Sensitivity Analysis

Linear scheduling Notes VII sensitiveness Analysis 1 Introduction When you use a mathematical model to describe reality you must stir approximations. The homo is more getd than the kinds of optimization b otherwises that we be able to bat. Linearity assumptions usually be signi? tail endt approximations. A nonher important approximation comes because you advise non be authoritative of the data that you put into the model. Your k right offledge of the relevant technology may be imprecise, forcing you to approximate fosters in A, b, or c. Moreover, entropy may variegate.Sensitivity analytic thinking is a systematic study of how sensitive (duh) rootages are to (small) removes in the data. The base idea is to be able to give performs to questions of the form 1. If the design turn tail variegates, how does the beginning swop? 2. If resources available form over, how does the ancestor shift? 3. If a timidity is added to the statement of work, how do es the resolvent change? One approach to these questions is to solve often of bilinear scheduling occupations. For example, if you think that the taboolay of your primary bug product exit be amidst $100 and $120 per unit of measurement, you faecal matter solve twenty di? pursue chores ( iodin for each whole number between $100 and $120). 1 This locate would work, just now it is inelegant and (for abundant problems) would involve a large keep down of computation time. (In fact, the computation time is cheap, and computing issues to similar problems is a specimen technique for studying sensitiveness in practice. ) The approach that I bequea intimacy describe in these nones takes full advantage of the structure of LP programming problems and their resolvent. It turns break that you can often ? gure out what happens in nearby linear programming problems just by thinking and by examining the study provided by the unidirectional algorithm.In this section, I l eave alone describe the sensitivity analysis information provided in outperform computations. I go out besides try to give an knowledge for the results. 2 Intuition and Overview Throughout these nones you should imagine that you must solve a linear programming problem, but past you take to see how the answer changes if the problem is changed. In every case, the results come to that just one motion virtually the problem changes. That is, in sensitivity analysis you evaluate what happens when all one parameter of the problem changes. 1 OK, at that place are in reality 21 problems, but who is counting? 1To ? x ideas, you may think about a particular LP, say the familiar example max 21 subject to 31 x1 2x 1 + + + 42 x2 32 x2 + + + + 3x 3 x3 2x 3 3x 3 + + + x4 4x 4 3x 4 x4 x ? ? ? 12 7 10 0 We know that the rootage to this problem is x0 = 42, x1 = 0 x2 = 10. 4 x3 = 0 x4 = . 4. 2. 1 Changing fair game Function Suppose that you solve an LP and therefore wish to solve oth er(prenominal) problem with the selfsame(prenominal) modestys but a slightly di? erent documental kick the bucket. (I will ever bugger off only one change in the problem at a time. So if I change the heading melt down, non only will I hold the coynesss ? ed, but I will change only one coe cient in the neutral function. ) When you change the purpose function it turns out that there are dickens cases to con expressionr. The ? rst case is the change in a non- basic uncertain (a unsettled that takes on the determine zero point in the solution). In the example, the relevant non-basic covariants are x1 and x3 . What happens to your solution if the coe cient of a non-basic variable devolves? For example, suppose that the coe cient of x1 in the bearing function above was lightd from 2 to 1 (so that the documentary function is max x1 + 42 + 33 + x4 ).What has happened is this You have taken a variable that you didnt requisite to use in the ? rst place (you set x1 = 0 ) and so made it little pro? disconcert ( subverted its coe cient in the objective function). You are still not red ink to use it. The solution does not change. Observation If you lower the objective function coe cient of a non-basic variable, then the solution does not change. What if you raise the coe cient? Intuitively, facts of life it just a little bit should not matter, but procreation the coe cient a lot might induce you to change the cling to of x in a way that take a craps x1 0.So, for a non-basic variable, you should expect a solution to lead to be valid for a lop of nourishs for coe cients of nonbasic variables. The redact should include all lower harbors for the coe cient and some higher values. If the coe cient growings teeming (and putting the variable into the behind is feasible), then the solution changes. What happens to your solution if the coe cient of a basic variable (like x2 or x4 in the example) decreases? This situation di? ers from the prev ious one in that you are utilise the basis variable in the ? rst place. The change makes the variable contribute less(prenominal) to pro? . You should expect that a su ciently large reduction makes you lack to change your solution (and lower the value the associated variable). For example, if the coe cient of x2 in the objective function in the example were 2 rather of 4 (so that the objective was max 21 +22 +33 + x4 ), 2 maybe you would want to set x2 = 0 instead of x2 = 10. 4. On the other hand, a small reduction in x2 s objective function coe cient would typically not cause you to change your solution. In contrast to the case of the non-basic variable, such a change will change the value of your objective function.You compute the value by plugging in x into the objective function, if x2 = 10. 4 and the coe cient of x2 goes down from 4 to 2, then the contribution of the x2 ter subtraction to the value goes down from 41. 6 to 20. 8 ( assuming that the solution rest the same). I f the coe cient of a basic variable goes up, then your value goes up and you still want to use the variable, but if it goes up abundant, you may want to adjust x so that it x2 is raze possible. In many cases, this is possible by ? nding another basis (and therefore another solution).So, intuitively, there should be a throw off of values of the coe cient of the objective function (a execute that includes the overlord value) in which the solution of the problem does not change. Out office of this range, the solution will change (to lower the value of the basic variable for reductions and growth its value of subjoins in its objective function coe cient). The value of the problem always changes when you change the coe cient of a basic variable. 2. 2 Changing a Right-Hand Side Constant We discussed this topic when we talked about duality. I argued that dual prices capture the e? ct of a change in the measuring rods of available resources. When you changed the essence of resourc e in a non-binding constraint, then summations never changed your solution. Small decreases also did not change anything, but if you decreased the amount of resource enough to make the constraint binding, your solution could change. (Note the similarity between this analysis and the case of changing the coe cient of a non-basic variable in the objective function. Changes in the right-hand situation of binding constraints always change the solution (the value of x must adjust to the peeled constraints).We saw earlier that the dual variable associated with the constraint measures how much the objective function will be in? uenced by the change. 2. 3 Adding a Constraint If you add a constraint to a problem, two things can happen. Your received solution satis? es the constraint or it doesnt. If it does, then you are ? nished. If you had a solution before and the solution is still feasible for the juvenile problem, then you must still have a solution. If the reliable solution does not suffer the new constraint, then possibly the new problem is infeasible. If not, then there is another solution.The value must go down. (Adding a constraint makes the problem harder to satisfy, so you cannot possibly do better than before). If your original solution satis? es your new constraint, then you can do as well as before. If not, then you will do worse. 2 2 There is a rare case in which originally your problem has multiple solutions, but only some of them satisfy the added constraint. In this case, which you contend not worry about, 3 2. 4 Relationship to the Dual The objective function coe cients sum to the right-hand align unvarieds of resource constraints in the dual.The aboriginals right-hand side constants correspond to objective function coe cients in the dual. hence the exercise of changing the objective functions coe cients is sincerely the same as changing the resource constraints in the dual. It is extremely usable to become comfor add-in switching st icker and forth between original and dual relationships. 3 Understanding Sensitivity Information Provided by Excel Excel permits you to create a sensitivity report with any single-minded LP. The report contains two send backs, one associated with the variables and the other associated with the constraints.In reading these notes, keep the information in the sensitivity instrument panels associated with the ? rst simplex algorithm example nearby. 3. 1 Sensitivity Information on Changing (or Adjustable) Cells The top table in the sensitivity report refers to the variables in the problem. The ? rst column (Cell) tells you the location of the variable in your spreadsheet the guerilla column tells you its name (if you named the variable) the third column tells you the ? nal value the quaternaryth column is called the minify cost the ? fth column tells you the coe cient in the problem the ? al two columns are labeled permissible increase and deductible decrease. Reduced cost, p ermissible increase, and permissible decrease are new terms. They need de? nitions. The allowable increases and decreases are easier. I will discuss them ? rst. The allowable increase is the amount by which you can increase the coe cient of the objective function without ca employ the optimum basis to change. The allowable decrease is the amount by which you can decrease the coe cient of the objective function without causing the optimal basis to change. Take the ? rst row of the table for the example. This row describes the variable x1 .The coe cient of x1 in the objective function is 2. The allowable increase is 9, the allowable decrease is 1. 00E+30, which core 1030 , which real means 1. This means that provided that the coe cient of x1 in the objective function is less than 11 = 2 + 9 = original value + allowable increase, the basis does not change. Moreover, since x1 is a non-basic variable, when the basis stays the same, the value of the problem stays the same too. The inf ormation in this line con? rms the intuition provided earlier and adds something new. What is con? rmed is that if you lower the objective coe cient of a non-basic ariable, then your solution does not change. (This means that the allowable decrease will always be in? nite for a non-basic variable. ) The example also demonstrates your value will stay the same. 4 that increasing the coe cient of a non-basic variable may lead to a change in basis. In the example, if you increase the coe cient of x1 from 2 to anything greater than 9 (that is, if you add more than the allowable increase of 7 to the coe cient), then you change the solution. The sensitivity table does not tell you how the solution changes, but common sense suggests that x1 will take on a positive value. placard that the line associated with the other non-basic variable of the example, x3 , is remarkably similar. The objective function coe cient is di? erent (3 rather than 2), but the allowable increase and decrease are the same as in the row for x1 . It is a coincidence that the allowable increases are the same. It is no coincidence that the allowable decrease is the same. We can conclude that the solution of the problem does not change as long as the coe cient of x3 in the objective function is less than or compare to 10. Consider now the basic variables. For x2 the allowable increase is in? ite 9 while the allowable decrease is 2. 69 (it is 2 13 to be exact). This means that if the solution wont change if you increase the coe cient of x2 , but it will change if you decrease the coe cient enough (that is, by more than 2. 7). The fact that your solution does not change no matter how much you increase x2 s coe cient means that there is no way to make x2 10. 4 and still satisfy the constraints of the problem. The fact that your solution does change when you increase x2 s coe cient by enough means that there is a feasible basis in which x2 takes on a value lower than 10. 4. You knew that. Examine the original basis for the problem. ) The range for x4 is di? erent. Line four of the sensitivity table says that the solution of the problem does not change provided that the coe cient of x4 in the objective function stays between 16 (allowable increase 15 plus objective function coe cient 1) and -4 (objective function coe cient minus allowable decrease). That is, if you make x4 su ciently more attractive, then your solution will change to permit you to use more x4 . If you make x4 su ciently less attractive the solution will also change. This time to use less x4 .Even when the solution of the problem does not change, when you change the coe cient of a basic variable the value of the problem will change. It will change in a predictable way. Speci? cally, you can use the table to tell you the solution of the LP when you take the original constraints and replace the original objective function by max 21 + 62 + 33 + x4 (that is, you change the coe cient of x2 from 4 to 6), then the soluti on to the problem remains the same. The value of the solution changes because now you compute the 10. 4 units of x2 by 6 instead of 4. The objective function therefore goes up by 20. . The reduced cost of a variable is the smallest change in the objective function coe cient needed to arrive at a solution in which the variable takes on a positive value when you solve the problem. This is a mouthful. Fortunately, reduced costs are redundant information. The reduced cost is the negative of the allowable increase for non-basic variables (that is, if you change the coe cient of x1 by 7, then you arrive at a problem in which x1 takes on a positive 5 value in the solution). This is the same as construction that the allowable increase in the coe cient is 7.The reduced cost of a basic variable is always zero (because you need not change the objective function at all to make the variable positive). Neglecting rare cases in which a basis variable takes on the value 0 in a solution, you can ? gure out reduced costs from the other information in the table If the ? nal value is positive, then the reduced cost is zero. If the ? nal value is zero, then the reduced cost is negative one times the allowable increase. Remarkably, the reduced cost of a variable is also the amount of inert in the dual constraint associated with the variable.With this interpretation, complementary slackness implies that if a variable that takes on a positive value in the solution, then its reduced cost is zero. 3. 2 Sensitivity Information on Constraints The game sensitivity table discusses the constraints. The cell column identi? es the location of the left-hand side of a constraint the name column gives its name (if any) the ? nal value is the value of the left-hand side when you plug in the ? nal values for the variables the shadow price is the dual variable associated with the constraint the constraint R. H. ide is the right hand side of the constraint allowable increase tells you by how muc h you can increase the right-hand side of the constraint without changing the basis the allowable decrease tells you by how much you can decrease the right-hand side of the constraint without changing the basis. Complementary Slackness guarantees a relationship between the columns in the constraint table. The di? erence between the Constraint Right-Hand Side column and the terminal Value column is the slack. (So, from the table, the slack for the three constraints is 0 (= 12 12), 37 (= 7 ( 30)), and 0 (= 10 10), respectively.We know from Complementary Slackness that if there is slack in the constraint then the associated dual variable is zero. Hence CS tells us that the second dual variable must be zero. Like the case of changes in the variables, you can ? gure out information on allowable changes from other information in the table. The allowable increase and decrease of non-binding variables can be computed knowing ? nal value and right-hand side constant. If a constraint is not binding, then adding more of the resource is not going to change your solution. Hence the allowable increase of a resource is in? ite for a non-binding constraint. (A nearly equivalent, and also true, statement is that the allowable increase of a resource is in? nite for a constraint with slack. ) In the example, this explains why the allowable increase of the second constraint is in? nite. One other beat is also no surprise. The allowable decrease of a non-binding constraint is equal to the slack in the constraint. Hence the allowable decrease in the second constraint is 37. This means that if you decrease the right-hand side of the second constraint from its original value (7) to nything greater than 30 you do not change the optimal basis. In fact, the only part of the solution that changes when you do this is that the value of the slack variable for this constraint changes. In this paragraph, the point is only this If you solve an LP and ? nd that a constraint is not binding, 6 then you can remove all of the unused (slack) portion of the resource associated with this constraint and not change the solution to the problem. The allowable increases and decreases for constraints that have no slack are more complicated. Consider the ? rst constraint.The information in the table says that if the right-hand side of the ? rst constraint is between 10 (original value 12 minus allowable decrease 2) and in? nity, then the basis of the problem does not change. What these columns do not say is that the solution of the problem does change. Saying that the basis does not change means that the variables that were zero in the original solution continue to be zero in the new problem (with the right-hand side of the constraint changed). However, when the amount of available resource changes, necessarily the values of the other variables change. You can think about this in many ways. Go back to a standard example like the diet problem. If your diet provides incisively the rig ht amount of Vitamin C, but then for some reason you jibe that you need more Vitamin C. You will sure change what you eat and (if you arent getting your Vitamin C through pills supplying pure Vitamin C) in order to do so you probably will need to change the physical composition of your diet a little more of some foods and perhaps less of others. I am saying that (within the allowable range) you will not change the foods that you eat in positive amounts.That is, if you ate only spinach and oranges and bagels before, then you will only eat these things (but in di? erent quantities) after the change. Another thing that you can do is simply re-solve the LP with a di? erent right-hand side constant and compare the result. To ? nish the discussion, consider the third constraint in the example. The values for the allowable increase and allowable decrease guarantee that the basis that is optimal for the original problem (when the right-hand side of the third constraint is equal to 10) r emains obtain provided that the right-hand side constant in this constraint is between -2. 333 and 12. hither is a way to think about this range. Suppose that your LP involves four proceeds processes and uses three basic ingredients. Call the ingredients land, labor, and capital. The outputs vary use di? erent combinations of the ingredients. mayhap they are growing fruit (using divide of land and labor), cleaning bathrooms (using lots of labor), making cars (using lots of labor and and a bit of capital), and making computers (using lots of capital). For the initial speci? cation of available resources, you ? nd that your want to grow fruit and make cars.If you get an increase in the amount of capital, you may wish to bring up into building computers instead of cars. If you experience a decrease in the amount of capital, you may wish to shift away from building cars and into cleaning bathrooms instead. As always when dealing with duality relationships, the the Adjustable Cells ta ble and the Constraints table really provide the same information. Dual variables correspond to autochthonic constraints. Primal variables correspond to dual constraints. Hence, the Adjustable Cells table tells you how sensitive primal variables and dual constraints are to changes in the primal objective function.The Constraints table tells you how sensitive dual variables and primal constraints are to changes in the dual objective function (right-hand side constants in the primal). 7 4 Example In this section I will present another formulation example and discuss the solution and sensitivity results. Imagine a furniture company that makes tables and contributes. A table requires 40 maturate feet of wood and a chair requires 30 board feet of wood. wood costs $1 per board foot and 40,000 board feet of wood are available. It takes 2 hours of skilled labor to make an un? nished table or an un? ished chair. ternary more hours of labor will turn an un? nished table into a ? nished t able two more hours of skilled labor will turn an un? nished chair into a ? nished chair. There are 6000 hours of skilled labor available. (Assume that you do not need to pay for this labor. ) The prices of output are given in the table below Product Un? nished Table completed Table Un? nished Chair Finished Chair Price $70 $140 $60 $110 We want to formulate an LP that describes the labor plans that the ? rm can use to maximize its pro? ts. The relevant variables are the number of ? nished and un? ished tables, I will call them TF and TU , and the number of ? nished and un? nished chairs, CF and CU . The revenue is (using the table) 70TU + 140TF + 60CU + 110CF , , while the cost is 40TU + 40TF + 30CU + 30CF (because impound costs $1 per board foot). The constraints are 1. 40TU + 40TF + 30CU + 30CF ? 40000. 2. 2TU + 5TF + 2CU + 4CF ? 6000. The ? rst constraint says that the amount of walk used is no more than what is available. The second constraint states that the amount of labo r used is no more than what is available. Excel ? nds the answer to the problem to be to construct only ? nished chairs (1333. 33 Im not sure what it means to make a swop 1 chair, but lets assume 3 that this is possible). The pro? t is $106,666. 67. Here are some sensitivity questions. 1. What would happen if the price of un? nished chairs went up? Currently they sell for $60. Because the allowable increase in the coe cient is $50, it would not be pro? table to produce them even if they sold for the same amount as ? nished chairs. If the price of un? nished chairs went down, then certainly you wouldnt change your solution. 8 2. What would happen if the price of un? nished tables went up? Here something apparently absurd happens.The allowable increase is greater than 70. That is, even if you could sell un? nished tables for more than ? nished tables, you would not want to sell them. How could this be? The answer is that at current prices you dont want to sell ? nished tables. Hence it is not enough to make un? nished tables more pro? table than ? nished tables, you must make them more pro? table than ? nished chairs. Doing so requires an even greater increase in the price. 3. What if the price of ? nished chairs fell to $100? This change would alter your occupation plan, since this would involve a $10 decrease in the price of ? ished chairs and the allowable decrease is only $5. In order to ? gure out what happens, you need to re-solve the problem. It turns out that the best thing to do is narrow down in ? nished tables, producing 1000 and earning $100,000. Notice that if you continued with the old production plan your pro? t would be 70 ? 1333 1 = 93, 333 1 , so the change in production plan 3 3 was worth more than $6,000. 4. How would pro? t change if pound off supplies changed? The shadow price of the lumber constraint is $2. 67. The range of values for which the basis remains unchanged is 0 to 45,000.This means that if the lumber supply went up by 5000 , then you would continue to specialize in ? nished chairs, and your pro? t would go up by $2. 67 ? 5000 = $10, 333. At this point you presumably run out of labor and want to reoptimize. If lumber supply decreased, then your pro? t would decrease, but you would still specialize in ? nished chairs. 5. How much would you be willing to pay an additional carpenter? Skilled labor is not worth anything to you. You are not using the labor than you have. Hence, you would pay nothing for additional workers. 6. Suppose that industrial regulations complicate the ? ishing process, so that it takes one extra hour per chair or table to turn an un? nished product into a ? nished one. How would this change your plans? You cannot read your answer o? the sensitivity table, but a bit of common sense tells you something. The change cannot make you better o?. On the other hand, to produce 1,333. 33 ? nished chairs youll need 1,333. 33 extra hours of labor. You do not have that available. So the change w ill change your pro? t. Using Excel, it turns out that it becomes optimal to specialize in ? nished tables, producing 1000 of them and earning $100,000. This problem di? ers from the original one because the amount of labor to create a ? nished product increases by one unit. ) 7. The possessor of the ? rm comes up with a design for a beautiful hand-crafted footlocker. for each one cabinet requires 250 hours of labor (this is 6 weeks of full time work) and uses 50 board feet of lumber. Suppose that the company can sell a cabinet for $200, would it be worthwhile? You could solve this 9 problem by changing the problem and adding an additional variable and an additional constraint. Note that the coe cient of cabinets in the objective function is 150, which re? cts the sale price minus the cost of lumber. I did the computation. The ? nal value increased to 106,802. 7211. The solution involved reducing the output of un? nished chairs to 1319. 727891 and increasing the output of cabinet s to 8. 163265306. (Again, please tolerate the fractions. ) You could not have guessed these ? gures in advance, but you could ? gure out that making cabinets was a good idea. The way to do this is to value the inputs to the production of cabinets. Cabinets require labor, but labor has a shadow price of zero. They also require lumber. The shadow price of lumber is $2. 7, which means that each unit of lumber adds $2. 67 to pro? t. Hence 50 board feet of lumber would reduce pro? t by $133. 50. Since this is less than the price at which you can sell cabinets (minus the cost of lumber), you are better o? using your resources to build cabinets. (You can check that the increase in pro? t associated with making cabinets is $16. 50, the added pro? t per unit, times the number of cabinets that you actually produce. ) I attached a sheet where I did the same computation assuming that the price of cabinets was $150. In this case, the additional option does not lead to cabinet production. 10

Professional Regulation and Criminal Liability Paper Essay

The principle of the Hippocratic Oath is one of the oldest binding documents in history. The oath adduces I will use those dietary regimens which will benefit my patient ofs check to my greatest major power and judgment, and I will do no harm or blemish to them. I will non give a lethal drug to anyone if I am asked, nor will I advise such a plan and similarly I will not give a woman a pessary to cause an abortion. In purity and according to divine rightfulness will I carry out my manners and my art. I will not use the knife, even upon those suffering from stones, bargonly I will leave this to those who atomic number 18 trained in this craft. Into any(prenominal) homes I go, I will enter them for the benefit of the tired of(p), avoiding any volunteer(prenominal) act of impropriety or corruption, including the seduction of women or men, whether they are exhaust men or slaves.Whatever I see or lift up in the lives of my patients, whether in connection with my affairal r adiation pattern or not, which ought not to be spoken of outside, I will keep secret, as considering whole such things to be private. So long as I apply this Oath faith all-embracingy and without corruption, may it be granted to me to partake of flavor fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate. (U.S. internal program library of Medicine, 2014) Medical identity card of calciumThe Medical mount up of calcium is the agency responsible for regulating doctors, surgeons and other allied health professions. The members of the mount up are appointed by the Governor of the state and have a four year term legislature. It is the responsibility of the members of the mesa to meet as one deliberating body. In addition, the board members are beseechd to learn intimately policies and statutes of twain licensing and enforcement functions. California Licensure Physicia n StatuteThere is no wizard physician licensure statute in the state of California. Instead, physician licensure rules have been interspersed at bottom the California code. Physicians wishing to practice music in California are required to obtain a full medical license issued by the state. Furthermore, there are no administrative regulations or state statue for granting aspecial or limited license to practice in the state remotely via telemedicine. The California licensure does not appropriate for license reciprocity amidst any states but allows physicians for consultative services without having to receive a full medical licensure. Moreover, licensed physicians in the military in any of the states, any a military physician officer or a civilian contract employee, are allowed to compassionate for fellow military members without having to receive supernumerary licensure. In the event of an emergency situation, a physician is allowed to administer address count onless if the physician is licensed in that particular state. A bodily examination is required by the California Medical Board Licensure to allow administration or prescription of medication over the internet. Investigative federal agencyThe investigative team consists of physicians that are a critical component to the board as they base its disciplinary actions on the feelings of physicians and not board staff. Physicians licentiousness a distinct role in the investigations. The board receives and look intos incoming complaints in the Central Complaint Unit (CCU). The physicians determine if there is a pick out for noble investigation by board investigative staff or if the complaint is largely resolved by a preliminary critique of the medical records and the accompanying physician narrative statement. Medical experts are asked to review case materials and must clearly articulate whether the physicians care under review fell below the standard. They must give their opinion if there is a potential violation of the Medical rehearse Act. trade and Professions Code Section 2050-2079According to the Federation of State Medical Boards, the tenth Amendment police power grants states the right to regulate the practice of medicine. Section 2052 of the demarcation and Professions Code states that any person who practices or attempts to practice, or who advertises or holds himself or herself out as practicing, any system or mode of treating the sick or afflicted in this state, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspendedcertificate as provided in this chapter or without being authorized to perform the act pursuant(predicate) to a certificate obtained in accordance with some other provision of jurisprudence is guilty of a public offense, punishable by a fine n ot exceeding ten thousand dollars ($10,000), by imprisonment pursuant to subdivision of Section 1170 of the Penal Code, by imprisonment in a county jail not exceeding one year, or by both the fine and either imprisonment (California transaction and Professions Code, 2014). Civil Complaint sufficeThe two major categories of incoming complaints to the Medical Care Board of California by the consumers are spirit of care and personal conduct. All complaints require physician review and all complaints which are not closed by CCU staff are referred to one of the boards district offices for formal investigation. According to the Medical Board, each district office is staffed with a superintendence investigator, five investigators, a deputy attorney general, an investigator assistant, clerical die hard staff and one or more medical consultants (The Medical Board of California, 2014). Risk Management & Quality AssuranceIt is important that physicians are credentialed and are given privi leges in any health care organization foregoing to practicing medicine. Physicians must receive training and education in risk counsel and review of federal and state regulations mandates. A successful risk worry strategy is to improve the quality of patient care and bring down the chance of an adverse outcome or a medical malpractice claim. Its objective is to reduce the risk to patients and liability to the physician. Furthermore, the foundation for risk management is the standard of care. introduce the quality of care of physicians must include Ongoing Professional Practice Evaluations (OPPE) and a peer review committee within an organization. Criminal quest for MalpracticePhysicians are in a unique position in regard to the law by the nature of their work. A physician may seem a charge of criminal negligence, manslaughter, or second-degree murder if a patient in his care suffers severe or lethal injuries. Negligence law offers plaintiffs the legal framework upon which to build their civil lodge. A plaintiff in a medicalmalpractice action must satisfy four elements-duty, breach, designer and damage- in order to prevail. In a negligence case, the wrongdoers actions are compared to what would be expected of a reasonable and prudent person in the same or similar circumstance (Monico, Kulkarni, & Calise, 2013). The practice of medicine is full of uncertainties. In some cases, bad outcome is the result of physician negligence. The patient and/or his family may institute a civil suit for malpractice if they believe that the bad outcome was a result of the physicians actions. It is very rare that a prosecutor decides the facts of a case imprimatur a charge of criminal malpractice. The prosecutors must see a repetitious negligent behavior that constitutes to a pattern that can be authenticated before criminal charges can be filed. ConclusionThe medical profession has many dedicated people who give themselves and sacrifices for the sake of saving lives. Physicians practice their profession according to the Hippocratic Oath. Furthermore, the have learned the rules and regulations mandated by the federal and State government in health care delivery. Quality of health care is an important objective of CMS. Physicians are required to adhere to the standards of quality care and the delivery of it.When physicians get in trouble with the law, they have to brass instrument various criminal and civil charges based on the severity of their case. In the current trend, doctors commit white-collar crimes when they take kickbacks, order questionable procedures, overbill patients and insurance policy companies, and bill for services they did not provide.The Medical Board of California ensures condom and protection of health care consumers through proper licensing and regulation of physicians by means of various objective enforcement of the Medical Practice Act.ReferencesCalifornia Business and Professions Code. (2014). Business and Professio ns Code Section 2050-2079. Retrieved fromhttp//www.liginfo.ca.gov/cgi-bin/displaycode?section=bpc&group Medical Board of California. (2013). Guide to the Laws Governing the Practice of Medicine by Physicians and Surgeons. Retrieved from http//www.mbc.ca.gov/about_laws/laws/_guide.pdf Monico, E., Kulkarni, R., & Calise, A. (2013). The Criminal prosecution of Medical Negligence. Retrieved from http//www.ispub.com/IJLHE/5/1/5237 The Medical Board of California. (2014). Laws and Regulations. Retrieved from http//www.mbc.ca.gov/about_us/laws/ U.S. National Library of Medicine. (2014). The Hippocratic Oath. Retrieved from http//www.nlm.nih.gov/hmd/greek/greek_oath.html

Literature During the Early Period (1900-1930) Essay

The twentieth century ushered in the development of Filipino lit in English. Weeks after the capitulation of Manila, the U.S. Military Government was set up and, almost seven schools were re-opened as a necessary strategy to sanction the pacification of the Filipinos and the dissemination of common culture. English was start-off taught merely as a subject because the Spanish system of education then lively in the Philippines was allowed to continue.In April 1900, by virtue of President McKinleys directives of the Philippine Commission, English became the official medium of instruction in the public schools. In order to accelerate the pacification drive, schools were established in all split of the Philippines. The former(a) teachers were taken in directly from the army. To augment the small add of American teachers, the Philippine Normal School, now Philippine Normal University, was founded in 1902 to train Filipinos in the art of teaching and eventually take stir of elementary education. In the same year, the Army transport, Thomas, brought six hundred American teachers to the Philippines who replaced the soldiers as teachers. They introduced to the Filipinos English and American publications in the form of whole kit written by Irving, Chaucer, Milton, Donne, Shakespeare, Emer give-and-take, Hawthorn, Poe, Longfellow, Bryant, Keats, Shelley, Coleridge, Lamb, Joyce, Tennyson, Macaulay, and other famous writers. These were the writers who became the models of the early Filipino writers in English.At first, Filipino writing in English was quite form-only(prenominal) and imitative, thus, the common reference to this period was known as Apprentice period. Influences from the Spanish language could be seen in the use of Spanish expressions and in rhetorical style. Grammatical expression were at times awkward and there was obstacle in the use of prepositions and pronouns.The first thirty years of Philippine literature in English produced little in the fiel ds of drama and novel. promiscuousness was hardly written, because vernacular plays and zarzuela still dominated the stage. The plays producedwere highly emotional, non reason experiences.The mindless stories produced during this period were either romantic tales of the past with legendary figures or were imitations of plots or themes taken from American and other sources. The most significant short story produced during the period was Dead Stars by Paz Marquez Benitez.Poetry was dominated by nave sentimental love lyrics written in a loose rhetoric without much intellectual significance and overblown to achieve intensity. oral exuberance made the poems bombastic, artificial and insincere.The seek took a form kindred to that utilized by British and American writers, but because the essay is a free form of composition, it soon developed its own personality. The Philippine essay in English is less inhibited by requirements inherent in other literary genres. It matured earlier i n the favourable surroundings and successfully projected Philippine customs and traditions.However, most critics agree that the early literary output in English can be considered decidedly commendable. It can be favourably compared to the Colonial Period of American publications in relation to English literature of those times.Footnote to YouthJose Garcia VillaDodong, who is 17 years old wanted to marry Teang. He wanted to go home so that he could tell his catch and ask for his permission. At first, he was hesitant of saying it, but he wanted him to know. For Dodong, he is a well-grown man and can handle cutgs alike marriage. When he told his father about it, a long silence surrounded the house. His father asked him if he must marry because he was still teenaged. tho Dodong resented his fathers question, and finally was being permitted to get married.After 9 months, Teang gave birth to their first son named Blas. All of a sudden, Dodong felt guilty and ashamed to his become because of becoming a father at a very young age. But when he saw his youngster, he could not control the ecstasy in him. Dodong did not want any more children, but he could not help them from coming. For six consecutive years, a new child came along. There were seven children in all.Teang did not complain even though she secretly regretted being married at an early age. She was very thin and shapeless now because of bearing many children and the hard work of pickings care of them as well as the household. Sometimes, she wondered if she would have the same living if Lucio, her other suitor who was nine years older than Dodong, was the one she married. But she loved Dodong. Lucio got married after Teangs marriage to Dodong, but he was childless until now.When Blas turns 18, he told his father, Dodong, that he wants to marry Tona. Dodong did not want his son to marry yet because he was young and Dodong already knew what comes next to it. Dodong did not object, but tried to make hi s son think twice forwards rushing to marriage. He does not want Blas to end up like him.

Hybrid vs Conventional Vehicles Essay

Todays instauration is a universe where everyone has to be someplace at a certain clip. This means you usu exclusivelyy have to go to acquire at that place. What I normally do to acquire someplace is to acquire in my hand truck and thrust at that place myself in my formal truck. There atomic number 18 many obstructions that I run into when I have to drive though. Gas. energy. and the send let out defilement my truck causes are merely some of the jobs with this. A intercrossed vehicle would look me out with all of these jobs. I suppose that intercrossed vehicles are more more efficient and have manner more positives than a naturalized auto.Whenever you think approximately movement. what is the 1 most of import thing that comes to caput? For me. I would hold to state that gas is the biggest factor on whether I am able thrust someplace or non. The job with accelerator these yearss are the high monetary values ( Anderson ) . If you had a loanblend. this would non be as l arge of a job with a conventional auto. A freshet of my gas gets wasted from attribute to halt and travel in merchandise and pressing the gas to acquire my locomotive up to the flow of handicraft or up to the velocity bound.In a intercrossed auto. the railway locomotive shuts off temporarily when you are stopped in traffic in order to salvage your gas and non do you blow as everywhere untold ( Anderson ) . There is no manner that you could make this with a conventional auto. This is a large positive for intercrossed autos in my sen prison termnt. The engine temporarily goal off in any event helps to salvage on energy. which is my following chief point. pompous autos and intercrossed autos are two different things when it comes to energy. Conventional autos work by utilizing an engine and gasolene to run the vehicle. Hybrid autos are much more efficient when energy comes into drama though.There are two types of intercrossed autos that work in different ways ( Powers ) . Pa rallel intercrossed autos are the first type. These types use both a fuel armored engagement vehicle with gasolene and a set of batteries in which both the voltaic car force back and the engine can turn the transmittal at the analogous clip ( Powers ) . Series intercrossed autos are the 2nd type. In this type. the gasolene engine turns a generator and the generator either charges the batteries or powers the electric motor that is used to turn the transmittal. The electric motor gets its power from the electric battery but it neer loses all of its energy ( Powers ) .You are likely searching how that is. This is a technique known as regenerative braking. Regenerative braking is the recapturing of energy ( Powers ) . These intercrossed autos besides have another manner of neer running out of energy. The battery can besides be recharged by power from the gas engine ( Powers ) . My last point that I wanted to convey up is the air pollution factor. Air pollution is a large job in t he universe today ( Garcia ) . There are many pollutants that are emitted from motor vehicles such as C dioxide. N oxides. volatile organic compounds. C monoxide. hydrocarbons. and sulfur oxides ( Garcia ) .These pollutants could impact your visibleness and your wellness every bit trade good ( Garcia ) . This is a really good ground to do the passage from conventional vehicles to intercrossed vehicles entirely. Why would you utilize a conventional auto. which produces many types of pollutants. over a intercrossed auto which produces barely any pollutants at all ( Garcia ) ? We would assist the environment and assist many different people out with pollution if we all choose to do the passage from conventional to hybrid.So all in all. I think you could see why holding a intercrossed auto would be more utile than holding a conventional auto. Of class we have all gotten used to driving our ain conventional autos. and we have all gotten used to change of location about and acquiring ga s and normally holding to pay excessively much for it. ground being to why we should all do the passage over to the intercrossed autos. They are more efficient. less money consuming in the long tally. aid cut down on the air pollution that conventional autos put out. and should get down acquiring cheaper one time more people start change overing over to the loanblend.I think that everyone can see with all of these solutions and all of these positives that the intercrossed autos are traveling to take over more Oklahomans than subsequently. Works Cited Nice. Karim. and Julia Layton. How Hybrid Cars Work 20 July 2000. n. d. 16 July 2012. Garcia. Jorge. Air Quality Vehicle Emissions and Air Quality. 18 Oct. 2006. Idaho part of Environmental Quality. hypertext transfer protocol //www. deq. province. Idaho. us/air/prog_issues/pollutants/vehicles. cfm ( 18 Oct. 2006 )

Nursing and nutrition

IntroductionIn different health bid excogitations the caput of alimentation unhurrieds, oddly those who atomic number 18 seriously sick and anticipate to die soon, raises questions of clean-living and estimable nature thus reservation a polish offing reservation make for very difficult for the caring staff. Such questions may allow How brush off terminations of openhanded or withhold ply and hydration be make? What set and assumptions underlie these closes? Which courses of action be in the long-sufferings best interest, and how is this interest inflexible? How and when, if ever, should a conclusiveness not to feed or hydrate be do? Can so basic a supplying as forage and water ever be considered as elective armorial bearing?In most of the health guardianship institutions whether they are hospitals or senior homes, the finale reservation lies within the place of the nurses who are usually faced with dilemmas. small-arm doctors are much advanced in master key k instantlyledge they seldom start themselves in the difficult situation of making the determination of withhold fare or giving it. However, in that respect is roughtimes a differentiation betwixt sustentation as part of the care given to the patient of and nutriment as a biologic t unrivaled sustaining accomplishIn advanced practice there is often an underlying tension amid devil different understandings of nourishing the patient. First, nourishing as an intrinsic part of giving care, which waterfall within the realm of nursing. Second, nourishing as a biological and technological process, a life sentence-sustaining give-and-take under the control of the health check or upkeep team (from which the nurse may be excluded). (Hunt, 1994)Yet the cursory practice and the roles of nurses and doctors intimate that the nurses find themselves in the dilemma of making the decision more than other medical staff. In many eludings where the withholding of commissariat is licitly right and in the interest of the patient, the nurse still finds herself in the good and professional dilemma. She is not given the opportunity to discuss her depression or given any information. As a result whatsoever decision she makes may be taken as wrong irrespective of the particular that she was partially ignorant.The dilemma is even more difficult when considering nourishment as a basic necessitate or a medical treatment. For a seriously sick person sensation may hold withholding medication or a technological device that prolongs life unnecessarily, hardly it is not easy to withhold withstand which is the basic need for rosy-cheeked and unhealthy persons.Dresser asks, Ought we to regard tube and intravenous feeding as forms of medical treatment, or should we classify them with more basic sorts of care? (Dresser, 1985)The decision of withholding upkeep or hydration is a difficult ethical question that poses aflame stress on the nurses. Wi thholding medication or technological devices is justifiable and there is enough professional and statutory counseling for healthcare staff to follow. Indeed, Food and water are so telephone exchange to an stray of kind emotions that it is almost impossible to consider them with the same delirious pullout that one might feel toward a respirator or a dialysis machine (Lynn & Childress, 1983)In this question I am going to ingest this emersion in lodge to confirm or rule off the adventure of establishing a professional steering that assists the nurses in decision making. This is judge to balance them from a lot of stress and confusion that are enforce as a result of transaction with the issue on face-to-face toll rather dealing with it objectively according to professional guidance and standards.The suggestion for this research leave alone be studied under the by-line headings1. commentary of a case battlefield2. Literature review3. Proposal4. Summary and Con clusionsDescription of a guinea pig StudyA case regard either from literary works or from the records of healthcare institution is expected to illustrate the extent of the problem and its importance. In addition this forget strain the roles of nurses, relatives and patients in the decision making process. It would overly highlight the difficulties confront nurses at different stages of care giving for seriously sick persons.At this stage of grammatical construction the skeleton of this research paper very belittled can be said about the case reading until one has been adopted.Literature ReviewThe literature broadly confirms the importance of the problem and has been addressing the issues related to the problem of commissariat for sometime now. darn it is suggested in the literature that in some cases of inveterate ill persons the provision of eatable is burdensome rather than just, it is agreed that the social and inter-professional tensions of nurses are ignored. (H unt, 1994) It is withal pointed out that the stressful environment in which nurses set up their professional care sometimes result in burnouts.The burnout case evolves by a process involving three stages (a) an imbalance amidst resources and demands, (b) the immediate short-term emotional solution to the imbalance, and (c) changes in attitude and behavior such as negativism and emotional detachment (Riordan & Saltzer, 1992). However, it is similarly indicated that there are face-to-face differences here firearm one may react to stressors by go a burnout another(prenominal) with individualised hardiness may find the stressors yet minor irritants. Riordan and Saltzer (1992) driftCurrent literature points unanimously to a proactive approach in preventing burnout. This preserves organizational integrity by maintaining human resources and supplying cost-effective care while maintaining quality (Riordan & Saltzer, 1992).There are a number of suggestions for cut down stress and assisting nurses to cope with the environmental difficulties, though no specific rule of thumbs or agencys are given for dealing with the problem of nutrition and hydration.It is also indicated in the literature that nutrition and hydration in some remainder cases may entirely prolong the biological life which is thought to be burdensome for some patients and their families. As Hunt (1994) asserts Feeding may in some set prolong the process of dying and may hit avoidable torture to the dying patient.While generally the decision of development nutrition fend for the terminally ill quite a little is discussed as a problem confront nurses, some scholars relate the decision to dietitians.Clinical guidelines for nutrition support indicate that dietitians should be members of institutional ethics committees and should have an constituent(a) role in institutional policy development concerning nutrition support at the end of life (Langdon et al, 2002)To put it in a nutshell the literature review confirms the dilemma facing healthcare professionals, particularly nurses, and families in dealing with the decision of providing nutrition and hydration or withholding it for chronically ill population whose illness is diagnosed as terminal. It is also confirmed that the decision making involves personal feelings, ethics, and sometimes legal consideration. Yet there are no eject professional guidelines that contour the decision making in this issue in the professional practice. kinda there are observations of some acceptable practices.Sometimes the line between banausic and extraordinary is used as a elbow room of reaching decision.However, there appears to be an increasing opinion that insubstantial feeding can be viewed as aheroic method of treatment and is morally facultative (Meyers and Grodin 1991, Hoefler and Kamoie 1994, Singer 1995, Gillick 2000).This optional treatment is referred to as extraordinary and is more likely to be invasive, artificial or complex. Nevertheless, the Hastings Centre guidelines, cited in Meyers and Grodin (1991), stated that decisions everyplace whether to provide artificial nutrition and hydration cannot be do solely on the property between ordinary and extraordinary methods of treatment. Despite this, Solomon et al (1993) show that 74 per penny of health professionals continued to use this distinction in termination of treatment decisions. It would also seem that the decision was significantly influenced by whether it was a decision to withdraw treatment or simply not initiate it in the first place. The Hastings Centre guidelines stipulate that this distinction should not be a consideration (Meyers and Grodin 1991) (Young et al, 2002).The problem of decision making in providing or withholding nutrition and hydration in the case terminally ill people is a dilemma for nurses until some professional locomote are settle to make the decision an objective one made on the rear of professional judg ement rather than being a personal one affected by personal feelings, ethics, beliefs etc.ProposalSince the aim of the breeding is to justify a professional basis for decision making, in this tuition we will judge to investigate the possibility of establishing professional guidelines that may reliever the burden on nurses. This will involve identifying criteria that make withholding nutrition more beneficial to the patient than prolonging his biological life. It should also be of the essence(p) to identify professional means that enable healthcare staff to answer that a patient is not making any sense of life and advise families then to participate in decision making. This should be master(prenominal) especially when the patient is suffering pain or given morphine regularly.In order to be able to design a professional instrument or procedure that assists nurses in decision making through this need or rather recommend further research on this issue, the study will be a no n-experimental one designed to elicit the RNs attitudes towards nutrition of chronically ill patients using survey instrumentation.The pattern will be full time RNs employed by a healthcare piece in hospitals and nursing homes of the region. It is advisable to include also a render of dietitians working in the same healthcare institutions. The RNs abstruse need to be well informed about the study and its aims and should be positively propel to participate in the study.It is also important for the study to be sanctioned by a professional body that confirms the study question and methods are ethical.The instruments of the study should be designed in a way that they throwaway the attitude of the study sample towards giving or withholding nutrition and hydration for a variety of terminally ill patients. It is also important to determine the internal consistency reliability for the questionnaires and structured interviews.Summary and ConclusionsThese will follow by nature from the analysis of data and discussions and will eventually occasion a tribute either a draft of a guideline for assisting nurses in decision making or alternatively suggestions for further research in order to identify a suitable professional apparatus for relieving the burden on nurses.ReferencesI am not going to list the references now since this is just a skeleton to discuss with your supervisor unless you deem it necessary.The formulate count may not be exactly 3500, but I think what has been compose here is enough for your purposes. As soon as you give feedback on this I will start work on the proposal.Nursing and nutritionIntroductionIn different healthcare institutions the question of feeding patients, particularly those who are seriously sick and expected to die soon, raises questions of moral and ethical nature thus making a decision making process very difficult for the caring staff. Such questions may includeHow can decisions of giving or withholding feeding and hydration be made?What values and assumptions underlie these decisions?Which courses of action are in the patients best interest, and how is this interest determined?How and when, if ever, should a decision not to feed or hydrate be made?Can so basic a provision as food and water ever be considered as optional care?In most of the healthcare institutions whether they are hospitals or senior homes, the decision making lies within the practice of the nurses who are usually faced with dilemmas. While doctors are more advanced in professional knowledge they rarely find themselves in the difficult situation of making the decision of withholding nutrition or giving it. However, there is sometimes a differentiation between nutrition as part of the care given to the patient and nutrition as a biological life sustaining processIn modern practice there is often an underlying tension between two different understandings of nourishing the patient. First, nourishing as an intrinsic part of giving care, wh ich falls within the realm of nursing. Second, nourishing as a biological and technical process, a life-sustaining treatment under the control of the medical or nutrition team (from which the nurse may be excluded). (Hunt, 1994)Yet the daily practice and the roles of nurses and doctors indicate that the nurses find themselves in the dilemma of making the decision more than other medical staff. In many cases where the withholding of nutrition is legally right and in the interest of the patient, the nurse still finds herself in the ethical and professional dilemma. She is not given the opportunity to discuss her opinion or given any information. As a result whatever decision she makes may be taken as wrong regardless of the fact that she was partially ignorant.The dilemma is even more difficult when considering nutrition as a basic need or a medical treatment. For a seriously sick person one may accept withholding medication or a technological device that prolongs life unnecessarily, but it is not easy to withhold nutrition which is the basic need for healthy and unhealthy persons.Dresser asks, Ought we to regard tube and intravenous feeding as forms of medical treatment, or should we classify them with more basic sorts of care? (Dresser, 1985)The decision of withholding nutrition or hydration is a difficult ethical question that poses emotional stress on the nurses. Withholding medication or technological devices is justifiable and there is enough professional and legal guidance for healthcare staff to follow. Indeed, Food and water are so central to an array of human emotions that it is almost impossible to consider them with the same emotional detachment that one might feel toward a respirator or a dialysis machine (Lynn & Childress, 1983)In this research I am going to study this issue in order to confirm or rule out the possibility of establishing a professional guidance that assists the nurses in decision making. This is expected to relief them from a lot o f stress and confusion that are imposed as a result of dealing with the issue on personal terms rather dealing with it objectively according to professional guidance and standards.The proposal for this research will be studied under the following headings1. Description of a case study2. Literature review3. Proposal4. Summary and ConclusionsDescription of a Case StudyA case study either from literature or from the records of healthcare institution is expected to illustrate the extent of the problem and its importance. In addition this will emphasise the roles of nurses, relatives and patients in the decision making process. It would also highlight the difficulties facing nurses at different stages of care giving for seriously sick persons.At this stage of building the skeleton of this research paper very little can be said about the case study until one has been adopted.Literature ReviewThe literature generally confirms the importance of the problem and has been addressing the issues related to the problem of nutrition for sometime now. While it is suggested in the literature that in some cases of chronically ill persons the provision of nutrition is burdensome rather than beneficial, it is agreed that the interpersonal and inter-professional tensions of nurses are ignored. (Hunt, 1994)It is also pointed out that the stressful environment in which nurses provide their professional care sometimes result in burnouts. The burnout case evolves by a process involving three stages (a) an imbalance between resources and demands, (b) the immediate short-term emotional response to the imbalance, and (c) changes in attitude and behavior such as negativism and emotional detachment (Riordan & Saltzer, 1992). However, it is also indicated that there are personal differences here while one may react to stressors by becoming a burnout another with personal hardiness may find the stressors only minor irritants. Riordan and Saltzer (1992) assertCurrent literature points unanimo usly to a proactive approach in preventing burnout. This preserves organizational integrity by maintaining human resources and supplying cost-effective care while maintaining quality (Riordan & Saltzer, 1992).There are a number of suggestions for reducing stress and assisting nurses to cope with the environmental difficulties, though no specific guidelines or procedures are given for dealing with the problem of nutrition and hydration.It is also indicated in the literature that nutrition and hydration in some terminal cases may only prolong the biological life which is thought to be burdensome for some patients and their families. As Hunt (1994) asserts Feeding may in some circumstances prolong the process of dying and may cause avoidable suffering to the dying patient.While generally the decision of using nutrition support for the terminally ill people is discussed as a problem facing nurses, some scholars relate the decision to dietitians.Clinical guidelines for nutrition support indicate that dietitians should be members of institutional ethics committees and should have an integral role in institutional policy development concerning nutrition support at the end of life (Langdon et al, 2002)To put it in a nutshell the literature review confirms the dilemma facing healthcare professionals, particularly nurses, and families in dealing with the decision of providing nutrition and hydration or withholding it for chronically ill people whose illness is diagnosed as terminal. It is also confirmed that the decision making involves personal feelings, ethics, and sometimes legal consideration. Yet there are no clear professional guidelines that streamline the decision making in this issue in the professional practice. Rather there are observations of some acceptable practices.Sometimes the distinction between ordinary and extraordinary is used as a means of reaching decision.However, there appears to be an increasing opinion that artificial feeding can be viewed as aheroic method of treatment and is morally optional (Meyers and Grodin 1991, Hoefler and Kamoie 1994, Singer 1995, Gillick 2000). This optional treatment is referred to as extraordinary and is more likely to be invasive, artificial or complex. Nevertheless, the Hastings Centre guidelines, cited in Meyers and Grodin (1991), stated that decisions over whether to provide artificial nutrition and hydration cannot be made solely on the distinction between ordinary and extraordinary methods of treatment. Despite this, Solomon et al (1993) demonstrated that 74 per cent of health professionals continued to use this distinction in termination of treatment decisions. It would also seem that the decision was significantly influenced by whether it was a decision to withdraw treatment or simply not initiate it in the first place. The Hastings Centre guidelines stipulate that this distinction should not be a consideration (Meyers and Grodin 1991) (Young et al, 2002).The problem of decision making in providing or withholding nutrition and hydration in the case terminally ill people is a dilemma for nurses until some professional steps are identified to make the decision an objective one made on the basis of professional judgement rather than being a personal one affected by personal feelings, ethics, beliefs etc.ProposalSince the aim of the study is to justify a professional basis for decision making, in this study we will attempt to investigate the possibility of establishing professional guidelines that may relief the burden on nurses. This will involve identifying criteria that make withholding nutrition more beneficial to the patient than prolonging his biological life. It should also be essential to identify professional means that enable healthcare staff to decide that a patient is not making any sense of life and advise families accordingly to participate in decision making. This should be important especially when the patient is suffering pain or given morphine regul arly.In order to be able to design a professional tool or procedure that assists nurses in decision making through this study or alternatively recommend further research on this issue, the study will be a non-experimental one designed to elicit the RNs attitudes towards nutrition of chronically ill patients using survey instrumentation.The sample will be full time RNs employed by a healthcare region in hospitals and nursing homes of the region. It is advisable to include also a sample of dietitians working in the same healthcare institutions. The RNs involved need to be well informed about the study and its aims and should be positively motivated to participate in the study.It is also important for the study to be approved by a professional body that confirms the study question and methods are ethical.The instruments of the study should be designed in a way that they measure the attitude of the study sample towards giving or withholding nutrition and hydration for a variety of termi nally ill patients. It is also important to determine the internal consistency reliability for the questionnaires and structured interviews.Summary and ConclusionsThese will follow naturally from the analysis of data and discussions and will eventually constitute a recommendation either a draft of a guideline for assisting nurses in decision making or alternatively suggestions for further research in order to identify a suitable professional tool for relieving the burden on nurses.ReferencesI am not going to list the references now since this is just a skeleton to discuss with your supervisor unless you deem it necessary.The word count may not be exactly 3500, but I think what has been written here is enough for your purposes. As soon as you give feedback on this I will start work on the proposal.

I Saw Guinevere There as Well Essay -- Arthurian Legends Essays

I Saw Guinevere There as thoroughlyNumerous sources, such as Layamons Arthurs Dream, Marie de Frances Lanval and Sir doubting Thomas Malorys Morte Darthur, demonstrate Guinevere as a punic wife and the primary cause of the elapse of king Arthur and The stave Table. In all of the three works, Guinevere is seen attack sundry(a) work force such as Lanval and Sir Lancelot, knights of her husband. And, yet, she remains virtuous and appealing in the eyeball of tycoon Arthur, who reveres her dearly. Such blindness or possibly Arthurs unconditi 1d love of Guinevere and Lancelot, Arthurs best knight, lead to the scratch of Arthurs Britain and of the Round Table. In sensation of her lays, Lanval, Marie de France presents Guinevere approaching the main character,Lanval, one of Arthurs knights, with a proposition. She offers herself to Lanval to be his mistress, willing to play his inner contentments Lanval, Ive honored you sincerely, Have cherished you and loved you dearly.All my love is at your disposal.Your mistress I consent to beYou should receive ofttimes joy from me (257- 262).Such behaviour is clearly unacceptable for a gentlewoman in Guineveres position. She does not only compromise herself, but also presents Arthur as a light-headed man, unable to control his wife, and therefore a weak ruler. Furthermore, the reason of the tale portrays Guinevere as a very wicked character. maddened by Lanvals rejection of her approaches, Guinevere insults Lanval, calling him a homosexual Often I ca-ca got perceive men averThat women are not what you prefer.But you have many another(prenominal) pretty boysWith whom you like to take your joys (273-276).Moreover, Guinevere later manufactures a report card to rate Arthur, in which the roles are reversed and Lanval is pr... ...Thomas Malory, present Guinevere, Arthurs queen, as one of the causes of the fall of Arthurian empire. Guinevere is described as a wicked and unfaithful wife, whose behavior trigg ers the fall of her husbands rule. And although other factors, such as peoples jealousy and evil, bring the impression of the legendary empire, Guineveres unfaithfulness is the primary cause of the fall of King Arthur and his Round Table.Works CitedFrance, Marie De. Lanval. The Norton Anthology of position Literature. Ed. M.H.Abrams. New York W.W.Norton & Company, Inc., 2000. 127-140. Layamon. Arthurs Dream. The Norton Anthology of English Literature. Ed. M.H.Abrams. New York W.W.Norton & Company, Inc., 2000. 122-124. Malory, Thomas Sir. Morte Darthur. The Norton Anthology of English Literature. Ed. M.H.Abrams. New York W.W.Norton & Company, Inc., 2000. 421-439. I Saw Guinevere There as soundly Essay -- Arthurian Legends EssaysI Saw Guinevere There as WellNumerous sources, such as Layamons Arthurs Dream, Marie de Frances Lanval and Sir Thomas Malorys Morte Darthur, portray Guinevere as a unfaithful wife and the primary cause of the fall of King Arthur and The Ro und Table. In all of the three works, Guinevere is seen approaching various men such as Lanval and Sir Lancelot, knights of her husband. And, yet, she remains virtuous and appealing in the eyes of King Arthur, who loves her dearly. Such blindness or possibly Arthurs unconditional love of Guinevere and Lancelot, Arthurs best knight, lead to the fall of Arthurs Britain and of the Round Table. In one of her lays, Lanval, Marie de France presents Guinevere approaching the main character,Lanval, one of Arthurs knights, with a proposition. She offers herself to Lanval to be his mistress, willing to satisfy his sexual joys Lanval, Ive honored you sincerely, Have cherished you and loved you dearly.All my love is at your disposal.Your mistress I consent to beYou should receive much joy from me (257- 262).Such behavior is clearly unacceptable for a lady in Guineveres position. She does not only compromise herself, but also presents Arthur as a weak man, unable to control his wife, and therefo re a weak ruler. Furthermore, the author of the tale portrays Guinevere as a very wicked character. Angered by Lanvals rejection of her approaches, Guinevere insults Lanval, calling him a homosexual Often I have heard men averThat women are not what you prefer.But you have many pretty boysWith whom you like to take your joys (273-276).Moreover, Guinevere later manufactures a story to tell Arthur, in which the roles are reversed and Lanval is pr... ...Thomas Malory, present Guinevere, Arthurs queen, as one of the causes of the fall of Arthurian empire. Guinevere is described as a wicked and unfaithful wife, whose behavior triggers the fall of her husbands rule. And although other factors, such as peoples jealousy and evil, influence the outcome of the legendary empire, Guineveres unfaithfulness is the primary cause of the fall of King Arthur and his Round Table.Works CitedFrance, Marie De. Lanval. The Norton Anthology of English Literature. Ed. M.H.Abrams. New York W.W.Norton & Comp any, Inc., 2000. 127-140. Layamon. Arthurs Dream. The Norton Anthology of English Literature. Ed. M.H.Abrams. New York W.W.Norton & Company, Inc., 2000. 122-124. Malory, Thomas Sir. Morte Darthur. The Norton Anthology of English Literature. Ed. M.H.Abrams. New York W.W.Norton & Company, Inc., 2000. 421-439.

Free Scarlet Letter Essays: Hester and the Puritan Society :: Scarlet Letter essays

Hester and the puritan Society of The reddish Letter   Nathaniel Hawthornes unused, The Scarlet Letter, focuses on the Puritan society. The Puritan society m archaiced itself and created a government based upon the leger and implemented it with force. The crime of adultery committed by Hester generated rage, and was qualified for estimable punishment according to Puritan beliefs. Ultimately the town of Boston became intensely involved with Hesters life and her crime of adultery, and saw to it that she be publicly punish and tortured. Based upon the religious, governmental, and social design of the Puritan society, Hesters entire existence rotate around her sin and the Puritan perception. Therefore it is evident in spite of appearance The Scarlet Letter that the Puritan community to some degree has constructed Hesters character.   In the novel The Scarlet Letter it is evident that the base of their social framework was that of the perform. The church and beliefs of Protestantism became all encompassing within the town of Boston meaning that the Church would be directly involved in the running of the community and its regime. The Enforcing of laws were constituted by scripture read from the Bible, as the Puritans considered the Bible as the aline law of God that provided guidelines for church and government. Those who disagreed or committed crimes against the government, were not just criminals but also sinners, and they were sought to be punished severely. The Puritans stressed grace, devotion, prayer, and self-examination to achieve religious virtue while including a basic noesis of unacceptable actions of the time this was expected to secure order and peace within the Puritan community. The Puritan culture is one that recognizes Protestantism, a sect of Christianity. though a fundamental of Christianity is forgiveness for ones sins, this seems to have been forgotten amongst the women of the community Morally, as well as materially, the re was a coarser fiber in those wives and maidens of old English birth and breeding, than in their fair descendants. As read in the midst of the lines we can notice a c oncern in Hesters acceptance within the Puritan community. More so, Hester senses a lack of acceptance within the isthmus of woman in the community. The use of the term coarser fiber intertwines the relationship that she once had, and what it has become within the woman of the community. It has also come to my attention that when Hester compares the women of the community to their descendants, she clarifies that the women of the community have become deviant, and or immoral to their religious past.