Christifidelis Laici Essays - Buddhism, Laity, Baptism,

Christifidelis Laici Christifidelis Laici Christifidelis Laici was written with the intention to bring together experience with theory. This was in order for concrete ways in which the laity according to the Vatican II could be implemented into an authentic living experience. Resulting from Vatican II the lay participation blossomed in the Church's mission. Through faith and baptism lay people are engrafted to Christ and that the laity thus have a positive understanding of their vocation and mission. Through baptism one becomes the child of Christ and members of Christ's body. Because of this lay people share in Christ's mission as a priest, prophet, and king in ways appropriate to them as laity. Due to our call by Christ we must live our lives with his message in mind opening others to the church and spreading the good news to all as a mission of the church. Pope John Paul II mentions two temptations to which the laity may be exposed in their Christian vocation. One of these temptations is of, legitimizing the unwarranted separation of faith from life, that is a separation of the Gospel's acceptance from the actual living of the Gospel in various situations in the world. In other words that means that when the laity hear the good news of the Gospel they accept what they hear but do not act it out once outside the church. For example the reading of the Gospel contains the parable of the Good Samaritan. Later in the week say Tuesday, the boy who heard the message and accepted it as good news, is in the city when he sees an elderly couple struggling to climb the many steps of a building. The boy offers no help or assistance but just thinks to himself, oh they'll be fine, but I have to get into this building for a social services interview since I want to help people. This boy heard the message on Sunday about helping others but in the real world he is separated from the Gospel's acceptance and the actual living of the Gospel. Religion Essays

Using Response Cost in Classroom Behavior Management

Using Response Cost in Classroom Behavior Management Response cost is the term used for removing reinforcement for an undesirable or disruptive behavior. In terms of Applied Behavior Analysis, it is a form of negative punishment. By removing something (a preferred item, access to reinforcement) you decrease the likelihood that the target behavior will appear again. It is often used with a token economy  and is best used when a student understands the implications. An Example of Response Cost Alex is a young child with autism. He often leaves the instructional setting, requiring the teacher to get up and leave. He is currently working on sitting in the instructional setting while participating in an imitation program. He is given tokens on a token board for good sitting during instruction, and earns a three minute break with a preferred item when he earns four tokens. During trials he is given constant feedback on the quality of his sitting. Even though his leaving the site of instruction has decreased, he does occasional test the teacher by getting up and leaving: he automatically loses a token. He quickly earns it back when he returns to the table and sits well. Eloping from the classroom has been extinguished. Leaving the instructional site has dropped from 20 times a day to three times a week. With some children, like Alex, response cost can be an effective way to extinguish problematic behavior while supporting other behavior. With others, response cost can present some serious problems. Response Cost as Part of an ABA Program The basic unit of instruction in an ABA Program is the Trial. Usually, a trial is very brief, involving an instruction, a response, and feedback. In other words, the teacher says, Touch the red one, John. When John touches the red one (response), the teacher gives feedback: Good job, John. The teacher may reinforce each correct response, or every third to fifth correct response, depending on the reinforcement schedule. When response cost is introduced, the student may lose a token for an inappropriate behavior: the student needs to know that he or she can lose a token for the target behavior. Are you sitting nicely John? Good Job or No, John. We dont crawl under the table. I have to take a token for not sitting. You need to constantly be evaluating the effectiveness of response cost. Does it really reduce the number of inappropriate behaviors? Or does it just drive the inappropriate behavior underground, or change the misbehavior? If the function of the behavior is control or escape, you will see other behaviors popping up, perhaps surreptitiously, that serve the function of control or escape. If it does, you need to discontinue response cost and attempt differentiated reinforcement. Response Cost as Part of a Classroom Token Economy Response cost can be part of a Classroom Token Economy, when there are certain behaviors that can cost a student a token, a point (or points) or money (a fine, if you are using play money, School Bux or whatever). If it is a classroom program, then everyone in the class has to be able to lose points at a set rate for a certain behavior. This reductive method has been shown to be effective with students with ADHD, who often never get enough points for positive behavior, so they end up very quickly bankrupt in the classroom economy. Example: Mrs. Harper uses a token economy (point system) in her Emotional Support Program. Each student gets ten points for each half hour that he/she stays in their seat and works independently. They get 5 points for each completed assignment. They can lose 5 points for certain infractions. They can lose 2 points for less severe infractions. They can get 2 points as bonuses for exhibiting positive behavior independently: waiting patiently, take turns, thanking their peers. At the end of the day, everyone records their points with the banker, and at the end of the week they can use their points in the school store. Cost Response for Students with ADHD Ironically, the one population for whom cost response is effective are students with Attention Deficit Hyperactivity Disorder. Often they fail at classroom reinforcement schedules  because they can never quite earn enough points to get the prize or the recognition that comes with earning points. When students start with all their points, they will work hard to keep them. Research has shown this can be a powerful reinforcement regimen for students with these behavioral disabilities. Pros of a Response Cost Program When you have real clarity about the behaviors for which a student can lose points, tokens or access to reinforcers, it is likely that you will see very little of those behaviors. At the same time, you are reinforcing the desired behavior.Response cost is easy to administer,When the student has a behavior that prevents his or her peers from learning, creates a danger to himself or others (eloping, climbing on furniture) response cost can provide a swift punishment without actually applying any aversive. Cons of a Response Cost Program If the ratio of positive reinforcement is not at least 3 to 1, your students may never get out of the hole. It will merely be punitive, and never really take hold.If response cost is not consistently applied in a non-emotional way, it will become the source or recrimination and bad blood between students and staff or students and teacher.If it builds dependence on punishment, it will be counter-productive. Reinforcing replacement behavior is still the most effective way to change undesirable behavior. Resources and Further Reading â€Å"Behavior Modification in the Classroom.† Learning Disabilities and Challenging Behaviors: A Guide to Intervention and Classroom Management, by Nancy Mather et al., 3rd ed., Brookes, 2008, pp. 134-153.Walker, Hill M. â€Å"Applications of Response Cost in School Settings: Outcomes, Issues and Recommendations.† Exceptional Education Quarterly, vol. 3, no. 4, 1 Feb. 1983, pp. 47-55.

Disaster Simulation Essay Example | Topics and Well Written Essays - 750 words

Disaster Simulation - Essay Example Emergency guides advice that one should have enough resources to take care of him for at least 72 hours after the beginning of a disaster. In addition, one should prepare for his travel in case he receives an evacuation order. This involves ensuring that the gas tank is full and all items needed are in the car. It is also important to ensure that all family members are well prepared for the disaster. For instance, one should ensure that all the important documents of family members such as passports and birth certificates could be easily retrieved when the family leaves the house. Keeping the documents in fireproof box can be helpful. In addition, one should ensure that he communicates well with all family members about the escape routes and other disaster preparation strategies. Communicating to them about the warning signs of the expected disaster is vital. Other modes of communication such as radios and television also help one to prepare effectively for the disasters (Gow & Paton , 2008). Nurses have an important role to play if a disaster occurs in a work place. They should be aware of the specific disaster response plans in their hospitals. During a disaster, patients’ safety especially those in critical conditions should be the top priority in hospital. One of the nurses’ roles during a disaster in their place of work includes ambulating patients to a safer location. They should also ensure that the patients’ beds are placed in windowless areas. The situation prevents patients from being injured by broken windows during a disaster. If it is difficult to move the beds to areas that do not have windows nurses should ensure that the window blinds and drapes are closed. It is also important to protect them from debris by giving them more pillows and blankets. Additionally, nurses should ensure that all hallways are open so that patients’ needs are

Feasibility study Research Paper Example | Topics and Well Written Essays - 2500 words

Feasibility study - Research Paper Example Protein is in the spotlight today because it is not only healthy, but it is also truly the essence of life. The Atkins diet hasn’t hurt the business any either but rather it has enlightened the mankind about importance of protein rich diet and ho it is healthy and valuable to the human beings. Many consumers have found cheese great for their diets and it has helped spur growth in the single-serve cheeses that are purchased in the grocery stores as an easy means of a quick snack readily available off the corner. Convenient foods are an ever growing food segment too which mostly contain cheese. Peezanoâ„ ¢ seeks to leverage and capitalize on the numerous competitive advantages its patents are able to provide in the food service (bulk cheese) and packaged cheese goods markets. In addition, the Company has identified a line of proprietary, delicious tasting, health conscious and convenient meal solutions. Peezano will initially target the domestic mozzarella cheese market as a means to leverage its advantage over the mozzarella cheese. This market represents well over 3 billion pounds of cheese produced and consumed each year which represents over pounds 4 billion in sales. The Company’s Peezanoâ„ ¢ cheese, will be marketed as a Premium level cheese with more flavor, fewer calories, less cholesterol, more tender and with a longer shelf life. Phase 1 : Product/Service Feasibility Analysis Cheese manufacturing technology developed by Peezanoâ„ ¢ allows it to produce a new kind of cheese that is better tasting than mozzarella and yet at a 30% lower cost. In 2010, the British consumers have consumed more than 2.6 billion pounds of cheese (www. .dairyco.org.uk). According to the most recent statistics, â€Å"Latest  Kantar Worldpanel  data shows that cheese volume sales have increased by 3.2% (12,649 tonnes) to 407,642 tonnes in the 52 weeks ending 26 December 2010, when compared to the same period in 2009. Spend has also increased compared t o the previous year, up by 3.6% (?84.8m) to ?2.5bn for the 52 weeks ending 26 December 2010.   The total average price stood at ?6.03/kg, 0.4% (?0.02/kg) more than the same period last year.† (www.dairyco.org.uk). Cheese is a highly nutritious and palatable food which contains protein, essential minerals, vitamins, and other nutrients found in the milk base. â€Å"Almost all households in Britain purchase cheese with the average household buying 1.5 times per week. The typical basket size was up by 4.7% over the last year with the average price paid of ?2.70 per kilogram giving a total spend per person of ?95.68.†Ã¢â‚¬  (www.flex-news-food.com) Today, British manufactures are using more than one-third of their milk production to produce cheese for the country. Concept and usability Testing:   The new technology of cheese manufacturing and the cheese quality produced was subjected to extensive consumer taste research. The concept was

Interpreting different cultures Essay Example | Topics and Well Written Essays - 2000 words - 1

Interpreting different cultures - Essay Example meaning of this statement is that the differences that people living a certain place have makes them unique in their various ways, similar to those living in another place. When people come together they can exchange this ideas, thus learn how to treasure and value each other. According to Louis Dumont, the oneness that has to exist in the different human societies does not often require reducing the diversity to that of unity. The people living in a certain place or culture need to have a common language, which plays an essential role towards passing that culture from one generation to another. One of the things that can be critical towards ensuring the success of the different human cultures is developing an effective understanding of these cultures. This understanding is important since it helps in the preservation of those cultures for other people to learn from them. In this regard, the society needs to created special institutions in which people’s cultural differences can be understood effectively. This paper examines the importance of the differences existing in human cultures focusing on ways of understanding these cultures in the most effective way. It focuses on the views and perspectives provided by Richard Shweder’s and Geertz’s views in their â€Å"Culture Theory† and â€Å"The Interpretation of Culture† respectively. Culture, as an independent term has often been given different meanings. To some people, culture can be described as the appreciation of the different art, food, literature and music among others (Gannon & Rajnandini,  2010). To biologists and other researchers in this field; it simply means a colony of microorganisms and other kinds of bacteria that grow in a special kind of nutrient medium specially kept in a Petri dish in the laboratory. For behavioral scientists and anthropologists, culture is interpreted as the broad range of various learned human actions and other behavioral patterns. In this regard, culture is taken to

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

Virgin In A Tree Essay -- essays research papers

This poem was written in 1958, after Sylvia Plath left her job at Smith College to write for a living. It was during this time she found writing extremely difficult and resorted to set themes and deliberate exercises in style, in her efforts to find a release. The poem is based on a drawing "The Virgin in a Tree" by Paul Klee. Sylvia Plath expresses her feelings about the concept of virginity, virgins etc. She holds their morals and values accountable, for what they believe to be right and what they believe to be wrong. Sylvia Plath uses great many mythical allusions to illustrate her perceptions about virgins, especially in Ancient Greek mythology, many of which have been a direct bearing on the title of the poem; 'Virgin in a Tree'. The first most obvious allusion is that of Daphne. 'Ever since that first Daphne Switched her incomparable back For a bay-tree hide,' In Greek mythology Daphne was a nymph, the daughter of the river god Peneus. She was a hunter who dedicated herself to Artemis, goddess of the hunt, and, like the goddess, refused to marry. The god Apollo fell in love with Daphne, and when she refused his advances, he pursued her through the woods. She prayed to her father for help, and as Apollo advanced upon her, she was changed into a laurel tree (Daphne in Greek). Grief-stricken at her transformation, Apollo made the laurel his sacred tree. With reference to Apollo made in the phrase; 'god-haloed'. The other phrase 'goat thighed', may signify Philocetes (Trainer of the heroes) or Pan (god of the woods). It is most obviously Pan, with evidence in future reference in the fourth stanza. Pan, in Greek mythology, was the god of woods, fields, and fertility, the son of Hermes, messenger of the gods, and a nymph. Part animal, with the horns, hoofs, and ears of a goat, he was a lusty deity, the god of the shepherds and the goatherds. A w onderful musician, he accompanied, with his pipe of reeds, the woodland nymphs when they danced. He invented this pipe when the nymph Syrinx, whom he was pursuing, objected to his advances and was transformed into a bed of reeds, enabling her to escape him. 'Celebrate Syrinx whose demurs Won her the frog coloured skin, pale pith and watery Bed of a reed.' Pan then took reeds of unequal length and played on them. The god was always wooing one of the nymphs by playing on his pipes, but was always rejected ... ... root to top' 'Her fingers Stiff as twigs, her body woodenly Askew' Her tone throughout is very indignant, severe and at times mocking. 'How this tart fable instructs And mocks! Here's the parody of that moral mousetrap' 'They descant on the serene and seraphic beauty Of virgins for virginity's sake.' 'Be certain some such pact's Been struck to keep all glory in the grip Of ugly spinsters and barren sirs' Plath also makes use of faint colour imagery here and there, to strengthen her ideas and give support to her literary prowess. 'White bodies' use of the colour white may signify coldness of the virgins, or their supposed purity. 'Bark's nun-black habit' the colour black may point to the restricted, non-reproachable characteristics, while the colour green ('Green virgins') indicates inexperience. This poem is in many ways a social commentary, by Sylvia Plath, on the dilemmas modern society is faced with. Especially concerning roles of women as nurturers, mothers, wives and daughters. As well as their role in being virgins. Sylvia Plath definitely does not believe strongly in woman's role as a virgin, whether it be for purity or chastity's sake. Virgin In A Tree Essay -- essays research papers This poem was written in 1958, after Sylvia Plath left her job at Smith College to write for a living. It was during this time she found writing extremely difficult and resorted to set themes and deliberate exercises in style, in her efforts to find a release. The poem is based on a drawing "The Virgin in a Tree" by Paul Klee. Sylvia Plath expresses her feelings about the concept of virginity, virgins etc. She holds their morals and values accountable, for what they believe to be right and what they believe to be wrong. Sylvia Plath uses great many mythical allusions to illustrate her perceptions about virgins, especially in Ancient Greek mythology, many of which have been a direct bearing on the title of the poem; 'Virgin in a Tree'. The first most obvious allusion is that of Daphne. 'Ever since that first Daphne Switched her incomparable back For a bay-tree hide,' In Greek mythology Daphne was a nymph, the daughter of the river god Peneus. She was a hunter who dedicated herself to Artemis, goddess of the hunt, and, like the goddess, refused to marry. The god Apollo fell in love with Daphne, and when she refused his advances, he pursued her through the woods. She prayed to her father for help, and as Apollo advanced upon her, she was changed into a laurel tree (Daphne in Greek). Grief-stricken at her transformation, Apollo made the laurel his sacred tree. With reference to Apollo made in the phrase; 'god-haloed'. The other phrase 'goat thighed', may signify Philocetes (Trainer of the heroes) or Pan (god of the woods). It is most obviously Pan, with evidence in future reference in the fourth stanza. Pan, in Greek mythology, was the god of woods, fields, and fertility, the son of Hermes, messenger of the gods, and a nymph. Part animal, with the horns, hoofs, and ears of a goat, he was a lusty deity, the god of the shepherds and the goatherds. A w onderful musician, he accompanied, with his pipe of reeds, the woodland nymphs when they danced. He invented this pipe when the nymph Syrinx, whom he was pursuing, objected to his advances and was transformed into a bed of reeds, enabling her to escape him. 'Celebrate Syrinx whose demurs Won her the frog coloured skin, pale pith and watery Bed of a reed.' Pan then took reeds of unequal length and played on them. The god was always wooing one of the nymphs by playing on his pipes, but was always rejected ... ... root to top' 'Her fingers Stiff as twigs, her body woodenly Askew' Her tone throughout is very indignant, severe and at times mocking. 'How this tart fable instructs And mocks! Here's the parody of that moral mousetrap' 'They descant on the serene and seraphic beauty Of virgins for virginity's sake.' 'Be certain some such pact's Been struck to keep all glory in the grip Of ugly spinsters and barren sirs' Plath also makes use of faint colour imagery here and there, to strengthen her ideas and give support to her literary prowess. 'White bodies' use of the colour white may signify coldness of the virgins, or their supposed purity. 'Bark's nun-black habit' the colour black may point to the restricted, non-reproachable characteristics, while the colour green ('Green virgins') indicates inexperience. This poem is in many ways a social commentary, by Sylvia Plath, on the dilemmas modern society is faced with. Especially concerning roles of women as nurturers, mothers, wives and daughters. As well as their role in being virgins. Sylvia Plath definitely does not believe strongly in woman's role as a virgin, whether it be for purity or chastity's sake.