Development of Entrepreneurship in Ghana the Way Forward

DEVELOPMENT OF ENTREPRENEURSHIP IN GHANA: THE WAY FORWARD Entrepreneurship is the most powerful economic force known to mankind. The Entrepreneurial Revolution that captured our imagination during the 1990s has now permeated every aspect of business thinking and planning. As exemplified by industry players and era definers like Sam Walton of Wal-Mart, Fred Smith of FedEx, Bill Gates of Microsoft, Mark Zuckerberg of Facebook, Alhaji Asuma Banda of Antrak Group of Companies, Mike Adenuga Jnr of Globacom, and Kofi Amoabeng of UT Financial Services, the applications of creativity, risk taking, innovation, and passion lead the way to economic development far greater than anyone could imagine. Entrepreneurship is the process of creating or†¦show more content†¦Ideas must be matched with basic skills and an understanding of business practices and these are things that can be taught to help burgeoning entrepreneurs create successful businesses. ïÆ'Ëœ Lack of education. Entrepreneurship has not been given much attention both in our various homes as well as our educational institutions. The government has not done any better in this regard. It is too challenging that it is very difficult differentiating a business man from an entrepreneur. The tomato seller at Central Market believes she is an entrepreneur. Our educational system has failed us in this regard. Most schools do not teach on this area and even the few who do teach on this subject, little can be deserved of the knowledge imparted to the student. This challenge has ripple effects on several other challenges. The unawareness created by the lack of education causes the ignorance as spoken of under the financial support challenge The way forward A comprehensive approach to promoting entrepreneurship must work on three levels-individuals, firm and society. To motivate individuals to become entrepreneurs, they should be made aware of the concept of entrepreneurship and this should be made sufficiently attractive option. They should be equipped with the right skills to turn ambitions into successful ventures. For entrepreneurial ventures to developShow MoreRelatedSELF EFFICACY BUSINESS PLAN Essay4753 Words   |  20 PagesKolvereid and Isaksen 2006) 2.2 MEASURING ENTREPENEURIAL SELF-EFFICACY A number of students tend to be from the viewpoint that its not essential to possess a particular entrepreneurial self-efficacy creating, instead of recommending an over-all way of measuring self-efficacy. (Chen, Gully et al .2004).You will find presently in congruencies within exactly how scientists start recording the actual dimensionality from the entrepreneurial self-efficacy creates. 2.3 ENTREPRENEURIAL SELF-EFFICACYRead MoreThe United States1518 Words   |  7 Pagescountries, establishing multinational corporations and emerging new markets to explore international waters to help other nations flourish and gain a competitive advantage. For many years Africa has been floating in the U.S radar. The U.S has looked for ways to cultivate the land, understand the culture; people and strengthens its relationship with the African government. In recent years the continent has grown significantly with the opportunity of U.S market access and the creation of new export tradeRead MoreEffect of Internal Controls on Financial Performance11978 Words   |  48 Pagesowners. SMEs engagements have to become a dynamic and integral part of the market economy. The identification of factors that determine new venture performance such as survival, growth or profitability has been one of the most central fields of entrepreneurship research (Sarasvathy, 2004). A multitude of research papers has focused on exploring various variables and their impact on performance (Bamford et al., 2004). However, in order to be able to analyze and model the performance of new ventures andRead MoreUNV 504 Topic 4 Final1630 Words   |  7 Pagesstudents into our society whom are adept at adopting and implementing change in entrepreneurial initiatives as they progress through their career. Some people are naturally born with the innate ability to have the drive to be risk takers and in some way be willing to step outside the box in terms of creativity; those people are known as Entrepreneurs. For many years there were worries surrounding the idea but until recently, there has been an outbreak of entrepreneurs making money and living a betterRead MoreThe Study of Contributions of the Commercial Banks to the Development of Small-Scale Firms13196 Words   |  53 Pagesthrough restless, direction and guidance, constructive criticism, tolerance and unique encouragement, all of which combined to make the project work effective and successful. Other thanks go to all the Lecturers in the Accountancy Department who in one way or the other contributed to my success throughout my study. My next gratitude goes to my Mom (Aunt Margaret Nyantakyiwaa Addo, U.K) for her love, advice, and priceless supports throughout my course of study. May God richly bestow an everlasting blessingRead MoreImpacts of Microfinance on Grassroot Development a Case Study Uf the Ketu North District16020 Words   |  65 PagesCHARTED INSTITUTE OF FINANCIAL AND INVESTMENT ANALYST (CIFIA) ASSESSING THE IMPACT OF MICROFINANCE IN GRASSROOT DEVELOPMENT. BY PRAISE DAVIDSON AMU 1 DECLARATION I hereby declare that this piece of work is the outcome of my own research except for the references which served as a source of information which I have acknowledged. This work has therefore never been presented for another certificate, Diploma or Degree. I therefore fully accept all omissions and errors that might appear in this paperRead MoreScramble for Africa1841 Words   |  8 Pagesinterests at the turn of the century, the European powers turned their searchlight to Africa, Asia and the Middle East for new markets by consolidating previously held trading posts and sea route communications and grabbing new territories along the way; hence the scramble for Africa. The partition has been described as one of the most important turning points in the history of the relationships between the â€Å"Haves† which signifies the industrialised European powers versus the â€Å"Have-nots† that representsRead More Crisis of African Agriculture Essay2005 Words   |  9 Pages Resource: If African countries were able to adopt and adapt some of the same practices used in Asia and Latin America, much more food would be available for consumption and sale by African people. ?Africa?s Fertilizer Summit was called to study ways of creating a agricultural breakthrough in Africa - a goal that Annan said was achievable despite environmental degradation, extreme reliance on rainfall rather than irrigation, high transport costs and undercapitalized farmers facing tough globalRead MoreBuilding Social Business8301 Words   |  34 PagesSEMINAR ADMINISTRATION DEVELOPMENT 1 BUILDING SOCIAL BUSINES ‘D’ BY JULIUS KWAKU KATTAH STUDENT ID. NO. 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Diagnosis of Fatal Attraction Essay - 2194 Words

1. What is the name of the movie you watched? For this assignment, I watched â€Å"Fatal Attraction.† 2. Describe the demographics of the character of â€Å"patient† that you are evaluating. Alex Forrest was the patient in this movie. She is a white female in her 40’s. She is single and works as an editor for a publishing company, however she is not shown working after the beginning of the movie. 3. Summarize the plot of the movie. As the movie begins, Dan and his wife, Beth, go to a company party when he meets Alex Forrest for the first time. The next morning Beth and daughter, Ellen, leave for the weekend to look at a house they are considering moving into while Dan stays at home for a business meeting. When he arrives at the†¦show more content†¦When Beth goes out looking for Ellen she gets in an accident and is taken to the hospital. That night Dan goes to Alex’s apartment and attacks her and tries to strangle her, but then stops. While they are catching their breath Alex tries to stab Dan with a kitchen knife, but he gets it from her and leaves. Dan brings Beth home from the hospital and helps take care of her, Dan is downstairs as she starts a bath when Beth discovers Alex in the room with a knife. Alex attacks her and Dan hears the screaming and rushes in to attack Alex. He tries to drown her in the tub, but she comes back alive and is then shot by Beth. 4. Formulate a DSM-IV-TR diagnosis for this character and outline how he or she meets each of the criteria for that disorder. After reviewing the behaviors of Alex Forrest, I have decided that a borderline personality disorder is most appropriate for her. It also seems like Alex may have a mild form of histrionic personality disorder, but does not actually meet all of the criteria to be fully diagnosed and therefore is not a comorbid diagnosis. A list of the diagnostic criteria for borderline personality disorder and a description for how they are met is following, Alex meets six of the criterion and the DSM-IV-TR requires at least five criterion be present. Criterion 1: Frantic efforts to avoid real or imagined abandonment; note: do not include suicidal or self-mutilating behavior covered in criterion 5. AlexShow MoreRelatedDifferential Diagnosis of Alex Forrest of Fatal Attraction1915 Words   |  8 Pagesstudy my group and I chose the movie â€Å"Fatal Attraction†, and we chose Alex Forrest for our case study. For my part I chose to do the diagnosis aspect on Alex Forrest. Throughout this paper I will be diagnosing Alex Forrest. The following key clinical data will be discussed: client demographics, presenting problem, preliminary diagnostic information, symptoms, client characteristics and history, diagnostic impressions, potential disorders, and the DSM diagnosis. Demographics Alex Forrest is a CaucasianRead MoreMovie Analysis : Fatal Attraction 827 Words   |  4 PagesMovie Summary: â€Å"Fatal Attraction The movie stars Dan Gallagher as a well and successful lawyer, who is happily married to Beth for nine years, and has a sic year old daughter Ellen. Dan had a wild passionate affair with Alex Forest client of Dan on a weekend both Beth and Ellen was out of town. Alex is a beautiful, successful and independent editor who works for a publishing company. Because both Alex and Dan had a free time, they spent the one night and part of the next day (weekend) having sexRead MoreEssay on Sexual Masochism746 Words   |  3 PagesMasochism is a general paraphilia, and is an abnormal or unnatural sexual attraction. It is recurring sexually arousing fantasies, urges, or behaviors in which the person is beaten, bound, or humiliated in order to achieve sexual excitement (Sexual Disorders 2001). 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ALT is generally located in the cytosol . Liver disease results in the releasing of the enzyme into the serum. Measurements of this enzyme are used in the diagnosis of certain types of liver diseases such as viral hepatitis and hepatic necrosis, and heart diseases. The ALT level remains elevated for more than a week after hepatic injury (Sodikoff, 1995). Fibrinogen, albumin, and globulins constitute the majorRead MoreA Brief Note On The Refugee Agency Un2619 Words   |  11 Pagespeople so that they can communicate with Ali and Jamila and their community members can introduce the Australian Health care system by which they can obtain their Medicare card if eligible which will be beneficial for them and with their social attractions they can learn to use different health care services and more over social gatherings will help them emotionally to speak their problems to someone in their own language which will eventually decrease their stress level. 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The Avengers Review Free Essays

The Avengers PG-13 Nick Mantegani 5/7/2012 EN121 The Avengers is a Sci-Fi/Action movie directed by Joss Whedon. It is rated PG-13. The movie stars a vast assortment of stars, including Robert Downey Jr. We will write a custom essay sample on The Avengers Review or any similar topic only for you Order Now , Chris Evans, Samuel L. Jackson and more. It was released in May 2012, and is available in a 3D format. The Avengers is the first movie in an ongoing series. The film acts as a sort of sequel to several films made by Marvel Comics, including Iron Man and Iron Man 2 (starring Downey, 2008 and 2010, respectively), The Incredible Hulk (Edward Norton, though the character has been replaced by Mark Ruffalo, 2008), Thor (Chris Hemsworth, 2011), and Captain America: The First Avenger (Evans, 2011). In The Avengers, ancient Norse god Loki (Tom Hiddleston), brother of Thor, gathers an army from an alternate universe to enslave the people of Earth. He acquires a powerful weapon called the Tesseract, capable of destroying nearly anything. Nick Fury (Jackson), director of S. H. I. E. L. D. , an agency protecting the world, enlists the help of a group of superheroes. Iron Man, Captain America, Hulk, and the Black Widow (Scarlett Johansson) join the effort, and are later joined by Thor and Hawkeye (Jeremy Renner). Though at first the big personalities of the heroes clash and they fight each other, Fury eventually teaches them the importance of working together as a team to defeat the enemy. Fighting alongside each other, the Avengers manage to thwart Loki’s evil plan and send him, along with Thor, and Loki’s army, back to where they came from. The Avengers is every comic book lovers dream come true. The individual hero movies leading up to the release of this movie were such a success that fans had been salivating to see these extraordinary beings come together and fight alongside each other. Whedon brought the characters together in a spectacular way. The banter between Iron Man and Bruce Banner (Hulk) shows a meeting of great minds. The relationship between the Black Widow and Hawkeye creates many questions that make these two lesser characters seem much more significant, which is important to the appeal of the movie. The clashing personalities of Iron Man, a self-described â€Å"Playboy billionaire† who questions everything and doesn’t play by the rules and Captain America, a man thrust forward in time from the 1940’s who still has his sense of values and morals from the his time, shows two men who have to work together who couldn’t be any different. All these relationships and more are what makes the fact that all these people coming together is truly a remarkable thing and could potentially have been disappointing if Whedon had downplayed any of the elements that makes each character who they are. Whedon managed to take each character and let them act as they are intended to, such as Stark’s cockiness and Thor’s nobility, and still be able to not glorify or discourage any of them to make the team more significant than the individual heroes. Roger Ebert compares the Avengers to the dogs in the Best in Show category at the Westminster Dog Club. â€Å"You have breeds that seem completely different from one another (Labradors, poodles, boxers, Dalmatians), and yet they’re all champions,† says Ebert. He is right; though the characters differ in many ways, they are all the same in that they have spectacular powers that they use to fight evil. This makes the â€Å"team mentality† work perfectly in this film. Never did one character seem to mean more to the group than any of the others (except for when Hawkeye was brainwashed to fighting for Loki, but once he returned, he was just as much as part of the Avengers as anybody). The Avengers did not start acting like a team at first, but once they did, they managed to defeat Loki with relative ease. The message of the film is that it stresses the importance of teamwork. It shows that no matter how talented the individuals in a group may be, they can’t perform to their best abilities until they all start working together and use each other to bring out the best in themselves. The acting in The Avengers was fantastic all around. Those who were fans of the original Avengers comics (or the individual heroes’ comics) expect their idols to be portrayed accurately, and just about every single one is done so to a great degree. Ruffalo, Renner, and Johansson do great justice to their characters, and are very likeable and portrayed well. Ruffalo does a particularly good job in showing his struggle to keep his cool so as not to transform into the Hulk. Hemsworth shows that apart from his fantastic resemblance to the comic book character and his obvious good looks, he has the right idea as to what Thor is really like. He is a god and a mighty warrior, but he knows he is not above anyone and will protect the earth no matter what. Evans and Downey both fit their characters perfectly, and their attitudes are correct for who they play. Samuel L. Jackson does a great acting job in the movie. You cheer for him at times, and then despise him at others, which is always impressive when a character can get that sort of reaction out of an audience. However, as great as his acting was, it seems as if the creators of the recent Marvel Comics movies wanted to put him in The Avengers somehow, so they stuck him in the role as Nick Fury. To Avengers fans, this could be slightly irritating. Clearly he looks nothing like the original character, and the original character never acted like Samuel L. Jackson, but now Nick Fury will be remembered always by many, many people as a Jackson-like character, which is frowned upon by fans of the comic book. A more accurate portrayal of Fury could’ve been done by George Clooney, who is also a talented actor and, when one compares the two, looks exactly like the character in the comic book. The textbook says, â€Å"There is the ever-present danger that all the [special effects] in action, adventure, and science-fiction films will dazzle us but do little to increase our understanding of the world we live in or the drama of human life. (264). The Avengers relies heavily on the use of special effects and CGI to portray the heroes in action or the world itself, from the giant, levitating headquarters of S. H. I. E. L. D. to monsters only Ebert can describe as â€Å"Loki’s ginormous slithering, undulating snake-lizard-dragon machine, which seems almost to have a mind of its own and is backed up by countless snakelings. † I ndeed, it would be impossible to show the same movie without as much CGI as was used to make it. However, the heavy amount of CGI doesn’t take away from the acting and story of the ovie. If anything, it enhances the characters in not just a visual way, but it shows the viewer who the characters are and what they are truly capable of. In addition, the 3D format of The Avengers is a nice touch. For decades, comic book fans have enjoyed the adventures of the Avengers and have grown up in love with the heroes in the super group. A large scale movie featuring this group is what the fans have always desired. Each superhero received their own movie, building anticipation for the combining of these extraordinary people. Whedon made that combination happen, and the actors involved brought these heroes to life in grand style. Works Cited Barsam, Richard Meran. , and Dave Monahan. Looking at Movies: An Introduction to Film. New York: W. W. Norton, 2010. Print. Ebert, Roger. â€Å"The Avengers. † Roger Ebert. com. 2 May 2012. Web. 07 May 2012. http://rogerebert. suntimes. com/apps/pbcs. dll/article? AID=/20120502/REVIEWS/120509997/1001. IMDb. â€Å"The Avengers. † Internet Movie Database. Web. 07 May 2012. http://www. imdb. com/title/tt0848228/. How to cite The Avengers Review, Essay examples

Business European Journal Of And Management -Myassignmenthelp.Com

Question: Discuss About The Business European Journal Of And Management? Answer: Introducation Medibank Private Limited is the largest private health insurance provider in Australia. It operates in the health insurance industry. It insures and sells its policies under the brand names: Medibank and AHM. It has around 3.8 Million members and covers 29.1% of the market share. It operates as a public listed company on ASX. It also deals in assisting the health insurance business, thereby earning income from its Complimentary Services. Resources are also retained to compensate its regulatory reserves, which generates monetary benefits from its portfolio of investment assets. Regulatory Authority of the private health insurance sector in Australia The private health insurance sector is regulated by Australian Prudential Regulation Authority (APRA) in Australia (APRA, 2018). The organizations operating in the private health insurance sector in Australia have to comply with the APRA rules and Prudential Standards . Also it is mandatory for the private health insurers to provide information under the Financial Sector (Collection of Data) Act, 2001 and its reporting standard to APRA. The organizations have to submit certain forms and follow directions of APRA in this regard (Kokobe Gemechu, 2016). Applicable Financial Framework on Medibank Private Limited The applicable laws and legislations on the Medibank Private Limited are: Auditing and Assurance Standards Board Australian Accounting Standards Board Australian Prudential Regulation Authority Australian Securities and Investment Commission Financial Reporting Council Financial System Inquiry Standard Business Reporting Nature of Companys Operations, its governance structures and its investments The company operates in the private health insurance sector in which it provides health insurance to the people. Along with this, it also provides consultancies for health management and telehealth services for the government and corporate consumers. It also trades in the travel, life and pet insurance products and services. The health insurance business granted 91.6 % of the groups revenue and 95.4 % of the segment operating profit in 2016 (Medibank, 2016). The amount of revenue amounted to 91.9 % whereas the segment operating profit decreased to 93.3 % in 2017 (Medibank, 2017). From the overall income earned by the group in 2016 and 2017, the resident health insurance policies sold to the retail and corporate consumers contributed to 97.8 %. In 2016 and 2017, the investment portfolio was $2.5 Billion comprising of cash and other investments. It provides sufficient cash to cover the insurance obligations and the mandatory reserves to meet claims related to the Health Insurance business (Medibank, 2017). The governance structure of Medibank Private Limited is as follows: Audit committee- It supervises the financial reporting Risk Management Committee- It assesses the organizations present and future risk management. Investment and Capital Committee- It controls the investments and capital management events. People and Remuneration Committee- It supervise the policies related to remuneration and people. Nomination Committee- It controls the overall board and committee membership and hierarchy of the organization. Apart from the committees, the Chief Executive Officer and Executive Leadership Team are accountable for the performance of the company. According to the Medibank (2016) the net income after tax in 2016 amounted to $417 Million while in 2017 it was $ 452 Million. The total assets amounted to $ 3266.2 Million in 2016, while in 2017 it was $ 3462.5 Million (Medibank, 2017).The total liabilities amounted to $ 1578.7 Million in 2016 while in 2017, it was $ 1742.7 Million. The total equity which comprises of Contributed Equity, Reserves and Retained Earnings amounted to $1578.7 Million in 2016 while in 2017; it amounted to $ 1719.8 Million. The organizations investment portfolio comprises of 25 % /75% for growth and defensive assets respectively. The company invests in listed and unlisted securities which are quoted at their fair value. Application of Accounting Policies in Medibank Private Limited The financial statements of the entity are authorized to be issued according to the resolution of the directors. They are prepared for the consolidated entity (Group) comprising of Medibank and its subsidiaries. The statement of accounts has been prepared according to the Historical Cost Convention except the financial assets, land and building and liabilities quoted at their fair value or market price. Also it follows different accounting policies according to its various segments. Entitys Objectives The organization has set the following objectives for achieving better health for the human community as a whole: It aims to diversify the Medibank and AHM products to distribute the best services and consultancy to its consumers. It focuses on developing and offering the leading services to its customers. Also as a part of its corporate social responsibility, it invests $ 4 Million towards childhood obesity. The Medibank Better Health Foundation focuses to develop health awareness in the society. It has evolved ecofriendly policies as it believes that a healthy environment can create healthy humans. It has endeavored to develop the green space in urban areas up to 20% by 2020(Medibank, 2018). Assessment of related Business and Financial Risks The substantial business risk which could influence Medibanks business activities are as follows (Auditing and Assurance Standards Board, 2013): Competition and retaining of consumers: The emergence of new firms, with their partnership with the existing firms can pose a threat to companys existence in the market. The private health insurers and assessment websites compete to retain the consumers regarding price, products, service and channels which results in the diversion of the customers. Health care prices and utilization: The increase in the health care costs can have an impact on product margins. This can lead to reduction in the value of products. Change in the legislations: The change in the government policy and legislations may affect the regulatory incentives, resulting in the decrease in the number of members. Product pricing and design: The products design and prices are subject to governments approval. So, if there is a change in the governments policies, it can pose a threat to the products value. Inappropriate claims: Inappropriate claims may arise due to frauds or errors resulting in the entitys outflow. Capital Management and Investment Returns: The portfolio is subject to market risks which can influence the value of the investment and income volatility. Loss of Healthcare Agreements: Non-fulfillment of the health care agreements may result in poor consumer experiences, loss of brand value and market share. Loss of data: There may be loss of data, procedures and mechanisms in the organization. Also, it may be influenced by cyber-attack (Ridha Alnaji ,2015) The Financial Risk comprises of the following risks: Market rate risk: It comprises of the risk resulting from the variations of fair value or future cash flows of the financial instruments, resulting from the variations in the market prices. It has the following parts: Interest rate risk: The fluctuations in the market interest rates resulting in the variations in the future cash flows is the risk of interest rates. The company is facing the risk of variations in the interest rates in the cash and cash equivalents and fixed income investments. In 2016, $1883.5 Million of the financial assets were exposed to Australian variable interest rate risks (Medibank, 2016). In 2017, the number increased to $ 2167.1 Million (Medibank, 2017). Foreign currency risk: The risk influencing the variations in the foreign exchange rates results in the foreign currency risk. The companys is facing transaction currency exposures, emerging from the purchase in foreign currencies. They comprise of dealings from operational cost within the business and purchase of foreign currency denominated instruments .In 2016, the financial instruments exposed to foreign currency risk amounted to $ 91.6 Million (Medibank, 2016). In 2017, the number decreased to $ 76.4 Million (Medibank, 2017). Price Risk: The risk resulting from the variations of the market prices of the fair value of future cash flows of financial instruments is price risk. The entity is subjected to equity price risk comprising of investments in the infrastructure, property and Australian and international equities (Otieno Nyangechi , 2013). Credit risk: The risk arising from the possible defaults of counterparty is termed as credit risk. The company is facing the credit risk to the amounts equal to its financial assets consisting of cash and cash equivalents and the financial assets at a fair value. Liquidity Risk: The risk faced by the company where it confronts the problems in arranging funds to fulfill its commitments associated with financial instruments. It may result from incapability to sell the financial assets at their fair value, failure of the counter party to repay its contractual liabilities or the company is unable to arrange the funds or an unexpected insurance liability due for payment (Deloitte, 2017). In the overall liquidity risk, the financial assets consist of property, plant and machinery and investments in working capital (OECD, 2014). Identification of Account Balances Subjected to Risk of Material Misstatement Specific account balance (i) (ii) (iii) Name of the account balance Liquidity Risk Credit Risk Price Risk (a) Explain why the account balance is at significant risk of material misstatement. The firm is facing the risk of raising funds to fulfil the obligations concerned with financial instruments. So, it may manipulate the accounts receivables by liquidating them and thereby increasing the amounts of cash and cash equivalents (PWC, 2016). The firm is facing the risk of possible defaults by counterparty, thus it is subjected to the risk of material misstatements. The firm does not have any financial mechanisms to lessen the credit risk .Also all the instruments are unsecured. The management can alter the amounts of the financial assets and project false accounts in the financial reports to show that it applies certain measures to mitigate the risk. The firm is facing the risk of fluctuations in the fair value of the financial instruments .It occurs due to variations in the market prices. As the firm is subjected to price risk in the fixed income investments due to changes in its credit spreads. The management can falsify the value of the investments which are influenced by the price risk. It can manipulate the value of equities in the financial statements (Flynn, 2016). (b) Explain the key assertion at risk of not being valid. Existence - The auditors believe that the amounts of the resources and financial obligations do not exist as stated in the books of accounts. Completeness- The financial events have not been recorded and the revelations are not made in the books of accounts. Accuracy- The auditors have a doubt on the valuations of the assets and liabilities (ACCA, 2016). (c) Detail one (1) relevant substantive audit procedure to address the assertion at risk as identified in b) above. Planning: According to KPMG (2015),the auditors shall analyse the possible risks and frauds by contrasting the various amounts related to accounts receivables. Testing Controls and transactions: The auditors shall evaluate the internal controls and examine the appropriateness of the dealings. Testing Balance: The auditors shall examine the companys performance by using the financial ratios and statistical sampling (ICPAK , 2017). (d) Detail one (1) relevant practical internal control that would mitigate the risk in relation to the assertion at risk as identified in b) above. Reconciliations: Sudden accounting reconciliations can guarantee that the balances in the companys books can match with those of the other entities (KPMG, 2018). Trial Balances: With the help of double entry book keeping system, the reliability regarding the balancing of books of accounts can be ensured. Approval Authority: Specified managers should be allocated the various responsibilities regarding the authenticity of transactions (AICPA, 2014). Conclusion To, conclude, the auditors PricewaterhouseCoopers have conducted an analysis of the financial statements of Medibank Private Limited regarding the assessment of its environment and business risks. It has evaluated its various account balances and stated the results pertaining to its study. They have identified the various risks of substantial mismanagement which can be minimized with the help of key audit procedures (PWC, 2017). The auditors have reviewed various audit policies and procedures complied by the firm with respect to the rules and regulations of the APRA and other legislations as mentioned in the above paragraphs. Also the firm follows the Corporate Governance Principles and has formed various committees for better administration and accomplishment of its strategies and objectives. Also, the environment in which the organization operates is full of vulnerabilities and market fluctuations. So, the auditors have observed all the accounting policies of the organization and with the help of various audit procedures and assertions; they tried to regulate the risks of material misstatements. References ACCA(2016). The Audit of Financial Statement Assertions. Retrieved from https://www.accaglobal.com/in/en/student/exam-support-resources/fundamentals-exams-study-resources/f8/technical-articles/assertions.html# AICPA(2014). The Importance of Internal Control in Financial Reporting and Safeguarding Plan Assets. Retrieved from https://www.aicpa.org/content/dam/aicpa/interestareas/employeebenefitplanauditquality/resources/planadvisories/downloadabledocuments/plan-advisoryinternalcontrol-hires.pdf APRA(2018). About APRA. Retrieved from https://www.apra.gov.au/AboutAPRA/Pages/Default. Auditing and Assurance Standards Board (2013). Auditing Standard ASA 315 Identifying and Assessing the Risks of Material Misstatement through Understanding the Entity and Its Environment. Retrieved from https://www.auasb.gov.au/admin/file/content102/c3/Nov13_Compiled_Auditing_Standard_ASA_315.pdf Deloitte(2017). 2017 Insurance Regulatory Trends. The Wall Street Journal. Retrieved from https://deloitte.wsj.com/riskandcompliance/2017/03/21/2017-insurance-regulatory-trends/ Flynn, K.(2016). Financial fraud in the private health insurance sector in Australia: perspectives from the industry. Journal of Financial Crime. 23(1).143-158. ICPAK (2017).Conducting Risk Assessment Auditing the Internal Control System. Retrieved from https://www.icpak.com/wp-content/uploads/2017/03/RISK-ASSESSMENT-AUDITING-ICS1.pdf Kokobe, S.A. Gemechu, D.(2016). Risk Management Techniques and Financial Performance of Insurance Companies. International Journal of Accounting Research.4(1). KPMG(2015). Audit quality . Retrieved from https://assets.kpmg.com/content/dam/kpmg/pdf/2016/03/audit-quality-report-2015.pdf KPMG(2018). Internal controls over Financial Reporting. Retrieved from https://home.kpmg.com/be/en/home/insights/2017/12/internal-controls-over-financial-reporting.html Medibank(2016). Annual Report 2016. Retrieved from https://www.medibank.com.au/content/dam/medibank/About-Us/reporting-centre-2016/Annual%20report/Medibank_Annual_Report_2016.pdf Medibank(2017). Annual Report 2017. Retrieved from https://www.medibank.com.au/content/dam/medibank/About-Us/pdfs/MPL_Annual_Report_2017.pdf Medibank(2018). Corporate responsibility : Our Approach. Retrieved from https://www.medibank.com.au/about/corporate-responsibility/community-fund/ OECD (2014). Corporate Governance: Risk Management and Corporate Governance. OECD Publishing. Otieno ,S. Nyangechi ,E. O. (2013). Effectiveness of Internal Control Procedures on Management Efficiency of Free Primary Education Funds: a case of Public Primary schools in Kisii central District, Kenya. Journal of Sociology and Social Work. 1(1).22-41. PWC(2016). Aligning Growth and Risk. Retrieved from https://www.pwc.com.au/pdf/how-enterprise-resilience-can-help-drive-growth-in-financial-services.pdf PWC(2017).Understanding a financial statement audit. Retrieved from https://www.pwc.com/im/en/services/Assurance/pwc-understanding-financial-statement-audit.pdf Ridha, M. B. Alnaji , L. (2015). Analysis and Measurement of Risks in Business: A Case Study on the Jordan Valley Authority. European Journal of Business and Management. 7(9).

A memorable day Essay Example

A memorable day Essay A memorable day it was today. That Bassanio fellow approached me and claimed he was there to borrow money from me. Me, a Jew? Bassanio had to be desperate and I could read his face, so much tension and worry. In my head I figured it could not be a large sum as Bassanio was known for his extravagant spending habits, however, as he mentioned that the sum would be 3000 ducats but in Antonios name, my face seemed to light up. Antonio, that Christian scoundrel, the same man that spat on me. He humiliated me in public and he resents my religion. Antonio had called me a dog, a sinner and now he chooses to come to me in his time of need. I took advantage of this situation and placed Antonio at my mercy.At first I simply mocked Bassanio and repeatedly stated the details of the bond: 3000 ducats for 3 months and the fawning publican Antonio bound, over and over again I stated it in a manner that grew more condescending each time. I thought out loud and put emphasis on the dangers that ships en tail such as the treacherous winds and the pirates, after all it would not be the first time that a merchants ships and fortunes were lost to the all too brutal seas. As imagined, Bassanio did not take kindly to my words of fret.As the bond had been discussed Antonio was summoned to confirm it. We were to settle a rate of interest. Christians, those self-righteous fools who refuse to charge interest on loans yet offer interest to those borrowed from, Antonio is this kind of typical Christian. I confronted his hypocritical ways to which his anger fuelled, it was quite humorous to watch him rile up in such a way.I forced him to listen to the teachings of the Torah, I preached to him in a way that he could not ignore. Words from the religion he had spoken ill of. It is his turn to be pushed around and mocked; I would make sure of it. I would retaliate against his harsh words, brutal actions and his criticism of my values, I would make him pay.I saw right through him, the weakness in hi s heart for his trusted friend, Bassanio, the desperation he feels to fulfil the needs of his friend, the presence of this predilection makes revenge so much easier for me. To make Antonio feel the pain he has induced upon me all these years would be the ultimate comeuppance.Finally I announced the terms of the bond. If for some reason Antonio was not able to pay Shylock back with the full amount loaned, then I would be entitled to be paid back in kind, a pound of Antonios fair Christian flesh. The expression on Bassanios face dropped and he became hesitant. He told Antonio that he would rather live without his need than have Antonio pay this outrageous price. This proved to boost Antonios self confidence making him seem arrogant and obnoxious, not that that was far from his general attitude. This attitude irritated me and to feign a nonchalant attitude I simply compared his human flesh to the worth of common meat, this I knew would enrage him further which turned out to be quite en tertaining.I have no guarantee that anything will happen to Antonios ships, yet the risk or peril is greater than the chance of safe return, if he pays me on time then that is where I will be compelled to leave it, however if there is a glitch with his income then I will carry out the bonds terms and conditions. Thisis bad blood between two religions, if I am not to carry out this task of cutting a pound of flesh from his body then I will understand that a greater force has not allowed me to do so.Now, some may say Im evil or that I am in fact a person without feelings, but how wrong they are. I am spit upon in public because of the religion I was born to. Did I have any part to play in this decision of nature? From being the victim I must prove myself to be worth more whether it be a hero or a villain. In a sense, I would be both, villain to the Christians and hero to the Jews from my sacred nation, Israel. For this ancient grudge my people have been enslaved and abused. This is wh ere I take my stand.

Battle of Waxhaws in the American Revolution

Battle of Waxhaws in the American Revolution The Battle of Waxhaws was fought May 29, 1780, during the American Revolution (1775-1783) and was one of several American defeats in the South that summer. In late 1778, with the fighting in the northern colonies increasingly becoming a stalemate, the British began to expand their operations to the south. This saw troops under Lieutenant Colonel Archibald Campbell land and capture Savannah, GA on December 29. Reinforced, the garrison withstood a combined Franco-American attack led by Major General Benjamin Lincoln and  Vice Admiral Comte dEstaing the following year. Seeking to expand this foothold, the British commander-in-chief in North America,  Lieutenant General Sir Henry Clinton, mounted a large expedition in 1780 to capture Charleston, SC. The Fall of Charleston Though Charleston had defeated an earlier British attack in 1776, Clintons forces were able to capture the city and Lincolns garrison on May 12, 1780 after a seven-week siege. The defeat marked the largest surrender of American troops during the war and left the Continental Army without a sizable force in the South. Following the American capitulation, British forces under Clinton occupied the city. Escaping North Six days later, Clinton dispatched Lieutenant General Lord Charles Cornwallis with 2,500 men to subdue the South Carolina back country. Advancing from the city, his force crossed the Santee River and moved towards Camden. En route, he learned from local Loyalists that South Carolina Governor John Rutledge was attempting to escape to North Carolina with a force of 350 men. This contingent was led by Colonel Abraham Buford and consisted of the 7th Virginia Regiment, two companies of the 2nd Virginia, 40 light dragoons, and two 6-pdr guns. Though his command included several veteran officers, the majority of Bufords men were untested recruits. Buford had originally been ordered south to aid in the Siege of Charleston, but when the city was invested by the British he received new directions from Lincoln to assume a position at Lenuds Ferry on the Santee River. Reaching the ferry, Buford soon learned of the citys fall and commenced withdrawing from the area. Retreating back toward North Carolina, he had a large lead on Cornwallis. Understanding that his column was too slow to catch the fleeing Americans, Cornwallis detached a mobile force under Lieutenant Colonel Banastre Tarleton on May 27 to run down Bufords men. Departing Camden late on May 28, Tarleton continued his pursuit of the fleeing Americans. Armies Commanders Americans Colonel Abraham Buford420 men British Lieutenant Colonel Banastre Tarleton270 men The Chase Tarletons command consisted of 270 men drawn from the 17th Dragoons, Loyalist British Legion, and a 3-pdr gun. Riding hard, Tarletons men covered over 100 miles in 54 hours. Warned of Tarletons rapid approach, Buford sent Rutledge ahead towards Hillsborough, NC with a small escort. Reaching Rugeleys Mill mid-morning on May 29, Tarleton learned that the Americans had camped there the previous night and were around 20 miles ahead. Pressing forward, the British column caught up with Buford around 3:00 PM at a location six miles south of the border near Waxhaws. The Battle of Waxhaws Defeating the American rearguard, Tarleton sent a messenger to Buford. Inflating his numbers to scare the American commander, he demanded Bufords surrender. Buford delayed responding while his men reached a more favorable position before replying, Sir, I reject your proposals, and shall defend myself to the last extremity. To meet Tarletons attack, he deployed his infantry into a single line with a small reserve to the rear. Opposite, Tarleton moved directly to assault the American position without waiting for his entire command to arrive. Forming his men on a small rise opposite the American line, he divided his men into three groups with one assigned to strike the enemy right, another the center, and the third the left. Moving forward, they began their charge approximately 300 yards from the Americans. As the British approached, Buford ordered his men to hold their fire until they were 10-30 yards away. While an appropriate tactic against infantry, it proved disastrous against cavalry. The Americans were able to fire one volley before Tarletons men shattered their line. With the British dragoons hacking with their sabers, the Americans began surrender while others fled the field. What happened next is a subject of controversy. One Patriot witness, Dr. Robert Brownfield, claimed that Buford waved a white flag to surrender. As he called for quarter, Tarletons horse was shot, throwing the British commander the ground. Believing their commander to have been attacked under a flag of truce, the Loyalists renewed their attack, slaughtering the remaining Americans, including wounded. Brownfield insinuates that this continuation of hostilities was encouraged by Tarleton (Brownfield Letter). Other Patriot sources claim that Tarleton ordered the renewed attack as he did not wish to be encumbered with prisoners. Regardless, the butchery continued with American troops, including wounded, being struck down. In his report after the battle, Tarleton stated that his men, believing him struck down, continued the fight with a vindictive asperity not easily restrained. After approximately fifteen minutes of fighting the battle concluded. Only around 100 Americans, including Buford, succeeded in escaping the field. Aftermath The defeat at Waxhaws cost Buford 113 killed, 150 wounded, and 53 captured. British losses were a light 5 killed and 12 wounded. The action at Waxhaws quickly earned Tarleton nicknames such as Bloody Ban and Ban the Butcher. In addition, the term Tarletons Quarter quickly came to mean that no mercy would be given. The defeat became a rallying cry in the region and led many to flock to the Patriot cause. Among those were numerous local militias, particularly those from over the Appalachian Mountains, which would play a key role at the Battle of Kings Mountain that October. Vilified by the Americans, Tarleton was decisively defeated by Brigadier General Daniel Morgan at the Battle of Cowpens in January 1781. Remaining with Cornwallis army, he was captured at the Battle of Yorktown. In negotiating the British surrender, special arrangements had to be made to protect Tarleton due to his unsavory reputation. After the surrender, the American officers invited all of their British counterparts to dine with them but specifically forbade Tarleton from attending.

Case Study of MGM Example | Topics and Well Written Essays - 500 words

Of MGM - Case Study Example The highly competitive nature of the hospitality and gaming industry is considered one of the biggest threats for MGM. The competitors vary considerably in terms of their size, quality of services, financial potency and capabilities, level of facilities and the diversity that exists in terms of geographic location. MGM faces competition from several public and private companies that operate in the hotel, gaming and resort business. In just the short period, that MGM has been in the market, its portfolio has vastly increased. MGM is actively in pursuit of development opportunities in the main regions that show some form of opportunity, both domestically and internationally. However, now MGM seems to be highly reliant on Las Vegas to generate the larger part of its revenue. Secondly, MGM has taken up several initiatives in order to set it apart from its competitors. Building themed hotels came outdated and a clichà © over time, which in turn necessitated the need for MGM to take up on something different and unique. This is relevant in ensuring that the hotel can offer to its customers what the other hotels in the hospitality and gaming industry do not have to offer. Furthermore, in order to get a head start in the changing era of the competitive industry, MGM has collaborated with the digital entertainment party known, as bwin party waiting for the time when gambling shall be made legal. The world is vastly changing to be a digital and customers are everyday hoping to do everything online. Offering online poker is likely to give MGM competitive advantage in the gaming industry. The resource-based model is ideal when venturing into international markets as a way of maintaining competitive advantage and attaining above average returns. Furthermore, MGM should focus on training the employees in order to deliver consistent excellent customer service across all of its

Stress response Outline Example | Topics and Well Written Essays - 500 words

Stress response - Outline Example Stress as it is widely known and is linked to negative effects (Pond 2004). According to Braun and Anderson (2007), communication between cells is a stress response. The authors explain that a disturbance of homeostasis by harmful forces lead to stress. Additionally, stressors cause stress and can be either endogenous or exogenous. Coping with stress depends on various factors. Some of the factors that can determine ways of perceiving or coping stress are health, age, genetic factors and social support. Homeostasis reliability is a stress response. However, destruction of body tissues can occur with time in case there is an excess in response to stress. Neuroendocrine response and hormones are initiated when there is an excess to stress response. Stressors activate different patterns of response which in turn initiate different neuroendocrine pathways and neural. Stress is common to the human body because of its capability and its adaption to experience stress. Stress is regarded as negative if it persists due to challenges met by humans. Psychological impacts of stress vary depending on stressors. Study of stressors common on children or teenagers such as abuse, violence, marital problems and other stressing events in the family provide a clear view of psychological impacts of stressor. Child abuse is the most common problem in the society and has severe implications. For example, a child can view education negatively or perform poorly in school. Marital problems or divorce renders a child anti-social. The child remains depressed, anxious and less social than the peers. In adulthood stage, the child from divorced, or family with conflicts shows more stress and less friend support than a person from a family with no marital problems. Unrelieved stress causes depression, post traumatic stress disorders, panic attack conditions and drug or alc oholism addiction. Research shows that a child develops post traumatic stress disorder later in life when exposed to

Sample Quality Article Example | Topics and Well Written Essays - 500 words

Sample Quality - Article Example It lowers the cost of carrying out a research, enables faster collection of data, improves the quality of the data, and ensures homogeneity and accuracy of results. This paper will analyze sample quality in the listed articles. In doing this, paper will seek to define the population in each case and quote the sampling method used. It will also explain the choice of the sample and state who participated in the study. It will equally seek to qualify the research to other populations. In deducing, the sampling method used, it will be necessary to define the various sampling methods that we have. Random sampling involves the random selection of sample from the population. In cluster sampling, selection of samples is in clusters close to each other like households in the same estate. Quota sampling involves selection of samples nonrandom according to a fixed quota. Snowball sampling involves the identifying of samples that meet the criteria for inclusion in a study. Purposive sampling involves sampling with a  purpose  in mind.  Availability sampling involves using just the available samples (Trochim Web). In the article by Scott et.al, the population was all Canadian elderly patients with anxiety disorders and clinically significant anxiety symptoms. Quota sampling method selected a sample of 36,984 adults aged 55 years and above who participated in the Canadian Community Health Survey in 2008. The selection of the people in the sample was because they suitably represented the target population.  The actual participants in the study were 12,792 individuals, living in Canada (Scott et.al 792). The researchers cannot generalize it to other populations because the analysis focused on adults aged 55 years and above which are usually the minority in any society. In the Yang et.al study, population was all adolescents 6 months after the 2008 Wenchuan earthquake in China. Quota sampling selected a sample of 2,463 middle schools and grade 10 students. Their selection was

Effects Of Climate Change On Vietnamese Agriculture Environmental Sciences Essay

Effects Of Climate Change On Vietnamese Agriculture Environmental Sciences Essay In the last decade, an overwhelming consensus has emerged among the worlds most reputable climate scientists that the world has entered a period of rapid global climate change, much of which is accountable to anthropogenic greenhouse gas (GHG) emissions (NSAC 2009). The agreement is demonstrated in the 1996 report of the Intergovernmental Panel on Climate Change (IPCC), an international body of leading natural and social scientists sponsored by the United Nations Environment Programme and the World Meteorological Organization. According to the panels report, an equivalent doubling of atmospheric carbon dioxide (CO2) concentration will force a rise in global average surface temperature of 1.0 to 3.5 degrees Celsius by 2100. It will result in an increase of sea level by 19 to 59 cm. Because a warmer atmosphere holds more water vapor, average precipitation also will go up as much 10 to 15 percent (IPCC 2007). Agriculture is highly sensitive to climate variability and weather extremes, such as droughts, floods and severe storms. Even warmer climate may give positive effects on food production, the increased potential for droughts, floods and heat waves will pose challenges for farmers. Global climate change is also expected to impact agriculture by causing shifts in precipitation, soil quality, pest regimes, and seasonal growth patterns (NSAC 2009). The exact nature and degree of these changes for any given region will be difficult to predict. CASE OF VIETNAM Situated in South East Asia in the Indochinese Peninsula, Vietnam territory is lasting from 8Â °15 to 23Â °22 latitude and between 102Â °8 to 109Â °30 longitude (ADPC 2003). It has 329,314 sq. km of natural area, in which 7,348.5 thousand hectares (22.2 percent) is arable land, with population about 83 millions (WHO). Viet Nam lies in the region of tropical monsoon climate with a high temperature. The average temperature varies between 21Â °C and 27Â °C, rainfall volume of 1800-2000 mm/year and is not evenly distributed among the months of the year (Tran 2009). Versatile and various climates of the regions create a variety of vegetation and domestic animals which originated in the temperate, sub-tropical and tropical regions. Being an agricultural country, 75 percent of Vietnamese labor-force is engaged in agriculture, forestry, and fisheries. This sector contributes roughly 20 percent to the GDP. The output value structure of agriculture, forestry and fisheries was 77 percent, 4 percent and 19 percent, respectively (Tran 2009). Vietnam is likely one of the most vulnerable countries in the world to climate change, because of its geographical location (Oxfam 2008). During the last 50 years, Viet Nams annual average surface temperature has increased by approximately 0.50 0.70 C, while the sea level along its coastline has risen by approximately 20 cm (ISPONRE 2009). The El-Nino and La-Nina phenomena have caused increasingly adverse impacts to Viet Nam. Changes in climate can have serious implications for economic development, especially in the agricultural sector, due to its direct exposure to and dependence on weather and other natural conditions. Studies for the Southeast Asian region show that climate change could lower agricultural productivity 2-15 percent in Vietnam (Bingxin et al. 2009). It is very likely that global warming is leading to an increase in weather extremes like heat waves and heavy rainfall. Droughts will occur more often, and that tropical cyclones (typhoons and hurricanes) will become more intense. Vietnam has always been suffering from extreme weather events and is struck by typhoons annually. Strong winds and sea surges cause death and destruction along the narrow and low-lying coastal area, while heavy rains hit the mountainous hinterland and river deltas with floods and landslides (Vietnam Red Cross 2007). For example, the river flood in Mekong Delta in 2000 killed 548 people; it flooded and damaged 401,342 ha of rice fields. An estimated loss of this flood is about 250 million USD (Chaudhry Ruysschaert 2007). The peak occurrence for typhoon landfalls has been during the month of October in the Central region and November in the South. A partial explanation of this lies in the sea surface temperatures (SSTs), which decrease later in the season. T yphoons are generated where SSTs are 26 Â °C or above, and by September, this is only found in those ocean areas further south where the SST remains around 25-28 Â °C throughout the year (ADPC 2003). Climate change may lead to an increase in sea surface temperatures in higher latitudes and a resulting increase of typhoon activity in North Vietnam. An increase of extreme events, both in intensity and duration, will be the most catastrophic preventing the agriculture development. Flood damage is expected to be aggravated because of a predicted increase in daily rainfall of 12 19% by 2070. In other times of the year, an increase in evaporation and the variation in rainfall will intensify drought problems about 3 percent in coastal zones and 8 percent in inland areas by 2070 (Chaudhry Ruysschaert 2007). Climate change impacts on agriculture are also channeled through changes in temperature. According to the third assessment report of IPCC, the temperature in this century will increase by 4-50 C. The International Rice Research Institute (IRRI) modeler determined that, as a general rule, yield of rice will decrease by 0.5 ton per hectare for every 10C increase in growing seasonal minimum temperature (Javellana 2007). According to the medium emissions scenario, the average temperature is expected to increase by nearly 2Â °C in the southern regions of Viet Nam and up to 2.8Â °C in the northern regions by 2100. However, in the high emissions scenario this could be as much as 3.6Â °C in the North Central Coast region (United Nation 2009). So, it is predicted that yields of summer rice will decrease by 3 6% by 2070 when compared to the 1960-1998 period. The impact on spring rice may be more serious, especially in the north where yields are expected to decrease by 17% (Chaudhry Ruyssc haert 2007). The evapotranspiration rate will also increase due to increasing temperature, depicted in figure 1 2. Rainfall in the dry season will decrease by 2070 in Central parts of Viet Nam and droughts would occur more frequently, because rainfall would be concentrated in the rainy season (WHO). Figure 1: The projected change of mean daily maximum temperature since 1980s to 2070s (Le 2010) Figure 2: The projected change of mean daily minimum temperature since 1980s to 2070s (Le 2010) Climate also creates a shift in amount and pattern of precipitation. It will affect hydrology and runoff, which will alter the availability of water for irrigation and other uses. The projected runoff changes for the two major rivers from three organizations show different trends. In the Red River, the IPSL scenarios show decreased wet-season flow. GISS and MONRE projections show increased dry season flow. In Mekong River, major flow reduces under IPSL projection, depicted in figure 3 (Ringler 2010). Significant rice yield decline is observed in all scenarios, ranging from 4.2 percent in MONRE-2030 to 12.5 percent in IPSL-2030. The impact is especially large in the Central Highlands and the northern zones, highlighting the enlarged gaps in food supply in these regions. Although the impact of climate change is relatively moderate in the major rice-producing region of the Mekong River Delta, the average rice yield is projected to drop by 1.4-8.3 percent by 2030 (Bingxin et al. 2010). Figure 3: Percentage of Basin Runoff Changes (Ringler 2010) Besides increasing average temperature, global warming also raises the sea water level which has resulted in salt-water-invasion and land loss. A recent study on the potential impacts of sea level rise in 84 developing countries suggested that Vietnam would rank among the top 5 affected countries. About 43 million Vietnamese or about 55% of the countrys population are living in vulnerable low elevation coastal zones (LECZ) (38 % of Vietnams urban population) (Waibel 2008). In Vietnam, the sea level has risen between 2.5 to 3.0 cm per decade in the last 50 years, but with regional variations (Oxfam 2008). According to ADPC report, sea levels may increase by 9 cm in 2010, 33 cm in 2050, 45 cm in 2070, and 1 meter in 2100 (ADPC 2003). If sea level rises 1 meter, a national potential land loss is predicted of 12% which will expose about 17.1 million people or 23.1 % of the population (Schaefer 2002). The Mekong River Delta will be the most affected region with 1.77 million ha of saline l and, accounting for 45 percent of the land (Chaudhry Ruysschaert 2007). Land loss and sea water invasion in the Mekong River Delta and parts of the Red River Delta, which are the most important agricultural areas in Vietnam, will cause serious risks to farmers as well as agricultural exports, and possibly to national food security. In summary, climate change is a very real threat to Vietnamese socio-economical development. Higher temperatures, the rising of sea water level and extreme weather events will all have significant impacts across the nation. However, the concept of climate change and its effects are just well known by experts and management agencies. Dealing with the serious implications of climate change will be a major challenge for Vietnam in the next decades.

Review of an Ecological Science Research Article from a Primary Scientific Source :: essays research papers

Powell, K., 2005. Fish farming, Eat your Veg, Nature, 426, 378-379.   Ã‚  Ã‚  Ã‚  Ã‚  The article that I chose to review discussed the possibility of maintaining and sustaining aquaculture by changing the diets of the farmed fish. The idea of carnivorous fish turning into vegetarians would help for future sustentation of aquaculture. There were pros and cons to either side of vegetarianism and the maintaining of carnivores. There are issues that would require research and analysis to which the author points out to the reader.   Ã‚  Ã‚  Ã‚  Ã‚  Aquaculture has increased by 5% over the past 10 years. The wild stock of fish that is caught to feed the fish farms has numbered 11 million tons, which is 12 % of the total fish hauled from the sea each year. Carp and tilapia are the most farmed fish in the industry that already are consisting of a vegetarian type diet. Salmon and trout are the next largest farmed fish. The difference is that the salmon and trout are carnivores. The author reports that the carnivorous fish are more expensive to cultivate and more resources are needed to maintain these types of farmed fish.   Ã‚  Ã‚  Ã‚  Ã‚  Most farmed fish are fed on a diet that consists greatly of fish oil and fishmeal. Fishmeal is made from a protein rich powder of ground up cheap fish as a source of nutrients and proteins. The problem with using these within the farm diet is that the demand for the fish oil will overpower the supply as aquaculture expands and booms. The author states that the â€Å"demand will outstrip supply of oil by 2010.† (Powell).   Ã‚  Ã‚  Ã‚  Ã‚  Feed companies which supply the fish farms with fishmeal and fish oil as a staple to the diet of the carnivorous fish will seek different sources of protein. This protein could possibly come from larger fish such as mackerel, herring, and blue whiting. If this happens it would put more pressure on the natural stock already being harvested for other purposes. Some companies are traveling to the Antarctic to collect krill, which has repercussions for the bottom of the food chain in that the ocean itself is a primordial web of life.   Ã‚  Ã‚  Ã‚  Ã‚  The author boosts that the fish will be able to eat Soya beans, corn, rapeseed, sunflower seeds, flaxseeds, and wheat gluten if converted to a vegetarian diet. The author also reports that some salmon farms already use these foods as staples in their fish farm diets.

Economic Background – Greece

Greece has a mixed capitalistic economy with a large public sector that accounts about half of GDP. Besides, Greece is a major beneficiary of European Union aid, which equal to about 3. 3% of annual GDP. In addition, Greece is an agricultural country and one of the poorest countries of the European Union with the second to lowest average income, after Portugal. In January 2002, Greece adopted the euro as its currency. The adoption provided Greece, formerly a high inflation risk country under drachma, with access to competitive loan rates and also to low rates of the Eurobond market which led to a dramatic increase in consumer spending and gave a momentous boost to economic growth. Between 2003 and 2007, Greece economy grew by nearly 4. 0% per year. The preparation for the Athens Olympic Games during 2004 gave an impulse to the Greece economy. However, the financial crisis had slowed down the Greece’s economic growth to 2.0 % in 2008. As a result of the world financial crisis and its impact on access to credit, world trade and domestic consumption, the economy went into recession in 2009 and contracted by 2. 0%. In late 2009, eroding public finances, misreported statistics, and inadequate follow-through on reforms prompted major credit rating agencies to downgrade Greece’s international debt rating, which has led to increased financial instability and a debt crisis. Greek government has approved a three-year reform program that includes cutting government spending, reducing the size of public sector, tackling tax evasion, reforming the health care and pension systems, and improving competitiveness through structural reforms to the labour and product market under the intense pressure by the EU and international lenders. The Greek Government projects that its reform program will achieve a reduction of Greece’s deficit by 4% of GDP in 2010 and allow Greece to decrease the deficit to below 3% by 2012. Greece requested activation of a joint European Union-International Monetary Fund support mechanism designed to assist Greece in financing its public debt in April 2010.

Concept Analysis on Acuity Nursing Essay Sample

Concept Analysis on Acuity Nursing Essay Sample Concept Analysis on Acuity Nursing Essay Example Concept Analysis on Acuity Nursing Essay Example The focus of this concept analysis paper is acuity. On the surface, â€Å"acuity† appears to be a precisely defined concept because of its prevalent use in health sciences-related literature. For instance, many authors have acknowledged the rising patient acuity in the course of the last three decades. Moreover, numerous tools have been developed to quantitatively measure patient acuity. Some of these tools include the Revised Easley-Storfjell Patient Classification Instrument, the Can Slyck and Associated Acuity System, the Injury Severity Score, the National Therapeutic Intervention Scoring System, the Acute Physiology, Age, Chronic Health Evaluation instrument, and the Resource Utilization Group Classification System. Despite the existence of several measurement tools for patient acuity, the literature is inconsistent with respect to the definition and measurement of the concept. This concept analysis paper has the main aim of evaluating the definitions of acuity in various disciplines, concepts related to patient acuity, usages of the concept, antecedents of patient acuity, and the consequences of patient acuity. A personal definition of the concept is also provided along with a conceptual model. Before analyzing the concept of acuity, there is the need to have valid measurements, which emphasize on the clarity of the concept being measured. Regardless of the fact that â€Å"acuity† is frequently used, the inconsistent definition and measurement tools of the concept have made it impossible to make a cross-comparison of acuity measurements in diverse settings. In addition, this inconsistency has increased the difficulty of exploring the relationship between acuity and its respective outcomes. As a result, there is the need to perform a concept analysis in order to clarify the meaning and move towards the development of standardized definitions as well as measurements as it relates to acuity. The concept analysis was guided by the Morse’s concept classification method (Morse, 1995). According to Morse (1995), a concept will rarely seem well described and mature, which can be attributed to vast literature covering the concept that provides comprehensive descriptions, clinical empirical evidence as well as quantitative tools used in measuring the concept. However, a closer look reveals inconsistent definitions and several rival implicit theories, which is the case with the concept of patient acuity. The concept clarification method recommended by Morse (1995) encompasses performing a review of literature, and content analysis of literature with respect to the underlying values. In addition, the concept analysis process involves analyzing the attributes of the concept including the consequences and antecedents. A search for the term â€Å"acuity† was performed in the abstract and titles of papers published in the English language in electronic databases and citation indexes such as Google Scholar, PsycINFO, MEDLINE, CINAHL, and PubMed. The Oxford and Merriam-Webster English Dictionaries were also searched. A complementary Internet search using Google was performed. The searches yielded about 100 papers. Only one published report on the topic of concept analysis of patient acuity was found. An inclusion and exclusion criteria was employed in order to filter the papers to remain with relevant resources. Specifically, papers with the term â€Å"acuity† in the abstract or title were incorporated in the concept analysis whereas papers that lacked the term were excluded. The reason for the exclusion of the papers lacking the term â€Å"acuity† in the abstract and title was the possibility that no novel information regarding the concept of acuity could be obtained from these s ources. Definitions of Acuity The Miriam-Webster dictionary defined acuity as â€Å"the ability to understand, hear or see something easily.† In this light, acuity denotes the keenness associated with perception. The Oxford English Dictionary defines acuity as â€Å"keenness or sharpness of hearing, vision or thought.† In literature, there are several definitions of acuity that vary across discipline. For instance, Hebasevich (2012) defined acuity in healthcare settings as the intensity of care needed for a patient determined by a registered need. In this respect, six categories exist that range from minimal care to intensive care. In healthcare settings, when acuity increases, there is the need to allocate more nursing resources in order to guarantee safe care. Hughes (2008) defines patient acuity as the patient requirements for nursing care, which are used in the management of nursing quality, costs and personnel resources. In psychology, acuity has been defined as the sharpness of the mind, which depends on a number of factors including understanding, concentration and focus. An elderly individual with Alzheimer’s Disease is considered to have low mental acuity since he/she is unlikely to remember the events that happened during their youth. In addition, the elderly individual is unlikely to have a precise memory of when and how something occurred. He/she may be slow in understanding relatively simple things like operating a remote control. A person can enhance his/her mental acuity using activities that engage the mind such as mental puzzles. Gorman and Campbell (1995) also defined mental acuity as the sharpness of the mind in terms of understanding, concentration, memory and focus. However, mental acuity is not concerned with intelligence. Mental acuity denotes how well or poorly an individual’s brain is functioning and not his/her ability to undertake complex tasks. A number of factors have irreversible impacts on mental acuity such as the onset of Alzheimer’s disease, encephalitis and prolonged substance abuse. Moreover, some short-term conditions that lessen mental acuity also exist such as high stress and fatigue levels, distractions, external and external interruptions. Table 1 below illustrates the various definitions of acuity as found in the review of literature. Education, Medicine, Psychology, and Nursing Despite the fact that there are some different terminologies and views in the definition of acuity in the various disciplines, a common theme that spans across all the definitions of acuity is that the concept measures something. In all of the definitions, it is evident that acuity denotes the degree to which something being described by the various disciplines manifests itself. For instance, in medicine, acuity denotes the degree to which an illness is severe, or the extent to which an illness requires urgent medical attention. Visual acuity refers to the range to which a person is capable of seeing clearly at a certain distance (Pelosini et al., 2012). In the context of nursing, acuity refers to the aggregate of the nursing services required, which may be in the form of the level of difficulty of the nursing care needs (Buerhaus, 2009), the level of demand for the nursing skills and service (Boudreaux, Friedman, Chansky, Baumann, 2004), the level of patient’s dependence on the nursing staff (Hughes, 2008), the amount of time required to offer nursing care, and the amount of nursing care (Arling, Kane, Mueller, Lewis, 2007). Similarly, in psychology it is evident that acuity denotes the amount of the psychological element being defined; for instance, acuity may denote the severity of the psychological distress, cognition and memory, and sharpness of the mind (Turnage, Kennedy, Smith, Baltzley, Lane, 1992). A similar approach is evident in the definition of acuity in the field of education. From all the definitions, acute represents the smallest degree of whatever is being defined. For instance in medicine, a disease that requires the most urgent medical attention is considered acute. Similarly, a serious psychological distress can be considered acute such as acute depression, implying that it is severe. In mental or intellectual acuity, people with high degrees of sharpness, concentration can be considered to have acute intelligence. Among the various definitions of acuity in the various fields, it is evident that the field of nursing offers the most comprehensive definition of acuity. The definition of acuity in nursing spans focuses on complexity, workload and nursing care needs, which all represent intensity. The nursing care needs represent the amount and concentration of nursing care required – high acuity demands more nursing care and vice versa. Nursing workload with respect to acuity represents the time required in offering the nursing care as well as the level to which a patient relies on nursing staff. Complexity symbolizes the degree of difficulty of the care requirements and the demand for the nursing skills and services. Overall, the definition of nursing is multi-dimensional, as opposed to the definition of acuity in other disciplines, which focus only on a single aspect. Concept Use In order to provide a further clarification of the concept of acuity, it is necessary to examine the different uses and situations involving the usage of the concept. In order to delineate the use of the concept of acuity, it is imperative to establish the attributes associated with the concept. In this respect, the attributes associated with acuity revealed four uses and situations where â€Å"acuity† could be applied, which included patient-related acuity, non-patient related acuity, provider-related acuity, and system-related acuity (Hughes, 2008; Boudreaux, Friedman, Chansky, Baumann, 2004; Cherry, 2003; Chin Muramatsu, 2003). Patient-related acuity emphasizes on the onset of an illness or the timing of the medication intervention such as the treatment of a disease. For instance, high patient acuity could be used when a patient requires urgent medical attention. Patient-related acuity can also be used in differentiating care facilities in terms of those providing long-term care and acute care facilities. Acute care facilities attend to patients with high patient acuity; that is, those requiring urgent medical attention. This is in contrast to long-term care facilities that attend to patients with low acuity. Acute care can also involve the patient receiving active albeit short-term treatment to severe injury. Acute care is in contrast to longer-term care or chronic care. Patient-related acuity can also be used in describing the severity of the illness. An example of the inflammatory acuity, which denotes the extent of the actual inflammatory process, or with respect to a particular illness such as chronic kidney disease or an acute cold. Emergency departments use the term injury acuity for triage purposes. In addition, psychological acuity can be used to represent the severity of a psychological disease such as acute depression. It is evident that in patient-related acuity, the use of acute implies the highest level of severity, requiring urgent attention, and nursing care administered on a short-term basis. This is in contrast with chronic, which represents the need for long-term care. Chronic and acute are on the opposite ends of the patient condition spectrum (Abualrub, 2007). In the context of patient-related acuity, the intensity of nursing care and illness severity can be used in determining the level of patient acuity. It is imperative to note that intensity and severity aspects of acuity are similar, and their uses overlap. Intensity and severity can be utilized interchangeably to refer to the type, duration and amount of nursing care needs required by a particular group of patients. Intensity and severity can also refer to the seriousness of the illness (Abualrub, 2007). The concept of acuity can also be used in non-medical settings to represent keenness or sharpness in various domains including sensation, social intellectual, and coming to a point. With respect to sensation, there are numerous uses of acuity including visual acuity (Pelosini, et al., 2012), tactile acuity, spatial acuity, sensory acuity (Turnage, Kennedy, Smith, Baltzley, Lane, 1992), proprioceptive acuity, perceptual acuity, olfactory acuity, and auditory acuity (Cherry Reed, 2007). Visual acuity is the most commonly used in the non-patient acuity and refers to the clearness and acuteness of one’s vision. Auditory acuity refers to the ability to trace a sound in a given space (Rischbieth, 2006). Essentially, auditory acuity places emphasis on localization acuity. With respect to coming to a point, papers that used this description of the concept of acuity referred to positioning or repositioning of the sense acuity. These papers had the main objective of determining a quantitative error of measure in regards to the positioning of joints in order to relive pain, facilitate a motion range, and come up with diagnostic techniques as well as rehabilitation programs that can be applied to joint-related injuries. In the intellectual domain, intellectual acuity is mostly used when referring to memory and cognition (Cherry, 2003). An example of this could be the strategies that are utilized in helping elderly people maintain their mental capacities and capabilities during aging, and interventions and medicines utilized improving attentiveness and memory among others. Social acuity is used to refer to keenness, sensibility and social awareness with respect to one’s ability to interact with other individuals socially (Salvia, Ysseldyke, Bolt, 20 12; Rischbieth, 2006). Provider-related acuity refers to the intensity of nursing care required for a patient. In this case, intensity represents the care burden that a patient imposes on the nursing staff in regards to surveillance, mental concentration, skills and time in order to satisfy the needs of the patient. The intensity aspect of acuity can be looked at in three ways: in terms of complexity, workload, and care needs (Boudreaux, Friedman, Chansky, Baumann, 2004; Chin Muramatsu, 2003; Pelosini, et al., 2012). Complexity in provider-related acuity refers to the level of difficulty of the medical and nursing care needs of the patient, which involves physicians and nurses’ surveillance, concentration and skill needed to offer care services for patient(s). Workload is an attribute of acuity, whereby high patient acuity requires a high nursing workload. In this respect, high patient acuity is described by a decrease in the period of stay for patients and an escalation in the illness severity (H ughes, 2008). Nursing workload usually denotes a surge in the demand for nursing skills and services, and measures the nursing requirements to satisfy the needs of a patient (Arling, Kane, Mueller, Lewis, 2007; Cherry Reed, 2007). With respect to nursing care needs, it is evident that the severity of the illness often determines the nursing care needs; as a result, there is a close relationship between the intensity and severity aspects of acuity. Seriousness of the illness can be perceived as the amount of nursing resources and care utilized by the patient. Intensity can be looked at in terms of the amount of time needed to offer care to the patient. Some of the measures of nursing intensity could include the nursing intensity weights, and the nursing hours per patient per day (Abualrub, 2007). Other aspects of provider related acuity include the extent to which the patient depends on the nursing staff for their health care needs, which is sometimes referred to as nursing depende ncy. Patient severity could also be used to describe the nursing interventions and the amount and type of nursing care activities (direct and indirect) that are needed for the patient. Other measures of patient severity aspect of provider-related acuity can include patient debility and functional status. With respect to provider-related acuity, based on the review of literature, it can be argued that high acuity requires more nursing care, an increased workload, and complex patient needs; the case is the oppose for low acuity patients. System-related acuity is concerned with the pairing of attributes of acuity with other concepts. The uses of system-related acuity include triage/urgency, classification system and case mix. Urgency/triage are used in emergency medicine settings in ascertaining the severity of illness in order to ensure that the patient is matched with the suitable nursing and medical requirements (Abualrub, 2007; Craig Huber, 2007; Rischbieth, 2006). Classification systems are used in pairing acuity with nursing costs. In this context, acuity denotes the amount of care required. This often involves measuring the patient characteristics in order to ascertain the amount of nursing resources required and determine the nursing assignments. In addition, the classification systems can be used to match and predict staffing needs with respect to the patient needs. Case-mix is also an aspect of system-related acuity and is concerned with the number of patients in a given hospital who can be put in the same group depending on their nursing care needs. The case mix determines the resource utilization needed by a patient grouped in every category (Abualrub, 2007). Patients can also be grouped in accordance with the illness severity and the intensity of care. Acuity measurements can also be utilized in a number of other predictions such as the assignment of patients to nurses or case managers, budgeting, staffing, costs of care, mortality and morbidity (Abualrub, 2007). Antecedents The nursing work environment is continuously evolving, which as a result has increased the demands placed on nurses while at the same time increasing the distance between the nurse and patient, requiring the presence and attention of nurses. There is widespread agreement in the literature that patient acuity is rising, which can be attributed to a number of factors. The first factor is the shortened length of patient stay in hospitals as hospitals embark on reengineering their workflows in order to lessen delays. This reengineering has focuses on nursing care and nurses through various. For instance, a hospital can adopt a screening tool aimed at enabling nurses to recognize patients who may require physical therapy as well as produce early consultation to be undertaken with the physical therapy department. Moreover, other hospitals are modifying their discharge procedures in order to make sure that the discharge takes place early during the day in order to accommodate patients being transferred from emergency rooms and surgery. Moreover, other hospitals have embarked on enhancing multidisciplinary rounds in order to make sure that all departments within the hospital have adequate information in a timely manner. It is evident that all of these changes have resulted in novel demands of the nursing staff’s time and has lessened the nurse-time for lower-intensity patients. An increase in throughput results in a high rate of admissions, which increases the demands placed on the nurses’ time. In addition, the durations of patient stay are also being reduced because of the fact that patients are being discharged at a faster rate to post-acute care in home health and skilled nursing facilities. The outcome of faster discharge is an increase in patient acuity in both hospitals and patients placed under post-acute care. Therefore, nursing in post-acute care and hospital care are handling higher acuity patients. According to Lang, Hodge, Olson, Romano, Kravitz (2004), the rising patient acuity and the novel work demands posed by the modified workflow cannot be addressed using higher nursing staffing levels; instead, there is the need to change the manner in which nursing staff use their time. The second factor contributing to patient acuity is an increase in demand for nursing services because of the aging of the population. It is projected that from 2000 through 2020, the population will grow by 18% (Duffield OBrien-Pallas, 2003; Lang, Hodge, Olson, Romano, Kravitz, 2004). In addition, the population growth for the over-65 population will be 54%, which translates to an increase in healthcare needs by this population. Studies have affirmed that the population is aging, and that elderly people comprise a considerable and growing percentage of people being admitted in hospitals and emergency departments. Elderly people usually develop complex health illnesses that are likely to result in chronic diseases. In addition, in hospital settings, elderly patients have reported relatively higher adverse events rates as well as higher chances of becoming deconditioned. According to Duffield OBrien-Pallas (2003), nurses must use all means necessary to avoid prolonging the duration of stay in hospitals for older patients, which requires the use of care models that shun deconditioning while at the same time promoting functioning. In addition, it is imperative to note that an increase in the demand for acute services has increased consistently during the last decades, with older people comprising of the fastest increasing population of those admitted for acute services. Lankshear, Sheldon, Maynard (2005) notes that the increased demand for acute services goes hand in hand with the decrease in the number of available acute hospital beds as well as the increased use of early patient discharge models. The clinical needs and problems of elderly patients are significantly different from the needs and problems presented by younger people (Craig Huber, 2007; Mazzocco, Feigenson, Halberda, 2011). A majority of elderly patients are often admitted with either sub-acute or acute illness that manifests itself ambiguously and is likely to be characterized by functional and mental deterioration. In addition, elderly patients are likely to have multifaceted social needs and several co-morbidities. Studies have shown that elderly have a lesser likelihood of being cleared from acute units. Moreover, when they are admitted, they are more likely to stay in the hospital for longer durations. Elderly patients also have higher rates of readmission (Abualrub, 2007). The healthcare cost pressure has also been associated with the increase in patient acuity. The increase in the use of managed care during the 1990s played a pivotal role in increasing the cost pressure, especially in hospitals employing large numbers of registered nurses. During the 1990s, places with higher enrollments of managed care were characterized by slower employment growth and wage growth for registered nurses when compared to places having lower enrollments. With the spread of managed care, the employment and wage growth for registered nurses fell at the national level in the late 1990s (Hall, Doran, Pink, 2004). This resulted in changes in hospital payment systems in order to lower spending and reduce the duration of patient stay in hospitals. Therefore, registered nurses in hospitals treat patients who are averagely sick although the intensity of their work increased, contributing to patient acuity (Lankshear, Sheldon, Maynard, 2005; Rischbieth, 2006). The nursing work environment and workload have also been linked to patient acuity. As a response to the increasing cost pressure, hospitals embarked on cutting the staffing levels and adopted mandatory overtime policies aimed at ensuring the availability of nurses during unanticipated increases in the number of patients admitted. The outcome has been an increase in nursing workload. In addition, this has resulted in a reduced nurses’ control with respect to weekend and night work. A direct implication of the increased workload could have been an increase in the wages of nurses; however, their wages have actually remained constant, which can be attributed to the increased competition in the healthcare industry. Increased workload contributes to high patient acuity in two ways. First, it reduces the nursing time and resources available to a patient. Second, it contributes to nursing shortage since it discourages people from entering or remaining in the nursing profession. Studie s have affirmed that nurses with higher patient loads (workloads) report higher burnout and dissatisfaction. Consequences Numerous studies have reported a significant relationship between the levels of nursing staffing (patient acuity) and the quality of care for patients in both nursing homes and hospitals. For instance, a study conducted by Unruh (2003) reported that increasing the number of hours of nursing care per day per patient is related to improved health outcomes such as reduced duration of stay; reduced rates of illnesses including cardiac arrest, pneumonia, gastrointestinal bleeding, and urinary tract infections; and reduced mortality associated with complications. Another study by Lankshear, Sheldon, Maynard (2005) revealed that increasing the number of patients per nurse (patient load) increases the probability of patients dying. Specifically, the study reported that, for each patient increased for each nurse, there is a 7% increased chance of death within one month of admission. The researchers also indicated that, for each patient increased per nurse, there is a 7% increase in the proba bility of dying from complications. In the context of nursing homes, studies have also reported a relationship between the quality of care and staffing levels (patient acuity) (Lankshear, Sheldon, Maynard, 2005). Studies have also documented the outcomes associated with increased nursing workload, which is an attribute of patient-related acuity (Hall, Doran, Pink, 2004; Hall, Doran, Pink, 2004; Hughes, 2008). The workload on nurses can be grouped into three categories including the unit, job, and patient levels. At the unit level, the nurse-patient ration is often used in measuring the level of nurse workload. Studies have reported that increased nursing workloads (lower nurse-patient ratio) can negatively affect patient outcomes. As a result, it has been suggested that increasing the number of nursing staff in a unit and reducing the number of patients that are assigned to a single nurse can help in enhancing patient care (Unruh, 2003). Nevertheless, these suggestions are not feasible because of nursing shortages and costs. At the job level, the extent of the nursing workload is determined by the specialty such as operating nurse versus Intensive Care Unit nurse. Studies have reported a re lationship between job-level nursing workload and nursing outcomes like job satisfaction and stress. At the patient level, the extent of the workload depends on the patient’s clinical condition. Several empirical studies have explored relationship between nursing workload and patient outcomes (Duffield OBrien-Pallas, 2003; Hughes, 2008). Increased nurse workload is associated with sub-optimal patient outcomes as well as lessened patient satisfaction (Rothberg, Abraham, Lindenauer, Rose, 2005; Unruh, 2003). The majority of the research studies exploring the effect of nursing workload on patient outcomes have placed an emphasis on the nursing staffing levels – an attribute of patient acuity. For instance, reduced levels of nursing staffing has been associated with increased rates of pneumonia. In this regard, Unruh (2003) reported that increasing the number working hours of nurses by 1 hour per patient day results in an 8.9% increase in the likelihood of surgical patients developing pneumonia. The study also reported that higher pneumonia rates for units that staff fewer nurses. The levels of nursing staffing have also been reported to have an effect on nosocomial infections. In this respect, increasing the number of nursing hours for a patient resulted in a decrease in the rates of urinary tract infection (Hal l, Doran, Pink, 2004). The understaffing of nursing personnel has also been associated with an increase in the prevalence of E cloacae (Rischbieth, 2006). Evidence also suggests that nurse-staffing levels have an effect on mortality and failure to rescue. For instance, increasing the number of hours of registered nurses care per day resulted in reduced rates of failure to rescue. In addition, lower nurse-patient rations have been associated with an increase in the length of stay for admitted patients; specifically, a nurse patient ratio of 1:2 for the case of evening shifts results in a 20% increase in the duration of stay (Duffield OBrien-Pallas, 2003). Moreover, increased working hours are associated with a reduction in the duration of stay (Buerhaus, 2009). Nursing workload does not only affect patient outcomes but nursing hours as well. There is no doubt that nursing workload has an impact on the time available for a nurse allocate for the various tasks. When the workload is high, nurses are unlikely to have adequate time in undertaking tasks having a direct impact on patient outcome. In addition, increased workload for nurses is likely to lessen the time that nurses spend communicating with other physicians, monitoring patients, and make use of safe practices. For instance, nurses may have no time to conform medications. Increased workload for nurses also resulted in decreased motivation and dissatisfaction, which can lead to reduced morale, increased absenteeism, increased organizational turnover, reduced job performance, and poor quality of care. Stress and burnout have also been associated with increased workload for nurses, which can contribute to medical errors because of the reduced attention that nurses put on performing critic al tasks. Nursing workload has also been associated with work-around and violations among nursing staff. Violations comprise of nurses intentionally deviating from established practices that are necessary to guarantee safe operations and improved health outcomes. In this respect, increased nursing workload has been established to increase the difficulty of nurses adhering to guidelines and rules, which in turn can compromise quality of care and patient safety. An example of violation is insufficient hand washing. Moreover, increased nursing workload increases the probability of making errors during decision-making; this is because high workload increases high cognitive workload, which can result in mistakes, lapses or slips. An example of this is nurses forgetting to administer drugs to patients. Rationale for Antecedents, Criteria and Consequences Selection The antecedent healthcare cost pressure was excluded from the table because it has no direct impact on patients. It is evident that the cost pressures on hospitals can be attributed to the competitive nature of the healthcare industry rather than patient-related and nurse-related factors. Nurses and patients are only on the receiving end in the sense that hospitals have to respond to cost pressures by cutting staffing levels, which ultimately affects patients, albeit indirectly. Essentially, because of the cost pressures, hospitals have changed their payment systems in order to cut spending and reduce the duration of patient stay in hospitals. Therefore, registered nurses in hospitals treat patients who are moderately sick although the intensity of their work has increased, contributing to patient acuity. The underlying argument is that, although they indirectly affect patient acuity, they cannot be used in determining the nursing care requirements by patients. In included shortened length of stay, high demand for nurses because of an aging population and nursing workload because they have a direct effect on the amount of nursing care resources allocated to a patient. The criteria intensity of nurse work and clinical condition of the patient were used because they are measures that can be used in determining the staffing levels – an attribute of patient acuity. In addition, the nurse-patient ratio was included as a criterion because it is a measure of the nurse workload – also an attribute of patient acuity. Increased patient acuity was included in the consequences because of the resulting effect associated with increased demand for nurses and shortened length of patient stay. In addition, I synthesized the negative patient outcomes associated with nursing workload as poor health outcomes, and negative nurse outcomes such as poor job satisfaction, low motivation and morale, and increased burnout and stress, which are all linked to higher patient acuity. Personal Definitions of Concept The severity aspect of acuity can be used to refer to the patient’s psychological and physical status, which is the clinical condition of the patient. The intensity aspect of acuity represents the nursing care requirements and needs of the patient, which can be used to refer to the nursing workload for a particular patient or a group of patients. Therefore, the nursing workload depends on the intensity of care needs, which further depends on the illness severity. From this, acuity can be defined as the degree of illness severity and the corresponding workload intensity that required for the patient. It is imperative note that this definition incorporates both patient needs and the corresponding care required from the nurse. The association between intensity and severity aspect of patient acuity can be both non-linear and linear. For instance, Lankshear, Sheldon, Maynard (2005) pointed out that a direct positive relationship exists between patient acuity and the intensity of n ursing care, which suggests that, with an increase in the severity of illness, the nursing care needs increase. Nevertheless, the association between intensity of care and illness severity can also be influenced by the treatment goals. For instance, the nursing care requirements for a patient who have undergone a bone marrow transplant is likely to increase with respect to illness severity in instances where the treatment plan draws upon curative care when compared to a treatment plan that draws upon palliative care (Arling, Kane, Mueller, Lewis, 2007). The association between intensity of care and illness severity is linear to a degree to which the patient decides to decline further treatment. At this point, the nursing care requirements are significantly reduced whereas the severity of the illness remains high. In the same light, patients needing long-term care may need complex interventions and therapies despite the fact that their illness severity is relatively stable relative to a patient that requires short-term care (high acuity patient) (Rothberg, Abraham, Lindenauer, Rose, 2005). In order to further clarify the concept of acuity, it is imperative to develop an operational definition that can be used in measuring acuity. In this regard, two attributes of acuity can be measured including provider-related and patient-related acuity. Provider-related acuity focuses on the measures intensity, which can be measured using nursing care needs in terms of amount, nursing care needs in terms of time, workload and complexity of care. The nursing care needs measured in terms of the amount, can be assessed by counting data about the number of tasks/activities accomplished for a single patient within 24 hours (Buerhaus, 2009). Nursing Intensity Weights can also be used in assessing the nursing care needs, which is based on a scale that ranges from 1 to 5 based on the nursing care requirements with higher scores indicating higher requirements (Abualrub, 2007). The nursing care needs in terms of time can be measured using the nursing hours per patient day (HPPD) and the minut es needed for particular indirect and direct care activities. Workload can be determined by using count data relating to nursing needs indicators. The care complexity is a categorical variable that depends on primary diagnosis, needs of the patient, and the case manager activities. Patient-related acuity can be measured using the Acute Physiology, Age, Chronic, Health Evaluation (APACHE), which is a weighted score relating to the patient physiological status including chronic health and age (Craig Huber, 2007). Conceptual Framework This concept analysis of acuity has a number of implications for nursing research and practices. For nursing researchers, it is imperative to distinguish the acuity attribute that is being researched between severity (patient-related acuity) and intensity (provider-related). With respect to practices, it is evident that there are no consistent tool that is being used in measuring acuity, especially when measuring provider-related acuity. This is because the developers of these tools were not precise regarding the acuity attribute being measured. Therefore, these tools used in measuring acuity were not helpful in clinical situations. It is imperative to develop the tools for measuring acuity by drawing upon sound conceptual framework in order to affirm their relevance as well as validity for a specific patient population. From this concept analysis paper, I have discovered that patient acuity is a multifaceted concept that should be analyzed from both the provider and patient perspect ive, after which the two perspectives should be reconciled in order to match the patient requirements with the amount of nursing care provided in terms of amount and time.