached was often much different than how we resolve conflict today. Such is the case of a boundary dispute with neighboring landowners Passavante di Sesto and Chianne di Ghiandoro. It mattered a great deal whether Passavante’s wife had cut down a certain tree secretly or openly: â€Å"Open, i. e. , public, direct action was a claim to rights; people could see you doing it, and would conclude that, if you were not challenged, you had right on your side. ’(Wickham 83) This example provides evidence that simple claims were considered, even if the reasoning was a bit skewed by today’s standards. The study of Tuscan judicial development is an important point in the exploration of family life, especially considering the marriage rituals. Due to the fact that religion and government played an important role in the culture, both of these components were represented in the marriage process. According to one author, weddings of the Italian Renaissance were different than those found in the rest of Western Europe (Thomas 4). This historian draws from her knowledge of fourteenth century Florence to describe each step of the tradition. If a Tuscan couple wanted to get married, they would first present the idea to both of their families. The first phase was the meeting of the men of both families to draw up the marriage contract (Thomas 5). At this meeting, members of the judicial system, guarantors and arbiters, would be present to help negotiate the dowry and other financial agreements. To make it official in the eyes of the law, a notary was on hand to write up -5- the final contract. The second place took place in the bride’s home, where the bride and groom and their relatives were present, along with a notary (Thomas 6). This is the point where the Church enters the picture. The notary’s job was to ask questions that had been dictated by the Church in order to receive the couple’s statement of mutual consent. Once the couple agreed to the stipulations of the Church, the man placed a ring on the woman’s finger and they were considered husband and wife. It is also worth noting that in Italy at this time the act of marrying was referred to as ‘giving someone the ring’ (Thomas 7). The bride’s family celebrated with a substantial banquet for all. Typically, the final phase of the ceremony concluded at the end of the ring day, when the bride joined her new husband at his home. Escorted by her husband’s friends and family, the bride rode a white palfrey through town to her new home, the way lit by torchlight. In Rome, the spouses met Sunday at church, where they attended Mass and received a blessing from the priest. In Florence, however, the entire ceremony remained secular (Thomas 8). This entire practice eventually succumbed to more pressure from the Church, which required the mutual consent phase to happen within its doors, similar to the way we conduct our traditional marriages today. The marriage ceremony was very much the same throughout all class systems of medieval Tuscany. Of course, the level of pomp and circumstance was the main distinguishing factor between them, but not much else. Social intercourse in its highest and most perfect form now ignored all distinctions of caste, and was based simply on the existence of an educated class as we now understand the word (Burckhardt 2). Due to a -6- flattened hierarchal structure, the birth and origin of a person did not influence their standing in society, with some exceptions. Members of truly elite families who inherited wealth and leisure through generations generally held decision making positions of power. These people worked in judicial systems, law or medicine but were just as respected as those who worked the fields. This was one of those rare times in history when classes were fused. It was a direct result of the dynamic built within city walls, where the nobles and burghlers dwelt together. Here, the interests and pleasures of both classes were thus identified and the feudal lord learned to look at society from another point of view than that of his mountain castle (Burckhardt 4). Families benefited from this in many ways, sons and daughters could marry into a more wealthy family without much disagreement or societal stigmas associated with it. Parents were optimistic for their children, since there were more options than ever to move up and around within the system. This approach differed from the rest of Europe, where English and French chivalry reigned supreme. Those who were knights and valiant warriors were placed on a pedestal and more valued than others, earning higher titles and more land with each adventure. To the Tuscans, the cultivation of the soil, as practiced by the ancients, would be much nobler than this senseless wandering through hills and woods, by which men make themselves like to the brutes than to the reasonable creatures (Burckhardt 8). These Italians respected hard work, family and community consciousness much more so than travel exploits and conquering. According to one early historian: And, as time went on, the greater the influence of humanism on the Italian mind, -7- the firmer and more widespread became the conviction that birth decides nothing as to the goodness or badness of a man. In the fifteenth century, this was the prevailing opinion. There is no other nobility than that of personal merit. The cultivation of the soil, as practiced by the ancients, would be much nobler than this senseless wandering through hills and woods, by which men make themselves like to the brutes than to the reasonable creatures (Burckhardt 12). This way of thinking was quite popular during the time of Dante, who addressed the culture in context with a more traditional hierarchy in some of his writings. Dante, for example, derives from Aristotle’s definition, ‘Nobility rests on excellence and inherited wealth,’ his own saying, ‘Nobility rests on personal excellence or on that of forefathers’ (Burckhardt 12). Even the rich families who prided themselves on wealth did not receive any special treatment in matters of law or politics due to such a strong cultural structure. The Church, in more traditional societies of the time was used as a means to provide for the younger sons of noble families. This was not the case in Tuscany. Bishoprics, abbacies and canonries were often given from the most unworthy motives, but still not according to the pedigrees of the applicants. If the bishops in Italy were more numerous, poorer, and, as a rule, destitute of all sovereign rights, they still lived in the cities where their cathedrals stood and formed, together with their chapters, an important element in the cultivated society of the place (Burckhardt 12). In the meantime, the government supported the humanistic movement. One leader, Cosimo, who lived during 1389-1464, ruled the city of Florence and spent much of his fortune on charitable acts. He fostered a climate of simple living while cultivating -8- literature and the arts. During his rule and that of his sons and grandson, Florence became the cultural center of Europe and the cradle of the new Humanism (galileo. rice. edu 3). This elite family enjoyed the support of the masses, who, for the most part, followed this example to work hard and become educated. But the Tuscan people did more than work. They enjoyed many entertainment options that served as welcome distractions from business and intellectual life. Lorenzo de Medici, Cosimos grandson who was known as The Magnificent, influenced the types of entertainment held and often sponsored the activities. Mystery plays, based on the theme of the Passion (the sufferings of Jesus), were regularly staged for the enjoyment and edification of the citizens (www. learner. org 5). Festivals also served as a way to bring communities together, in addition to celebrating religious holidays. Families brought children young and old to celebrate the feast day of Saint John, Florence’s patron saint. Horse races were held throughout the city and magnificent festivals were especially common in the late fifteenth century (www. learner. org 6). This allowed the populace to convene and relax in a fun setting. Contrary to much of the rest of the civilized world, some of Tuscany’s Church leaders applauded these efforts. The culture was very much steeped in a strong spiritual movement that veered from the traditional way of Christian thinking. A preacher named Savonarola helped to establish its roots among city citizens. His thinking ultimately spread beyond Florence and throughout Tuscan households to change the thinking of many. The idea was simplicity within a time of prosperity. Savonarola was concerned about what he considered abuses by the church and -9- about peoples excessive interest in material goods. He preached against the accumulation of worldly possessions and called for a bonfire of the vanities in which people were to burn immoral paintings, cosmetics, and such entertainment-related items as musical instruments and playing cards (www. learner. org 9). Although his philosophies found many avid listeners in Tuscany’s humanist culture, the Church ultimately condemned him for blasphemy against their beliefs. The Church, after all, was one of the most wealthy establishments in the country. Of course, all good things must come to an end. The Aragonese government, established by the middle of the fifteenth century, started in Naples what followed a hundred years later in the rest of Italy – a social transformation in obedience to Spanish ideas, of which the chief features were the contempt for work and the passion for titles (Burckhardt 15). The caste-focused culture made its way through even the smallest towns by 1500 and what was once considered noble work was quickly sacrificed as Tuscans made a mad dash to find higher places in society within categories such as law, medicine, officer or knight. It is no wonder that the splendor and richness of the area declined steadily after a caste-system was put into place. Families were now forced to live a life that they were born into. Lower class parents would grow their families as large as possible for the main purpose sustaining their own household economy with parents employing children as sharecroppers to increase yield. Some Marxist analyses assume that sharecropping is a form of surplus labor extraction based on increasing labor intensity, because of inherent tendencies of households to exploit the unpaid labor of its family members (Emigh 22). -10- In this way, parents were able to feed their children and participate in the local economy. The slow transition into a capitalist society affected families in different ways. The families who already had wealth in their bloodlines were typically more successful than others. This still required a fair amount of enterprising creativity, but richer and larger families had a better chance to benefit from the system. Once Florentines entered local markets, however, they completely dominated them, because Florentines were much wealthier than local inhabitants and could generally outbid them. Florentines bought land from local inhabitants, who generally still sold land for the same reasons but were rarely able to purchase land (Emigh 17). As a result, local market structures, which might have been successful if they were able to compete locally, were largely eliminated. A problematic economy meant many changes for households. A family who might have owned land for generations was suddenly forced to sell the land in marriage dowries that they couldn’t afford make with cash. Partible inheritance, dowries, and local markets were mutually reinforcing. These practices divided the land into relatively small pieces, which were frequently bought and sold to adjust for the size of a family, to recombine pieces of land split apart by inheritance, to dispose of land at inconvenient locations, and to pay off debts (Emigh 35). The land that was once owned by many was beginning to be bought up by an elite few. Poverty became more rampant and, with it, the decline of education and culture. The change in economy was due to a number of various variables. The onset of the â€Å"Black Death† in 1348 contributed to the reduction of labor supply and increased the need for human capital. A new social norm, that came to prevail in the marriage market -11- with the demise of the feudal system, both contributed to the increase in urban dowries from the 13th to the 15th centuries. In his famous Divina Commedia, the poet Dante Alighieri was the first to suggest that dowry values were increasing in Florence at the end of the thirteenth century and the beginning of the fourteenth century (Botticini 1). By the mid-1430s, the average dowry in the city was 820 lire – eight times its value in the thirteenth century. At the same time, the rural dowry stayed constant, perhaps as a result of less class influence. Rural communes, as they were known, were slow to follow trends of the city, and by the fifteenth century they were still enjoying some benefits of a flattened hierarchal society. Village living was still diverse and citizens depended on cooperative relationships between people to prosper, rather than clear-cut social levels. Families lived the simple life that Savonarola preached, not only because it strengthened their communities, but it also was a natural way of life. It’s interesting to note that, although there were more communes in Tuscany than urban cities, there has been little research done to analyze how these families were affected by urban changes. With the help of a humanistic culture and a flattened hierarchal structure, Tuscan families of all class levels flourished. It was a remarkable time for prosperity. The children of this era had numerous opportunities to flourish in a diverse culture that encouraged creativity in all forms of life, especially the arts. The judicial system worked hand in hand with the church to preserve a society that valued hard work and community over greed and power. Once the latter two elements entered the picture, however, lower class households adapted to form self-supporting farms in order to survive the introduction of capitalism. -12- WORKS CITED Botticini, Maristella. â€Å"Social Norms, Demographic Shocks, and Dowries in Florence, 1250-1450. † Society for Economic Dynamics Meeting Papers. (2004): 1. Burckhardt, Jacob. â€Å"The civilization of the Renaissance in Italy: Part 5, Society and festivals. † Athenaeum Reading Room web site. 7 Mar. 2005. http://evans-experientialism. freewebspace. com/burckhardt07. htm Dameron, George. Florence and Its Church In The Age of Dante: Middle Ages Series. Pennsylvania: University of Pennsylvania Press, 1994. â€Å"Dante Alighieri on the Web. † Dante Alighieri web site. 7 Mar. 2005 http://greatdante. net Emigh, Rebecca Jean. â€Å"Economic interests and sectoral relations: the undevelopment of capitalism in fifteenth-century Tuscany. † The American Journal of Sociology 108 (March 2003): 1075. Radding, Charles. â€Å"Review: Courts and Conflict in Twelfth-Century Tuscany. † Rev. of Courts and Conflict in Twelfth-Century Tuscany, by Chris Wickham. Institute of Historical Research web site. 7 Mar. 2005. http://www. history. ac. uk/reviews/paper/raddingC. html -13- â€Å"Renaissance: What inspired this age of balance and order? † Learner web site. 7 Mar. 2005. http://www. learner. org/exhibits/renaissance/florence_sub. html â€Å"The Medici Family. † The Galileo Project web site. 7. Mar. 2005. http://galileo. rice. edu/gal/medici. html Thomas, Kirsti. â€Å"Medieval and Renaissance Marrage: Theory and Customs. † Author web site. 7 March, 2005. http://www. drizzle. com/~celyn/mrwp/mrwed. html Van Helden, Albert. â€Å"Florence and Tuscany. † Connexions web site. 7 Mar. 2005 http://cnx. rice. edu/content/m11936/latest/ Wickham, Chris. Courts and Conflict in Twelfth-Century Tuscany. Oxford: Oxford University Press, 2003: 83. -14-

Improving Quality of Care Through Pain Management

Improving Quality of Care Through Pain Management Patrick Bobst A Qualitative Study Quantitative research involves testing hypotheses, making predictions, studying specific variables, collecting numbers and statistics, identifying statistical relationships, and making observations under controlled conditions (Johnson Christensen, 2008). None of the aforementioned attributes appear in chapter 17 â€Å"Improving the quality of care through pain assessment and management†. Hence. this chapter written byWells, Pasero, McCaffery, (2008) is a detailed deductive qualitative analysis which aims to increase opportunities to develop empirically supported ideas and theories with applicable relevance in the field of pain management for healthcare practitioners. Unlike inductive analysis, applied when not enough former knowledge about a phenomenon is known, deductive content analysis is used when the structure of analysis is initiated based on previous knowledge and with the intent to test a theory(Elos Helvi, 2008). The authors of chapter 17 provided qualitative resea rch by studying the issue of pain control as a whole without immersion into variables. They defined the purpose of the study by subjectively understanding and interpreting interactions with words, identifying patterns and themes, and making observations of occurrences in a natural environment(Johnson Christensen, 2008). Qualitative research is more concerned with describing social meaning and therefore provides the flexibility to follow ideas and explore processes(McGonigle Mastrian, 2012). Research Problem The level of pain a patient experiences is emerging as the fifth vital sign in health assessments statuses (Ju-Ling Wen-Chu, 2013). Pain is a common occurrence and an expectation in hospitalized patients especially during the postoperative period; yet despite the availability of analgesics along with national guidelines to manage pain a disconnect remains in in proper pain management resulting in undertreatment for about 50% of patients with moderate to severe pain(Wells et al., 2008). Inadequately managed pain can lead to an arsenal of negative adverse physical and psychological outcomes including immune system suppression resulting in infections and poor healing, sympathetic activation causing cardiac ischemia and ileus, reducing mobility resulting in deep vein thrombosis, as well as pulmonary embolus, or pneumonia(Nwachukwu, 2012). All mentioned adverse conditions carry along the potential consequence of extending a patient’s length of stay in the hospital decreasing patie nt satisfaction and increasing organizational costs(Nwachukwu, 2012). The Affordable Care Act of 2010 has established changes in the way hospitals are reimbursed for services. Value-based purchasing has come to the forefront in the healthcare industry with the centers for Medicare and Medicaid services (CMS) withholding full reimbursements for poor quality care or even nonpayment for patients readmitted within 30 days. Low patient satisfaction score indicators being tracked by CMS will not only affect an organization’s bottom line but also stand to lose its reputation(Wells et al., 2008). When pain is not managed properly through an organization’s pain management policy and procedure guideline the entire collaborative team responsible for managing a patient’s pain may be liable for legal action(Wells et al., 2008). Research Translated Into Practice The Agency for Healthcare Research and Quality (AHRQ) focuses on current issues, patient safety and quality of healthcare providing practitioners the best research for optimal patient outcomes. AHRQ is an active participant in pushing evidence forward into practice with its Translating Research Into Practice (TRIP) initiative to generate knowledge about evidence-based care and with the TRIP-II initiative the focus is on utilizing information technology to affect translational research and health policy (McGonigle Mastrian, 2012). The TRIP database is a clinical search engine designed to identify high-quality clinical evidence for clinical practice that utilizes contextual issues such as the magnitude of the health issue, economic costs of the problem, the reliability, relevance, and validity of the data along with the quality and consistency of the evidence (Glasgow Emmons, 2007). The authors in the pain assessment and pain management research study utilized the TRIP database probi ng for the terms â€Å"pain assessment† and â€Å"pain management† in the literature search, filtered only the English language and publications dated within the last 10 years, meta-analysis, practice guidelines, literature reviews, clinical trials, and random clinical trials (RCT). To use evidence in practice, the validity of research is evaluated on an evidential hierarchy that is defined and the value is assigned to the information source on a scale from 1 to 6, one being the highest evidence from a systemic review and six being the evidence from the opinion of experts(McGonigle Mastrian, 2012). The evidence table provided by the authors in the pain assessment and pain management study exhibits excellent research validity with multiple design types rating high on the evidential hierarchy scale listing. The authors utilized evidence from a meta-analysis study (Level 1), twelve RCT studies (Level 2), seven systematic literature reviews (Level 5), three literature rev iews (Level 6), and one qualitative massage study (Level 7)(Melnyk Fineout-Overholt, 2011). The RCT is considered the most reliable source of evidence in the hierarchy and the meta-analysis is the best quality evidence because it uses a multiple individual research studies to come to a consensus (McGonigle Mastrian, 2012). Practice Implications The implications of this TRIP intervention designed to increase the use of evidence-based practice (EBP) in pain assessment and management highlights scientific evidence for practitioners to augment their clinical decision-making. Recommendations for successful implementation of pain assessment and management include education, the utilization of appropriate tools in pain assessment, a multimodal analgesic approach, continuous evaluation, and an established organizational pain management guideline. Patient and family education has been a central recommendation regarding pain management prior to any surgical procedure in that comprehensive pain evaluations can uncover patient’s attitudes, beliefs, level of knowledge, and unrealistic expectations that can be addressed(Wells et al., 2008). Wells et al. (2008) found that frequent communication, shared goals, and shared knowledge in education contributed to better pain outcomes. The most critical aspect of proper pain management is assessing pain levels on a regular basis using a standard format, and in order to meet the patient’s needs pain should be reassessed after each intervention evaluating the effects and determining whether modification is needed(Wells et al., 2008). Based upon systematic reviews of pain quality improvement studies the emphasis has shifted from processes to outcomes where clinicians recognize and treat pain promptly, involve patients and families in pain management plans, adjust pain management plans as needed, and monitor processes and outcomes(Wells et al., 2008). Utilizing a multimodal approach for pain management is recommended which includes opioids, and non-opioids such as nonsteroidal anti-inflammatory drugs, and adjunct medications such as anticonvulsants can improve the safety of the therapy (Wells et al., 2008). With safety issues regarding the use of morphine, hydromorphone, and fentyal clinicians need to be educated about safe pain management to help prevent undertr eatment of pain and the resulting harmful effects. A series of systematic reviews indicate poor results and outcomes using the intramuscular route (IM) administering of an opioid analgesic (Wells et al., 2008). The IM route is painful, has an unreliable absorption time and can be dangerous since patients are often alone at the time of peak affect and can become excessively sedated, vomit, and aspiratenevertheless produces the poorest outcomes (Wells et al., 2008). Unfortunately,Wells et al. (2008) describe the evidence for nondrug techniques of pain management including relaxation, music, massage, heat and cold therapies are neither supportive nor consistent, are considered weak in reducing acute pain, and may not improve outcomes. Ample evidence revealed the appropriate use of analgesics with the proper drug at the correct interval can provide good pain relief for the majority of patients, and organizations should place their emphasis on improving assessments and administration tec hniques (Wells et al., 2008). The psychological, emotional, and financial toll of uncontrolled pain is monumental and everyone experiencing discomfort because of pain justly expects and needs to receive appropriate pain management. Research Implications The research provided supports the evidence-based treatments with analgesics in the management of pain, and appears to be effective in controlling acute pain. However, the undertreatment of acute pain remains prevalent due to the clinician’ behaviors, which includes inadequate pain knowledge, assessment skills and administration of analgesics (Wells et al., 2008). Krenzischek, Wilson, Newhouse, Mamaril, Kane (2004) also assert a lack of pain management knowledge and the reduced usage of clinical practice guidelines is a high contributor in poor pain management. Research is needed for effective strategies in changing clinician attitudes and behaviors that will result in better pain management for patients as well as non-drug therapies (Wells et al., 2008). Wells et al. (2008) asserts, â€Å"Lack of standardization of nondrug therapies is one of the drawbacks of the current literature† (p. 11). Integration of Informatics The authors of this study integrated informatics through data, information and knowledge to support clinicians and patients in their decision-making regarding the best practices in accomplishing favorable outcomes and to improve the quality of care through pain assessment and management. Wells et al. (2008) utilized the informatics infrastructure to seek and manage validated studies from various sources, capture proper demographic, treatment and outcome information, and the AHRQ to share project information, results, and insights. The informatics infrastructure is critical to EBP and promotes the use of clinical judgment and knowledge with procedures and protocols to what is scientifically proven rather than what is customary(McGonigle Mastrian, 2012). The paradigm of â€Å"this is the way I’ve done it for years â€Å"is no longer acceptable and it is upon clinicians to apply the aforementioned viable knowledge, experience, understanding, and insight derived from EBP throug h informatics to gain and synthesize the effervescent wisdom needed for high quality patient care and optimal outcomes. References Elos, S., Helvi, K. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. http://dx.doi.org/10.1111/j.1365-2648.2007.04569.x Glasgow, R., Emmons, K. (2007). How can we increase translation of research and to practice? Types of evidence needed. Annual Review of Public Health, 28, 413-433. http://dx.doi.org/10.1146/annurev.publhealth.28.021406.144145 Johnson, B., Christensen, L. (2008). Educational research: quantitative, qualitative, and mixed approaches. Thousand Oaks, CA: Sage Publications. Ju-Ling, H., Wen-Chu, W. (2013). Factors of accepting pain management decision support systems by nurse anesthetists. BMC Medical Informatics and Decision Making, 13(16), 1-13. http://dx.doi.org/10.1186/1472-6947-13-16 Krenzischek, D. A., Wilson, L., Newhouse, R., Mamaril, M., Kane, H. L. (2004). Clinical evaluation of the ASPAN pain and comfort clinical guideline. Journal of PeriAnesthesia Nursing, 19(3), 150-159. http://dx.doi.org/10.1016/j.jopan.2004.03.003 McGonigle, D., Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (2nd ed.). Burlington, MA: Jones and Bartlett. Melnyk, B. M., Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Lippincott, Williams and Wilkins. Nwachukwu, C. N. (2012). Decreasing pain and length of stay in the post anesthesia care unit (PACU) by implementing the ASPAN pain and comfort guidelines (Doctoral dissertation, The Catholic University of America). Retrieved from http://aladinrc.wrlc.org/bitstream/handle/1961/10269/Nwachukwu_cua_0043A_10311display.pdf?sequence=1 Wells, N., Pasero, C., McCaffery, M. (2008). Improving the quality of care through pain assessment and management. Rockville, MD: Agency for Healthcare Research and Quality.

Book Review of Hear My Testimony Essay -- essays research papers

Book Review of â€Å"Hear My Testimony†   Ã‚  Ã‚  Ã‚  Ã‚  This is probably one of the most moving books I have ever read in my life. It is basically a narrative story of the life of an El Salvadorian women named: Maria Teresa Tula. Maria is a wonderful storyteller and the fact the she is describing her own real life experiences greatly add to the impact of the book.   Ã‚  Ã‚  Ã‚  Ã‚  Most of the chapters in the book are just her telling about her life. She was born a very poor and sickly child, growing up with her mother and grandmother, after her mother had left her abusive husband. This was only the beginning of a very rough and trying life that she would face. She went on to describe her childhood, how other Salvadorian women were treated and the Salvadorian way of viewing women. Raised as a strict Catholic, she was taught by her grandmother at a young age to â€Å"act like a proper young women.†   Ã‚  Ã‚  Ã‚  Ã‚  From there on she continues to talk about her adolescence where she quickly learned about the threat of physical abuse and molestation towards young girls. She did not continue with school pat the age of 9 and in her small job of working in the local market she was confronted with true and absolute poverty on a daily basis. She got pregnant at age 15. At 16 she had her first fist fight with her abusive physically brother. And at 17 met the father of her other future children. While with this man, Rafael Canales, she learned first hand the hardships of poor domestic life. She also learned to assert herself even towards her own husband.   Ã‚  Ã‚  Ã‚  Ã‚  In 1978, the year I was born, Maria Teresa joined a human rights group called CO-MADRES. (The Mothers and Relatives of Political Prisoners, Disappeared and Assassind of El Salvador) Due to her husband being jailed and severely tortured after a sugar mill strike she found herself unsuspectingly thrown into a political arena. It is her work with this organization that begins to completely consume her life and is the core of the entire book.   Ã‚  Ã‚  Ã‚  Ã‚  Once aligned with this organization Maria’s eyes are opened to the bigger picture of political oppression in her country. She, along with many other women of El Salvador, watch as hundreds of their men are unjustly jailed, tortured and disappeared. She was also a witness to the inhuman... ...e. After saying all this, it is hard for me to find a weakness. The only minor weakness that I could see would be that of intense emotion. The way that this book is written is such that it is truly soaked with emotion. This being a first hand account also added the level of intimacy one feels when reading this, and for some this may translate into uncomfortable feelings. It is also clear that Maria does express her own personal opinions, on her government, on her views of women’s roles in society, and especially on the American government. Maria does use the words â€Å"they† and â€Å"them† to describe Americans sometimes and some may feel that her generalizations are unfair, especially seeing as how she did receive support from sympathetic Americans while in the US. Some may also feel that she is overly critical and excessively faulting the US for the events in El Salvador, however all I could say to people who feel this way is; it would be very difficult to not f ind American policies and actions accountable for many unthinkable tragedies all over Latin America. Personally however, I do not feel that these small weaknesses in any way, take away from the strength of the book or her story.

The Tragedy of Global Warming :: Greenhouse Effect Climate Change

The Tragedy of Global Warming The health issues of global warming are causing the human population rate to decrease over time. The health issues are caused by infectious microbes, pollution by chemical and biological wastes. Many of these diseases will cause illnesses or even death in the future. In fact, many scientists and doctors have discovered these diseases will cause human population to decrease by deaths as they are transferred from one person to the next either physical, eating animals contaminated, mosquitoes, or even blood transfusions though needles. Global warming has been discovered to be very dangerous to human health and is causing many deaths around the world. These tragic experiences in other countries are causing the health hazards to become more aware to humans and are giving the USA more time to plan cures for it before it becomes an issue for them. Global warming is affecting the health issues in today’s generation as well as the future’s generation. Global warming causes many different health issues to the human body. With the temperature’s rising, the risk of cancer is increasing. According to the U.S. National Cancer Institute between 1975 and 1991 skin cancer increased by 812 percent. â€Å"El Nino made1998 the warmest year ever recorded†(Bell 129). The warm temperature resulted in the worldwide outbreak of mosquitoes. With the warm temperatures mosquitoes were infected with different diseases such as malaria, dengue fever, yellow fever, rift valley fever and several other kinds of diseases. The World Health Organization said there were â€Å"quantitative leaps† in malaria cases around the world. â€Å"Thousands were infected with Rift Valley fever in Kenya, resulting in 200 deaths†(129). Many people around the world think that the earth is in danger because of global warming. â€Å"Rising temperatures will have enormous impact on the earth in the future†(pewtrust). With the temperatures rising this will cause the icebergs to melt and make the sea level rise. â€Å"Rising sea levels inundating coastal communities, altered crop yields and water supplies, increased floods and droughts and surge in infectious disease. The water will be tainted because of the water runoff pushing chemicals into our water supply. This will cause people to get sick or even die. With it getting hotter the carbon dioxide levels are rising. This may cause weeds to grow faster and take over the crops we need. Paul R. Epstein, a doctor from Harvard Medical School found a very interesting fact in his research that discussed how many people he estimates are going to be affected by global warming in the future.

Why Death Is Better Than Life in Prison?

Life in prison. When you look at the death penalty system in action, you realize that the only purpose it serves is retribution or revenge, it is seriously (and intrinsically) flawed in application and that there is a serious and continuing risk of executing innocent people. And, it costs much more than life in prison. Here are some facts about the death penalty system. While these refer to the system in the United States, similar things would apply to other nations as well. 130 people on death rows have been released with proof that they were wrongfully convicted. DNA, available in less than 10% of all homicides, can’t guarantee we won’t execute innocent people. If someone is convicted and later found innocent you can release him from prison, but not from the grave. The death penalty doesn't prevent others from committing murder. No reliable study shows the death penalty deters others. Homicide rates are higher in states and regions that have it than in those that don’t. Life without parole, on the books in 48 states, also prevents reoffending. It means what it says, and spending 23 of 24 hours a day locked in a tiny cell is not a picnic. Life without parole costs less than the death penalty. The death penalty is much more expensive than life in prison, mostly because of the upfront costs of legal process which is supposed to prevent executions of innocent people. (upfront=before and during the initial trial) The death penalty isn't reserved for the worst crimes, but for defendants with the worst lawyers. It doesn't apply to people with money. When is the last time a wealthy person was on death row, let alone executed? Families of murder victims are not unanimous about the death penalty. However, even families who have supported the death penalty in principal have testified that the drawn-out death penalty process is painful for them and that life without parole is an appropriate alternative. Problems with speeding up the process. Over 50 of the innocent people released from death row had already served over a decade. Speed up the process and we will execute innocent people. Sources: Death Penalty Information Center, www. deathpenaltyinfo. org, for stats on executions, reports on costs, deterrence studies, links to FBI crime stats and links to testimony (at state legislatures) of victims' family members.