Accident, Illness and Emergency Policy for Childminders Essay Example for Free

Accident, Illness and Emergency Policy for Childminders Essay The safety of children in my care is paramount and it is my policy to take necessary steps to keep children safe when they are in my care. I will promote good health, will prevent accidents and take steps to prevent the spread of illness and infection. I have a responsibility to all children in my care to ensure that a safe and healthy environment is provided at all times. I hold contact details of parents (or another appropriate person, such as grandparent) at all times, provided by parents and stored securely within the child’s records. I hold written permission from each of the children’s parents in the child’s record form files to enable me to seek emergency treatment for their child if it’s needed. As a registered childminder I am required to notify Ofsted of any serious accidents, illnesses or injuries of any child whilst in my care within 14 days of an incident occurring. I will ensure that my pets are safe to be around children and do not pose a health risk. ACCIDENT POLICY As a registered childminder, I am legally required to have a valid first aid certificate. This enables me to administer basic first aid treatment, and my first aid boxes are clearly labelled and easily accessible and are stored in the outside and inside play-room’s. Parents are asked to sign an accident book if injuries occur whilst in my care. Also if a child should come into my care with an injury of any kind, the parent will be asked to sign the book reporting the injury.  Parent/guardian will be contacted immediately. I will use my best judgement as to how other children will be looked after. You would be consulted about this by phone. There is a parent ring round provision in the event of an emergency to inform all parents of children under my care. If an accident or incident involving a child in my care may result in an insurance claim I will contact my public liability insurance provider to discuss my case and be allocated a claim number. This may involve discussing details of the child in my care with a third party. ACCIDENT PROCEDURE In the event of an accident whilst the child is in my care, I will: †¢ deal with any minor accidents. †¢ record all information, including names of witness(es), in the accident book. †¢ request parents, on picking up the child / children, to sign the accident book and read the information regarding the incident. †¢If I am unable to get hold of parents or other named appropriate adult, he/she will immediately be taken to see a doctor at Bishops Waltham Health Centre – or hospital if necessary and I will stay until parent arrives In the event of an accident in the home: †¢ Parents must inform me of any accident at home and record it in the accident at home area of the accident book. Further observation of injury on a child which has not been reported to me by the parent nor occurred whilst in my care, parents will be asked for information on the incident and instructed to write in the back of the accident book. In the event of me being subject to an accident: If I have an accident, I will get the nearest responsible adult to help, while my emergency back-up people are being contacted. I will do my best at all times to make sure the children in my care are safe, reassured and kept calm. ILLNESS POLICY I will do everything I can to take care of your child if they are feeling unwell by comforting them and giving them appropriate medicine you have approved and have signed a declaration permitting me to administer. If I am in need of support or advice regarding a serious illness or incident involving a child in my care I may contact National Childminding Association who will log information regarding the incident with regard to their safeguarding policy. A NCMA designated officer will be assigned to my case and all the information given to them will be kept confidentially unless their appear is to be a child protection issue which will be reported accordingly. ILLNESS PROCEDURE You must inform me if your child has been ill overnight or the previous day. I might have other children I am taking care of and need to ensure your child does not have an infectious illness. Medicines will be kept in a safe place and will be logged in the ‘medicine book’. However, if you child arrives ill, I will take a decision as to whether the child is fit to attend or not. If not, the parent will be asked to take the child home. If your child becomes ill whilst in my care, I will: 1.Contact you for agreement to administer ‘calpol’ (if appropriate and agreed) and if your child remains ill after one hour you will be asked to collect your child and make a doctors appointment. 2.You will be required to keep your child at home until they are recovered so that your child can be cared for on a one to one basis at home. 3.In the following circumstances children may be required to stay at home: Diarrhoea and/or vomiting, a rash, conjunctivitis. 4.If I am unable to get hold of parents or other named appropriate adult, he/she will immediately be taken to see a doctor at Bishops Waltham Health Centre – or hospital if necessary and I will stay until parent arrives Infectious illness: In the event of your child contracting chicken-pox, mumps, measles etc, or a fever or temperature of 101 degrees Fahrenheit, or 38 degrees centigrade or over your child will not be able to attend under my care and must remain at home. EMERGENCY POLICY Parent/guardian will be contacted immediately. In the event of an accident requiring hospital treatment, I will attempt to inform the parents immediately and take the child to hospital. I will stay with the child until the parents arrive. EMERGENCY PROCEDURE As a registered Child-Minder and trained paediatric first aider, I will ensure that the most appropriate treatment is given or acted upon for your child in my care; however if I have more than 1 child in my care, I will use my best judgement as to how other children will be cared for. Initial action will be reporting the incident to the parent by phone. We practice a parent ring round provision in the event of an emergency to inform all parents of children under my care. If parents do not arrive or I am unable to contact them, I will stay with the child until the appropriate treatment has been given and then return home where your child would be cared for until the arrival of the parent

Pacs Implementation Within A Radiology Department Information Technology Essay

Pacs Implementation Within A Radiology Department Information Technology Essay Information technologies and systems have revolutionised the way people think and act in many spheres of life. Information systems are deemed to be one of the major tools available for business managers for achieving operational excellence, developing new products and services, improving decision making and achieving competitive advantage (Laudon Laudon, 2009). The domain of information systems is an exciting evolution creating digital content in their products and services and delivering them over digital networks as being practiced widely in businesses, including in the healthcare enterprise. In the healthcare industry, information systems have created opportunity to restructure both the operational and architectural aspects in general, particularly in the radiology department (Rostenberg, 2006, p. 15). Perhaps as Jalaludin et al. (2005, p. 56) stated, no other specialty in medicine has benefited as greatly as in radiology with respect to advances in electronics and computers. The transformation of digital radiology will strive on giving way from the expensive and time-consuming endeavour of film and paper based methods to the faster and simpler computer based ones. As radiology continues to grow and evolve, paradigm changes such as reengineering information storage and delivery, as well as refining the overarching data repositories and access systems that support the healthcare consumer is required in order to be competitive. In keeping with the challenges, a prominent feature of evolution would be the proliferation of enterprise-wide electronic Picture Archiving and Communication Systems (PACS), which has changed the face of radiology by radically altering the core drivers of traditional film-based imaging facilities. Filmless image management systems will become popular in all hospitals in the near future (Furukawa et al., 2004). Therefore one should investigate the merits demerits of implementing this system effectively taking into consideration the productivity improvements and cost reductions while providing better patient care. 2.0 Purpose The purpose of this report is to propose PACS implementation within a radiology department in a public sector medical centre located in Kuala Lumpur, Malaysia, as part of a strategic business plan to create competitive advantage in the ever increasing patient demand. The author will conduct an analysis of the competitive environment and resources evaluating the strategic options in implementing PACS. Apart from this, an outline of the MIS requirements for the successful implementation of the selected PACS strategy and the associated plan needed to be undertaken will also be highlighted. This will lend a hand in securing funding and to provide a roadmap for its implementation within the timeline of one (1) year. The judicious planning of PACS strategy business plan will aim towards reengineering information storage and digital delivery as part of fulfilling the departments goals and objectives in creating a filmless environment, thus adding value and improving the business of radiology. 3.0 Organisational and Environmental Audit. The development of PACS strategy in the evolving field of radiology, as stated by Chan (2002) consists of two main interrelated processes such as: gaining insight into the organisation and its environment; and positioning the organisation for sustained competitive advantage Organisations need to respond to changes in their environment by continuous adaptation, which warrants making decisions on how to adjust and develop their products and services by keeping pace with environmental changes; otherwise they will lose their competitiveness (Chan, 2002). In addition, government regulation such as Health Insurance Portability and Accountability Act (HIPAA) has driven many to demand improvements in the management of the information systems within the healthcare system with PACS being one of the primary components of this requirement (Smith Hirschorn, 2006, p.157). As such, it is important to answer three essential strategic questions and develop the framework for PACS strategy, thus focusing on few elements that relatively contribute to sustained competitive advantage (Table 1). Strategic Questions Framework Where is our organisation right now? Wide range of information is collected. Where do we aim to go in the future? Insight developed and options generated. How do we get there? Implementation of new strategy. Table 1: Strategic questions and framework in PACS strategy development (Chan, 2002) As part of gathering wide range of information to set the framework for PACS strategy development, strategic analysis such as external environment and organisational audit is required as shown in Table 2. Strategic Analysis Outcome Development in radiology context External Environment Review events and trends that have occurred, occurring or anticipated to occur. Changes in economic, governmental, technologic, physical, cultural and managerial process. Mandate the conversion from the analogue paper and film based systems to a purely digital department. Organisational Evaluate the structure, operations, resources and culture of the organisations. Identify the current capabilities and the availability for the future strategic initiatives. The support of personnel from all levels will bring it closer to the department goals of going filmless. Capabilities enhanced through proper training and coaching sessions. Table 2: Strategic Analysis in PACS development (Chan, 2002) In addition, it is also imperative to gain information regarding the interrelationships between the two. As such, a simple integrative analysis, known as SWOT is performed to highlight the inherent strengths and weaknesses, as well as opportunities and threats about the organisation and the relevant environmental factors facing the organisation in implementing PACS strategic business plan, as shown in Table 3. STRENGTHS: The development of an organisations particular set of resources, which leads to sustainable competitive advantage. Collective organisational learning that results in superior performance, especially in coordinating and integrating new activities and workflows. New strategy and initiatives fosters new views of the role of radiology in the health care industry, thus adding value to the services rendered. WEAKNESSES The resulting strategy may fall out of favour as a result of plans becoming too detailed and cumbersome to implement. Different divisions may be inflexible in the face of changing business conditions and new competition. Should this be unsuccessful, the managers and employees who were responsible for the implementation of the chosen strategy may feel disempowered. OPPORTUNITIES Building new capabilities and inventive in the use of limited resources to close gap should there be misfit between available resources and the resources needed for the desired goal. The push to possess leadership qualities along the new development path and change management. Room to exercise imagination and creativity throughout the development and implementation of new strategy. THREATS External events or environmental trends that cannot be foreseen by observers could affect or even invalidate the viability of each strategic option that is considered. High costs of increased government regulations in radiology practices may deter the implementation. Table 3: Authors framework of SWOT analysis about the organisation and the relevant environmental factors in implementing PACS strategic business plan 4.0 Competitive Analysis Once the insight of an organisation and its environment is gained, it is fundamental to undertake competitive analysis. These include a definition of the immediate radiology market, a description of competitors and the status of their PACS implementations (Levine, 2006, p. 37). In creating the framework to help determine industry competition, arguably the most widely used model will be Porters five forces model (Figure 1). Figure 1: The five competitive forces that shape strategy (Porter, 2008) According to Porters five competitive forces model, the strategic position of the firm and its strategies are determined by competition with its traditional direct competitors and also greatly affected by new market entrants, substitute products and services suppliers and customers (Laudon Laudon, 2009, p. 107). A market research conducted by Frost and Sullivan (2010) stated that the radiology markets in Southeast Asia have considerable potential, regardless of their maturity. In addition, the analyst further reiterated that with the decline in costs and advancements in PACS applications, smaller hospitals have begun to implement PACS in radiology and also in various medical disciplines such as the cardiology and dentistry departments that produce medical images too; thus enabling better image management. Therefore, the strategic plan should note any PACS advertising done by local competitors in order to highlight any potential threat to market share, then perform the market share at risk if PACS is not implemented at this institution to estimate the amount of additional revenue that may be shifted to or from a competitor that has respectively superior or inferior radiology services. However Levine (2006, p. 39) stated that, a potent argument for PACS in the strategic plan will be to compare capacity and productivity gains that can be expected to accrue from the implementation to the future increases in demand for radiological services due to the normal growth and increased market share. As such, applying Porters five forces competitive analysis in PACS strategy would generate a framework as shown in Table 4. Competitors: Government hospitals Teaching hospitals Private medical centres Potential competitors: All radiology businesses Substitute products: Advances in hardware and software Breakthrough products in other emerging imaging technology with built-in information systems Networking only a few workstations together from radiology department to a particular department Buyers: Individual hospitals or medical centres Regional health care networks and integrated delivery systems Government programmes Managed care organisations Suppliers: Information technology providers (HIS, RIS, PACS, Application Service Providers) Manufacturers of imaging devices and supplies Table 4: Authors framework using Porters five forces competitive analysis applied in PACS strategy 5.0 Strategic Implications There are three basic strategic options available to organisations for gaining competitive advantage, according to Porters Generic Competitive Strategies model (Figure 2), namely, cost leadership, differentiation and focus, thus developing the edge, which brings revenue for the organisation and takes it away from ones competitor (Mind Tools, 2011). Figure 2: Porters Generic Competitive Strategies model (MBA Knowledge Base, 2011) With the implementation of PACS, this organisation aims to provide low-cost, thus achieving cost leadership by gaining market share, whilst maintaining profitability and pursue a differentiation-based strategy by offering unique product and services; thus offering a greater value package to customers and competitors. In addition, it is imperative to use technology, where possible, to create or enhance customer value and satisfaction. As such, Porters value chain model (Figure 3) can be generalised to the practice of radiology to identify the key value drivers to build customer satisfaction through the implementation of PACS as a new strategy. Figure 3: Porters value chain generalised to the practice of radiology (Schomer et al., 2000) The model views a series of primary and support activities that add value to the organisations products or services (Laudon Laudon, 2009). In radiology practice, these include four support activities; namely, the organisation infrastructure, human resources, technology development and procurement, which is straightforward, focusing on reducing costs in these areas for both customers and organisation. On the other hand, the five primary activities, namely, inbound logistics, operations, outbound logistics, marketing and service are quite specific and leveraging using technology, such as the PACS, can often significantly enhance each of these activities. Each activity has an associated cost and therefore the residual margin (black area in Figure 9) will be retained as the shareholder earnings (Schomer et. al., 2000). 6.0 PACS Strategic Plan Recommendation What is PACS and why choose this strategic plan in a radiology set-up? PACS include computers or networks with dedicated storage, retrieval, distribution and image management, which are stored in an independent Digital Imaging Communications in Medicine (DICOM) format (Amber Diagnostics, 2010). PACS can eliminate many of the time-consuming processes associated with film-based medicine and enable the practice of filmless medicine (Figure 4). This adds value to the radiological services, which not only provides services by generating diagnostic reports, but also expedites the timely delivery of results (Levine 2006, p. 27). PACS completely reengineers radiology practices by enabling ubiquitous availability of images to be electronically viewed virtually anywhere and simultaneously, resulting in improved clinical care and productivity throughout the healthcare enterprise. Figure 4: Film-based medicine and filmless medicine (Furukawa et al., 2004). The current set-up of the radiology department encompasses of digital multi-modalities such as, Computed Tomography (CT) Scan, Magnetic Resonance Imaging (MRI), Digital Angiography and others performing approximately 180,000 200,000 examinations per year. As part of aiming towards creating a digital environment, besides procuring these digital modalities, the department has also established connectivity to a Radiology Information System (RIS) and Hospital Information System (HIS). The HIS feeds verified patient demographics to the RIS, which in turn is responsible for scheduling orders, capturing relevant clinical information and providing a platform for radiologists to prepare examination reports. However, currently hard-copy medical images are the only image capture, display and storage medium. Besides radiology, view boxes are found in diverse locations such as wards and clinics in order to view the radiological images. There is usually only one copy of film to be displayed at any one time, thus reducing the efficiency and effectiveness of patient management. The image management in a conventional environment involves exceedingly complex, high manual and work-intensive processes involving as many as eight (8) different types of personnel performing up to ten (10) different tasks and takes about 1 to 4 hours to generate results [Figure 5(a)]. However in a fully electronic environment, this can be reduced to approximately eight (8) tasks, many accomplished by computers, allowing the number of people involved to be reduced to four (4) and results to be generated within 45 minutes to 1 hour [Figure 5(b)]. As such, the implementation of PACS will foster stronger development of consolidated delivery networks at not only the departmental level but also at the organisational level. Figure 5: Workflow process from radiological examination request to final report in a (a) conventional environment and in an electronic (b) RIS and PACS environment [distrib. = distributed, Dx = diagnosis, Phys. = Physician, Sched. = schedule] (adapted from Bryan, 2003) With the need for increased quality, clinical effectiveness and meeting the pressure of market competition in the digital world, PACS is seen as an opportunity to provide patients with clinical services that could never be provided in the analogue world. The scope and benefits of PACS reach beyond the radiology department, whereby, it also greatly expands the exposure, expense and operational impact; hence the need to be comprehensive and include all key players in the decision making process, planning and the development of new strategy is crucial (Chaney Cotter, 1998). Implementing and integrating PACS requires significant planning, workflow redesign, system configuration and training. However a common problem in implementing PACS will be recognising the mix of image generation technologies or modalities and identifying different types of interfaces (Chaney and Cotter, 1998). With regard to this, older equipment already installed in this radiology department may require specialised protocol conversion to talk to the new PACS equipment although the established communication standards can be supported by the newer equipment in the market today. As such, the PACS and modality vendor input is crucial to identify the required number of modalities to be linked and whether any licensing or implementation costs attached to each modality connection will be required. An enterprise-wide strategic planning methodology for PACS, which involves a broad cross section of the imaging and user community, proposed for this medical centre is outlined as in Figure 6. Figure 6: Development of an enterprise-wide PACS strategic plan (adapted from Chaney and Cotter, 1998) Once a structured PACS strategy planning process to establish a sound business case has been undertaken, the next step will be developing a Request For Proposal (RFP) and conducting the PACS vendor selection process. The PACS equipment needs and archive size requirements are instrumental in preparing an effective RFP. The RFP will include detailed specifications for the locations and types of required equipment and a high-level project plan in order to specify the installation accurately as shown in Figure 7. Figure 7: PACS life cycle overview (adapted from Chaney and Cotter, 1998) In addition, it is also imperative for vendors to be able to specify all devices required during the vendor quotation phase of the project. Finally, establishing connections to the already existing RIS-HIS, computed radiography, digital radiography and results reporting may consume months prior to the roll-out of the system as shown in Gantt Chart (Appendix 1). 7.0 Financial analysis The financial analysis plays an integral part of the business case development and is crucial to the assessment of the economic viability of the proposed PACS initiative. This would set the stage for the technical and performance specifications prior to the establishment of a procurement exercise. Lim (2008) stated that the budgets for PACS acquisition project are usually identified as capital budget estimate, which encompasses the probable costs to purchase and implement the technology and recurrent budget estimate that represents the projected future costs of managing and maintaining the system in a sustainable operational state. The capital and recurrent costs descriptive items are as shown in Table 5. Types of costs Descriptions of items Capital costs Capital purchase costs of PACS Installation and commissioning costs Any costs associated with imaging equipment upgrades Infrastructure costs (e.g. data centre, network, computers for image distribution) Change management Recurrent costs Staff and accommodation Consumables Ongoing training Upgrade costs Table 5: Capital and recurrent costs for PACS acquisition project (Lim, 2008) With regards to the PACS acquisition, Lim (2008) further stated that there are a few financial models to be considered when acquiring PACS, namely: The traditional purchase, where purchase is outright and owned and managed by the institution, with vendor providing technical support under a service contract agreement, which is a common method in public sector; Application Service Provider (ASP), where the facility purchases a service from the vendor with charges based on fee-per-service arrangements; Leasing models, which can have some financial incentives in private sector context. The proposed budgetary costs for PACS implementation recommended for this public sector medical centre is based on a traditional purchase acquisition model, which illustrates how a capital and recurrent budget may be established amounting to costs assumption of RM 3,487,000 presented in Appendix 1. However, calculating the purchase, upgrade and running costs is only half of the budgeting task, the other side of the equation is the cost savings, efficiencies and service improvements that this technology can bring to an imaging facility. These savings include film and stationery costs such as jackets, chemistry costs, film storage and handling including space and file room staff, processor purchase and running costs. Therefore it is important to undertake a cost-benefit analysis to see whether an individual option has financial or economic merit. A study conducted by Van Genip et al., (1994, cited in Becker and Arenson, 1994) stated that the overview of data from 15 cases collected with CAPACITY (Cost and Critical Analysis of PACS Indicating its Yield) cost-modelling software suggests that, when the cost of hardware components is allowed to drop 5% to 25% per year, some hospital-wide systems will become less expensive than film in the future with breakeven between 4-8 years, which is applicable for this scenario. As such, with the fast decreasing price of digital storage in the current market, it is deemed that PACS will provide cost and space advantage as compared to film archives. However, a downtime contingency plan, where costs for backup film printing using laser printers is also crucial to support successful implementation. Cost benefit analysis will provide useful information, but not all the answers. Therefore, one should also consider the intangible benefits such as the service efficiencies and quality improvement that PACS can generate, particularly with fast throughput of images; hence these factors should be taken as part of any economic justification. 8.0 Conclusion The informed decision to select, implement and operate PACS begins with a sound, business oriented approach and judicious planning up front in implanting PACS as a strategy. As such building a documented business case and report is the first step to establish baseline expectation for system implementation throughout the enterprise as well as providing an accountability structure and project leadership as has been presented in this report. In this age of high information density and the necessity of its efficient and rapid dissemination through the integrated delivery of networks in healthcare, enterprises should see the decision to implement PACS as a necessary step in maintaining their market position. The greater value of a secure and fast repository of images provided by PACS, will improve the detection of disease through improved patient outcomes. These factors will have a huge impact on the way medicine is practiced and the quality of care patients receive. As such it is important for the radiology department to adopt PACS considering the service efficiencies, cost savings and service quality improvements that it can generate; thus creating a competitive advantage in the business of radiology. 9.0 References AMBER DIAGNOSTICS. 2010. Radiology Management System RIS / PACS. Amber Diagnostics [WWW] http://www.amberusa.com/ris/ris-index.asp (29 October 2010). Becker, S. H. and Arenson, R. L. 1994. Costs and Benefits of Picture Archiving and Communication Systems. Journal of the American Medical Informatics Association. [Online journal]. 1(5). pp. 361-371. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC116218/ (10 April 2011). Bryan, R. N. 2003. The Digital rEvolution: The Millennial Change in Medical Imaging. Radiology. [Online journal]. http://radiology.rsna.org/content/229/2/299.full. (22 March 2011). Chan, S. 2002. The Importance of Strategy for the Evolving Field of Radiology. Radiology. [Online journal]. http://radiology.rsna.org/content/224/3/639.full. (25 March 2011). Chaney, D. M. and Cotter, N. K. 1998. Comprehensive business planning for PACS. Applied Radiology. [Online journal]. 27(12). (http://www.appliedradiology.com/uploadedfiles/Issues/1998/12/Articles/v0027i12/00801387/main.pdf (25 March 2011). Furukawa, H., Endo, M. Aramaki, T., Morimoto, N., Uematsu, T., Yukizawa, S. and Yuen, S. 2004. Picture Archiving and Communication System Introduced to a New Japanese Cancer Center Hospital. Japanese Journal of Clinical Oncology. [Online journal]. 34 (7). pp. 425-428. http://jjco.oxfordjournals.org/content/34/7/425.full (20 March 2011). Frost and Sullivan. 2010. Overview of Total Southeast Asian RIS-PACS Market. [WWW] http://www.frost.com/prod/servlet/report-toc.pag?ctxixpLink=FcmCtx1searchQuery=PACSrepid=P48C-01-00-00-00bdata=aHR0cDovL3d3dy5mcm9zdC5jb20vc3JjaC9jYXRhbG9nLXNlYXJjaC5kbz9xdWVyeVRleHQ9UEFDU0B%2BQFNlYXJjaCBSZXN1bHRzQH5AMTMwMjcxMzI1NjAxNA%3D%3DctxixpLabel=FcmCtx2 (23 April 2011). Jalaludin, M. A., Abdullah, B. J. J., Sarji, S.A. and Hoong, N. K. 2005. University of Malayas Vision for Research Imaging. In: Abdullah, B. J. J., Sarji, S.A., Ranganathan, S. and Hoong, N. K. eds. A New Phase For Imaging, Kuala Lumpur: University of Malaya Press. p. 56. Laudon, K. C. and Laudon, J. P. 2009. Essentials of Management Information Systems. 8th edn. New Jersey: Pearson Education, Inc. LEVINE, A. L. (2006) PACS Strategic Plan and Needs Assessment. In: Smith, G. ed. Administrative Issues. In: Dreyer, K. J., Hirschorn, D. S., Thrall, J. H. and Mehta, A. (eds.) PACS: A Guide To The Digital Revolution. 2nd edn. United States of America: Springer Science+Business Media, Inc. MBA Knowledge Base. 2011. Porters Generic Competitive Strategies. [WWW] http://www.mbaknol.com/marketing-management/porters-generic-competitive-strategies/ (10 April 2011). MindTools. 2011. Porters Generic Strategies: Choosing your Route to Competitive Advantage. [WWW] http://mindtools.com/pages/article/newSTR_82.htm (12 April 2011). Porter, M. 2008. The Five Competitive Forces That Shape Strategy. Harvard Business Reviews. [Online journal]. http://hbr.org/2008/01/the-five-competitive-forces-that-shape-strategy/ar/1 (28 March 2011) Rostenberg, B. 2006. The Architecture of Medical Imaging: Designing Healthcare Facilities for Advanced Radiological Diagnostic and Therapeutic Techniques, United States of America: John Wiley Sons, Inc. Schomer, D. F., Schomer, B G. and Chang, P. F. 2001. 2000 Plenary Session: Friday Imaging Symposium: Value Innovation in the Radiology Practice. RadioGraphics. [Online journal]. http://radiographics.rsna.org/content/21/4/1019.full (1April 2011). Sim, L. H. 2008. Budgeting for PACS. Biomedical Imaging and Intervention Journal. [Online journal]. http://www.biij.org/2008/4/e32/e32.pdf (12 April 2011) Appendix 1 PACS Implementation Strategy Plan Gantt Chart (activities based on PACS life cycle overview presented in Figure 7) Phase Activities Month Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 1 PACS comprehensive planning (business technical, functional) 2 PACS vendor selection signing of contract 3 PACS system implementation, training testing 4 PACS implementation system support and enhancement

tundra :: essays research papers

The tundra artic plains completely covering most of the earth’s lands north of the coniferous forest belt. The tundra’s ecosystem is very sensitive. It doesn’t have a good ability to restore itself. Controlled by sedge, heath, willow, moss, and lichen. Plains that are pretty much alike, called alpine tundra, occur above the timberline in the high mountains of the world. Even the Antarctic area has a couple of its own arctic regions itself.   Ã‚  Ã‚  Ã‚  Ã‚  The climate of the tundra is characterized by harsh winters. The average temperature in the tundra area is about –27 degrees. But what is even worse are the long night. At nights the lowest temperture recorded was –67.36 degrees. There are even times in the year when the sun doesn’t come up for days. In the tundra we have little snow and even less rainfall. The rainfall is about a quarter inch in a yearly rainfall. Even though the tundra’s winters are long a harsh there summers are the shortest season of all. Do to the terrible weather and climate in the tundra their animals and plant life is very limited. This artic tundra is mainly formed by permafrost, â€Å"a layer of permanently frozen subsoil in the ground. Putting frozen ground and flat landscape stops the drainage of water. As the water is being held up on the surface it makes ponds and bogs that give moisture for the plants, or countering the low precipitation. â€Å"The periodic freezing and thawing of the soil forms cracks in the ground in regularly patterned polygons†. Some areas are not drained very well causing irregular landforms. Some of these landforms like the following hummocks, or knolls, frost boils, and earth stripes. Another common area to the alpine tundra is a â€Å"bare rock covered ground† also known as fell fields, in which not alone support but helps the growth of lichens. The many â€Å"microhabitats† given by these landforms provide a variety to the tundra’s landscape. As you already know the amount of different plant species in the tundra is very few. Also their growth level is low, â€Å"with most of the biomass concentrated in the roots. To add to the many difficulties the growing season isn’t very long its self. The plants are better off â€Å"to reproduce vegetative by division and budding than sexually by flower pollination†. The main plant life in that area is cotton grass, sedge, and dwarf heath also including mosses and lichens. tundra :: essays research papers The tundra artic plains completely covering most of the earth’s lands north of the coniferous forest belt. The tundra’s ecosystem is very sensitive. It doesn’t have a good ability to restore itself. Controlled by sedge, heath, willow, moss, and lichen. Plains that are pretty much alike, called alpine tundra, occur above the timberline in the high mountains of the world. Even the Antarctic area has a couple of its own arctic regions itself.   Ã‚  Ã‚  Ã‚  Ã‚  The climate of the tundra is characterized by harsh winters. The average temperature in the tundra area is about –27 degrees. But what is even worse are the long night. At nights the lowest temperture recorded was –67.36 degrees. There are even times in the year when the sun doesn’t come up for days. In the tundra we have little snow and even less rainfall. The rainfall is about a quarter inch in a yearly rainfall. Even though the tundra’s winters are long a harsh there summers are the shortest season of all. Do to the terrible weather and climate in the tundra their animals and plant life is very limited. This artic tundra is mainly formed by permafrost, â€Å"a layer of permanently frozen subsoil in the ground. Putting frozen ground and flat landscape stops the drainage of water. As the water is being held up on the surface it makes ponds and bogs that give moisture for the plants, or countering the low precipitation. â€Å"The periodic freezing and thawing of the soil forms cracks in the ground in regularly patterned polygons†. Some areas are not drained very well causing irregular landforms. Some of these landforms like the following hummocks, or knolls, frost boils, and earth stripes. Another common area to the alpine tundra is a â€Å"bare rock covered ground† also known as fell fields, in which not alone support but helps the growth of lichens. The many â€Å"microhabitats† given by these landforms provide a variety to the tundra’s landscape. As you already know the amount of different plant species in the tundra is very few. Also their growth level is low, â€Å"with most of the biomass concentrated in the roots. To add to the many difficulties the growing season isn’t very long its self. The plants are better off â€Å"to reproduce vegetative by division and budding than sexually by flower pollination†. The main plant life in that area is cotton grass, sedge, and dwarf heath also including mosses and lichens.

Preemies and Pain :: Newborn Infants Medicine Papers

Preemies and Pain "Ouch!!" Ordinarily, that word elicits a predictable response. However, is that response one that is unilaterally perceived? The topic of pain endurance is one that is often discussed. It is understood that the feeling of discomfort is something abhorrent to all people, and is intrinsic at birth. While most people assume that the level of torment is comparable in all people, scientists have recently begun exploring the possibility that pain tolerance may be greatly dissimilar among individuals. Recently, in class, we have wondered how anyone could be sure that pain is felt to the same degree in all people. It is a fact that all humans feel pain due to the presence of pain receptors. When confronted with a stimulus, the nerves send signals to the brain, which interprets the signals as discomfort. We know that others feel pain because we are able to communicate with one another. If something hurts a person, that individual is able to say, "Ouch, that hurts." While the majority of humans are able to express their discomfort, there is one group that does not have that luxury. Because babies are unable to speak, and subsequently communicate their feelings, we automatically assume they feel no pain. Because of this situation, there has long been a debate concerning babies and their threshold of pain. People recognize that babies signal their pain in a variety of ways, including crying and contorted facial gestures. Although scientists might deem these reactions as mere reflexes because they have no definitive measure of the infant's pain threshold, most doctors believe that a newborn feels pain. This tenet is due to the existence of a completed nervous system. If people are at the mercy of their systems, and this is why they feel pain, it would make sense that an infant, with a complete nervous system, would feel the same way. Nevertheless, until ten years ago, it was not acknowledged that premature, or even, unborn children feel pain because people believed that their nervous systems were too immature to function properly (2). Because of this, it was acceptable practice in the past for doctors to operate on premature babies without anesthesia because they thought that, even if the babies felt pain, they would not suffer any long-term damage (1).

An Unforgettable Person Essays -- Personal Narrative Teachers Educatio

An Unforgettable Person Parents are–or should be–the teachers of their children in many areas, a natural relationship of handing down what they have learned to their offspring. But there is something special about the profession of teaching where an individual chooses to make an impact on students ,they hardly know on Day 1 of class and yet they have a goal of sending those young faces on their way to a well-rounded education in the 180 or so days they will have them in his or her care. At Vikas junior college, more teachers continued their influence on my life, and many of them have enjoyed long teaching careers. Several have retired, but several are still hard at it with the current crop of students The bell rings, and all the students waits for him to come. He is nothing but our math lecturer Mr.P.Ramesh. He is about 6 feet tall, thin man. He dresses himself in formals. He has a good hair style like wave’s .he is handsome too. His classes are so interesting. All the students get involved to listen to his classes. We never miss his classes. He is very friendly, polite, and casual. He is hailed by many students here and there. ``Hello!'' ``Hi!'' ``Nice to see you!'' Whenever he comes across anyone he knows, he always says hello to them first, wearing a big smile, whether or not they are older or younger than him. In this society where many people often pass by without greeting each other, seeing him might be like seeing an oasis in a desert. He loves childre n in ear...

Life as a Female Slave Under the Code of Hammurabi Essay

I am a female slave, given into slavery for 4 years by my father, he owed a debt that he could not pay. A debt for grain that he was to pay back 3 fold. The debt collector would have taken what little we had and perhaps would have made father pay with his life if Hammurabi had not made a way for my family to cancel our debt in this way. It is only for 4 years, such a long time for so little a debt, but we are fortunate to have this option. I will be provided with the basic necessities for survival. I am counted as nothing more than property, or currency, for my Master. I am not considered human. I was formerly a member of the middle class, paupers that can farm. There are only three classes in our society, the wealthy, the poor, and the slaves. Now, I am a slave for the next four years. It is very common practice, so much so that even the poor have slaves. Our most common forms of currency are grain, silver, slaves, cattle, and livestock. As you can imagine, I am not alone in my experience in slavery. Many of my peers are or have been enslaved at least once in their lives. Both my mother and father were slaves at some point. Many female slaves usually end up with their Master for many more years than the 4 required by law. After 4 years, they are no longer slaves and are often in the same class as the man they have lived with. In our society many children are products of those relationships. Until the time of slavery is up, I must work off a debt. I am not permitted to deny my Master, or I could be punished. One such punishment could involve having my ears cut off. This is not very common. Many of us understand we are here to work and that we must be submissive to avoid conflict. As I mentioned we will be allowed the basic necessities, food and water, and protection from the environment if the weather is harsh. The laws of how I live as a female and as a slave are outlined in Hammurabi’s Code. Hammurabi is a fair and just man. I feel his laws are fair and just given my position and given the alternatives that could have taken place if my father’s debt went unpaid. And to lose an ear and not a life for disobedience is more than fair. Hammurabi has provided us with options which has been beneficial for us at this time. We all know the laws. We can all read and understand them. Our officials rule by the law and laws pertain to everyone. For example, I am safe with my Master, should anyone take me from my Master- he could be put to death.. Everyone in the city knows this law and should someone see another take me from my Master, they will notify officials. The officials will investigate the matter. The person who takes me could be put to death. Few people risk this. Also, should my Master lend me out to another man and that man harm me, he would have to pay my Master fines for the damage he caused. It is very difficult for the common man to pay fines, so little harm is ever done to a slave that is on loan. Slavery here is not a social stigma. I am of the same class as the majority and speak the same language. Business and practicality are more important here than ideology, thus it is more beneficial for a Master to have strong, healthy slaves for commercial purposes. The law is clear and written out and encourages this kind of a society. Physical abuse is not very common among our people, but it is used in extreme cases. I was very surprised when studying this to discover that laws regarding slavery in the United States, while similar in many ways, were more harsh than the laws for the slaves in a more primitive environment. For example, the Code of Hammurabi stipulates that if a slave is given in trade for a debt it is for a period of 4 years. In the Unites States, the slave codes suggested that slavery was a life long event. There was no limit to the length of time a person could be a slave. I could not find many similarities, with the exception that it was not uncommon for female slaves to bear children with their Masters. In further research I found evidence that slaves in Babylonian captivity not too long after the Code of Hammurabi was implemented, owned property and were allowed to trade. Some even made more money than their Masters. So, I could not really compare and contrast the Code of Hammurabi with the Slave Codes of the Southern States, which was not only disappointing but deeply troubling. The one thing that does stand out as the most obvious similarity to something we are familiar with today is the epilogue to the Code of Hammurabi and the Preamble of the US Constitution. Both introduced a set of laws that were created to protect the people, provide a basis for justice, promote the welfare, ensure prosperity. Actually, I believe Hammurabi said it best, â€Å"That the strong might not injure the weak†.

Gender and Language Essay

Other forms which establish their superiority over women is their need for scientific jargon, to prove to women (and sometime themselves) that they are the more intelligent of the two genders. Other male magazines tend to use abbreviated terms for titles or objects, which connote authority, such as ‘FHM’, ‘GQ’ or even ‘MAX POWER’. These titles connote the idea of periodic and scientifically symbols or even macho representations such as G. I Joe. Max Power being a prime example of the bigger is better theory shared by a majority of males. In which case all the titles connote the idea that by reading these magazines they will fundamentally gain enjoyment and authority as well as establishing the male gender as the more dominant of the two. The placing of the title also suggests that what men really want from a magazine is what the media has always believed to be true; Sexually portrayed, attractive young women spread across the front cover, regardless if the title can be seen or not, is always more likely to sell to a male audience rather than another male being shown. The actress Tara Reid is the focus point of the front page and draws the reader in, due to her seductive pose. She is inviting but yet still shows sign of vulnerability and innocents as her ensemble of clothing is of very lacy and more to the point of white fabric, white connoting all that is good and untouched by others. The tag line also insinuates that the article containing her will also be of great interest to a male audience as it is sexually oriented and suggests phallic implications. This has been chosen to suit what is speculated to be the needs of today’s man, which is the chance to be the more dominant of genders and who is capable of giving women security. This ideology and belief has now been shifted, as women today are more than capable of dealing with life much better on their own without a man. Men are also more aware of how women like to be seen as equal to them, and some are very open to this change while others prefer to remain in the past and continue to view women as docile individuals. The cover of ‘Maxim’ doesn’t encourage today’s changes in genders, which suggest this is how they maintain an audience of male chauvinists, or at least to gain their attention. Within the actually magazine stories and articles are very similar to those found in female magazines but obviously aimed at a male audience. It’s very refreshing to see that the barriers between the two sexes are very alike, in terms of language used and design. The typical ‘hard’ image of what men perceive to be has in some ways become more softer and less aggressive, showing that the new man of the twenty-first century can also adapt to new ideas, and that the gap between the two genders draws closer with each generation. Obviously certain aspects of the magazine must be deemed just for a man, or at least of more interest to a man than to a women, for instance an article which expressed ways in which police officers captured and tormented their prisoners, showed images of guns and military dressed young men with vicious blood thirsty dogs barking at the prisoners. The overall affect of the images were very crude and somewhat inhumane, but for some men the idea of human destruction and war will always be of interest to them, for reasons which still hold questions as to why? Overall the identification of this magazine being targeted at a male audience can be said to be true, due to the following aspects: – A Semi- nude female (preferably blond) will be spread across the front page, more identifiable if the female is already well known. – The title expresses a large quantity as mentioned by theorist Raymond Williams that men are prone to the idea that ‘Big is always better’ – Sub-headings denote issues, which contain those related to sport, especially as the world cup is due to start. – And current affair issues which reflect destruction and chaos from around the world whereas with a female magazine the current affairs brought up are mostly directed at individuals who are form the world of showbiz or contain humour. In terms of the last point, female magazines such as ‘MORE! ‘ tend not to dramatise or even discuss issues which reflect those found on the news unless it is of relevance to their British, female audiences. This in some ways might be because they still fear that women are quite frail and are more prone to show emotion to such topics. Hence defeating the object of a magazine being a medium of entertainment, if the issues raised are of a more serious nature. This is where the difference between magazine journalism and that of newspaper journalism lies. As Newspaper writing is aimed at various individuals and not to one set gender or age group it allows for news and entertainment of both kinds to be expressed without the fear of upsetting anyone, as this is what it is set out to do. Magazines such as MORE, are what give female audiences a break from reality and allow them to indulge into the world of gossip and fame. A belief shared by most people, in particularly men, that women enjoy gossip. Mary Crawford states that gossip allows women to communicate with their peers and gives them a sense of comfort; being allowed to know what other people are doing from another world, which in turn is very different to that of their own gives them satisfaction and enjoyment. In conclusion what I have noticed within my brief analysis is that although times have changed male magazines still seem more relatable to today’s society and contain more in-depth issues which a lot of female magazines fear to tread on. However this may only be the start, barriers have already started to break between the two genders and with time these barriers may cease to exist. As women are now given more sexual freedom and social changes have taken place in terms of media influences (for instance commercials now cater for all genders and represent them as equal to men). A lot more of society now embrace the new feminist women and single mothers and radical changes have taken place in order to have reach this state as well as changes from men and their somewhat narcissistic attitudes. A quote, which most women of today’s society can now identify with would be that of Charles Fourier in 1808, which said stated that ‘The extension of women’s rights is the basic of all social change. ‘ In other words allow women to live the way in which they choose and not condemn them for it and changes within the sexes will be made for the better. Bibliography Crawford, M ‘Talking difference: on Gender and Language’, Sage 1995 Fourier C, ‘ Theories of the forth Movement, 1880 Martin, M, ‘Ways of reading’, language and gender, 2000 Williams, R. (1980/1996) ‘Advertising the Magic System’, Media Studies: A Reader