The anesthesia technician & technologist’s manual: All you need to know for study and reference Essay

Improvements of Anesthesia Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   From nineteenth century, there have been important and continuous improvements in the field of medicine in United States, particularly in discovery of microorganisms as the root cause of disease and anesthesia. The improvements have been of great importance in facilitating effective, convenient, and safest methods of treatment. The paper below discusses anesthesia improvements, and importance of its improvement in treatment. Improvements of anesthesia   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The direct use of volatile anesthetics and intense cold were the most important steps in anesthesia in nineteenth century. The steps were used in surgical sites during treatment of traumatic injuries. This was possible by bringing down local temperature of body tissues by the application of salt and ice during the surgeon. However, to estimate the cold projection was extremely complex when using salt and ice. This gave rise to new techniques such as topical application of Dutch oil and vaporization of ether and ethylene chloride by fumigation and spraying. Since then, there was continuous discovery of more anesthetic liquids such as amyl hydrate and vaginal Dutch. Having improved the anesthetic liquids, there was a major challenge in obstruction of sprays used. As a result, there came need to improve the jet, which was possible by designing different systems of nozzles. Almost to the end of the century, some medical practitioners recommend ed the improvements best for surgeon but many individual called for alternative approach, especially in minor surgery (Walter, 2014).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   All the way from 19th century to transition into the twentieth century, there have been many improvements of anesthesia care (Woodworth, 2012). For instance, the common practice discussed above changed by introduction of cocaine around 1884.Later in 1934, the sodium Pentothal was introduced for intravenous anesthetic administration. Despite its many challenges associated with its negative side effects when administered to some patients, it remained the most effective until 1977 when Dr.Brian Kay introduced muscle relaxants and rubber endotracheal tubes. In 1980s, pulse oximetry and end tidal CO2 were introduced that facilitated EKG monitoring. Use of the improvement in medical practice today   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Some of above discussed improvements are still used across the United States. For instance, the improvement of EKG monitoring makes it possible to manage neuromuscular blockade .In addition, the use of muscle relaxants and rubber endotracheal tubes makes it easy for anesthesiologists to monitor the condition of the patient .The monitoring of the patients’ condition primarily involves checking of blood pressure as well as pulse rate. Being able to process EEG measurement, end tidal CO2 and pulse oximetry have made it possible to quantify the depth of anesthesia. The monitoring incorporated with some of discussed advances has led into the best anesthetic practice by improving patient’s safety.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Indisputably, there is significant from the use of advances though some of the anesthetic practices used today for surgery have changed tremendously. Unfortunately, while bringing the changes in transformation of anesthesia surgery, the dramatic change in body knowledge and skills developed from the improvements has resulted to inseparable and complex medical disciplines. Future developments in anesthesia   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Aside from the above important improvements discussed such as introduction of pulse oximeter in aesthesia practices in United States today, there are many cases of mortality and morbidity in anesthesia. It is therefore obvious that the discoveries are not the â€Å"end of the road† but the push to new heights .However, with improved, optimal, and creative anesthetic management evident in United States ,there is hope of continued improvement to develop most safer and effective anesthesia practices while cutting down the pressure from medical economics. This will only be possible if anesthesiologists rise to the challenge. References Walter. (2014). In Encyclopedia Britannica. Retrieved from http://www.britannica.com/EBchecked/topic/482821/puerperal-fever Woodworth, G., & Kirsch, J. (2012).  The anesthesia technician & technologist’s manual: All you need to know for study and reference. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Source document

Human Rights Problem

On May 21, 1999, a local road construction company, Dumez Limited, attacked a group of peaceful protesters with clubs, daggers, axes, machetes, and other dangerous weapons. Tension began to arise when on April 26, 1999 the company began destroying newly planted crops of local farmers in the Ogoni kingdom of Gokana. They did so without paying adequate compensation for the crops or carrying out an Environmental Impact Assessment (EIA) for the road project, as required by international environmental standards. On May 8, 1998, a Human Rights Defender, Olisa Agbakoba, was arrested at Murtala International Airport in Lagos. The arresting officers were members of the Security Force, an agency of the Nigerian government. No reason for his arrest was given. This arrest was preceded by an earlier encounter in March 1998 where he was attacked and arrested by members of the Nigerian Police when he tried to speak at a pro-democracy rally in Yaba, Lagos. On January 8th and March 23rd of 1998, Batom Mitee and Barileresi Mitee who are brothers of Ledum Mitee, President of the Movement for the Survival of the Ogoni People (MOSOP), were arrested. No charges were ever given for their arrests. Batum Mitee was kept detained for several weeks without having access to his lawyers, his family, or a doctor. On January 18, 1998 he was brought before a judge who declared that the case was not within his competence because of its political character. Mitee was later transferred to a military hospital because of the beatings and ill treatment inflicted by the military. These incidents of brutality and harassment are just a few examples of the abuse by members of the police, security forces, and Nigerian government and how it remains to be a persistent human rights problem. There are numerous underlying factors that contribute to the problem of human rights in Nigeria. One the major factors is that of religion. Religious differences often correspond to regional and ethnic differences. For example, the northern region is overwhelmingly Muslim, as are the large Hausa and Fulani ethnic groups of that area. Many southern ethnic groups are predominantly Christian. About half the country†s population practice Islam and about 40% practice Christianity. Approximately 10% practice exclusively traditional indigenous religions or no religion at all. Many persons practice both elements of Christianity or Islam and elements of an indigenous traditional religion. Consequently, it is difficult to distinguish religious discrimination from ethnic and regional discrimination, which is pervasive. Although the government has never outlawed proselytizing, it continues to discourage and criticize it publicly because it believes that it stimulates religious tensions. Both Christian and Muslim organizations allege that the Ministry of Foreign Affairs and the Immigration Department restricted the entry into the country of certain religious practitioners, particularly persons suspected of intending to proselytize. Consequently, Nigeria†s constitution prohibits state and local governments from adopting an official religion. Though Nigerian law prohibits religious discrimination, it is common for government officials to discriminate against persons who practice a religion different from their own, notably in hiring or awarding contracts. There have been documented reports of harassment of Christian missions by local government officials in predominantly Islamic regions. In April and again in August 1998, the local council of Lafia, in Nasarawa State, reportedly ordered the closure of a Protestant Christian mission church in connection with a dispute about the mission†s title to the land. In March 1998, State Security Service officers detained and interrogated the mission†s pastor. The mission sought to convert members of the generally Islamic Kambari ethnic group. The lack of concern for the environment and the people that it affects has also been a major concern in the struggle for human rights. Since 1958, oil companies such as Shell have exploited oil wealth in the region of the Ogoni people. As a consequence, they have suffered extreme economic deprivation and the environmental devastation of their land. Since Shell began drilling in Nigeria†s Niger Delta, it has spilled oil on farmland and in water sources, bulldozed across farms and flared gas just meters from Ogoni villages. The people of Ogoniland suffer extreme health problems from the air and water pollution. The Nigerian military has played a significant role in the continued persecution of the Ogoni. When the Ogoni began to demand environmental justice, villages were attacked, villagers were killed and their leader was executed by the judgment of a military court. Shell has even admitted to paying the military, which brutally silences voices crying for justice from the government of Nigeria and Shell, along with other multinational oil corporations. Shell is only one of many multinational oil corporations operating in Nigeria. Mobil, Chevron, and Texaco are also found in Nigeria, operating as partners of the Nigerian government, as required by Nigerian law. â€Å"Shell is certainly not the only Oil Corporation that abuses its money, power, and feeling of superiority over the people of Nigeria. † The country†s population of about 120 million is ethnically diverse, comprising more than 250 ethnic groups, many of which speak distinct primary languages and are concentrated geographically. There is no majority ethnic group. The three largest ethnic groups are the Hausa-Fulani of the north, Yoruba of the southwest, and Igbos of the southeast, who together make up about two-thirds of the population. The fourth largest group, the Ijaw, has a population of approximately 12 million. â€Å"Societal discrimination on the basis of ethnicity is widely practiced by members of all ethnic groups and is evident in private sector hiring patterns, de facto ethnic segregation of urban neighborhoods and a continuing paucity of marriage across major ethnic and regional lines. There is a long history of tension among diverse ethnic groups. Although the country†s successive constitutions all have prohibited ethnic discrimination by the State, northerners and particularly Hausas have long been predominant in the national government, including the military officer corps. Tradition continued to impose considerable pressure on individual government officials to favor their own ethnic groups and ethnic favoritism persisted. Resentment of northern domination of the Government aggravated by the suspension of federal decentralization under the Abacha regime and resentment of Igbo success in private commerce, have contributed to ethnic and regional tensions. Possibly the most controversial issue within Nigeria is that of the political structure of the government. Since Nigeria received its independence from Britain, in 1960, there has been conflict in regards to the military and authoritarian system of government that existed. The citizens of Nigeria have longed for a democratic system of government that included themselves as active proponents. Nigeria became a Republic in 1963 and Nnamdi Azikiwe was made the President of the Federal Republic. In January of 1966, some Igbo army officials staged a coup d†etat to overthrow the government, who were primarily Hausa, because they objected to the population census. They felt it over estimated that number of people in the northern region thereby giving them a larger representation in the federal parliament. They succeeded in killing many of the senior officers but Azikiwe was not harmed. As a result of the attempted coup, the government promised a progressive program, a return to civilian rule determined by elections, and vowed to stamp out corruption and violence. Though idealistic in theory, these promises were never realized. Instead, it became the common practice of the government to consider democracy, but continue to practice authoritarian rule. Nigeria would bear witness to numerous coup attempts over the next three decades, most involving the transition to democracy. It wasn†t until the death of Sani Abacha, possibly the most famous President of Nigeria, in June 1998 that civilian rule would be realized. A new transition program was established that would lead the country back to democracy by Abdulsalam Abubakar, the man chosen to replace Abacha. After a series of elections, Olusegun Obasanjo was declared the new and current, democratically elected president on May 29, 1999. At the end of May 1999, Nigeria completed its transition from authoritarian rule to a formal democracy. A number of Nigerian groups have managed to create strong institutional structures, with narrowly defined mandates and internal staff structures as well as program plans. While there are still growing pains within many of these groups, this type of planning process has resulted in â€Å"the Nigerian human rights community†s being far ahead of its anglophone neighbors in putting human rights institutions into place. † The Center for Advanced Social Sciences (CASS) was formed in 1992 and is based in Port Harcourt, Nigeria. CASS is a think tank concerned with improving management and public policy in Africa. It has a Board of Trustees and is governed by an international Board of Directors. The Civil Liberties Organization (CLO), established in 1987, is one of Nigeria†s largest human rights organizations. The CLO is a non-governmental organization set up for the defense and expansion of human rights and civil liberties. It investigates human rights abuses and campaigns through litigation, publications, and communications with the government on behalf of people whose rights have been abused. Another human rights advocate is the Constitutional Rights Project (CRP) that was set up in 1990. Their aims are to ensure that Nigerian legislation conforms to international standards, monitor institutions whose activity impact on the rights of citizens, and to provide legal assistance to victims of human rights abuses. The cry for human rights reform in Nigeria hasn†t fallen on deaf ears from those of the international community. On November 12, 1998 the 53rd session of the General Assembly of the United Nations (UN) met to discuss the situation of human rights in Nigeria. The General Assembly reaffirmed that Nigeria is a party to the International Covenant on Human Rights and thereby making it a Member State. All Member States have an obligation to promote and protect human rights and fundamental freedoms. The Nigerian government was â€Å"strongly encouraged† that the establishment and strengthening of national structures and institutions in the field of human rights are of the utmost importance for the promotion and protection of human rights in Nigeria. The sanctions imposed on Nigerian government by the European Union, the Commonwealth and the government of the United States of America were to be lifted in light of the progress made towards the restoration of democratic government and respect for human rights. The Nigerian government in its transition to democracy was applauded for its establishment of the Independent National Electoral Commission and the issuance of a detailed timetable for the election process. Overall, the UN General Assembly was satisfied with the progress of the Nigerian government in its transition to democracy. Nigeria has seen some very turbulent times in its history as it relates to democracy and human rights. Democracy consolidation, which appears to be the most immediate challenge for the human rights movement in post transition Nigeria, will require forward thinking and cohesive action on the part of the human rights community. It has been clearly demonstrated that in Africa relatively free and fair elections observed by international monitor and elaborate â€Å"handing over ceremonies† will not necessarily bring about genuine democracy and a human rights culture. Civil society organizations will have to work gradually to expand the democratic space and rebuild the institutions of civil society. The long years of military dictatorship have decimated these institutions and virtually erased the rule of law according to AFRONET Reports. Though politicians glibly vocalize democratic jargon, it is still evident that democratic values and attitudes are not yet commonplace in the political class. Also, among ordinary Nigerians, popular mentalities need to change; the people have become accustomed to not expecting anything but the worst from their leaders in terms of political leadership, economic management and respect for civil liberties and human dignity. The average Nigerian has been driven by economic hardship to adopt a survivalist mode of life in which he or she is preoccupied with access to the bare necessities of life and does not demand or expect accountability or respect for human rights from their leaders. The Nigerian government, though its history is not favorable, is making sincere efforts to overwrite its history. But unless the human rights community and the people they represent adopt a more positive attitude towards its government, change can not be realized.

Active Audiences & the Construction of Meaning

Active Audiences & the Construction of Meaning â€Å"Media messages are central to everyday lives†¦ Audiences are active interpreters of meaning. † â€Å"Audiences interpret media in diverse ways. †(255-256). People in the media industry believe that the audience is a mass of passive readers who accept media messages uncritically.Nevertheless, the audiences actively take part in the interpretation of media texts which is an essential process when media messages start meaning something to people who assign their own implication to the texts. Sometimes audiences can interpret the message in the same way as intended by the producers, but sometimes they construct meaning that is very different. People interpret media texts in all types of social settings. Therefore, media has become a significant part of the social life.Since audiences are active receivers of media texts, they can change media messages by collective action such as prohibition of certain media texts, ca mpaigns that show audiences’ disapproval of media products, public writing of letters of complaint regarding media, foundation of independent media that criticize main media but also supply audiences with alternative perspectives. Audiences from different races, ethnicities, genders and social classes construct various interpretations of the same media message.So, media texts are characterized by polysemy, they have multiple meanings. According to John Fiske (1986) there is abundance of meaning embedded in the media texts. Therefore, media messages are structured in a way that enables people to make different readings and interpret them actively, not simply to accept the dominant interpretation. People have agency but there is no structure. However, people from different social backgrounds construct various interpretations of same media texts. Social statuses shape audience members’ viewpoints, interests and attitudes towards media.As a result, people must be aware of their agency- the opportunity to construct meaning- and of the social constraints as well. People often construct interpretation that is based on widely accepted norms, values and beliefs about the world around us. According to Stuart Hall’s encoding-decoding model messages are constructed on the basis of specific â€Å"codes†, encoded by the producers and decoded by the active audience. To decode the media texts, audiences have to know the basic medium conventions and cultural values.Since media messages draw on some taken-for-granted beliefs and cultural codes, the audience uses its knowledge about them to construct meaning and decode the media texts. This factor hinders us from being fully autonomist. Active audiences use media for diverse reasons and construct different interpretations but the big corporations will always be there to nudge us in certain directions. Fortunately, people like me will often refuse to accept the preferred meaning and develop oppositiona l reading and resistance, which are related to social action.Audiences’ oppositional decoding is part of the resistance to the traditional roles and rules. People are suppose to use media to relax, fantasize and escape from the social reality or solve some problems and live in harmony not to be subliminally attacked by producer beliefs. Some people experience ‘pleasure of resistance’ by making interpretations opposing to the dominant meanings. Overall there will always be a give and take between the media and the people, what we have to remember is we can have control over these media influence as long as we can take a step back and acknowledge their presence.

Establish the topic from the paper Essay Example | Topics and Well Written Essays - 1250 words - 1

Establish the topic from the paper - Essay Example There have been numerous comparisons made of the Federalist Papers to Locke’s theories and also interpretational differences with the Publius political theory by religious groups such as the Muslims. According to Locke’s initiative, an ideal government has as its foundation the natural rights, dignity, and of course unlimited ownership. Self-interest is a dominant trait of political liberalism as people naturally must respect their individual rights while safeguarding the rights of others. The society as a whole must operate according to its needs and not answer to a system modeled on the divine right of kings and queens. Societies, and therefore, governments are best when they become a natural unfolding of the principle of together we stand, divided we fall. Locke deems that a person can give up their right to live by dedication to a cause such as war but property itself cannot be so easily sacrificed since mortality is abstract and property is tangible and acquired as the right of each individual. In short, a governing body can take lives for defense of a system but possessions, such as land, is not under their realm of jurisdiction. The immutable standard of right is contained in a natural state of morality. Morality, in the state of nature, according to Locke, displays no subordination to a ruling dynamic but relies on a natural state of human customs, habits, and most notably, a universal law entombed within the natural human faculty of reasoning. Locke attributes this instinctual inclination of people as a logical avenue of expansion of life in sync with nature. A community consists of a conscientiously guided network, not by rules of compulsion or tyranny, but through the inherent dignity of entitlement scorning superiority. The ultimate standard of a natural state of morality recognizes the sanctity of life through the collective judgment of good or bad behavior or conduct in consideration of all humans.. Society, when striped of all adorn ments, is fundamentally a contract that unites humanity in order to protect their investments, with property ownership being the paramount source of concern. As a community, humankind begins to accumulate more land and more possessions, thereby creating a bona fide and dire need for the protection of these very things. Without a law that is capable of fairly regulating the action of all, society is left open to the corrupted ascendancy of the violation of natural rights. Locke’s society provides the rights, laws, and codes of behavior acceptable to curtail any tresspassing on the people’s perogative to sidestep violence and war. Locke’s ideology of equality adventageouly contributes to society but omits to consider those that are not landowners. Such unfortunates are protected by the rules of the government but their privledges and voice in such matters is diminished. The stability of a society is the strongest indication of a successful centralized authority th at protects the rights and privileges of landowners from arbitrary seizure of possessions. The creation of a division of authority strengthens the checks and balances system on government power over the people. The proper role of people in this manmade law of just, peaceful and protected existence depends on the basic need of interaction and general agreement between each other. The appropriate conduct of people in a society is to take the responsibilities and the duties along with the benefits

2000 word research paper on potential career paths Essay

2000 word research paper on potential career paths - Essay Example The network of IT services provided by Bremmar Consulting is not restricted to Western Australia alone but extends across Australia as well as other countries of the world. Bremmar Consulting offers advanced technological services which equip the customers with the right firepower to compete in the cutthroat world of business. Bremmar Consulting is committed to help its customers accomplish their business goals by providing the best IT support and IT management. The firm takes care of every minute detail leaving the customer totally focus on his business. Bremmar Consulting is a small organization with fifteen staff members in its Perth office. The firm hires only the best engineers for its project management who are qualified Microsoft Certified Professional with a working experience of at least five years in the IT industry. The qualified team of engineers is capable of completing the project on time, within the budget allocated and to the satisfaction of the customers. It specializes in consulting, network administration, installation and repair and technical assistance. Although a small firm, Bremmar has a list of satisfied clients. It provides custom-made IT management and IT support to its customers. Bremmar appoints a three member team which efficiently monitors the client’s entire IT environment round the clock. The three members’ team provides phone, remote and on-site IT support. Incase of an emergency, the team appointed is quick to respond as per the response time agreed in the service contract. This close surveillance enables the dedicated Bremmar staff to identify any problem even before it becomes noticeable; the spot-on problem identification ensures flawless and uninterruptible operation of the working environment of the customer. The team also provides detailed report including the causes of trouble, steps taken to resolve the issue and who requested the work. Bremmar Consulting also provides the customers with

THE EFFECTIVENESS OF FOCUS ON FORM IN L2 LEARNERS' CLASSROOM Essay

THE EFFECTIVENESS OF FOCUS ON FORM IN L2 LEARNERS' CLASSROOM - Essay Example Thus, recasting is perfect for classroom use and is often applied by teachers to see the degree of production reached by their student (Loewn & Philp). However, there is an alternative view to this mode of teaching. Critic Lyster feels recasts to be an ineffective form of teaching (2001). This claim lays on the idea that the other forms of feedback make a more impressive difference. This is because recasts are unable to prove the difference they make. Recasts in their own form are indefinite in showing he progress that is obtained from being used. The advantage of recasts is their similarity to different types of corrective methods used to L2 learning. This makes 50% of the results used by this form prove to be of great benefit to any learner. Recasts take up different forms. Each form has different characteristics which help determine the effectiveness of its model. The success of this form is evident in the help it provides to the learner and the use of this form. Thus, despite the overriding criticism, this essay will move to prove the different types of recasts and the methods that can be employed to make it a very effective form of learning. Research: including theoretical articles and reviews on this form of study have found support that a linguistic form of teaching adds to the communication that focuses solely on creating meaning and is thus of great help in the classroom (Doughty & Williams). Greater emphasis is laid for focus on form because it allows the student to learn from mistakes that arise in linguistics instead of paying too much attention to meaning and communication (Long 2002). This allows a natural flow in the class as it allows the student to learn from their mistakes instead of focusing on a specific and particular way of teaching. This is known as response moves and allows the student to decipher their own error in the words they make. van Lier considers this form of recast to be present in the

Automotive Assignment Example | Topics and Well Written Essays - 1500 words - 1

Automotive - Assignment Example The rate of motor vehicles deregistration stands at 20% yearly. However, the owners of the abandoned motor vehicles are not easily traced. The New Zealand authorities always try to locate the owners of the abandoned vehicles. Their search at times pays. The authorities are able to locate about 35% of the abandoned car owner. However, this rate is minimal compared to the rate of vehicles which are being abandoned yearly (Kenny, 2001). New Zealand had a total of 1.5 million passengers’ cars in the year 1986. This number considerably increased to 2.5 million in the year 2004. The approximated value of used cars that are being imported to the country stands at 70%. Most of these used cars are abandoned by their owners on both private and public properties. The abandonment of these used cars possessed a lot of environmental concerns. This has prompted the motor vehicle industry to come up with policies that reduce the pollution caused. Some of these policies are removal of operating fluids, battery, LPG tanks, tires, CFCs present in the air conditioning units, and defusing of air bags and seat-belts. New Zealand authorities therefore, need to benchmark with Western Europe countries so as to solve their motor vehicle abandonment practices. This is because Western Europe currently leads the world in the management of used motor vehicles. Some of the laid down approaches for proper motor vehicle management are th e use of the EU Directive. This directive on motor vehicles was adopted in the year 2000 (Cassells, 2004). EU directive takes into consideration the extended manufacturer responsibility. The directive has also set reuse and various recovery targets. The success of this directive cannot be easily determined at the moment. However, other member countries like the Netherlands and Germany has taken the lead in the implementation of this policy. These two countries have successfully been able to recycle used motor vehicles within their territory. Sweden being

Managerial Financial Resources and Decisions Research Paper

Managerial Financial Resources and Decisions - Research Paper Example Certain debt agreements impose business restrictions. These restrictions may impair the firm's borrowing abilities C) Appropriate sources Though Wal- Mart Stroes Inc. is properly appropriately financed at present financed with as most of its finance has come through equity contributions. It is low geared company as its debt equity ratio is 0.60. That company may not be playing on gearing but the equity holders are in control with the affairs of the company. Further financing can be raised though debts in case the company intend to take advantage of the gearing. However, at present the company is appropriately financed. Question No. 2 a) Cost of different sources of funds; Costs of Public Issue Costs of Public issue depend upon the size of issue and the level of marketing adopted. The important expenses normally incurred for a public issue are as under: Underwriting expense, Brokerage, Fee to the mangers to the issues, Fee to the Registrars to the issue, Printing Expenses, Courier and Postage expenses, Advertising and Publicity Expenses, Listing fee, and Stamp duty. Public offer of debt The mechanisms for a public offer of a debt security are much the same as that of a public offer of equity. But a debt issue cannot be made unless credit rating from a credit rating agency is obtained and disclosed in the offer document. So rating agency's cost is in addition to cost of public issue Obtaining term loan This is perhaps the cheapest source o obtaining long term finance, as generally the dealings between company and the financial institution providing the loan do not invite costs of the type involved in public issues. However, the company has to pay for professional for obtaining feasibility and other reports. b) Importance of... The mechanisms for a public offer of a debt security are much the same as that of a public offer of equity. But a debt issue cannot be made unless credit rating from a credit rating agency is obtained and disclosed in the offer document. So rating agency's cost is in addition to cost of public issue This is perhaps the cheapest source o obtaining long term finance, as generally the dealings between company and the financial institution providing the loan do not invite costs of the type involved in public issues. However, the company has to pay for professional for obtaining feasibility and other reports. Financial planning is part of a larger planning system in the firm. The planning process begins with a statement of the firm's goal or mission, which is usually stated in qualitative terms. From the mission of the firm, the strategy is derived which defines the products or services the firm will produce and markets it will serve. To support the strategy, policies and budgets are developed in various areas such as research and development, production, marketing, personnel, and finance. A financial planning represents a blue print of what a firm purposes to do in future. Financial planning have generally the following elements: 3.

Research design Essay Example | Topics and Well Written Essays - 1750 words

Research design - Essay Example Implication to professional application is included. RCT potentially prevents bias and reduces confounding Dauphin et al. (1999) were able to come up a significant result concering the bias and precision in visual analogue series (VAS) while successfully employing the RCT. In this study, they were able to investigate the characteristics of VAS especially in the measurement of symptoms’ intensity or frequency. Prior to finding this, the research investigation included study samples under a prevention trial involving supplementation by antioxidant vitamins and minerals of respondents who were 35-61 years gathered from the general population in France. There was inclusion of randomisation from samples prior to investigating the actual point of the study. the same process was initiated during the first and second trials. This means that the actual general data were assumed to represent the entire information obtained from the entire samples. This is a remarkable strength of the st udy because this will eventually reflect on the kind of data that will be used for the VAS. Thus, the study of Dauphin et al reflects the actual framework involved in RCT research design. The RCT in general is trying to create an inference of a particular intervention by randomly employing samples from the entire study sample from a population that should therefore be randomly identified as the treatment or intervention groups and control groups respectively (Bonita et al., 2006, p.50). Below is the actual diagram or framework showcasing the general flow involved in the RCT research design (Evidenced-Based Dentistry, 2013). One important strength in employing RCT as found in the study of Dauphin et al. (1999) is the presence of consistent result, as depicted by the... In some clinical studies, researchers may be looking forward to a specific treatment response of some certain illnesses to a given drug. In this reason, they may be able to compare treatment groups with control groups not receiving the medication. In employing a particular clinical study, the reliability of a certain drug may be proven effective or not because of the associated empirical evidence that one could generate thru the employed research design. Furthermore, there are some studies that would require precise measurement of the actual empirical evidence, so minimising the allocation of bias and other predictive factors has become necessary. One of the most important drawbacks in some studies is the inclusion of probable bias especially in generating data prior to the actual analysis and presentation of results. There are many statistical methods that could try to prevent this from influencing the reliability of the study. However, one common logical approach in statistics is to initiate random trials in response to selecting or acquiring of data. The RCT has relevant advantages and weaknesses, but the bottom line boils down to the skills of the users on how they should properly initiate the research design including its associated process. The RCT is so powerful research design for as long as it tries to represent a general idea about the impact of a certain prevention or treatments applied in a certain population. As a result, it could help determine a generalise conclusion of the general case. Although individual cases cannot be entirely determined, the RCT still proves to be an efficient research design that could be freely integrated within the clinical studies especially in ensuring precision of results and warding off probable bias.

Trisomy 18 Essay Example | Topics and Well Written Essays - 1750 words

Trisomy 18 - Essay Example The incidence of the condition during first trimester scanning is 1 in 400 (Chen, Emedicine). There is a strong female predominance with more than 80 percent of the detected cases being females. The condition does not have any racial predilection(Chen, Emedicine). 95 percent of pregnancies with trisomy 18 embryos spontaneously abort. Of the remaining which are born, only 5-10 percent survive beyond the first year of life. Thus, the mortality rate of this condition is very high. The mortality rate is because of the severely malformed organs like the heart, kidney and the brain, feeding problems, high rates of infection and breathing difficulties. The longest survival reported for this condition so far is 27 years (Chen, Emedicine). The condition is detectable in the prenatal period. Some of the features which point to the possibility of trisomy 18 are maternal polyhydramnios or oligohydramnios, very small placenta, single umbilical artery, intrauterine growth retardation, fetal distress, defective fetal reflexes and decreased fetal activity. In the postnatal period, the clinical condition is obvious because of the array of clinical features. The new born usually has generalized hypotonia, apnea, jitteriness and seizures. The child will have marked failure to thrive, recurrent apnoiec episodes and poor feeding (Chen, Emedicine). On examination several organ defects will be obvious. The child may have defects of the skull manifesting as microcephaly, wide fontanellaes, prominent occiput, elongated skull or even narrow bifrontal diameter. Facial deformities include microphthalmia, micrognathia, microstomia, short palpebral fissures, epicanthal folds, choanal atresia, periauricular tags, and narrow palatal arch. S evere skeletal deformities exist including growth retardation, radial hypoplasia, clenched hands, syndactyly, rocker bottom feet, narrow pelvis, talipes equinovarus, etc. Typical of the clenched fingers include "overlapping digits, with the second and

Visualizing and Inferring Research Paper Example | Topics and Well Written Essays - 500 words

Visualizing and Inferring - Research Paper Example This comparison helps in understanding the dimensions with regard to the magnitude and time in a much better way as the five senses are put to task (Yopp & Yopp, 2001). For instance, the use of close texts where one has to think using the clue and prior personal encounter to arrive at an appropriate word missing in a passage before they can be provided with the opportunity to check against their choice. A teacher reading a comprehension or even a poem while the students listen to important details aids the students to use the self questioning to eliminate what is key from the rest of the text by having to think harder, paying keen attention to what is being read and even asking to be reread for an area they feel they missed out (Burmark, 2002). They try to visualize and relate the text to others, they have read before (Harvey & Goudvis, 2000). They read the text and look for new information learnt and what they intend to know before they create a map of concepts for further investigations. The texts sink into the students’ minds through the aid of illustration. This can be achieved through the use of charts, pictures, discussions, drawings and other visual images. These ease the complicated texts and enable the students to organize the information obtain in an understandable manner (Burmark, 2002). The use of adjectives in a large text accompanied by vivid description brings clarity in the memory of the students as they read through. Discussion of the text creates a unique understanding of the topic as one gets clarification from other students as well as the teacher, concerning the theme of the text and distinguishing it from the plot. The student gets the opportunity to ask questions about unclear concepts or marked during the reading period. Note taking accompanied by real life examples help students draw the picture of what they visualise and can trace a place in the

Background check of hiring employee Essay Example for Free

Background check of hiring employee Essay In nowadays, background check of hiring employee is practicing by almost all agencies. Point is that, the skills of the applicant can be, somehow, figured out. It is much more difficult to assess the level of trust, honesty, mental toughness, and loyalty. Reading through chapter 9, and conducting a slight research, my answers to the questions of the given scenario are as follows: 1.Do temporary agencies have a â€Å"duty† to run background checks? If so, did Robert half â€Å"breach that duty?† Why or Why not? According to the law of negligence, temporary agencies should follow the duty policy on background check on pre-employment, in order not to satisfy an element of negligence. In case of Robert Half International Inc., and Fox Associates, Inc., I don’t think, that duty was breached, the company trusted to provided information by Ms. Ross about herself, and she got good recommendations from her former employers. At some extend, it is a background check. 2.The court ruled against Fox Associates. Was the court correct? Do you think Fox should have done its own background check? Why or Why not? I agree with the court decision, that it was determined that duty is not breached, because it happened unknowingly. Even though the company recommended the employee, Fox could do its own background check as well. 3.The fact pattern mentions that Sunbeam suffered similar damages when it failed to do its own background check on Mr. Dunlap, its former CEO. Who was more at fault, Sunbeam or the Executive search agency? In this case, the fault has an Executive search agency more, than Sunbeam, as it its straight duty to check background before approve for hiring. However, Sunbeam is liable for its losses also, because it should request and check the information about hiring employer. 4.Strategically and legally speaking, why do you think the former employers said nothing about Ms. Ross’ history and gave her good recommendations? There could be some reasons: 1). the former employers might feel sympathetic towards Ms. Ross, and they don’t believe that she has stolen any funds; 2) Ms. Ross, indeed a good specialist in her field; and the last 3) The former employers just didn’t tell the truth. 5.Develop one  unique background check policies for your company on employees hired through a search firm or temp agency. The main idea on background check which I’d like to develop, besides gathering information, confirmation of address, criminal records searches, is that pre-employee will answer some â€Å"simple† questions, which will ask him/her the same, but in different manner, and maybe I would add some psychological tests, which will let me know if that employee was capable to do something unethical in his past work experience.

Intervention to Reduce Progression of Diabetes

Intervention to Reduce Progression of Diabetes Developing an Intervention to Reduce Progression and the Development of Complications from Diabetes Mellitus in Adults in Glasgow. Introduction Type 2 diabetes is a serious medical condition that is increasingly prevalent in developed countries (International Diabetes Federation, 2013) and the most common variants of the condition are Types I and II. Type I patients have a deficiency in their pancreatic beta cells which leaves them unable to produce insulin. Thus in these individuals, some control over the condition can be achieved using insulin therapy (Schilling, 2007). Type II diabetics, have cells that have become resistant to the effects of insulin resulting in a delayed reduction in blood glucose (Skrha et al., 2010). There are additional types of diabetes; gestational, and a variety of Type III diabetes, however, the overwhelming majority of cases are of Type II with a significant minority of type I cases (Hardt et al., 2008). Complications of Diabetes Regardless of the underlying aetiology, the long-term complications of diabetes are similar. Excess blood glucose is thought to drive increases in oxidative stress both directly and via the derangement of mitochondrial energy pathways (Cade, 2008). Long term macrovascular damage will inevitably increase the risk of coronary heart disease (CHD), and ischaemic heart disease, with diabetics estimated as having a 3 and 5-fold increased risk of CHD mortality for men and women respectively (Loveman et al., 2008). Cerebrovascular disease is also a consequence of the chronic macrovascular damage with similar increases in stroke risk (Naci et al., 2015) Since each organ has its own microvascular supply, chronic hyperglycaemia also results in diffuse and widespread damage to a variety of body organs. As a result, diabetic complications include visual disability due to diabetic retinopathy; the leading cause of blindness in working age adults in the UK (Fowler, 2008; Kempen et al., 2004). In addition, patients suffer end stage renal disease from diabetic nephropathy (Adler et al., 2003), diffuse impairments of autonomic and somatic neural function, including pain perception, due to diabetic neuropathy (Stirban, 2014; Voulgari et al., 2013). Furthermore, the combination of microvascular damage, and reduced pain sensation, usually in the lower limb, results in many patients developing ulceration and necrosis of the inferior surface of the foot, the most common cause of non-traumatic amputations in the UK (Elraiyah et al., 2016). Costs of Diabetes In addition to the significant cost to the individual suffering with diabetes in terms of reduced personal health and quality of life, there are significant financial costs in treating the condition. In 2010-11, the total cost of diabetes to the UK was estimated at  £23.7bn (Hex et al., 2012). This was comprised of  £9.8bn in direct costs related to treating the disease, and  £13.9bn in indirect cost (e.g. lost productivity through absenteeism, early retirement or unemployment, (Hex et al., 2012)). More recently, the direct costs were estimated at  £13.7bn in 2012 (Kanavos et al., 2012). Within these direct costs, only around a quarter is directly spent on treating diabetes its self, and the remaining three quarters is spent on treating the complications following from the disease, (e.g. CHD, retinopathy, liver failure, diabetic foot, neuropathy (Kanavos et al., 2012)). Risk Factors for Diabetes There are a variety of factors that have been identified that places individuals at risk of developing type II diabetes, these include; having a family history of diabetes, obesity assessed using body-mass index, hypertension, visceral adiposity, adverse blood lipids, smoking, and impaired fasting glucose control (Lyssenko et al., 2008). Notably, several of these risk factors, including blood lipids, BMI, hypertension and visceral adiposity, are shared risk factors for CHD, which may in part explain the elevated risk of CHD in diabetics (Haffner et al., 1998). Indeed the clustering of these risk factors has been shown to be predictive of both CHD and diabetes (Haffner et al., 1998) and are collectively referred to as the metabolic syndrome. Moreover, these risk factors, appear to primarily be related to obesity in general, and excessive visceral adiposity in particular (Wozniak et al., 2009). Early work by West and colleagues (1978) demonstrated a strong positive association between rates of obesity and rates of diabetes with a variety of populations. Since then, the epidemiological link between excess body fat and risk of developing type II diabetes in particular has been repeatedly supported. For example, in the Nurses Health Study (Chan et al., 1994) females who had a BMI of greater than 35 kg.m-2 had a risk of diabetes 95 fold higher than those with a BMI of less than 21 kg.m-2 . Epidemiology of Diabetes The incidence and prevalence of diabetes have increased dramatically in the last two decades. Currently, the World Health Organisation estimates that diabetes effects around 9% of the adult global population (International Diabetes Federation, 2013) with variations in prevalence ranging from 26.4% in Kiribati to 1.54% of the population in Manin (International Diabetes Federation, 2013). Overall the UK ranks relatively favourably; in the same data from 2014, the UK had a prevalence of 3.9% (172nd out of 193 countries). Despite this relatively low ranking, the UK, in line with many developed countries, has experienced a rapid growth in the proportion of the population suffering with diabetes. Between 2007 and 2015 the number of patients diagnosed with diabetes increased by 75% from two to three and a half million cases (Diabetes UK, 2015). There are also an estimated half a million undiagnosed individuals at any one time. Indeed, the absence of overt symptoms in the early stages of the disease means that it is not uncommon for patients to have had the disease for several years prior to diagnosis, and confounds attempts to accurately calculate prevalence rates. Scotland has experienced similar increases, with the number of individuals diagnosed with diabetes increasing markedly over the last decade. The Scottish Diabetes survey (2014) demonstrated that the number of individuals with diabetes doubled from approximately 100,000 to 200,000 individuals between 2002 and 2007 despite a stable population of 5 million. Currently estimates for Scotland indicate that there are 276,500 diabetics in Scotland resulting in an overall prevalence that is a third higher than the UK average at 5.2% (NHS Scotland, 2014). Diabetes and Deprivation While the reasons that link indices of deprivation to diabetes are likely multifactorial, they undoubtedly exist. Individuals living in the most deprived areas of the UK are 2.5 times more likely to suffer from diabetes than those in the least deprived areas (Diabetes UK, 2006). Moreover the complications arising from diabetes such as CHD and stroke are more than three times higher in the lowest socio-economic groups and those with lowest educational achievement are twice as likely to have heart disease, retinopathy and poor diabetic control (Diabetes UK, 2006; International Diabetes Federation, 2006). The cause of the increased risk is not clear, however many of the risk factors such as obesity, smoking and physical inactivity, are also higher in those areas with the greatest degree of deprivation (Diabetes UK, 2006; International Diabetes Federation, 2006). From the data outlined above, the development of diabetes is a serious chronic medical condition that can result in early morbidity and mortality and is associated with significant personal and healthcare costs. Despite many of the risk factors for its development being modifiable, it remains a significant and increasing health risk that has a disproportional focus on the areas of greatest deprivation. Given that there is strong evidence that Glasgow has higher rates of both deprivation and type 2 diabetes than the rest of the UK, the aims of this paper are to discuss methods of describing the degree of the problem in Glasgow, as well as identifying, implementing and evaluating initiatives designed to reduce the burden of Type 2 diabetes within that area. Epidemiological Investigation of Diabetes in Glasgow The Centre for Disease Control defines public health research as consisting of four phases, public health tracking, public health research, health intervention programmes, and impact and evaluation (CDC, 2015). Thus before designing and implementing a diabetes focused health initiative, it is necessary to first establish that there is a public health need within Glasgow. This can be undertaken using primary or secondary data sources. Although secondary data sources are repositories of data that have been collected for some purpose other than the investigators main research question, Bailey et al. (2012) suggest that secondary sources also have several advantages. Typically, they are large data sets, and their use is highly cost efficient, as the data collection has already taken place. In terms of this investigation into Diabetes prevalence in Glasgow, there are a number of possible secondary data sources. The most directly relevant data is from the Scottish Diabetes Survey, the most recent data for which covers 2014 (NHS Scotland, 2014). In the most recent report, there is evidence that diabetes is a specific public health concern in Glasgow. For example, while it is not surprising is that Glasgow has the highest number of diabetics, around 22% of Scotlands diabetic population, since it is also the most densely populated region. However, this also translates to the region having the highest age adjusted prevalen ce of diabetes within Scotland at 5.8%. Furthermore the Greater Glasgow and Clyde (GGC) NHS board is criticised as falling behind other NHS health boards within Scotland, in its system of managing and screening its diabetic population in order to limit the progression of the disease. In addition, the Scottish Public Health Observatory (SPHO) provide a number of secondary data sources which may be valuable in triangulating conclusions and include; mortality rates, primary care information from GP practices, the Quality Outcomes Framework (QOF) detailing the performance of GP practices in dealing with key health issues, the Scottish Diet and Nutrition Survey, and the Health Education population survey (Scottish Public Health Observatory, 2015). In addition, both English and Scottish governments produce databases of indices of multiple deprivation (IMD), which can be useful when attempting to standardise the degree of a public health issue by deprivation level. This secondary data should be supported with primary evidence of the population of interest. While there are a number of research designs that could be used to collect primary data on Glasgow residents with diabetes, in this instance a cross-sectional observational design would be most useful. This method has several advantages, it is cost effective, requires only a single group, and each participant is only required to be assessed at a single time-point. This means that it becomes feasible to assess relatively large numbers of people (Bailey Handu, 2012). The limitations of this method are that it represents a single point in time and as a result, cannot be used to determine the sequence of events for a given set of exposures and outcomes. Therefore, it is not possible to infer causality from cross-sectional data. This type of research is most useful for determining prevalence rates for a specific condition (Bailey Handu, 2012).. An ecological study design might also be used, however, in this case, there are wide variations in income levels and deprivation levels within specific postcodes. Thus the possibility for the data to be affected by unknown confounding variables is significant. Similarly a case control study design has some additional control regarding possible confounders, but is again limited in being retrospective in nature and is predominantly used for rare diseases, which type 2 diabetes is not (Greenfield, 2002). Experimental designs such as prospective cohort studies or randomised control trials are the most internally valid designs to attribute causation of a condition to a specific exposure. However, they would not be appropriate in this instance, as they time consuming, expensive, and typically include far fewer individuals. Thus in order to use this type of study, the cost would be greater than the cost of any proposed intervention. In addition, while such designs are internally valid, they often lack ecological validity. That is, while the exposure and outcome can be linked in the study, at the population level, individuals may experience exposure to several predicating factors, and several protective factors. Thus, it is not always straightforward to transfer the findings from a highly controlled study to individuals (Peat et al., 2008). In order to undertake the cross-sectional survey, would require defining a series of areas (e.g. roads or school catchment areas) within specific post-codes to act as the sample frame. The survey data would be collected on these areas. The main problem with collecting this kind of data is a low response rate (Levin, 2006), and the possibility that individuals may responder or not due to the influence of some other factor introducing some systematic bias into the data. The main protection from this is to maximise the response rates. This is best done using face-to-face interviews with individuals in the sample frame (Levin, 2006). Diabetes Interventions The evidence for the type of behaviours that are useful in limiting the adverse complications of diabetes, have been the subject of several large scale epidemiological studies. In the UK the UK Prospective Diabetes Study (UK Prospective Diabetes Study, 1998) and its 10 year follow up (Holman et al., 2008) evaluated the effect of managing type II diabetes through diet alone, versus aggressive management aimed at restricting blood sugar concentrations. The data from the study indicated that while both the aggressive intervention only lowered blood sugar for one year, this translated into significantly lower rates of complications at the 10-year follow up. In the US, the Diabetes Control and Complications Trial (DCCT, 1993) and its 10 year follow up (the Epidemiology of Diabetes Interventions and Complications EDIC (Nathan et al., 2005)) also demonstrated that limiting increases in blood sugar, by maintaining concentrations within strict individualised limits, reduced the incidence of c omplications at the 10 year follow up by 57%. Similar reductions in adverse outcomes have also been found when diabetics have measures of blood lipids, blood pressure, nephropathy, retinopathy and diabetic foot complications assessed at regular intervals. It is also noteworthy that the Greater Glasgow and Clyde NHS region regularly performed in the lowest quartile of Scottish NHS authorities for implementing each of these evaluations (Scottish Diabetes Survey 2014). In long-term conditions such as Type 2 diabetes, the most appropriate strategies to control and manage the condition is for patients, to recognise themselves as stakeholders in their own treatment and to take ownership of the critical aspects of their care such as pharmacological treatment, dietary modifications and physical activity recommendations (National Institute for Health and Care Excellence, 2015). There have been several interventions that have aimed to use patient education to allow for a greater degree of self-management with a resulting closer control of risk factors for diabetic complications. Most recently Minet et al. (2010) evaluated the efficacy of 47 RCT studies aimed at improving diabetic patient education, and found that there was a significant reduction in the degree of hyperglycaemia experienced by the patients at the 6 and 12 month follow up time points. Similar meta analyses have supported the role of education in reducing the incidence of nephropathy and dia betic foot (Elraiyah et al., 2016; Loveman et al., 2008). Given that the UKPDS (1998) demonstrated that even short term reductions in blood glucose can reduce the numbers of patients who progress to sever complications, and given that the majority of the financial burden in treating type 2 diabetes is related to complications rather than the disease its-self. It seems clear that patient education could significantly improve the prognosis of diabetics as well as reduce the costs of future treatment. Implementing an Intervention in Glasgow Having identified a suitable educational intervention, the next stage is to ensure its faithful and appropriate replication within patients with Diabetes in Glasgow. A limitation of much of the available research is that interventions are predominantly applied in academic settings, and the effectiveness of interventions in community and primary care settings are frequently lower than anticipated from the scientific literature. This is a continuing challenge for implementing evidence-based strategies for public health issues. Kilbourne et al. (2007) recommend the REP framework, which although originally devised for faithful implementations of HIV educational programmes has been evaluated and found to help improve the effectiveness of other public health interventions. In order to use the REP framework for educational programmes aimed at Diabetics in Glasgow, the four stages of the REP framework would be developed. Pre-condition requires the identification of a suitable educational intervention. In this phase it is important that the chosen intervention is both feasible and appropriate for the setting in which it will be used. Pre-implementation requires that all staff involved in the intervention undergo training not only in the interventional educational curriculum, but also in the underpinning theories that shaped the original intervention. Implementation requires the educational programme is rolled out to diabetics within Glasgow, and that feedback is sought from stakeholders including patients undergoing the education. In this way it is possible to modify the intervention to better fit the situation, while still remaining faithful to the initial conceptual design. Finally, maintenance and evaluation requires further feedback regarding the effe ctiveness of the intervention, as well as ongoing support for partners who are delivering or helping ensure the continuation of the intervention. Monitoring an Evaluation For the proposed educational intervention, the evaluation would use the RE-AIM framework. This is the most widely adopted model for evaluation of public health interventions originally proposed by Glasgow and Colleagues (1999). This framework proposes the evaluation of five key elements of the intervention. Reach assess the number of individuals from the target population who received the interventions. Efficacy evaluates the degree to which the education intervention improved patients ability to manage their condition (e.g. better control of blood glucose, maintained or lowered blood pressure). Adoption would focus on the number of patients receiving the educational intervention whose behaviour was altered as a result. Implementation attempts to assess the degree to which the intervention was faithful to the evidence base upon which it was designed or was there pragmatic or other issues that meant the interventions was poorly delivered, or delivered in a manner not originally envisa ged. Maintenance attempts to quantify the degree to which the intervention becomes self-sustaining. This can be at an institutional level, i.e. does the health authority feel the programme is sufficiently successful to continue its development. However, it can also be at the individual level, were patients value the intervention and it becomes part of the persons habitual processes. Conclusion The aim of this paper was to investigate an intervention aimed at reducing the complications of type 2 diabetes in individuals diagnosed with the condition, living in Glasgow. It has established that in order to implement any such strategy, it is necessary to evaluate the degree of the problem using secondary and if required primary sources of data. In addition, any intervention should be evidence based, and attempt to replicate those interventions that have been demonstrated to be successful. This should be attempted in a strategic and structured manner in order to ensure high fidelity conversion from research evidence to intervention. The intervention its-self needs robust evaluation to determine if it was effective, and if not was it because of a failure of the underpinning theories or a failure in delivery. Unless they are well managed, individuals with Type 2 diabetes are at a significant risk of serious and life threatening complications. Educational interventions may be one wa y to provide effective strategies to enable better outcomes and reduced personal and financial costs. References ADLER, A.I., et al., 2003. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney International. 63(1), pp. 225-232. BAILEY, S. and HANDU, D., 2012. Introduction to epidemiologic research methods in public health practice. Jones Bartlett Publishers. CADE, W.T., 2008. Diabetes-related microvascular and macrovascular diseases in the physical therapy setting. Physical Therapy. 88(11), pp. 1322-1335. CDC. 2015. Public Health Cycle [Online]. [Viewed 4th April 2016]. Available From: http://www.cdc.gov/ncbddd/hearingloss/publichealth.html. CHAN, J. M., RIMM, E. B. COLDITZ, G. A. 1994. Weight gain as a risk factor for clinical diabetes mellitus in women. Diabetes Care, 17, 961-9. DIABETES CONTROL AND COMLICATION TRIAL RESERCH GROUP, 1993. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl j Med. 329(14), pp. 977-986. DIABETES UK 2006. Diabetes and the disadvantaged: reducing health inequalities in the UK World Diabetes Day 14 November 2006. A report by the All Parliamentary Group for Diabetes and Diabetes UK. https://www.diabetes.org.uk/Documents/Reports/Diabetes_disadvantaged_Nov2006.pdf. DIABETES UK. 2015. Diabetes Facts and Stats November 2015 [Online]. [Viewed 20th March 2016]. Available From: https://www.diabetes.org.uk/Documents/Position statements/Diabetes UK Facts and Stats_Dec 2015.pdf. ELRAIYAH, T., et al., 2016. A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. Journal of Vascular Surgery. 63(2), pp. 46S-58S. e2. FOWLER, M.J., 2008. Microvascular and macrovascular complications of diabetes. Clinical Diabetes. 26(2), pp. 77-82. GLASGOW, R.E., VOGT, T.M. and BOLES, S.M., 1999. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American Journal of Public Health. 89(9), pp. 1322-1327. GREENFIELD, T. 2002. Research Methods for Postgraduates, London, Arnold. HAFFNER, S.M., et al., 1998. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. New England Journal of Medicine. 339(4), pp. 229-234. HANLON, P., et al., 2005. Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a Scottish Effect. Journal of Public Health (Oxford, England). 27(2), pp. 199-204. HARDT, P.D., BRENDEL, M.D., KLOER, H.U. and BRETZEL, R.G., 2008. Is pancreatic diabetes (type 3c diabetes) underdiagnosed and misdiagnosed?. Diabetes Care. 31 Suppl 2 pp. S165-9. HEX, N., et al., 2012. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabetic Medicine. 29(7), pp. 855-862. HOLMAN, R.R., et al., 2008. 10-year follow-up of intensive glucose control in type 2 diabetes. New England Journal of Medicine. 359(15), pp. 1577-1589. International Diabetes Federation 2006. Diabetes, deprivation and outcomes in a wealthy world. Diabetes Voice, 51, 37-40. INTERNATIONAL DIABETES FEDERATION. 2013. IDF Diabetes Atlas [Online]. [Viewed 20th March 2016]. Available From:https://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf: IDF. KANAVOS, P., VAN DEN AARDWEG, S. and SCHURER, W., 2012. Diabetes expenditure, burden of disease and management in 5 EU countries. LSE Health and Social Care. KEMPEN, J.H., et al., 2004. The prevalence of diabetic retinopathy among adults in the United States. Archives of Ophthalmology (Chicago, Ill.: 1960). 122(4), pp. 552-563. KILBOURNE, A.M., et al., 2007. Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implementation Science. 2(1), pp. 1-10. LOVEMAN, E., FRAMPTON, G.K. and CLEGG, A., 2008. The clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review. Health Technology Assessment. 12(9), pp. 1-136. LYSSENKO, V., et al., 2008. Clinical risk factors, DNA variants, and the development of type 2 diabetes. New England Journal of Medicine. 359(21), pp. 2220-2232. MINET, L., et al., 2010. Mediating the effect of self-care management intervention in type 2 diabetes: a meta-analysis of 47 randomised controlled trials. Patient Education and Counseling. 80(1), pp. 29-41. NACI, H., et al., 2015. Rethinking the appraisal and approval of drugs for type 2 diabetes. BMJ Open. 351(h5260),. NATHAN, D.M., et al., 2005. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group: Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 353 pp. 2643-2653. NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE, N. 2015. Type 2 diabetes in adults: management: NICE guidelines [NG28] [Online]. [Viewed 20th March 2016]. Available From:https://www.nice.org.uk/guidance/ng28: NIHCE. NHS SCOTLAND 2014. Scottish Diabetes Survey 2014. Scottish Diabetes Survery Monitoring Group. PEAT, J., BARTON, B. ELLIOT, E. 2008. Statistics Workbook for Evidence-Based Health Care, Wiley-Blackwell. SCHILLING, J. A. 2007. Diabetes Mellitus: A guide to patient care, Ambler, USA, Lippincott. SCOTTISH PUBLIC HEALTH OBSERVATORY. 2015. Overview of Key data sources [Online]. [Viewed 4th April 2016]. Available From: http://www.scotpho.org.uk/publications/overview-of-key-data-sources/introduction. SKRHA, J., CERIELLO, A. GITT, A. K. 2010. Chapter 6 Microvascular and Macrovascular Complications. In: HALAN, P. (ed.) DIAMAP 1 : Roadmap for Diabetes Research in Europe. http://www.diamap.eu: European Union. STIRBAN, A., 2014. Microvascular dysfunction in the context of diabetic neuropathy. Current Diabetes Reports. 14(11), pp. 1-9. UK PROSPECTIVE DIABETES STUDY (UKPDS) GROUP, 1998. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). The Lancet. 352(9131), pp. 837-853. VOULGARI, C., PAGONI, S., VINIK, A. and POIRIER, P., 2013. Exercise improves cardiac autonomic function in obesity and diabetes. Metabolism. 62(5), pp. 609-621. WEST, K.M., 1978. Epidemiology of diabetes and its vascular lesions. Elsevier. WOZNIAK, S.E., GEE, L.L., WACHTEL, M.S. and FREZZA, E.E., 2009. Adipose tissue: the new endocrine organ? A review article. Digestive Diseases and Sciences. 54(9), pp. 1847-1856.

EGovernment: History, Causes and Trends

EGovernment: History, Causes and Trends BENCHMARKING EGOVERNMENT SERVICES Abstract: Governments around the world have embraced the use of Information and Communication Technologies (ICTs). This represents a relatively new branch of study within the IT field. EGovernment Services are provided through many different means of access and to a variance of audiences, citizens, businesses or even other governmental entities. After clarifying the definitions and differences among similar terms (i.e. eGovernance and Digital Government, eDemocracy) this paper examines how eGovernment is measured by analyzing the dominating methodologies that are used. Furthermore, following specifically the eGovernment benchmarking methodology that is used by the European Commission, a greater focus in the evolution of eGovernment in Greece has been made. The finding through this assessment was far from satisfactory. Particularly, comparing the 20 Basic eGovernment Services offered in Greece, from 2007 to 2009, no development in terms of improvement, has taken place. Finally, the measures tha t governments need to undertake are discussed. Introduction In the past years, assisted by the invasion of Information Technology in everyday lives, governments all over the world have begun widely using information technologies for increasing the effectiveness and quality of the services they provide. These initiatives have become known as â€Å"electronic government† or eGovernment services. In most cases, when words gain that attractive â€Å"e-â€Å" in front of them, the popular belief is that they have become â€Å"electronic†, whatever that means, even though in some cases it does not make much sense. This confusion is much more obvious when the original word itself has conceptual and abstract meanings. Words like Government and Governance. Section I presents the most popular definitions, choosing the one that describe each term the best, and clarifies boundaries between the most common terms. Furthermore, the different ways that eGovernment can be classified, depending on the delivery model or the audience, is outlined. Although the definitions of eGovernment may vary widely, there an obvious shared theme emerges; eGovernment involves using information technology, and especially the Internet, to improve the delivery of government services to citizens, businesses, and other government agencies. It acts as enabler for citizens to interact and receive services from governments twenty four hours a day, seven days a week. Monitoring eGovernment development and evaluating its effectiveness is a complex and challenging task, as the phenomenon is new and dynamic. In Section II, the basics of Benchmarking are presented and its structural elements are analyzed. Focusing on specific examples of methodology used, a set of four dominant practices that represent the longest running efforts for measuring eGovernment is chosen to be explored further. Using the reports publish by each one of them, on a periodical basis, their inner workings are analyzed and the various developments, changes and evolutions in the methods employed by each one are mentioned. Section III focuses at benchmarking of eGovernment Services in Europe. In order to recognize how eGovernment has evolved and matured within the European Union, the relevant European directives, initiatives and frameworks for the development of eGovernment Services in the region since 1999 are examined. Following that, the methodology used for benchmarking eGovernment the European Union is examined in detail. All measuring elements, including some that were used for the first time in the most recently published report are evaluated. Having established what eGovernment is, what Benchmarking is and how its methodologies function, Section IV uses the data from the latest European eGovernment Benchmarking Report, which was published in November 2009, to assess how the Greek eGovernment landscape evolved since the previous report in 2007. The results are disappointing. When comparing the 20 Basic eGovernment Services offered in Greece, there was no improvement, what so ever, from 2007 to 2009. Following that, Greek performance in the two new indices introduced in the latest report (EProcurement and User Experience) is reported and compared to the respective EU27+ average. Finally, in Section V, a general overview is provided along with the conclusions about the (lack of) progress in eGovernment in Greece. Scope and aims The scope of this project is to analyze how the meaning of eGovernment has evolved in the past few years and then review the current trends in benchmarking the penetration sophistication of eGovernment services in Europe and the rest of the world. Furthermore, this project reports and analyses the level of eGovernment services offered in Greece. The basic aims of this project are: Define the eGovernment ecosystem, typology and taxonomy. Analyse the dominant methodologies of benchmarking eGovernment services Gather and process existing results about eGovernment in Greece, regarding service penetration and sophistication, along with other relevant metrics. Resources This project relies heavily on research. In particular, a lot of research on what the different and sometimes contradicting terms that define eGovernment as well as the rest of the relevant terms in academic papers throughout the previous decade was made. Following that, further research about the current and past trends in benchmarking in general and eGovernment benchmarking in particular are is conducted. From there on, having established what eGovernment is and what the provided services should be, along with how they are measured, more research was conducted in order to reveal what the actual current level of provided eGovernment services is. To accomplish this, reports from many different parties are used. These include reports published both by well knows analyst firms or government bodies in various levels as well as reports issued at a global level such as the United Nations to local reports issued by the authorities of each country such as the IT Observatory in Greece. Typology Convention Throughout the bibliography, or any other sort of resource for that matter, â€Å"electronic† terms do not have a consistent representation. So, just like electronic mail can be found abbreviated in quite a few forms, â€Å"electronic† Government is abbreviated to eGovernment, e-Government, E-Government etc. To avoid this inconsistency, through this project the term eGovernment will be used (changed to EGovernment only in the beginning of sentences). This convention will apply to â€Å"electronic† terms that will be used such as eGovernance. I. EGovernment, eGovernance and Digital Governance EGovernment is one more of the recent years â€Å"buzzwords†. It is usually either paired with the word â€Å"services† at the end or other words like eGovernance and Digital Government. Like every other (relatively) new and cool â€Å"buzzword† they are used widely by a broad spectrum of individuals who represent mostly two different backgrounds. Information technology and politics. The first because it is a technological issue, the later because they have come to realize, even though a little late, that they represent an excellent vehicle for them to provide a better experience to anyone who interacts with the Government. But, what do these terms mean? Do they collide or conflict each other? How about covering or including one another? A. EGovernment Definitions There is not one, unique and commonly accepted definition for eGovernment. It is quite difficult to decide over a specific one but after the research made, the following definition from the World Bank (ÃŽ  ÃŽâ€˜ÃŽ ¡ÃŽâ€˜ÃŽ  ÃŽÅ¸ÃŽÅ"ÃŽ  ÃŽâ€") describes it best: â€Å"Government refers to the use by government agencies of information technologies (such as Wide Area Networks, the Internet, and mobile computing) that have the ability to transform relations with citizens, businesses, and other arms of government. These technologies can serve a variety of different ends: better delivery of government services to citizens, improved interactions with business and industry, citizen empowerment through access to information, or more efficient government management. The resulting benefits can be less corruption, increased transparency, greater convenience, revenue growth, and/or cost reductions ((AOEMA), 2004). Although other definitions have been provided, this definition is preferred. The reason is that it is the most concise and the easiest to be understood since apart describing in simple words how eGovernment is utilized, it goes on to offer a very brief, yet to the point, reference to its main advantages. EGovernment definitions various other sources as follows:  · United Nations definition ((AOEMA), 2004): â€Å"E-government is defined as utilizing the Internet and the world-wide-web for delivering government information and services to citizens.† * Global Business Dialogue on Electronic Commerce GBDe definition ((AOEMA), 2004): â€Å"Electronic government (hereafter e-Government) refers to a situation in which administrative, legislative and judicial agencies (including both central and local governments) digitize their internal and external operations and utilize networked systems efficiently to realize better quality in the provision of public services.† * Gartner Groups definition: â€Å"the continuous optimization of service delivery, constituency participation, and governance by transforming internal and external relationships through technology, the Internet and new media.† * Definition of the Working Group on eGovernment in the Developing World: E-government is the use of information and communication technologies (ICTs) to promote more efficient and effective government, facilitate more accessible government services, allow greater public access to information, and make government more accountable to citizens. E-government might involve delivering services via the Internet, telephone, community centers (self-service or facilitated by others), wireless devices or other communications systems.† EGovernment is in the first stages of development. Most governments have already taken or are taking initiatives offering government services online. However, for the true potential of eGovernment to be realized, government needs to restructure and transform its long entrenched business processes. EGovernment is not simply the process of moving existing government functions to an electronic platform. Rather, it calls for rethinking the way government functions are carried out today to improve some processes, to introduce new ones and to replace those that require it. The range of services that may be provided by e-government spans from simple information sites to fully interactive experiences where users and government engage in a dialog mediated by information technology. Internal information systems of Government agencies, information kiosks, automated telephone information services, SMS services and other systems all comprise e-Government services. All these are applications of Information and Communications Technologies (ICT) to improve the services of the Government towards its primary clients: the citizens. In the last few years, there has been much talk of mobile government or m-government. MGovernment refers to the use of wireless technologies like cellular/mobile phones, laptops and PDAs (Personal Digital Assistants) for offering and delivering government services. MGovernment is not a substitute for e-government, rather it complements it. 1. Benefits of eGovernment E-Government initiatives contribute to citizen empowerment by making information about government processes and decisions easily available, and allowing information-sharing among people and organizations, and between citizens and the civil service (Accenture and the Markle Foundation, 2001). Well-informed citizens are better able to hold their governments accountable. Governments are then compelled to improve the quality of services, expand accessibility of these services, and increase responsiveness to their constituents. Many Government services rely on information passed among different offices within a department or across departments. The large amount of information and paperwork required results in an environment where for red tape rips, the workforce is inefficient and bureaucratic, and the delivery of services is ineffective. With the usage of ICT, the government bureaucracy and citizens are both winners in the battle against the paper trail. eGovernment allows government kno wledge and data exchange to be accessed more easily (whether public or secure) by the appropriate offices or individuals. By this, it reduces redundancies of information flows, and resulting in overall increased productivity. Another result of the integration of operations of government agencies is the improvement of transparency in government. EGovernment minimizes redundant information flows, helps to eliminate duplications of functions, and improves the adherence of public servants to proper government procedures, thereby reducing opportunities for corruption. This, provided it is accompanied by well-informed and active citizens, will assist in limiting the relationship between bureaucracy and corruption and will help lead to a higher sense of accountability among officials. B. EGovernment Taxonomy EGovernment can be classified according to different criteria. It can be classified according to its level, its audience and last but certainly not least, according to the delivery mechanism used. 1. Reach EGovernment can be categorized in the following five distinct levels depending on how broad it is. The levels are: * International * National * Regional * State/Provisional * Local These levels are illustrated below (see 1 adapted from Heeks, 2006) 2. Audience The question of where eGovernment originates is pretty much self-explanatory. Nevertheless, the same does not apply when wondering about who is in the receiving end. The answer that first comes to mind is, the citizens. But isnt so. Apart from citizens, there are other entities that are benefited by eGovernment services. According to Backus, â€Å"the three main target groups that can be distinguished in eGovernment concepts are government, citizens and businesses/interest groups. The external strategic objectives focus on citizens and businesses and interest groups, the internal objectives focus on government itself† (Backus, 2001). a) Government to Citizens (G2C) Government to Citizen activities are those in which the government provides, on-line, one-stop access to information and services to citizens. G2C applications allow citizens to ask questions of government agencies and receive answers, such us: * File income taxes * Pay taxes * Arrange driving tests or renew drivers licenses * Pay traffic tickets * Make appointments for vehicle emission inspections and * Change their address In addition, a government could: * Distribute information on the web * Provide downloadable forms online * Conduct training (e.g., in some US States, the classes for the drivers tests are offered online) * Assist citizens in finding employment * Provide touristic and recreational information * Provide health advice about safety issues (e.g. warnings for epidemics like the recent H1N1 virus) * Allow transfer of benefits like food coupons * File natural disaster relief compensation electronically through the use of smart cards; and the list goes on. b) Government to Business (G2B) Government to Business activities refers to those where the government deals with businesses such as suppliers using the Internet and other ICTs. It is a bidirectional interaction and transaction: Government to Business (G2B) and Business to Government (B2G). B2G is about businesses selling products and services to government. The most important G2B areas are eProcurement (which essentially is actually a reverse auction) and the auction of government surpluses. c) Government to Government (G2G) Lastly, Government to Government refers to those activities that take place between different government organizations/agencies/entities. Many of these activities aim to improve the effectiveness and efficiency of overall government operations. One such example is the Intelink, an intranet that carries classified information shared by different U.S. intelligence agencies. 3. Delivery Mechanism EGovernment services are provided not only via the Internet. Instead, many other means are often used. In fact, studies and reports indicate that these â€Å"other† means of eGovernment services provision show in some cases extremely high utilization. For example: * Telephony dominates channel usage in some situations: Accenture (2005) reports 63% of industrialized country respondents contacting government by telephone; compared to 31% using the Internet over a 12-month period. * In-person visits dominate in other situations: an Australian survey reports half of government contacts to be face-to-face compared to one-fifth undertaken via the Internet (AGIMO 2005). * Survey data also reflects an ongoing preference for telephone or in-person channels especially for transactional, problem-solving, urgent and complex interactions (AGIMO 2005, Horrigan 2005). a) Multichannel Examples Some Governments have embraced this reality and adopted a multichannel approach to the services they offer. In its Progress Reports, the European Comission includes some specific examples: * In Malta, citizens can access their personal social security records and payments via the internet, and may also opt to be notified about their social security payments via SMS rather than receiving printed payment advice by post. However, the most innovative initiative is the introduction of eGovernment Agents that act as intermediaries to those without access. (ePractice eGovernment Factsheets Malta, 2009) * In Austria, all websites that belong to the .gv.at domain are available free of charge or connection fees via wireless hotspots (WLAN), and via public kiosks, thanks to an excellent cooperation between the Austrian Government and two major telecommunication providers. Similar to Malta, Austria also has legislation in place allowing officials to act as intermediaries for citizens who do not have online access or a citizen (ePractice eGovernment Factsheets Austria, 2009) * In Spain, 060 is the magic code providing a single access point. Many services provided by different administrations can be accessed via the 060 network, whether they are office-, internet-, or phone-based. Citizens can access the networks 2800 points of presence in the street or their office on the web, by the phone (060) or SMS. The 060 phone number is intended to replace over 1000 phone numbers available for citizens to access information of the General Administration of the State. The network is available 24/7 and currently offers 1225 national, regional and local public services. It is worth noting that In August 2007, only 15 months after its creation, the citizen information phoneline 060 had already dealt with 700000 enquiries. (ePractice eGovernment Factsheets Spain, 2009) C. EGovernance Definitions Just like eGovernment, there is not a single common definition to describe eGovernance. However, the UNESCO defines it best: â€Å"E-governance is the public sectors use of information and communication technologies with the aim of improving information and service delivery, encouraging citizen participation in the decision-making process and making government more accountable, transparent and effective. E-governance involves new styles of leadership, new ways of debating and deciding policy and investment, new ways of accessing education, new ways of listening to citizens and new ways of organizing and delivering information and services. E-governance is generally considered as a wider concept than e-government, since it can bring about a change in the way citizens relate to governments and to each other. E-governance can bring forth new concepts of citizenship, both in terms of citizen needs and responsibilities. Its objective is to engage, enable and empower the citizen.† Other definitions include * â€Å"EGovernance, meaning ‘electronic governance is using information and communication technologies (ICTs) at various levels of the government and the public sector and beyond, for the purpose of enhancing governance.† (Bedi et all, 2001, Holmes , 2001 and Okot-Uma, 2000). * Whereas according to Backus (2001), eGovernance is defined as the, â€Å"application of electronic means in (1) the interaction between government and citizens and government and businesses, as well as (2) in internal government operations to simplify and improve democratic, government and business aspects of Governance.† D. Digital Government The term Digital Governance was introduced more than 7 years ago (McIver Elmargarmid, 2002). Notions such as eGovernment, eGovernance and any future technology of ICT (e.g. Web 2.0 applications), should fall under the Digital Governance umbrella (Schellong, 2009). This term has been preferred by other researchers as well, due to the excessive usage of adding letters like â€Å"e† (electronic), â€Å"m† (mobile), â€Å"u† (ubiquitous) or â€Å"2.0† to government-related terms. Schellong goes further to suggest a specific typology (2008) as illustrated below in 2: EGovernment contains the terms: * EAdministration Internal use of ICT * EServices. External use of ICT * EDemocracy. Use of ICT for direct public participation in government (decision making or voting) EGovernance is a completely different branch and deals with government, society and economy. E. Open Government In the last decade, there have been many efforts to promote eGovernment. A new initiative has emerged though, Open Government, or OpenGov as it is usually abbreviated. OpenGovernment efforts have begun not only in the US but also in other countries, like Greece. Although OpenGovernment and eGovernment have similar characteristics and share common goals, the greatest one being the promotion of transparency, they are not the same. Open Government can be argued to be an evolution of eGovernment (GUSTETIC, 2009), since the only reason that it exists as an initiative today is because of advances made by eGovernment along with various technological improvements and innovations. II. Benchmarking A. Definition Benchmarking is defined as the process of measuring the performance of an organization along with the practices it applies in key areas and subsequently comparing them to other organizations. It is widely accepted in the private sector and is being used as a practical tool in order to achieve positive results with unlimited potential. EGovernment benchmarking means undertaking a review of comparative performance of eGovernment between nations or agencies. These studies have two purposes: * Internal: Benefit the individual and/or organization undertaking the benchmarking study * External: Benefit achieved for users of the study. This project falls into the first category, as described in the Scope and Aims paragraph earlier in the document. B. Goals With new expectations about their performance, government entities are being encouraged to look at ways of implementing changes in their practices. Benchmarking provides them with one of their most useful options. In every industry, there are ways of doing things that are broadly recognized as standard practices for that industry. However, every industry has its leaders. These leaders are organizations that over perform when measured against those standards. They have achieved â€Å"best practices† as demonstrated by their results in quality, cost, customer satisfaction and responsiveness. Benchmarking aims to discover what the â€Å"best practices† are that lead to superior performance. In greater detail, the process of benchmarking e-Government : * Fosters accountability for eGovernment projects. * Helps meeting rising public expectations * Enables government officials to take more informed decisions and corrective actions * Validates the generated public value * Fosters projects interchange Moreover, benchmarking can be distinguished from other traditional forms of evaluation by its attempt to visualize â€Å"best practices† through normalizing comparison and by urging public entities to ask themselves what they can do to promote them. Benchmarking enables and motivates them to determine how well current practices compare to others practices, locate performance gaps, experience best practices in action, and prioritize areas for improvement or other opportunities. It is quite important to note that â€Å"Benchmarking is not the same as benchmarks. Benchmarks are performance measures and benchmarking is the action of conducting the evaluation.† (Yasin, 2002). C. Data Sources After establishing what benchmarking is, the most common data sources are evaluated.. 1. Calculated Indicators Quite a few benchmarking reports use composite indicators, for example, for the purposes of national rankings. Because it is not always clear how they are calculated or researched, composites have been criticized (UIS 2003) for their lack of transparency along for their subjectivity. Fortunately, a guide for good practice in use of composites has been developed (eGEP 2006a:45) and includes: * Developing a theoretical framework for the composite. * Identifying and developing relevant variables. * Standardizing variables to allow comparisons. * Weighting variables and groups of variables. * Conducting sensitivity tests on the robustness of aggregated variables. Other than the composite calculation of national rankings, there seems to be little use of calculated indicators in the benchmarking of e-government. The most commonly used indicators include: * Benefit/Cost Ratio. * Demand/Supply Match. * Comparative Service Development. * National Ranking Some examples along with the methods used for each indicator are illustrated in Table 1below (adapted from Heeks, 2006). Calculated Indicator Example Method Benefit/Cost Ratio Expected financial benefit (impact) / Financial cost (input) (NOIE 2003) Interview (internal self-assessment / internal administrative records) Demand/Supply Match Preference for online channel in particular services versus Online sophistication of that service (Graafland Essers Ettendgui 2003) Mass citizen survey Comparative Service Development Stage model level of citizen services versus business services (Capgemini 2005) Stage model level of different service cluster areas (Capgemini 2005) Third party Web assessment National Ranking Composite of features and stage model level for national websites (West 2005) Composite of ICT and human infrastructure with stage model level for national/other websites (UN 2005) Composite of stage model level, integration and personalization of national websites (Accenture 2005) Third party Web assessment Table 1 Calculated Indicators Used in eGovernment Benchmarking (Heeks, 2006). 2. Standard Public Sector Indicators Apart from calculated indicators, others (Flynn 2002) suggest using a standard indicator set for public sector performance. This set is displayed in Table 2 below (adapted from Flynn 2002). Indicator Explanation eGovernment Example Benchmark Economy The amount of inputs used Expenditure per capita on IT None Internal efficiency The ration of input intermediates Cost per website produced per year Minimization External efficiency The ratio of inputs: outputs (use) Cost per citizen user of government websites per year Minimization Internal effectiveness The fit between actual outputs (use) and organizational objectives or other set targets The extent to which underserved communities are users of e-government services Maximization External effectiveness The fit between actual impacts and organizational objectives or other set targets The extent to which citizens are gaining employment due to use of an eGovernment job search service Maximization Quality The quality of intermediates or, more typically outputs (use) The quality of eGovernent services as perceived by citizen users Maximization Equity The equitability of distribution of outputs and impacts The quality of time/money saved by eGovernment service use between rich and poor Maximization Table 2 Standard Indicators for eGovernment Performance (Flynn 2002) D. Methodologies Having described the methodologies used more commonly when benchmarking eGovernment services, the next step is to illustrate how the necessary data is gathered. There are a number of official methods (eGEP 2006b): * Focus groups * Internal administrative records * Internal self-assessment * Mass user surveys * Official statistics * Pop-up surveys * Third part web assessment * Web metrics and crawlers Each of these methods can be compared in four different and distinct factors (Heeks, 2006). Those are: * Cost: The time and financial cost of the method. * Value: The value of the method in producing data capable of assessing the downstream value of e-government. * Comparability: The ease with which data produced can be compared across nations or agencies. * Data Quality: The level of quality of the methods data. In particular, Heeks suggests using the CARTA (Complete, Accurate, Relevant, Timely, Appropriate) check list when assessing data quality (2006). There is also a set of methodologies that are not used as frequently as the ones mentioned earlier. These are: * Intermediary Surveys. * Intranet Assessment. * Public Domain Statistics. * Public Servant and Politician Surveys. 1. Automation With new eGovernment services being introduced by Governments every day, benchmarking is gradually becoming a more and more important mechanism for identifying best practices and keeping track of developments, but as the number of the offered services increase, data collection becomes more and more difficult. Apart from that, since eGovernment is being expanded to other eGovernment levels, as illustrated earlier in 1, it is only natural that the number of benchmarking studies is increasing fast. Thus, the traditional approach of fata collection has not only become a very challenging but also a very resource intensive task. In order to address this matter, there are projects (eGovMon) which attempt to automate the data collection (Research Council of Norway, 2009). In particular, the eGovMon project is co-funded by the Research Council of Norway and â€Å"is developing methodology and software for quality evaluation of web services, in particular eGovernment services, concerning four areas:†  · Accessibility  · Transparency  · Efficiency  · Impact Additionally eGovMon will provide a policy design tool Case study: SIGMUND FREUD Case study: SIGMUND FREUD Sigmund Freud  (1856-1939),  Austrian physician, neurologist, and founder of psychoanalysis, who created an entirely new approach to the understanding of human personality. Through his skill as a scientist, physician, and writer, Freud combined ideas prevalent at the time with his own observation and study to produce a major theory of psychology. Most importantly, he applied these ideas to medical practice in the treatment of mental illness. His newly created psychotherapy treatments and procedures, many of which in modified form are applied today, were based on his understanding of unconscious thought processes and their relationship to neurotic symptoms (see Neurosis). Regarded with skepticism at the time, Freuds ideas have waxed and waned in acceptance ever since. Nevertheless, he is regarded as one of the greatest creative minds of the 20th century. I. Freuds life Freud  was  born  into  a middle-class Jewish family in Freiberg, Moravia (now PÃ…â„ ¢Ãƒ ­bor, Czech Republic), on May 6, 1856. When he was three years old his family, fleeing from the anti-Semitic riots then raging in Freiberg, moved to the German city of Leipzig. Shortly thereafter, the family settled in Vienna, where Freud remained for most of his life. Although  Freuds  ambition from childhood had been a career in law, he became intrigued by the rapidly developing sciences of the day after reading the work of British scientist Charles Darwin. Freud decided to become a medical student shortly before he entered Vienna University in 1873. Inspired by the scientific investigations of the German poet Johann Wolfgang von Goethe, Freud was driven by an intense desire to study natural science and to solve some of the challenging problems confronting contemporary scientists. In  his  third  year  at  the university Freud began research work on the central nervous system in the physiological laboratory under the direction of German physician Ernst Wilhelm von Brà ¼cke. Neurological research was so engrossing that Freud neglected the prescribed courses and as a result remained in medical school three years longer than was normally required to qualify as a physician. In 1881, after completing a year of compulsory military service, he received his medical degree. Unwilling to give up his experimental work, however, he remained at the university, working in the physiological laboratory. At Brà ¼ckes urging, he reluctantly abandoned theoretical research to gain practical experience. Freud  then  spent  three years at the General Hospital of Vienna, devoting himself successively to psychiatry, dermatology, and nervous diseases. In 1885, following his appointment as a lecturer in neuropathology at Vienna University, he left his post at the hospital. Later that year he worked in Paris with French neurologist Jean Charcot. On  his  return  to  Vienna in 1886 Freud began private practice in neurology. Also that year Freud married Martha Bernays, to whom he had become engaged four years earlier. The first of their children was born the following year. Their family would become complete with the birth of Anna in 1895, who herself would become an important psychoanalyst (see Anna Freud). In  1902  Freud  was  appointed professor of neuropathology at the University of Vienna, a post he held until 1938. In 1923 he developed cancer of the jaw. Although repeated operations and prosthetic appliances in his mouth made his life most uncomfortable, he continued working incessantly until his death. When the Germans occupied Austria in 1938, Freud was persuaded by friends to escape with his family to England. He died in London on September 23, 1939. II. Freuds work Freud  was  by  training a research scientist and a physician. His decision to devote himself to the neglected and poorly understood area of emotional disorders has to do with currents of the time as well as his own interests. Chief among these was the prevailing attitude toward scientific endeavor at the time. Scientists were looking for causes and for connections between previously unrelated phenomena. Although Jewish by birth and cultural tradition, Freud saw all religion as illusory and was non-practicing. Instead, he can be seen as a determinist, viewing the world and human experience as understandable in terms of cause and effect. A. Hypnosis and the influence of Charcot In  1885  Freud  was  awarded a government grant enabling him to spend 19 weeks in Paris as a student of French neurologist Jean Charcot. Charcot, who was the director of the clinic at the mental hospital, the Salpà ªtrià ¨re, was then treating nervous disorders by the use of hypnotic suggestion. Fascinated by the apparent success of these treatments, Freud met and studied with several of the leading figures in the field. Charcots  group  had  been tackling the problem of hysteria, a term derived from the Greek word for womb. Hysteria traditionally was seen as a condition of women and was characterized by unexplained fainting, paralysis, loss of sensation, tics, and tremors. In time, Charcot came to see that men could also be so troubled. Although the mechanism of hysteria was not understood, Charcot and his contemporaries showed that its symptoms could be cured by hypnosis. Freuds studies under Charcot influenced him greatly in channeling his interests to psychopathology (the study and treatment of disorders of the mind). In  his  practice  in  Vienna, Freud met many patients with nervous disorders for which there was no apparent physical cause. Their symptoms included paralyzed limbs, tics, tremors, loss of consciousness, memory impairment, and numbness that could not be explained. These unexplained cases were labeled as neurotic, meaning that they were similar to neurological conditions. In time they became known collectively as neuroses. Freuds  observation  of Charcots use of hypnosis in the treatment of similar disorders led him to conclude that there could be powerful mental processes operating that remain hidden from conscious understanding. He began to employ hypnosis in his own practice, publishing articles on the subject in 1892. Freud came to understand hysterical neurotic symptoms as the product of a conflict between opposing mental forces. Conscious forces representing will were balanced by unconscious opposing forces representing counterwill. He understood hypnosis to act on the side of will to subjugate the counterwill, thus obliterating the symptom. The idea of conflict proposed in the 1892 paper A Case of Successful Treatment by Hypnotism: With Some Remarks on the Origin of Hysterical Symptoms Through Counterwill' was to become a fundamental principle of psychoanalysis. B. The beginnings of psychoanalysts The  next  important  development in Freuds theory of psychology came out of work he conducted with his friend and colleague Josef Breuer, a Viennese physician who was involved in the treatment of a young woman who was distressed while caring for her dying father. The patient had developed a number of hysterical symptoms, which Breuer initially treated by hypnotic suggestion. Initial success gave way to disappointment when on her fathers death her symptoms returned with increased severity. Somewhat at a loss as to how to proceed, Breuer had continued to talk to his patient on a daily basis and in time she began to talk about various reminiscences from the past and about her daydreams. Remarkably, as her narrative revisited memories from the past, which were associated with the onset of a particular symptom, each symptom disappeared when accompanied by an emotional outburst. Breuer made use of this discovery to eliminate her symptoms one at a time. He called the treatment the ca thartic technique (from the Greek katharsis meaning purgation). The treatment was time consuming and required considerable effort to reach dimly recalled and otherwise inaccessible memories. Freud  and  Breuer  published the case and several others in 1895 under the title Studies on Hysteria. Their view was summed up in the statement Hysterics suffer mainly from reminiscences. They proposed that when faced with emotionally traumatic memories, hysterics subjugate them from conscious appreciation to prevent the unbearable emotional pain and suffering that they cause. Rather than being driven out of the mind, however, these memories are driven into an area of the mind that is unconscious and inaccessible. Here the memories may be redirected from the emotional system into the somatic (bodily) system and appear as apparently unexplained physical symptoms. The cases that constitute Studies on Hysteria outline the transition from treatment by hypnotic suggestion to the earliest descriptions of what is now known as psychoanalysis. Working  on  his  own  Freud hypothesized that hysterical symptoms were most likely to arise when repressed traumatic memories related to adverse childhood sexual experiences. This view generated tremendous controversy at the time because the existence of childhood sexuality was not widely accepted. In time Freud was forced to reconsider this aspect of his theory, instead relating the repressed memories to childhood fantasies of sexuality and their relationship to parental figures. 1. Dreams The  next  development  in Freuds theory stemmed from his observations on dreaming. He came to see that many of the characteristics of dreams were shared with the symptomatic memories recalled by his patients in the narrative of free association. In his therapeutic relationship with his patients, Freud had abandoned hypnotic suggestion in favor of encouraging the person to speak freely about whatever came into his or her mind. Unintentionally, the patient would bring order to these free associations, whose structure and content Freud used to try to understand underlying unconscious processes. In  dreams  Freud  noted  the same apparently unstructured experiences of thoughts and images coming into the mind that seemed to be representative of some underlying unconscious process. To explain these phenomena, he suggested the existence of an inner censor that effected a compromise between conflicting mental forces and in the process disguised their meaning from conscious appreciation. He defined resistance as the unconscious defense against awareness of repressed experiences in order to avoid the resulting anxiety. He traced the operation of unconscious processes, using the free associations of the patient to guide him in the interpretation of dreams and slips of speech. Slips of speech or parapraxes, now known as Freudian slips, Freud claimed, were revelations of unconscious wishes. His 1904 publication, The Psychopathology of Everyday Life, discusses these ideas. Freud  came  to  understand the mind as a series of layers, with the most superficial layers in conscious appreciation and the deeper layers containing repressed memories and remaining unavailable to conscious thought. He termed this the topographical model and likened it to an iceberg, a small part of which is visible above the surface while the greater submerged part remains obscured from view. These ideas were published in 1900 in The Interpretation of Dreams. During  the  first  two  decades of the 1900s Freud concentrated on modifying and improving his theory of psychoanalysis. He defined a number of principles and described a model of personality development. 2. The unconscious Perhaps  Freuds  greatest contribution was to describe the unconscious and to postulate that it obeys the principle of psychic determinism, which holds that human thoughts, feelings, and impulses, rather than being random, are linked in a system of causally related phenomena, behind which lies some reason or meaning. Freud concluded that on this basis unconscious processes could be investigated and understood. Some experiences that are not immediately accessible to conscious appreciation can be brought into the conscious mind by the process of remembering. Freud referred to these experiences as the preconscious. Still-deeper thoughts cannot be remembered and are actively repressed in the unconscious. Unconscious  experiences, according to Freud, are not subject to the same logic characteristic of conscious experience. Unconscious ideas, images, thoughts, and feelings can be condensed or dramatized in the form of abstract concepts and imagery. Often the relationship between the original experience and the unconscious symbolic representation can seem obscure. 3. Role of conflict The  central  theme  of  conflict had arisen early in Freuds work. Conflict arises in a persons conscious mind when one set of beliefs impacts adversely on another area of belief, causing emotional suffering felt as disappointment, anger, or frustration. Freud was interested in the unconscious aspect of mental conflict. He described the pleasure principle as another fundamental of psychoanalytic theory. This holds that human beings have a tendency to seek pleasure and avoid pain. The principle is said to dominate in early life, bringing the developing individual into conflict with the external world. These conflicts are retained in the unconscious. Freuds  original  concept held that the conflicts of early life arose as a result of innate human drives or instincts. He conceptualized how development might occur in terms of the drives and their satisfaction according to the pleasure principle. Among the chief drives was the libidinal, or sexual, drive, which serves the human species by directing individuals to reproduce. Awareness of a need to keep rein on the free expression of drives gradually develops, and failure to rein in these drives (and fantasies about their expression) is felt as guilt. Life becomes an equilibrium between drives, conflicts, and reality.  Freud  believed  that  by understanding the crucial events and fantasy wishes of childhood, psychoanalysis could shed understanding on later adult character development with its attendant conflicts and neurotic symptoms. Later, he extended his model to include psychoses (serious mental disorders in which people have a distorted view of reality). Conflicts  repressed  into the unconscious are retained, according to Freud. From time to time they may overcome repression and reemerge into conscious appreciation, precipitating anxiety or panic. To counteract this, the individual unconsciously produces various defense mechanisms, which become part of that persons character. Examples of defense mechanisms include projection, where the individual ascribes to others his or her own unconscious desires (I hate you, for example, becomes You hate me), and reaction formation, where the individual adopts a pattern of behavior directly opposed to a strong unconscious drive.  In 1923 Freud reformulated his ideas in a structural model of the mind that postulated the existence of the id, the ego, and the superego. Freud  gave  the  name  id to unconscious drives. The id knows nothing of morality or reality. It seeks only to gratify the instinctual drives, and it operates solely according to the pleasure principle. Freud held that the biological drives of a young person are often frustrated by delays and restricted by the demands of parents and other older members of the family. As time passes, the demands of the community or society also become important obstacles to id gratification. In adapting to the environment, the child begins to acquire an ego, or set of conscious perceptions, memories, and thoughts that enable the person to deal effectively with reality. Thus, according to Freud, the ego obeys the reality principle. As the individual absorbs the teachings of family and society, he develops a superego, or conscience, that frequently conflicts with the drives of the id. In many cases the ego reduces the conflict by at least partially fulfilling the id impulses through socially ac ceptable behavior. Often, however, the conflict disappears on the conscious level as unfulfilled impulses are repressed into the unconscious mind. Freuds  therapy  consisted of listening to the patient relate a narrative of free associations over many sessions. By listening to the patients associations, Freudian slips, contents of dreams, and thoughts, he linked and interpreted these experiences to the patients conscious world. He came to understand the nature of transference, in which the patient develops feelings for the therapist that are in fact representative of previous feelings toward other important figures in the patients life. These thoughts and feelings Freud interpreted and linked to the patients current emotional state.   C. Major influences Freuds  early  psychological work shows the influence of the sciences of the day on his thinking. Ideas from physics, chemistry, and evolutionary theory occur regularly in his writing. At the time,  Charles Darwins writings, especially the theory of evolution, were challenging contemporary Judeo-Christian belief. Indeed it was Darwin who emphasized instincts for survival and reproduction, formulated in Freuds theory as basic drives.   Freuds  ideas  can  be  seen in the same context as Darwins. Freud, too, challenged philosophical and religious thinking by suggesting that human beings were rather less in control of their own thoughts and actions than previously believed. His contention that unconscious thoughts and actions had to arise from within the self rather than from God conflicted with the contemporary notion of soul. From Freuds time on, the disciplines of philosophy and psychology developed separately. Freud  was  particularly interested in the association school of psychology, which included Johann Friedrich Herbart and Wilhelm Max Wundt, the former of whom may have contributed to free association as a therapeutic technique. Psychodynamic theory-the model of conflicting forces influencing the subconscious-also has its origins in the physical concepts of opposing forces and vector analysis. Freuds theory that unresolved conflicts can be converted into physical symptoms reflects the principle of conservation of energy held by the first law of thermodynamics. Yet  Freuds  ideas  were new and radical, and it is easy to see why Freud came into conflict so readily with the society and establishment of his time. He relied on the support of friends such as Breuer. By 1906, however, a small number of pupils and followers had gathered around Freud, including Austrians William Stekel, Alfred Adler, and Otto Rank; American Abraham Brill; and Eugen Bleuler and Carl Jung from Switzerland. Other notable associates, who joined the circle in 1908, were Hungarian Sà ¡ndor Ferenczi and Briton Ernest Jones. Pakistan: Deep inside the World’s Most Frightening State Pakistan: Deep inside the World’s Most Frightening State BOOK REVIEW â€Å"PAKISTAN DEEP INSIDE THE WORLD’S MOST FRIGHTENING STATE† Author: Mary Anne Weaver Mary Anne Weaver, the writer of â€Å"Pakistan Deep inside the World’s Most Frightening State† has been a long time foreign correspondent for the New Yorker magazine. She is an expert in South Asian and Middle Eastern affairs and political and militant Islam. She has also written on the rise of militant Islam. She has reported from over thirty countries of the world, and currently resides in New York. She has won many writing awards including Citation, the Cornelious Ryan Award for the best non-fiction book on international affairs. Moreover, she has worked for The Sunday Times of London, London Times, Washington Post, and some other groups. She is Bachelor of Arts in Political Science and Journalism from Pennsylvania State University and Master of Arts in Arab Affairs from the American University in Cairo. The other important book that she has written is A Portrait of Egypt: A Journey Through the world of Militant Islam. She has written article on the consequences of S audi and American funding and Egyptian support of Islamic militants fighting the Soviets in Afghanistan. She has also written â€Å"India’s Bandit Queen†. The author’s political and philosophical viewpoint is based on years of experience as a journalist and personal vignettes overseas. She is quite critical on the rise of Militant Islam and the dire need of Pakistan to the United States. General Summary: The book is basically about a country which is surrounded by such challenging and complex circumstances that we can find no parallel of. The country is one and only Pakistan. The author has given a classical account of the situation the country has passed through. A nuclear armed state sandwiched between Afghanistan and India, having militant influence inside has been elaborated by her as the most dangerous place on Earth. The country’s integration is an utmost requirement for the world peace. The book gives an account of the most important factors, i.e. Militancy, Nuclear Arsenal, Neighbors, Role in the War on Terror and the shifting policies in different Dictatorial tenures. Moreover, the role of United States and Saudi Arabia has been discussed and the Baloch Tribal Culture and Kashmir, that has been the main bone of contention between Pakistan and India has been utmost importance in the book. Author’s Thesis or Conclusion: The author during the journey of writing this book met many important figures of the time, such as General Pervez Musharraf, the then President and Chief of Army Staff of Pakistan Army, Benazir Bhutto, G.M.Syed, Nawab Akbar Khan Bugti, and some more. The author has given an account of the circumstances in which General Musharraf took over. There was an overall policy shift after he came into the chair, as his takeover was followed by the 9/11. According to her, there was a huge difference in Zia and Musharraf policies. She elaborates the role of Saudi Arabia and Inter-Services Intelligence of Pakistan in Afghanistan and explains how both contradict their interference. The event of 9/11 led Pakistan into circumstances that it had to become an ally of the United States in the War on Terror. The point of concern for her was that if they counter the Taliban, how they will manage the Jihadis then. Initially, Pakistan benefitted from the United States, as sanctions were removed and aid pac kages were received. She also highlights the role of nationalists like G.M.Syed. She tells that Osama bin Laden had popular support in Pakistan. People were ready to come out on streets for him. He received help from many tribal elders of Balochistan. The tribal elders of Balochistan were against the education and development in their province, as they see reduction in their influence. Further, she talks about the role of Mullahs in the society and most importantly the politics of Pakistan. Arabs are very close to Pakistan. They mostly come there for hunting purposes with the approval of the authorities. Then she talks about Benazir. She tells that at that time Benazir Bhutto seemed a serious threat to Musharraf, as intelligence agencies at that time had the view that she was the most popular leader of the country. She gives an account of Zulfiqar Ali Bhutto’s death and Benazir and family’s condition at that time. She gives a comparison of Musharraf’s liberal an d Zia-ul-Haq’s conservative tenures. She also talks about the role of military in politics. The tussle between India and Pakistan has also been discussed. India blames Pakistan for any incident happening inside its territory and so does Pakistan. India claims that organizations such as Lashkar-e-Taiba, etc. are being operated from Pakistan. The objective of United States was to carry out attacks and limit the members of Al-Qaeda, whereas she gives some indication of Pakistani reluctance also. Regarding Kashmir, the major bone of contention between Pakistan and India, she tells the views of both sides. Pakistan forces for a plebiscite as decided by the United Nations, whereas India has a stance that it is a bilateral issue after the Simla Agreement. There is a major deadlock between both the nations, and none of them can afford to lose Kashmir. For this reason, both sides remain on maximum military alert. She highlights a very important aspect that the organizations which were once formed and trained by the intelligence agencies of Pakistan, like Jaish-e-Muhammad, twice tried to assassinate General Musharraf. This is a point of high concern. Pakistan is hence elaborated as one of the most difficult and tough countries of the world. My Reaction to Author’s Views: I agree with the author’s views in most of the aspects she has given. She is absolutely correct about the difference in the approaches, i.e. liberal and fundamentalist of Musharraf and Zia ul Haq. She correctly tells about the support and sympathies Osama bin Laden had in the country. The Baloch tribal elders themselves do not want economic and educational empowerment in their province, in order to keep in order their influence. The aspect of Arabs which she has discussed is in my point of view correct and having a line in order with Arabs is a basic compulsion on Pakistan, for financial, economic and political reasons. The role of military in politics is a truth, and still politics is not free of their influence. Moreover, the most important aspect in my point of view is that of the organizations that were formed under the influence of our security agencies and now they are our own enemies. This has been clearly witnessed by the whole world. So, her view of Pakistan, one of t he most difficult states in the world is correct, as the complexity of problems that can be witnessed here, are not that common in the world. Summary and General Recommendations: The book is well written, and covers many of the problems and, complexities of the problems, that Pakistan is facing today. The author has herself met many bigwigs and then mentioned the experiences on the basis of those meetings and travels that she had in the country. The book includes index, map, but lacks pictures. As far as referring the book is concerned, yes, I will refer the book to others, for the reason that it contains a whole analysis along with the background of the problems that the country is surrounded by today. This book is a good read for the general reader.