Stefan’s Diaries Origins Chapter 8 Free Essays

I’m not sure how long we stayed in the room together. The minutes ticked away on the grandfather clock in the corner, but all I was aware of was the rhythmic sound of Katherine’s breath, the way the light caught her angular jaw, the quick flick of the page as we looked through the book. I was dimly conscious of the fact that I needed to leave, soon, but whenever I thought of the music and the dancing and the plates of fried chicken and Rosalyn, I found myself literally unable to move. We will write a custom essay sample on Stefan’s Diaries: Origins Chapter 8 or any similar topic only for you Order Now â€Å"You’re not reading!† Katherine teased at one point, glancing up from The Mysteries of Mystic Falls. â€Å"No, I’m not.† â€Å"Why? Are you distracted?† Katherine rose, her slender shoulders stretching as she reached up to place the book back on the shelf. She put it in the wrong spot, next to Father’s world geography books. â€Å"Here,† I murmured, reaching behind her to take the book and place it on the high shelf where it belonged. The smell of lemon and ginger surrounded me, making me feel wobbly and dizzy. She turned toward me. Our lips were mere inches apart, and suddenly the scent of her became nearly unbearable. Even though my head knew it was wrong, my heart screamed that I’d never be complete if I didn’t kiss Katherine. I closed my eyes and leaned in until my lips grazed hers. For a moment, it felt as though my entire life had clicked into place. I saw Katherine running barefoot in the fields behind the guest house, me chasing after her, our young son slung over my shoulder. But then, entirely unbidden, an image of Penny, her throat torn out, floated through my mind. I pulled back instantly, as if struck by lightning. â€Å"I’m sorry!† I said, leaning back and tripping against a small end table, stacked high with Father’s volumes. They fell to the floor, the sound muffled by the Oriental rugs. My mouth tasted like iron. What had I just done? What if my father had come in, eager to open the humidor with Mr. Cartwright? My brain whirled in horror. â€Å"I have to †¦ I have to go. I have to go find my fiancï ¿ ½e.† Without a backward glance at Katherine and the stunned expression that was sure to be on her face, I fled the study and ran through the empty conservatory and toward the garden. Twilight was just beginning to fall. Coaches were setting off with mothers and young children as well as cautious revelers who were afraid of the animal attacks. Now was when the liquor would flow, the band would play more loudly, and girls would outdo themselves waltzing, intent to capture the eyes of a Confederate soldier from the nearby camp. I felt my breath returning to normal. No one knew where I’d been, much less what I had done. I strode purposefully into the center of the party, as if I’d simply been refilling my glass at the bar. I saw Damon sitting with other soldiers, playing a round of poker on the corner of the porch. Five girls were squeezed onto the porch swing, giggling and talking loudly. Father and Mr. Cartwright were walking toward the labyrinth, each holding a whiskey and gesturing in an animated fashion, no doubt talking about the benefits of the Cartwright-Salvatore merger. â€Å"Stefan!† I felt a hand clap my back. â€Å"We were wondering where the guests of honor were. No respect for their elders,† Robert said jovially. â€Å"Rosalyn’s still not here?† I asked. â€Å"Y know how girls are. They have to look just ou right, especially if they’re celebrating their impending marriage,† Robert said. His words rang true, yet an unexplainable shiver of fear rushed down my spine. Was it just me, or had the sun set remarkably quickly? The revelers on the lawn had changed to shadowy figures in the five minutes since I’d been outside, and I couldn’t make out Damon within the group in the corner. Leaving Robert behind, I elbowed my way past the party guests. It was odd for a girl to not show up at her own party. What if, somehow, she’d come into the house and she’d seen †¦ But that was impossible. The door had been closed, the shades drawn. I walked briskly toward the servants’ quarters near the pond, where the servants were having their own party, to see if Rosalyn’s coachman had arrived. The moon reflected off the water, casting an eerie, greenish glow on the rocks and willow trees surrounding the pond. The grass was wet with dew, and still trampled from the time when Damon, Katherine, and I had played football there. The knee-high mist made me wish I were wearing my boots instead of my dress shoes. I squinted. At the base of the willow tree, where Damon and I had spent hours climbing as children, was a shadowy lump on the ground, like a large, gnarled tree root. Only I didn’t remember a tree root in that spot. I squinted again. For a moment, I wondered if it could be a pair of intertwined lovers, trying to escape prying eyes. I smiled despite myself. At least someone had found love at this party. But then the clouds shifted, and a shaft of moonlight illuminated the tree–and the form beneath it. I realized with a sickening jolt that the shape wasn’t two lovers in mid-embrace. It was Rosalyn, my betrothed, her throat torn out, her eyes half open, staring up at the tree branches as if they held the secret to a universe she no longer inhabited. How to cite Stefan’s Diaries: Origins Chapter 8, Essay examples

Investment Decisions Under Uncertainty Financial Markets

Question: Describe about the Investment Decisions Under Uncertainty for Financial Markets. Answer: 1. Financial Investment and uncertainty: Text Paraphrase Introduction Arestis et.al (2012) The development of the financial sector ever since the financial liberalization process, which started in the early 1970s, and the great evolution of financial investment through this period suggest that serious consideration of this complex phenomenon is in order. The increasing importance of financial activities also exerts another effect on accumulation via uncertainty. The development of financial activities, which has permitted the appearance of new activities and financial assets without a strong regulation of them has boosted speculation, thereby promoting the creation of financial bubbles. According to this view, an increase in uncertainty means that businessmen face difficulties in their attempt to foresee the future, which is less predictable now. Our model also highlights a negative incidence of uncertainty on accumulation, since this phenomenon makes it more difficult for businessmen to foresee the future. The financial liberalization process paved the way for the emergence of the financial sector which along with the progress of financial investment has brought this intricate issue to the forefront. Accumulation is also affected by the rapidity of financial activities via uncertainty. Financial bubbles originate from increasing speculation which is a result of the lack of regulation on financial activities and assets. Rising uncertainly implies the failure of corporate houses to anticipate the future. Our model emphasizes the adverse effect of uncertainty on accumulation. Rigotti Shannon (2005) Knight (1921) argues that uncertainty, however, creates frictions that these institutions may not be able to accommodate. Ellsberg (1961) suggests a more precise definition of uncertainty, in which an event is uncertain or ambiguous if it has unknown probability. In particular, Ellsbergs paradox illustrates important consequences of this distinction by showing that individuals may prefer gambles with precise probabilities to gambles with unknown odds. According to Knight (1921), uncertainty gives way to conflicts that such corporations might fail to absorb. Uncertainty, according to Ellsberg (1961), is defined as an event which is associated with an unknown probability. Ellsbergs paradox posits situations where gambles with given probabilities are preferred to gambles with unspecified odds. (Davidson 1991) According to the Keynesian literature, the investment decision has to be taken in a context characterized by the presence of uncertainty and the absence of perfect information. In this uncertain world, there is no room to apply probability as the ultimate way to predict the expected values of economic variables (Davidson 1991). Keynesian literature suggests that investment decisions have to be made under uncertainty and lack of perfect information. Davidson (1991) claims that probability cannot be used as a fundamental instrument to forecast the expected values of economic variables. Keynes, 1973 Keynes views about uncertainty have been explored at great length by Shackle, Vickers, Davidson and others. For Keynes, the information needed to make an optimal investment decision - the future net revenues that will be generated by each potential investment project - does not exist and therefore cannot be known at the moment of choice. It is not out there for agents to find. For Keynes, the future is created by current and future agent decisions that are inherently unpredictable: About these matters there is no scientific basis on which to form any calculable probability whatever. We simply do not know (Keynes, 1937, p. 214). Nonetheless, firms and wealth holders must make investment and portfolio selection decisions; they cannot avoid the decision- making dilemma created by Keynesian uncertainty. We do not know what the future holds. Nevertheless, as living and moving beings, we are forced to act (Keynes, 1973, p. 124). According to Keynes (1973), the complete set of information that an optimal investment decision requires the potential return from each investment project - is not available and hence cannot be accounted for at the point of decision-making. He suggests that the future is an end result of the decisions taken by economic agents in the present and future which again cannot be foreseen. However, investment and portfolio decisions have to be made by corporations and investors who are subject to the dilemma that Keynesian uncertainty generates. Keynes, 1973 Keynes, by way of contrast, outlined a solution to this problem: he adopted a theory of conventional decision making. Keynes theorized an expectations formation process based on custom, habit, tradition, rules of thumb, instinct, and other socially constituted practices.5 He argued that in normal times at least, agents base their forecasts on conventional assumptions such as: (1) the future will look like the relevant past extrapolated (modified only to the extent that we have more or less definite reasons for expecting a change [Keynes, 1936, p. 148]); and (2) while individual agents understand themselves to be inescapably ignorant of the future, the collective or average opinion or the conventional wisdom is seen as reasonably or even scientifically well informed. As an alternative solution, Keynes (1973) opted for conventional decision-making. He suggested the generation of expectations according to the custom, tradition, habit, instinct, rules of thumb and other social phenomenon. According to Keynes, generally economic agents form anticipations in accordance with conventional assumptions: (1) the future is a reflection of an accurately deduced past, (2) Though individual agents may be unaware about the future, the mass collaboration is considerably well informed. Hong Bo and Robert Lensink (2007) the outcome of empirical study may be explained by the fact that, on the one hand, an increase in uncertainty increases the investment threshold, whereas, on the other hand, an increase in uncertainty increases the probability that the investment threshold will be hit. A rising uncertainty pushes up the investment threshold as well as the probability that this threshold will be reached. Lucas 1981, p. 224). Lucas has argued that in cases of uncertainty, economic reasoning will be of no value (1981, p. 224). Lucas (1981) asserts that economic logic will be non-functional under uncertainty. Chuli et.al 2013 The effects of uncertainty on equity prices and other financial variables have also been analyzed. In this stream, Bansal and Yaron (2004) provide a model in which markets dislike uncertainty and worse long-run growth prospects reduce equity prices. In the same line, Bekaert et al. (2009) find that uncertainty plays an important role in the term structure dynamics and that it is the main force behind the counter-cyclical volatility of asset returns. According to Bansal and Yaron (2004), in which uncertainty reduces equity prices via effects on long-run growth. Bekaert et al. (2009) suggest that the counter-cyclical volatility of asset returns emerges from uncertainty. Chuli et.al 2013 Empirical studies have frequently relied on proxies of uncertainty, most of which have the advantage of being directly observable. Such proxies include stock returns or their implied/realized volatility (i.e., VIX or VXO), the cross-sectional dispersion of firms profits (Bloom, 2009), estimated time-varying productivity (Bloom et al., 2014), the cross-sectional dispersion of survey-based forecasts (Dick et al., 2013; Bachmann et al., 2013), credit spreads (Fendolu, 2014), and the appearance of uncertainty-related key words in the media (Baker et al., 2013). Although these uncertainty proxies have provided key insights to the comprehension of uncertainty, and have been reliable starting points for the analysis of the economic impacts of uncertainty on economic variables, most of them have come under criticism, most notably from Scotti (2013) and JLN. On the one hand, volatility measures blend uncertainty with other notions (such as risk and risk-aversion), owing to the fact that they do not usually take the forecastable component of the variation into account before calculating uncertainty. Empirical studies have often been based on proxies of uncertainty such as stock returns or their implicit / acquired volatility, the cross-sectional dispersion of firms profits, estimated time-varying productivity, cross-sectional dispersion of survey-based forecasts, credit spreads and the display of uncertainty-related key words in the media. These proxies have rendered considerable perceptions to the analysis of uncertainty and to the analysis of the effects of uncertainty on economic parameters. However, they have time and again been criticized. Since volatility measures do not account for the predictable component of variation before determining uncertainty, they can combine uncertainty with other issues such as risk and risk-aversion. Crotty 1993 confidence in the meaningfulness of the forecasting process will shatter, and key behavioral equations may become extremely unstable. These are the points of crisis and panic that have pride of place in Keynesian, Minskian, and Marxian theories of investment instability, but are prohibited by assumption in neoclassical investment theory because they are incompatible with its Vision. The validity of the anticipation process will fade out and the main behavioral equations may be subject to tremendous instability. These points are highlighted in the Keynesian, Minskian and Marxian theories of investment instability. However, in the neoclassical investment theory, these are rues out by assumption due to stark contradictions. Mishkin 1997 A dramatic increase in uncertainty in financial markets, due perhaps to the failure of a prominent the financial sector, a recession, political instability, or a stock market crash, makes it harder for lenders to screen out good from bad credit risks. The increase in uncertainty, therefore, makes information in the financial markets even more asymmetric and may worsen the adverse selection problem. The resulting inability of lenders to solve the adverse selection problem renders them less willing to lend, leading to a decline in lending, investment, and aggregate activity. Differentiating between good and bad credit risks has become difficult for lenders due to the growing prevalence of uncertainty in financial markets. The reasons behind this may be a recession, political instability or a collapse of the stock market. Thus, the asymmetry of information in the financial markets and the issue of adverse selection are further magnified. This naturally results in the reluctance of lenders to lend because of the difficulty of adverse selection which in turn reduces investment and aggregate economic activity. Aistov and Kuzmicheva, 2012 Theoretical and empirical research singles out several mechanisms (channels) through which uncertainty affects investment. Nevertheless most studies specify the negative effect of uncertainty on investment. The effects of uncertainty on investment have been segregated through theoretical and empirical research. As an inference, both suggest the negative influence of uncertainty on investment. 2- Financial Investment and Instability: Text Paraphrase Intro (*) The hypothesis of financial instability was developed by economist Hyman Minksy. He argued that financial crisis are endemic in capitalism because periods of economic prosperity encouraged borrowers and lender to be be progressively reckless. This excess optimism creates financial bubbles and the later busts. Therefore, capitalism is prone to move from periods of financial stability to instability. This is a type of market failure and needs government regulation. Economist Hyman Minsky developed the hypothesis of financial instability. He suggests that the incautiousness of the borrowers and lenders during phases of economic prosperity leads to incessant financial crisis. The optimistic expectations on the part of the agents generate financial bubbles and consequent bursts. Hence capitalism is subject to fluctuations from periods of stability to those of instability. This necessitates government intervention to prevent the market failure. Minsky 1985 Indeed, he maintains that the capitalist system is flawed and prone to cyclical boom and bust. He believes modern complex financial markets to be responsible for their own crisis, by getting tangled up in risky credit structures. He states in his Financial Instability Hypothesis (FIH), that periods of stability make borrowers and lenders more and more reckless, which ultimately fuels asset bubbles. Minsky states that economy goes from hedge borrowing to speculative borrowing and eventually to Ponzi borrowing, when borrowers are most likely to default. Banks keep lending hoping that increased asset prices will enable repayment, but ponzi lending is not sustainable. People start selling their assets to keep up with other payments and this pushed assets prices down and causes crises. Later economist termed this as Minsky moment He suggests that the deficiency of the capitalist system stems from the fact that it is subject to cyclical boom and bust. According to him, financial markets pave the way for their own crisis due to their involvement in risky credit frameworks. His Financial Instability Hypothesis proclaims that temporary phases of stability turn borrowers and lenders inattentive and this ultimately culminates in asset bubbles. According to Minsky, an economy shifts from hedge borrowing to speculative borrowing to Ponzi borrowing and borrowers tend to default in the last stage. Banks endlessly lend in anticipation of rising asset prices that will ease repayment of loans. However, this lending procedure is unsustainable. In order to meet repayment mandates, people end up selling their assets thus bringing down asset prices and setting off financial crises. This is popularly known as Minsky movement. Minsky 1985 The financial instability hypothesis, therefore, is a theory of the impact of debt on system behavior and also incorporates the manner in which debt is validated. The financial instability theory describes the effect of debt on system behavior and also reflects on the procedure of debt validation. Wolfson (1986) Wolfson (1986) not only presents a compilation of data on the emergence of financial relations conducive to financial instability, but also examines various financial crisis theories of business cycles. Financial crisis theories have been studied by Wolfson (1986) in addition to collection of data relevant to financial instability. Evans 2007 Evans, differently from mainstream macroeconomists, underlines the importance of money and financial markets in a capitalist economy. Firms invest in various type of assets (i.e., diversification) to reduce risk if one of the assets fail. Although financial system has diversified certain risks, it has the potential to cause instability for the system as a whole. Money and financial markets play a crucial role in the capitalist economy according to Evans (2007). Firms diversify their investment portfolio to hedge risk. The financial system despite being vital to the diversification of risks is itself exposed to instability. Evans 2007 Since the 1970s, the financial systems in the developed capitalist countries have all experienced a major increase in size and complexity as a result of an extensive process of innovation, deregulation and internationalisation. Although the financial system has succeeded in diversifying certain forms of risk, we believe that it has created new sources of potential instability that increase the risk of a major crisis for the system as a whole. The financial liberalization has led to an expansion of the size and complications of the financial framework in the developed capitalist economies. This is an end result of widespread upheaval, deregulation and exposure to the global economic forum. On one hand, the financial system has eased the diversification of risks in certain forms. On the other hand, it has generated new sources of instability that magnifies the risk of a vital crisis for the entire economy. Mishkin 1997 The causes of financial instability occurs when shocks to the financial system interfere with information flows so that the financial system can no longer do its job of channeling funds to investment opportunities. The asymmetric information analysis we have used to understand the structure of the financial system suggests that there are four categories of factors that lead to financial instability: increases in interest rates, increases in uncertainty, asset market effects on balance sheets, and problems in the banking sector. Financial instability stems out of intervention from shocks into the financial system which deviate the channel of funds from investment opportunities. Asymmetric information analysis provides four main causes of financial instability: increases in interest rates, increases in uncertainty, asset market effects on balance sheets and problems in the banking sector. 3- Financial Investment and global crisis: Text Paraphrase Evan 2007 While the financial system plays a major role in promoting investment and growth in a capitalist economy, it can also lead to major disruption. In the nineteenth and early twentieth century, as first Britain and then the US and other European countries industrialised and built up their financial systems, major financial crises occurred about once a decade, culminating in the great crash of 1929. Financial system in addition to stimulating growth and investment might also rapidly distort a capitalist economy. Extensive financial crises that collectively led to the great crash of 1929 were actually consequences of the developing financial systems in the industrialized Britain, US and other European countries in the nineteenth and early twentieth centuries. Crises stem, in part, from the nature of credit. A credit involves a promise to pay, but if companies are unable sell all their output, despite the best of intentions, they might be unable to meet a promise to pay. Because banks are engaged in extensive networks of borrowing and lending, both amongst themselves and with firms and households, the impact of a default can be transmitted rapidly throughout the financial system. This danger is exacerbated by a widely noted tendency for banks to over-lend during periods of rapid business expansion, sometimes prompting a sharp contraction of lending a credit crunch when they find themselves overstretched, or when they fear that the expansion is about to end, something that can then set off the downturn they feared. Such instability can be reinforced by the behaviour of financial markets. The price of financial assets is strongly influenced by expectations: if the price of an asset is expected to rise, then the demand for it will increase and its price will tend to rise. In the course of a business expansion, a rise in asset prices can set off a speculative bubble, and, as a bubble takes hold, investors might borrow in order to take advantage of the rising price of shares, or of property or raw materials. But when a bubble bursts, this prompts widespread sales as investors seek to avoid a further loss, thereby exacerbating the fall in asset prices. Investors who borrowed money might now find themselves unable to repay their loans, thereby putting pressure on the banks. The credit market gives way to financial crises. Companies might unwillingly fail to meet their credit terms if they cannot sell their entire produce. Substantial borrowing and lending operations executed by banks amongst themselves and with households have exposed the entire financial system to any default on the part of the bank. Banks tend to worsen this situation by over-lending in the massive business expansion phases. When they become too overstretched or anticipate the end of the business expansion, they assert credit-crunch or shrinking lending. Financial markets further fortify such instability. Expectations largely determine the price of financial assets when individuals expect the price of an asset to rise in the near future, their demand for that asset also rises thereby actually pushing up the price of the underlying asset. During the period of business expansion, rising assert prices are likely to commence a speculative bubble. As the bubble comes to the forefront, inv estors tend to borrow such that they can benefit from the increasing share prices, property prices and resource prices. When the bubble bursts, investors in an attempt to secure themselves against further losses, sell off the assets thereby setting a decreasing trend in asset prices. As a consequence of this, they may not be able to repay their loans to the banks thereby subjecting the latter to financial pressures. Evan 2007 The period of greater financial liberalisation which began in the 1970s has also been associated with a notable increase in financial instability. The major central banks are, however, by no means sanguine about the future, and they have begun to hold internationally-coordinated exercises in which they rehearse their responses to a major financial breakdown. The pressure to achieve higher returns has led banks and other financial institutions to adopt much riskier investment positions, fuelled by the massive growth of the derivatives market, and driven by the highly leveraged activities of hedge funds and private equity funds. Although the risk of a major crisis might still be relatively low, if a financial breakdown were to spin out of control, it would have a devastating economic and social impact. Financial liberalization beginning in the 1970s was accompanied by financial instability. Uncertainty about the future has led the major central banks to acquire internationally-coordinated exercises in which they prepare beforehand for any drastic financial collapse. Banks and other financial institutions have subject themselves to highly risky investment positions in anticipation of higher returns. The main driver behind this is the tremendous development of the derivatives market coupled with highly leveraged activities of hedge funds and private equity funds. A financial collapse will adversely affect the socio-economic scenario. However, the probability of the occurrence of one is comparatively low. Barnes, P. (2010) The financial consequences of the 2007-9 financial crisis were similar to those in 1866 and 1987 in other ways. With the loss of confidence in investments and their difficulty in continuing to provide high returns, investment schemes were put under pressure. Not surprisingly, there were many failures in investment banking as a result of their dependence on profits from the boom and Ponzi schemes were discovered and collapsed. The financial crisis of 2007-09 resulted in the reduction of conviction on investments and high return prospects due to which investment schemes were subject to pressure. Investment banking failed because of their reliance on the boom for profit. Ponzi schemes subsided on discovery. References: Aistov A. and Kuzmicheva, E.E. (2012) Investment Decisions Under Uncertainty: Example of Russian Companies, Proceedings in Finance and Risk Perspectives, Dr.othmar Lehner, Dr. Heimo Losbichler (editors). Enns: Australia. Arestis, P., Gonzlez, A. R. and scar Dejun, O. (2012) Investment, Financial Markets, and Uncertainty. Working Paper No. 743. The Levy Economics Institute. Davidson, P. (1991) 'Is Probability Theory Relevant for Uncertainty?', A Post Keynesian Perspective. Journal of Economic Perspectives, 5(1), pp. 1943. Kuzmicheva, E. E. (2014) 'The Influence of Financial Constraints and Attitude Towards Risk in Corporate Investment Decision', Basic Research Program, Working Papers Series No. 36/FE/2014 . Lucas, R. Studies in Business-Cycle Theory. Cambridge. MA: MIT Press, 1981. Minsky, H. (1985) 'The Financial Instability Hypothesis: A Restatement'. In: P Arestis and T Skouras (eds): Post Keynesian Economic Theory. A Challenge to Neo Classical Economics. Sussex: Weatsheaf Books. Evans, T. (2009) Money and Finance Today, in: J. Grahl (ed): Global Finance and Social Europe. Edward Elgar. Bo, Hong(2005)'Is the Investment-Uncertainty Relationship Nonlinear? An Empirical Analysis for the Netherlands.'Economica, 72 (286). pp. 307-331. Mishkin, F.S. (1997) The Causes and Propagation of Financial Instability: Lessons for Policymakers',Proceedings - Economic Policy Symposium - Jackson Hole, Federal Reserve Bank of Kansas City, pages 55-96. Barnes, P. (2010) Minskys financial instability hypothesis: Information asymmetry and accounting information. An addendum: the financial crisis of 2007-9 in the UK. Proceed in The sixthAccounting HistoryInternational Conference, Wellington , New Zealand 18 - 20 August 2010 Rigotti, L. and Shannon, C. (2004) 'Uncertainty and Risk in Financial Markets', Econometrica, Vol. 73 (1) 2005), pp. 203-243. Knight, F. H. (1921): Uncertainty and Profit. Boston: Houghton Mifflin. Ellsberg, D. (1961) 'Risk, Ambiguity, and the Savage Axioms', Quarterly Journal of Economics, 75 (4), pp.643669. Wolfson, M.H. (1986) Financial Crises. Armonk New York, M.E. Sharpe Inc.

Needle Stick Injury free essay sample

Method In 2003, a sharps awareness campaign began in San Martino Hospital in Genoa, Italy. In 2005, a safety catheter was introduced and healthcare workers were trained in its use. Data for all occupational accidents from 2003 to 2007 were collected and analysed. Results After introduction of the sharps awareness campaign and use of safety catheters, reported incidents of sharps injuries involving catheters fell from 19 in 2004 to two in 2007 and in neither of those two cases were needlestick prevention devices used. Overall, the rate of needlestick injuries was 24. 1 per 100,000 cases when conventional catheters were used and 0. 4 per 100,000 cases with safety catheters. Conclusion The sharps awareness campaign and newly adopted needlestick prevention device may have contributed to the prevention of percutaneous injuries caused by catheters. Until the onset of the campaign, the reported annual incidence of needlestick injuries was six. This increased to a peak of 19 reported injuries in 2004, which could be attributed to improved reporting effected by the campaign. We will write a custom essay sample on Needle Stick Injury or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Authors Dimitri Sossai, manager, Health Safety and Prevention Department, Azienda Ospedaliera Universitaria San Martino, Genoa; Vincenzo Puro, manager, Department of Epidemiology, Istituto Nazionale per le Malattie Infettive, Lazzaro Spallanzani, Rome; Luca Chiappatoli and Giulio Dagnino, biomedical engineers; Bernardo Odone, chemist; Annamaria Polimeri, biologist, Health Safety and Prevention Department, Azienda Ospedaliera Universitaria San Martino, Genoa; Laila Ruzza, Paola Palombo and Marian Stella Fuscoe, registered nurses, Azienda Ospedaliera Universitaria San Martino, Genoa; Paola Scognamiglio, epidemiologist, Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, Rome, Italy. Email: dimitri. [emailprotected] it Keywords Needlestick injuries, risk prevention, safety needle system These keywords are based on subject headings from the British Nursing Index. All articles are subject to external double-blind peer review and checked for plagiarism using automated software. For author and research article guidelines visit the Nursing Standard home page at www. nursing-standard. co. uk. For related articles visit our online archive and search using the keywords. 42 march 24 :: vol 24 no 29 :: 2010 SHARPS INJURIES are one of the most common types of occupational accidents that healthcare workers experience (Elder and Paterson 2006). The Centers for Disease Control and Prevention (2004) in the United States (US) has estimated that around 400,000 percutaneous injuries occur in the hospital setting each year. However, true injury rates are difficult to assess as underreporting is assumed to be as high as 70% (Lee et al 2005). There is a risk of disease transmission of blood-borne pathogens with a sharps injury, particularly if it is caused by a hollow-bore needle used to access veins or arteries (Trim 2004). Worldwide, 2. 5% of cases of human immunodeficiency virus (HIV) and 40% of cases of hepatitis B and hepatitis C among healthcare workers result from occupational exposure to infected blood (Wilburn 2004). The risk of infection following percutaneous exposure to infected blood is notable, with rates of 6-30% for hepatitis B, 0-7% for hepatitis C and 0. 3% for HIV (White 2008). In addition to the hazard of disease transmission, the fear of potential infection may pose a considerable burden on the psychological, emotional and social wellbeing of the injured healthcare worker (Lee et al 2005). More than 38% of all occupational accidents involving biological hazards in the NHS result from skin contact, while 24% are caused by accidental puncture with injection needles (Sossai 2006). The rates for hospitals are even more concerning. According to a study of the Italian National Society for Prevention and Protection in the Health Service (Associazione Italiana Responsabili Servizi Prevenzione e Protezione in Ambiente Sanitario), more than 50% of occupational accidents in hospitals are caused by accidental puncture with injection needles (Sossai 2006). Exposure prevention remains the primary strategy for reducing occupational contact with blood-borne pathogens (Huber and Terezhalmy 2007). Over the past 20 years, numerous preventive measures have been implemented including educating and training staff, changes in practice, hepatitis B vaccinations, awareness campaigns and needlestick injury policies. One particular NURSING STANDARD preventive strategy uses engineered needlestick prevention devices to protect hospital workers from accidental injuries. There are two types. Passive needlestick prevention devices have a safety feature that is activated automatically, while active needlestick prevention devices require the user to activate the safety mechanism (Trim 2004). The use of needlestick prevention devices and the documentation of all needlestick injuries by healthcare workers has been enforced by law since 2000. Similar regulation efforts are under way in Europe (Hadaway 2001, Wilburn 2004, Hoban 2005, White 2008). In Italy, and elsewhere in Europe, employers have a statutory obligation (Directive 2000/54/CE and 89/391/CEE) to prevent occupational risks and protect workers. In line with these requirements, San Martino Hospital in Genoa, Italy, one of the largest hospitals in Europe with more than 1,400 beds and more than 4,400 employees, launched a sharps awareness campaign in 2003. This campaign consisted of specific staff training, education and the gradual introduction of needlestick prevention devices (safety catheters) to replace conventional intravenous catheters. By March 2005, almost all conventional catheters had been replaced by needlestick prevention devices. Aim The aim of this study was to verify the effect of the sharps awareness campaign and the introduction of needlestick prevention devices on the rate of needlestick injuries in San Martino Hospital. Method The hospital chose the passively activated Introcan Safety IV Catheter system (B. Braun). This has a self-activating safety clip that automatically shields the needle’s sharp bevel during retraction of the needle after cannula insertion. With regard to design and handling, this safety catheter is identical to the conventional catheter (Trim 2004, Wilburn 2004). At San Martino Hospital, a sharps awareness campaign was launched in 2003. In 2005, safety devices were first introduced, initially in departments at increased risk of needlestick injuries or infection (infectious diseases, general surgery and organ transplant departments). By the end of 2005, they had been introduced in all hospital departments. Healthcare workers in approximately 90 departments including outpatient clinics, operating theatres, intensive care units, day hospitals and surgery, received training in using the device. Training sessions were carried out by manufacturers of the safety catheter and by members of the hospital’s NURSING STANDARD department of health safety and prevention. Between 2005 and 2007 this practical training was supplemented by courses on the biological risk of needlestick injuries aimed at all long-term employed healthcare staff. In addition, a compulsory training course on the need for prevention and safety precautions related to needlestick injuries, and the correct practical application of safety devices for all new employees, began and was carried out monthly. During this period, 596 of 3,392 (18%) long-term employed physicians, nurses and technicians and 882 (100%) new employees received safety training. In San Martino Hospital, a specific protocol needs to be followed when an accident entailing biological risk occurs. The affected employee has to report the accident to the department of preventive and occupational medicine where health monitoring and infectious prophylaxis are initiated, if required, in collaboration with the Institute for Hygiene and Preventive Medicine. Subsequently, the injured person is required to register the accident at the hospital’s human resources department where detailed information on the injury and the injured person are recorded on a standardised incident report form and in an incident reporting file. Reports of the accident are forwarded to the National Institute for Insurance gainst Accidents at Work (Istituto Nazionale per Assicurazione Infortuni sul Lavoro) and the Hygiene Institute of Genoa University. The incident reporting file is the hospital’s internal administrative database for all occupational accidents and is used for statistical purposes. It provides the data for an annual injury monitoring report. The file began in 1994 and holds detaile d documentation of all occupational injuries occurring at San Martino Hospital. Documented details include the time, location and accurate descriptions of an accident, and the profession, department, ward or operating unit of the injured employee involved. The type of device responsible for sharps injuries and the use of any safety measures during the incident are also documented. In this study, occupational injury data collected between 2003 and 2007 were obtained from the incident reporting file and analysed retrospectively. Data of interest included all occupational incidents and all percutaneous injuries caused by catheter needles and sharps. In particular, needlestick injuries caused by catheters were investigated. For all needlestick injuries from catheters, the occupation of the affected staff member was examined. The total number of catheters used each year was the denominator. All hospital employees were included in the study. The human resources department supplied data on the number and march 24 :: vol 24 no 29 :: 2010 43 art science research type of staff in the hospital. Formal ethical approval was not required because the population used was recruited from the database of the occupational injuries register of the human resources department. The data used were taken from official declarations and total anonymity was guaranteed. conventional device is more than 25 times higher than the risk associated with the use of the safety device. Discussion The implementation of a sharps awareness campaign and the introduction of needlestick prevention devices at San Martino Hospital resulted in a significant reported decrease in needlestick injuries. Conventional catheters appear to carry a significantly higher risk of injuries than safety catheters (Table 1). This suggests that the needlestick p revention devices contributed to the prevention of percutaneous incidents. A potential problem of this type of surveillance results from factors that could influence healthcare staff to report injuries, especially those with a low risk of infection. In this study, reporting rates are unknown and these could have influenced the findings. Injury reporting was encouraged during training, so an increasing rate of underreporting appears unlikely. Similar results have been observed with other safety needle devices (Asai et al 2002, Trim 2004, Adams and Elliott 2006, Tuma and Sepkowitz 2006). These results are consistent with estimates in which the use of engineered safety devices accounts for definite prevention in 21% and probable prevention in 61% of needlestick injuries (Elder and Paterson 2006). However, the results of the current study are limited by the short observation period and initial findings need to be confirmed by a follow-up study. Three and two incidents occurred with catheters in 2006 and 2007 respectively. Only one of these incidents occurred with a safety catheter. The catheter’s safety mechanism was not activated because of an unexpected movement by the patient before insertion of the cannula. Risk for the healthcare worker was estimated at almost zero, as the needle had not come into contact with the patient’s blood. In the other four incidents, conventional devices were used that did not have a safety Results The overall number of employees at San Martino Hospital fluctuated annually between 4,447 and 4,636 individuals from 2003 to 2007. The number of occupational accidents documented decreased from 537 to 405 in the same period. During the study, the number of injuries with needles and sharps entailing biological risk reported annually reduced from 163 to 86. These accounted for approximately one quarter to one third of all occupational incidents. After launching the sharps awareness campaign in 2003, the number of injuries caused by catheters increased initially (n=10 in 2003 and n=19 in 2004), possibly because the sharps awareness campaign aimed to reduce underreporting. From 2005 to 2007 the total number of reported injuries decreased (n=10 in 2005, n=3 in 2006, and n=2 in 2007). During the study period, nurses were affected more often by needlestick injuries than physicians. The overall annual number of needlestick prevention devices used by the hospital after their introduction in 2005 (n=130,000) increased to 165,000 in 2006 and decreased to 163,000 in 2007 (Tables 1 and 2). The average number of annual injuries per 100,000 phlebotomies performed were calculated (estimated by needles used per year). The relative risks were calculated as the ratio of the injury rates for the conventional catheters and for the safety catheters. The results highlight a lower rate of annual needlestick injuries until the start of the sharps awareness campaign and an escalation of reported incidents after its launch. This phenomenon might have resulted from underreporting, confirmed by the low incident rate of reported needlestick injuries before the onset of the campaign. Underreporting of needlestick injuries is a common and serious problem. It is even observed after needlestick injuries with high-risk patients and occurs with all types of healthcare worker (Wilburn 2004, Hoban 2005, Makary et al 2007). True injury rates may be ten times higher than those reported (Elder and Paterson 2006). The increase in incidents in 2003 suggests that educational measures and training might have sensitised healthcare staff to the seriousness of the problem and increased their readiness to report needlestick injuries for their own safety. Only timely reported needlestick injuries allow for immediate preventive measures and effective post-exposure treatment (Lee et al 2005). Even after 2003, it may still be possible that not all needlestick injuries were reported. Although all new employees received training after 2005, accounting for approximately 25% of the hospital’s healthcare staff until 2007, before then only 18% of employees of long standing participated in safety education measures. Thus, the majority of employees lack theoretical education in sharps safety and may be more prone NURSING STANDARD to misjudge the risk of needlestick injuries and consequently fail to report incidents. It might also be possible that some long-term staff increased their risk awareness after observing colleagues. It is to be expected that the awareness of possible injury outcome and reporting will improve further as the sharps safety awareness campaign continues as a result of cumulative training of hospital staff (Makary et al 2007). Despite introducing continuous on-the-job training with all employees, a certain degree of underreporting is still likely to occur because, contrary to better knowledge, some employees will avoid the time-consuming effort associated with administrative and medical procedures involved in needlestick injury reporting (Lee et al 2005, Makary et al 2007).

Abraham Lincoln1 essays

Abraham Lincoln1 essays regarded by many historians as the greatest president ever to stand at America's helm. This reputation is extremely well deserved, as Lincoln was able to preserve the Union and gain victory in the civil war, despite his fighting an uphill battle against his own presidential cabinet. Had he not been struggling against this divided government, President Lincoln could have achieved victory with extreme efficiency and a minimum of wanton bloodshed (Angle 659). After Lincoln was inaugurated on March 4, 1861, he was forced to battle a split cabinet because of campaign promises made to various Republican factions, which made it almost mandatory for certain individuals to be appointed to cabinet posts. He ruled his cabinet with an iron hand, and often acted without cabinet consent or advice. Although his opponents called his method of rule "dictatorial" and "unconstitutional," it was the only effective way to get anything done (Simmons 142). In the beginning, Lincoln's secretary of state, William H. Seward, clearly considered himself the President's superior, and blandly offered to assume the executive responsibility. He entered the cabinet with the thought of becoming the power behind the 2 Presidential chair and openly opposed Lincoln's control of the Union. This made Lincoln's position as Chief of State exceedingly difficult and hindered his communication and control of the military. As time passed, however, Seward recognized Lincoln's capabilities and gave him complete loyalty (Simmons 174). This could not be said of Salmon P. Chase, Lincoln's first secretary of the treasury. Blinded by an inflated ego, Chase pursued his own presidential aspirations. He was in constant conflict with Seward, and in general opposition to Lincoln, particularly over the issue of slavery. Chase has been described as "jealous of the President," and "overly ambitious." Lincoln's personal secre ...

Coursework portfolio Essay Example | Topics and Well Written Essays - 2000 words

Coursework portfolio - Essay Example The required skills for the aforementioned job position comprise brilliant communication skills, proficiency in Information Technology (IT) related skills and effective problem-solving as well as decision-making skills (Warwick District Council, n. d). The major duties for the job position of a sales presenter would comprise business development activities, meeting the customers, generating leads and making sales presentations. The required skills include outstanding communication abilities, tenacity, superior level of confidence and self-motivation (International Finance Corporation, n. d). Conversely, the main responsibilities as well as roles of a care assistant are to provide active support as well as deliberately working with the students and most importantly assisting the teaching staffs associated with Individual Care Plans. Moreover, the care assistants would also have to attend and enthusiastically contribute towards Individual Care Plan reviews in conjunction with maintaini ng any kind of related records. Working mutually with the coordinators of Learning Support along with the lecturing staffs and offering useful practical services to the students are also acknowledged to be the duties of a care assistant. In addition, the other important duties of a care assistant include periodic reporting to the Coordinators of Learning Support, Wellbeing Advisors and teachers along with other relevant external agencies. The skills which are required for this particular job position are high enthusiasm, optimism, self motivation and superb communication skills (Trussville City Schools, 2006). Suitability for Each Job On The Basis Of Seven CBI ‘Employability Skills’ Employability Skills Customer Service Advisor Sales Presenter Care Assistant Application of Numeracy I have completed my graduation course which included the subject of Mathematics and also pursued a financial accounting course which involved numerous calculations. Team Working I was a part of a dynamic team in a knowledge process outsourcing (KPO) organisation where I was required to work jointly with the team members and perform as a team during my one year of service. Self Management I experienced the value of self management quality while working in the KPO organisation. Business and Customer Awareness I am presently pursuing a business management course which principally focuses upon the awareness as well as the satisfaction of the customers in the business sector. Application of IT During my graduation, I also pursued a course in Advanced Diploma in Computer Hardware Engineering (ADCHE). The main subjects included Computer Basics, Microsoft Office, Internet, Software Installation and Networking. Problem Solving In one of my subjects in Graduation i.e. Business Regulatory Framework and Company Law (BRF & CL), I had to learn to analyse as well as to recognise the different problems which I had applied in the past while I was working in the KPO organisation. Communi cation & Literacy Though I had completed my graduation program from abroad, it was a remarkable experience for me to communicate with various people belonging to diverse

Crash Cultural Identity Assignment Essay Example | Topics and Well Written Essays - 500 words

Crash Cultural Identity Assignment - Essay Example The fact, that he was brave enough to fight with the guy, who tried to steal his car, became the evidence of the inner change, which had happened to Cameron. At the same time, it should be noted, that the characters put their cultural identity not only in their group, but they also want to be accepted and acknowledged in all cultural groups. On the other hand, the characters, who are supposed negative, as Ryan (the policemen, who has sexually assaulted Christine, Cameron's wife) or the attorney's wife Jean, being extremely impatient towards any other race except her own, also try to put themselves forward not only in their cultural group, but in others as well. Ryan not only wants to be the best among his co-workers, who are of Caucasian race, he also wants to show his superiority over other races, and thus make them understand his significance in terms of all races. The issue of cultural identity is shown to be manipulated through the scene in the attorney's office.

Nursing Retention in South Africa

Nursing Retention in South Africa 2nd Paper Quantitative Research Title Mokoka,K.E., Ehlers, V.J. Oosthuizen, M.J. (2011). Factors influencing the retention of registered nurses in the Gauteng Province of South Africa. Curationis, 34(1), 9. Retrieved from http://dx.doi. org/10.4102/curationis. v34i1.16 Introduction South African Nursing Council has predicted a critical nursing staff shortage within the country in the near future. This phenomena occurred as the number of nurse graduates has reduced by 42% over a period of 10 years. The authors carried out this exploratory descriptive quantitative study with the intention to investigate work related factors that influence nurses decision to stay with current employer. Questionnaires were posted to 536 registered nurses selected using random sampling method. Authors employed postal questionnaires as data collection instrument to targeted respondents with covering letters and stamped addressed return envelope. However, only 108 questionnaires returned where 73.1% of responded nurses expressed thoughts of leaving their job. Data analysis of this study employed quantitative descriptive procedures using Statistical Package for the Social Sciences (SPSS) tool. As a result, financial factors was the most important factor influencing nurses retention. Re commendations based on the results of this study made to the employers for implementation to reduce turnover and enhance retention. Data collection method will be discussed in this study. Data collection method Structured self report survey-based method was used by the authors in the data collection. Researchers have the options of face to face interview, phone interview, postal questionnaires and online (electronic) questionnaires. Since this cross sectional quantitative survey consisted of large number of sample to achieve generalization of the study, postal questionnaires as data collection instrument is favored (Stenhammar et al., 2011). In addition to that, Ashby et al. (2010) reported that postal questionnaires tool is frequently used for health services research. In fact, postal questionnaires approach used by researchers can be distributed throughout a wider geographic area thus increases the number of return samples. McDonald and Adam (2003) claimed that postal data collection received twice response rate than online method. Similarly, Shih and Fan (2007) reported that postal mail survey gives better response rate as compare to electronic mail after a review into 35 studies. Subsequently, high questionnaires response rate will ensure studys validity and avoid bias (Stenhammar et al., 2011). However, postal survey with incomplete questionnaires is excluded hence the occurrence of item-missing data reduce s data quality. Meanwhile, force function set up to ensure completion of questionnaire for online data is not possible for postal data. Indeed, Basi (1999) found that completion of data by online respondent is more than that of postal respondent. On the contrary, Stanton (1998) compared postal and online questionnaires and suggested that there were no differences in the item variability and amount of incomplete data. Even so, there were variety of findings in the studies that compare the postal and online methods (e.g. Buchanan,2003; Epstein et al., 2001; Lewis et al., 2009). As many researchers begin to recognize the impending trend where network interactions progressively gain popularity among the population, it is highly possible that electronic devices will play an active role in time. According to McDonald and Adam (2003), online technologies might include interactive television, handphones and 3D simulations touch screen devices. However in 1999, Dommeyer and Moriarty concluded that online data collection methods do not result in higher response levels and Cobanoglu et al. (2001) stated that postal survey was a common research method in year 2000. When exploring the social background of the participants, mail response samples showed conventional and introvert profiles. Whereas, the online response samples showed profile of technology savvy group (Schillewaert Meulemeester, 2005). Clearly, penetration of technologies and adaptation of users are other important factors to consider by researchers while referring to the social-demographics pattern of t he population. There were total of 89 questions in this study that may reduce the response rate significantly. Given the circumstances that nurses in the sample group have been busy at workplace and back home (handling household chore), they are less likely to participate in the study actively. In this case, question designs by researchers must be focused and short to extract required information and encourage participation. As pointed out in a pilot study carried out by Jepson et al. (2004) the threshold for questionnaire length on a favorable response rate was approximately 1000 words. In addition, Edwards et al. (2003) supported this hypothesis after the review of 251 relevant reports concluding that using shorter questionnaire increases response rate. In another word, questionnaire design is important to speed up returns. All things considered, novice researchers consider the use of questionnaires are advised to refer experts and literature on the similar study ( Drummond et al., 2007; Dunn et al., 2002; Marshall, 2004 ). Then again, traditional research method such as postal survey costs more as compared to online survey. Postal cost includes those of printing, preparing mail cover and two way postage (MacDonald Adam, 2003; Mehta Sivadas, 1995; Weibie Wallace, 1998). Moreover, to improve postal questionnaire response rates few measures were introduced for examples including pencils and erasers in the postage package, sending reminder in the form of text messages or electronic mail. For the study on cost effectiveness of including pencils and erasers, Aveyard et al. (2001) found that there was no benefit shown to set off the cost. Nevertheless, text messages as suggested can be conveniently implemented as a strategy to increase response rate by researchers because participants take shorter time to access text messages on phone than electronic mail ( Keding et al., 2016; Man et al., 2010). Conclusion Selection of data collection instrument is essential to enhance survey quality while taking into consideration the aspect of accuracy, cost and timeliness. Unfortunately, studies looking at comparative result among different data collection methods over the years has produced conflicting outcome (Weigold et al., 2013). In time, health care providers being the technologically sophisticated population may be able to provide higher response rate in web-based survey with the improvement of internet accessibility and successful technology adoption (Weible Wallace, 1998). On the whole, ongoing study is required to monitor the evolution of health care research so that the researchers can decide on the suitable method for their studies.