Benefits of Different Oxygen Levels Administered in ICU

Benefits of Different Oxygen Levels Administered in ICU ABSTRACT: There have been numerous studies conducted to identify the benefits of different oxygen levels administered in ICU (Intensive Care Unit) patients. However, the studies do not reveal a definitive conclusion. The proposed systematic review plans to identify if either conventional or conservative oxygen therapy methods is more constructive in critically ill adult patients who are admitted in ICU. BACKGROUND Oxygen therapy is a treatment that provides oxygen gas to aid breathing when it is difficult to respire and became a common form of treatment by 1917. (Macintosh et.al 1999). It is expended for both acute and chronic cases and can be implemented according to the needs of the patient either in hospital, pre-hospital or entirely out of hospital based on their medical professionals opinions. It was established as the most efficient and safest medicines required by the health system by World Health Organisation (WHO). PaO2 has become the guideline test for finding out the oxygen levels in blood. And by the 1980s, pulse oximetry method which measures arterial oxygen saturation was also progressively used alongside PaO2 (David 2013). The chief benefits of oxygen therapy comprise slowing the progression of hypoxic pulmonary hypertension, emotional status, cognitive function and improvements in sleep (Zielinski 1998). In UK, according to the national audit data about 34% of ambulance journey s involve oxygen use at some point while 18% of hospital inpatients will be treated with oxygen at any time (Lo EH 2003). In spite of the benefits of this treatment, there have been instances where oxygen therapy can negatively impact a patients condition. The most commonly recommended amount of saturation for oxygen intake is about 94-98%, and saturation levels of about of 88-92% are preferred for those at risk of carbon dioxide retention (BMA 2015). According to standard ICU practice, the conservative method denotes that patients receive oxygen therapy to maintain PaO2 between 70 and 100 mm Hg or arterial haemoglobin saturation between 94-98% while conventional method allow PaO2 values to rise up to 150 mm Hg or SpO2 values between 97% and 100% (Massimo et al. 2016).There are also low flow systems where the delivered oxygen is at 100% and has flow rates lower than the patients inspiratory flowrate ( i.e., the delivered oxygen is diluted with room air) and, hence the Fraction of Inspired Oxygen(FIO2) may be low or high. However, this depends on the particular device and the patients inspiratory flowrate. AIM To investigate and conclude whether the use of a strict protocol for conservative oxygen supplementation would help to improve outcomes, while maintaining PaO2 within physiologic limits among critically ill patients. RESEARCH QUESTION A well- defined, structured and exclusive research question will lead as a guide in making meticulous decisions about study design and population and consequently what data can be collected and used for analysis.(Brian, 2006) The early process of research for finding the research questions is a challenging task as the scope of the problem is bound to be broad. Significant time and care is needed to polish, extract and compare the information required from the vast sea of information (Considine 2015) .If a proper and specific research question is not formed, the whole process will be useless (Fineout-Overholt 2005). The fundamental success of any research project is attributed in establishing a clear and answerable research project that is updated with a complete and systematic review of the literature, as outlined in this paper. A PICO framework is a universally used framework used to develop a robust and answerable research question which is also a useful framework for assuring the quality or for evaluating projects. PICO stands for Problem / Population, Intervention, Comparison, and Outcome. The research question presented in this paper is to identify whether conventional or conservative oxygen therapy methods is more beneficial among critically ill adult patients admitted in Intensive Care Unit. LITERATURE REVIEW The literature has focused on the effect of conservative and conventional oxygen therapy methods on mortality among patients in an Intensive Care Unit. Although there have been several studies to analyse which of the two methods is more beneficial to critically ill patients, a definitive study which determines the mortality rate among the different categories needs to be analysed and investigated for its benefit. Different devices used to administer Oxygen: Nasal cannula provides about 24-40% oxygen and flow rates up to 6L/min in adults (Fulmer JD 1984). A basic oxygen mask delivers about 35-50% FIO2 and can have flow rates from 5-10L/min depending on the fit and requirement of flow rate. The other respiratory aiding device is a partial rebreathing mask which has an additional reservoir bag with it which is also classified as a low flow system with flow rate of 6-10L/min and delivers about 40-60% oxygen. The non-breathing system is similar to the partial rebreathing mask, where it has an additional series of one way valves and it delivers about 60-80% FIO2 with a flow rate 10L/min. Review and findings of different oxygen therapy studies: A systematic review of two different published Journals indicated that the usage of additional oxygen when managing acute myocardial infarction arrived at the same result: that there is no significant benefit when oxygen therapy is administered while being assessed with air breathing (Cabello 2010) and it may in fact be damaging which results in greater infarct size and higher mortality rate (Wijesinghe 2009). Although a number of smaller studies could clarify the reviews, none of the original studies could reach a statistically substantial result ( Atar 2010); this stresses the need to provide data that validates the requirement for further analysis. Studies to support this have already been started, where The AVOID (Air Versus Oxygen In Myocardial Infarction) study is presently hiring patients to resolve this critical medical question (Stub 2012).Actual clinical trial data suggesting the effects of varied inspired oxygen levels are even more inadequate in acute ischemic stroke. It is proposed that oxygen therapy may be beneficial if administered within the first few hours of commencement, however it has also been observed that with continued administration, it may induce harmful results (higher 1-yr mortality) (Ronning 1999). In a survey of group study where more than 6,000 patients were case studied following resuscitation from cardiac arrest , hyperoxemia ( defined as a PaO2 > 300 mm Hg (40 kPa),the results obtained were considerably worse than both normoxemia (60-300 mm Hg (8to 40kPa) and hypoxemia (PaO2 There is also no robust proof for the postulation that an increased PaO2 is interrelated with improved long-term survival in critically ill patients( Young JD2000).A reflective study where more than 36,000 patients were considered and arterial oxygenation was administered while being mechanically ventilated, signs of a biphasic relationship was observed within a span of 24 hours between PaO2 and in-hospital mortality(De 2008).The average PaO2 level found was 99mm Hg, yet the foundation for unadjusted hospital mortality was just below 150mm Hg. A very similar study of more number of patients was conducted in Australia and New Zealand and this resulted in a report recording a mean PaO2 of 152.5mm Hg, indicating supraphysiological levels of oxygenation, with 49.8%of the 152,680 group was categorised as hyperoxemic PaO2>120mmHg(Eastwood , 2012). In contrast to the Dutch study, even though hypoxemia was associated with elevated mortality, after an adjustment of disease severity, a progres sive association between progressive hyperoxemia and in-hospital mortality could not be linked together effectively. (Martin 2013). The assumption that patients with hypoxemia secondary to ARDS (acute respiratory distress syndrome) respond positively to elevated arterial oxygenation reinforces many studies done in this field (McIntyre 2000). Nevertheless, data from clinical trials in patients with ARDS seem to disregard this assumption as frequent oxygenation and long-term outcome have a disconnection (Suchyta 1992). And the studies that report a correlation arterial oxygenation and mortality, a systemic review of 101 clinical studies in ARDS patients came to the conclusion that P/F ratio was not such a reliable predictor (Krafft 1996). Thus a more intense study was conducted to compare the supplementary oxygen therapy with no oxygen therapy in normoxic patients with ST Segment elevation myocardial infarction (STEMI). Oxygen therapy has been known to be only universally used for the initial treatment of patients with STEMI which is based on the belief that the additional oxygen may increase oxygen delivery to isc hemic myocardium and hence reduce myocardial injury and is supported by laboratory studies done by Atar in 2010. The adverse effects of supplementary oxygen therapy were noted from a meta-analysis of 3 small, randomized trials as done by Cabello in the same year. More recently, another analysis was done by comparing high concentration oxygen with titrated oxygen in patients with suspected acute myocardial infarction which found no difference in myocardial infarct size on cardiac magnetic resonance imaging (Ranchord 2012). Hence, there are no studies that assess the effects of supplemental oxygen therapy in the setting of contemporary therapy for STEMI, specifically acute coronary intervention. With these reports and analysis put together, we can safely deduct that there remains a substantial amount of uncertainty over the usage of routine supplemental oxygen in uncomplicated Acute Myocardial Infarction, with absolutely no clear indication or recommendation for the level of oxygen th erapy in normoxic patients in the STEMI guidelines. More recently, another analysis was done by comparing high concentration oxygen with titrated oxygen in patients with suspected acute myocardial infarction which found no difference in myocardial infarct size on cardiac magnetic resonance imaging (Ranchord 2012). The annual congress of European Society of ICU (2016) states that patients dying in the ICU was lowered by 9% while using conservative oxygen strategy as compared with the conventional one(JAMA 2016). METHODOLOGY Firstly the terms method and methodology needs to be differentiated. Method is a process used to collect and examine the data whereas methodology includes a philosophical inquiry of the research design as stated by Wainworth (1997). It is vital that the suitable methodology needs to be analysed in carrying out the research question and in assembling the data (Matthews 2010). Research Methodology is a way to find out the result of a given problem on a specific matter or problem that is also referred as research problem (Jennifer 2011). In Methodology, researcher uses different criteria for solving the given research problem and always tries to search the given question systematically in their own way to find out all the answers till conclusion. If the research does not work systematically on the problem, there would be less possibility to find out the final result. For finding or exploring research questions, a researcher faces lot of problems that can be effectively resolved while us ing a correct research methodology (Industrial Research Institute, 2010). This research proposal was done under the systematic review method because it provides a very comprehensive and clear way of assessing the evidence (Chalmers 2001). Also it lowers error and bias and establishes a high standard of accuracy (Jadad, 1998). Healthcare providers, researchers, consumers and policy makers are overwhelmed with the data, evidence and information available from healthcare research. It is unlikely that the all this information is digested and used for future decisions. Hence a systematic review of such research will help to identify, assess and synthesize the information based on evidence needed to make those critical decisions. (Mulrow 1994). There are a number of factors for choosing systematic review for this study. A systematic review is generally done to resolve mismatched evidence, to verify the accuracy of current practice, to answer clinically unanswered questions, to find changes in practice or to focus for the need for any future research. Systematic reviews[AD1] are increasingly being used as a preferred research method for the education of post graduate nursing students (Bettany- Saltikuv, 2012). One of the best resources available on the conduct of systematic reviews of interventions is the Cochrane Collaboration (Tonya 2012). As defined by the Cochrane Collaboration (Higgins Green, 2011[AD2], Pg 6); A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria in order to answer a specific research question. It uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made. The aim of a systematic review is to incorporate the existing knowledge into a particular subject or regarding a scientific question (British Journal of Nutrition (2012). According to Gough et al (2012) a systematic review is a research method that is undertaken to review several relevant research literatures. Systematic reviews can be considered as the gold standard for reviewing the extensive literature on a specific topic as it synthesises the findings of previous research investigating the same or similar questions (Boland et al 2008). Using systematic and rigorous methods systematic reviews are often referred to as original empirical research because they review primary data, which can be either qualitative or quantitative (Aveyard Sharp 2011). Over the past years, various standards have been evolved for portraying systematic reviews, staring from an early statement called the QUOROM guidelines to an updated widely accepted statement called the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Moher et al, 2009). While there are many differences in how each author approach a systematic review and there is no universal approach on one methodology for conducting review. However there are a set of fundamental set regarding the report of systematic reviews that authors are recommended to follow (Tonya 2012). METHODS SEARCH STRATEGIES: The selection of relevant study is based on two concepts: sensitivity and specificity (Wilma 2016).The purpose of the literature search is to identify existing published research in the particular area of interest to assist the researcher to clarify and specify the research question, and to identify whether the research question has been answered. The search of the literature must be strategic and systematic, and informed by a documented strategy. Search strategies have two major considerations: search terms, and databases. Some of the most common and beneficial search strategies used in systematic reviews are using the database of Cochrane Central Register of Controlled Trials (CENTRAL), hand searching, Grey literature which contains unpublished studies, clinical trials and ongoing research on the trials. Contacting an expert and extracting information is another useful method. The internet provides access to a huge selection of published and unpublished database. Studies can also b e found by referring the reference lists of the available published data. The database that have been referenced in this paper have been searched, collected and for extraction from the vast base of Northumbria [AD3]University accessible Journals. Journals from Medline, Ovid, ELSEVIER, PubMED and Cochrane Central Register of Controlled Trials, Journal of the American Medical Association( JAMA), newspaper articles from CHEST, Intensive Care Medicine ,CLOSE and ANZICS Clinical trial group, Resuscitation, Critical care journal, (all of the selected journals from the databases was validated as peer reviewed journals) were reviewed for this paper. INCLUSION AND EXCLUSION CRITERIA The inclusion of unpublished and grey literature is essential for minimizing the potential effect of publication bias (Cochrane Corner 2007). If systematic reviews are limited to published studies, they risk excluding vital evidence and yielding inaccurate results, which are likely to be biased as always positive results (Alderan 2002). The inclusion criteria should consider gender, age of participants, year(s) of publication and study type. For this review purpose, as conventional and conservative oxygen therapy studies are the primary research questions, patients aged 18 years or older and admitted to the Intensive Care Unit (ICU) with an expected length of stay of 72 hours or longer were considered for inclusion. Exclusion criteria also need to be justified and detailed and papers may be excluded according to paper type (such as discussion papers or opinion pieces), language, participant characteristics, or year(s) of publication. For the exclusion criteria, patients under 18 years, pregnant patients, and those who were readmitted in ICU, patients with DNACPR (do not actively resuscitate) and neutropenia or immunosuppression and the patients on who more than one arterial blood gas analysis was performed in 24 hours. STUDY SELECTION For the purpose of this research proposal the literature selected are based on Randomized Clinical Trials of conservative oxygen therapy methods and conventional (traditional) [AD4]oxygen therapy methods used in ICU and some systematic reviews of effective oxygen therapy in ICU, if they met the inclusion criteria. The controlled clinical trials provide the most appropriate method of testing effectiveness of treatments (Barton 2000). Observational studies on effect of hyperopia on post cardiac arrest are also reviewed. These studies can help to determine whether conservative oxygen therapy can help increase mortality among critically ill patients. PREPARATION FOR DATA EXTRACTION Data will be[AD5]extracted from the studies and grouped according to outcome measure. The data extraction tools should be used to ensure relevant datas is collected, minimise the risk of transcription errors, allow accuracy of data to be checked and serve as a record of the data collected. The data collected for extraction should be validated against evidence. It is necessary to extract the necessary studies and data that will help in resolving the research question which involves analysing different studies and a preferred way of methodology that reduces errors and bias. QUALITY ASSESSMENT Cochrane risk of bias tool (Higgins2011) will be[AD6]used for the assessment of risk of bias in estimating the study outcome. For the better outcome of this review involved few randomized clinical trials, some observational studies and pilot RCT studies for comparison among various methods. Quality assessment is given special importance because of the inclusion of RCT and non-RCT methodology (Eggers et al 2001). And only quality studies that satisfies the inclusion, exclusion and data requirements, validity and no bias and studies that are needed to answer the research question are carefully selected. SYNTHESIS STUDIES Synthesis helps to summarize and connect different sources to review the literature on a specific topic, give suggestions, and link the practice to the research (Cosette 2000). It is done by gathering and comparing evidence from a variety of sources when there is conflicting evidence or limited number of patients or large amounts of unclassified data. Systematic reviews of RCTs(Randomized control Trial) encompass the most strong form of clinical evidence (Sheik 2002) and occupies the highest layer in the hierarchy of evidence-based research, at the same time qualitative case studies and expert opinions occupy the lowest layer (Evans 2003 and Frymark et al 2009). RCT helps to understand the differences data among various studies (For Example, the studies considered here, conventional versus Conservative Oxygen therapy methods). RCT is the most applicable study used in assessing the results of an intervention, because it limits the effects of bias when performed correctly. (CRDs Guide 2009). It also easier to understand and any observed effect is easily contained to the treatments being compared. (Stuart 2000). The favourable results of an RCT lies with the methodology domain followed in the trial and it reviews its practicality which helps healthcare professionals, clinicians, researchers, policymakers and guideline developers to apply and review the effectiveness of the trials and tests. For example, if a study overestimates the effects of an intervention, it concludes wrongfully that the intervention works; similarly if the study is underestimating the effects, it wrongfully reflects that there is no effect to that study. This is where RCTs stands out, where minimum bias and evidence is the basis of such a study (According to Cochrane reviews). Hence this is why RCTs form the gold standard of comparison studies while questioning effectiveness of different interventions while limiting bias. As an example, groups that are randomly assigned are different from groups that follow criteria in the sense that the investigator may not be aware of certain attributes that they might have missed. It will also be likely that the two groups will be the similar on significant characteristics using chance. It is possible to control the factors that are known but randomisation helps to control the factors that are not known, which drastically reduces bias. Therefore assigning participants in other study designs may not be as fair and each participant may vary in characteristics on main standards. (Cochrane Handbook for Systematic Reviews of Interventions 2017) The observational studies or non-randomised studies can be argumentative as the choice of treatment for each person and the observed results may cause differences among patients being given the different types of treatments. (Stuart 2000). ETHICAL CONSIDERATION A systematic review is the scientific way of classifying the overabundant amount of information existing in research by systematically reviewing and accurately examining the studies concerning a particular topic. But in doing so, topic of ethics is hardly questioned. This will have some major downsides as some systematic reviews may have studies with ethical deficiencies, which in turn lead to the publication of an unethical research and such research is susceptible to bias. Systematic review does not automatically give the updated approval for an original study. Hence systematic reviews that are methodically and ethically assessed will have better ethical and methodological studies overall (Jean et al 2010). If an original study does not mention the ethical issues, it does not automatically mean that the studies in original papers avoided those ethical concerns and may indicate a lower risk (Tuech 2005).A primary rule for publishing articles is that redundant and overlapping data sh ould be avoided or needs to be cross-referenced while making the purpose clear to the readers in an unavoidable case. (Elizabeth et al 2011). Plagiarism is clearly unacceptable and care should be taken care to not replicate other peoples research work and the original words and data needs to be acknowledged as a citation or quote. A responsible publisher should follow the COPE (Committee on Publication Ethics) flowchart that explains suspected plagiarism (Liz 2008). It is also important to give information on funding and competing interests. The Cochrane Collaboration (2011) has very strict rules about funding and it is important to give reasons why the author may or may not be neutral or impartial on the review prepared and it relates to financial support, while competing interests can be personal, academic or political (WAME Editorial Policy and Publication Ethics Committees 2009). REFLECTION The objective of systematic reviews is to translate the results to clinically useful and applicable information while meeting the highest methodological standards. They offer a very useful summary of the present scientific evidence on a particular domain which can be developed into guidelines on the basis of such evidence. However, it is imperative that practitioners understand the reviews and the quality of the methodology and evidence used (Franco 2012). This study proposes to find the systematic review approach of conservative and conventional oxygen therapy methods used among critically ill adult patients in ICU. Incidentally, a RCT study by Susan (2016) found that the strategy of conservatively controlling oxygen delivery to patients in ICU results in lower mortality than the conventional and more liberal approach whereby patients are often kept in a hyperoxemic state.

Hamlets Relationships Essay -- essays research papers

In William Shakespeare's Hamlet, the character of Hamlet has many relationships with all characters. The theme human relationships is very strong in this play. A human relationship is a logical or natural association between two or more people. Hamlet has many of these associations with King Hamlet's Ghost, Gertrude, Claudius, Ophelia, Polonius, Horatio, Rosencrantz and Guildenstern. Many of his relationships are just and unjust according to the character's flaws and feelings. The ghost of King Hamlet played an important role during the book. The first interaction between King Hamlet's Ghost can be simply called extreme. Hamlet is extreme when he goes with the ghost that looks like his father even though his friends warn him that the ghost may be evil and ". . .tempt you toward the flood . . . Or to the dreadful summit of the cliff . . ." (Act 1, Scene IV, Lines 69-70). If the prince was thinking right he would not have gone with the ghost that resembled the old ". . . King, father, royal Dane . . ." (Act 1, Scene IV, Line 45) Hamlet's radical actions let him find out about Claudius' devious murder of his brother, King Hamlet . The ghost of King Hamlet has described Claudius as "...that incestuous, that adulterate beast" (Act 1, Scene V, Line 43). King Hamlet wants Hamlet to get revenge against Claudius for killing him, but he does not want Gertrude to get hurt while this is going on. Hamlet therefore delays in killing Cl audius because he needs to find out if his mother has anything to do with the treachery. Hamlet took this relationship cautiously and did this correctly because ghosts were thought as underhandedly evil. The relationship between Hamlet and Gertrude is interpreted as the Oedipus complex. The Oedipus complex refers to the thoughts some men have regarding their mother or maternal figures. Many scenes from the play can prove Hamlet did have these thoughts about his mother, such as acts one and three. Gertrude's fondness and helpfulness to protect her son is also displayed throughout the play. This can be seen in the play many times, even up to when Gertrude is about to die. She tries to save Hamlet from drinking the poison himself. Also when Hamlet tries to get Gertrude to believe him that Claudius killed King Hamlet, she thin... ... breath with your mouth,". (Act 3, Scene II, Lines 348-349) As the play continues Hamlet is sent off to England with Rosencrantz and Guildenstern for him to pay for his crimes. Hamlet finding the letter to England changes it to say kill the possessors of the letter. Hamlet on the way to England gets supposedly kidnapped by pirates, while Rosencrantz and Guildenstern go to England and get executed. Hamlet felt they got what they deserved when they followed out the king's plan of action. With all of the corruption and back stabbing in Denmark, Hamlet thought out every decision with great intelligence. Hamlet's human relationships with the ghost, Gertrude, Claudius, Ophelia, Rosencrantz and Guildenstern were all very just and deserving. As Hamlet finds out they all contain lies and have hidden intentions within them. Hamlet's blinding rage against Polonius was very hurtful and unjust. Hamlet's friend, Horatio, was his only true friend and he helped Hamlet until the end. As Marcellus said it best, "Something is rotten in Denmark." (Act 1, Scene 4, Line 90) That being the lies, which have replaced or covered the true state of each character.

History Of Skateboarding :: essays research papers

Skateboarding has rich history of innovation and is full of intriguing stories. Many of these stories are documented in this book in great detail. However, this essay will provide you with an overview of the last nine decades. The first type of skateboards were actually more like scooters. These contraptions, which date back to the early 1900's featured roller skate wheels attached to a two by four. Often the wood had a milk crate nailed to it with handles sticking out for control. Over the next five decades kids changed the look of the scooter and took off the crate and started cruising on two by fours with steel wheels. Tens of thousands of rollerskates were dismantled and joyfully hammered on to planks of wood. In the 1950's modifications were made to the trucks (the device that hold the wheels) and kids started to maneuver more easily. Towards the late 1950's, surfing became increasingly popular and people began to tie surfing together with cruising on a board. By 1959, the first Roller Derby Skateboard was for sale. Clay wheels entered the picture and sidewalk surfing began to take root. By the time the 1960's roll around, skateboarding had gained an impressive following amongst the surf crowd. However, when Larry Stevenson, publisher of Surf Guide begins to promote skateboarding, things started to take off. Larry's company, Makaha designed the first professional boards in 1963 and a team was formed to promote the product. The first skateboard contest was held at the Pier Avenue Junior School in Hermosa, California in 1963. In 1964, surf legend Hobie Alter teamed up with the Vita Pakt juice company to create Hobie Skateboards. While most skaters took to the street or sidewalk, some brave souls decide to ride empty swimming pools. By 1965, international contests, movies (Skater Dater), a magazine (The Quarterly Skateboarder) and cross country trips by teams of skateboarders elevated the sport to enormous heights. Over fifty million boards were sold within a three year period and then all of a sudden skateboarding died in the fall of 1965. The first crash of skateboarding came about due to inferior product, too much inventory and a public upset by reckless riding. The manufacturers were so busy making product that little was done in the way of research and development. Although some companies developed better quality wheels, clay wheels were the cheapest to manufacturer. However, clay wheels did not grip the road well and skaters fell everywhere.

Culture- IBM v. Trilogy :: miscellaneous

Culture- IBM v. Trilogy Whenever two or more people come together with a shared purpose, they form a culture with its own written and unwritten rules for behavior. Our families, workplaces and communities all have cultures. These cultures have a tremendous, though rarely recognized, impact upon our behavior as individuals, and as groups. Each cultural environment provides a somewhat unique set of standards to which we must adapt. Our behavioral patterns change dramatically from cultural context to cultural context. For example, on the job we are expected to behave in accordance with certain social standards. Expectations about behaviors at work usually differ from what is expected of us in our kitchens and in our bedrooms. We may not choose to behave in accordance with our cultures, but if we choose not to go along, we must be prepared for ongoing consequences. When we select goals for ourselves that violate the culture, we must either change the culture or endure a never-ending struggle. I'd like to illustrate the seeming similarities, and the actual differences, between the cultures of two organizations- Trilogy and IBM. This comparison is unique in that it points out the major similarities between two very different organizations. IBM with its 200,000+ employees is a virtual giant compared to Trilogy with just under 1,000 employees. How can these two cultures be so strikingly similar? Current industry recruiting trends follow what's desirable to college graduates! We're fast approaching the millenium, and the new buzz-words are PEOPLE, PEOPLE, PEOPLE!!! But, while many companies boast to potential hires of freedom and friendship, many of those same companies fall short of following through with their promises. Realistically, there are limitations that come with having over 200,000 employees. Likewise, there are limitations with having only 1,000 employees. How do these two companies stack up in comparison? So, what are the desired job traits that college graduates are looking for? To name a few:  · Personal and Professional Growth Opportunities  · Flexible hours and freedom  · Likable teammates Personal and Professional Growth Opportunities It's not surprising that today's companies place emphasis on employee 'growth'. As recent graduates, new hires are accustomed to a constant stream of new knowledge and skills. Obviously this learning has led to great success, so why stop there? Recent graduates are well aware of the importance of marketability. To ensure a secure career outlook, continued training and experience are a must.

Applications of Total Quality Management Essay

Total Quality Management (TQM) is a philosophy of management that strives to make the best use of all available resources and opportunities through continuous improvement. TQM means achieving quality in terms of all functions of the enterprise. Many researchers attempted to analyze how IT and TQM can jointly add value to organizations and the purpose of this first post on TQM is to evaluate the practicality of TQM in an IT service. In this evaluation, a balance of the service management needs with the reality of bottom-line effectiveness is provided. The post also provides a list of critical success factors to consider in a change management initiative engaged by an IT service. TQM in Practice : The essence of quality is to do it right the first time, and to satisfy customer requirements every time by involving everyone in the organization. The works of Crosby and his colleagues on the evolution of TQM cut across all pervasive philosophies of management. TQM has been a key business improvement strategy since the 1970s, as it has been deemed essential for improving efficiency and competitiveness. TQM aims to achieve an overall effectiveness which is higher than the individual outputs from the sub-systems such as design, planning, production, distribution, customer focus strategy, quality tools and employee involvement. This philosophy of management strives to make the best use of all available resources and opportunities through continuous improvement. As a management philosophy, TQM makes use of particular set of principles, practices, and techniques to expand business and profits and provides a bypass to enhanced productivity by avoiding rework, rejects, waste, customer complaints, and high cost. This can be achieved by emphasizing the organization’s commitment from data-driven, problem-solving approaches to quality accruing. The five basic pillars of TQM are : a) top management commitment for quality enhancement, b) customer centric advancements of processes and building a long-lasting trustworthy relationship between the organization and the customer, c) relentless development by setting goals and deadlines, d) benchmarking with several specific tools and quality-adding techniques, and e) strengthening the employee base by concentrating at any stage of a process on quality, where customer satisfaction is stationed. Table 1 provides a summary of the key dimensions that constitute TQM. TQM key dimensions : 1. Top management leadership : Top management commitment is one of the major determinants of successful TQM implementation. Top management has to be the first in applying and stimulating the TQM approach, and they have to accept the maximum responsibility for the product and service offering. Top management also has to provide the necessary leadership to motivate all employees. 2. Customer relationships : The needs of customers and consumers and their satisfaction should always be in the mind of all employees. It is necessary to identify these needs and their level of satisfaction. 3. Supplier relationships : Quality is a more important factor than price in selecting suppliers. Long-term relationship with suppliers has to be established and the company has to collaborate with suppliers to help improve the quality of products/services. 4. Workforce management : Workforce management has to be guided by the principles of: training, empowerment of workers and teamwork. Adequate plans of personnel recruitment and training have to be implemented and workers need the necessary skills to participate in the improvement process. 5. Product design process : All departments have to participate in the design process and work together to achieve a design that satisfies the requirements of the customer, which should be according to the technical, technological and cost constraints of the company. 6. Process flow management : Housekeeping along the lines of the 5S concept. Statistical and non-statistical improvement instruments should be applied as appropriate. Processes need to be mistake proof. Self-inspection undertaken using clear work instructions. The process has to be maintained under statistical control. 7. Quality data and reporting : Quality information has to be readily available and the information should be part of the visible management system. Records about quality indicators have to be kept, including scrap, rework, and cost of quality. TQM and Change Management Initiative for IT Performance : A business firm achieves world-class status when it has successfully developed operational capabilities through TQM to support the entire company in gaining a sustained overall performance over its competitors. Although there is insufficient statistical evidence to conclude significant simple relationships between TQM and IT services quality performance, many studies investigated the notion that TQM practices provide approaches to improve the economic position in the service sectors in general. Both IT and TQM had, and will continue to have a significant impact on most organizations. I only regret the lack of empirical research on the relationship between the two and how they both relate to business performance.

Marraige Life vs Singal Life

The difference between the marriage life and the single life is there are advantages, and disadvantages. Although married life sounds stable, there are more benefits to being single, in the short and long term picture. (Marriage Vs Single Life. ) In today society a lot of people are being married and still being single. This particular way of thing has changed their lives. In this compare and contrast the difference between single and married people lives. Single life mainly has no responsibility at all. Being single you don’t have to come home to anyone. If you like being alone this is the perfect lifestyle for you. You don’t have to share your money, everything is about you. There are a lot of people that would like to be stress free no one nagging them. Single people can spend their time with anyone they choose. They can come in at anytime they like, and they don’t have to worry about cleaning up behind others. They just have to clean up behind the selves. Single people also have very big trust issue. Marriage people have the companionship of each other and their children. Compared to the single people married people schedule are too busy. Married people have to conduct their partners and children lives as well. Married people can’t live a free life if they want to go with their friends they have to let their partner know there are rules to having a happy successful life. Never both partners be mad at once, never yell all ways talk problems out in a normal voice. Never discuss your problem around a crowd of people, always agree with your partner around crowds , but if you disagree let them know later. Being married emotional support is expected or given with every thought or action. I would choose the married life over the single life. I love the sharing part and the company. I’ve always love being around people so I personally think that I would be a good candidate for the marriage life. I wouldn’t choose the single life because being single and coming to your own empty house not having anyone waiting for me to share my day or thoughts. In this conclusion being single takes a toll on you, while being married has its toll too. But you have someone too,but you will have someone deeply share them with a true friend for life like the marriage says. â€Å"Till death do us part. â€Å"

Merit: Why Do We Value It? Essay

Louis Pojman has stated three different opposing views about merit in terms of the societal and political aspects of philosophical attributes. The first one being influenced by Homeric culture called meritocracy. The second one guided by desert-based concept. The third one is based on free will and responsibility.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Meritocracy reveals that how people perceive and individual is dependent on one’s achievements and success, and the status or position that one holds in society. This is accounted for regardless of the moral and belief values that one holds. The desert-based system was rooted from the idea of Immanuel Kant, which opposes the Homeric viewpoint of judgment and regard. The worth of a person is dependent on one’s intentions and moral values, as opposed to success and wealth that determines the worth of a person in the Homeric context. The third one is a more complex take on merit and desert. The interplay of free will and responsibility is the gauge for an individual’s worth. Merits that are granted to people who exude excellence and display quality performance should not at all be awarded to them because one’s talents, abilities, and moral values are influenced by the family, heredity and the environment. (Pojman, 1999)The three aforementioned viewpoints have now become the basis of arguments and debates over the meaning of worth and the basis of merit. At this point, we ask ourselves on which ground do we stand on? How do we perceive the contributions of other people? How do we define excellence? On what grounds should we base the merits granted to other people? Why are merits valuable to us? These are just some of the questions we ask ourselves when presented with conflicting ideas about how we should perceive people’s contributions and the intentions of their actions, and on what grounds should we base the merits that shall be granted to them. The author has expressed his own opinion about the topic of conversation, and according to him, merits are dependent on desert. This ubiquitous idea is based on the concept that we should deserve what we earn because what we earn is dependent on our intentions and actions. Therefore, those who are righteous and honorable should be merited because they deserve it. On the other hand, those who are vicious should be punished based on the intensity of their actions. (Pojman, 1999)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The balance or symmetry in merit and desert should be the ideal principle that governs people in terms of what they deserve due to their way of thinking, beliefs, and actions. However, this ideal notion of merit and desert does not materialize in the state of our world at present. There is too much injustice in society that the idyllic system of merit and desert, or earning what we deserve, is just an idea that we wish our world should be. This system of injustice and precariousness lead us to depend upon Cosmic justice in order to attain the equilibrium between merit and desert. (Pojman, 1999)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This idea of order inspired by Cosmic justice is vindicated by moral truths that were based on the scriptures. Randy Alcorn, who writes for the Eternal Perspective Ministries, explains the interplay between actions and rewards by stating evidences from the Holy Bible. Alcorn stresses that the scriptures support the concept of balance between merit and desert. Rewards are obtained by doing good deeds, and God’s judgments are based on the morality and uprightness of man’s actions and works on earth. Moreover, these good deeds are the basis for the salvation of man. (Alcorn, 2007)   As Alcorn revealed passages from the Holy Bible and interpreted each text in terms of actions, rewards, and punishments, he restated that righteous desert or actions are the things that people do according to desires of God, and these particular actions are the ones which deserve rewards. Alcorn continues to discuss about the significance of rewards in the biblical context. Based on the scriptures, rewards that shall be granted to man are dependent on one’s capacity to remain faithful to the Divine Being. This is because what man chooses to believe and have faith in determine man’s destination eternally. Righteous works and actions give man eternal life. Moreover, these righteous works and actions determine what man shall receive as a reward from God. (Alcorn, 2007)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Straying away from the biblical concept of â€Å"we deserve what we earn,† we are going to shift to the views of Kant which strongly supports the desert-based system of granting merits. According to Kant, deeds are worthy of merit. Moreover, desert done as a moral duty is deserving of a reward or a positive appraisal. According to Kant, estimable actions deserve rewards despite the morality or uprightness of an action. This becomes a point of argument between two opposing views of the desert-based system. However, the similarities between Kant’s desert-based system and man’s common view about merits and desert do not differ from one another. (Johnson, 1996)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The commonality between Kant’s desert-based system and the viewpoints of the majority of man is grounded on the need for granting merits to an act that was done according to one’s duty and responsibilities and the morality and uprightness that comes with it. (Johnson, 1996) Moreover, man would not argue that those who conduct vicious behavior should not be given merit, but on the other hand, be granted punishments that are in equal weight with the negative behavior committed. The evaluation of action, according to Kant is based on the intentions and the results of the particular action. The evaluation of action to the ordinary and common viewpoint of man is based on the morality and uprightness of a certain action. The evaluation of action according to the scriptures is grounded on the righteousness of God as revealed in the Holy Bible. References Alcorn, R. (2007). Can We Really Earn Eternal Rewards? Retrieved April 6, 2008, from Eternal   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Perspective Ministries. Website: http://www.epm.org/articles/earn.html Johnson, R. N. (1996). Kant’s Conception of Merit. Retrieved April 6, 2008, from University of   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Missouri. Website: http://web.missouri.edu/~johnsonrn/merit.pdf Pojman, L. (1999). Merit: Why Do We Value It? Journal of Social Philosophy. Malden:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Blackwell Publishers