Tuesday, January 28, 2020

Analysis of Hospital Quality Management Team

Analysis of Hospital Quality Management Team Contents INTRODUCTION BACKGROUND History Vision Mission Core values MAIN SERVICES AVAILABLE, HOW SERVICES ARE DELIVERED AND TARGET POPULATION ISSUES IDENTIFIED ANALYSIS OF QUALITY MANAGEMENT PROGRAM REFERENCES INTRODUCTION This is an in-depth analysis of quality management program conducted in Villingili hospital. Improving the quality of care management practice is a concern in many countries regardless of differences in definition, organization, and funding of services. Quality assurance involves a commitment to guaranteeing the quality of services, not as an additional element attached to the service, but as part of an ongoing system in which performance is monitored and achievement measured against set standards or benchmarks (Camp, 1989; Crosby, 1979; Oakland, 1993 cited in Clarkson Challis, 2003). First a brief introduction of the hospital will be presented followed by the discussion of various quality related issues that can be identified within the hospital. Followed by this, one quality management effort, which is the indoor environment of the hospital, will be analyzed. Subsequently, recommendations for any other strategies that could be implemented to improve the present situation and to overcome quality issues that are not part of any quality program at present will be elaborated. BACKGROUND History Villingili hospital was first opened as a health center in 21st April 1994. The health center was initially opened as a branch of Male’ Health center. The health center was set up in a four room building provided by Male’ municipality. On 15th April 2002, the government changed the health center to a three story building. On 14th August 2014, the health center was changed to a third grade hospital; same level as an atoll hospital. Vision: strive to provide healthcare services to people of Villingili and to make the community aware regarding health life styles and to provide ideal, quality and acceptable health care service to residents of Villingili. Mission: To provide an uninterrupted health care to residents of Villingili. To diagnose and treat different types of diseases and work towards the prevention of these diseases. To further develop the laboratory services. Core values: no core values are identified by the organization. Even though the Villingili Hospital have a rich history, it was depressing to find that the staff of the hospital was unaware of the vision, mission and core values of the organization. MAIN SERVICES AVAILABLE, HOW SERVICES ARE DELIVERED AND TARGET POPULATION The main services available in this hospital are, consultation services from general practitioners, consultation from specialized practitioners, laboratory services, community health care, vaccination and nursing care services. The target population is the residents of Villingili, whose population is around 17,000 people according to Villingili hospital. Specialized doctors’ consultations are on specific days. Gynecological consultations are done on Sundays and Wednesdays from 08:00am to 04:00pm. Orthopedics consultations are done on Sundays and Mondays at 08:00am to 04:00pm by Orthopeadician Dr. Hussain Faisal. Pediatrician consultations are done on Mondays and Tuesdays at 08:00am to 04:00 pm. All consultants are arranged sent from IGMH. Vaccination and child growth monitoring is done on all working days from 09:00 am to 01:00 pm. All available services are provided within the hospital. Even though they have a community health service unit, home visiting are not done. Services are provided 24 hours throughout the day, and shift duties are done by all consultants, nurses, receptionists, interpreters, ambulance drivers and attendants. Even though specialized consultations are done, it is evident that both the consultants and clients face enormous difficulty to diagnose and treat diseases and conditions as essential and compulsory diagnostic services such as ultra sound scanning and x-ray services are not available in the hospital. ISSUES IDENTIFIED After conducting surveys in the Villingili hospital and interpreting the results, I have identified some issues related to quality of service provided by the facility. Here are the results of the survey conducted in the facility. In the survey questionnaire, a question was used targeting to identify the staff response to patients need and their courteousness. The evaluation will be accurate if we analyze the situation in both directions. According to the hospital officials, clients can consult general practitioners through a walk in OPD. But the consultation for specialized practitioners such as the orthopeadician and gyneacologist, clients have to make appointment prior to consultation. Appointments are issued until the planned slots are filled. From the interviews conducted, we understood that the time delay dissatisfaction usually arose during busy situations where the doctor who is consulting in the OPD have to attend in patients or emergency cases. Some clients also noted that the doctors sometimes goes for break while more than 10 clients are waiting outside. A service provider have to consider suitable timings in order to provide a quality service to the clients. In order to evaluate this, we questioned whether they are satisfied with service timing of the facility, both general and specialized consultations. Among 10 clients, 2 clients (20%) informed that they are not satisfied with the time for specialized consultation while 3 clients (30%) told that they are moderately satisfied and 5 patients (50%) are fully satisfied with the service timing. Figure 1 Even though they get the appointment for specialized consultation and can consult the general practitioner through a walk in OPD, the time taken to consult the doctors vary. To verify the time taken to consult the doctor, we gave time ranges from 0-10 minutes, 20-30 minutes and more than 30 minutes. According to the clients who gave the interviews 5 clients (50%) informed that they had to wait between 0-10 minutes, 3 clients (30%) told that they waited between 20-30 minutes for the consultation and 2 clients (20%) stated that they waited for more than 30 minutes to consult the doctor. These findings are presented below in figure 2. Figure 2 Identification of the client satisfaction and dissatisfaction is crucial in order to upgrade and provide an ideal and acceptable quality service to the clients. In order to identify the overall satisfaction of the clients regarding the time they spent during consultation, we included questions targeting this issue. According to 7 clients, (70%) they are fully satisfied with the time they spent and 3 clients (30%) are not satisfied. These results are shown below in figure 3. According to the information we collected, we found that most clients highlighted that the biggest issue they face is the way the staff communicate with them. Some clients have informed that they were left feeling like a fool during consultations and some staff spoke rudely to them. Few noted they feel that the staff are overburdened with responsibilities and they seem very unenthusiastic. In addition to this, some clients informed that the staff seems to be involved in their personal things while attending the clients who goes to the counter for different things. Communication effectively with patient and family is a cornerstone of providing quality health care (Patient care improvement guide, 2008). The manner in which health care provider communicate information to a patient can be equally important as information being conveyed (Patient care improvement guide, 2008). Patient surveys have demonstrated when communication is lacking, it is palpably felt and can lead to patients feeling increased anxiety, vulnerability and powerlessness (Patient care improvement guide, 2008). Among 10 clients, 5 clients (50%) informed that the staff was poor in areas being respectful, friendly helpful and courteous. Another 3 clients (30%) noted that the staff was fair in this area while the remaining 2 clients (20%) informed that the staff was good in this area. It is depressing to note that not even one client told that the staff was great in this area. The information is shown in a pie chart below in figure 1. Figure 1 The next question was whether the staff explained the procedure and how they answer questions asked by clients. Among 10 clients, 6 clients (60%) informed that the staff was poor in explaining the procedure and answer questions asked by them. Another 3 clients (30%) noted that the staff was fair in this area. The remaining 1 clients (10%) informed that the staff was good in this area. The information is illustrated in figure 2. Figure 2. According to the information collected through survey, it is clear that most clients highlighted that the biggest issue they face is the way the staff communicate with them. Some clients have informed that they were left feeling like a fool during consultations and some staff spoke rudely to them. Few noted they feel that the staff are overburdened with responsibilities and they seem very unenthusiastic. In addition to this, some clients informed that the staff seems to be involved in their personal things while attending the clients who goes to the counter for different things. The issues identified through survey with clients of this facility that, may hinder the quality of service provided are, ineffective communication and unenthusiastic staff. Additionally, by conducting interview with the senior administrative officer of Villingili health center, it is evident that some staff lack knowledge in some areas such as care during emergency situations. Lack of knowledge is due to lack of practice as the institute have less inpatients who needs constant care. Communication effectively with patient and family is a cornerstone of providing quality health care (Patient care improvement guide, 2008). The manner in which health care provider communicate information to a patient can be equally important as information being conveyed (Patient care improvement guide, 2008). Patient surveys have demonstrated when communication is lacking, it is palpably felt and can lead to patients feeling increased anxiety, vulnerability and powerlessness (Patient care improvement guide, 2008). ANALYSIS OF QUALITY MANAGEMENT EFFORT As the Villingili Hospital is being rebuild to accommodate required facilities to function as a hospital, patients’ and staff are facing various difficulties. The major difficulty that most people face is that consultant rooms are situated in the first floor of the building. A person does not have to be elderly to have a difficulty to climb stairs, and because of this arrangement some patients have faced difficulty. It is evident that the changes to the present building is being brought on to provide a quality service to the customers. However, the effect of physical environment on healing process is evident through research. The arrangement of wards, labor rooms, consultant rooms and waiting areas and its physical environment such as ventilation, lighting, and temperature is important aspects to consider to provide a quality hospital environment. From my personal experience, it is clear that the physical environment of hospital is set to ease the staff only and patient prefer ence or perspective is rarely considered. As I have experienced, I have faced immense difficulty when I went for a consultation with high grade fever and wheezing. The consultant’s room air conditioner was set a temperature where it was difficult for me to utter a single word without clattering my teeth. Additionally, I have found that the present physical environment of the Villingili hospital can be considered dangerous for patient especially the elderly and young. The present construction activities and especially the smooth tiles put on the floor of the hospital is a hazard for falls. For this analysis, I will be looking into the extraneous factors of the hospital in order to deliver a quality service. Extraneous factor of hospital The physical work environment often influences (positively or negatively) the mindset of the service providers and their efficiency and capability to innovate in delivering expanded services (). Sometimes the aspects of the consultation rooms can have a negative impact. Such as the consultation room being too cold, hot, dark, noisy or unwelcoming (Moulton, 2007). Distractions in the room include visual distractions (eye catching photographs or art), auditory distractions (sounds from the waiting room or next consultation room) and olfactory distractions (bad odors or body odor of previous patients) (Moulton, 2007). Suboptimal seating arrangement also can be a negative extraneous factor of hospital, such as seats being hard and uncomfortable (Moulton, 2007). In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families as well as for healthcare staff (Huisman, Morales, Hool Korts, 2012) Studies have shown that excessive noise, glare and poor air quality can create stress as is evidenced by increased heart and blood pressure and reduced oxygen level in the blood in both adults and babies who are exposed to these environment (Blomkvist, Ericksen, Theorell, Ulrich, Rasmanis, 2005; Hagerman, Rasmanis, Blomkvist, Ulrich, Eriksen, Theorell, 2005;Zahr Traversay 1995 cited in Zborowsky Kreitzer, 2008). A healing environment with appropriate physical aspects contribute to patients’ outcome such as shorter length of stay, reduced stress, increased patients satisfaction and others (Ulrich et al., 2004 cited in Hussain Babalghith, 2014). REFERENCES Clarkson, P., Challis, D. (2003). Quality Assurance Practices in Care Management: A Perspective from the United Kingdom. Care Management Journals, 4, (3), 142-151. Huisman, E. R. C. M., Morales, E., Hool, J. V. Korts, H. S. M. (2012). Healing environment: A review of the impact of physical environmental factors on users. Building and Environment (58), 70–80. Moultan, L. (2007). The Naked Consultation: A Practical Guide to Primary Care Consultation Skill (1st ed). United Kingdom, UK: Radcliffe Publishing. WHO. (2004). Quality Improvement in Primary Health Care; A Practical Guide. WHO regional publication, Eastern Mediterranean Series 26. Zborowsky, T., Kreitzer, M. J. (2008). Creating Optimal Healing Environment in Health Care Setting. Clinical and Health Affairs, 91(3), 35-38. Saushan Rasheed Quality Assurance in Health Care Assignment 2

Monday, January 20, 2020

Nervous Breakdowns :: Nervous Breakdown Mental Collapse Stress

In the middle Ages, it was called melancholia. In the early 1900s, it was known as neurasthenia. From the 1930s to about 1970, it was known as a nervous breakdown. "Nervous breakdown" is a term that the public uses to characterize a range of mental illnesses, but generally it describes the experience of "snapping" under massive pressure, mental collapse or mental and physical exhaustion. Have you ever wondered how you can tell if someone is having a nervous breakdown? Or what causes them or how they're caused? Well, the causes of nervous breakdowns are very similar to panic attacks, ADD, and ADHD. There is always a trigger or catalyst that sparks a nervous breakdown. Breakdowns usually stem from a change in a major life event such as a broken relationship, death of a loved one, a demanding job or financial difficulties On some cases getting nervous breakdowns are genetics, you receive them because a past family member has had one or in simpler words family history. Another sign is Coexisting medical conditions such as vitamin deficiencies or thyroid disorders. Stress, drugs, alcohol and depression are one if the most main causes of nervous breakdowns. You can always treat a breakdown. Sometimes people talk to therapist or someone they trust to discuss their issues and just â€Å"let it all out† instead of breaking down. As for others talking doesn’t always work at times it may tend to worsen the problem, so they take prescribed depression pills. Other treatments are drugs, alternative treatments, surgery, and lifestyle changes. If you feel close to having a nervous breakdown right now you are probably feeling like you have hit rock bottom. Many people who are close to a nervous break down feel a million miles from their real self. Feelings of anger, negativity, exhaustion and anxiety are probably overwhelming you and your ability to pursue a 'normal' life and 'normal' relationships is no doubt proving tough. Obviously the best approach is to prevent the breakdown from occurring in the first place. Recognizing the warning signs of a nervous breakdown and reducing and managing stress levels can often produce excellent results and prevent the total collapse usually associated with a nervous breakdown.

Sunday, January 12, 2020

A Comparative Look at Beethoven and Mozart Lives

Beethoven and Mozart are great and famous composers of classical music who share similarities in musical composition and still both exhibit certain differences. Being counted among the list of the most influential composers in the history of music, Wolfgang Mozart and Ludwig Beethoven are artists who have much in common.This paper draws on the views that both of these composers have the same musical foundation having been introduced to music by their fathers. It seeks to explore the similarities as well as differences in the lives of Mozart and Beethoven in the history of music.Mozart and Beethoven are from the same origin and they worked in the same musical genres such as classical and romantic thus exemplifying themselves as very talented musician a as well as prolific composers. However, it is plausible to accept the fundamental truth there are no two people are exactly the same. On this basis, Mozart and Beethoven harbor certain differences that emanate from their different perso nalities and perspectives in music. As a result, it emerges that the age at which they began composing points out clear differences in their composition and musical careers coupled by their musical style.Differences The first notably difference between Mozart and Beethoven lies in their musical style. Brown (23-25) postulates that the overwhelming greater part of the composition of Mozart is not only light but also very aerial and delightful. As such, music critics have attributed that the musical pieces of Mozart aim at general entertainment and extensively apt relaxation which underlies the whole paradigm in which music is composed and performed. On the hand, Beethoven’s music is typical of intensive drama which makes it heavier and typical of a wide range of pith.In light of this, Wallace (105-107) explains that the music of Beethoven exhibits a lot of in-depth passion and dynamism in composition as well as performance. Notably, another important difference that marks the Beethoven and Mozart is their entry age in the field of musical composition. Arguably, Mozart began his musical career at the age of five and grew up composing music for royal people in most cases (Lancaster, 37-39). On the same note, Beethoven is said to have delved into music when he was already a teenager and concentrated a composing music for the public at large.With regard to this difference, both musical artists grew in different circumstances as pertains their introduction to music and thus, their audience became marked by the conditions that characterized their entry in music. With the different audiences, Mozart and Beethoven had to compose music at deferent condition and they addressed different thematic concerns hence marking their greatest difference in their lives and music (Pestelli, 52-54). Significantly, it is prudent to note their difference in notation styles. Mozart continued to produce musical piece that was marked by clear and neat notations.Comparatively, this was greatly different from the notational styles of Beethoven since his composition was marked by sloppy, unclear and somewhat careless notations (Brown, 49-51). Extensively, the style of their music as well as the audience they composed for left them emotionally feeling different. For instance, as Mozart became a happy, easy-going composer and person in life while Beethoven was typical of bad temper and largely became depressive. On this note the life experiences of these two life time composers propelled them to different pedestals.Essentially, Beethoven led a lone life but his due to the question that he composed and performed for the general public he received an honorable burial after his death at the age fifty six. On the other hand, Mozart who specialized in composing for the royalties was buried in unmarked grave in Vienna at the age of thirty six (Lancaster, 87-89). Unlike Mozart, Beethoven had a method of composing which mirrored a situation where he recorded ideals in not ebooks and later used them in building up blocks for his composition.For example, the Ode of Joy, a symphony that was build on the theme of seeds was a concept conceived several years ago Accordingly, it is a reflection of a long gestation period of composition where Beethoven paid supreme attention to minute details in a bid to depict that in the music lies strength of idealism (Wallace, 36-38). This creative process marked the inspirational ability of Beethoven. However, Mozart was radical and was dubbed the Trent Reznor of his lifetime. He succeeded in his spontaneity ability as well as his outspoken nature.With regard to their musical works, Beethoven composed pieces that rapidly diverged from his teacher and peers. Revolution was in air and Beethoven’s symphonies mirrored both political and artistic features. For example, his third symphony was dedicated to Napoleon but later own, Beethoven deleted his name on the title of the Symphony after the realization that Napoleon had already declared himself an emperor (Pestelli, 41-42). The resulting events led to Beethoven to produce shorter symphonies such as his fourth and eighth.In light of this, Beethoven explored new areas in life and extensively wrote string quartets following the influence he got from his teacher Haydin. The works of Beethoven largely bordered personal introspective works that slid into uncharted musicals that still remained intimate. As a result, Brown (45-48) highlights that Beethoven composed various pieces that included several overtures, a mass and opera as well as concertos. He even stretched his base to write for piano with a host of sonatas and concertos for violins.On the other hand, Mozart influenced greatly on the musical development by drawing his works from figures and preludes and extensively employed fugal writing within the larger composition of symphonies. Although this influenced greatly on the development of classical music, it had little connection to his creati vity. Wallace (28-29) argues that the feelings, thoughts and ideologies of Mozart formed the basis of his influence and success in musical composition. As a result, these influence strove Mozart to commit to the depth of musical form and thus position him as a successful romantic composer.In the same vein, both great musicians had extraordinary pieces of music and performed in different era. Mozart belonged to the classical period while Beethoven belonged to the romantic era. As such, Mozart ended up being criticized for composing radical music that endangers the morals of the women since majority of these women were aroused with Mozart music. Beethoven on the other hand Beethoven had the advantage of in paving way for the creation and invention of pianoforte. The greatest music of Beethoven is his symphonies which are still heard in the present time as they were listed to in his time.Compared to Mozart, Beethoven continued to unify contrasting movements using musical continuity. Of ten, his music would have unclear ending, something that made his symphonies a bit longer (Brown, 57-61). Similarities It is worth noting that ideas and differences between Beethoven and Mozart can not suffice to say that either of them was better than the other but the interesting point of focus should be built around the understanding that both of them made major contributions in the world of classical music; contributions which led to the development of music as an art.Arguably, we can draw from their differences to construct a viewpoint of how Mozart and Beethoven are similar. Significantly, considering the fact that both of them were creative and gifted innovators of classical music during the classical and romantic period, both Mozart and Beethoven share a similar characteristic of being musical genius (Pestelli, 12-17). In addition, Brown (65-67) illustrates that Beethoven went at length of achieving the iconic status of musical composer.This factor is equally shared by Mozar t and thus, the iconic status as a composer was a status achieved as a result of ones revolutionary and immense influence on the development of music within the milieu of pivotal points in terms of the classical and the romantic periods. As such, the symphonies of Mozart as well as Beethoven demonstrates the development for music in these eras as the themes portrayed in these symphonies resonate what was entirely used as the European anthem. Moreover, their images are construed within the parameters of musical history.Beethoven, just like Mozart was born into a musical family where the father and grandfather were singers. Although this is not to the same extent, it is plausible to argue both Beethoven and Mozart were musical prodigies who were taught music by their parents at a tender age. Lancaster (121-122) asserts that the education of these two musical composers was courted by musicians such as Neefe; a factor which enabled them to demonstrate their musical talents in areas such as keyboard playing piano and harpsichord.In addition, composers during their eras were employees of the church, state or rich patron who were requested to compose musical works to articulate different occasions that were deemed important within the precincts of religion as well as secular. According to Wallace (23-44) both Beethoven and Mozart exhibited some sense of independence in their creative works. As such, they could set their own agenda in the entire composition.The basis of the set agenda gave these artists the opportunity to express their deepest feelings in life as exemplified by Beethoven who have his three symphonies reflecting the ideals of republicanism, liberty, religious beliefs as well as the aspect of brotherhood in the society. Conclusion From the foregoing discussion, it is evident that Beethoven and Mozart are great and famous composers of classical music but both exhibit certain differences. Being counted among the list of the most influential composers in t he history of music, Wolfgang Mozart and Ludwig Beethoven are artists who have much in common.However, both Mozart and Beethoven harbor certain differences that emanate from their different personalities and perspectives in music. All these similarities and differences fall within the wider framework of their musical careers, experiences and musical styles of composition. Work Cited Brown, P. The Musical Times: Mozart and Beethoven. Cambridge: CUP 2007 Lancaster, E. The Golden Age of Symphony: Mozart and Beethoven. London: Alfred Music Publishing 2000 Pestelli, G. The Age of Mozart and Beethoven. Harvard: HUP 1984 Wallace, R. Classical Equilibrium in Music. Oxford: OUP 2009

Friday, January 3, 2020

Multiple Choice Questions Sample

Multiple Choice Questions Sample 2. it is shifted 4 units UP 3. 16.91 4. 88.53 5. two solutions 6. one solution 8. Quadratic 9. (2,20) and (-3, 0) 10. (-1, 1) and (7, 33) 11. 3.54 12. Reaches a maximum height of 22 feet after 1.00 second. 13. Reaches a maximum height of 372.25 feet after 4.63 seconds. 14. x=2, x= -6 16. -3 and 2 17. -3 and 9 18. 5 m 19. 225/4 20. -11.56, 1.56 21. 7.53, -0.53 22. -7 and 3 23. exponential

Thursday, December 26, 2019

Nautical Petroleum Plc Market And Financial Performance Finance Essay - Free Essay Example

Sample details Pages: 10 Words: 3041 Downloads: 8 Date added: 2017/06/26 Category Finance Essay Type Argumentative essay Did you like this example? This report evaluates the Nautical Petroleums market and financial performance for the past two years by studying the annual reports of 2009 and 2010. The report also highlights the economic factors that the group faces to illustrate its current risks and growth. This will include the social and technological concerns related to the industry. Don’t waste time! Our writers will create an original "Nautical Petroleum Plc Market And Financial Performance Finance Essay" essay for you Create order Furthermore, the companys overall market coverage has been briefly analyzed along with its customer profile, distribution channels and the product offerings as compared to its competitors. The report will also establish the ownership and control of the business highlighting the expertise of management. Thereafter, the financials of the company will be assessed through the examination of its profitability and returns. Finally, this report will provide an investment suggestion on basis of the asset value per share given by the company. Introduction to Nautical Petroleum PLC Nautical Petroleum plc  is an independent hydrocarbon exploration and development company listed on the London AIM. The company was listed on the Alternative Investment Market (AIM) in April 2005. A 75% interest in Nautical Petroleum AG, a subsidiary of  International Energy Group AG (IEG), was transferred into Nautical Holdings Limited. This entity participated in the Reverse Takeover (RTO) in April 2005 which created Nautical Petroleum plc as a listed entity on AIM. (History, Nautical Petroleum) Nautical Petroleum plc intends to become a significant producer of heavy oil, initially in the United Kingdom Continental Shelf (UKCS) and in Europe. Currently, the companys operations span to UK, France and Ireland and the aim is to secure further heavy oil discoveries in the UKCS and EU through acquisitions, farmins and licensing rounds. (www.oilbarrel.com) Marketing and Economics INDUSTRY SECTOR MARKETS CUSTOMERS Nautical Petroleum operates in the Energy sector and its core business is trading of crude oil and refined oil products. The company has established a worldwide representation in major oil trading hubs with international activity serving a clientele which includes most of the recognized participants in the global crude oil, gas and re ¬Ãƒâ€šÃ‚ ned products markets. Nautical Petroleum undertakes physical oil trades with private and state sector oil producers, oil majors, independent traders, re ¬Ãƒâ€šÃ‚ ners, power generators and other consumers. The market for these UK heavy oils remains strong, specifically from specialist refiners. This is reflected in prices achieved for Alba, Captain and Harding (Nauticals acquisitions). COMPETITORS Nautical Petroleum competes with major players in the market like British Petroleum (BP), Shell and Elf and also with the smaller but listed companies like Enterprise Oil Plc, Falkland Oil and Gas, Northern Petroleum Plc, WHAM Energy Plc, Encore Oil Plc, etc. RGFC has to compete with a number of competitors in the UK food industry, particularly in the bakery and confectionery sector. A few of the major competitors of RGFC include Greggs PLC, Abf Grain Products Ltd, Warburtons Limited, Warburtons Holdings Limited, Rank Hovis, British Bakeries, Baxters, United Biscuits (Holdings) Plc and Allied Bakeries. SOCIAL ISSUES The major social issue related to the oil and gas industry is the pollution caused due to oil spills, both for aquatic as well as land forms. Another issue that has been highlighted by a recent study about social and environmental effects on communities which are economically dependent on the oil and gas industry is social dysfunction and biological impoverishment. The research, published in Conservation Biology, revealed that over a nine year period the number of registered sex offenders in energy boomtowns was two to three times higher than towns dependent on other industries. Other symptoms of social change seen in energy boomtowns across the western United States include the use of illicit drugs, domestic violence, wildlife poaching and a general rise in crime. The research suggests that these changes occur because of the differences between the traditional rural residents and the incoming workforce. (Rise of sexual Predators in Oil Natural Gas Boomtowns, https://www.medicalnewstoday.com/articles/179328.php) TECHNOLOGICAL ISSUES Petroleum science has evolved from rudimentary geology to elaborate supercomputer-based calculations and 3D views of the subsurface. It has taken the drilling process from a lets try over there guessing game to the precise targeting of ever smaller pockets of fields that have already produced for half a century, as well as areas that have produced nothing before. It requires state of the art technologies to extract the hydrocarbons as well as highly skilled and competent professiona ls to manage the industry. The EP industry is using cutting technology to locate hydrocarbons and optimize efficiency in production. These technologies include the use of complex reservoir modeling and simulation, nuclear magnetism, sonic and ultra-sonic technologies, magnetic resonance, advanced chemical engineering, fluid mechanics, telecommunication, process engineering etc. As easy-oil has become a thing from the past, the industry is moving towards frontier areas to increase production. Optimizing the recovery of hydrocarbons from the existing production fields (called brown fields) remains an existing challenge. Growth and Risks of the Company Nautical has exhibited strong growth prospects and is committed to progressing both Mariner and Kraken projects to field development plan (FDP) submission and adding value to the third leg of material appraisal and exploration opportunities. Notwithstanding the growth of the company, that the fact still remains that in common with all oil and gas exploration and production operations, there is uncertainty and therefore risk associated with operating parameters and costs. Whilst costs can be budgeted with a reasonable degree of confidence, operating parameters can be difficult to predict and often outside the Groups control. In addition, other risks, including industrial accidents, technical failures, labour disputes, environmental hazards, machinery breakdown, unavailability of parts, government action, war and terrorism, are all beyond the Groups control. Oil and Gas Exploration, Production Risks and Insurance There are risks inherent in the exploration and production of oil and gas. This area of business, by its nature, involves significant risks, and hazards, including environmental hazards, industrial incidents, labour disputes, fire, drought, flooding and other natural calamities. The occurrence of any of these hazards can delay or interrupt production, increase production costs and result in liability to the owner or operator of the oil and gas asset. The Group may become subject to liability for pollution or other hazards against which it has not insured or cannot insure. Market Risk The marketability of any oil or gas discovered will be affected by numerous factors beyond the control of the Group. These factors include market fluctuations, proximity and capacity of oil and gas pipelines and processing equipment and government regulations including regulations relating to taxation, royalties, allowable production, importing and exporting of oil and gas and environmental protection. Environmental Factors The operations of the Group are dependent on environmental regulations in every jurisdiction it operates in. Environmental legislation and permits are liable to develop in a way which will require more austere standards and enforcement, augmented fines and penalties for non-compliance, stricter environmental assessments of projects and an increased degree of responsibility for companies and their directors and employees. There can be no assurances that such new environmental legislation once implemented will not oblige the Group to incur significant expenses and undertake significant investments which might adversely affect the Groups business, financial condition and operational results. Licenses and Title The Groups exploration and production activities are dependent upon the grant of appropriate licenses, concessions, leases, permits and regulatory consents which may be withdrawn or made subject to limitations. The decisions to advance explorations may call for other companies participation whose inte rests and objectives may differ from those of the Group. Volatility of Oil and Gas Prices There has been a wide fluctuation in oil and gas prices and they are affected by several factors over which the Group does not hold control, including currency exchange fluctuations, world production levels, consumption patterns and global or regional political events. The collective effect of these factors is next to impossible to forecast. Consequently as a result of the above factors, price forecasting can be difficult to predict or imprecise. Currency and Exchange Rate Fluctuations Since commodity prices are conventionally denominated in the US$, majority of the income of the Group will be expected in US$ and the Group is therefore exposed to volatility in exchange rates. Contractual risks All agreements are subject to interpretation, and some agreements are not binding. There is no guarantee that the Company will be able to enforce all its rights under its agreements or a rrangements with third parties. Competition There exists aggressive competition in the petroleum industry, mainly for the discovery and acquisition of commercially viable properties. The Group will compete with other exploration and production companies, many of which possess greater financial resources in comparison to the Group, for leases and other interests plus for the retention of qualified personnel. These factors might prove to be a hindrance for the Group to lock new exploration areas or recruit and retain talent. Financing risks The furthering of the Groups properties is based on its ability to obtain finance through the farming-out of projects, public financing or supplementary means. There is no assurance that the Group will successfully be able to obtain the requisite financing. Any additional equity financing may be dilutive to Shareholders and debt financing, if available, may entail restrictions on operating activities. In case the Group is unsuccessful i n obtaining additional finance as required, it may be required to reduce the scope of its operations or anticipated expansion. Taxation Future changes to the nature and basis of taxation may impact on the net revenues and cash flows of the Group. Political Although political conditions in the countries in which the Group may operate are generally stable, changes may occur in their political, fiscal and legal systems, which might affect the ownership or operation of the Groups interests, including, inter alia, changes in exchange rates, control regulations, expropriation of oil and gas rights, changes in government and in legislative and regulatory regimes. Liquidity of the Groups Shares The market for the Groups shares may be highly volatile and subject to wide fluctuations in response to a variety of factors which could lead to losses for Shareholders. These factors include amongst others; additions or departures of key personal, litigation if any, press, newspape r and other media reports and the results of appraisal and exploration activity. Legal Systems Some of the countries in which the Group may in the future, operate, have legal systems which are not as developed as those in established economies. In such cases, this can result in uncertainties, ambiguities, inconsistencies and anomalies, and/or difficulties in obtaining redress through the local courts, and ultimately in investment risks that do not exist in more developed legal systems. Ownership and Management The board of Nautical Petroleum Plc is led by Chairman John Conlin who is also a Non-Executive Director and joined the board in June 2009. Out of 63,408,291 ordinary shares (as on 30 June 2010), J Conlin holds nil (but holds 60,000 share options). Similarly, Finance director Will Mathers and Non-Executive Director Philip Dimmock hold zero ordinary shares but possess 200,000 and 250,000 share options instead. The highest number of ordinary shares is held by Chief Executive Stephen Jenkins and Commercial Director Paul Jennings who hold 876,096 shares each (1.38 percent) apart from holding 1,125,000 and 800,000 share options respectively. The Non-Executive Director Patrick Kennedy holds 75,000 ordinary shares (0.12 percent) and 250,000 share options. Financial Performance Evaluation: Profitability, Liquidity and Gearing PROFITABILITY The cost of sales, including impairment and operating costs of extended well test equipment, was  £157,000 in 2008 which rose significantly to  £2,500,000 in 2009. Again in 2010 it dropped to a mere  £84,000. Since the revenue for the year 2008 was zero, the group incurred a gross loss of  £157,000. Because of the significant increase in the costs and only a marginal increase of  £25,000 in sales, the loss increased to  £2,475,000 in 2009. Though, in 2010 the Groups financial position improved due to increase in sales and cost reduction, thereby limiting the gross loss to  £16,000. As a result, the Groups gross profit margin has improved from  £9,900,000 in 2009 to - £23,500 in 2010. Similarly, the net profit margin has shown a remarkable improvement from - £23,548,000 in 2009 to - £3,354,000 in 2010. Return on capital employed (ROCE) shows a similar trend. Since the Group has incurred losses through the considered period, there has been negative ROCE, though there has been a decrease in the losses and ROCE has gone up to -2.8% in 2010 in comparison to -10.5% in 2009, approximately by one fifth. LIQUIDITY The current ratio of the group was 4.4:1 in 2008 which was considerably lower compared to 24.3:1 in 2008, reflecting significant decrease in the liabilities. The liabilities of the group decreased steeply at 82.63% over the period of 2008 to 2009. But in contrast, in 2010 the assets fell sharply exhibiting a decline of 36.14% because of which the current ratio dropped to 14.2:1. This trend indicates that even though the Group has been running in loss, its ability to meet its short term financial obligations is adequate enough. The liquid or acid test ratio also represented exactly the same trend in the financial period considered. This is due to the reason that the quick assets of the Group are same as the current assets since there has not been any inventory. In terms of efficiency, the group showed an improved performance over the financial years with respect to repaying of the payables. The trade creditors show a constant reduction from  £1,806,000 in 2008 to  £504,000 in 2009 to  £312,000 in 2010. Therefore, the trade payable days has reduced from 4141 days to 1337 days from 2008 to 2010 (though it significantly reduced to 73 days in 2009). Also, the trade receivable days of the Group reduced significantly from 7114 in 2009 to 2509 in 2010, illustrating the fact that fewer funds were tied up with debtors for each  £1 of sales in 2010 than in 2009. But, since the past three years (2008 to 2010) a significant amount of approximately  £470,000 has been given on debt. GEARING Nautical Petroleum Plc is lowly geared. The annual report suggests that the business has negligible debt and non-current borrowings. The Groups borrowings, in terms of accruals and amount owed to related companies, have dropped remarkably over the three years. The gearing ratio of the group tells us that the gross gearing reduced greatly from 4.36 to 0.51 during the period from 2008 to 2009. Though, in 2010 it increased to 0.99, it still remains low. This highlights the fact that the Group has just 1% borrowing, and the business is majorly financed by equity. Attractiveness of the Groups Equity Shares Settlement as of 04/02/2011, at 5:45 p.m. Nautical Pet fractionally up, achieving a modest profit of +0.37%. After a weak start to the day at 536, above the previous sessions low, we saw steady growth as trading continued and a bullish close of 547, near the session high. In the weekly comparison, Nautical Pets trend is more pronounced than the FTSE AIM 100 Ix trend line, revealing investors greater propensity to buy Nautical Pet stock compared to the index. Status and Trend Analysis Technically, Nautical Pet is in a strong uptrend with resistance in the 561.7 area, while the most immediate support is listed at 517.7. The trading outlook is positive, with the bulls likely to target the 605.7 level (green line in the chart). Risk Analysis Heres a word of caution for risk-averse traders, who should consider this a potentially risky investment given that intraday volatility is up at 8.97. Buying or selling decisions should primarily be made in an intraday context, as daily volume has fallen to 170,167, against a volume moving average of 402,945 for the last month. The earnings per share for Imperial Tobacco Group rose from 50.6 pence to 65.5 pence from 2008 to 2009, indicating the fact that the earnings available to the shareholders increased by about 30 percent. As mentioned in 2009s annual report of the company, its adjusted earnings per share have grown by 15 percent on a compound annual basis. The dividend per share also showed a remarkable hike from 62.93 pence in 2008 to 73 pence in 2009 amounting to a 17 percent increase in the value distributed amongst the shareholders. As mentioned in the Chairmans statement in the annual report of the group: Over the past ten years we have outperformed the FTSE A ll-Share Index by 286%. With dividends reinvested,  £100 invested in Imperial Tobacco ten years ago would now be worth  £517 compared to just  £134 invested in the FTSE All-Share Index. (Chairmans Statement, Annual Report 2009) Total Shareholder return over the past ten years Graph showing Imperial Tobacco Group PLCs performance against the FTSE All-Share index for the past ten years Source: Imperial Tobacco Group, Annual Report 2009 Although the dividend yield increased to 3.18 percent, the dividend cover of the business remained constant over the year at 1.1 times. The price per earnings ratio of the group was 29.75 times, which reveals the fact that the capital value of the share is quite high compared to its current level of earnings. This reflects the market confidence concerning the future of the business and that the investors are prepared to pay more in relation to the earnings stream of Imperial Tobacco Group. But this value has dropped by 30 percent over the fiscal year. Similarly, since the market price of the share has not risen significantly in comparison to the remarkable increase in the cash flow per share, the price to cash flow ratio also dropped from 11.30 pence to 5.65 pence in 2009. Overall, the sales volume of the group has fallen in Russia, Spain, Ukraine and the US due to the rise in the counterfeit cigarette market and also because smokers generally have switched from cigarettes to cheaper tobacco in the economic slowdown. The price to earnings ratio and the price to cash flow ratios have also fallen significantly. On the other hand, the company still has a good dividend yield and strong profitability from operating activities. The PE ratio also suggests that the stock might be undervalued. Hence, considering all the parameters on the whole, it is recommended for the existing shareholders to hold their investment. For those who are yet to invest, the companys prospects look good only in the long term. Appendix INVESTMENT RATIOS Note: Market price taken as on 30th November 2009 is 1886 pence. XVI Dividend per share (DPS) = Taken from Directors Report 2008 DIVIDEND PER SHARE = 62.93 p 2009 DIVIDEND PER SHARE = 73 p XVII Earnings per share (EPS) = Taken from Income Statement 2008 EARNINGS PER SHARE = 50.6 p 2009 EARNINGS PER SHARE = 65.5 p XVIII Dividend Yield = Total Dividend/Current Market Price x 100 2009 DIVIDEND YIELD = 59.93/1886 x 100 = 3.18% XIX Dividend cover = EPS/DPS 2008 DIVIDEND COVER = 50.6/45.6 = 0.804 2009 DIVIDEND COVER = 65.5/59.93 = 0.897 XX Price Earnings Ratio = Current Market Price/EPS 2009 PRICE EARNINGS RATIO = 1886/ 63.40 = 29.75 XXI Price to Cash flow = Current Market Price/Cash flow per Share 2009 PRICE TO CASH FLOW = 1886/334 = 5.65 pence

Wednesday, December 18, 2019

Aids Hiv Screening Rates - 1718 Words

Dear: Michael York From: Webster Hospital and the Health Department Topic: HIV Screening Rates In Middleboro Summary: HIV is an existing issue in Middleboro and in the United States. Hillsboro county and capital city have the highest rates of HIV/AIDS in the state. 70% of the people living with AIDS in Hillsboro County are white and the remaining 30% of people living with aids are distributed among African Americans, Hispanics and other [1]. In capital city the largest proportion of AIDS patients are white with 48% then African Americans with 36%. New HIV cases are frequently occurring in the male population, statewide there is a rate of 11.5% increase of new HIV infections in adults and adolescents [1]. There has been an Increase in HIV rates in Capital city and Hillsboro County during 2004 and 2014, from 21.3% to 22.9% in capital city, and 17.2% to 20.9% In Hillsboro County [1]. This increase of HIV/AIDS is a call for a population health solution. The rising rates of HIV lead us to believe there are barriers for HIV needs. Webster Hospital and the Health Department are proposing a mobile health innovation to increase encouragement among patients so they may seek HIV health services from their provider. We are also requesting affordable HIV Screening that will be covered by health plans without establishment of risk factors. The mobile health innovation will be a text message to encourage testing, preventative services and treatment. Webster Hospital and the HealthShow MoreRelatedHiv And The Transmission Of Hiv1354 Words   |  6 PagesEpidemiology: HIV is known to be transmitted through blood products, semen and vaginal secretions, making the transmission of HIV infection most commonly through sexual contact and IV drug use. 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According to Renata Simone, producer of the documentary, â€Å"African Americans make up about 12 percent of the nation’s population, but account for almost half of all people infected with HIV, the virus that causes AIDS.† The documentaryRead MoreEssay on Reproductive Health in Low Income Women1436 Words   |  6 Pages The District of Columbia (D.C) is made up of 52.8% females, 54% African Americans, and 40.6% Caucasians. Of the roughly 600,000 living in D.C., 101,400 (or 16.9%) are living below the poverty line (US Census, 2009). Over the years, the poverty rate in D.C. has continued to grow. With this number growing, there is a profound need to learn more about the women that are being affected. That being said, it is important to learn more about sexual and reproductive health in low-income women. 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Tuesday, December 10, 2019

Good God Essay Example For Students

Good God Essay Good GodWhen one walks through the streets of humanity, one must choose their destiny. Is it to believe in God, or to become conservative and choose not to believe?Well, the people of the world should all just creep within their minds, andchoose not to follow the Messiah onto the deceptive fields of love. These peoplebecome sicken with doubt, and unleashing them are quite easy. But the world maynever know, for the fools that are blinded with salvation still wander inoblivion. Objection number one is that, can one actually prove the existence of God? Howcan one experience divinity, without experiencing death first? No men on thisearth can! Not the Pope, Saint Anselm, nor William Paley, who actually tired toprove the existence of God. William Paley once said , If a man wandered upon ahill, and discovered a watch; who would question the fact, that the watch wascreated by a designer? Its possible that the statement is true, but a watchcant be compared to a universes creation. Paley would later say that the worldmust have a designer, meaning a God. The watch of coarse must of been createdby a designer, but the world is totally different. Its more like a carpenterbuilding a house or building. People can relate more to a building than auniverse, cause its possible that one can experience living within a house. Its not possible for anyone to live among the outside world, and think that Godcreated everything. This only proves Paleys downfall, and ideas that have noback bone! The world to be created by God is impossible, only cause man seeksmore than his environment. God cannot be proven!Belief! The question of believing, is a question of faith. This is a story offaith. Jeremiah once entered a church full of greed, and listened to the wordsof God. When the sermons of Christ ended, the preacher and his followers handeddown baskets, filled with money. Jeremiah just sat in confusion, wondering whyand where is all that money going to. As Jeremiah left the church, he over heardthe preachers wife, Now can you buy me diamond ring? Jeremiah began to weep,as the rage within him rushed throughout his mind. At home, Jeremiah told hismother about the fury within , and he spoke this: Mother! Why is the entirechurch of Christ corrupt? Why is the world so cold? Doesnt God even exist? WellI know one thing th ats certain; there is no longer true faith among thisplanet! Humanity, along with false ministers have killed God! God is truly dead-- His mother just stood in shock, watching him draw a picture of a madbishop, revealing and exploiting the meanings of Jesus Christ. This is thesadness that one who believes in God, can actually discover, and feel a sense ofbetrayal. There is many people who believe God is all Powerful, God is all good, and evilexist. These are the propositions that gives a religious man true faith. But ifGod was all powerful, then there wouldnt be no evil. God would simply destroy,or cast out evil within the world. And if God was all good, then why would someinnocent child be raped , and be left for dead? God is all powerful, and chosenot to save an innocent child. Who now is evil, and who now is good? And last isthe evil that burdens the lands all walk on. Its sad that evil exist among theworld, but evil still exist. Some people perceive evil as symbol of wrong doing, thus, creating and using good as a tool to confront, and destroying all ofevil thats around everyone. But if man is here to defeat evil all by himself,then why would God be needed? Evil exist only to explore the other sides ofwhats good. This is the confusion that one may encounter, if accepting thebeliefs of these propositions. .u5a8e6669567084b27dc6ac911712810a , .u5a8e6669567084b27dc6ac911712810a .postImageUrl , .u5a8e6669567084b27dc6ac911712810a .centered-text-area { min-height: 80px; position: relative; } .u5a8e6669567084b27dc6ac911712810a , .u5a8e6669567084b27dc6ac911712810a:hover , .u5a8e6669567084b27dc6ac911712810a:visited , .u5a8e6669567084b27dc6ac911712810a:active { border:0!important; } .u5a8e6669567084b27dc6ac911712810a .clearfix:after { content: ""; display: table; clear: both; } .u5a8e6669567084b27dc6ac911712810a { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u5a8e6669567084b27dc6ac911712810a:active , .u5a8e6669567084b27dc6ac911712810a:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u5a8e6669567084b27dc6ac911712810a .centered-text-area { width: 100%; position: relative ; } .u5a8e6669567084b27dc6ac911712810a .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u5a8e6669567084b27dc6ac911712810a .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u5a8e6669567084b27dc6ac911712810a .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u5a8e6669567084b27dc6ac911712810a:hover .ctaButton { background-color: #34495E!important; } .u5a8e6669567084b27dc6ac911712810a .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u5a8e6669567084b27dc6ac911712810a .u5a8e6669567084b27dc6ac911712810a-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u5a8e6669567084b27dc6ac911712810a:after { content: ""; display: block; clear: both; } READ: Endangered Species EssayThe will to believe, and the life after death. The only thing man has going forhim, is will power. He can either use it to oppose, or accept God, it reallydoesnt matter. The will to believe in an afterlife is beautiful, and heartwarming. Its beauty is expressed in a sense of hoping for something beyond thisworld, and that is so capturing to souls that hunger for more. The entiremeaning of creating salvation within the soul is creative, and creativity isprobably the greatest assets a religious person can have. This is the creditthat all can present to the prodigies of God. Today in society the world still lives off the false faith of God, and now mustsociety change in order to become true. Man is true at heart, when the doubts ofGod are no more, and so must all turn away from he. Science today is God, andthere is no longer a need to pray. The evidence that opposes the existence ofGod is great, and still the people of God wonder why? Why must one choose todisbelieve in the existence of God? And why call for such an action? Thesolution to this query is, cause this world is a will to power- and nothingbesides(Nietzsche550)!!!!!!!!!!THE END