Airline industry analysis by Porters Five Forces Essay Example for Free

Airline industry analysis by Porters Five Forces Essay The Airline industry provides a very unique service to its customers. It transports people with a high level of convenience and efficiency that cannot not be provided by any other industry or substitute. Airline companies pride themselves on the way they treat their customer during the flight. They have things such as food, drinks, entertainment, and a welcoming staff. The service of transportation is provided in other industries but the airline surpasses all of them when it comes to timeliness. The geographic scope of the airline industry is at a global level. Some firms are able to fly their planes all over the world while others focus on smaller geographic areas. The five forces model is one way to answer the first basic question in strategic management; â€Å"Why are some industries more attractive than others?† This model shows the five forces that shape industry competition; threat of new entrants, bargaining power of buyers, threat of substitutes, bargaining power of suppliers, and competitors. In order to analyze the airline industry we have look at each of these forces. Bargaining power of Buyers The airline industry is made up of two groups of buyers. First, there are individual flyers. They buy plane tickets for a number of reasons that can be personal or business related. This group is extremely diverse; most people in developed countries have purchased a plane ticket. They can do this through the specific airline or through the second group of buyers; travel agencies and online portals. This buyer group works as a middle man between the airlines and the flyers. They work with multiple airline firms in order to give customers the best flight possible. Between these two groups there is definitely a large amount of buyers compared to the number of firms. There are low switching costs between firms because many people choose the flight based on where they are going and the cost at the time. This is some loyalty to firms but not enough for high switching costs. Each customer needs a lot of important information. They need to know the details of what  is provided during the flight. Buyers need to understand the timing of the flight and the safety aspects of flying in general. The service provided is unique. Each airline has a niche. Some airlines focus on cost, while others focus on having the best amenities, etc. Overall the bargaining power of buyers has an extremely low threat in this industry. Bargaining Power of Suppliers Next we look at the bargaining power of the suppliers. In this case the major suppliers are the airplane manufacturers. The top two manufacturers in the world currently are Boeing and Airbus(Odell,Mark). In this industry the inputs are extremely standardized. Airline companies only seem to differentiate with amenities. The planes are very similar. Currently some manufacturers are trying to make their plans more ecofriendly. Airline companies cannot easily switch suppliers. Most firms have long term contracts with their suppliers. Planes are such high capital products that firms probably make long term loan agreements and have more favorable credit terms when they don’t switch companies. It is difficult to enter into the plane manufacturing industry because of the capital needed to enter. The amount of money and expertise needed to make even one plane is around 200 million dollars. For this reason there are very few suppliers in the airline industry. Airline firms are the only source of income for these manufacturers so their business is extremely important. Based on these things the bargaining power of suppliers has a low threat as well. Threat of New Entrants Threat of new entrants is another major aspect of the five forces. This aspect has a low threat for the airline industry. There are two aspects that do however raise the threat level. First, there are extremely low switching costs. Second, there are no proprietary products or services involved. Even with these two aspects the industry still has a very low threat overall. Existing firms have a large cost advantage. This industry requires  a large amount of capital and without a strong customer base there will be little to no profit in the first few years. Existing firms can and will use their high capital to retaliate against newer firms with whatever means necessary such as lowering prices and taking a loss. Although there are low switching costs between brands, consumers tend to only chose well-known names. Airline tickets are expensive so people don’t want to give that money to firms they don’t trust. There is also a huge safety aspect involved and most consumers feel safer with firms that have been around for a long period of time. This industry requires plane and flying experience which also lowers the threat of entry. When firms decide to enter the market they first have to become licensed which can take about a year. After that they are constantly being regulated by several organizations such as the Federal Aviation Administration and the Department of Transportation. The time and money spend to solely open an airline company is enough to prevent most people from entering the industry. Threat of Substitutes After looking at the threat of entry it is important to also consider the threat of substitutes. This industry has a medium substitute risk level. There are substitutes in the airline industry. Consumers can choose other form of transportation such as a car, bus, train, or boat to get to their destination. There is however a cost to switch. Some means of transportation can be more costly than a plane ticket. The main cost is time. Planes are by far the fastest form of transportation available. Airlines surpass all other forms of transportation when it comes to cost, convenience, and sometimes service. Consumers do sometimes choose other methods for various reasons such as cost if they are not traveling very far which raises the risk. Rivalry among Existing Players The last area of the five forces is the rivalry among existing players. The rivalry in the airline industry is very intense for many reasons. The industry is currently very stagnant. It seems to be in the mature stage of the business cycle. The number of competitors stays the same in the long run  and it doesn’t seem to be under or over capacitated. The fixed costs are extremely high in this industry. This makes it hard to leave the industry because they are probably in long term loan agreements in order to stay in business. The products involved or the planes are highly complex which also heightens the competition. The competition is lessened by the brand identities of different firms. For example, Jetblue is known for its amenities and Southwest is known for its low prices. The market share seemed to be equally distributed because each company has its own part of the market and because switching costs are low none of the firms can really hold a large percentage of the market. The strongest forces in this industry are the competition of existing firms and the power of suppliers. The rivalry of existing players is high and will push out any firm that doesnt have enough capital. Suppliers are strong forces because planes are so costly to make. If the suppliers changed the credit terms by even a small amount it could mean a significant loss for the firm. On the other hand the other forces involved seem to have a weak threat. It is costly and time consuming to enter the market which lowers the risk of entry. Buyers have a weak force because of the low switching costs and substitutes are weak because they are usually too costly. The profit in this industry is high because for most people flying in necessary. It is not a trend which makes this industry profitable for the long term. Airlines that are more profitable are in a better position because they usually have more planes and a larger variety of flights which provides further convenience for the consumer. Recently there have been some changes in some of the forces. Some airplane manufacturers have been making ecofriendly planes, which is a change in the bargaining power of suppliers. This would differentiate the products, raising the threat of suppliers. Another recent change is the use of web portals such as Expedia to book flights. This positive change creates a whole new group of buyers and makes purchasing flights faster and easier. The increase in gas prices has also been a positive change for the industry  because it lessens the power of substitutes. People are more willing to fly to their destination if driving would be more expensive. After looking at the Five Forces Model firms should make dealing with the competition their main priority. The other areas in the model seem to have an overall low threat so existing firms don’t have to focus on those areas as much in their business strategy. Now that we have brought you through our Porters Five Force analysis, the last thing that is important to consider when exploring an industry, are the dominant economic features. The next section of our report will give you an overview of what features affect the airline industry most.

Estimation Model And Decomposition

Estimation Model And Decomposition In this lecture we introduce project estimation to estimate project resource requirements, time duration, human effort, and cost. We also discuss the models and techniques used in the project estimation. We also discuss the estimation methods such as comparative, top-down, bottom-up (engineering), historical analogy and expert judgment. Then we presented decomposition technique to break down the project into tasks to assist us in estimating the project. We focus on the work breakdown structure (WBS) decomposition method. Learning Outcomes Understand estimation model Understand decomposition technique and planning tools 1.0 Introduction In this lecture we continue discussion of project management in software engineering. We start by introducing the project estimation to estimate project resource requirements, time duration, human effort, and cost. We discuss the models and techniques used in the project estimation. We also discuss the estimation methods such as comparative, top-down, bottom-up (engineering), historical analogy and expert judgment. Then we present decomposition technique to decompose the project into tasks to assist us in estimating the project. We focus on the work breakdown structure (WBS) decomposition method. 2.0 Estimation Model Project estimation is a highly subjective and person-dependent process. A project task could be done in one day by one person but could take a few hours by another person. Hence, different estimates could be given by different persons of the time it takes to perform a task. After actual execution and performing of the task, the time it has taken to be performed is a measured, actual and real time. Accordingly, any time estimate to performing the task that is not close to the actual time is inaccurate. Project estimates are established at early in a project by the software development team and corporation management. These estimates are required for project resources, work to be done, project cost, project schedule, and time to delivery. Project estimates are required during project planning which is a crucial phase of the project lifecycle. Project estimating techniques are available based on metrics accumulated from past similar project experiences. Projects should be estimated in a structured and formal way, otherwise, estimates are inaccurate and projects could be handed in late. Structured and formal project estimation methods that use sound techniques and understanding have the following advantages: They make estimates more accurate They allow the project team to reach a consensus on the estimates They improve the accuracy of those estimates They make it much more likely that projects will come in on time Project planning requires estimates of the: Resource requirements Human effort- in person-months Time project duration- in calendar time Project cost and budget In practice, project history and past experience are often used as a guide in estimating the above values. The estimation usually requires breaking the project into pieces. At early stages in a project the software development team and management team must establish estimates for resources required (human resources, equipment, software, space, tools, etc.), work to be done and time to product delivery. Cost, time, and resource estimating techniques are available based on metrics accumulated from past similar project experiences. Usually, several approaches and methods are used to estimate these values. Then, estimated values that result from different estimation methods are compared. If these values vary widely, then this variance is taken as an indication of the need for more information. Projects could fail due to different causes related to project estimation. For example, the initial estimation of the budget needed for the completion of the project could be too little or too much. This can also be applied to the duration of the project, as some projects fail due to too little time being assigned for completion. As well as this, another factor that leads to project failure is ill planning, where the whole project is not planned out right from the start. Also, the goals and objectives of a project, which are developed at the start of the project may be regularly altered/changed which as a result causes confusion within the workforce. In addition to this, due to technology being a fast-paced industry, the personnel of the project need to stay up-to-date with this rapid change in order to use the correct the technology for the project. Finally, a lack of or ineffective communication between the workforce of the project, regardless of their role and position, can also l ead to broken interactions and project failure. Estimates could be inaccurate due to different reasons including people injury, sickness, or resign. Project development teams could run into unexpected technical problems, etc. Therefore, the objective of estimation is that people in the organization who have the training and knowledge to give an honest, well-informed opinion of the effort (time, cost, resources, etc. ) required to do a task. The uncertainty about the project could be reduced and more accurate estimates could be generated by producing well-documents about the project scope and vision by the organizations management and by reaching a consensus on the tasks that must be performed by the development team members. This consensus could be reached through discussion of assumptions. The following are some project estimation techniques (models): Source Lines of Code (SLOC): Source Lines of Code (SLOC) is the oldest metric for estimating project effort and thus is the primary input of older cost estimation models. The accurate estimation of a software project estimate is based on size of the project to be built. Project size is translated into human effort, time and money. Software Equation: In software equation estimate data is collected for thousands of similar projects and a the estimation model is a software equation as given below: EPM = (L x Sk(1/3) / PP)3 x (1/d4) Where EPM- is the Effort in Person Months L is the number of code Line Sk is the factor of Special sKills PP is the Parameter of Productivity D is the project Duration Using SLOC as input for cost estimation has some disadvantages because estimating the SLOC early in the software development lifecycle can be difficult. Therefore, if the SLOC estimate is inaccurate, the output of the dependant cost estimation model will be inaccurate. Software LIfecycle Management (SLIM): SLIM was developed in the late 1970s. Wideband Delphi: Wideband Delphi is an effective technique in estimating software tasks. Proxy Based Estimating (PROBE): This is an estimation method that looks at the history of a person in terms of components he has built in the past. It states that a person constructing a component that he has previously constructed (or one similar to it) then the amount of effort that will go into building this component will roughly be the same. The Constructive Cost Model (COCOMO): COnstructive COst MOdel (COCOMO) is a software cost and schedule estimating method which was developed in the early 1980s. It was developed through an experiment which involved the analyzing and evaluating of results for 63 software development projects. COCOMO was updated in 1991 for modern development life cycles, in order to accommodate larger sets of data. It is calculated on the basis of 15 cost factors. These factors, sometimes called variables, cover the cost of the software needed, any computer hardware that will be used, and the cost of labor (wages). These are inputted into the model and as a result, an output is arrived at estimating the size and effort that need to be put into the project for it to succeed. The Planning Game: The Planning Game is the software project planning method developed by Extreme Programming (XP). It was developed in the 1990s. It is basically used to manage the negotiation between the development team and the stakeholders (Business customers). Unlike Delphi, PROBE, and COCOMO, the Planning Game does not require a documented description of the scope of the project to be estimated. Rather, it is a full planning process that combines estimation with identifying the scope of the project and the tasks required to complete the software. Estimates use comparative estimate, grass roots estimate, engineering estimate (bottom-up), top-down estimate, historical analogy estimate, expert judgment estimate, models estimate, and/or rules-of-thumb estimate. Typically, estimates are made using some combination of these/some of these estimate methods. These estimate methods are described in the following paragraphs. Comparative estimate: Comparative estimate compares project with past similar projects. One advantages of this method is that estimates are based on actual experience. One disadvantages of this method is that truly similar projects must exist. Engineering estimate (Bottom-up): Engineering Estimate (Bottom-up) assigns different components of the project to individuals to estimate. Then, component estimates are summed to obtain total estimate of the project. Advantages of this method include generation of accurate estimates because of detailed basis for estimate, promotion of individual responsibility, and support of project tracking. Some disadvantages of this method are that the method is time- consuming, detailed data is needed which may not be available, especially before the project starts or early in the project, and integration costs may be disregarded. Top-Down estimate: Top-Down estimate partitions the project into lower level components where life cycle phases begin at highest level. Some advantages of this estimate are that it is more applicable to early project estimates, it considers system level activities, it is faster, and easier to implement. Some disadvantages of this estimate is that it is less accurate than other methods, it tends to overlook lower-level components, and it provides little detail. Historical analogy estimate: Historical analogy estimate is based on using the software size, effort, or cost of a comparable project from the past. The comparison is made using measures or data that has been recorded from completed software projects. Analogical estimates can be made at high levels using total software project size and/or cost for individual Work Breakdown Structure (WBS) categories in the process of developing the main software cost estimate. Expert judgment estimates: Expert judgment estimates specifies that software development team consults with one or more experts. Some advantage of this estimate is that little or no historical data are needed, and it is good for new or unique projects. Some disadvantages of this estimate is that experts tend to be biased, and their knowledge level is sometimes questionable. This is a subjective estimate based upon what the estimator remembers from previous projects and gets modified mentally as deemed appropriate. If the estimator has significant recent experience in both the software domain of the planned project then, expert judgment can be relatively accurate. Model-based estimate: Model-based estimate uses mathematical relationships or parametric cost models. Parametric cost models are empirical relationships derived by using statistical techniques applied to data from similar previous projects. Rules-of-thumb estimate: Rules-of-thumb estimate come in a variety of forms and can be a way of expressing estimates as a simple mathematical relationship (e.g. cost = Lines_of_Code / 10) or as percentage allocations of effort over activities or phases based upon historical data (e.g. coding task is 22% of Total Effort). The popular project estimates approach is to use several methods and compare values. If these values vary widely, then this variance is taken as an indication of the need for more information. Model-based estimates along with high-level analogies are the principal source of estimates in early conceptual stages. At early stages of the project or before it starts, we usually do not have a clear estimates, but as a project matures and the requirements and design are better understood, analogy estimates based upon more detailed functional decompositions become the primary method of estimation, with model-based estimates used as a means of estimate validation or as a correctness check. Whatever method is used, it is most important that the assumptions and formulas are documented to enable more thorough review and to make it easier to revise estimates at completion of the project when assumptions may need to be revised. Expected Value for Software Size is computed as follows: Suppose that: Expected value for estimation variable (size) estimate = S, Weighted Average of Optimistic estimate = (S opt) Most likely estimate (S m) Pessimistic estimate (S pess ) Then, S can be computed as: S = (S opt +4 S m + S pess)/6 The calculation of the effort put in, in terms of persons-month, in a dynamic multi variable model can be defined as follows: Software Equation (E) = [LOC * B0.333/P]3 *(1/t4) Where: E is effort in person-months, t is the duration of the project, B is special skills factor, P is productivity. 2.1 Decomposition Technique Decomposition technique is used to estimate the project as presented in the previous section. After decomposing the entire project into a number of smaller tasks, we make project estimates. It is easier to handle smaller tasks than to handle a very larger project as a whole. So, the entire project (problem) is broken down into number of smaller tasks (problems) and then each smaller problem could be solved easily. Decomposition technique is used as a technique or model for cost and project estimate. It is difficult to estimate the project as one task. Therefore, the project is decomposed into smaller tasks and each task is estimated individually and then the partial estimations of project tasks are added up for the whole project. Decomposition technique is used as a technique or model for cost and project estimate. It is difficult to estimate the project as one task. Therefore, the project is decomposed into smaller tasks and each task is estimated individually and then the partial estimations of project tasks are added up for the whole project. A sound and formal estimate starts with a work breakdown structure (WBS). A WBS is a list of project major phases, deliverables, and work components (tasks) that will be built by the project that, when completed, will produce the final product. These work components/tasks can then be broken down into the activities that are required to build them. The concept of this technique is to break down the work into smaller tasks. Each task can in turn be broken down further. This technique is very useful for the project development team and project management team to become familiar with the scope of the project, identifies work tasks, needed resources, and cost estimation. It also helps to monitor the projects progress. Project managers use the Work Breakdown Structure (WBS) to estimate projects and make complex projects more manageable. Some advantages of using WBS include: Assists with more accurate project estimation in cost, effort, resources, and schedule Assists with project organization Helps with assigning responsibilities to project development team members. A WBS that is correctly designed allows for the easy assignment of tasks to a specific element of the WBS, cutting down on confusion/duplication of assigned tasks. Shows the control points and project milestones Helps explain the project scope to customers and stakeholders Assist in planning and control of the project Tasks and Subtasks are related to each other in the sequence of project task networks. Project Task networks graphically visualize the tasks/sub-tasks and their relationships. Project Task networks are also known as activity networks. The Work Breakdown Structure is a tree structure. The root of the tree is the whole project and the children of the root are the main tasks at first level of the tree which compose the project. At level 2 of the tree are the sub-tasks of the main tasks of the project at level 1. The rest levels of the tree are constructed similarly. Using the tree structure of the WBS allows the determining of secondary costs for tasks, resources, etc., into their advanced level parent tasks, materials, etc. The WBS is the basis for dividing work into defined tasks from which the, schedule, cost, and labor hour reporting can be established. There are many ways to decompose a project into tasks. Different project break-down ways lead to different estimates. If the generated WBS is incorrect, then the project estimates are wrong and time is wasted in doing the estimates. The project can be broken down by feature, by project phase (requirements tasks, design tasks, programming tasks, QA tasks, etc.), or by some combination of the two. WBS uses similar previous projects history and previous experience of projects that have been developed to generate project t estimates. Large projects are broken into more tasks than smaller projects or they can be broken into larger tasks than smaller projects. WBS, when created, is used by the project team to create an estimate of the effort required to perform each task. The most accurate estimates are those that rely on similar projects history and prior experience. Team members should review previous project results and find how long similar tasks in previous projects took to complete. Sources of delays in the past should be taken into account when making current estimates. The level of granularity of WBS varies depending on the level of abstraction and what information is available. At lower-levels of the WBS, expert judgment is the primary method used, while at higher levels of the WBS model-based estimates are more common. It is not possible to define a task set for the project uniquely. No set of tasks is appropriate for all types of projects. Project breakdown into tasks is dependent on the size of the project, complexities involved in the project, constraints of the projects and the skill set and capabilities of the team members working on the project. Project tasks have to be properly distributed according to the needs of the project deadlines and schedule. To develop a project schedule, a task set must be distributed on the project time line. The project set of tasks is defined based on the category of the project which is dealt with by the development team. Summary In this lecture we introduce project estimation to estimate project resource requirements, time duration, human effort, and cost. We also discuss the models and techniques used in the project estimation. We also discuss the estimation methods such as comparative, top-down, bottom-up (engineering), historical analogy and expert judgment. Then we presented decomposition technique to break down the project into tasks to assist us in estimating the project. We focus on the work breakdown structure (WBS) decomposition method. Exercises Is it possible to create a realistic estimate before the project team has agreed on the technical design for the software? When the team is working together to generate an estimate, should the testers estimate tasks which will be performed by the programmers? List three models of project estimate. What is estimated using project estimate? Describe the objectives of using decomposition technique? List advantages of decomposition technique for company managers. Describe the Source Lines of Code (SLOC) estimation method. List two advantages and two disadvantages of using The Constructive Cost Model (COCOMO). What is the difference between Engineering estimate (Bottom-up) and top-down estimate? Explain decomposition techniques. How do you define a task set for the software project? What are project task networks?

How Spreadsheets can Solve Complex Problems

How Spreadsheets can Solve Complex Problems Explain how spreadsheets can be used to solve complex problems (P1) Task 1: Generate a report explaining how spreadsheets can be used to solve the following complex problems giving examples to support your explanation Cash flow forecasting Cash flow forecasting is used to see what comes into a business and what goes out. This estimates amounts of cash that comes in and goes out during a period of time. A cash flow forecast will show what the firm is spending its money on.   Ã‚   Cash flow forecasting can be used in spreadsheets as you can use formulas on it to calculate sums and there is less errors whilst using it. It saves time you can calculate things quicker on it rather than doing it one by one. You can conditional format on it which sets rules and highlights the rows you need highlighting. This cash flow sheet shows the money coming and going out between a time. It shows money that comes in each month of the year and how much goes out for things like expenses, wages and so on. When you input data into the cells it will automatically calculate the data with the formulas in the cells. They can then use this years cash flow sheet and compare it to next years seeing if there is any difference. Budget control Budgetary control is how well you utilise budgets to keep track of costs under control and operations in a certain time period. Budget control is a process for managers to put financial and performance targets in place with budgets, compare the final result, and adjust performance when it is needed. Organisations will use budget control to keep costs under control so they dont over spend. This budget control shows the budget limit which is $5,000 and they have spent $3,000 leaving them with $2,000 available. This show that they have spent $1,000 on internet, $500 on postage and $1,500 on rent. It has calculated the total and has shown how much they have left to spend. What-if scenarios What-if scenario is the way businesses use a planning and modelling technique to get various projections for outcomes based on selectively changing the inputs. Scenario planning lets a business to be prepared for dramatic situations more quickly and act effectively because they have made strategies to use. In this spreadsheet, there are 11 people who have taken the test. The people who have an average of over 15 have passed and the ones who have an average of less than 15 have failed. The people who have passed are coloured in green and the people who have failed are in red. The colours displayed are according to the what-if scenario. Sales forecasting Sales forecasting is the process of predicting sales in the future. An accurate sales forecast enables companies to make informed business decisions and predict short-term and long-term performance. Companies can base their forecasts on past sales data and economic trends. If a business is creating a sales forecast on paper they will get many errors in calculations as they have to enter the data and calculate it manually. If a business uses excel to make their sales forecasts they will find it easier as there will be less errors and it will calculate automatically without any errors. Payroll projections In any businesses or organisations, they will have a system which will work out the wages for the staff and this system also calculates taxes payed according their wage. In other words, it shows how much to pay workers and employees during a week, month or other period. In this payroll projection sheet, you can see the included amounts that the business will pay its employees. This is based on the hours that they are working regularly, vacation/holidays hours, sick hours, gross pays, taxes, net pay etc. This is easy for a business to use at it will automatically adjust the wage according to the hours they work. Statistical analysis Statistical analysis is the collection of data, presenting large amounts of data and exploring data to find   patterns and trends. They can use average, mode and median to calculate the overall figures. After the data has been collected you can present it in different formats such as graphs and tables. Once the graph has been completed you are bale to analyse it for underlying patterns and trends. In statistical analysis, a business or an organisation can solve complex problems by entering different sorts of formulae to calculate the average, mode, median or total of a cell. Trend analysis Trend analysis is an analysis that will let businesses to predict what will happen with a stock in the future. Trend analysis is based on data from the past about the stocks performance given the overall trends and patterns of the market and certain indicators within the market. Trend analysis gives out ideas and records on past income, expenses and net cash flow of the past so they can use this to improve the production of their businesses. This graph show the amount of money a brand makes within a month. We can see which brand has the least and highest amounts by looking at the graph chart. By using graphs and charts it becomes more organised and shows who has made profit and who has lost money. Discuss how organisations can use interpretation methods to analyse data (D1) Comparisons of data Organisations can use many interpretation methods to analyse data. They can compare data from using SUM, AVERAGE, COUNT, SUMIF, ROUND, SUBTOTAL, RAND, RATE, MIN, MAX, SYD FV etc. Sum The sum is a formula which will allow you to add different values from different cells. This makes it easier for you as it will allow you to add big numbers together without any errors. The calculation is done automatically. For example = SUM (B4:B12) =SUM (B9:B12, D4:D17) Average The average or arithmetic mean is the calculation of 2 or more different values. Where number 1 may contain a cell reference or range that you want as an average. And number2 can be optional numbers that can go up to 255 max. The average normally refers to the mean value of a variety of numbers in a set that is found by adding all the numbers in the set and then dividing the answer by how many numbers there was in the set. Count The count function counts all the cells that contains numbers and it will put all the numbers in a list of arguments. The use of count function is to get a number field in a range of numbers. For example; we can enter a formula or function that would count the from B1:B27 =COUNT (B1:B27) Sum IF The use of SUMIF function is to add up the values in a range that would meet the task or criteria that you choose. For example, if you want to add/sum only the values that are larger than in a column, you can use the formula =SUMIF (C2:C25,>5) or you can just click on any option from conditional formatting. Round The round function rounds a number to an any decimal point you want. For example, if cell E2 contains 55.86987, and you want it to be rounded to two decimal places then you can use this formula =ROUND (E2.2) then your number will be rounded to 55.86. Subtotal A subtotal is a list or database in a spreadsheet where it only contains subtotals from cells of larger cells. Once you have created a subtotal you can then edit or modify it by using the subtotal function which is SUBTOTAL (function, ref2, [ref3],). Trend analysis Trend analysis is the movements and the course of a trend that can suggest not only what has happened in the past but it can also predict what will happen in the future. The objective of the trend analysis is there to answer questions by assessing changes in a collection of values of a variable. This can things such as the changes in the profit made daily for a specific product. Businesses can use trend analysis in spreadsheets by using graph charts that would allow people to easily see the trend analysis of the business and it will be able to be understood quicker. They can also see where the business is making profit and where it is making loss. Purpose of Trend Analysis Business leaders can make mistakes, and these mistakes can cost them. Trend analysis is a helpful tool that leaders use to limit the risk of tactical, operational and financial tactics. This tool   can let leaders make decisions linked to trends that suggest the success of one opportunity compared to another. By doing this they cause less room for error and businesses will be more successful. Charts and Graphs: Many businesses and organisations use different types of charts and graphs to determine whether if they are going to experience a loss or profit by adding all monthly or yearly expenses. These charts can include pie charts, line chart, brick chart, bar box and vertical bar graph etc. Pie Charts: Line charts: Series 1: Loss: 3% Profit: 4.5% Series 2: Loss: 1.9% Profit: 3% Series 3: Loss: N/A Profit: 5% Bar box: Category 1: Series 1: 4.2% Series 2: 2.4% Series 3: 2% Category 2: Series 1:2.5% Series 2: 4.3% Series 3: 2% Category 3: Series 1: 3.5% Series 2: 1.8% Series 3: 3% Category 4: Series 1: 4.5% Series 2: 2.8% Series 3: 5%

A View From The Bridge Essay-Arthur Miller -- English Literature:

A View From The Bridge Essay-Arthur Miller â€Å"A View From The Bridge† is a story with many themes and aspects such as love, The American Dream, Justice, Law and Family Honour. The story â€Å"A View From The Bridge† is about an Italian American community living in Red Hook, New York. The Italian American community in Red Hook are mainly all immigrants living in the country unlawfully. I will briefly describe the play. Alfieri, an Italian-American lawyer in his fifties, enters the stage and sits in his office. From his desk he talks to the audience and he introduces the story of Eddie Carbone. Alfieri compares himself to a lawyer in Caesar’s time. Eddie walks down the street to his house As Eddie reaches his front door two fellow Longshoremen, Louis and Mike greet him. Eddie’s niece, Catherine reaches out of the window and waves to Eddie and Louis. When Eddie enters the house he gently scolds Catherine for flirting with the boys. Eddie thinks she should be more reserved and not †walk so wavy†. Beatrice, Eddie’s wife, is also home. When Beatrice and Catherine set the table for dinner, they convince Eddie to let Catherine take a job as a stenographer down by the docks but Eddie didn’t want her to take the job because he thinks the men will take advantage of her and he wants Catherine to finish college. Eddie informs Beatrice that her cousins Marco and Rodolpho will be arriving early from Italy. Beatrice and Eddie plan to hide Marco and Rodolpho while they work in the country illegally to send money back home. Marco and Rodolpho arrive at the house and a brief reunion. Marco tells the Carbone family that he has three children and a wife back home that he will be sending money to. Rodolpho is the younger blond... ... sight of a man destroying himself, while those around him are as powerless as the audience to prevent it. This is hinted at by the beginning of the play. This play shows a whole range of emotions and tackles many issues such as The American Dream, Justice, Law and family Honour. In the end I thought that because Eddie and Catherine cared deeply for each other this led to Eddie being jealous of Rodolpho and over protective of Catherine, which split the relationship between Catherine and Eddie but also led towards the death of Eddie. All the characters in the play then suffered a tragedy because nobody gained anything in the play or achieved their dreams but mostly lost things instead of gaining things. Family honour might have been satisfied, but only through Eddie so that also proved to be negative because only Eddie dealt with it and nobody else did.

Language in Shakespeares The Tempest Essay -- essays research papers

This essay will attempt to find out the type of language that Shakespeare has used to portray the hatred and utter spite Prospero evidently has over Caliban. The great number of offensive dialogue during the argumentative conversation between Caliban and Prospero will be commented on. During the conversation, many ill-disguised remarks of contempt are made by all three characters. This will be analysed further and the reasons and consequences of the exchange will be described. There are a great number of reasons for why Prospero and Caliban are not by any means on respectful terms, and the factors that have lead to this occurrence will be expressed in order to explain the spiteful nature of Prospero in particular. In the play ‘The Tempest’, Prospero and Caliban are portrayed as two completely opposite characters with contradictory and clashing views. Prospero, who was the rightful heir to become duke of Milan before being cast away and the ‘deformed slave’ Caliban are symbolic of opposite extremes, particularly in their roles in society and hierarchy. Prospero is a natural leader and is intellectually disciplined, while Caliban not only does not behave in this kind of manner, he seems to completely stand against it and ignore any order and is ‘capable of all ill’ according to Prospero. Caliban’s careless, unethical nature, and being born as part of a ‘vile race’ is an immediately apparent reason for Prospero’s hatred of him. Shakespeare quickly portrays the two characters as of clashing personalities during the passage, depicting Prospero as a person who emphasizes social lustre and class and uses his great intellect to onl y give others what he thinks they deserve. While Caliban is illustrated as an animalistic character, wi... ...can show his true contempt. In conclusion, the language Shakespeare uses to depict the hatred Prospero has for Caliban emphasises the separate backgrounds and values they share and the lack of understanding they have for one another. The fact that Prospero is heir to being duke of Milan and Caliban is the product of an unholy passion between the witch Sycorax and the devil, suggest opposing themes of backgrounds and therefore they share contradictory views of each others heritage and conduct. Therefore they stand against what the other values, causing a clash. The reader may feel that Prospero’s contempt of Caliban is within reason, due to his attempted violation of Miranda, and the fact that Prospero has been hurt and betrayed by many in the past, and therefore has a great amount of vengeance he can share out due to the attachment he has with his fiery emotions.

Healthcare-associated infections (HAIs) Essay

BACKGROUND Healthcare-associated infections (HAIs) are bacterial infections acquired during a patient’s stay in a healthcare institution.   It imposes a huge burden on healthcare institutions, costing billions of dollars for additional care costs as well as a significant fraction of lost lives (Houghton, 2006).   Current estimates depict that approximately 2 million patients acquire healthcare-associated infections (HAIs) or nosocomial infections each year, of which 90,000 to 100,000 patients die (Houghton, 2006), making HAIs not only a national health problem, but a global threat as well.   Common HAIs include hematological, surgical site, dermatological, respiratory, urinary and gastrointestinal systems.   In order to control the increase in number of healthcare-associated infections, it is fundamental to identify key factors that make healthcare institutions susceptible to such outbreaks.   There is a need to evaluate the sensitivity and efficiency of healthcare institutions to healthcare-associated infections in order to prevent future outbreaks. PROBLEM STATEMENT   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This study will investigate the sensitivity of detection and efficiency of reporting healthcare-associated infections to the hospital administration, in the context of providing measures in improving the current surveillance program in the country.   The guidelines to identification of a healthcare associated infection will be evaluated through personal interactions with healthcare workers using questionnaires which will be designed using a multiple choice approach. CONCEPTUAL/THEORETICAL FRAMEWORK   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This study is based on the need to address the current epidemic of healthcare-associated infection that is emerging around the world.   Before an effective solution to the problem is designed, it is essential that shortcomings in the standard procedures of healthcare institutions be identified.   This may be done by determining the level of sensitivity of healthcare personnel to symptoms of healthcare-associated infections, as well as knowing what are the first set of actions to be done once an infection is confirmed within a healthcare institution.   This study may serve as the first measurement tool that addresses these aspects of the global epidemic.    RESEARCH QUESTION/HYPOTHESIS   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This investigation aims to address the question of whether the current hospital administration is sensitive enough to detect and substantially efficient to report to healthcare institutions any incidents of healthcare-associated infections.   This will be directly evaluated using survey data collections from retrospective cases of particular health institutions as related to dates of hospital admission, confirmation of infection and treatment time.    SIGNIFICANCE OF THE STUDY   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There is a need for an effective surveillance and control program for healthcare-associated infections that are based on current settings in a healthcare institution.   Through surveys that inquire on common practices and responses of healthcare workers, any shortcomings or avoidable gaps in the hospital system may be reformed, which in turn will alleviate the spread of infection in the healthcare institutions.   Review of medical records and interviews with attending healthcare personnel will be performed in order to determine whether there are certain discrepancies and gaps in the healthcare protocol that facilitate contamination and further spreading of infectious microbials around the healthcare institution.   This study may facilitate the identification of key factors that influence the increase in frequency of nosocomial infections in hospitals.   The results of this investigation may positively serve as a tool to healthcare workers such as nurses and laboratory technicians. STATEMENT OF THE PURPOSE (OBJECTIVES)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This research will determine the sensitivity and response rate of healthcare workers to healthcare-associated infections.   This proposal aims to develop a measurement tool that will determine the sensitivity for identification, efficiency of reporting and the response rate to a healthcare-association infection, with the aim of designing a cost-effective and quick way of controlling and ultimately eradicating the healthcare-related problem.       LITERATURE REVIEW   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The prevention and control of HAIs requires a comprehensive approach that addresses as many pathogens as possible (Wiseman, 2006). Urinary tract infections (UTI) associated with catheter use are the most common HAIs, with hospital-acquired pneumonia having the highest mortality rate (Houghton, 2006).   These infections are frequently problematic to treat due to the fact that the microorganisms involved have become resistant to antibiotics (Broadhead, Parra and Skelton, 2001). Recent media coverage of meticillin-resistant Staphylococcus aureus (MRSA) has increased the awareness of healthcare professionals to the threat of this particular microbe.   S. aureus infections can result in cellulitis, osteomyelitis, septic arthritis and pneumonia, and some of the systemic diseases such as food poisoning, scalded skin syndrome and toxic shock syndrome (Zaoutis, Dawid and Kim, 2002).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   MRSA and vancomycin-resistant Enterococcus (VRE) are the primary causes of nosocomial infections and are significant factors in increased morbidity and mortality rates. These microbes are currently endemic in many healthcare institutions, particularly problematic in intensive care units (ICUs) (Furuno, et al. 2005).   VRE Infections have become prevalent in U.S. hospitals over the last decade, increasing in incidence 25-fold (Ridwan et al., 2002).   Vancomycin is the antibiotic frequently used to treat infections caused by MRSA, but recent years have seen the emergence of Staphylococcus aureus infections that have high-resistance to vancomycin, which makes the future effectiveness of this drug questionable (Furuno et al., 2005). All known variants of the vancomycin-resistant Staphylococcus aureus (VRSA) isolates have possessed the vanA gene, which carries with it resistance to vancomycin.   This development is believed to have been acquired â€Å"when the MRSA isolate conjugated with a co-colonizing VRE isolate† (Furuno et al., 2005, p. 1539). This means that patients who suffer co-colonization from MRSA and VRE have an increased risk for colonization and infection by VRSA (Furuno et al., 2005). Furthermore, Zirakzadeh and Patel (2006) stated that VRE has become a major concern due, in part, to its ability to transfer vancomycin resistance to other bacteria, which includes MRSA.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Infection of susceptible patients typically occurs in environments that have a high rate of patient colonization with VRE, such as ICUs and oncology units (Zirakzadeh and Patel, 2006).   In these healthcare settings, VRE has been known to survive for extensive periods and research has also observed that VRE has the ability to contaminate virtually every surface (Zirakzadeh and Patel, 2006). Efforts to control HAIs, such as VRE, have focused on prevention, such as through hand hygiene, as the first line of defense.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Hand hygiene has been improved by using â€Å"user-friendly, alcohol-based hand cleansers, but there still remains the goal of achieving consistently high levels of compliance with their use† (Carling et al., 2005, p. 1).   Screening-based isolation practices have likewise improved transmission rates of MRSA and VRE; however, logistic issues and the cost-effectiveness of these practices are still being analyzed (Carling et al., 2005). Additionally, despite isolation practices, outbreaks and instances of environmental contamination have been documented in regards to MRSA, VRE and Clostridium difficile, which cannot be screened with any practicality (Carling et al., 2005).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The numerous obstacles that exist in regards to effective screening practices suggest that a focus on improving existing cleaning/disinfecting practices may prove to be more effective in halting the spread of HAIs (Carling et al., 2005). Studies over the last several decades have shown that there is often contamination of surfaces in and around the patient, as pathogens associated with the hospital environment have been known to survive on surfaces for weeks or even months (Carling et al., 2005). Significant rates of contamination with Clostridium difficile have been connected with symptomatic and asymptomatic patients (Carling et al., 2005).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In 2002, the CDC issued guidelines that called for hospitals to â€Å"thoroughly clean and disinfect environmental medical equipment† surfaces on a regular basis (Carling et al., 2005, p. 2). Other organizations have followed suit and stressed repeatedly the need for healthcare provides to focus on environmental cleaning and disinfecting activities, yet these guidelines have not provided directives that address precisely how healthcare providers can either evaluate   their ability to comply with professional guidelines on this topic or ensure that their procedures are effective (Carling et al., 2005).   Nevertheless, literature on the subject does offer some guidance.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Surveillance, evidence-based infection control practices and the responsible use of antibiotics have been determined to be crucial to controlling HAIs (Wiseman, 2006).   The establishment of comprehensive surveillance programs has facilitated the creation of national databases the compile cases of infection which may be useful to researchers investigating progression rates and causal factors.   Evidence-based control practices may be implemented by distributing guidelines for aseptic hospital protocols, hospital hygiene, personal protective equipment and disposal of biohazardous sharps.   A review of commonly used antibiotics in terms of proper dosage and length of treatment based on clinical evidence and best practice guidance should also be performed.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Curry and Cole (2001) reported that the medical and surgical ICUs in large inner-city teaching hospitals developed an elevated patient VRE colonization rate. A multi-faceted approach was instituted to correct this problem, which involved changing behavior by â€Å"shifting norms at multiple levels through the ICU community† (Curry and Cole, 2001, p. 13). This intervention consisted of five levels of behavioral change. These encompassed: â€Å"1. intrapersonal and individual factors; 2. interpersonal factors; 3. institutional factors; 4. community factors and 5. public factors† (Curry and Cole, 2001, p. 13).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Educational interventions were developed that addressed each level of influence and behavioral change was predicated on â€Å"modeling, observational learning and vicarious reinforcement† (Curry and Cole, 2001, p. 13). These procedures resulted in a marked decrease of â€Å"VRE surveillance cultures and positive clinical isolates† within six months and this decrease has been consistent over the next two years (Curry and Cole, 2001, p. 13).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Research has shown that the nutritional status of preoperative and perioperative patients can influence their risk for acquiring a HAI (Martindale and Cresci, 2005). This is particularly true for patients who are undergoing surgery for neoplastic disease as this can commonly result in immunosuppression (Martindale and Cresci, 2005). Inadequate nutrition, â€Å"surgical insult, anesthesia, blood transfusions, adjuvant chemotherapy/radiation/ and other metabolic changes† have been identified as contributing to suppression of the immune system (Martindale and Cresci, 2005). Furthermore, studies have also associated infection risk with glycemic control Maintaining blood glucose levels between 80 and 110 mg/dL vs. 180 and 200 mg/dL has been shown to result in fewer instances of â€Å"acute renal failure, fewer transfusions, less polyneuroopathy and decreased ICU length of stay† (Martindale and Cresci, 2005, p. S53).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Citing Ulrich and Zimring, Rollins (2004) states that getting rid of double-occupancy rooms and providing all patients with single rooms that can be adjusted to meet their specific medical needs can improve patient safety by reducing patient transfers and cutting the risk of nosocomial infections. While these researchers admit that the up-front cost of private rooms is significant, this will be offset by the savings accrued through lowers rates of infection and readmission, as well as shorter hospital stays (Rollins, 2004).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   A recent study conducted by researchers at Chicago’s Rush University Medical Center found that enforcing environmental cleaning standards on a routine basis resulted in less surface contamination with VRE, â€Å"cleaner healthcare worker hands, and a significant reduction in VRE cross-transmission in an ICU† (Cleaning campaign, 2006, p. 30). These improvement in VRE contamination continued to be experienced even when VRE-colonized patients were continually admitted and healthcare workers compliance with hand hygiene procedures were only moderate (Cleaning campaign, 2006). The strategies that the researchers implemented included that they: held in-services for housekeepers about why cleaning is important–emphasizing thorough cleaning of surfaces likely to be touched by patients or workers. increased monitoring of housekeeper performance. recruited respiratory therapists to clean ventilator control panels daily. educated nurses and other ICU staff on VRE and how they could assist housekeepers by clearing surfaces that need cleaning. conducted a hand hygiene campaign, including: mounting alcohol gel dispensers in common areas, patient rooms and every room entrance (Cleaning campaign, 2006, p. 30).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   CDC guidelines indicate that if hands are not visibly soiled, using an alcohol-based hand rub should become habitual between patient contacts. When hands are visibly soiled, use of an anti-microbial soap and water is required. If contact with C difficile or Bacillus anthracis is possible, it is recommended that the healthcare provider wash with anti-microbial soap and water, as other antiseptic agents have poor efficacy against spore-forming bacteria and the physical friction of using soap and water at least decreases the level of contamination (Houghton, 2006). Page (2005) indicates that the CDC has joined with the US Department of Health and Human Services, the National Institutes of Health (NIH and the Food and Drug Administration (FDA) to lead a task force of 10 agencies and departments, which have developed a blueprint outlining federal actions to combat this problem. This template emphasizes the efficacy of hand washing, among other points (Page, 2005).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In 2002, the CDC issued updated hand hygiene guidelines, which address new development and research on this topic, such as â€Å"alcohol-based hand rubs and alternatives to antibacterial soaps and water† (Houghton, 2006, p. 2). However, while the efficacy of hand hygiene is well accepted, it is also well known that healthcare workers â€Å"of all disciplines† frequently fail to abide by adequate hand hygiene practices (Houghton, 2006, p. 2). In fact, research has shown that adherence rates to hand hygiene guidelines are lowest in ICUs, where to the frequency of patient care contact, multiple opportunities for hand hygiene exist on a hourly basis (Houghton, 2006). According to Houghton (2006), any direct patient-care contact, which includes contact with gloves and/or contact with objects in the immediate patient vicinity, constitutes an â€Å"opportunity† for appropriate hand hygiene.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This suggests that the proposed intervention should also include asking healthcare employees at the site of the intervention to participate in a survey that examines, first of all, how closely hand hygiene protocols are followed and, if they are not followed, why not. It may be that the activity level of ICUs is so great that the practitioners feel that they cannot take sufficient time to do adequate hand hygiene. If this is the case, alternative methods of hand hygiene to that institution’s traditional policy may need to be investigated.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Just as this study revealed factors that can be associated with non-compliance, a similar investigative effort may be called for to determine reasons why compliance may not be satisfactory for cleaning/disinfecting environmental surfaces. Again, it may be that non-compliance hinges on factors of time.   It may be, therefore, expeditious for hospitals and other healthcare organizations to look into hiring additional personnel to aid with cleaning/disinfecting tasks. It may also prove necessary, to cope with factors of time and efficiency, to train cleaning personnel to take a systematic approach to patient room cleaning that includes all â€Å"high touch† areas. As noted previously, researchers at Chicago’s Rush University Medical Center found that holding in-service training for housekeepers was an effective component of their overall strategy in lowering VRE related infections (Cleaning campaign, 2006). This process could be facilitated by a checklist approach or by periodically reevaluating rooms according to the Carling et al. (2005) methodology.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Given these detailed accounts of healthcare-associated infections in hospitals, it is of significant importance that the sensitivity and response rate of health personnel be identified in order to know if there are any discrepancies and gaps in the standard hospital protocols that foster the expansion of microbials in hospitals.   This study aims to determine the level of sensitivity and response rate of healthcare institutions to the growing epidemic of healthcare-associated infections.    SUMMARY   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   HAIs are an unnecessary tragedy, increasing morbidity and mortality figures and adding to healthcare costs. While there are ways to treat all the various HAIs, the clearest remedy for this insidious drain on healthcare resources and personnel is prevention, which begins with the simplest of acts–washing one’s hands–but also extends to considering all hospital surfaces as having the potential to harbor pathogens. This means rethinking some healthcare institutional procedures. It means habitually and routinely cleaning all surfaces, as well as everywhere and anything that is routinely touched, whether by a bare or gloved hand.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Stopping the spread of HAIs includes multiple factors, such as restrained and appropriate use of antibiotics. However, the first line of defense is cleaning/disinfecting procedures. This constitutes the â€Å"ground zero† foundational line for battling HAIs and this means that all healthcare practitioners should keep the goal of reducing the spread of HAIs foremost in their minds while going about their daily routines, washing hands between each patient contact and paying attention to other sepsis concerns. In other words, the first step in stopping HAIs is simply to keep them in the forefront of practitioner consciousness. References Broadhead, J. M., Parra, D. S., & Skelton, P. A. (2001). Emerging multiresistant organisms in the ICU: Epidemiology, risk factors, surveillance, and prevention. Critical Care Nursing Quarterly, 24(2), 20. Carling, P. C., Briggs, J., Hylander, D., & Perkins, J. (2006). An evaluation of patient area cleaning in 3 hospitals using a novel targeting methodology. American Journal of Infection Control, 34(8), 513-519. Centers for Disease Control and Prevention. (2006). Healthcare-Associated Infections (HAIs).  Ã‚   Retrieved March 17, 2007, from http://www.cdc.gov/ncidod/dhqp/healthDis.html Cleaning campaign targets VRE transmission. (2006). OR Manager, 22(7), 30. Curry, V. J., & Cole, M. (2001). Applying social and behavioral theory as a template in containing and confining VRE. Critical Care Nursing Quarterly, 24(2), 13. Furuno, J. P., Perencevich, E. N., Johnson, J. A., Wright, M.-O., McGregor, J. C., Morris Jr, J. G., et al. (2005). Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococci co-colonization. Emerging Infectious Diseases, 11(10), 1539-1544. Harrison, S., & Lipley, N. (2006). Wipe It Out infection control initiative extended. Nursing Management – UK, 12(10), 4-4. Houghton, D. (2006). HAI prevention: The power is in your hands. Nursing Management, 37(5), 1-8. Johnson, A.P. Pearson, A. and Duckworth, G.   (2005):   Surveillance and epidemiology of MRSA bacteraemia in the UK.   J. Antimicrob. Chemo.   56:455–462. Lopman, B.A., Reacher, M.H., Vipond, I/.B., Hill, D., Perry, C., Halladay, T., Brown, D.W., John Edmunds, W. and Sarangi, J.   (2004):   Epidemiology and Cost of Nosocomial Gastroenteritis, Avon, England, 2002–2003.   Emerg. Infect. Dis.   10(10):1827-1834. Martindale, R. G., & Cresci, G. (2005). Preventing Infectious Complications With Nutrition Intervention. JPEN, Journal of Parenteral and Enteral Nutrition, 29(1), S53. Page, S. (2005). MRSA, VRE and CDC’s plan to combat antimicrobial resistance. Vermont Nurse Connection, 8(3), 6-7. Parienti, J. J. M. D. D. T. M., Thibon, P. M. D., Heller, R. P. P., Le Roux, Y. M. D. D., von Theobald, P. M. D. D., Bensadoun, H. M. D. D., et al. (2002). Hand-rubbing with an aqueous alcoholic aolution vs traditional surgical hand-scrubbing and 30-day surgical site infection Rates. JAMA, 288(6), 722-727. Ridwan, B., Mascini, E., Reijden, N. v. d., Verhoef, J., & Bonten, M. (2002). What action should be taken to prevent spread of vancomycin resistant enterococci in European hospitals? British Medical Journal, 324(7338), 666. Rollins, J. A. (2004). Evidence-Based Hospital Design Improves Health Care Outcomes for Patients, Families, and Staff. Pediatric Nursing, 30(4), 338. Sheff, B. (2001). Taking aim at antibiotic-resistant bacteria. Nursing, 31(11), 62. STATA 8.0. College Station (TX): STATA Corporation; 2002. Stevenson, K.B., Searle, K., Stoddard, G.J. and Samore, M.H. (2005):   Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci in rural communities, Western United States.   Emerg. Infect. Dis.   11(6):895-903. Tacconelli, E. Venkataraman, L., De Girolami, P.C. and D’Agata, E.M.C.   (2004):   Methicillin-resistant Staphylococcus aureus bacteraemia diagnosed at hospital admission: distinguishing between community-acquired versus healthcare-associated strains.   J. Antimicrob. Chemother. 53:474-479. Wiseman, S. (2006). Prevention and control of healthcare associated infection. Nursing Standard, 20(38), 41-45. Zaoutis, T., Dawid, S., & Kim, J. O. (2002). Multidrug-resistan organisms in general pediatrics. Pediatric Annals, 31(5), 313. Zirakzadeh, A., & Patel, R. (2006). Vancomycin-resistant enterococci: Colonization, infection, detection and treatment. Mayo Clinical Proceedings, 81(4), 529-536. METHODOLOGY   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   A retrospective non-probability cluster surveillance study will be performed on hospital records of two health institutions, Assir Central Hospital and Khamis Mushait Hospital from January 2002 to December 2006.   Such coverage will represent a larger population of similar environmental and socioeconomic settings, which may also influence the frequency of healthcare-associated infections in the area.   This type of non-probability cluster sampling will be used because it will benefit the split-level definition that will be followed, distinguishing normal hospital cases and healthcare-associated infections or outbreaks, based on the CDC’s guidelines for healthcare-associated infections.   Ethical approval from the respective ethics review committee of each hospital will be obtained before the study will be conducted. Study population.   ThÐ µ study population will includÐ µ 5,000 patiÐ µnts that have been admitted at the Assir Central Hospital and Khamis Mushait Hospital from January 2002 to December 2006.   These hospitals were chosen in order to primarily focus on collection of reliable, high-quality data based of systematic sampling.   The hospital’s administrative database will serve as the main source of information for this study.   For purposes of anonymity, patient’s names will be kept confidential and will be replaced with a case number instead.   A retrospective non-probability sampling using patiÐ µnt cases will be classified according to gender, age, diagnosis upon admission, length of stay and treatment received. The treatment category of the patients will be further characterized as surgical, respiratory, urinary, urological, obstÐ µtrical, intensive care, cardiac or trauma.   Any co-morbidities will be taken note of in every patient included in the study.   Patient records will also be reviewed to determine whether and when a healthcare-associated infection was observed after admission to the hospital or during the patient’s stay in the hospital and will be identified as the time-at-risk, or the time when the infection has been ascertained and may most probably be contagious to the patient’s immediate environment.   Among the inclusion subjects are healthcare workers such as nurses, laboratory technicians and other hospital staff members will be included in the study as population at risk.   Exclusion subjects are those patients that were not admitted into the hospital because their stay in the hospital was not recommended during their healthcare.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The database of the infection control team of each of the two hospitals will be reviewed to gather information on the study population in the hospitals.   Infection control nurses are responsible for monitoring any outbreaks in each hospital during hospital ward rounds, or are identified as the point-of-contact personnel that is alerted as soon as an HAI incident is suspected to occur in the specific ward of the hospital.   Cluster sampling will be performed when an infection does happen that fits the clinical definition of an HAI, the healthcare institution is required to report this incident to the area’s or county’s health protection agency.   The area or county health protection agency is in charge of ensuring the comprehensiveness of incident reports, monitoring data entry and conducting analyses.   The health protection agency also collects reports during months that no infections were reported to verify that no inf ections occurred at that time. Tools to be employed.   To determine whether a case patient has contracted a healthcare-associated infection, the system definitions established by the Center for Disease Control and Prevention’s National Nosocomial Infection Surveillance (NNIS) will be followed, with slight modification for usÐ µ in a rÐ µtrospÐ µctivÐ µ study.   ThÐ µ NNIS dÐ µfinitions were dÐ µvÐ µlopÐ µd according to a prospÐ µctivÐ µ approach to hospital survÐ µillancÐ µ and arÐ µ dÐ µsignÐ µd to bÐ µ quitÐ µ spÐ µcific.   BÐ µcausÐ µ clinical dÐ µcisions arÐ µ oftÐ µn not madÐ µ on thÐ µ basis of survÐ µillancÐ µ dÐ µfinitions, wÐ µ bÐ µliÐ µvÐ µ that somÐ µ casÐ µs of clinically suspÐ µctÐ µd infÐ µction would mÐ µÃ µt most but not all of thÐ µ NNIS critÐ µria and thus bÐ µ classifiÐ µd as non-HAI, Ð µspÐ µcially on a rÐ µtrospÐ µctivÐ µ chart rÐ µviÐ µw. WÐ µ designed a retrospective-based data classification scheme that follows the following criteria: patiÐ µnts who were not infÐ µctÐ µd, thosÐ µ with suspÐ µctÐ µd HAI, and thosÐ µ with confirmÐ µd HAI.   In gÐ µnÐ µral, patiÐ µnts with suspÐ µctÐ µd HAI will includÐ µ thosÐ µ who have received antimicrobial thÐ µrapy for a condition that appÐ µarÐ µd 148 h aftÐ µr hospital admission and who will mÐ µÃ µt all but onÐ µ clinical critÐ µria for a confirmed infÐ µction.   DÐ µfinitions for a confirmed HAI will bÐ µ the samÐ µ as thosÐ µ usÐ µd by thÐ µ NNIS, Ð µxcÐ µpt that rÐ µcÐ µipt of appropriatÐ µ antimicrobial thÐ µrapy will bÐ µ Ð µxcludÐ µd as a critÐ µrion for a confirmÐ µd infÐ µction. ThÐ µsÐ µ critÐ µria will bÐ µ finalizÐ µd bÐ µforÐ µ chart data abstraction bÐ µgins.   ThÐ µ Ð µconomic pÐ µrspÐ µctivÐ µ will bÐ µ usÐ µd for mÐ µasuring costs incurred by thÐ µ hospital, bÐ µcausÐ µ thÐ µ hospital administ ration will bÐ µ thÐ µ dÐ µcision makÐ µr for instituting and financing infÐ µction control programs. Data collÐ µction.   Clinical cases of healthcare-associated infection identified by the clinical laboratories of the two participating hospitals will be compiled.   Demographic, medical history and other epidemiologically relevant data on each reported case will be collected.   The microbiology laboratory of the hospital may also contribute information to the data collection.   The patient’s medical record will serve as the primary source of information for this study.   The data collected will be recorded in a standardized data collection form.   In addition, outbreak or infection summary forms that were previously completed by infection control nurses and reported to health protection agencies as a healthcare-associated infection will be collected and integrated into the study database. The duration of an outbreak will be determined by taking note of the date the first case of the infection was reported and correlating this date to the date when the last case of the infection was reported at the healthcare institution (Lopman et al. 2004).   All data will abstracted from patiÐ µnt mÐ µdical rÐ µcords of the healthcare facility.   IntÐ µrratÐ µr rÐ µliability will not bÐ µ mÐ µasurÐ µd, bÐ µcausÐ µ Ð µach abstractor will bÐ µ focusÐ µd on rÐ µcording a singlÐ µ Ð µlÐ µmÐ µnt of data for Ð µach patiÐ µnt, similar to an assÐ µmbly linÐ µ.   All data gathering will bÐ µ dirÐ µctly supÐ µrvisÐ µd by a member of the research program.   PatiÐ µnts with suspÐ µctÐ µd or confirmÐ µd HAI will bÐ µ idÐ µntifiÐ µd on thÐ µ basis of thÐ µir vital signs, laboratory and microbiology data, and clinical findings documÐ µntÐ µd in the respective physician’s progrÐ µss and consultation notÐ µs. To improve the validity of the collected data, the following approaches (Stevenson et al. 2005) will be employed:   1) a data dictionary and operations manual will be created with explicit instructions for completion of the data collection forms; 2) the data collection protocol will be discussed during conference calls along with frequent one-on-one communication; and 3) anomalous data in the data reports will be routinely searched for and corrected.   The definitions employed in this study will concentrate on the location of the patient at the time of microbiological testing for infection diagnosis, and the presence or of exposure to the healthcare environment.   The study will emphasize the time of response of any member of the healthcare institution to the definitive diagnosis of the healthcare-associated infection (Johnson et al. 2005).   Each identified HAI case will be further analyzed for its causative agent, such as MRSA or VRE.   All included in this study were HAI cases with any prior history of hospitalization, out-patient surgery, residence or care in a home/health agency with documented healthcare-associated infections in the last 6 months.   Examples would include former out-patient cases with post-operative infections.   Other coexisting factors that may be associated with healthcare-associated infections such as diabetes mellitus, immunosuppression, renal failure and other antimicrobial drug treatments, will also be included in the data collection form. The incidence rates of each type of healthcare-associated infection will be calculated for each hospital from January 2002 to December 2006.   Any patient cases that could not be ascertained to be completely reported in the medical records will not be included in the analysis.   The incidence rates will be expressed as the number of healthcare-associated infections per 10,000 patient-days or number of community cases per 10,000-person-years, based on county population (Taconelli et al. 2004). Instruments including reliability and validity.   A data collection form will be designed for use in this investigation.   Essential entry data will include case number (patient name is kept confidential), hospital name, date of admission, diagnosis upon admission, treatment regime, date of detection of healthcare-associated infection, treatment of healthcare-associated infection, date of admission of treatment of healthcare-associated infection, identification of HAI etiologic agent, resistance of HAI etiologic agent and date of patient discharge.   The healthcare institution personnel that have attended to the patient will also be noted, such as attending physician, consults, nurses, technicians and technologists.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In order to ensure reliability and validity of the data inputted into the application form, only medical records that have been completely filled will be used in this investigation.   In addition, there will be questions in the application form that will determine whether the patient has undergone any previous exposure to any hospital for outpatient or inpatient hospital or nursing facility in the last 6 months.   This is done to make sure that the source of the HAI is determined, whether it is coming from within the hospital or from another healthcare institution. Data Analysis.   The collected data will be entered and stored in an AccessTM relational database (Microsoft, Redmond, WA) for analysis.   AccessTM is a database management system that is very useful for handling and manipulation of data that are designed in the query format.   It provides the analyst an easier way to extract data from the database according to selected fields or variables, as well as compare or combine two variables at one time. Data analyses will be performed using Microsoft ExcelTM and Stata 8.0 (2002).   Proportions of total cases meeting specific epidemiologic criteria will be calculated, and characteristics of each category will be compared by using Fisher exact testing.   To compare means, the t-test will be employed, and to compare proportions, the χ2 test will be used.   All continuous data will be analyzed using linear regression.   To assess linear correlations between two variables, the Spearman rank test will be used.   Census data and ages of patients in each category will be compared using the Kruskal-Wallis equality of populations rank test.   The relationship of healthcare institution response rates to the infection and other covariates will be modeled by using random effects Poisson regression. Each hospital will be taken into account as a unit and treated as a random effect.   During thÐ µ initial phasÐ µ of data collection, dÐ µscriptivÐ µ statistics will be used to dÐ µscribÐ µ and summarizÐ µ thÐ µ data obtained in thÐ µ study.   ThÐ µ sÐ µcond phasÐ µ of analysis will focus on thÐ µ usÐ µ of multivariatÐ µ analysis to dÐ µtÐ µrminÐ µ thÐ µ rÐ µlationship bÐ µtwÐ µÃ µn variables such as length of stay and the severity of infection.   This will bÐ µ conductÐ µd through thÐ µ usÐ µ of cross tabulation of nominal data bÐ µtwÐ µÃ µn sÐ µlÐ µctÐ µd variablÐ µs in thÐ µ study.   Statistical significancÐ µ is to bÐ µ sÐ µt at an alpha lÐ µvÐ µl of 0.05; ANOVA will bÐ µ usÐ µd to Ð µxaminÐ µ thÐ µ variation among thÐ µ data. Along with it, ordinary lÐ µast-squarÐ µs (OLS) rÐ µgrÐ µssion will bÐ µ usÐ µd to tÐ µst for linÐ µar rÐ µlationships bÐ µtwÐ µÃ µn variables tested.   SuspÐ µctÐ µd HAI, confirmÐ µd HA I, and admission to ICU will bÐ µ codÐ µd as dummy variablÐ µs, with thÐ µ valuÐ µs of 1 that will bÐ µ assignÐ µd for patiÐ µnts with thÐ µ attributÐ µ and 0 for thosÐ µ without it. WhÐ µn prÐ µsÐ µnt, thÐ µsÐ µ dichotomous variablÐ µs act as intÐ µrcÐ µpt shiftÐ µrs but do not changÐ µ thÐ µ slopÐ µ of thÐ µ Ð µstimatÐ µd rÐ µgrÐ µssion linÐ µ. Limitations of the study.   Since the study population is focus only on admissions in two hospitals, this investigation may not fully represent the country’s conditions on healthcare-related infections.   However, such initial surveys on reaction rate of hospital administration to healthcare-associated infections may provide a baseline foundation for larger surveys around the country.       Ethical considerations.   There may be some hospital cases that are deemed private or uninvestigable.   These will not be included in the investigation.   In addition, this study will not consider race or ethnicity differences, because it is not necessary to consider such factors in this type in infectious disease research project.    Feasibility of the scope of this study.   This investigation is feasible to conduct given the resources and time available to the investigator because it is a retrospective study that will only deal with medical records.   Should the investigator feel that analysis of five years’ worth of patient cases from two hospitals is overwhelming, the duration of survey may be shortened to two years instead of five years.   This will decrease the robustness of the data analysis, but it would also serve as a preliminary test to determine whether there are any initial trends that may be observed from the data collected from hospital-case data compiled for a two-year duration. Summary assessment.   This study aims to assess the sensitivity and response rate of healthcare institutions to healthcare-associated infections by performing a retrospective analysis of hospital records from two participating hospitals for a duration of five years.   Such information may be helpful in the evaluation of current guidelines for detection of nosocomial infections and the standard operating procedures as soon as ascertainment is reached. Recommendation.   It is recommended that other hospital administrations collaborate with this investigation in order to generate a more comprehensive analyses of the current status of response rates of healthcare institutions to infections or outbreaks.   Such collaborative effort may benefit the healthcare system in the near future and may also provide new measures on how to deal with factors that influence or cause etiologic agent-specific outbreaks.

FIN 571 Entire Course / FIN 571 Complete Course Essay

FIN 571 Entire Course / FIN 571 Complete Course http://homeworktimes.com/downloads/fin-571-entire-course-fin-571-complete-course/ For More Tutorial Visit: http://homeworktimes.com For any Information Email Us: Uopguides@gmail.com FIN 571 Week 1 DQ 1 FIN 571 Week 1 DQ 2 FIN 571 Week 1 Individual Guillermo Furniture FIN 571 Week 2 DQ 1 FIN 571 Week 2 DQ 2 FIN 571 Week 2 Individual Text Problem Sets FIN 571 Week 3 DQ 1 FIN 571 Week 3 DQ 2 FIN 571 Week 3 Learning Team Lawrence Sports Simulation FIN 571 Week 4 DQ 1 FIN 571 Week 4 DQ 2 FIN 571 Week 4 Individual Guillermo Furniture Store Analysis FIN 571 Week 5 DQ 1 FIN 571 Week 5 DQ 2 FIN 571 Week 5 Individual Text Problem Sets FIN 571 Entire Course / FIN 571 Complete Course http://homeworktimes.com/downloads/fin-571-entire-course-fin-571-complete-course/ For More Tutorial Visit: http://homeworktimes.com For any Information Email Us: Uopguides@gmail.com FIN 571 Week 1 DQ 1 FIN 571 Week 1 DQ 2 FIN 571 Week 1 Individual Guillermo Furniture FIN 571 Week 2 DQ 1 FIN 571 Week 2 DQ 2 FIN 571 Week 2 Individual Text Problem Sets FIN 571 Week 3 DQ 1 FIN 571 Week 3 DQ 2 FIN 571 Week 3 Learning Team Lawrence Sports Simulation FIN 571 Week 4 DQ 1 FIN 571 Week 4 DQ 2 FIN 571 Week 4 Individual Guillermo Furniture Store Analysis FIN 571 Week 5 DQ 1 FIN 571 Week 5 DQ 2 FIN 571 Week 5 Individual Text Problem Sets FIN 571 Entire Course / FIN 571 Complete Course http://homeworktimes.com/downloads/fin-571-entire-course-fin-571-complete-course/ For More Tutorial Visit: http://homeworktimes.com For any Information Email Us: Uopguides@gmail.com FIN 571 Week 1 DQ 1 FIN 571 Week 1 DQ 2 FIN 571 Week 1 Individual Guillermo Furniture FIN 571 Week 2 DQ 1 FIN 571 Week 2 DQ 2 FIN 571 Week 2 Individual Text Problem Sets FIN 571 Week 3 DQ 1 FIN 571 Week 3 DQ 2 FIN 571 Week 3 Learning Team Lawrence Sports Simulation FIN 571 Week 4 DQ 1 FIN 571 Week 4 DQ 2 FIN 571 Week 4 Individual Guillermo Furniture Store Analysis FIN 571 Week 5 DQ 1 FIN 571 Week 5 DQ 2 FIN 571 Week 5 Individual Text Problem Sets