C.S.I. Movie Analysis and Review of Episode 321 FOREVER Essay

C.S.I. Movie Analysis and Review of Episode 321 FOREVER - Essay Example The episode is about a horse that stomps her trainer to death aboard a luxurious personal jet. This horse is then quarantined by a vetenary officer after the jet landed. Things become suspicious when the horse suddenly dies and the vetenary officer disappears (CSI Ep 21.). Conversely, another incident happens where two teenagers have been alleged to commit suicide and their bodies found in the middle of the desert. Detectives from CSI look at this cases separately to determine the truth behind them. The trampling death of the horse trainer is investigated by Grissom, Nick and Catherine. Warrick and Sara look into the two teenagers (Romeo and Juliet) scenario in the desert. Crime Scene Investigation (CSI) is an American crime and drama television series that premiered in 2000. This series follows The Las Vegas Criminalists in which the analysts use the physical evidence to solve murder cases in this unusual graphic drama. CSI has been acknowledged as the most popular dramatic series a nd has been awarded International Television Audience by CBS. It has also been awarded the Best Television Drama Series for the last three years. Most of the episodes in this television series deal with a team of forensic investigators who are trained to solve crimes based on the evidence that has been collected. They are specialized in collecting irrefutable evidence and find the missing pieces of the puzzle to unravel the mystery behind every case. A murder aboard in a deluxe 747 personal jet and the discovery of two formally attired teens found in the desert confound the chief analyst Grissom and his crew in this absorbing episode of CSI. First, a horse trainer is found dead inside the cargo bay of a privately own jet that is carrying 12 well –heeled passengers and a horse worth millions (CSI Ep 21.). At first, it appears that the victim was trampled to death; however Grissom and Catherine uncover evidence that suggest foul play. In a separate incidence, In Hell’s G ate section of Death Valley, CSI analysts Warrick and Sara probe the alleged suicide of a 15 year old boy whose body is found under a bed spread. This investigation becomes more intensified when a girl’s body is discovered half a mile away. This is one of the most memorable episodes in this series; it is not only well written but cleverly plotted. In the first case, Grissom and Catherine are in the quest to determine the cause of death of the horse trainer and the horse itself. Both of them go to the airport to gather pieces of evidence. They found some abnormalities inside the plane that insight them to carry out further investigations (CSI Ep 21.). When the horse dies, after it contracts uterine infection, they take it to the lab to determine the cause. After they perform an autopsy on the horse, they find diamonds inside the uterus. The crew on the plane orchestrated the death of the horse trainer to smuggle the diamonds inside the horse. Grissom says â€Å"uncut diamonds ? The horse is a â€Å"mule†. The horse trainer discovered the abnormalities in the horse and when he tried to help the horse, it stamped on him causing his demise. But, this was not the real story, the vet that was waiting for the horse at the airport knew about the diamonds. The killed the horse trainer because he was going to blow their cover and the diamonds could have been discovered. In the second scenario, a boy is found dead at the dead valley. It is a strange scenario to find a boy dressed in a suit who

Knowledge Management and the Competitive Strategy of the Firm Article

Knowledge Management and the Competitive Strategy of the Firm - Article Example The study reviews literature that tackles knowledge management in relation to the competitive advantage of an organization. The literature includes Porter ‘5 forces model’, and ‘Wernerfelt’s’ resource base view of a firm. The relationship between KM and strategy formulation by use of resource-based perception of the organization is established. The applicable literature that links KM with strategies is examined. The paper culminates with research findings, implications, and conclusions. Porter based his argument on SWOT analysis concept. Porter views that the five force model depends heavily on the competition level in the industry. The five forces include; the threats presented by new entrants in the market; suppliers bargaining power; threats offered by the substituting goods, and the jockeying among the existing contestants. When an organization has perfect information pertaining to the existence of the above factors they tend to conquer the market . This is because the organization will devise a strategic plan that counteracts the actions of the competitors. The strategy focuses on external factors that analyzing the opportunities and threats evident in the industry. Barney views that organizations that utilize their internal strengths to act on the opportunities at the same time weakening threats and avoiding internal weakness attain a significant value on the competitive competition. The theory argues that a firms’ success lies in its ability to incorporate its ability and resources. A firm’s resources must never be easily imitated by the competitors. Various researchers supporting the theory including Penrose, Barney, and Mahoney and Pandian asserts that; competitive advantage resources must be valuable, with no substitute and inimitable.

Case Study of Managing patient suffering Opoid constipation

Case Study of Managing patient suffering Opoid constipation This case study outlines the clinical management of a client with a problem with Opioid induced constipation. Opioid analgesics (narcotics) cause constipation in most people. Opioids slow down the stool as it passes along the intestinal tract. This causes the stool to become hard. If you have hard stools, have difficulty passing bowel movements and the movements become infrequent, then you have constipation. Constipation can be very bothersome and last as long as you are taking narcotics on a regular basis. Therefore, it is important that we learn to manage our bowels effectively. Throughout the analysis the anonymity and confidentiality of this patient will be protected as outlined by the Nursing and Midwifery Council (2008) and therefore the patient will be referred to as Mark Scott. Additionally consent was gained by Mark to allow the author to use his case for my assessment. History of present illness Mark Scott is a 64 year old gentleman who is 2 days post op following a Right Total Hip Replacement (RTHR). Total hip replacement involves removal of a diseased hip joint and replacement with a prosthetic joint. Whilst doing the medications Mark confided in the nurse that he may have a problem with his bowels and that he may be constipated. To enable the nurse to assess Mark she would have to understand constipation, it helps to know how the colon, or large intestine, works. As food moves through the colon, the colon absorbs water from the food while it forms waste products, or stool. Muscle contractions in the colon then push the stool toward the rectum. By the time stool reaches the rectum it is solid, because most of the water has been absorbed. Constipation occurs when the colon absorbs too much water or if the colons muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. As a result, stools can become hard and dry. Mark asked the nurse if there was anything she could give him to ease the discomfort he was experiencing, However as Mark has presented with a new problem with the possibility of him needing medication, the nurse would first need to undertake a holistic assessment of Mark. The purpose of assessment is to allow the nurse to examine all relevant factors of the problem and allow her to make the decision of whether prescribing a patient group directive (PGD) is an appropriate intervention (Humphries, 2002). Consider the patient When Mark stated he thought he was constipated, it was important to ascertain his own interpretation of what this meant. For example, Wondergerm (2005) states that for some, constipation may mean opening their bowels less than three times a day. On the other hand, constipation may mean opening of the bowels less than three times a week. There appears to be a general consensus that the range for normal bowel activity lies somewhere between three bowel motions daily to one bowel motion every three days. However, it is important to remember that a change from three bowel motions a day to one every three days may represent a significant change for the patient, despite remaining within the normal limits (Peate, 2003). Mark felt he was constipated because he hadnt had a bowel movement in the last five days. On further questioning it emerged that these symptoms had been going on approximately 4 days before his surgery and when he did have a bowel movement he had difficulty passing the stools and often had to strain. Mark also stated that the stools were very hard and painful to pass, the symptoms that Mark presented with were consistent with the side effects of constipation, However the cause of constipation is multifactoriol with many influencing factors that need to be investigated and eliminated wherever possible (Banks,1998). In Marks case it was the analgesia he was taking to control his pain post operatively. During Marks assessment, enquiries were made as to whether he was experiencing any other symptoms with his constipation, such as blood in the stools, rectal bleeding and/or mucus discharge, recent weight loss, abdominal pain or alternating constipation/diarrhoea. Edwards and Bentley (2001) state that this is important during history taking as all of these symptoms are common of colon and rectal cancer and the possibility of this disease should be in the mind of the nurse looking after Mark. Mark assured the nurse that he hadnt experienced any of the symptoms mentioned although he did have a little discomfort in the area of his abdomen, lots of wind but no pain. If Mark had any of these symptoms the nurse would have to liase with the patients consultant. No medication would have been given by the nurse at this stage. This is because as a nurse, she is accountable for her actions and omissions (NMC, 2008). For example, if Mark was to have a bowel obstruction such as a tumour which is c ontra-indicated for most laxatives, and the nurse had prescribed such medication then Mark may believe he has been harmed by her careless prescribing. Additionally failure to refer a patient for more senior opinion is considered to fall below an acceptable standard of care (Griffith and Tengnah, 2004). It is important to ascertain how much dietary fibre and fluids are being taken by the patient as high fibre content is effective in increasing stool weight and bowel movement frequency, ultimately preventing constipation. Additionally, low fluid intake has been associated with constipation, slowing colonic transit time or reducing stool output (Walker, 1997). Current medication regimes, whether prescribed or purchased over the counter is essential information and can assist in identifying any drugs that may be responsible for causing constipation (Annells and Koch, 2002). Additionally, a history of medicine taking should include noting whether a patient has any allergies. For example, arachis oil enemas have a nut basis and may cause allergic reactions (Edwards and Bentley, 2001). Pre and post operatively Mark had been prescribed analgesics in the form of Paracetamol, codiene and ibuprofen for his pain. He had been taking these regularly daily. Mark wasnt taking any other medication, wasnt allergic to anything he knew of and hadnt purchased anything over the counter for his constipation. Opioids are a common cause of constipation and act by increasing intestinal smooth muscle tone, by suppressing forward peristalsis and reducing sensitivity to rectal distension. This results in delayed passage of faeces through the gut (Fallon and ONeil, 1998). Through assessment together with eliminating possible causes and sinister abnormalities, the nurse diagnosed Mark with constipation secondary to opioid use. Which Strategy/Product Where the patient complains of feeling constipated and is experiencing discomfort, a rectal examination (DRE) is indicated in order to detect a loaded rectum and to determine which choice of product to administer, and this will depend on the consistency of the stool found on examination (Edwards and Bentley 2001). Digital rectal examination (DRE) is an invasive procedure and should only be performed after completion of a full assessment of constipation. The Royal College of nursing guidelines (2006) recommend that nurses undertaking digital examination are appropriately trained. Furthermore consent to this procedure needs to be gained as outlined by the Nursing and Midwifery Council (NMC) (2008) Further to examination, it emerged that no stools could be felt within the rectum. However, Edwards and Bently (2001) suggest that it is anatomically impossible to conclude that the rectum is empty through simple digital examination, as the length of the rectum is approximately 15cm and is th erefore beyond the reach of the longest index finger. Therefore due to Marks history, the preferred medical route will therefore guide the need to administer a laxative. Amongst the stimulant laxatives are senna and bisacodyl. These laxatives stimulate the intestinal mucosa, promoting the secretion of water and electrolytes, enourging peristalsis (Duncan, 2004). Timby et al (1999) recommend that stimulant laxatives be used only for short periods of time to allow normal bowel function to return as soon as possible as long term use may result in diarrhoea and hypokalaemia. However Marks constipation may remain for as long as he is using opioids or could re-occur. Therefore this type of laxative may not be sufficient. Osmotic laxatives act by retaining fluid within the bowel that they are administered to or by drawing fluid from the body. They include lactulose, macragols, magnesium salts, rectal phosphates and rectal sodium citrate (Peate, 2003). A phosphate enema would not be used in this case because this is usually used prior to radiology, endoscope and surgery for rapid bowel clearance. Additionally Mark stated he didnt want to go through having an enema, and would prefer something he could take orally. Lactulose is non-absorbable and acts by softening and increasing water absorption. This laxative may take up to 72 hours to act and bloating, flatulence, cramping and an unpleasant taste have all been reported side effects, (Banks, 1998). Additionally, lactulose may not be suitable in constipation where gut motility is impaired such as opioid use in Marks case, unless accompanied by a stimulant such as Senna. However, choosing a senna/lactulose combination, means that taken together they will act at different times (Edwards and Bently, 2001). However, evidence comparing different types of laxative is very limited. Nonetheless, a study was found comparing a low dose macragol with lactulose for the treatment of constipation. The treatment was 1-3 sachets of compound oral powder (movicol) versus 10-30g of lactulose daily. After 4 weeks patients in the movicol group had a mean number of stools and a lower median daily score for straining than the lactulose group (Attar et al, 1999).This concluded that movicol was more effective and better tolerated than lactulose in the treatment of constipation. This would then justify prescribing movicol for Mark, therefore increasing the frequency of bowel movements and reducing straining. However the Nurse had to get Marks doctor to prescribe Movicol as it is not listed in Patient group directive, so the nurse gave Mark 10mls of lactulose and 2 senna until this was prescribed. Negotiate contract In implementing the strategy the consent and agreement of the patient is paramount, and may be viewed as a shared contract between patient and nurse. This is known as concordance. It is important for nurses to adopt this approach to administering medication, as this directly involves patients in decision making about their treatment. It must be remembered that nurses owe a duty of care to their patients. Duty of care is a legal requirement owed by one person to another to take reasonable care not to cause harm. The courts have held that the nurse-patient relationship gives rise to such a duty (Kent v Griffiths, 2001). Additionally, common law decided from cases requires that nurses take care when prescribing, otherwise, a patient harmed by careless medicine administration can sue for damages by claiming negligence (Griffith and Tengnah, 2004). It is essential therefore that duty of care extends to quality of prescribing, including, assessment, advice and information giving, record ke eping, decision making along with medication selection and calculation, as well as communication with the patient and other professionals. The patient needs to know what is expected of them in carrying out the treatment plan and when the nurse needs to reassess the situation. Additionally the patient needs to know what the medication is for, how long it takes to work and how to take the product (Edwards and Bentley, 2001). In Marks case it was explained to him that he would be prescribed a product by the name of movicol for his constipation and evidence found on its appropriateness along with possible side effects for his condition was explained. He would receive 20 sachets with a view to taking 1-3 sachets a day. It was explained he would have to mix 1 sachet with 125ml of water (British National Formulary, BNF 2009) and the importance of drinking 2lts of fluid was explained along with the effects that movicol will have within his bowel. Mark was alerted to any know side effects of movicol as these could be alarming to the patient if that information is not given, for example, abdominal distension, pain and nausea. However this does not mean that Mark will experience any of these. Nonetheless, this information is essential and Mark was told to report any adverse effects to the nurse. Record keeping The NMC (2005) guidelines for records and record keeping, state that good record keeping is integral to our role as records are sometimes called in evidence in order to investigate a complaint. In light of this all details, including full assessment details, along with care plans which were both planned and executed, plans for review, and medications and prescriptions given, were all entered into Marks patient held records immediately. Additionally this was also recorded within notes in Nursing Notes. Marks own consultant was also informed of this information in order to assist with prescribing and also to avoid polypharmacy and adverse events from drug interactions. The nurse also ensured the drug card was signed as per NMC guidelines. Complementary Therapies Complementary therapies are treatments used to support regular or orthodox treatments such as medication. These treatments may be used to reduce stress and anxiety or may be used to help with problems such as pain, nausea and constipation. Abdominal massage has been shown to be effective as a marginally effective laxative regimen in one trial. However, massage is extremely demanding on staff time, and consequently is unlikely to be of widespread benefit to the patient. Acupuncture, One small within subject trial of sham versus true acupuncture showed some benefit in chronically constipated children, but acupuncture has never been tested for opioid-induced constipation. Herbal preparations such as Senna, a laxative, may be used as pods or a tea. Rhubarb stems (not the leaf, which contains poisonous oxalic acid), chrysanthemum stems, and peach leaves have laxative properties. Many preparations promoted as herbal or natural laxatives are in fact bulk forming preparations which should be avoided in opioid-induced constipation. However, if possible medication can be avoided as bowel movements may be facilitated if done at the same time every day, by mobility and physical activity, and increased dietary fibre and fluid intake. However, these approaches alone may not benefit all patients, especially those with severe constipation. Nevertheless, deficiencies in physical activity, and fluid and fibre intake should be addressed. Physical constraints and barriers should also be rectified, and commonsense toilet practices should be reinforced, such as not suppressing the urge to defecate, and using public washrooms if out of the house rather than waiting to return home. Summary The above account highlights that in the clinical management of medicine administration, it is vital that this is undertaken in an informed and systematic manner. This can be achieved through the selection and application of an assessment tool and by having clarity about the decision-making framework used to underpin Evidence Based Practice. The NMC emphasises that the administration of medicines is an integral and essential entry criteria for the Councils Professional Register (NMC, 2008). Furthermore, the Code of Professional Conduct clearly states that medication administration must not be seen solely as a mechanistic task but as a task that requires thought and the exercise of professional judgement (NMC, 2008). For nurses to practice competently, they must ensure that they possess the knowledge, skills and abilities required for lawful, safe and effective practice. They must acknowledge their professional competence and only undertake practice and accept responsibilities for those activities in which they are competent (NMC, 2008). The NMC guidelines of professional conduct (2008) require that nurses must maintain knowledge and competence. This can partly be achieved by the use of reflection on prescribing and administrating decisions. Word Count 3012 References Annells M Koch T (2002) Faecal impaction: Older peoples experiences and nursing practice. British Journal of Community Nursing. 7 (3)118-126 Banks A (1998) An overview of constipation: causes and treatment. International Journal of Palliative Nursing 4 (6) 271-275. Duncan J (2004) The management of constipation by nurse prescribers. Nurse prescribing 2 (2) 66-69. Edwards M Bentley A (2001) Nursing management of constipation in housebound older people. British Journal of Community Nursing, 6 (5) 245-252. Fallon M, ONeil (1998) ABC of Palliative Care. London, BMJ books. Griffith R, Tengnah C (2004) A question of negligence: the law and the standard of prescribing. Nurse Prescribing 2 (2) 90-92. Hardy, D., Smith, B. (2008) Decision Making in Clinical Practice. British Journal of Anaesthetic Recovery Nursing. Vol. 9 (1), pp. 19-21 Humphries J (2002) Assessment and evaluation in nurse prescribing, 2nd ed Palgrave, Hampshire. Kent v Griffiths (2001) QB 36 IN Griffith R, Tengnah C (2004) A question of negligence: the law and the standard of prescribing. Nurse Prescribing 2 (2) 90-92. Kyle, G. (2007) Bowel care, part 5 a practical guide to digital rectal examination. Nursing Times; 103: 45, 28-29. Nursing and Midwifery council (2008) Guidelines for records and record keeping. London. Nursing and Midwifery Council. (2008) The Code: Standards of Conduct, performance and ethics for nurses and midwives. London, NMC. Wondergerm F (2005) Relieving constipation. Journal of community nursing, 5 12-16 Peate I (2003) Nursing role in the management of constipation: use of laxatives. British Journal of Nursing. 12 (19) 1130-1136. RCN (2006) Digital Rectal Examination and Manual Removal of Faeces: Guidance for Nurses. London: RCN Timby B, Schere J, Smith N (1999) Introductory Medical-Surgical Nursing. 7th edn. , Philadelphia, Lippincott. Walker R (1997) Diagnosis and treatment of constipation. Practice Nursing 8 (4) 20-22

bar flies Essay -- essays research papers

Bar Flies   Ã‚  Ã‚  Ã‚  Ã‚  When you go to the bar it seems there are always people hanging around much like flies hang around a barn. The people that frequent bars are from many different backgrounds. They are there for a variety of reasons. Some are there to have a burger with friends. Others are spending their time drowning their sorrows with a few drinks. People who frequent bars can be classified into three groups; lifers, regulars, and those who are there to socialize.   Ã‚  Ã‚  Ã‚  Ã‚  The first category of bar flies is the lifers. The lifers are the people that always seem to be at the bar. Lifers spend five to seven nights of the week in the bar. They are not always drinking beer or alcohol often they are drinking coffee and talking with the bar tender. Th...

Cranium Filament Reductions SWOT Analysis

The company that I decided to do a SWOT analysis on is Cranium Filament Reductions which is a hair salon. After reviewing their business plan, I thought that it was very well written and detail-oriented. Below you will find my swot analysis of the hair salon business plan: Strengths: This venture does have experienced, creative leaders and researchers since Susan Sever (the owner) has years of management under her belt. Ms. Sever has done all of her research about the hair salon industry. The industry is easy for anyone to start and end a business which makes for a competitive market. Ms. Sever has realized that customers are looking for quality work and great customer service without paying an arm and a leg; so she has a plan to cater to all of her clients’ needs. She also has a line of products that she will be selling in the salon. In my opinion I think that her market segments are targeted correctly. Her target market includes men, women who cannot afford the expensive upscale salons, and women with children. She has a plan of hiring six experienced hair dressers and an experienced receptionist. Ms. Sever will be offering training to her employees so they can stay up to date on their skills. Weaknesses: There were a couple of weaknesses that I found in the business plan. The weaknesses that I could see were located within the business’ target market segments. Cranium Filament Reductions thinks that young women with children would be a great target for the company. I can understand that their children need their hair done as well but having children in the salon may deter other customers from coming in. Some people use â€Å"salon time† as a way to take time for their selves away from their children so why would they want to deal with other people’s children at a salon. Another weakness is the fact that Ms. Sever is depending on males to make up about seventy to seventy-five percent of their clientele. Depending on the atmosphere at the salon will determine whether or not men show up. If the salon seems to be too â€Å"feminine† then I highly doubt that men will be the majority of their clientele. Opportunities: If Cranium Filament. Reductions actually keeps to their plan about providing high end customer service at a low cost then they will have a strong opportunity to strive. There are people out there that don’t want to pay over $100 for a haircut and some pampering so if they were to find a place that offered everything that they were looking for at a lower rate they would become regular customers. Regular customers would spread the word to their friends and family members and reviews about the salon would be all over town. Having regular customers would give Cranium Filament Reductions the opportunity to become well known around the neighborhood and possibly even the state. If Cranium Filament Reductions can actually make their projected profit for the first year or double the profit, this may provide them with the opportunity to expand the business or the services that they offer. They would be able to buy newer equipment, send their employees for new training, or even expand the product line. Threats: I believe that Cranium Filament Reductions has underestimated the reactions from their competitors. Ms. Sever does realize that the hair salon industry is a highly competitive industry but I don’t think that she understands the lengths that someone will go to make sure your business is not successful. Ms. Sever plans to do a lot of promotional things during the first couple months but that doesn’t mean that another salon won’t start to offer the same promotional items. Cranium will need to stay on their toes to keep their business booming. A change in customer taste does occur rapidly within the hair industry so cranium will need to be up to date with all the new trends and their skills. Competitors may also try to compete with the product line that Cranium offers. Cranium will also need to be on the lookout for new up and coming salons. Everyone thinks that they have a passion for hair so this industry will always be increasing with competitors. Hair Salon Business Plan: http://www.bplans.com/hair_salon_business_plan/appendix_fc.php

Professionalism in the Army

A soldier is measured by his ability to do his job successfully, tactfully, and professionally. Being a professional at everything you do will help you succeed in every aspect of your life. The definition of professionalism as by Merriam-Webster is the conduct, aims, or qualities that characterize or mark a profession or professional person. Being in the Ranger Regiment we are considered professionals. How we train, perform, and even hold ourselves to the Army Values and Ranger Creed make us the elite fighting force we are.In this essay I will talk about what professionalism is, what professionalism means to me as well as what it means to this unit, 75th Ranger Regiment. In any profession there are many attributes accompanied with professionalism. In the 75th Ranger Regiment, like all professional jobs, in order to be successful experience, communication, and moral ethics will make any individual succeed. Experience can help save time and effort. Learning from ones past mistakes and accomplishments can be very valuable in any work place.Being able to effectively communicate is key. As an intelligence professional knowing what to say and how to get into peoples minds can prove to help a great deal on the battle field. Ethics is knowing the difference between right and wrong from good from bad, this is what being a professional is. Every single person’s morals and values of life are different. To me professionalism means to lead by example, to try your best and give it your all no matter who is watching.As well as to put in the time and effort, to act on your best behavior and to get any task presented done giving one hundred percent. These are all traits of what professionalism means to me. No matter if your a private or a commander being a professional within this unit is the standard we all should live by. What Professionalism means to the 75th Ranger Regiment is simple. If you follow and uphold the Ranger Creed you will always be successful within this unit.Giving one hundred percent even when no one is watching. Being the best at ones job giving one hundred percent, these are all traits of a professional within this organization, and what the Ranger Creed stands by. In conclusion, being a profession will help you succeed in life. Leading by example, or giving it your all when no one is watching. This is what I believe professionalism means to me as well as this unit. These are the conduct, aims, or qualities that characterize or mark a profession or professional person.