Online Blood Banking (Srs)

SRS FORMAT Index and Tables 1. Presentation Purpose of the Project: Online Blood Bank is points serving for human government assistance. We have all the data, you will ever require. Numerous individuals are here for you, to support you, ready to give blood for you whenever. We have done all the activity, rest is yours. search the blood bunch you need. You can help us by enlisting on Online Blood Bank on the off chance that you are happy to give your blood when required. As a pleased individual from OnlineBloodBank and a mindful person, you can help somebody out of luck. So give blood in on the web. Extent of the undertaking: Online Blood Bank is points serving for human welfare.We have all the data, you will ever require. Numerous individuals are here for you, to support you, ready to give blood for you whenever. We have done all the activity, rest is yours. search the blood bunch you need. You can help us by enlisting on Online Blood Bank in the event that you are eager to give your blood when required. As a glad individual from OnlineBloodBank and a dependable person, you can help somebody out of luck. So give blood in on the web. Modules: 1. Administrator 2. Donar 1. Administrator: This module centers around the two donars and acceptors. Every part in a donar and acceptor is given a client id and secret phrase, which distinguishes him uniquely.The part is given a login structure. he enters the login subtleties client id and secret phrase. .. The choices given to †¢ Change Password †¢ Maintain donar subtleties †¢ Maintain referral once †¢ Update donar subtleties †¢ View Experiances †¢ Logout Whenever a client needs to change his/her secret key he can choose the change secret word choice. The framework shows the structure, which approaches him for his old secret key and new secret word. The framework at that point contrasts the old secret key and the current secret phrase in the database and on the off chance that they coordinate, at that point the secret phrase is set to the new secret phrase in the database.The id for recovering the subtleties from the database is brought through the meeting, which is kept up utilizing treats in the structure. This evacuates the weight on client in composing client id again and furthermore keeps up security by not permitting one client to change secret phrase of other incidentally. 2. Donar: Each part in a Donar is given a client id and secret word, which distinguishes him interestingly. The part is given a login structure. he enters the login subtleties client id and secret word. .. The alternatives given to an every part in a staff are †¢ Change secret word †¢ Find a Blood gathering. †¢ Why give blood †¢ Who needs blood †¢ Find A Donar. †¢ Refer A Friend. †¢ LogoutWhenever a client needs to change his/her secret word he can choose the change secret key alternative. The framework shows the structure, which approaches him for his old secr et word and new secret phrase. The framework at that point contrasts the old secret key and the current secret phrase in the database and in the event that they coordinate, at that point the secret phrase is set to the new secret key in the database. The worker id for recovering the subtleties from the database is brought through the meeting, which is kept up utilizing treats in the structure. This expels the weight on client in composing client id again and furthermore keeps up security by not permitting one client to change secret word of other accidentally.At the end the client can log out from the framework utilizing the logout choice. References: 1. â€Å"Windows Programming Using MFC† †Jeff Prosice 2. â€Å"MFC Internals† †Geroge Shepherd 3. â€Å"Programming in Microsoft VC++† †Kruglinnki. 4. â€Å"Software Engineering Concepts† †Pressman 5. â€Å"Object Oriented Analysis and Design† †Rambaugh Technologies: you can u tilize the . NET Framework to build up the accompanying sorts of uses and administrations: †¢ Console applications. †¢ Scripted or facilitated applications. †¢ Windows GUI applications (Windows Forms). †¢ ASP. NET applications. †¢ XML Web administrations. †¢ Windows administrations. 2. Generally Description: Sotware Interface:OPERATING PLATFORM : WINDOWS 2000/NT/XP RDBMS: SQLSERVER 2000 SOFTWARE : VS. NET 2008 FRONT END TOOL : ASP. NET Hardware Interface: RAM :128MB HARD DISK :MINIMUM 20 GB 1. Information Flow Diagrams: Data streams are information structures moving, while information stores are information structures. Information streams are ways or ‘pipe lines’, along which information structures travel, where as the information stores are place where information structures are kept until required. Information streams are information structures moving, while information stores are information structures very still. Henceforth it is concei vable that the information stream and the information store would be comprised of similar information structure.The following are some DFD images utilized in the task External elements DATAFLOWS FIRST LEVEL DTAFLOW DIAGRAM donar Information Employee Status DFD For Admin DFD For User Account 2. Brought together Modeling Language Diagrams (UML): †¢ The bound together displaying language permits the product designer to communicate an investigation model utilizing the demonstrating documentation that is administered by a lot of syntactic semantic and down to business rules. †¢ An UML framework is spoken to utilizing five unique perspectives that depict the framework from particularly alternate point of view. Each view is characterized by a lot of chart, which is as per the following. Client Model View i.This see speaks to the framework from the clients viewpoint. ii. The examination portrayal depicts an utilization situation from the end-clients viewpoint. Auxiliary model view (In this model the information and usefulness are shown up from inside the framework. (This model view models the static structures. Conduct Model View (It speaks to the dynamic of social as parts of the framework, portraying the collaborations of assortment between different auxiliary components depicted in the client model and basic model view. Execution Model View ? In this the auxiliary and conduct as parts of the framework are spoken to as they are to be built.Environmental Model View In this the basic and social parts of nature in which the framework is to be actualized are spoken to. UML is explicitly developed through two unique areas they are ? UML Analysis demonstrating, which centers around the client model and auxiliary model perspectives on the framework? ? UML configuration demonstrating, which centers around the conduct displaying, execution demonstrating and natural model compete Use-Case Model Survey: 1) Use Case Diagrams Admin: The Administrator is the client of t he framework. He is the mindful individual to require the new Donars and status, Matins the Add new Tasks Details.Donar: This module centers around the fundamental Donar. Every Donar is given a client id and secret word, which recognizes him extraordinarily. The Donar is given a login structure where in he enters the login subtleties client id and secret key. As he is an enlisted into the framework shows his structure with his/her select choices 1) Sequence Diagrams Administrator Login Sequence 2) Sequence Diagrams Employee Login Sequence . ELABORATION PHASE [pic] Flow outline: 3. Substance RELATIONSHIP Diagrams E-R (Entity-Relationship) Diagram is utilized to speaks to the connection between elements in the table. The images utilized in E-R outlines are: SYMBOL PURPOSERepresents Entity sets. Speak to traits. Speak to Relationship Sets. Line speaks to stream Structured examination is a lot of apparatuses and procedures that the expert. To build up another sort of a framework: The co nventional methodology centers around the money saving advantage and possibility examination, Project the executives, and equipment and programming choice an individual contemplations. Administrator Donar: 11. End This undertaking has helped us in executing the Visual C++ utilizing AppWizard and MFC. We computerized crafted by distributing movements to the Employee as indicated by their Designation and Gender . All Tasks are finished by various Groups.Each bunch framed as same division Employees or diverse office Employees. Age of movements assignment for Employee helped us in learning Object arranged highlights and executing them in MFC. We came to think about the planning the errands refreshing by time and have an arrangement of finishing task with in time legitimate structuring of Rotating the calendars. â€â€â€â€â€â€â€â€ Process: An exchange of data that dwells inside the limits of the framework to be module. DATASTORE:A vault of information that will be p ut away for use by at least one procedures, might be as basic as cushion of line or as a social database.Donar Module Admin data Module Donar New Registrations [pic] Matian Client Details donars Details Donar blood data Login Admin New Donar Registrations Donar Information Referral once Details Experiances Logout Validate Log name () Validate Password () Check for required benefits () Authenticate The id Admin Master Donar Registrations and Add New Task Details . Enter log name Login Get the Information regarding why give blood Find a donar Change Password Refer a companion ( Donar Administrator login ace Administrator login ace Login screen Admin Master Authenticate The id Check for required benefits ()Validate Password () Validate Log name () Enter log name Administrator login ace Administrator login ace Login screen Leave Applications and Information of Task and Shifts ( Admin Store re login Query Analyzer Authenticate the given boundary ( Check for a particular calendars apporti oned upon him Donate blood Store ery Analyzer Donar Supply the client ID Experiances Authenticate the client ID Store Sto Store re Query Analyzer Enter the necessary strategy boundaries Change Password Insert Admin Verify Data 3. 1 Verify Data 3. 1 Check for Donar Admin Master Admin Master Verify Data 3. 1 Admin Master Check for Schemes InsertAdmin Master Check for User Account User Master Insert Donar Verify Data 2. 1 Verify Data 2. 2 Verify Data 2. 3 Donar Master Page Check for the Donar Profile Insert Donar Master Check for the Donar Account Details Donar Registrations Who needs blood Donar data Phno Location yob BloodType Username Gender Password Full Name Admin Name Donar Detai

Literature Review Strategic Information System

Question: Talk about the Literature Reviewfor Strategic Information System. Answer: Writing Review: The eminent substances which have been represented in this report incorporate the assessment of an authoritative structure and the related operational weaknesses. Portrayal of the strategy for framework obtaining for the association could be noted as a conspicuous feature of the report. The task likewise considers the way toward creating and appropriation of bundles of bookkeeping programming (Ali Haslinda, 2014). Explicit conversation available for Tricor Australia that has been chosen for the report by alluding to its abilities as a known bookkeeping undertaking in Australia thinks about the suggestions for showcase versatility by actualizing data frameworks (Boonstra, 2013). The experience of Tricor has empowered it to procure dynamic development in an insignificant range of time in this way inferring conceivable inductions towards its capacity to address a differing grouping of business prerequisites set by customers. The accentuation of the association on tending to inventive just as pioneering business needs has additionally been seen as promising pointer of the associations drive and energy for achieving upper hand. Tricor Australia has portrayed cognizable improvement in the market of specialized and business bookkeeping administrations and has gained the notoriety of a potential player in the business. Prerequisite of budgetary consultancy benefits by CFOs of noticeable associations just as SMEs is additionally recognized as a justification for the companys steady turn of events. The capacities of Tricor in arrangement of expert bookkeeping administrations has prompted the development of a solid system of experts in the area of fund all through Australia just as other unmistakable areas around the globe, for example, Malaysia, Indonesia, United Kingdom and Japan (Dance, 2016). The cross fringe activities of the association are not restricted to these nations alone and the vital development activities have prompted promising satisfaction of hierarchical needs just as customer prerequisite in each territory served by Tricor Australia. The creative proportions of the association have effectively instigated positive results, for example, improvement of total assets of the organization close by improving the profits for customers of the association (Dance, 2016). Level authoritative structure can be accepted as the association structure that can be seen if there should be an occurrence of Tricor Australia. The authoritative structure is described by the end of larger part of jobs and obligations of the center administration in this way prompting rejection of a huge portion of elements of center administration. The end of remarkable elements of the center administration think about the decrease of hole between the top administration and the ground level staff, for example, representatives in the business office, clients and staff taking a shot at the cutting edge (Farantos Koutsoukis, 2016). One of the significant points of interest that can be gotten from the level authoritative structure alludes to the expansiveness of the structure that encourages recognizable decrease accordingly time of the association. Reaction time could be characterized from the point of view of variable client inclinations and conditions in the outer condition (Haron, Sabri Zolkarnain, 2013, November). The unmistakable spaces of the bookkeeping programming bundle for Tricor Australia could hence be related with the single level authoritative structure with irrelevant signs of help for a progressive hierarchical structure. The first substance bolstered by the areas of bookkeeping programming bundle of Tricor is the advancement of Group Policy improvement through mix of GPO in the PC units and clients in setting of the organization (Hoque, Hossin Khan, 2016). The ramifications of Group Policy propose that it is resistant to the authoritative structure close by showing that clients couldn't perform exercises, for example, WMI sifting and making of custom GPOs. The hierarchical structure of Tricor can be used for task of approaches inside the gathering and guarantee possible asset the executives attributable to the perception of a sensible sort. The watched level authoritative structure if there should arise an occurrence of Tricor Australia is fit for encouraging conceivable points of interest but with the worries for explicit issues and difficulties that can be seen in the operational parts of the association (Hovelja Vasilecas, 2013). The administration is consistently at the danger of losing authority over activities in a level hierarchical structure and in the event of Tricor Australia, the gigantic size of the level authoritative structure could be intelligent of worries for danger to the operational frameworks because of differences in appropriation of supervisors and representatives (Josiah, 2013). The administration of the association needs to confront extensive challenges as far as control because of absence of human capital for checking solitary conduct just as care staff for following up on the choices executed by the senior administration of Tricor. These suggestions could prompt considerable misfortunes for the working connections among people in a gathering prompting difficulties for the board of HR (Josiah, 2013). The administration can confront think about remarkable misfortunes in setting of individual cooperations with representatives. The ramifications of the advancement of individual cooperations of the administration with representatives can be seen in the upkeep of trust close by guaranteeing responsibility and duty among representatives for their work just as for keeping up their expert duties to the association (Kummer Schmiedel, 2016). The administration additionally faces recognizable constraints as decrease in worker confidence, authority issues, power battles and ambiguities among representatives relating to association the board. Worker maintenance can be a significant issue that can be seen if there should arise an occurrence of the level authoritative structure saw in Tricor Australia. The presentation of workers in the association must be reliant on the points of reference of looking reliably for cognizable enhancements in the organization profile separated from the improvement in their pay rates are intelligent of significant worries for acknowledging work fulfillment (Lee, et al., 2015). Representatives could confront impressive tendencies towards gaining work positions in different organizations where they see higher acknowledgment of their own endeavors and commitments to advancement of the authoritative profile with the references to augment in increase in salary just as advancements doled out to them. Level hierarchical structure is responsible for potential difficulties for authoritative development and the significant idea of progress close by the related fears can be significant traps for the organization. The administration of Tricor Australia can consider ceasing from inventive open doors by instigating endeavors for upkeep of authoritative structure prompting decrease of possibilities for the drawn out development of the association (Luse, et al., 2013). The level hierarchical structure is likewise responsible for expansion of unfortunate rivalry among workers along these lines causing decrease in inspiration of representatives and expanding the disarray among workers. The sensible framework securing technique for Tricor Australia would be a specially evolved programming since the handling prerequisites in the association are explicit for the association subsequently requiring own application programming. The custom advancement of the application programming can be guaranteed through the software engineers accessible with the organization who can facilitate with the investigators so as to build up inward data innovation system that can bolster the improvement of programming on custom premise (Rajendran, 2015). The association could actualize the administrations of a PC office or programming improvement association for achieving this target which appears to be nonsensical inferable from the huge size of the association and the accessibility of a full-time advancement group. The ultimate result of the advancement procedure is uniquely evolved programming that tends to the variable preparing prerequisites of organization and hence suits the particular necessities of Tricor. The outstanding advantages that can be acquired from the specially evolved programming framework obtaining technique allude to satisfaction of the authoritative necessities decisively and since expenses of the framework securing strategy would not trouble Tricor because of worldwide size of tasks, the framework procurement strategy gives suitable ramifications towards savvy answer for bookkeeping data the board. The flowchart for an associations deals strategy (as appeared in Appendix I) can be considered as a significant prerequisite for the selling of results of Tricor Australia. Deal can be characterized as the foundation of a connection among client and merchant close by advancing the consummation of the forthcoming stage (Rasiah, 2014). The suppliers of administrations and merchandise by using the channel of salespersons the goal is practiced by the finishing of deals as a reaction to ask for, assignment and procurement activities for the association (Ren, et al., 2015). The correspondence of item title and the pertinence of the item cost with the application highlights and the commitments that can be determined for the benefit of merchant for passing possession. The dangers or difficulties that have been perceived in the associations frameworks are significantly intelligent of the dangers to the information security of Tricor Australia. The dangers presented by hacking and the shifting deficiencies in the equipment and data frameworks system could prompt negative results, for example, burglary of private information identified with the association and the data relating to workers. These suggestions could represent

Example of Perfect Competition Sample Essay

Example of Perfect Competition Sample Essay The perfect competition is a market where many small firms produce the same products and do not have the ability to control prices for it. The number of buyers in such a market is also infinitely large. None of the market participants has more information than all the rest. This is a theoretical model, in real life, there are only a few of such markets where such conditions could be fully implemented. But some markets are close to perfect competition. These are the agricultural product markets (for example, the wheat market, the corn market), the fish market and the stock market where securities are sold. Why do individual producers operating in the markets of perfect competition fail to affect the market price? In the market, an equilibrium price has been established where there are infinitely many buyers and sellers selling exactly the same goods. For example, one of the sellers decides to sell the product at a higher price. Obviously, he will not sell his goods as there are still many sellers selling exactly the same goods at a lower price. As a result, the income of such a seller will only decrease. In case another seller decides to sell the goods cheaper. Of course, he will sell them. However, since there are many customers, he would sell his goods in any case, and if the price is too low, each unit of goods that was sold cannot bring him the right income. As a result, the proceeds of the second seller will also be less. Only at an equilibrium stock market price, the proceeds of sellers will be greatest. In the market of perfect competition, the seller is forced to accept a market price, he is a price-taker. In the short term, it is convenient to carry out the analysis of the industry and competition from the point of view of the model of perfect competition. It is assumed that many sellers sell a large number of standard products to a variety of consumers. Experts who study the industry of perfect competition, take into account that any decision taken by the firm to increase or decrease the price level will not affect the market prices in general. In addition, the analysis of the industry and its perfect competition implies the absence of non-price competition. In microeconomics, the industry with a model of perfect competition is the standard for maximising profit and assessing the effectiveness of the economy as a whole. The stock market is developing and growing that points out the efficiency of the perfect competition for developing the economy of any country. Acting on the stock market, where the level of competition in various industries largely depends on the countrys legislation, the firm faces a large number of competitors that somehow influence its activities and profit. Therefore, in the process of strategic and tactical planning, it is extremely important to conduct a comprehensive analysis of competition, which involves the research on the work of competing companies and the competitiveness of goods on sale.

Using The 75 Kpis Every Manager Needs - 1870 Words

Using The 75 KPIs Every Manager Needs To Know | Bernard Marr | LinkedIn. 2015. The 75 KPIs Every Manager Needs To Know | Bernard Marr | LinkedIn. [ONLINE] Available at: https://www.linkedin.com/pulse/20130905053105-64875646-the-75-kpis-every-manager-needs-to-know. [Accessed 16 October 2015]. I Picked 10 Kpi s from this Researched and these are my results. Operating margin By having a good operating margin which is a margin ratio used in measuring a company s pricing strategy and operating efficiency. The operating margin, measures your operating profitability, it indicates how much of each dollar of revenues used is left over after both costs of goods sold and operating expenses are considered. Operating margins are important because they measure efficiency. The higher the operating margin, the more profitable a company s core business is. For example, I created a mock report called Dean s report In the report I have the following numbers on my financial statement for my event I held. 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Persuasive Essay On Cyber Bullying - 754 Words

Cyberbullying. How often do we hear that word? Pretty often you would think considering how serious of an issue it is now a days. But no. Our society now does not emphasize enough how critical bullying has now become. Throughout the past several years many kids have been bullied. Over 3.2 million students are victims of bullying each year, and it’s sad to say that 1 in 10 students drop out of school because of repeated bullying. Even if the statistics might be low it still doesn’t mean that it is not a serious problem that needs to be addressed in better ways. First off, how critical do we take bullying? According to CDC suicide is the third leading cause to death of youth between the ages of 10-24. The 21st century has come to the point†¦show more content†¦This demonstrates that parents play a big role in this as well, because if their kids feel that they can’t talk to their parents or if they do tell them it won’t end well then they clearly do not have a good relationship. Which then causes kids to commit suicide because they feel that no one loves them and they have no one to talk to so they want it all to just end and that’s the only way they know how. Additionally, there have been a some good outcomes of bullying and people were not only able to overcome it but they learned from the experience and got stronger. Hailey Ellis’ experience is the perfect example of this because she was able to not let the bullying get to her. After sharing her experience she said â€Å"I was cyberbullied got my first two years of college by someone I had never met before. Let me repeat- I did not know this person at all in any way. But that doesn’t prevent cyber bullies from attacking their victims...Behind the screen they don’t care what they say or who it’s about. They feel invincible because no one can immediately stop them. Their victims become somewhat powerless and start to feel hopeless† (Ellis 2). In other words Hailey is talking from previous experience. Luckily with the help of her friends and family she was able to overcome this and not let it get to her and ruin her life. Ultimately, every situation in our lives have only two possible outcomes: to end in a good way or a badShow MoreRelatedPersuasive Essay On Cyber Bullying1623 Words   |  7 PagesThe Real Issue Bullying is no longer the big guy making a third grader give him his lunch money. In order to fully comprehend the word cyberbullying, one must understand that the definition goes into more depth than saying, kids are being mean to one another behind a phone/computer screen. With how rapidly our world is evolving, cyberbullying will not simply go away. 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Essay about How to Read the Bible for All Its Worth

Gordon D. Fee and Douglas Stuart, authors of How to Read the Bible for All Its Worth, have written an easy to read book for those who want to learn more about what the Bible has to offer. The authors present distinct principles for interpreting different genres found in the Bible. The book has sold over a half a million copies and is one of the most popular books regarding biblical interpretation. Fee is a seminary professor of New Testament studies at Regent College. He has authored several New Testament commentaries and is the general editor of the New International Commentary series. Fee has also contributed significantly to the field of hermeneutics and NT textual criticism. The author is a well known teacher and conference†¦show more content†¦The authors advise a three step process when interpreting Scripture; first, learning to do exegesis; second, proper hermeneutics; and third, application. The authors use this model when instructing the readers in the subsequent chapters. In the first chapter, Fee and Stuart state their goal: to heighten the reader’s sensitivity to specific problems inherent in each genre, to help the reader know why different options exist and how to make commonsense judgments, and especially to enable the reader to discern between good and not-so-good interpretations—and to know what makes them one or the other (18). The authors accomplish their goal as they give their advice on how to properly read the Bible through exegesis, hermeneutics, and applying the text. In the second chapter, Fee and Stuart address the topic of translation. They point out the problem of only using one translation. â€Å"The trouble . . . is that you are thereby committed to the exegetical choices of that translation as the Word of God† (33). The solution, Fee and Stuart propose, is to use more than one translation when studying the Bible. This will give the Bible student the opportunity to examine texts from different translations and after applying proper hermeneutics, choose the best translation for the meaning of the text. Fee and Stuart examine another issue with our current translations. â€Å"The problem has to do with the transferring of words andShow MoreRelatedAnalysis Of Bible Class Offered At Ohio Valley1477 Words   |  6 PagesIntroduction to Bible class offered at Ohio Valley University, I will be conducting a book review over the book How to Read the Bible for all its Worth by Gordon D. Fee Douglas Stuart published by Zondervan Publishing in 2014. In addition to reading the book, I have learned several new things and also learned the authors argument in how reading the Bible is important. 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Midland Health Campus Project Management

Question: Describe about overview of project scope, commencement of Construction works and fund development -2012-2015 and work breakdown structure of Midland Health Campus? Answer: 1. Introduction: Midland Health Campus (MHC) development project is one of the largest construction projects which are currently being executed in Western Australia (www.midlandhospitals.org.au, 2015). Construction works for MHC development project was started in 2012 and is expected to be finished within 2015 (www.sjog.org.au, 2015). However, the tasks related to EOI (Expressions of Interest) Phase and RFP (Request For proposal) phase were conducted during the period of 2010-2012 (Treasury.wa.gov.au, 2015). Health Department of Western Australia took the initiative for expanding Midland Health campus as a part of health infrastructure up gradation in Midland. However, the health department is undertaking this construction project of new campus in public private partnership (PPP) model. Brookfield Multiplex Pty Ltd, a well known constructor for infrastructure development, is appointed as the project manager (Brookfieldmultiplex.com, 2015).The organization is responsible for executing all construction works required for this campus expansion program. A contract is developed between the government and St John of God Health on operation of the campus. According to that contract, St John of God Health is responsible for all operational activities in MHC for next 23 years (www.federalfinancialrelations.gov.au, 2015). (Refer to Appendix) 2. Project Charter for Midland Health campus expansion: Elements of charter Description Scope overview Development of a new 367-bed hospital which can be expanded in future Development of expanded emergency unit Infrastructure for 24 hr. anesthesia unit Infrastructure for cancer treatment High Dependency units development General pediatric section Surgical infrastructure developments Post natal and neo natal care units Improved mental health care and rehabilitation infrastructure Infrastructure development for geriatric and general medical departments Business case analysis The current project is a part of health infrastructure improvement programs in Western Australia under WA Health Clinical services Framework 2010-20 Important Milestones Commencement of EOI(Expressions of Interest) Phase-6 October, 2010 Evaluation of EOI-December 2010 RFP (Request For proposal) Releasing-May 2011 Analysis of RFPS and selection of project manager-November 2011 Contract development June 2012 Commencement of construction-Sepetember-2012 Construction completion-November 2015 Operating new hospital-December 2015 Risk analysis Conflict among stakeholders Changes in Health policy Budget Estimation $360 million Stakeholder analysis Health Department of Western Australia St John of God Health Care Brookfield Multiplex Pty Ltd Overview of learned lessons Importance of communication in teams for large projects Strategy development Identification of subtasks in a large task Team Operating principle Arrangement of meetings, communication though telephonic calls and e-mails for maintaining collaboration Table1: Project Charter for MHC 2.1 Overview of project scope: The current project deals with development of a new hospital in Midland. Currently the hospital will be able to accommodate 367 patients (www.nmahs.health.wa.gov.au, 2015). However, according to the future plan, the total capacity will be increased up to 464 beds by 2020 (www.sjog.org.au, 2015).Key deliverables of MHC development project are a public hospital with capacity of 307 beds along with a private hospital with 60 bed-capacities (Treasury.wa.gov.au, 2015). However, according to the proposal, both hospitals will share health services infrastructure. As the new campus is being developed with the aim of increasing availability of advanced medical facilities in Midland area, both private and public hospital of new campus will possess infrastructure for major medical requirements. In both the hospitals of Midland campus special focus is given on providing 24 Hrs emergency services to patients (www.sjog.org.au, 2015). The new hospitals will include infrastructure for emergency care unit. As the project aims at providing medical services to local people at affordable cost, the infrastructure will be well- advanced and cost effective. However, in this campus, importance is also given on developing a well equipped surgical unit along with 24 hrs anesthesia unit. The project will also aim at optimizing effectiveness of its infrastructure. Development of high dependency units is included in MHC development project scope (Swan.wa.gov.au, 2015). As the new health campus in Midland targets to provide health services to all people, building proper infrastructure required by neonatal care units and geriatric units are incorporated into project plan (Treasury.wa.gov.au, 2015).Apart from building units for specialized services ,Brookfield multiplex will also develop general medical units. WA health department is planning to develop Midland Campus as a provider of all medical services. Deliverables of this project include mental health care and rehabilitation units. Apart from this infrastructure for providing 24 hrs ambulance services will be developed as part of whole project. 2.2 Business case analysis: Midland planning area, which covers several suburbs of Western Australia including Bellevue, part of Swan and Koongamia, is one of the highly populated areas in the region. Approximate population of Midland is about 11861(Swan.wa.gov.au, 2015).Although people of the age group 20-54 years constitute almost 51% of total population, about 37.5% of local people are above 55 years (Swan.wa.gov.au,2015). Population is increasing rapidly and about 20% of total population belongs to age group of less than 20 years (Swan.wa.gov.au, 2015). Currently Swan District Hospital is the main provider of health services in Midland. Analysis on the current population growth of this area indicates that requirement for health services are going to be increased in future. Thus the need for developing a campus which will be able to meet requirements of local people at low cost is also increasing. Primary reason for undertaking the project of MHC development is reducing the pressure on Swan District Hospital. However the project also a part of health infrastructure improvement in Midland area. 2.3 Milestone schedule: Task Date of completion Selection of respondent December 2011 Master plan for MHC developed February 2012 Announcing the name of CEO September 2012 Final plan developed November 2012 Construction began December 2012 Completion of 25% of whole project June 2013 Recruitment starts February 2014 Completion of 50% of whole project March 2014 Expected date of completion 2015 Table 2: Milestones schedule for MHC development Milestones for completing The Midland Health campus can be segmented into three categories on basis of their time of completion and nature of success criteria. As stated by Kovacic and Filzmoser (2014), large tasks are segmented into subtasks and milestones are set on basis of nature of a task to complete those in time to enhance efficiency of project members. The project was initiated in early 2011 through the commencement of RFP invitation. In the same year all tasks related to respondent selection and contract development were finished. Designing works for the new campus were started in next phase of project. However, the final plan was developed in November 2012 and the construction works also commenced for December in 2012.By 2013, Brookfield Multiplex successfully completed 1/4th of whole construction (www.sjog.org.au, 2015). In the next year, half of the total campus was built. Current progress in construction and administrative works indicates that new campus can be opened in 2015. Pre-project works- October, 2010- December 2011: Pre project works such as releasing and analyzing RFPs for the construction work started from May 2011. However, before conducting these tasks, the Health Department completed all works of EOI phase by late 2010. On receiving the proposals health department analyzed those. Finally, in December of 2011, the department selected St John of God Health Care as the preferred respondent for Midland Health Campus construction project. However, Brookfield Multiplex Pty Ltd was chosen for executing all construction works. Commencement of Construction works and fund development -2012-2015: Primary design of both public and private hospital was completed within February of 2012. The Health Department of Western Australia published the primary design. It was proposed that the campus will start operating in 2015 with a capacity of 367 beds. However, the design will allow future increase in number of beds. Main construction works of the proposed campus will include highly advanced units for critical care, surgical department, cancer treatment etc. However, the design also ensures that sufficient green spaces will be created. Apart from that, the design also focuses on increasing the use of sunlight in outdoors. However, the design as modified slightly as receiving feedbacks of local people. The finalized design was revealed in November of 2012.Brookfield Multiplex started the construction works in December of the same year. Although The Health Department of Australia adopted PPP model for development of MHC, the authority is accepting donations from local organizations (www.sjog.org.au, 2015). Ascheman (2013) stated that lack of funds is one of the most common reasons which can restrict timely completion of large projects. On other hand, delay in project works result significant increases in budgets (Bocquet, 2013). As the government is encouraging people of Western Australia to donate for MHC, chances of interruption in project work are reducing. However, the process of accepting donation for MHC was initiated in March of 2013 (www.sjog.org.au, 2015). Progress in construction works reflected that St Johns will be able to operate from 2015. Tasks related to staffing were started in the month of February of 2014.Currently, more than half of required infrastructure is completed. It is expected that MHC will be able to serve local people from 2015. 2.4 Analysis of risk and identifying constraints: According to Clements and Gido (2012) in case of hospitals and health care units, risks can be caused by poor quality of developed infrastructure. However in the current project, Brookfield is conducting the construction tasks and thus the risks of poor infrastructure development is reduced.Eric Kirkland (2014) opined that smooth operation of joint ventures in often interrupted due to complexity arise in contracts between two parties. However, the chances of conflicts increases in long contracts (Zhang and Bishop, 2013).The health ministry developed a contract for 23 years with St Johns Health Care for operating MHC. Activities of MHC can be hampered if any complexity arises among the Government and private partners in future. Apart from containing a public hospital, new campus in Midland will also contain a private hospital. However, any change in Government Health policies cam impact on operating of the private hospital and thus activities of MHC will be affected. Time can be considered as a constraint for this project. As the project includes development of two separate hospitals, large number of subtasks needed to be completed within time. However, all the stakeholders are working together to complete these tasks on time. 2.5 Budget estimation: Randolph (2014) opines that uninterrupted execution of tasks depends on accuracy of budget allocation. Estimated budget of competing MHC is about $360 million (www.sjog.org.au, 2015). Both the health Ministry and St Johns is collaborating with each other for development of fund. However, the authorities are also focusing on collection of find from local charities. 2.6 Stakeholder analysis: According to Morris (2013) nature of stakeholder influences success of a project.MHC development is a part of health infrastructure improvement and Health Ministry of Western Australian Government is one of its main stakeholders. However, the project is being executed as a joint venture between public departments and private organizations. St John of God Health Care another major stakeholder is responsible for operating the public and private hospital in Midland Health campus. Other stakeholders include Brookfield Multiplex and the organization is responsible for completion of construction works on time. The Authorities engaged charities and not-for-profit organizations with the project for designing and fund development. 2.7 Lessons learned: Working in large project gives several opportunities to learn new things which can be applied later (Rega, 2013).Both the members of our group got the opportunity of learning several techniques while working in MHC development project. After working in the project we learned the techniques of dividing a large task into subtasks. We realized the importance of maintaining regular communication among team members and also among different teams especially in case of large projects. Apart from this we took part in planning process of our team and it improved our ability of making strategies. 2.8 Operating principle of teams: Silvius (2012) states that operating principle of teams varies according to the size and nature of project. As different organizations were responsible for execution of project, the organizations created their teams for completing several tasks. All the teams in this project collaborate for planning and executing their allocated tasks. However, these teams also seek feedback from local people and modify their decisions according to these feedbacks. 3. Communication plan: SI Audience of meeting Meeting arranger Purpose of meeting Time/frequency Medium 1. Members of group Members of group Primary planning on task completion and budget allocation Before staring the project Face to face communication 2. Group leader Team members Resource and budget allocation Once before starting project /once in week Meeting 3. Team Members Group leader Status of work Daily E-mail 4. Whole team Leader Discussing issues Twice in a week Meeting Table 3: Communication plan in teams According to Davidson (2014), communication among members impacts on efficient execution of tasks. However Journal (2013) opines that nature of communication changes as the purpose changes. While executing the tasks members of our team and team leader communicated several times. However, the purpose of communication was different in each case. On basis of the purpose, the meetings of our team can be categorized as meeting for identification of issues, reporting, and resource distribution. Our first meeting was held before commencement of project .In that meeting we discussed on the plans for executing tasks. In that meeting we identified the resources required to complete tasks. Team leader arranged the second meeting for distribution of resources. Such meetings were arranged whenever we required resources. We reported status of work daily to the leader using e-mails. While executing the tasks we faced several issues. These issues were discussed with other members and leader twice in a week. In these meetings we also developed strategies to eliminate the effects of these issues. 4. Work Breakdown Structure (WBS): Figure 1: WBS for Midland Health Campus Development Generally a task in project is composed of several subtasks and successful execution of tasks depends on identification of subtasks (Hughes, 2012).Figure 1 indicates that the project is going to be completed in three phases. The first phase of MHC development deals with invitation of RFPs and selection of respondents as well as constructors. However, the contract between government and St John healthcare was also developed in this phase. The second phase deals with designing and construction. Tasks completed in this phase are development of master plan, feedback collection from locals and modification of primary design according to the received feedbacks. However, in the second phase, tasks related with fund collection were also conducted. Administrative tasks were executed in the third phase. In this phase, the contract was revised and recruitment of employees for MHC was started. 5. Conclusion: Analysis on the current project indicates that development of MHC in PPP model will enable the Government to finish all tasks within short time. As well known organizations like Brookfield and St John of God Health Care are engaged with this project, quality of services offered by health campus will be high. It is evident from current status that local people can get benefits of MHC from mid 2015.However, the effectiveness of this campus may get reduced is any complexity arises in contract between Health Department and other stakeholders. References Aschemann, R. (2013). Beyond consensus - improving collaborative planning and management. Impact Assessment and Project Appraisal, 31(3), pp.239-239. Bocquet, D. (2013). Fs Reborn: project on an ancient city. Planning Perspectives, 28(3), pp.512-514. Brookfieldmultiplex.com,. (2015). Brookfield Multiplex :: Brookfield Multiplex to Deliver $200 Million Hospital Redevelopment. Retrieved 28 February 2015, from https://www.brookfieldmultiplex.com/newsfeed/view/brookfield_multiplex_to_deliver_200_million_hospital_redevelopment_2012_02_24 Brookfieldmultiplex.com,. (2015). Brookfield Multiplex :: Company :: About Brookfield Multiplex - Global Platform. Retrieved 28 February 2015, from https://www.brookfieldmultiplex.com/company/about_brookfield_multiplex/global_platform/ Clements, J. and Gido, J. (2012). Effective project management. Mason, Ohio: South-Western Cengage Learning. Davidson Frame, J. (2014). Reconstructing Project Management. Project Management Journal, 45(1), pp.e2-e2. Eric Kirkland, C. (2014). Project Management: A Problem-Based Approach. Project Management Journal, 45(1), pp.e3-e3. God, S. (2015). St John of God Health Care. [online] Sjog.org.au. Available at: https://www.sjog.org.au/ [Accessed 2 Mar. 2015]. Hughes, B. (2012). Project management for IT-related projects. London: BCS. Journal, P. (2013). Agile Project Management. Hoboken: Wiley. Kovacic, I. and Filzmoser, M. (2014). Key success factors of collaborative planning processes. Engineering Project Organization Journal, 4(4), pp.154-164. Morris, P. (2013). Reconstructing project management. Chichester, England: Wiley-Blackwell. Randolph, S. (2014). Maximizing Project Value: A Project Manager's Guide. Project Management Journal, 45(2), pp.e2-e2. Rega, C. (2013). Ecological compensation in spatial planning in Italy. Impact Assessment and Project Appraisal, 31(1), pp.45-51. Silvius, G. (2012). Sustainability in project management. Farnham, Surrey, England: Gower. Swan.wa.gov.au, (2015). .: City of Swan :. Midland. [online] Available at: https://www.swan.wa.gov.au/Our_City/About_Swan/Local_Area_Planning/Midland [Accessed 2 Mar. 2015]. Treasury.wa.gov.au,. (2015). Midland Public Hospital Project. Retrieved 28 February 2015, from https://www.treasury.wa.gov.au/cms/uploadedFiles/_Treasury/Infrastructure_Strategy/midland_public_hospital_project_summary_V12.pdf?n=1463 www.federalfinancialrelations.gov.au,. (2015). Implementation Plan for Midland Health Campus. Retrieved 28 February 2015, from https://www.federalfinancialrelations.gov.au/content/npa/health_infrastructure/midland_health_campus/WA_IP.pdf www.midlandhospitals.org.au, (2015). A new era in free public health care. [online] Available at: https://www.midlandhospitals.org.au/wp-content/uploads/2012/11/Nov-2012-Midland-Pulse-Newsletter_final.pdf [Accessed 2 Mar. 2015 www.nmahs.health.wa.gov.au, (2015). North Metropolitan Health Service. Retrieved 28 February 2015, from https://www.nmahs.health.wa.gov.au/BuildingProgram/Midland/pdf/FAQs.pdf www.sjog.org.au (2015) Construction of new Midland Hospitals forges ahead; 25% complete. [online] Available at: https://www.sjog.org.au/PDF/Midland%20130605%20Media%20SJGMPPH%2025%20pc%20construction.pdf [Accessed 2 Mar. 2015]. www.sjog.org.au, (2015). Community wellbeing grants now open. [online] Available at: https://www.sjog.org.au/PDF/Midland%20community%20wellbeing%20grants%2018%20Mar%202013.pdf [Accessed 2 Mar. 2015]. www.sjog.org.au, (2015). First foundation laid for Midland Hospitals. [online] Available at: https://www.sjog.org.au/PDF/Midland%20media%20-%20Midland%20Foundation%20Laying%20General.pdf [Accessed 2 Mar. 2015]. Zhang, Y. and Bishop, C. (2013). Project-Management Tools for Libraries: A Planning and Implementation Model Using Microsoft Project 2000. Information Technology and Libraries, 24(3).

Language, Communication, and Augmentative and Alternative Communication (AAC)

Amibor Heart essays

Amibor Heart essays ADVANCED TECHNOLOGY: THE ABIOCOR HEART On September 13, 2002, mankind reached another technological milestone. Tom Christerson, a patient in Kentucky completed his first year of life sustained by a self-contained artificial heart. The heart, considered the bodys engine, keeps all the other organs working by supplying them with blood and nutrients. All of the bodys organs require blood to function. This means that a product of advanced technology, the plastic and titanium Abiocor heart, is now performing one of the most vital functions of a living human being. The Abiocor heart is the result of decades of research. 1The first artificial heart dates back to the mid-fifties when a team of scientists led by Willem Kolff, a Dutch-born physician, tested their model in animals. In 1969, a team led by Denton Cooley of the Texas Heart Institute successfully kept the first human patient alive for more than sixty hours with their model. Then, in 1982, a team led by William DeVries of the University of Utah, implanted the Jarvik-7 artificial heart into a patient named Barney Clark, who lived for 112 days. 2The Jarvik-7 was an air-driven pump that required Clark be bound to a compressor the size of a washing machine. Tubes from the compressor passed through his chest wall restricting him to his bed and causing constant infections. His blood kept clotting as it passed through the pump and he suffered numerous strokes before he died. After Clarks death, hopes for an artificial heart faded. Scientists focused on heart transplants and today, 386 percent of patients who receive a heart transplant survive for at least one year. More than 70 percent live for at least four years. However, there are only 4,000 hearts available for transplanting each year and at least 700,000 people suffer from heart failure. Faced with this shortage, scientists knew they had to design a smaller, ...

Sources of Communication Inputs and Their Influences in Daily Life Essay

Sources of Communication Inputs and Their Influences in Daily Life - Essay Example The only thing in this world that is constant is change. This is a pretty well known saying which existed as long as I can remember. Looking back 50 years and more from today, I can recall how we used to tackle in class about how people have lived centuries ago. Today, the upsurge of developments in technology has an undeniable effect on how organizations function within and with other institutions. For an organization, its success and failure greatly depends on how the organization was structured to work. The drive to improve peoples living pattern is still the same drive or factor which triggers international firms to globalize their operations and with that, today's latest technology makes the company's and consumers life easier It enable companies to reduce cost by using powerful equipment and machineries while consumers can have easier access to the newest products in the market. One of the first innovations of technology was the mainframe system and it was during the 1960's that computers and such started to impart in organizations and firms. The classic ways of hierarchal management systems started to disintegrate during these times. Through technological change, globalizing the operations of an international company could put up a plantation where they can reduce their labor cost. Not denying the fact that different people from different countries have different tastes, international companies could also personalize their products according to the consumers or markets preferences without eliminating their standards and trademark. Before, information control was basically handled by those in managerial positions in a linear manner according to rank. With these systems of technology, information was handled as such that company transparency is relatively existent for those who can get hold of certain information. The onslaught of developments in technology has triggered organizational structure alterations. These changes can be illustrated by considering two key variables: the location of information and the location of decision rights in the organization (Brynjolfsson E. and H. Mendelsson). With the innovative technological systems today, important information can now possibly be available to all employees or workers in an organization at all level. Before, information handling and privilege was limited to the persons that directly handle them. Now, the responsibility of handling information is left to information technologists or technicians. The technicians then put data or information into databases which are accessible to all components of the organization For example, an organization can have a website, regularly maintained and updated by professional information technologists. Here, employees, managers and customers alike, can log on to the website and access whatever information they needed. Furthermore, having websites is also a great advantage since helpful feedbacks are easier to get from both customers and employees. The growing need for technology innovations paves way to strengthening certain industries in a corporate world; like data management services, computer engineers, information technologists, software designers or engineers and so on and so forth. Although there are still organizations or companies that are hesitant to use information techn

Short Tandem Repeat (STR) Essay Example | Topics and Well Written Essays - 1250 words

Short Tandem Repeat (STR) - Essay Example Because of their varying repeat lengths, STRs are characterized with large number of alleles, which in turn make them being highly variable between populations (Lee et al, 1994). In addition, these microsatellite sequences account approximately for 3 percent of the human genome and occur on average every 10,000 nucleotides (Collins et al, 2003). Finally, among other types of biological material, STRs are characterized with consistency and stability, which practically means that any cell contains the very same profile of SRTs. From the forensic perspective, it means that regardless of type of biological material obtained in the crime scene, appropriate STR profile proving source attribution can be conducted using any type of cell without compromising the result. From the practical perspective, STR profile constitutes simply a panel of numerical designations of each STR allele repeat number based on their electrophoretic sizing information. The electrophoretic mobility of DNA is inversely proportional to the length of the fragment; the longer allele with more repeats migrates slower than the shorter alleles containing fewer repeats. If a snapshot (electropherogram) is taken at a time point when two alleles of different lengths are electrophoretically migrating through a gel, the shorter allele will appear further from the origin than the longer allele. When looking at multiple alleles simultaneously, the STR electropherogram pattern (profile) of an individual is different from that of another individual whose alleles may be longer or shorter and hence assigned with different allele numbers. The variation in STR allele sizes results in distinctive DNA profiles with a uniqueness of 1 in a trillion using the 13 core STR loci in the FBI’s national database known as COmbined DNA Index System (CODIS). These 13 loci were chosen for their unique characteristics, such as number of alleles and repeat sequence, present in each one of them. Their adoption in the

Cognitive Behavior Therapy: Palliative Care

Cognitive Behavior Therapy: Palliative Care Individuals that have been deemed by their medical team to have serious diseases that are resistant, nonresponsive or have failed reasonable treatments are often referred to specialists for comfort measures only. According to the World Health Organization, Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best possible quality of life for patients and their families (WHO, 1990). The National Center for Health Statistics (1996) estimated that 20% of all deaths and 30% of the deaths of elderly individuals occurred in extended care facilities. Extended care facilities are but one place where end-of-life issues are a common fact of daily life. However, regardless of the setting, each individual faces the end of life with his or her own view of life, death and the dying process. The estimated number of patients in palliative care varies due to the difficulty in capturing the actual numbers from hospitals, primary care practitioners, families and emergency rooms. The estimate of patients receiving the Medicare benefit for hospice and palliative care is approximately  ½ million, and it is estimated that, in 2000, approximately 20% of patients dying in the United States received hospice or palliative care services. It should be noted that although many, if not most, individuals in hospice/palliative care settings are age 85 or older, this level of care is not limited to older adults. Motor vehicle accidents, post-traumatic incidents, drug overdoses and other physiologically devastating disorders may result in permanent damage to the younger body as well as the older body. Mortality rates at a young age for those with mental illnesses is decreasing therefore it is estimated that by 2030 there will be 15 million individuals with mental illness residing in long term care facilities (SAMHSA, 2004). This chapter will focus on the reduction or modification of autonomic, psychiatric, or sensory symptom experience of these individuals through use of cognitive behavioral therapy. Cognitive behavior therapy (CBT) uses a structured and collaborative approach while helping individuals to recognize, evaluate and restructure the relationships between their thoughts, feelings and behaviors. Through a process of targeted interventions, the therapist assists individuals to identify, monitor and cognitively restructure the dysfunctional thoughts and/or to modify behaviors that are maladaptive, useless or even harmful (Beck, 1976; Turk, Meichenbaum, Genest, 1987; Freeman Freeman, 2005). CBT includes a range of both cognitive and behavioral techniques such as relaxation, guided imagery/visualization, biofeedback, behavioral experiments, guided discovery, stress management, training in pain or stress management strategies, and cognitive restructuring for dysfunctional thinking and many others . Although there is a paucity of research on the use of CBT in palliative care settings, CBT is effective for many of the psychological issues that are prevalent in palliative care including, depression, anxiety, pain management, and insomnia. The purpose of this chapter is to provide an overview on the use of CBT for assessment and treatment of psychological distress in palliative care settings. Assessment of Emotional Functioning in Palliative Care There are many challenges to the assessment of mood disorders in palliative care settings. An initial challenge is the myth that psychological distress is a normal reaction to end of life. Despite expectations, most individuals in palliative care settings do not have symptoms of anxiety, depression or dementia. Many individuals arrive at this stage of their lives or illnesses with a sense of calm resignation, if not expectations of relief and of going home to God, heaven or family members waiting for them in the hereafter. Therefore those individuals that are experiencing symptoms that require intervention may achieve significant benefit from the interventions. The most common presentations are those of depression, anxiety, pain management failures with exhaustion and anguish, and sleep disorders. The healthcare provider requires tools necessary to differentiate major depression from anger, sadness, and anxiety associated with the symptoms of an untreatable or chronic illness. Assessment of preparatory grief and depression. Another obstacle to the assessment process is simply overcoming the challenges of differentiating symptoms from normal grief of the illness itself. Differentiating between preparatory grief and depression is a key component to the proper assessment of depression in palliative care and has important treatment implications. Preparatory grief can be defined as what an individual must undergo in order to prepare himself for his final separation from this world (Kubler-Ross, 1997). Symptoms of preparatory grief include 1) Mood waxes and wanes with time, 2) Normal self-esteem, 3) Occasional fleeting thoughts of suicide, and 4) Worries about separations from loved ones (Periyakoil and Hallenbeck, 2002). Preparatory grief is a normal, not pathological, life cycle event (Axtell, 2008; Periyakoil and Hallenbeck, 2002). Major depression is defined as five or more of the following symptoms during the same two week period: depressed mood, marked diminish in pleasure, weight loss or gain, insomnia or hypersomnia, psychomotor agitation/retardation, fatigue/loss of energy, feelings of worthlessness or inappropriate guilt, lack of concentration/indecisiveness, and recurrent thoughts of death and suicidal thoughts or plans (APA, 1994). Table 1 provides a symptom list. The list is not intended to be all inclusive however it gives the clinician an overall view of symptoms that may be observed in the individual dealing with depression in a palliative care setting. Although some symptoms of grief and depression overlap, there are ways to distinguish between grief and depression. Table 2 summarizes the ways to differentiate symptoms of grief versus depression according to temporal variation, self-image, hope, anheonia, response to support, and active desire for an early death (Periyakoil Hallenbeck, 2002). The first step to proper recognition of depression involves the identification of possible risk factors (Wilson, Chochinov, de Faye, and Breitbart, 2000). Certain demographic characteristics, such as younger age, poor social support, limited financial resources and family history of a mood disorder, as well as a personal history of previous mood disorders place individuals at a greater risk for developing depression or anxiety in end of life situations. Risk for developing a mood disorder also is elevated with certain types of diagnoses, including pancreatic cancer and brain tumors, and particular medical interventions such as radiation therapy (Hirschfeld, 2000). Symptoms of the illness, including poor symptom control, physical disability, and malnutrition also place individuals at higher risk. The second step to the proper assessment of depression includes utilization of appropriate assessment tools. Many times it is the degree and persistence of symptoms that provide the information necessary when considering major depression. Major depression, which is estimated to occur in fewer than 25% of patients in end of life care, may be best screened with targeted questions such as: How much of the time do you feel depressed? In addition, for those individuals that have a difficult time describing their symptoms or history, asking family members to provide information about a previous history of depression or a family history can be very useful. Although studies validating assessment tools vary greatly, many of the self-report measures have been shown to be effective in palliative care patients. The most common utilized tools in palliative care settings frequently omit physical symptoms of depression. Many symptoms of depression overlap with the terminal disease process (Noorani Montagnini, 2007). Examples of self-report measures that omit somatic symptoms include the Beck Depression Inventory II (Beck, Steer, and Brown, 1996), Hospital Anxiety and Depression Inventory (Zigmond Snaith, 1983), and the Geriatric Depression Scale (Yesavage et al., 1983). The Hayes and Lohse Non-Verbal Depression Scale (Hayes, Lohse, and Bernstein, 1991) is a third party observational measure that can be completed by staff, family, or friends to assist with the diagnostic process. Terminally Ill Grief or Depression Scale (TIGDS), comprising of grief and depression subscales, is the first self-report measure designed and validated to differenti ate between preparatory grief and depression in adult inpatients (Periyakoil et al., 2005). Assessment of anxiety. The symptoms of anxiety may differ in individuals in the palliative care environment. Many times symptoms of anxiety have a physiologic component. For example in those individuals with chronic obstructive pulmonary diseases difficulty breathing, low oxygen levels and overall compromised respiratory function causes air hunger which is experienced as anxiety and even panic. Table 3 lists some of the common anxiety symptoms seen in this population. Family members are often at a loss as to what they can do to assist their loved one that is experiencing anxiety, and especially fearfulness. It is often useful to provide significant others with a checklist of items that are important to report to the healthcare provider. Involving the family has the benefit of giving them a structured guide for response which reduces their own anxiety in response to the patient. In addition the patient may relax more knowing that a family member is involved with their care in an approved, helpful manner. An example of a list of items for family members to watch for and report to the healthcare team is listed in Appendix 1. Cognitive Behavioral Interventions in Palliative Care Psychological intervention in the palliative care setting includes those aspects of treatment that would provide relief from emotional distress while an individual is dying. Often this time period includes depression, anxiety, grief and organic brain dysfunctions such as dementia and/or cerebral vascular diseases. Individuals and their family members are both considered the patient during these times. Many of these individuals are suffering from chronic, unremitting pain conditions which negatively impact their emotional health. Treatments for pain and chronic conditions also play a part in the individuals mental status. The use of Cognitive Behavior Therapy (CBT) is extremely useful for these individuals. Cognitive Behavioral Therapy has the strongest empirical support of any psychological intervention for the management of symptoms typically seen in a palliative care setting. The most common presentations of psychological distress in the dying patient include anxiety, depression, hopelessness, guilt over perceived life failures and remorse. Persistence of these thoughts and feelings interfere with functioning, makes the person generally miserable as well as those around them and can severely affect his/her quality of life. Medical treatments, such as antidepressants, anxiolytics and cholinesterase inhibitors, exist for these problems however supportive psychotherapy such as relaxation training, imagery, distraction, skill training, and negative thought restructuring improves the possibility of remission. CBT can also improve the symptoms of spiritual distress that may include feelings of disappointment, guilt, loss of hope, remorse, and loss of identity. CBT for depression. Symptoms of depression are common in end of life care. It can be one of the most distressing groups of symptoms an individual can experience and may interfere significantly with daily tasks of life. Some experts have estimated that up to 75% of patients with terminal illnesses experience symptoms of depression. Amelioration of some of the symptoms of depression can increase the amount of pleasure and meaning in life, as well as add hope and peace. Treatment for depression can reduce the experience of physical pain as well as general misery and suffering. In addition, reduction of the symptoms of depression may improve the treatment of coexisting illnesses more effective. Most importantly, given that one of the most serious symptoms of depression is suicidal ideation, it makes sense to treat depression in order to prevent successful suicidal outcomes. There is a paucity of literature in the area of the use of CBT with depression in Palliative Care, due to the high attrition rate resulting from physical morbidity and mortality (Moorey et al., 2009). Therefore, these factors pose significant barriers to conducting randomized clinical trials in Palliative Care to address these components. The following is a review of the sparse literature on CBT in Palliative Care with depression. In an attempt to address this problem, Moorey et al., conducted a cluster randomized controlled trial in order to determine if it was possible to teach nurses CBT techniques in order to reduce anxiety and depression symptoms in patients with advanced cancer (2009). Eight nurses were trained in CBT by attending several 1- and 2-day workshops and then were rated on the Cognitive Therapy First Aid Rating Scale (CTFARS) for CBT competence. Seven nurses did not receive training and served in the control group. A total of 80 home care patients entered the trial; however most of these participants were excluded due to being too ill to participate. A total of 16 patients were in the CBT group and 18 patients were in the control group. The participants received home care nursing visits in which assessments were conducted at 6-, 10-, and 16-week intervals. The individuals who received CBT reported lower anxiety scores over time, but no effect of the training was found regarding depression. It was noted that both groups experienced lower rates of depression over the course of the study. The authors noted the heterogeneity of the sample and the high attrition rate due to physical morbidity and mortality presented several barriers to conducting the study and may have played in a role in the findings (Moorey et al., 2009). Cole and Vaughan (2005), in their review on the feasibility of using CBT for depression associated with Parkinsons disease (PD), found that it is a promising option. The authors noted that depressed inviduals with comorbid PD experienced a significant reduction in depressive symptoms and negative cognitions. In addition they experienced an increased perception of social support over the course of treatment (Cole Vaughan, 2005). The recommended course of action for individuals in this setting included: stress management training, relaxation training, behavioral modification techniques for sleep hygiene, and cognitive restructuring. Modification of life stressors contributing to depressed mood should be identified and plans made to minimize stress and maximize quality of life. The use of thought restructuring is recommended in order to maintain a sense of purpose and fulfillment through meaningful activity and to adjust expectations of self and others. Individuals are also encouraged to return to previously enjoyed activities in order to maximize feelings of pleasure and happiness. Through systematic defocusing on physical conditions the person is able to experience more pleasant activities, which are also encouraged. Similarly, Dobkin et al, conducted a study which explored the effects of modified CBT for depressed patients with PD, in conjunction with a separate social support intervention for caregivers (2007). The patients received 10-14 sessions of modified CBT, while caregivers attended three to four separate psychoeducational classes. The modified CBT sessions were comprised of the same components of the previous Cole Vaughan, (2005) study, such as, stress management training, behavioral modification techniques for sleep hygiene, relaxation training, cognitive restructuring, modification of life stressors, and increasing engagement in pleasurable activities. The classes were targeted at providing caregivers with ways to respond to the patients negative thoughts and beliefs, as well as, strategies to offer appropriate support. As in the previous study, the modified CBT sessions were comprised of training in stress management, behavioral modification, sleep hygiene, relaxation techniques, an d cognitive restructuring. Participants reported a significant reduction in their depressive symptoms and cognitions and increased perception of social support at treatment termination and one-month post-treatment. CBT for anxiety. Along with depression, anxiety is a common mental health problem in palliative care settings and also appears to be alleviated with CBT interventions. In a small feasibility study examining the use of cognitive behavioral therapy techniques for mild to moderate anxiety and depression in hospice patients, four sessions of CBT techniques was found to significantly reduce anxiety and depression in a majority of patients (Anderson, Watson, Davidson, and Davidson, 2008). Overall, participants in the study found the CBT techniques acceptable, helpful, and qualitatively reported improved mood. A significant reduction in anxiety symptoms also was seen in a randomized controlled trial of CBT administered by home care nurses in patients with advanced cancer (Moorey et al., 2009). CBT techniques are particularly effective to assist with the management of anxiety related to breathing difficulties commonly seen with pulmonary diseases, such as chronic obstructive pulmonary disease (COPD). In a group of individuals with COPD, six sessions of guided imagery, a CBT relaxation technique, was found to significantly increase the partial percentage of oxygen saturation, which is a physiological indicator signaling more effective breathing (Louie, 2004). In another study, as little as 2 hours of CBT group therapy yielded a decrease in depression and anxiety among older patients with COPD, but there was no change in physical functioning (Kunik et al., 2001). CBT for pain management. Pain is not simply a biological response to unpleasant stimuli. It is a complex phenomenon that includes biological, psychological, behavioral and social factors that interact in complex ways to influence the pain experience. Some of the factors that can influence a persons experience of pain include: a) previous pain experiences, b) biologic and genetic predispositions, c) mood disorders such as anxiety and depression d) their beliefs about pain, e) fear about the pain experience, f) their individual pain threshold and pain tolerance level, and f) their skill with coping methods. Cognitive-Behavioral Therapy has the most empirical support for the management of chronic pain, especially when used as part of an interdisciplinary treatment approach to manage pain symptoms (Turk, Swanson, Tunks, 2008). Cognitive behavioral techniques can be used independently to assist with pain management or integrated into a comprehensive cognitive-behavioral case conceptualization framework to address pain (Turk, Swanson, Tunks, 2008). The three components to CBT for pain management are 1) Education and rationale for the use of CBT, 2) Coping skills training, and 3) Application and maintenance of CBT skills (Keefe, 1996). Useful behavioral interventions to assist with pain management include goal setting, relaxation strategies, such as deep breathing and guided imagery, and activities scheduling. Cognitive interventions would include increasing problem-solving skills and addressing an individuals maladaptive thoughts related to pain management. Examples of maladaptive thoughts include: 1) Ive tried every pain management intervention with no success, 2) I cannot do any of the things that I used to do, 3) nothing will help manage my pain, and 4) no one can help me feel better. CBT for pain manage ment has demonstrated efficacy in various diagnoses often addressed in palliative care. CBT has been found to be efficacious in the management of cancer-related pain in single studies (Syrjala, Donaldson, Davis, et al., 1995) as well as in systematic reviews (Abernethy, Keefe, McCrory, Scipio, Matchar, 2006). CBT for sleep hygeine. Insomnia, sleep duration and quality are major concerns for people with pain disorders such as osteoarthritis (Vitiello, 2009). Approximately 60 percent of individuals with chronic pain disorders report frequent nighttime awakening due to pain during the night. Disrupted sleep patterns exacerbate chronic pain intensity and experience which in turn causes more disturbance of the sleep/wake cycle. Successful treatment of interrupted sleep may reduce the pain experience as well as improve the overall quality of life for these individuals. Psychotherapeutic techniques that target sleep disturbances are easily incorporated within behavioral and cognitive management of other co-occurring disorders as well. Sleep disorders are common in patients who suffer from Parkinsons disease (PD) (Stocchi, Barbato, Nordera, Berardelli and Ruggieri, (1998). Specifically, insomnia, nightmares, REM sleep behavior disorder, sleep attacks, sleep apnea syndrome, excessive daytime sleepiness, and periodic limb movement in sleep result from changes in sleep structure, movement disturbances in sleep, disturbances in neurotransmission and medications. Individuals who are sleep deprived are at risk to develop infections, cardiovascular disease, hypertension, diabetes, depression, and require increased time to recover from stress (Schutte-Rodin, Broch, Buysse, Dorsey, and Sateia, 2008). CBT improves sleep by addressing unhelpful beliefs regarding sleep and misperceptions about the amount of sleep that one obtains. Many misperceive the amount of time they are actually asleep. People who suffer from insomnia actually sleep more than they are aware of because they are only attentive of when they are awake. Furthe rmore, many people believe they require 8 hours of sleep in order to be able to function during the day and any amount of sleep that is less is insufficient and will result in reduced ability to function during the day. Therefore, these beliefs and misperceptions can increase ones stress level about sleep and a stress response may result when one thinks about going to sleep. Clearly, a heightened stress response is not conducive to sleeping. CBT increases ones control over their unhelpful and inaccurate beliefs and enables them to replace them with more helpful and accurate beliefs (Whitworth, Crownover, and Nichols, 2007). CBT also addresses the behavioral components of ones sleep routine or patterns that interfere with ones ability to obtain restful sleep. Exercising, smoking, or drinking caffeinated drinks just prior to bedtime can interfere with ones sleep. All of these activities are stimulants that energize the body. Also, not having a bedtime routine, a regular sleep-wake pattern, or taking naps may interfere with ones ability to get restful sleep. Increasing ones sleep hygiene by developing positive habits that influence sleep such as, having a bedtime routine to prepare ones mind and body for sleep, regular exercise several hours before one intends to prepare for sleep, and avoiding coffee, alcohol, and smoking in the evening, as well as, increasing activities that produce relaxation (e.g., taking a hot bath one to two hours before going to bed, meditation, deep breathing, or muscle relaxation) can increase the likelihood of obtaining restful sleep. Another behavioral strategy utilized in CBT i s sleep restriction. This technique attempts to match ones actual sleep requirement with the amount of time one spends in his/her bed. The theory behind this approach is that reducing the amount of time spent in bed without sleep will increase ones desire to sleep (Harvey, Ree, Sharpley, Stinson, and Clark, 2007). Results of a study by Vitiello showed that treatment improves both immediate and long-term self-reported sleep and pain in older patients with osteoarthritis and comorbid insomnia without directly addressing pain control (2009). This study included 23 patients with a mean age of 69 years were randomly assigned to CBT, while 28 patients with a mean age of 66.5 years were assigned to a stress management and wellness control group. Participants in the control group reported no significant improvements in any measure while Individuals treated with CBT reported significantly decreased sleep latency (onset of sleep) by an average of 16.9 minutes and 11 minutes a year after treatment. Interruptions in sleep after sleep onset decreased from an average of 47 minutes initially to an average of 21 minutes after one year. Pain symptoms improved by 9.7 points initially to 4.7 points. Sleep efficacy (how rested does the person feel upon awakening) initially increased by 13 percent and 8 percent a year after treatment. The improvements remained robust in 19 of 23 individuals at a one-year follow-up visit. Furthermore, while many older adults experience insomnia, it is reported that up to two-thirds of those who experience these symptoms have limited knowledge regarding available treatment options. Sivertsen (2006), conducted a randomized controlled trial to compare the efficacy of non-benzodiazepine sleep medications with CBT. This study included 46 patients with a mean age of 60.8 years who were diagnosed with chronic primary insomnia. Participants were randomly assigned to either the CBT intervention (information on sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and progressive relaxation), sleep medication (7.5 mg zopiclone each night), or placebo medication. Treatment lasted 6 weeks, and the CBT intervention and sleep medication treatments were followed up at 6 months. Data regarding total wake time, total sleep time, sleep efficiency, and slow-wave sleep was collected utilizing sleep diaries, and polysomnography (PSG; monitors physiological activity during sleep). Results revealed that total time spent awake improved significantly more for those in the CBT group compared to the placebo group at 6 weeks and the zopiclone group at both 6 weeks and 6 months. In comparison, the zopiclone group did not reveal significant results from the placebo group (Sivertsen, 2006). The CBT group experienced a 52 percent reduction in total wake time at 6 weeks compared with 4 percent and 16 percent in the zopiclone and placebo groups respectively. A statistically and clinically significant finding was that participants receiving CBT improved their PSG-registered sleep efficiency by 9 percent at posttreatment, opposed to a decline of 1 percent in the zopiclone group. Total sleep time increased significantly between 6 weeks and 6 months for the CBT group. The zopiclone group showed improvements at 6 weeks and maintained these improvements at 6 months, but did not show further improvements. The CBT group showed significant improvements compared to the zo piclone group in total wake time, sleep efficiency, and slow-wave sleep; total sleep was the only area that did not yield a significant difference (Sivertsen, 2006). ADAPTING CBT TO THE PALLIATIVE CARE SETTING Overview of CBT in Palliative Care Cognitive-behavioral therapy is effective for many of common mental health issues seen in palliative care and often augments the success of pharmacological interventions. In addition to the individual with the terminal illness, their family members, as well as multiple health providers are considered integral members to the success of the collaborative relationship. Use of a CBT case conceptualization framework and various components offer flexibility, which makes the CBT approach feasible to implement within a palliative care setting. The following section provides an overview of the components of cognitive-behavioral therapy and necessary adaptations to palliative care settings. Collaborative Relationship As mentioned in previous chapters in this book, a collaborative relationship is a core component of an effective cognitive-behavioral intervention. In a palliative care setting, the collaborative relationship often involves more than just the client and the therapist. The interdisciplinary treatment team works with the individual to develop an individualized treatment plan that is central to the case conceptualization and goal setting of CBT. A variety of disciplines, such as nursing and social work, use CBT techniques in palliative care settings. Individuals receiving palliative care often need assistance with CBT interventions as their illness progresses. Individuals receiving palliative care often need assistance from the treatment team with practicing skills, such as relaxation techniques, and adapting CBT interventions as goals of care change. Some individuals in the Palliative Care setting may not be facing death in the near future, and if they are facing impending death, they may not be aware of it. In these cases the primary patient may be the family member or significant other. It is also common practice for most individuals to seek help for mental health problems from their family practitioner even though the typical family practitioner has very little training in psychiatric/mental health assessment, diagnosis and treatment. In cases where the family is relying on an under-trained health care provider it may be incumbent upon the mental health provider to negotiate the gap between family and medical care. Case Conceptualization and Goal Setting Therapy with the dying person should begin with having the person identify, explore and determine outcome goals regarding the issues at hand. Similarly to the primary care setting, case conceptualization and goal setting need to occur almost immediately. The therapist uses the Socratic Dialogue to explore the persons concerns and worries. This gives the individual more of a sense of control over what will be happening in the therapy session. Once this sense of control is established it becomes easier to explore other, more emotion laden topics. Goals should be small, obtainable and proximal to the session to be most effective. For example, Mrs. Jones I will be back to see you tomorrow. One of the things you have decided to practice is your deep breathing at least twice tonight and again in the morning. When I return I will check with you to see how you are doing with the practice. In palliative care setting, it may be necessary to discuss how other people involved in care can assist with reaching goals. For example, nurses might remind individuals to practice relaxation strategies during wakeful periods, as well as talk an individual through the relaxation technique when experiencing a high level of pain. Behavioral Interventions Pleasant Events Scheduling. Activities scheduling is a useful intervention to assist with mood disorders, pain management, and sleep hygiene issues seen in a palliative care setting. Engaging in pleasant events distracts an individual from negative thoughts and provides experimental evidence to support more adaptive thinking styles. Often times in palliative care the first barrier to overcome is identifying pleasant events that can occur in a palliative care setting due to health limitations. Pleasant events need to be person-centered, meaningful, and feasible activities that can be built into a daily routine. Meaningful pleasant events can be identified through both clinical interview and self-report methods. Clinical interview queries should include taking a history of an individuals daily schedule and identify activities the individual enjoyed engaging in on a routine basis prior to their illness. From the generated list of previously enjoyed pleasant events it needs to be determined which activities the individual can continue to enga