Patient Transition into Hospice Care Essay -- Analysis of Care Transit

I. Introduction The patient presented in this paper is Ms. H an 83 year old African American woman that appears younger than stated age with a history of Multiple Myeloma. The patient chart was reviewed and an interview conducted. Interestingly the patient had retained every note, lab, hospital H&P and discharge summary in a file folder in her possession. Ms. H was diagnosed with Multiple Myeloma in April of 2008 when she was being worked up at her dentist for a toothache. X-rays performed revealed she had bone lesions in her zygomatic process and in her skull above her right eye. She was referred to Oncology Hematology Care for further work-up. A bone marrow biopsy revealed she had Multiple Myeloma. During the course of treatment the patient received Thalidomide, Revlimid, Velcade, Aredia, Zometa, and Decadron. Remission was achieved and the patient underwent stem cell transplant in February of 2009. The transplant was successful and the patient was cancer free until August of 2012 when she receiv ed news that her cancer had recurred. Current meds are Lisinopril 20 mg PO daily for HTN, Omeprazole 40 mg PO for GERD, Topamax 25 mg BID for headaches, Calcium 500 mg PO TID for osteoporosis, Zofran 4 mg every 6 hrs/prn for nausea, Vicodin 5/325mg every 4 hours/prn for pain control. Ms. H has 3 adult children and 4 grandchildren that are in their early 20’s. During the initial treatment phase Ms. H was employed part time at J.C. Penney. Once she was sent to Jewish for bone marrow transplant, she retired. She is on traditional Medicare with Medicaid due to reaching the cap on her secondary Humana plan. Ms. H is divorced but has a supportive friend Mr. P that has been at her side throughout her diagnosis and treatment. He... ... benefit. V. Analysis of Transition Admission Forms Admission forms include Consent, HIPPA Acknowledgement Form, Patient and Family Rights Statement Receipt, Permission to Bill Medicare. Forms required for hospice admission are few and concisely written to reflect the Medicare Hospice Benefit. Patients who are compromised enough to sign their own forms are usually ill enough that the number of forms needed are appreciated. Ms. H and family were amazed and happy with the need for fewer signatures to admit. References (1.)Blood. 2008 March 15; 111(6): 2962–2972. doi: 10.1182/blood-2007-10-078022 PMCID: PMC2265446 (2)ASH 50th Anniversary Review Article on Multiple Myeloma†¦(look up) (3)Publication Date: 2008-03-18Medicare Benefit Policy Manual Chapter 9 - Coverage of Hospice (4) JOURNAL OF PALLIATIVE MEDICINE Volume 9, Number 6, 2006

Littlefield Technologies Essay

Managing Customer Responsiveness at Littlefield Technologies Background Littlefield Technologies (LT) has developed another DSS product. The new product is manufactured using the same process as the product in the assignment â€Å"Capacity Management at Littlefield Technologies† — neither the process sequence nor the process time distributions at each tool have changed. On day 0, the factory began operations with three stuffers, one tester, and one tuner, and a raw materials inventory of 9600 kits. This left the factory with $1,000,000 in reserves. Customer demand continues to be random, but the long-run average demand will not change over the product’ 268-day lifetime. At the end s of this lifetime, demand will end abruptly and factory operations will be terminated. At this point, all capacity and remaining inventory will be useless, and thus have no value. Management would like to charge the higher prices that customers would pay for dramatically shorter lead times. However, historic lead times often extend into several days, so management has been unwilling to quote the shorter lead times. Operations Policies at Littlefield LT uses a Reorder Point / Order Quantity raw material purchase policy. That is, raw kits are purchased as soon as the following three criteria are all met: (1) the inventory of raw kits is less than the reorder point, (2) there are no orders for raw kits currently outstanding, and (3) the factory has sufficient cash to purchase the reorder quantity. No order is placed if any of these three criteria are not met. So, for example, a team could prevent orders from being placed at all by setting the order quantity so high that there is insufficient cash to place an order. Kits are purchased in multiples of 60 because orders arrive in batches of 60. A reliable supplier delivers exactly the order quantity of batches, four days after the order is placed and paid for. Management considers physical cost of holding inventory negligible compared to the financial costs. Other details concerning the purchasing policy can be found in the â€Å"Littlefield Technologies — Overview† note. The current reorder point and reorder quantity can be changed by clicking on â€Å"Edit Data† on the Materials Buffer icon. Customers are willing to pay a premium for fast lead times, and you now have three pricing contracts to choose from: †¢ price = $750; quoted lead time = 7 days; maximum lead time = 14 days. (This is the contract that the factory starts with). †¢ price = $1000; quoted lead time = 1 day; maximum lead time = 3 days. †¢ price = $1250; quoted lead time = 0.5 days; maximum lead time = 1 day. As before, if an order’ lead time exceeds the quoted lead time, then the revenue for that s order decreases linearly, from the prices above for the quoted lead time to $0 for the maximum lead time. A contract is assigned to an order as soon as it arrives at the factory, and that contract cannot be changed subsequently for that order. Contracts for future orders can be selected by clicking on â€Å"Edit Data† on the Customer Order icon. You will also notice a few days where zero jobs are completed by the factory. On such days, the daily average lead time and daily average revenues are meaningless, so a value of zero will appear in the plots and downloaded data on those days. You are also allowed to buy and sell machines and change the scheduling rule at the tester. Assignment The factory has been running for 50 simulated days, and management has recalled the high-powered operations team (you) to manage the capacity, scheduling, purchasing, lot sizing, and contract quotations to maximize the cash generated by the factory over its lifetime. Management is not providing any operating budget beyond the cash generated by the factory itself. You will have control of the factory from day 50 to day 218. At 1 hour per simulated day, this translates to 7 real days. At day 218, you lose control of the factory, and the simulation will quickly run another 50 days of simulation. When you lose control of the factory, management expects you to leave the factory parameters set to maximize the factory’ cash position when the factory shuts down on day 268. After the simulation s ends on day 268, you can check the status of your factory, but the factory will no longer be running. Your team should turn in one summary of what actions you took during the week you had access to the factory, why you took those actions, and in retrospect whether you think you did the right thing. Show analysis to justify your conclusions. Your team’ grade will be s partially based on your performance, but mainly based on your summary. The summary cannot exceed 3 pages in length, and no appendices are allowed.

A Right to Bear Arms: Living the Second Amendment

Linda Hasselstrom vehemently defends her choice of means to protect herself in her essay, â€Å"A Peaceful Woman Explains Why She Carries a Gun†.The topic of gun control provides for a heated debate between those that believe guns are dangerous and unnecessary and those who rely both on the protection of the gun and the right to its possession.Rather than waxing philosophic on her rights under the Second Amendment, she describes years of feeling powerless and finding that the conventional and more passive methods of self-defense are simply ineffective. Hasselstrom makes a convincing case for her choice to carry a gun.The most persuasive aspect of the essay is the way that Hasselstrom leads the reader to the obvious conclusion that gun possession was her only option. She describes, on page 371, the advice given to women to avoid certain situations.While she complies, she is irritated at the idea that the precautions only apply to females, and that females must fear men. Next, s he describes incidents in which she felt helpless because more physically powerful men were immune to polite requests and common decency. Instead of going directly to the gun, she spent time learning martial arts and self-defense, only to realize that the sheer size difference was too great a disadvantage.Her most convincing argument is the story of the woman who called for help for a flat tire only to be raped and beaten. Hasselstrom’s implication is that if the woman had a gun in her possession, it never would have happened.In conclusion, Hasselstrom does not suggest that every woman carry a gun, nor does she recommend using that gun to threaten anyone unnecessarily. Rather, she keeps the gun for protection and only reveals it in order to protect herself.Not only is â€Å"A Peaceful Woman†¦Ã¢â‚¬  a convincing argument for gun possession, but it is also a tribute to the lasting nature of the Second Amendment.

On Human Humor and Irony essays

On Human Humor and Irony essays Analysis of The Kugelmass Episode by Woody Allen Sidney Kugelmass first wife was Flo with whom he had two dull sons. Their marriage was a failure ending with a divorce. He had to give alimony and support to his children and this eventually burdened him. Kugelmass second wife was an oaf woman named Daphne. Their marriage had been unhappy, too. Kugelmass had been telling his analyst how he regretted marrying fat Daphne who swelled up like a beach ball. (2) He also mentioned that, although he admitted it not to be enough, one of his reasons of marrying Daphne is her few bucks. (2) Aside from his marital qualms, he also brought up his desire for an implicit love affair with a new woman. He said that he wanted romance in Venice, at the famous New York restaurant 21, or in front of wine and candlelight. He also told him that the other woman must not come from City College where his wife and he, as a humanities professor, were working. He wanted the relationship to be discreet, though, for he nevertheless did not want a second divorce. Kugelmass also confessed about the dream he had the night before he went to the analyst. He dreamt of himself skipping through a meadow holding the Options-marked basket only to find out that the basket had a hole. His analyst was appalled by what Kugelmass disclosed. He told Kugelmass that an affair would not solve any of his problems. He tried to make it clear to his patient that he needed something more than this short-term cure for his deep-seated problems. He declared that he could not propose such an overnight solution since he was an analyst and not a magician. Kugelmass did not want to take it from his analyst so he terminated his treatment and opted for the Great Persky, a magician, who all of a sudden phoned him offering an instant fulfillment of his hidden desire for a new affair. He convened with Persky in a decr...

Basic Japanese Language Vocabulary with Audio Files

Basic Japanese Language Vocabulary with Audio Files When you are learning Japanese, it is essential to hear the words spoken. These audio words and phrases are grouped by topic and you can use them to learn to speak Japanese. Hiragana Pronunciation with Audio Files The following tables contains the 46 basic sounds found in Japanese. Click the link to listen the pronunciation of each hiragana character. (a) (i) (u) (e) (o) (ka) (ki) (ku) (ke) (ko) (sa) (shi) (su) (se) (so) (ta) (chi) (tsu) (te) (to) (na) (ni) (nu) (ne) (no) (ha) (hi) (fu) (he) (ho) (ma) (mi) (mu) (me) (mo) (ya) (yu) (yo) (ra) (ri) (ru) (re) (ro) (wa) (o) (n) Katakana Pronunciation with Audio Files   Here are the 46 basic Japanese sounds. Click the link to listen the pronunciation. (a) (i) (u) (e) (o) (ka) (ki) (ku) (ke) (ko) (sa) (shi) (su) (se) (so) (ta) (chi) (tsu) (te) (to) (na) (ni) (nu) (ne) (no) (ha) (hi) (fu) (he) (ho) (ma) (mi) (mu) (me) (mo) (ya) (yu) (yo) (ra) (ri) (ru) (re) (ro) (wa) (o) (n) Verbs Learning verbs when learning a new language is obviously very important. In the table below I have created a list of some of the most important verbs that someone new to Japanese should know.   If you are not familiar with Japanese verbs at all, follow this link to learn about verb groups and conjugations.  If you would like to hear the pronunciation of each verb, click the link and small audio file will play for you. Group 1 Verbs Dictionary Form(Basic Form) English Formal Form The ~ te Form aruku to walk arukimasu aruite asobu to play asobimasu asonde au to meet aimasu atte hairu to enter hairimasu haitte hajimaru to begin hajimarimasu hajimatte iku to go ikimasu itte kaeru to return kaerimasu kaette kakaru to take kakarimasu kakatte kaku to write kakimasu kaite kau to buy kaimasu katte kiku to listen kikimasu kiite matsu to wait machimasu matte motsu to have mochimasu motte narau to learn naraimasu naratte nomu to drink nomimasu nonde okuru to send okurimasu okutte omou to think omoimasu omotte oyogu to swim oyogimasu oyoide shiru to know shirimasu shitte suwaru to sit suwarimasu suwatte tatsu to stand tachimasu tatte tomaru to stop tomarimasu tomatte tsuku to arrive tsukimasu tsuite uru to sell urimasu utte utau to sing utaimasu utatte wakaru to understand wakarimasu wakatte warau to laugh waraimasu waratte yomu to read yomimasu yonde Group 2 Verbs kangaeru to think kangaemasu kangaete miru to see mimasu mite neru to sleep nemasu nete oshieru to teach oshiemasu oshiete taberu to eat tabemasu tabete Group 3 Verbs kuru to come kimasu kite suru to do shimasu shite At the Restaurant Click the link to hear the pronunciation.   ueitoresu waitress Irasshaimase. Welcome to our store. (Used as a greeting to customers in stores.) nanmei sama how many people (It is very polite way of saying how many people. Nannin is less formal.) futari two people kochira this way Sumimasen. Excuse me. menyuu menu Onegaishimasu. Please do me a favor. (A convenient phrase used when making a request.) Shou shou omachi kudasai. Please wait a moment. (formal expression) Douzo. Here you are. Doumo. Thanks. go-chuumon order boku I (informal, it is used by men only) sushi no moriawase assorted sushi hitotsu one (Native Japanese number) o-nomimono beverage Ikaga desu ka. Would you like ~? biiru beer morau to receive Kashikomarimashita. Certainly. (Literally means, I understand.) nanika anything Iie, kekkou desu. No, thank you. Rooms and Furnishings Click the link to hear the pronunciation.   heya room ima living room daidokoro kitchen shinshitsu bedroom toire bathroom genkan entrance niwa garden kabe wall tenjou ceiling yaneura attic yuka floor mado window Furniture kagu furniture tsukue desk hondana book shelf isu chair tansu chest of drawers beddo bed todana cupboard Appliances reizouko refrigerator reitouko freezer sentakuki washer kansouki dryer oobun oven denshi renji microwave suihanki rice cooker soujiki vacuum cleaner terebi TV More Audio Phrases and Words by Topic Animals: From bird to zebra, heres the menagerie. Body: These words are especially useful if you need medical help. Calendar: Months, days of the week, and seasons. Colors: All colors are treated as nouns. Listen to the rainbow. Dates: These follow a basic rule of the number plus nichi. Family: Learn how to talk about your family and somebody elses family. Foods: Basics for food, meals, and phrases related to eating. Greetings: The basic phrases you will need. Introducing People: Learn how to introduce people and hear the vocabulary and expressions. Location: Dont wander about lost. You need these phrases to get directions. Numbers: How to count in Japanese. On the Phone: How to speak a phone number, plus phrases you will need for a phone call in Japanese. Tea: How to order tea and how to  pronounce  different types of tea. Time: How to express the time of day and ask and answer questions about time. Travel: Words and expressions youll need when youre on the move. Useful Expressions: Simple yes, no, thanks, and other basics. Weather: How to talk about what its doing outside. Adjectives: from near to far, clean to dirty, youll want to know these modifiers. Adverbs: From always to never, together to separately.

In Class Essay #2 Example | Topics and Well Written Essays - 500 words

In Class #2 - Essay Example weat shop labor has become the major means of producing fake and cheap goods especially in the textile market and the working conditions are deplorable with meager wages being given to the workers. While Goodwin argues that sweatshop labor provides a means of employment for women who are dominated by men. The employment gives them a chance to be financially independent and to make their own choices. However, it must also be borne in mind that the women are subjected to horrendous working conditions and paid very little wages. It is their employer who enjoys maximum benefits out of the profit. This inequality in profit distribution will never help the working class to grow and lead a better life. Additionally all the goods produced by such companies are counterfeit and intellectual property theft has risen drastically over the past years. Purchase of such goods by consumers with the notion that they are genuine and later realizing that they aren’t results in loss of consumer tr ust and that in turn could be a major blow to design houses that invent the goods. Among the other countries China produces a major chunk of such fake products which have created a market for themselves. The massive unemployment coupled with economic restructuring has resulted in many people including children opting for job that pay meager wages. Employment of children by such companies has been on a rise as recent reports in China indicate that children could constitute about 20 percent of the workforce which prevents them from fulfilling their right to education. While men and women are paid only a fraction of the minimum wage that they are due, the plight of the children could be even worse. Their young age and vigor are misused and are expected to work day and night and in some cases with only one day off in a year. While the law states that it is illegal to employ children who are under 16 for work, it is not strictly enforced. Thus the entire scenario includes breach of human rights,

Annotated Bibliography& Academic Criticism Research Paper

Annotated Bibliography& Academic Criticism - Research Paper Example Such well-constructed annotations make all the difference when they are attached to a scholarly research paper. The skills required for such concise exposition has to be developed in a measured manner. A well-chosen annotated bibliography can raise the value of the research work and inform the reader of its reliability at the same time. Developing annotated biography demands greater intellectual and analytical skills. In order to achieve such skills of the higher order, greater efforts are needed and working on annotated bibliography equip the researcher with such finer skills besides familiarising them with formatting and other such aspects of creating annotated bibliography. In brief, the paper aims at developing the appropriate skills required to construct annotated bibliography which is well-directed, without compromising the refinement that it demands. Introduction The feedback received from peers and tutor can be summarised as below. The format of an annotated bibliography is s ignificant and its concise style holds the key. It has to be pithy and condensed. A forceful and uninterrupted progression of the thought stripped of all the details is an essential ingredient. Furthermore, a lucid style can retain the interest of the reader and convey the message or theme straightaway. It is worthwhile to keep in mind that the reader has greater importance than anybody else and therefore a narrative style that focuses on the theme and interest the reader has to be maintained throughout. Next up, the annotation must present the central argument vividly and convincingly. Listing the content is not the task on hand; the central recurring theme and the authority of the author are to be established beyond any doubt. It is always good to appraise and analyse the source content critically and evaluate its merit commenting on the author’s approach and way of presentation. In short, annotations are critical, concise and evaluative. Ebegbulem, J. C.(11June 2012).Corru ption and leadership crisis in Africa: Nigeria in focus. International Journal of Business and Social Science, 3 (11): 221-227. The paper by Ebogbulem throws light on the rampant corruption and inept leadership that plague post-independent Africa especially Nigeria. A country rich in natural resources bear the brunt of illiteracy, unemployment, malnutrition and poverty. Ebegbulem (2012) discuses in detail the factors that have contributed to the present crisis in Nigeria, that has brought democracy and economic growth to a standstill. Economic mismanagement and fraudulent misappropriation by people in power has spelled economic disaster, causing abject poverty for the people. The author further argues that the leadership crisis has been triggered by corruption. The paper categorically states that the leadership, both democratic and military, has ever inflicted untold miseries on the Nigerians, robbing public wealth. Ebegbulem goes on to examine how the democratic stability and econo mic growth are affected when corruption and its resultant bad governance strikes. Ebegbulem concludes that a strong leadership committed to the welfare of the people alone can reverse the trend. In the context of Nigeria the author drives home the point that corruption and bad governance destabilising the democracy and economy are entwined. The paper brings into limelight the stark realities haunting Nigeria. The narrative style is straightforward and objective. Obo,U. B &Obo E. B. (7 July 2013). Public Policies and the Crisis of Underdevelopment in Nigeria: A Critical