Alladin Essay

I enjoy going to the movies. My experience with movies began when my mom and dad first took me to watch â€Å"Alladin†(1992) a Disney feature film. I remember the long line of kids with their parents queuing up for popcorn and soda right before entering the darkened theater. If there was one word to describe how I felt and must have looked while watching what seemed to me giant cartoon characters dancing and singing on the big screen, I am guessing it would be â€Å"spellbound†. Nowadays, my affinity with the movies remains. To me there’s nothing better than settling down with popcorn, a soda, and perhaps a slice of pizza and maybe some candy while waiting for the movie to start. For anywhere between $7. 00-$9. 50, I can spend about a couple of hours eating while losing myself in the story that I have stood in line for to watch. There’s nothing else for me to do but sit back, relax and enjoy the program†¦Or at least that’s what’s supposed to happen. Like most â€Å"adult† relationships, my relationship with the movies has come to be of a â€Å"love/hate† nature. While I still enjoy the films, often I find my reverie and trip to â€Å"a state of mental suspension† interrupted by the most unbelievable and dismaying things. For example, comedies are a favorite of mine. Whether through slapstick or the more sophisticated and witty comedies, I enjoy a good joke as much as the next person does. Unfortunately, when that â€Å"next person’s† version of a laugh is loud and unrestrained and mixed with comments of â€Å"Boy I sure didn’t see that coming! that persists even after the funny part is through, it can rather put a crimp on my personal enjoyment. Date movies aren’t much better either. It can get rather difficult to distinguish whether the sounds I’m hearing are coming from the film or from the row behind me. I’ve noticed that in particularly mushy scenes, it is not unusual to hear sotto voce whispers of sweet nothings among the courting couples and giggling among the teenaged girls in the audience every time the lead characters would kiss . It can also be rather irritating when, in the middle of a rather climactic scene, some person’ s mobile phone would just go off ringing. Only three things can possibly happen then. One, the ringing is suddenly silenced by the apologetic offender hitting either the â€Å"reject† or â€Å"off† button. Two, ringing phone will be answered and â€Å"I’ll call you back† will be quickly whispered. Three, offender will let the phone play out the whole of his ring tone too mortified to admit ownership of the ringing phone and practically ruining two minutes o or more of the film for the rest of the audience. Of course I haven’t even mentioned this very select group of people who just can’t not take the call †¦ It can be unbelievable how important some people seem to think they are that they forget that they are intruding on the rights of others. And then there are also these people who seem to think that it is their sworn duty and obligation to provide a running commentary of the film’s story. For some reason, some people who have seen the film before and have gone to watch the movie again with friends feel obligated to assure their companions â€Å"Don’t worry. The bomb won’t explode. Just you wait and so-and-so hero will arrive in just a few seconds. † After which they proceed to detail how the hero or heroine will save the day. It can get rather tempting to just turn around and admonish them for this. If it’s not the plot spoilers, there are people who just can’t keep their emotions to themselves. I remember one time when I was sitting watching the film â€Å"Constantine† (2005) and heard several screams of the word â€Å"Run† or â€Å"Hide! in about five different languages from the audience. If I ever needed proof of how culturally diverse America has become, well there it was. Don’t get me wrong though. Despite all these, my enjoyment of the silver screen remains. While I admit that there were a few times when I â€Å"cheated† and just opted for a quiet night at home with some select DVD’s and some snacks on my sofa, I still go back to the movie theater. I suppose it can be viewed as a quirk of mine but I do miss the battle of wills I get into with my next-seat neighbor on who claims â€Å"rights† to the armrest separating our seats. I miss the â€Å"stand off† that takes place between myself and the guy behind me after I ask him to please take his foot off my seat back. All these things do not diminish my excitement of seeing the anticipation and enjoyment shared on the audience’s faces including my own as the movie starts its magic with the flashing of its beginning credits. Most of all, I look forward to the many and various reactions among the audience as the final credits roll on the screen and the house lights come on. It’s sad that some people can’t seem to fully appreciate the movie-going experience and treat it along with its audience with the respect they deserve. For me, despite the not so nice experiences in the movie house, the magic and excitement of going to the movies still exist. Our relationship endures and remains strong.

Payroll System

The solution has to take care of calculation of salary as per rules of the Company. This Payroll System is a full-featured system that manages financial information of every employee in an organization. It computes and processes the payroll in the certain payroll period. This Payroll System is also a flexible compensation administration solution. It is designed to help human resource professionals as well as finance and accounting personnel to manage employee compensation, deductions, allowances, and benefits in an organization.The system is integrated with the Employee’s information, offers efficient features and functionalities to manage company's expenses. Background of the Study Trends Asia Marketing and Services Corporation (TRAMSCO) provide superior corporate assistance and business solution by giving various services to the companies, business owners, entrepreneurs and professionals. Trends Asia Marketing and Services Corporation (TRAMSCO) offer solutions to help your b usiness succeed. They are committed to excellence in providing an effective, efficient support system for all phases of your business.They can assist you from start-up, taking care of the countless details that need to be handled, they can help with tasks relating to day-to day operations, and they can help formulate and implement effective business strategies to help your business grow and flourish. Because of these, Trends Asia Marketing and Services Corporation (TRAMSCO) grows immediately but Mrs. Agnes De Guzman Francia the owner realize that its hard to use the â€Å"Mano – Mano System† when she gives the salary and wages to her employees, since her business achieved the highly status recommendation around the Philippines.She decided to cooperate with a computer manufacturer in designing and analyzing the system. She request to the computer designer to do something that makes easier when she giving the salary of her employees. She adds some details like the log â €“ in form, because she said, she wants to personalize and to maintain the confidentiality of the information contains. She also added some details in the second form like employee’s name, and no. of hours worked and the other design and details are done by the computer designer. After 5 – 6 years working out with this system, Mrs.Agnes De Guzman Francia wants to update their Payroll System and change the other information. That‘s why we offer Mrs. Agnes De Guzman Francia a free system which conceptualized the information according to her wants. Problem Definition Last Friday December 11, 2009, we decided to start doing our system entitled Payroll System. To describe the system before we conceptualize it, it contains Employee’s Name, No. of hours worked, O. T. pay, Rate per hour, basic pay, and Gross pay. Now we added the deductions that typically reduced in the salary in a regular employee, it contains SSS, MED, Total Deductions and Net pay.Of course before we succeed in doing this system, we encounter a lot of problems and those are problems are not easy to solve like the calculation that we need to input to performed the right calculations in this system, we don’t know how much is the cost of the SSS, MED and the Other fees that we need to lessen in the salary of a employee. To solve these problems our group think some possibilities which help us to fulfil our project. First we asked some regular employees how much the cost of the SSS that their employer deducts in their salary.Our Second option is we search and surf the net to know the cost of following. Significance of the Study Payroll System is important to every company because any business that employed people will have to process those wages of the employee when they are due. In order to make sure that your payroll is processed correctly and accurately, you need a system which appropriate to your needs. That’s why this system exists. Payroll System is done by calculating how much each employee is owed, then making the appropriate deductions for tax, SSS pensions, etc. nd sending those to the relevant tax offices. Then payslips need to be printed and issued to employees and the duplicate copy will be given to the administration or to the accounting department to record the transaction. Scope and Delimitation CHAPTER 2 Existing systems overview Background of the Company Last quarter of 2004, four friends have conceptualized venturing into salon operations, since no one has knowledge in salon operations; they agreed to venture into salon franchise agreement.Trends Asia Marketing ; Services Corporation (TRAMSCO) was incorporated on October 4, 2004 to formally handle the franchise agreement with F Salon ; Body Spa. The franchise outlet was located in San Joaquin, Pasig Branch. First quarter of year 2005, the corporation engaged in various services aside from operating a salon franchise. The corporation engaged itself in providing manpower outsourcing and other allied services. Management of the franchise was left under Trends Asia Marketing ; Services Corporation (TRAMSCO).Conflict on financing the manpower activities which remained solely on the part of its operations manager, Mrs. Agnes De Guzman Francia, prompted her to segregate the F Salon ; Body Spa Franchise from Trends Asia Marketing ; Services Corporation (TRAMSCO), and pursue its manpower sourcing and allied services. The salon franchise is continuing to date with the original partners who established it and Trends Asia Marketing ; Services Corporation (TRAMSCO) was left under the management of Mrs. Agnes De Guzman Francia.Trends Asia Marketing ; Services Corporation (TRAMSCO) now was transformed as a family corporation. Having seen the viability and profitability of salon operation, the husband and wife team of Francia’s locate feasible locations for possible salon outlet. On September 2006, an existing salon outlet was being sold by its owner who is migrating abroad. Right there and then, the couple decided to buy out and pay for the existing salon and transform the salon outlet into what it is today. Yanna’s Salon ; Body Spa opened on September 24, 2006 till under the operation nd management of Trends Asia Marketing ; Services Corporation (TRAMSCO). Yanna’s Salon was named from the spouse’s youngest daughter â€Å"Yanna†. The Salon from the initial opening date, continue to how brisk business and good sales performance. Trends Asia Marketing ; Services Corporation (TRAMSCO) at present is continuing its manpower sourcing and business set up and accounting services. The 1st Yanna’s Salon is situated in corner Village East, Cainta Rizal which commences its operations on September 18, 2006 and the 2nd outlet in Rosario, Pasig City commences on November 24, 2006.The company has a target of at least maintaining 6 company owned salon locations starting within Rizal Area and in the future a possib ility of offering salon franchises in any parts of the Metropolis and in nearby provinces. Yanna’s Salon ; Body Spa is a full – service beauty salon adhering to consistently provide high customer satisfaction by rendering excellent service, quality products, and furnishing an enjoyable atmosphere at an acceptable price/value relationship.They will also maintain a friendly, fair and creative work environment, which respects diversity, ideas, and hard work. Existing Systems Overview Existing Systems Overview | | |UTILITY EXPENSE | |   | Annual Expense | | |Monthly Expense | | |   |   |   | |   |   |   | |WATER |P 1,800. 0 |P 21, 600. 00 | |   |   |   | |   |   |   | |   |   |   | | |UTILITY EXPENSE | |   | |Annual Expense | | |Monthly Expense | | |   |   | | |   |   |   | |TELEPHONE |P 3, 300. 00 |P 39, 600. 0 | |   |   |   | |   |   |   | |   |   | | Data Flow Diagram CHAPTER 3 System findings System Findings A nalysis for Proposed System Cost CHAPTER 4 System implementation System Implementation Chart of Comparison for the Existing and Proposed System [pic] Statistical Computation Monthly Benefit (MB) |Annual Benefit (AB) | |MB = EC – PC |EC * 12 Months =? | |MB = 30,000 – 15,000 |PC * 12 Months =? | |MB = 15,000 |AB = EC – PC | |   |AB = 360,000 – 180,000 | |   |AB = 180,000 | Break Even Analysis [pic] Comparative Chart for Monthly and Annual Benefit Existing Monthly Cost |Existing Annual Cost | |Existing Monthly Cost = 30,000 |Existing Annual Cost = 360,000 | |After 5 months = 150,000 |After 5 years = 1,800,000 | |Monthly Benefit = 6,000 |Annual Benefit = 72,000 | | | | |Proposed Monthly Cost |Proposed Annual Cost | |Proposed Monthly Cost = 15,000 |Proposed Annual Cost = 180,000 | |After 5 months = 75,000 |After 5 years = 900,000 | |Monthly Benefit = 3,000 |Annual Benefit = 36,000 | Comparative Chart for Monthly and Annual BenefitComparative Chart for Mon thly and Annual Benefit CHAPTER 5 Summary Summary Conclusion Recommendation Objective of the Study The Primary objective of this study is to continuously operate the Payroll Department of Trends Asia Marketing ; Services Corporation (TRAMSCO) which held the salary and wages of their employees. Secondly, the Payroll Department of Trends Asia Marketing ; Services Corporation (TRAMSCO) make a payroll report easier rather than before. [pic] ———————– START NO YES LOGIN CALCULATE EXIT B. P = N. H. W * R. P/H O. T = R. P/H * -1. 25 GP = B. P + O. T D = SSS + MED + OTHERS FEES N. P = GP – D OUT PUT END END FLOW CHART Payroll System Title: A LAN- Based Attendance Monitoring System Using Biometric Device For Don Jesus Gonzales High School Brief Description of the Proposed Thesis Don Jesus Gonzales High School is located at Pandacaqui Resettlement Mexico Pampanga . At present, the school doesn’t have an automated system which can verify if the person entering the school is a bonified student . The school security guard just check the id of the students one by one before entering the school. Sometimes, some people were able to pass even without id when there are many students going in. The proposed system will allow the guard to be able to know by the biometric device if the person entering the school is a registered student or not. Another, the faculty members also takes time in writing the time when they arrived and/or go out to school. The system will record the â€Å"time in† and â€Å"time out† of the faculty members . Upon scanning all their finger to the biometric device. It will also assure the safety of the students, staff and school. The system will use biometric device to verify all the finger if its registered on the database to ensure that the person entering the school is a bonified student. Also when the student entering the school has a violation, a notice will appear on the monitor screen. To keep record of the â€Å"time in† and â€Å"time out† of the faculty members, same procedure also by the use of biometric device, the information will be saved on the database The system itself is secured. Before a person access the system, he/she would be asked to input a username and password then it will be processed if it is granted or decried. The authorized persons are the principal, guidance councilor, the head of the computer subjects and one school coordinator. Statement of objectives These are the objectives of the proposed study General Objective The main objective of the study is to create a LAN based student monitoring and faculty attendance. Monitoring System using biometric device for Don Jesus Gonzales High School that will identify if the person enters the school is a bonified student and to record the â€Å"time in† and â€Å"time out† of the faculty members. Specific Objectives * To ensure the security of the school. * To increase the visibility of trespassers/intruders. * To have an accurate data about the attendance of the faculty. To automate the system that is efficient and user friendly. * To provide notification about student’s violation. Significance of Proposed Thesis Topic or Justification The study benefits its locale, Don Jesus Gonzales High School. The system is a good way in increasing the campus security. It will assure the safety of the students, faculty, staff and community. Also, it will incre ase the visibility of the intruders and avoid violence in the school.. The faculty members and students will also benefits on this study since the system will make the process faster and hassle free. Lastly, the system can also be a basis of other school in developing an students and faculty monitoring system. Review of Related Literature And Studies Fingerprint biometrics are used in a variety of applications including electronic door locks, smart cards, vehicle ignition control systems, USB sticks with fingerprint controlled access, and many others. Digital signal processing elements in fingerprint scanners perform complex DSP functions such as filters, transforms, feature extraction, matching operations and other algorithms. At the CARTES & IDentification 2011 conference in Paris, France, DigitalPersona, Inc. nnounced that the company has open sourced its new MINEX-certified FingerJetFX fingerprint feature extraction technology. FingerJetFX, Open Source Edition (OSE), is free, portable software that device manufacturers and application developers can use to convert bulky fingerprint images into small, mathematical representations called fingerprint â€Å"templates† for efficient storage or comparison. The software has been released under the Lesser GNU Public License (LGPL), giving developers the flexibility to adapt the extractor to their particular platforms and applications. DigitalPersona is also offering a separate commercially-licensed version that adds fast fingerprint matching for both identification and verification while still running in a small amount of memory. Once the image is captured the digital information is transferred to a digital signal processor to generate a match. The first step in the matching process is conditioning the scanned fingerprint. Finger print readers rarely use the full fingerprint for identification. Rather, DSPs use algorithms to extract the unique features and patterns of each print to generate a unique digital code. The second step in the software flow is to take the code generated from the scanned image and compare it to a database of potential matches. The compare step requires the system to have access to print information in a networked database or a non-volatile memory unit. Computer Hardware and Software to be Used The study will use several software and hardware for the development of the proposed system. Software * Visual studio * Visual Basic 2000- for the main design of the system interface of the system. * Microsoft Office 2007 Microsoft Access- for the database of the system. Hardware * Computer set * Processor Intel ® Pentium ® 4cpu 3. 00 GHz * Memory 1014MB RAM * Internet connection * Biometric device Detailed Features of the Proposed System These are the detailed features of the proposed system * Secured access of the system. * User Friendly interface. * Time-In time-Out of faculty using Biometric * Notification/Flash Message to students with violation * The system displays im age and other basic info about the students and faculty members * Biometric scanning to able to enter the school. Payroll System Telecommunications network is a combination of nodes and links which are arranged in a manner so that the message may pass from the one part of the network to the other by traveling over variable nodes. Essential Parts of the Network There are five basic segments of this type of network. These parts include terminals, channels, processors, computers and control softwares. The starting and ending point of the telecommunication networks is known as a network terminal. There are many input and output devices which are often placed under the heading of terminals. Telecommunication processors are often helpful in transferring data between the terminals of the network. These processors also provide variety of control and support functions. Telecommunication channels are the reception and transmission point for the data and messages. The network computers are arranged in a manner so that they establish a network connection using different media, these computer terminals help in communication. Telecommunication network software governs the control and functional activities with the help of software in a network. The structure of telecommunication network has three main components the control plane, the user plane and the management plane. As indicated by its name the control plane carries control information and data. The data plane or user plane monitors the user traffic in the network. The third and last component management plane carries the operation and administration traffic over the network. Types of Telecommunication Networks. Telecommunication network has many types like wide area network, metropolitan area network, local area network, campus area network, personal area network, virtual private networks, client server network, peer to peer network, network computing. The network which is spread over a large geographic area is known as wide area network. This network has helped businesses which are dispersed over different regions to communicate to the head office. Metropolitan area network covers the area of nearly one city or county. Its area and coverage is more than the local area network and less han the wide area network. The communication of computers in a very small geographical area is known as local area network. Campus area network is a network which is restricted to the small geographical area which is limited to the university campus or a building. Personal area network is a network which is limited to an individual. Virtual private network is built on the principle of secure encrypted network in order to provide complete security to the users. The client server network is network which is connected to the LAN at one end and the back up server at the other end. When a computer uses network browser to connect to the other computers in the network it is known as network computing. Microsoft office online is the good example of such kind of network. Peer to peer network is used for connecting only those computers which have copy rights to use each others resources. Examples of a Telecommunication Network The first example of the telecommunication network is computer networks . computer network is set of computers which are attached to each other for the purpose of resource sharing. The second example is the internet. Internet is the global network which allows the users in many dispersed areas to connect via web browsers and telecommunication technologies provide by internet services providers. Third example is of the public switched telephone networks, it is a circuit switched network which used to carry analog signals but now it carries digital signals mostly. The fourth example is the working of global telex; it is a set of machines which include teleprinters and tele typewriters. The last example is of the aircraft communication addressing Payroll System Title: A LAN- Based Attendance Monitoring System Using Biometric Device For Don Jesus Gonzales High School Brief Description of the Proposed Thesis Don Jesus Gonzales High School is located at Pandacaqui Resettlement Mexico Pampanga . At present, the school doesn’t have an automated system which can verify if the person entering the school is a bonified student . The school security guard just check the id of the students one by one before entering the school. Sometimes, some people were able to pass even without id when there are many students going in. The proposed system will allow the guard to be able to know by the biometric device if the person entering the school is a registered student or not. Another, the faculty members also takes time in writing the time when they arrived and/or go out to school. The system will record the â€Å"time in† and â€Å"time out† of the faculty members . Upon scanning all their finger to the biometric device. It will also assure the safety of the students, staff and school. The system will use biometric device to verify all the finger if its registered on the database to ensure that the person entering the school is a bonified student. Also when the student entering the school has a violation, a notice will appear on the monitor screen. To keep record of the â€Å"time in† and â€Å"time out† of the faculty members, same procedure also by the use of biometric device, the information will be saved on the database The system itself is secured. Before a person access the system, he/she would be asked to input a username and password then it will be processed if it is granted or decried. The authorized persons are the principal, guidance councilor, the head of the computer subjects and one school coordinator. Statement of objectives These are the objectives of the proposed study General Objective The main objective of the study is to create a LAN based student monitoring and faculty attendance. Monitoring System using biometric device for Don Jesus Gonzales High School that will identify if the person enters the school is a bonified student and to record the â€Å"time in† and â€Å"time out† of the faculty members. Specific Objectives * To ensure the security of the school. * To increase the visibility of trespassers/intruders. * To have an accurate data about the attendance of the faculty. To automate the system that is efficient and user friendly. * To provide notification about student’s violation. Significance of Proposed Thesis Topic or Justification The study benefits its locale, Don Jesus Gonzales High School. The system is a good way in increasing the campus security. It will assure the safety of the students, faculty, staff and community. Also, it will incre ase the visibility of the intruders and avoid violence in the school.. The faculty members and students will also benefits on this study since the system will make the process faster and hassle free. Lastly, the system can also be a basis of other school in developing an students and faculty monitoring system. Review of Related Literature And Studies Fingerprint biometrics are used in a variety of applications including electronic door locks, smart cards, vehicle ignition control systems, USB sticks with fingerprint controlled access, and many others. Digital signal processing elements in fingerprint scanners perform complex DSP functions such as filters, transforms, feature extraction, matching operations and other algorithms. At the CARTES & IDentification 2011 conference in Paris, France, DigitalPersona, Inc. nnounced that the company has open sourced its new MINEX-certified FingerJetFX fingerprint feature extraction technology. FingerJetFX, Open Source Edition (OSE), is free, portable software that device manufacturers and application developers can use to convert bulky fingerprint images into small, mathematical representations called fingerprint â€Å"templates† for efficient storage or comparison. The software has been released under the Lesser GNU Public License (LGPL), giving developers the flexibility to adapt the extractor to their particular platforms and applications. DigitalPersona is also offering a separate commercially-licensed version that adds fast fingerprint matching for both identification and verification while still running in a small amount of memory. Once the image is captured the digital information is transferred to a digital signal processor to generate a match. The first step in the matching process is conditioning the scanned fingerprint. Finger print readers rarely use the full fingerprint for identification. Rather, DSPs use algorithms to extract the unique features and patterns of each print to generate a unique digital code. The second step in the software flow is to take the code generated from the scanned image and compare it to a database of potential matches. The compare step requires the system to have access to print information in a networked database or a non-volatile memory unit. Computer Hardware and Software to be Used The study will use several software and hardware for the development of the proposed system. Software * Visual studio * Visual Basic 2000- for the main design of the system interface of the system. * Microsoft Office 2007 Microsoft Access- for the database of the system. Hardware * Computer set * Processor Intel ® Pentium ® 4cpu 3. 00 GHz * Memory 1014MB RAM * Internet connection * Biometric device Detailed Features of the Proposed System These are the detailed features of the proposed system * Secured access of the system. * User Friendly interface. * Time-In time-Out of faculty using Biometric * Notification/Flash Message to students with violation * The system displays im age and other basic info about the students and faculty members * Biometric scanning to able to enter the school. Payroll System Telecommunications network is a combination of nodes and links which are arranged in a manner so that the message may pass from the one part of the network to the other by traveling over variable nodes. Essential Parts of the Network There are five basic segments of this type of network. These parts include terminals, channels, processors, computers and control softwares. The starting and ending point of the telecommunication networks is known as a network terminal. There are many input and output devices which are often placed under the heading of terminals. Telecommunication processors are often helpful in transferring data between the terminals of the network. These processors also provide variety of control and support functions. Telecommunication channels are the reception and transmission point for the data and messages. The network computers are arranged in a manner so that they establish a network connection using different media, these computer terminals help in communication. Telecommunication network software governs the control and functional activities with the help of software in a network. The structure of telecommunication network has three main components the control plane, the user plane and the management plane. As indicated by its name the control plane carries control information and data. The data plane or user plane monitors the user traffic in the network. The third and last component management plane carries the operation and administration traffic over the network. Types of Telecommunication Networks. Telecommunication network has many types like wide area network, metropolitan area network, local area network, campus area network, personal area network, virtual private networks, client server network, peer to peer network, network computing. The network which is spread over a large geographic area is known as wide area network. This network has helped businesses which are dispersed over different regions to communicate to the head office. Metropolitan area network covers the area of nearly one city or county. Its area and coverage is more than the local area network and less han the wide area network. The communication of computers in a very small geographical area is known as local area network. Campus area network is a network which is restricted to the small geographical area which is limited to the university campus or a building. Personal area network is a network which is limited to an individual. Virtual private network is built on the principle of secure encrypted network in order to provide complete security to the users. The client server network is network which is connected to the LAN at one end and the back up server at the other end. When a computer uses network browser to connect to the other computers in the network it is known as network computing. Microsoft office online is the good example of such kind of network. Peer to peer network is used for connecting only those computers which have copy rights to use each others resources. Examples of a Telecommunication Network The first example of the telecommunication network is computer networks . computer network is set of computers which are attached to each other for the purpose of resource sharing. The second example is the internet. Internet is the global network which allows the users in many dispersed areas to connect via web browsers and telecommunication technologies provide by internet services providers. Third example is of the public switched telephone networks, it is a circuit switched network which used to carry analog signals but now it carries digital signals mostly. The fourth example is the working of global telex; it is a set of machines which include teleprinters and tele typewriters. The last example is of the aircraft communication addressing Payroll System Telecommunications network is a combination of nodes and links which are arranged in a manner so that the message may pass from the one part of the network to the other by traveling over variable nodes. Essential Parts of the Network There are five basic segments of this type of network. These parts include terminals, channels, processors, computers and control softwares. The starting and ending point of the telecommunication networks is known as a network terminal. There are many input and output devices which are often placed under the heading of terminals. Telecommunication processors are often helpful in transferring data between the terminals of the network. These processors also provide variety of control and support functions. Telecommunication channels are the reception and transmission point for the data and messages. The network computers are arranged in a manner so that they establish a network connection using different media, these computer terminals help in communication. Telecommunication network software governs the control and functional activities with the help of software in a network. The structure of telecommunication network has three main components the control plane, the user plane and the management plane. As indicated by its name the control plane carries control information and data. The data plane or user plane monitors the user traffic in the network. The third and last component management plane carries the operation and administration traffic over the network. Types of Telecommunication Networks. Telecommunication network has many types like wide area network, metropolitan area network, local area network, campus area network, personal area network, virtual private networks, client server network, peer to peer network, network computing. The network which is spread over a large geographic area is known as wide area network. This network has helped businesses which are dispersed over different regions to communicate to the head office. Metropolitan area network covers the area of nearly one city or county. Its area and coverage is more than the local area network and less han the wide area network. The communication of computers in a very small geographical area is known as local area network. Campus area network is a network which is restricted to the small geographical area which is limited to the university campus or a building. Personal area network is a network which is limited to an individual. Virtual private network is built on the principle of secure encrypted network in order to provide complete security to the users. The client server network is network which is connected to the LAN at one end and the back up server at the other end. When a computer uses network browser to connect to the other computers in the network it is known as network computing. Microsoft office online is the good example of such kind of network. Peer to peer network is used for connecting only those computers which have copy rights to use each others resources. Examples of a Telecommunication Network The first example of the telecommunication network is computer networks . computer network is set of computers which are attached to each other for the purpose of resource sharing. The second example is the internet. Internet is the global network which allows the users in many dispersed areas to connect via web browsers and telecommunication technologies provide by internet services providers. Third example is of the public switched telephone networks, it is a circuit switched network which used to carry analog signals but now it carries digital signals mostly. The fourth example is the working of global telex; it is a set of machines which include teleprinters and tele typewriters. The last example is of the aircraft communication addressing

Bowlby Juvenile Study

Bowlby Juvenile Study In the following essay I will be looking at the case study of John Bowlby and the 44 Juvenile thieves. I will be describing the original hypothesis of the study and what Bowlby aimed to find. I will then look at two other key psychological studies into human behaviour. Once I have looked at all three of the studies, I will then look at the research methods used by all three. I will closely look at the ethical implications of the studies as well as the practical applications used in each. John Bowlby (1907-1990) was a Psychoanalyst who worked at the London Child Guidance Clinic between 1936 and 1939. Bowlby believed that mental health and behavioural problems could be attached to early childhood experience just as Freud did. He aimed to prove that separation from Mothers or sole carers before the age of five affected children’s adolescent behaviour. Bowlby took 44 patients that had come into his clinic who were thieves that had been recommended by their school, parents or soci al carers. The group of thieves were split into two groups, these were grade I who had only stolen once, and the other was grade IV who were repeat offenders. He then took another group of 44 children who were emotionally disturbed but not thieves, this group was known as the control group. The 88 children involved in this study were all aged between five and sixteen. In the group of thieves there were 31 boys and 13 girls whilst in the control group there were 34 boys and 10 girls. There were three key studies in this case study which were run by a psychologist, social worker and a psychiatrist. The first was an IQ test which was invigilated by one of the clinic psychologists; the test was done as each of the participants entered into the clinic. The psychologist found that as well as all of the participants being similar in age, they were all similar in their IQ so they were no anomalies when comparing the educational background of the children. The second study was an interview o f the participant’s parents that was held by a social worker, the aim of this was to record details of the child’s early life. The third study was an interview held with the child and the parent that they were with; this was held by a psychiatrist to see if the details given by the parents matched with those of the child. The social worker and psychiatrist made separate reports which were compared when they had completed them in regard to each child. Once the reports had been compared, the children were then split into different groups, these were; Normal No Abnormal symptoms Depressed Showing symptoms of depression Circular Showing symptoms of depression and over activity Hyperthymic Over activity Affectionless No affection for others and no sense of shame or responsibility Schizoid Withdrawn and lacking relationships with others Priggish Showing symptoms of anxiety or hysteria    The results have some significant anomalies; the 14 affect ionless characters are statistically significant, this is because 13 of the 14 (93%) were grade IV thieves; this clearly shows that the affectionless have been very misguided and uncared for in the childhood. Over half of the grade IV thieves were affectionless. Other findings are that 19 of the cases had suffered prolonged separation from their sole carer during their first five years. 17 of the 19 that had suffered prolonged separation were thieves and 12 of these 17 were classed as affectionless. Of the 23 that were grade IV thieves, 14 of them had suffered prolonged separation.

Starbucks Case Analysis Essay Example | Topics and Well Written Essays - 1000 words

Starbucks Case Analysis - Essay Example Numerous companies have sensed the competitive demands of Starbuck’s differentiated strategy. According to some economic analysts, Starbucks has influenced the world market and they have made to coffee what McDonald’s have made to fast food. In such circumstances, it is probable that even Starbucks is not generating profit but through rapidly obtaining market share it is in a status to hang around for competitors to experience financial problems resulting in the beginning of consolidation. Profit is starting to decline because of the weakening in sales. Customer satisfaction has declined which is manifested in the sudden drop of customer visits. Its stock price has plummeted. There was a sudden downward change in customer experience. These issues, and others, are troubling Howard Schultz as he attends to the various needs and demands of the company. On January 30, 2008, in a press junket with Wall Street reviewers, Howard proclaimed his commitment to initiate a revolutionary change through â€Å"reigniting the emotional attachment with our people and our customers† and â€Å"sharpening our competitive advantages of†¦ passion, curiosity, community, commitment and authenticity† (Business Wire, 2008, para 1). Several of the reasons for the sudden impact of negative trends to Starbucks are accountable to its customer service. One, there always appears to be a long stand in line at Starbucks; consequently, the crew members appear haggard and stressed out. Second, their coffee became weak and distasteful; their cappuccino tasted like water with milk. Third, the ambiance of their shops and the attractiveness of their brand name lose their customer appeal. And lastly, employee turnover increased in an unprecedented manner. In order to analyze comprehensively the current Starbucks economic status, it is important to have relevant data or information on various components of strategic customer-driven approach. Internal

Strategic Management in a Global Environment Assignment - 2

Strategic Management in a Global Environment - Assignment Example Other issues that may also arise include the lack of infrastructure which may result to challenges during distribution of the products and supply management. In order to conquer entry barriers, the market has to choose to go it alone, form partnership or employ local players. c) Strategies to build profitable position. After finding entry strategies, the next thing leaders should focus on is ways on creating defensible position that will meet the businesses long term goals (World Bank & International Finance Corporation, 2013). This can be achieved through understanding of their competitors, marking the target customers and finally through configuration of their local operations in order to deliver your capabilities efficiently. BRICS is an acronym that stands for an association of some five emerging global economies. The members of this association hail from developing countries or the newly industrialised countries. The distinguishing factor is that these countries have fast growing economies and they hold great influence on both global and regional affairs (Pant, 2013). Despite the praise the BRICS get from their commentators, they have received criticism as well. For instance, they are said to be defenders as well as promoters of developing states. BRICS is likely to face some issues in the coming decade due to a number of factors. For example, the West is yet to accept that the group is running by itself. With the creation of BRICS development bank, western analysts cited that BRICS states were very different and therefore could never agree. The other issue within the BRICS is the quantity of the stated issues in the Fortaleza Declaration as well as the Action Plan (Stuenkel, 2014). This is because some parts of the document were largely criticised. One scholar Alan Alexandroff wrote that the group was â€Å"almost breathtaking chutzpah† in condemnation of the groups’ unilateral action. He argued that â€Å"no state should

Sexual Offenders Research Paper Example | Topics and Well Written Essays - 1250 words

Sexual Offenders - Research Paper Example The management of sexual offenders is very challenging especially when a time comes for reunification with family members. This is especially so because most of these sexual crimes are perpetrated by known people most of who are family members (Langan, Schmitt & Durose, 2003). This is supported by Campbell (2007 p. 3) who argues that â€Å"preditors pose a serious threat to society even after they have served their sentences.† According to Fenner (2008 p. 2) the safety and protection of victims should be the first priority in the management of sex offenders combined with effective collaboration of the different stakeholders. Research has shown that recidivism rates are high for sexual offenders after they are released from prison. This is despite the various treatments available for offenders either in the community or in prisons. This research is aimed at discussing self offenders. It will look into the reasons why they engage in such conduct, why recidivism rates do not decl ine despite various interventions and also the various forms of treatment in place for such offenders. Sexual Offenders Sexual offenders in this case refer to those engaged in sexual crimes of rape, sexual assault, child molestation and statutory rape. ... 16) Child molestation involves sexual crime against children while statutory rape involves non forcible sexual acts such as incest, adultery. The definition of a child or minor varies from state to state or from one country to another but in most cases the consenting age is the age between 14 and 18 though many states considers those below the age of 16 as minors. Sexual acts with a minor whether forcible or non forcible are considered a sexual offense in the United States though with some exceptions (p. 5). First, for it to be considered a crime the offender must be above age 18. Secondly, the age difference between the offender and victim must be established and if the offender is less than 3 years older than the victim, then it is not an offense. Another exceptional case is whereby the offender is married to a minor; in this case if the sexual act was consented it is not an offense. However, these may vary across various jurisdictions. Research indicates that most offenders are li kely to repeat the offense even after incarceration (Langan et al. 2003; US Office of Justice Programs, 2012). In light of this, it is only appropriate to try and figure out why people engage in sexual offenses against family members especially children and also strangers in the first place. Many theorists have put forward various reasons as to why individuals perpetrate sexual violence against children. Some believe it is a result of multiple factors while others attribute it to cognitive distortions. However, all agree that biological, cultural, social and psychological factors combine to drive the offenders to abuse children or even adults (Fenner, 2008; Wad, Polaschek & Beech, 2006). One theory developed by Finkelhor’s in 1984 known as

Registerd nurse interview analysis Essay Example | Topics and Well Written Essays - 250 words

Registerd nurse interview analysis - Essay Example She said that this was tough when her children were still young because they rarely see each other due to her schedule. Sometimes, she cannot be with them on holidays because of her work. She said that she does not regard patients as difficult. Sometimes they can be demanding and grumpy but as a nurse, she has to understand the situation of the patient that they just want to feel better. The resource person narrated that nursing is not just an eight to five job where you punch in and get paid. It is a profession as well as a vocation because the job affects people’s lives. To be successful in this profession, one has to be genuinely concerned with people. A nurse has to understand that patients are already in pain and the least the nurse can do is to alleviate and make the pain bearable to the patient. Nurses also work long hours and they do not follow the Monday to Friday work routine nor the eight to five schedule. It is because illness do not follow schedule and hospitals are open throughout the year. There are also emergency cases where a nurse has to work

The Invasion of Sicily Essay Example | Topics and Well Written Essays - 2000 words

The Invasion of Sicily - Essay Example The invasion of Sicily had been on the agenda ever since the Casablanca Conference of January 1943. The success of the "TORCH" landings in French North Africa the previous November was the incubus of Franklin D. Roosevelt's and Winston Churchill's plan for a seaborne assault as soon as the Axis had been defeated in Tunisia. "TORCH was the first major amphibious assault against the Axis, although, in the Pacific, the marines landed on Guadalcanal on Aug 7th. It had to be staged from Continental US, go almost 3000 miles, through U boat infested waters, land troops on hostile beaches, and then keep the sea lanes open for reinforcements"2. While "TORCH" had been mostly unopposed, Sicily, it was estimated, would be a more difficult conquest because the Italians would be then fighting on their home ground, buttressed by good German troops. That notwithstanding, the allies remained undaunted. A blend of the battle-hardened men of Eighth Army under Montgomery, the profusion of US war ammunition and other materials, and American troops of the Seventh Army under Patton were considered enough to overwhelm the island garrison and bring the war to mainland Italy. Amphibious ships and landing craft were the resource that defined Allied military strategy in 1943-4, and it took six months to assemble enough for the main component of HUSKY, an operation involving 150,000 men and 3,000 ships. The Allied invasion of Sicily also known as "Operation Husky" was a major World War II invasion. During the invasion, the Allies took Sicily from the Axis. The Allies were primarily from the American, British, and Canadian armies. The axis represented Italy and Nazi Germany. The invasion is often referred to as a grand scale airborne and amphibious exercise, supplemented with approximately six weeks of land combat. The invasion of Sicily, documented all over the world, was heralded by Canadian newspapers. The invasion is described as one that was easy with little fatalities3. The reader is encouraged with the impression of the "shock and awe" that Iraq was met by the United States and British forces in the 21st century. Clearly, one reading the tales of control and bravery would never guess that Sicily was seized with worthy resistance. Newspaper accounts regale the at home reader with the "spectacle" of British and Canadian forces entering Sicilian borders with some stubborn resistance, but the tone is one of confidence. Eisenhower himself states: "The enemy's losses in men and equipment since the commencement of the campaign had been enormous. Of his panzer divisions, the equivalent of five had been destroyed and a further six severely mauled. The equivalent of 20 infantry divisions had been eliminated and 12 more (including 3 crack parachute divisions) had been badly cut up. Three divisions were trapped in Brittany and another division was isolated in the Channel Islands. By 25 August the enemy had lost, in round numbers, 400,000 killed, wounded, or captured, of which total 200,000 were prisoners of war"4. While the newspapers report with pride, the accomplishments of the axis, the history books tell a different story. Tales of heroism and outstanding bravery were reported in Canada. Indeed, one officer who rallied his troops by stating "Never mind the Germans, they can't shoot straight!" was

The Use of Information Technology In the Delivery of Hospitality Essay

The Use of Information Technology In the Delivery of Hospitality Services - Essay Example Impact of Information Technology on Hospitality Firms Without a doubt, in the past few years from entertaining visitors or guests and creating menus to monitoring staff members, information technology has significantly changed and modernized the way the hospitality sector works at the present time (Pandey, 2010). In the past, the hospitality firms have used cards, physically, or paperwork at the front desk with the purpose of keeping up a communication with old and existing customers. In this scenario, hospitality firms were for the most part at the compassion of the needs of guests to get there, as well as on their own efforts and staff to be there for possible surges or extended deficiencies of tenancy. On the other hand, in the absence of IT supported tools and applications hospitality firms were facing serious business issues. In their article, (Nikolis, 2008) outline a variety of significant areas of the hospitality firms where IT tools and applications are being used to offer s ervices. For instance, one of the basic reasons that IT has turned out to be critical is its helpfulness for the billing section of the hospitality firms, which has been significantly improved with the emergence of IT. In fact, manual data entry and traditional paper-based was slow, time-consuming and unproductive, and it did not offer effective support in letting the hospitality firm know what is the current status of their firm. On the other hand, in order to deal with these issues the advancements of IT in the form of state-of-the-art record keeping systems keep in mind a hotel owner to keep up to date with what they have with good grace available, how much investment it will take and how much time it will take (Nikolis, 2008). In addition, in order to make effective use of... This essay stresses that information technology is playing a significant role in every walk of life. Our lives are always surrounded by the information technologies. Seeing the ever-increasing importance of information technologies hospitality industry has started making use of information technologies in different forms. This paper has presented a detailed analysis of some of the important uses of information technologies in the hospitality industry. This paper has summarized the viewpoints of other researchers. At the present, the Internet is playing a significant role in the hospitality industry. The majority of hotels is adopting this tool for marketing purpose. Many hotels use their web sites to communicate with their customers and receive their feedback. The information technology has also helped the hospitality firms to automate their manual or traditional business processes. This paper has also discussed some of the latest technologies which can be adopted by hotels in order to get a competitive edge over other hotels and get the attention of more customers. However, it depends on an organization how effectively it makes use of information technology. A hospitality firm should keep in mind the interest of their customers and offer facilities on the basis of their interests. The use of the information technology has offered a lot of benefits and opportunities for the hospitality industry.

New England and Chesapeake Essay Example for Free

New England and Chesapeake Essay During the 1610, the New England and Chesapeake region were both settled largely by people of English origin, but by 1700 the regions developed into two distinct societies. The distinctions of development arose due to differences in economy and political structure. The economy and political structure of New England and Chesapeake differed based on the geography, needs and the different values or purposes that the regions served, causing two distinct societies to emerge by 1700. In terms of economics, early distinctions occurred in that the economy of the Chesapeake colonies was based on large plantations whereas the economy of New England was based on subsistence farming and mercantilism. In early 17th century Virginia, tobacco became Virginia’s biggest profits. By 1700, 40 million pounds of tobacco was produced and large plantations were dedicated to just growing tobacco, producing a single crop economy. The large plantations provided landowners or tobacco growers with cheap and plentiful labor through the use of slaves and indentured servants. In document C, the passengers aboard the ship bound for Virginia are all mostly made up of single men well below the age of 40, showing that many are probably indentured servants who are going to work in the large plantations. By the 1660s the overproduction of tobacco dramatically decreased tobacco prices causing indigo and rice to become greater commodities. Still large plantations dominated the economy by producing indigo and rice as well. However New England colonies were based on subsistence farming and a barter economy in the early 17th century. Only enough food would be grown to support the community. Fishing oysters, whaling and homespun industry (artisans) dominated the economy. In document B, many craftsmen ventured to New England, showing that artisans were an important part of the economy. There were a few number of farmers aboard the ship as well indicating that farming was not a large part of the economy. After the Restoration and the Navigation Acts in the 1660s which restricted colonial trade to England, New England became a mercantile based economy. Trade dominated the economy. The Chesapeake colonies depended more one agriculture in their economy whereas the New England colonies depended more on trade due to the geography of the two regions. Chesapeake was located further south than New England, therefore having longer warmth periods and flat lands. These geographical  advantages allowed the Chesapeake colonies to have a longer growing season and to be able to create large plantations. The geography of the New England colonies restricted the growing season due to the high ground with many rocks and the cooler climate. New England was located along the coast giving it access to many deep harbors to foster trade. Chesapeake and New England were able to develop in to distinct societies due to their different economies where Chesapeake relied on agriculture while New England relied on mercantilism. In terms of economics, the economy of the regions differed in that Chesapeake was based on slave labor and indentured servitude whereas New England was based on reciprocity. Document A shows how New England is based on reciprocity. John Winthrop, claims that in order for the Massachusetts Bay Colony to succeed, everyone in the colony must work together productively and fend for one another. â€Å"We must be knit together in this work as one man. We must entertain each other in brotherly affection, we must be willing to abridge ourselves of our superfluities, for the supply of other’s necessities.† This shows that the colonists of New England not only work as a group by helping each other achieve success, but also treat each other with respect. Document B shows that most of the passengers heading to New England are heading there with their entire family, indicating there must be a cooperation system in New England where people cooperate with each other to meet their needs and gain profits. Many families are also traveling with their own servants therefore it can be seen that indentured servants or slave labor was not the foundation of the New England economy. In contrast document C shows that the p eople heading towards Virginia (Chesapeake colony) are mostly young single men who are probably indentured servants thereby showing that the economy of the Chesapeake colonies are based on slave labor and indentured servants. During the early 1600s, the Chesapeake colonies mostly depended on indentured servants and some slave labor since a large and cheap labor source was needed for the tobacco plantations. Since many people did not come in families, families formed slowly and could not provide a strong and abundant labor force. Natives in the colonies died quickly, causing a need for a more reliable labor force. Therefore the colonists of the Chesapeake colonies turned to indentured servants, displaced farmers in England who wanted to venture to the colonies, but did not have enough money to pay for the voyages by themselves. A plantation owner would pay for the indentured servants’ voyage and the indentured servant would have to work off the debt by working on the plantations with the promise that they would get land and shelter once they were freed. However, in the 1660s indentured servants became scarce and many of them were freed from service causing plantation owners to turn to slave labor to maintain their plantations. The economy of the Chesapeake colonies depended on slave labor and indentured servitude while New England depended on reciprocity due to Chesapeake’s dependence on agriculture for wealth and New England’s dependence on trade and crafts for wealth. Plantations worked most effectively through the use of cheap and abundant labor while trade and mercantilism worked most effectively through cooperation. In terms of political structure, differences in government can be seen in that the Chesapeake colonies were based more on the landed aristocracy whereas the New England colonies were based more on religion and the church. In the Chesapeake colonies the plantation owners of the landed aristocracy had most control over the government. Many landowners and the landed aristocracy made up the government including the council and the House of Burgess in Virginia. These officials made up the laws and collected taxes, giving them control over the government. William Berkeley, the governor of Virginia during the mid-1600s adopted many policies favoring the plantation owners and used his powers to benefit the landowners, giving large planters economic and political control in the colony. Many freemen who worked off their debts did not have land. The favoring of the landowners by the government soon erupted into a rebellion led by Nathaniel Bacon. In Document F, Bacon’s Manifesto claims that the government is corrupt and only concerned for their own estates, collecting all the money from the taxes to better develop their estates, showing how the planters dominated the political life of New England. The government failed to protect the frontier settlements where most yeoman farmers were from Indian attacks and instead only concerned themselves with the large plantations. In contrast the government of the New England colonies were centered on religion. In the Plymouth settlement, the church became the civil and social institution of the colony. People who did not conform to the religious values or ideals of the Puritans were executed as seen in the Salem Witch Trials, where the government ordered and allowed the execution of â€Å"witches† or social outcasts  in 1692. In Massachusetts, communities of pure Christians were made. The government did not tolerate any religious views besides Puritan views. Even educati on and literacy centered on religious values. Land in the New England colonies were maintained and controlled by the Elders of the church and the amount of land given to each family would depend on their usefulness to the church as well as the size of the family. Every family should have enough to sustain themselves. The church also dominated political authority. Only male church member could vote, pass taxes, settle disputed, hold town meetings and appoint government officials. The government of the New England colonies was centered on religion whereas the government of the Chesapeake colonies was centered on planters. The differences are due to the original purpose of each region/colony. Virginia and Maryland were founded primarily for commercial venture causing land and commodities to become most important, thereby having land equated power. Massachusetts and Plymouth were founded primarily for refuge for English separatists or puritans causing religion to become the most important aspect of colonial life and thereby giving power to the church. All in all the New England and Chesapeake settlements evolved into two distinct societies despite their English origin due to their economic and political differences. The economy of New England was based on mercantilism and reciprocity/cooperation whereas the economy of Chesapeake was based on agriculture and slave labor. The political system also differed in that New England was based on religion whereas Chesapeake was based on the landed aristocracy and the planters. The differences caused the different regions to develop distinctive needs in order for the regions to prosper, leading to two distinctive societies.

Nurse-led Clinics in Respiratory Care: a Literature Review

Nurse-led Clinics in Respiratory Care: a Literature Review INTRODUCTION 1. What is a nurse-led clinic? As the coined term suggests, a nurse-led clinic is a health care centre in which nurses are involved in high level specialist procedures and assessments. In such centres, nurses are the critical decision makers, being involved in patient care at the micro-, meso-, and macro-levels. While the role of the physician in the provision of health care is undisputable, the deity-like status that medical practitioners typically have in the mind of patients, coupled with the limited time available for individual patient consultations, make it hard for these group of health care professionals to tackle the ‘softer’ side of patient care. Nurses, on the other hand, defined by the Oxford Medical Dictionary as health care professionals that are trained and experienced in nursing matters and entrusted with the care of the sick and the carrying out of medical and surgical routines, are better placed to provide this essential follow-up, especially in the care of patients with chronic dise ases. According to Hatchett (2003), a nurse-led clinic is a clinic in which nurses have their own patient case loads of whom they take complete charge. Hatchett broadly describes the components of such a clinic. There would be an increase in autonomy associated with the nursing role in the nurse-led clinic, with the power to admit, discharge or refer patients, as appropriate. In Hatchett’s own words, the roles which nurses adopt in these revolutionary settings can be broadly classified as follows (Hatchett, 2003): Education Psychological support Patient monitoring The initiation of nurse-led initiatives probably owes its origins to the rise in nursing specialties in the United Kingdom. Throughout primary and secondary care, nurses are taking senior positions in health care institutions, such as nurse specialists, nurse practitioners, nurse consultants, nurse prescribers, etc, leading to a marked change in service delivery and the profile of the nursing profession. In addition to the usual registered nurse training, nurses working at higher levels of practice receive training to acquire a range of other medical skills such as physical examination and medical history taking in order to recognise abnormal clinical findings. In a two-phase exploratory study to evaluate the domains of structure, process and outcome of nurse-led clinics in supporting intermediate care after the acute phase of disease, Wong et al (2006) interviewed nurses from 34 clinics and 16 physicians and observed 162 nurse-led clinic sessions. Their findings demonstrated the high level of skill and experience of the nurses who ran the clinics. Their work involved skills such as adjusting medications and initiating therapies, and diagnostic tests according to protocols. Interventions included assessments and evaluations, and health counselling. All patients studied showed improvement after the nurse clinic consultation, with the best rates reported in wound and continence clinics; satisfaction scores for both nurses and clients were high. However, although physicians valued their partnership in care with the nurses, they were concerned about possible legal liability resulting from the advanced roles assumed by these nurses. Ultimately, nurse-led clinics provide an integral and invaluable patient-centred approach to the management of chronic disease which build upon skills such as counselling, teaching and health promotion which are key to contemporary nursing practice, as well as newly acquired medical skills. The advent if nurse-led clinics provides an opportunity for nurses to develop enhanced roles in which they can achieve more autonomy in their practice. This can be made a reality if adequate training and education, as well as effective leadership are in place (Wiles et al, 2001). 2. The general roles of nurses in chronic care management The chief nursing officer, Sarah Mullally has proposed ten key roles for nurses in autonomous patient care. These are outlined below as cited by Hatchett (2003): Order diagnostic interventions: just like a medical practitioner would, the present-day nurse is able to ask for laboratory or clinical diagnostic tests to aid the process of diagnosis. Furthermore, a well-trained nurse will also be able to read and interpret laboratory results effectively Make and receive referrals directly: while the all-important roles of nurses are recognised, the need for a multidisciplinary approach to patient care remains key in order to optimise patient outcomes. Accordingly, nurses should be able to recognise the patients’ needs and refer them to the appropriate health care service as required. Similarly, nurses should be ready to accept referrals from other health care disciplines as necessary. Admit and discharge patients for specified conditions, within agreed protocols: in order to make the best use of the often limited hospital resources, a nurse should have the power to recommend patients for hospital admission and subsequent discharge Manage patient case loads: in nurse-led clinics, nurses are also responsible for managing their individual case loads. It is important to delegate patient cases to other members of the team, when necessary to ensure that patients receive the best care possible. Run clinics: the autonomous role of the nurse in a nurse-led clinic includes all aspects of the management and day-to-day running of the clinic. Prescribe medications and treatments: nurse prescribers are able to advise patients on appropriate treatment, based on diagnosis of ailment and individual characteristics and laboratory findings. Carry out a wide range of resuscitation procedures, including defribillation Perform minor surgery and outpatient procedures: especially in injury clinics. While nurses are probably not equipped to carry out full-fledged surgical operations alone, they are trained to conduct emergency processes as appropriate. Triage patients, using the latest information technology, to the most appropriate health care professional Take a lead in the way local health services are organised and in the way they are run Nurses have always been considered as a supplement to the fundamental care provided by medical doctors. In fact, in some geographical regions, nursing roles are limited to menial tasks such as changing bedpans etc. In the new age, the nursing role as we know it is becoming increasingly important with nurses taking on infinitely more clinical roles. This has led to controversial debates with critics arguing that nurses cannot replace doctors in the provision of health care services. As Richard Hatchett very astutely pointed out (2003), the increased autonomy being acquired by nurses is not a bid to compete with medical doctors. Instead, â€Å"it is a case of considering who can provide the most appropriate service to the patient† (Hatchett, 2003). Thus, it is clear that the roles of nurses in chronic care management is very diverse and can be integrated into any nurse-led clinic intervention to the utmost benefit of the patient and all stakeholders. There have been numerous studies on the role of nurses in the care of patients with chronic diseases. In addition, and more specifically, the feasibility and benefits of implementing nurse-led clinics in practice have also been investigated to some extent. In the subsequent sections, we will review the evidence to support these innovative nursing interventions in an attempt to make the best use of health care resources. 3. Nurse-led clinics in the management of chronic care diseases: the evidence The World Health Organization (2002) defines chronic diseases as health care problems that require ongoing management over a period of years or decades. The nature of these disease conditions make it necessary to provide long term care and follow-up for the afflicted patients. Nurse-led interventions have been investigated a wide range of chronic diseases. It could be a logical, user-friendly, cost-effective and practical approach to improving long-term patient outcomes and should be explored fully to maximise the contributions of nurses to the chronic care management. Although this review aims to analyse the effectiveness of nurse-led clinics in the treatment of respiratory diseases, a prior look at the role of these interventions in the management of other chronic care diseases will provide an insight to the general contributory roles of nurses and will serve as a foundation for complete understanding of this state of the art intervention. 3.1 Nurse-led interventions in the management of diabetes Numerous studies have evaluated the benefits and practicalities of nurse-led clinics in the long-term management of diabetes. The renal diabetic nurse specialist is described as an â€Å"essential player† in organising the management of, and to meet, all aspects of need of this group of patients (Marchant, 2002). An unintended benefit of a nurse-led clinic to reduce cardiovascular risk is improved glycaemic control, HbA1c (Woodward et al, 2005). In particular, nurse-led diabetic clinics have been shown to benefit specific ethnic groups. Matthias et al (1998) identified the needs of diabetic patients from minority ethnic groups, such as blacks and Asians and postulated that nurse-led clinics were of particular benefit in this patient group. As epidemiological data show that diabetes is most common in minority ethnic groups (Carter et al, 1996), the importance of these innovative interventions is further emphasised. 3.2 Nurse-led interventions in the management of cardiovascular disease Care of patients with cardiovascular diseases is broad and involves many aspects, from risk factor management (non pharmacological interventions), primary and secondary prevention of clinical events, pharmacological therapy, surgical procedures, etc. Through a large well-designed randomised controlled trial in Scotland, Campbell et al (1998) showed that nurse-led clinics were practical to implement general practice and led to an significant increase in various aspects of the secondary prevention of coronary heart disease. Significant improvements were noted in aspirin management, blood pressure management, lipid profile management, diet and physical activity, regardless of the individual patient’s baseline cardio performance or status. However, surprisingly, there was no recorded improvement on smoking cessation, which would have been a beneficial intervention in most acute and chronic disease states, including respiratory diseases. In addition to the apparent effectiveness of the nurse-led clinics in the long-term primary and secondary prevention of coronary heart disease, the optimal use of nurses in the care of these patients has been shown to be cost-effective in terms of quality adjusted life years (QALYs) (Raftery et al, 2005). In this large cost-effectiveness analysis, although the cost of the nurse-led clinic intervention was  £136 higher per patient, the differences in other National Health Service (NHS) costs was not statistically significant. Furthermore, there were 28 more deaths in the non-intervention group leading to a gain, in the intervention group, in mean life-years per patient of 0.110 and of 0.124 QALYs. 3.3 Nurse-led interventions in rheumatology The role of clinical specialist medical doctors in the care of their patients is unquestionable; however, the role of nurses in the therapy area of rheumatology (i.e. in patients with rheumatoid arthritis) is also well documented. Hill and colleagues (1994) clearly demonstrated the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic. Although this was a small study with a sample size that only included 70 patients, the statistical significance of the findings of this randomised controlled trial cannot be ignored. In patients managed in the Rheumatology Nurse Practitioner clinic, pain, morning stiffness, psychological status, patient management and satisfaction all improved significantly (p = 0.001; p = 0.028; p = 0.0005; p In addition, patient satisfaction is frequently higher in patients who are allocated to nurse care than those allocated to standard medical care (Hill, 1997). In yet another study by Dr Jackie Hill, a registered nurse at the Academic and Clinical Unit for Musculoskeletal Nursing in the Chapel Allerton Hospital in Leeds, the researchers concluded that a nurse-led clinic is effective and safe and is associated with additional benefits, such as greater symptom control and enhanced patient self-care, compared with standard outpatient care. 3.4 Nurse-led interventions in cancer care The effectiveness of nurse-led care in different common cancer afflictions has been researched variously. An extensive review article by Loftus and Weston (2001) discussed the patient needs that could be met by nurses working in nurse-led clinics and highlighted the experience and skills of advanced nursing practice that make such innovative care a reality. The types of nurse-led interventions are as varied as the different types of cancers for which they are used. These range from nurse-led telephone clinics in patients with malignant glioma (Sardell et al, 2001); nurse-led follow up in patients receiving therapy for breast cancer (Koinberg et al, 2004); and nurse-led screening programmes in Hong Kong Chinese women with cervical cancer (Twinn and Cheung, 1999). In a randomised controlled trial in a specialist cancer hospital and three cancer units in southeastern England, Moore et al (2002) assessed the effectiveness of nurse-led follow-up in the management of patients with lung cancer. The findings of the study showed high levels (75%) of patient acceptability. This negates the possibility of patients’ reduced confidence in nurses’ ability and preference for standard medical doctor care. Clinical outcomes were also greatly improved as shown by less severe dyspnoea at three months (p=0.03), better scores for emotional functioning (p=0.03), and less peripheral neuropathy at 12 months (p=0.05). 3.5 Nurse-led interventions in the management of HIV infection Using a rigorous model of comprehensive care nurse-led clinic in genitourinary medicine to compare nurse-led and doctor-led clinics at a central London medicine clinic, Miles and colleagues (2003) reported reliable and valid results to support the use of the nurse-led variety as an acceptable alternative to the existing doctor-led clinics. More specifically, the British HIV Association (BHIVA)/British Association for Sexual Health and HIV (BASHH) advocate the benefits that can be accrued from a nurse-led educational intervention in the care of patients with HIV infection (Poppa et al, 2003). A small pilot study that investigated the effects of a 6-month nurse-led educational programme reported that improved virological responses were seen in treatment-experienced patients (Alexander et al, 2001). While a majority of the studies on nurse-led clinics in other chronic diseases can be broadly applied to nurse-led care in patients with respiratory diseases, differences in the nature of these diseases and the necessary care pathways mean that the extent to which these tested interventions can be applied to other therapy areas is, in actual fact, limited. Government policies that advocate the clinical and economic effectiveness of nurse-led interventions frequently pool together evidence from all therapeutic areas. Indeed, it can be hypothesised that, if nursing interventions are shown be practical alternatives for medical care in complex diseases with poor prognoses, such as cancer, HIV and coronary heart diseases, care of patients with respiratory diseases which generally have better prognoses should be easily, effectively and safely undertaken by qualified and well-trained nurses. Nevertheless, these findings of the effectiveness of nurse-led interventions in the numerous chronic diseases explored in previous sections, should be applied to the different patient population with respiratory diseases. As much as possible, research findings from similar patient groups should be applied in clinical practice in order to ensure that evidence-based practice in this case is relevant. 4. Government policies influencing the establishment of nurse-led clinics Government health policies in the United Kingdom actively support the extension of nurses’ skills into areas such as nurse prescribing and the development of nurse practitioner posts (NHS Plan 2000; Department of Health). Government initiatives that that strive to reduce consultation waiting times and optimise the use of medical practitioners indirectly support the establishment of nurse-led clinics. The Government has endorsed the implementation of nurse-led clinics as a means of increasing access to specialist health care and treatment more quickly and also as an effective way to manage chronic conditions (Hatchett, 2003). In the Department of Health (1999) document, ‘Making a difference’, government plans for strengthening nursing contribution to health care is presented. The Government has launched an ambitious programme of measures to improve the National Health Service and the health of the public, and the role of the nursing profession in this initiative cannot be overemphasised. The key nurse-related points of the document are outlined below: To extend the roles of nurses, midwives and health visitors to make better use of their knowledge an skills – including making it easier for them to prescribe To modernise the roles of school nurses and health visitors in supporting the new health strategy and other policies To see more nurse-led primary care services to improve accessibility and responsiveness The document highlights numerous nurse-led initiatives that have been effectively implemented all around the United Kingdom. A nurse-led minor injury service in rural Cornwall has provided patients with a number of benefits: easier accessibility, reduced waiting times, reduced need for on-site medical; attendance, increased patient satisfaction and reduced need for transfers to local Accident and Emergency departments. Similarly, a nurse-led rapid response team in Peterborough responds to acute crisis cases and allows patients to be nursed at home. Evaluation has shown that 71% of patients referred to this ‘hospital at home’ service would have been admitted to hospital if the service did not exist. Other effective live nurse-led services include a nurse-led rheumatology service in Merseyside and a nurse-led intermediate care unit in Liverpool. Furthermore, several nurse interventions are advocated in the document for contributing to the management of cardiovascular disease. Several of these are also applicable to respiratory diseases; these include: Smoking cessation clinics using national smoking cessation guidelines Healthy lifestyle clinics in collaboration with other health professionals to address factors such as diet, nutrition and exercise, thus improving overall health Care for patients with congestive cardiac failure under ‘home-based’ initiatives Nurse-led chest pain clinics or risk factor screening and reduction clinics Nurse-led blood pressure clinics to identify and help manage blood pressure disorders and medication adherence 5. Review objectives The objectives of this review are: To briefly summarise various studies on effectiveness and cost-effectiveness of nurse-led interventions in common respiratory diseases To critically appraise the methods employed by these studies To evaluate, interpret, and where possible, compare the findings of the various studies To explore the applicability and generalisability of the results to practice in the appropriate patient population To make suggestions for future studies in this area. METHODS Literature search A search of two major databases, MEDLINE and EMBASE, was conducted to identify articles published from 1990 through 2008. Search terms that were used include nurse, nurse-led clinic, nurse-led interventions, respiratory diseases, asthma, chronic obstructive pulmonary disease, bronchiectasis, tuberculosis, cystic fibrosis, cost-effectiveness analysis, cost-benefit analysis, and economics. A secondary search of the reference lists was then conducted to identify relevant articles, editorials, and other unoriginal reports that may have been missed in the primary search. Some studies were excluded based on the following criteria: They were not conducted in patient populations with respiratory diseases Independent nurse-led interventions were not investigated The study populations being investigated were mixed in terms of diagnosis, which would affect the integrity of the study findings for respiratory diseases The methodology and/ or statistical analysis methods were not clearly elucidated 6. Nurse-led clinics in the management of respiratory diseases: a review of the evidence The role of the specialist respiratory nurse has evolved since the early 1980’s with the support of the Royal College of Physicians (RCP 1981). The possible complexity of respiratory patients’ regimens necessitates support with various aspects of their care plans, such as: Supervising nebuliser and inhaler techniques Monitoring progress, i.e. by periodical assessment of lung function and exercise capacity Education on the specific disorder, medications, potential adverse events, etc Counselling and education on positive lifestyle, or non-pharmacological, changes Adherence support and monitoring The role has developed further with nurses providing nurse-led clinics in chronic obstructive pulmonary disease (COPD) and asthma along with nurses providing early supportive discharge and ’hospital at home’ for patients with COPD (French et al, 2003). Some schools of thought argue that nurse-led clinics would culminate in the neglect of the more traditional nursing roles, as nurses focus on a more medical-focused aspect of patient care. However, research in other therapy areas, such as rheumatology (Hill et al, 1994) and mental health (Reynolds et al, 2000) shows that nurses can effectively combine the medical role with the traditional nursing approach. Nursing care strives to provide a holistic approach to care through practical management of disability, education and counselling and referral to other health care services as required (Rafferty and Elborn 2002). 6.1 Bronchiectasis Nurse-led clinics have been evaluated, compared with regular doctor-led clinics, in a single randomised controlled trial in patients with bronchiectasis, a respiratory condition in which there is widening of the bronchi or their branches (Sharples et al, 2002). The study was a randomised controlled crossover trial including 80 patients in a bronchiectasis outpatient clinic. Patients received 1 year of nurse led care and 1 year of doctor led care in random order, and were followed up for 2 years. Various outcome indicators were used in the comparison, including lung function and exercise capacity, infective exacerbations, hospital admissions, quality of life and cost-effectiveness of the intervention. The results of this study are illustrated in Table 1 below. Table 1: Nurse-led and doctor-led care in care of patients with bronchiectasis (Sharples et al, 2002) Measurement outcome Nurse-led Doctor-led Mean difference (95% CI) p-value Forced expiratory volume in one second (FEV1) (%) 1.87 1.86 0.01 (-0.04 to 0.06) Forced expiratory volume in one second (FEV1) (L) 69.7 69.5 0.2 (-1.6 to 2.0) Forced vital capacity (FVC) (%) 87.6 87.6 -0.02 (-1.5 to 1.4) 12 minute walk distance (m) 765 746 18 (-13 to 48) Infective exacerbations (patient years of follow up) 262 (79.4) 238 (77.8) 0.34 Hospital admissions attributable to patient’s bronchiectasis 43 23 0.22 As the table above clearly shows, there was no statistical difference in FEV1/FVC percent predicted or distance walked between nurse led and doctor led care in the two treatment periods. Furthermore, 262 episodes of infective exacerbations were recorded by patients in the nurse practitioner-led care group in 79.4 patient years of follow up, compared with 238 in 77.8 years in the doctor-led care group. Thus, nurse practitioner-led care is associated with a relative rate of exacerbations of 1.09 (95% CI 0.91 to 1.30), p=0.34. Using the St Georges Respiratory Disease questionnaire to assess differences in health-related quality of life between the two groups, there was no statistically significant differences in each of the scores for Symptoms, Control, Impact or total score. Also, the study showed that nurse-led care resulted in significantly higher costs per patient compared with doctor-led care; this was largely due to the difference in the number of hospital admissions and intravenous and nebulised antibiotic costs. The authors concluded that nurse practitioner-led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care, but may use more resources. This study has several potential limitations which could invalidate the findings. As the study relied on patient report to record the prescriptions issued by general practitioners, these may have been underestimated and could grossly affect the cost analysis. Conversely, the nurse practitioner was required to record prescriptions and tests issued at the clinic, and thus these records are probably more reliable and she would be more likely to have ensured that patients left with supplies of routine treatment. Another possible drawback of this study is the use of a crossover design in the methodology. Unless a wash-out period is incorporated in the study design, there is the possibility of a carryover effect with crossover study designs, with the danger that the effects of the earlier treatment is falsely attributed to the final experimental treatment. In this study, there was no allowance for a washout period and thus this could affect the reliability and validity of the study results. This order and time effect needs to be checked for within the analyses but it can rarely be excluded as potential biasing factors (Pocock 1983). However, as recruited patients received the interventions in random order, this may negate the carryover effect. Despite the possible limitations of the study that could potentially hinder its applicability in practice, the findings support the implementation of a nurse-led clinic in patients with chronic cases of bronchiectasis as an alternative to the standard rigid medical care. 6.2 Asthma Similar to the findings in the study by Sharples and colleagues (2002) in patients with bronchiectasis, Nathan et al (2006) more recently compared the effect of follow-up by a nurse specialist with follow-up by a respiratory doctor following an acute asthma admission. In a single centre prospective randomised controlled trial, 154 patients admitted with acute asthma were randomly assigned to receive an initial 30-min follow-up clinic appointment within 2 weeks of hospital discharge with either a specialist nurse or respiratory doctor. The intervention comprised a medical review, patient education, and a self-management asthma plan. Further follow-up was then arranged as was deemed appropriate by the corresponding doctor or nurse, and all patients were asked to attend a 6-month appointment. Despite hospital outpatient follow-up, there was a significant proportion of patients in both groups who had exacerbations. However, there was no statistically significant difference between the two groups (Table 2). In the same manner, there was no statistically significant difference in quality of life assessed with two different validated questionnaires, the Asthma Questionnaire and the St George Respiratory Questionnaire. Mean change in peak flow at 6 months was similar between the two groups, probably indicating equivalence of the two tested interventions. Nathan et al (2006) concluded that follow-up care by a nurse specialist for patients admitted with acute asthma can be delivered equivocally with comparable safety and effectiveness to that traditionally provided by a doctor practitioner. Table 2: Nurse-led and doctor-led care in follow-up care of patients admitted with acute asthma (Nathan et al, 2006) Measurement outcome Nurse-led Doctor-led Odds ratio (95% CI) Mean difference (95% CI) p-value Change in peak flow 1.39 (-3.84 to 6.63) 0.122 Infective exacerbations (%) 45.6 49.2 0.86 (0.44 to 1.71) 0.674 Quality of life 87.6 87.6 -0.02 (-1.5 to 1.4) Asthma Questionnaire 0.78 (-0.64 to 2.19) 0.285 St George Respiratory Questionnaire 1.08 (5.05 to 7.21) 0.891 The possible limitations associated with this study is the large amount of missing data for some outcomes, especially peak flow and quality of life

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