Ending Poverty in the Third World Essay Example for Free

Ending Poverty in the Third World Essay Poverty continues to be a large part of the third world countries, affecting many people’s wellbeing and country stability in the new millennium, despite many strategies put in place to alleviate the poor status. Due to the continued prominent place of poverty in the third world countries, significant strategies are coming up comprising of political, social, spiritual, environmental, and managerial coping strategies. The strategies have realized various levels of success although it highly depends on the place of implementation and the taskforce mandated to implement the development strategies. The failure or minimal success of some of the strategies geared towards ending poverty in the third world, has encouraged the developed and developing countries, and developmental related agencies to focus on coming up with new theories with the likelihood of more success. Nevertheless, poverty in the third world continues to be a major challenge in the world with many strategies, some successful and others marked with dismal failure coming up to alleviate third world poverty. Description of Poverty in the Third World Poverty implies a lack of adequate food and shelter, lack of better housing, sanitation, access of safe drinking water attributed to lack of income to facilitate acquisition of basic necessities, a sense of powerlessness, and vulnerability to adverse shocks (Parsed et al, 2005, p. 290). The concept of poverty encompasses a large spectrum of attributes such as levels of income and consumption, health, education, security, and housing. Nevertheless, poverty is largely an attribute of low income that prevents individuals and families from acquiring and enjoying basic life necessities such as nutritious food, clothing, shelter, and clean water. Regions highly affected by the incidence of poverty are Africa and Asia, also referred as the third world, the developing nations, or less developed countries, although Africa suffers a more rampant extent of poverty compared to Asia (Parsed et al, 2005, p. 290). Among these countries, the poor live mostly on less than a dollar a day, although some live on $2 a day, although the incidence and gap may not be significant either in the African or Asian developing countries. In the past decade, the development of the concept of globalization gave promise to the reduction of poverty in the third world because of the removal of control on free movement of goods and services; however, the initial hope is yet to be realized. Encouraging the possibility of poverty eradication within the emergence of globalization has been the United Nations and the development of goals towards alleviation of poverty, and the entry of the international community in the process of poverty eradication in the third world. Poverty and the Millennium Development Goals At the turn of the millennium in 2000, the United States member states agreed on eight international development goals to be achieved by 2015 that the countries adopted in 2001 in order to assist impoverished nations and create a sustainable global community. The first goal of the eight was to eradicate extreme poverty and hunger, with the target being to half the number of people living on less than a dollar per day and reduce by half the number of people suffering from hunger. From the creation of the Millennium Development Goals (MDGs), the United Nations Development Programme (UNDP), Non-Governmental Organizations (NGOs), and various public, private, and federal agencies worked towards establishing developmental strategies that would facilitate the realization of the goals (Eggen and Bezemer, 2007, p. 1). The strategies have been constructed mainly along the international community through the UNDP, NGOs funded by international groups, the World Bank, and the International Monetary Fund (IMF) towards poverty reduction. Agreeably, poverty reduction especially in the third world has been an ongoing process in many countries. However, its recognition by the UN made it a priority within the international community with the MDGs becoming a coherent expression of global development priorities and an instrument to shape development policies (Eggen and Bezemer, 2007, p. 2). The introduction of the MDGs meant that the world had a standard by which to measure the success of policy interventions in poverty reduction within a certain period. In the discussion of the strategies set towards ending poverty in the third world, the policy interventions attributed to the MDGs, and the international community forms a critical part of the exploration. Therefore, throughout the paper, reference to the MDGs, the international community, and globalization are inevitable. Strategies towards Ending Poverty in the Third World When considering the interventions being developed towards ending poverty in the third world, one should consider the causes of poverty and their role in determining the responses towards poverty by all key players including inhabitants of third world countries, potential donors, and those from developed countries or economies. Among some of the determined causes of poverty in the third world first is the high and underdeveloped population in the third world attributed to lack of ability among the people, unwillingness to change traditional ways and customs, lack of proper resource management, lack of attempt at self-improvement, laziness, and lack of knowledge (Panadero and Vazquez, 2008, p. 574). The second cause is poor governance in third world countries attributed to corruption and inefficiency among the governments, while the third cause is exploitation of the third world countries by other countries especially developed countries and by the world economy and banking systems, and lack of an open market system. The fourth cause of poverty in the third world according to Panadero and Vasquez (2008) is war whereby the governments spend too much on arms and more is spent in restoring the country after a war or keep the country afloat in the course of the war. Lastly, third world poverty is attributed to natural causes that include diseases, pests and insects that destroy crops, natural disasters because of poor climatic conditions and lack of environmental friendly knowledge. Alleviation and eradication of poverty in the third world will take the effort of the inhabitants of these countries, those from the developed economies and the organizations key to development such as UNDP, World Bank and the IMF. The effort should focus on strategies that will facilitate reduction and eventual eradication of poverty, and ensuring people from the third world gain the knowledge and provisions needed to prevent them from going back to their current status. Agreeably, the eradication of poverty in the third world requires a multidimensional focus that does not only concentrate on reducing income poverty, which has been the focus of many interventions, but also include interventions geared towards reduction of human deprivation in all dimensions (Chopra, 2005, p. 52). To achieve a global reduction of poverty as per the MDGs by 2015, the third world countries comprising the world’s poorest countries need to pursue wide ranges of reforms with developed nations responding to the effort through improved trade terms and increased aid. According to Chopra (2005), action is critical in ensuring global financial stability and ensuring that poor countries are at par with developed nations in the adoption of technology and in scientific and medical research (p. 52). Further, the wealthy nations must open their markets to the products of the poor countries, with aid and debt relief increased to help the poor countries help themselves without the interference of the wealthy nations, which has marked most of the intervention programs. Nevertheless, the poor nations need to give voice to their need and influence decision-making in international forums, noting that in most forums the powerful developed countries make much of the decisions related to the development of the poor nations. Therefore, for the world to end third world poverty and ensure that the global platform allows equal opportunities and competition to all, the international community needs to review existing intervention programs. Among interventions that can aid the process of ending third world poverty that have been part of the implemented strategies, include one promoting equal opportunity through the expansion of economic opportunities for poor people through the stimulation of overall growth (Chopra, 2005, p. 51). Additional strategies towards offering equal opportunity is building up the poor countries assets and increasing the asset returns through market and non-market action. As stated in the discussion of causes of poverty, one of the mentions causes is an underdeveloped population; therefore, offering opportunities for economic expansion will help these populations begin thriving thus facilitate a reduction of poverty. Furthermore, another attributed cause of poverty is a closed market that does not allow the poor nations to promote their products in the developed nations; however, creation of opportunities through the opening of markets will enable them access the international market. Additionally, the promotion of assets especially within the international community is another strategy of providing equal opportunities to the poor nations. Second intervention is facilitating empowerment through adoption of accountability in state institutions and response to the needs of the poor people, as well as strengthening the participation of poor people in political processes and local decision-making (Chopra, 2005, p. 52). Further, empowerment requires people be encouraged to participate in political processes, local decision making, and eradicating social barriers that contribute to gender, ethnic, racial, religious, and social distinction. Dealing with unaccountability in state institutions including governments ensures successful address of some of the cause of poverty, which is corrupt government. Further, strengthening people’s participation in decision-making will provide the link between the people, the leadership, and the resources resulting in better resource usage that has been lacking in many third world countries. The third factor in addressing poverty in the third world is enlargement of security through reduction of people’s vulnerability to ill health, economic shocks, policy induced dislocations, natural disasters, and violence (Chopra, 2005, p. 52). Notably, health is a significant factor in development because when people are healthy they are more likely to engage in economically productive activities compared to when they are ill or undergoing natural circumstances that reduce their efficiency. Security should also include protection from violence, and helping the people deal with adverse shocks when they occur. Maintenance of security is important to offer people an opportunity to work towards developmentally beneficial activities without fear of violence, disease, or natural disasters, and incase such events occur people should know their country has the capacity to address them and restore order. The implementation of some of these factors as discussed in the subsequent section has been ongoing in many parts of the third world realizing a steady decline in poverty. However, the number of the poor continues to be significant denoting a failure in the effective of the strategies, and requiring developmental agencies and developing nations to either adopt different strategies or approach the existing strategies from another side. Nevertheless, one cannot claim that the international community has not been trying to meet the MDGs especially in the third world and some poor parts of the developed nations.

Report On Bed Capacity Planning In Hospitals

Report On Bed Capacity Planning In Hospitals Nowadays, the number of medical treatment and medicines increases which allows a spectacular growth of the health care sector. Despite this development, the sector suffers from inefficient management and ineffective planning [15]. Managing patients, nurses and physicians is a difficult problem that needs to be solved. Hospital bed planning is a central problem that affects hospital capacity, health care quality and also management of nurses and physicians. During the last decades, hospitals are a non profit organization where the demand is not a primary concern for the manager of these hospitals. Today, many private hospitals are acting with a primary objective to satisfy the demand and to provide outstanding services to compete with other private hospitals [10]. The hospital is not just a medical care unit but also is providing hotel and transportation services. To insure competiveness of hospitals we need to improve the quality of services and to satisfy as much as we can the deman d. Therefore, hospitals need to look for their supply chain and how to manage it. In this report, we focus on the supply chain management of hospitals in Dubai. Dubais health services are internationally recognized and due to their high standard and their modern facilities equipment, are comparable to other developed countries. The location of hospitals in Dubai is strategic to ensure accessibility for patients. There are approximately 20 clinics and hospitals distributed across the Emirate. The ratio of clinics/hospitals to patients is 1:78,000. One of the more impressive practices of medical professionals in Dubai is the post-clinic, private medical call. These are considered as part of their responsibilities. Medical attention is provided, regardless of residency or nationality. In general, Dubai aims to improve the over-all wellbeing of its people. Its strategy is to provide patient-specific care. The most popular medical services provided by healthcare providers in Dubai include immunizations and vaccinations, psychiatric treatments, medical fitness examinati ons, community services (such as marriage and family counseling), adult and infant yoga therapy, rehabilitation, and education on health and nutrition. We focus on this report on Rashid private hospital in Dubai, UAE. We mainly present a multiple objective stochastic programming for the bed capacity planning taking into account the quality of the service and the stochastic demand in that hospital. In the next chapter, we present a general overview of the hospital supply chain in general before we present in chapter 3 some of the Rashid hospital operations. In chapter 4, we focus on hospital bed capacity planning in order to introduce to the multiple objective stochastic program that we are going to propose for Rashid hospital bed capacity planning. The obtained model is transformed in chapter 6 into its certainty equivalent and solved in chapter 7 using data from Rashid hospital. Chapter 2 Hospital supply chain 2.1. Introduction Health is defined as à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"a state of complete physical, mental and social well beingà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ã‚ . The health care sector is an important sector as regards to the welfare of people. Health services require the synchronization of various resources, such as Human resources, medicines and medical equipment. In any organization, a supply chain must be designed in accordance with its mission. The mission of all hospitals includes the maximization of the level of patient care. The size of a hospital, geographical location, diversification, and the various specializations all affect the nature of care provided in a hospital and, therefore, the goals of its supply chain. The hospital chain may have some of the following goals [7]: To secure the availability of product , To Reduce the storage space and to maximize the patient care, To reduce time and cost of handling the medical team (nurse, pharmacist, physician) Minimize the stocks of inventory The main functions of hospital supply chain are defined as follows [7]: To allocate the main resources (technical platforms, beds, physicians, nurses ) and their location in the hospital. To plan for extra resource needed (medical staff, medical equipment), and to schedule the care activities. To organize transportation of patients and equipment. Generally, the hospital supply chain may be split into two parts (see Figure1): the external chain and the internal chain [14]. Fig 1: Hospital supply chain [15] 2.2. The external supply chain The external chain begins with companies specialized in the creation of the raw material (patent, drug, machinery, etc). The raw material can be materialized (machine, drug, etc.) or immaterialized (know how to cure). The manufacturer may itself be the creator or a company that works in relationship with him. In this case, the company is responsible for the duplication (making molecules on a large scale and add excipients or drug) for the test and for the control. Once the product is ready to be used and receives the necessary certifications, the role of the distributor is to place the product on the market. The market is generally formed by a central purchasing (WHO, national distributors, NGOs, etc) or individual (hospital, pharmacy, etc). Each health facility may maintain direct relations with manufacturers so that products pass through certain distributors. 2.3. The internal supply chain The health establishment is the last link in a supply chain consisting of manufacturers and distributors from various industries (medical supplies, pharmaceuticals, food, laundry, maintenance, etc). The supply chain within the hospital is complex. The size of the hospital, the geographical location, the diversification, various specializations, the high cost and perishable goods, all affect its supply chain. The first characteristic of the appropriate health care supply chain is its diversity in distribution channels. Inside the hospital, the hospital product is made up of items at low prices or high-prices and durable and perishable goods that are consumed in large or small quantities. A health institution is composed of five main activities that manage different types of flows to offer many services or products to patients. These activities are defined as follows: Intralogistics activities which are the fact that the hospital acquire, receives and distribute different supplies used in the service. The demand management that is the planning and the coordination between the different necessary resources. Operations and services given to the patient within the hospital from admission to discharge. External logistic represented by the medical follow-up for the patient. Services to the patient which are all auxiliary activities that are not linked to medical activities offered to the patient (gift shop, religious programs, etc). The supply chain within the hospital can therefore be presented as follows: 2.4. Conclusion The hospital supply chain must be developed for a specific product based on its unit cost, demand variability and the physical size. We can say that integration of the supply chain in the health care sector requires the synchronization of internal and external supply chains to each individual service. A good supply chain management within a hospital is necessary and must be performed efficiently Chapter 3 Operations in Rashid hospital 3.1. Introduction Rashid Hospital is a 454-bed general medical/surgical hospital in Dubai, the United Arab Emirates, and is a part of the Dubai Government Dubai Health Authority. Rashid Hospital is considered in Dubai as one of the first medical facilities for trauma, emergency, ambulatory care and critical care which provide a high-quality of services to all patients within the community. The Rashid hospital provides also leadership in the training and education of health care professionals. In the emergency, Rashid Hospital is considered as one of the most reputable and prominent medical centers in the Gulf region. It receives the majority of complicated case other hospitals are destined to Rashid hospital which coordinates also closely with the Dubai Civil Defense and Police for the training of emergency medical staff inside the airports In Rashid hospital, two types of admissions are used: the outpatient admission and the admission through emergency department 3.2. Outpatient registration This type of admission or registration is present in all hospitals and it can be defined as follows: An outpatient admission is presented when a patient is admitted to the hospital, surgical center or ambulatory center for a surgical or nonsurgical operation, therapeutic procedure or diagnostic procedure, that does not require an overnight hospital stay. The preparation for outpatient admission varies with each procedure [20]. In Rashid hospital, the responsible physician, the treating physician and the admitting physician are responsible of the admission procedure of the outpatient. The registration of the outpatient is done after the patient gets a discharge from the emergency department or the inpatient unit. This must is done by the physician who gives the patient an outpatient appointment for follow up with the required specialty. After that the patient will be transferred to the required specialty. The next step is the direct admission which must be done during the same day. The admitting physician/clinic nurse informs the case manager and the admission office that the patient requires admission, and then the admission of the concerned patient is linked with the availability of a bed. Next, the account department or the admission office informs the patient about charges for treatment as per the hospital payment policy. The clinic nurse will inform the patient about the admission conditions and about provisional diagnosis. But if the hospital cant find an available bed, the treating physician will give to the patient another appointment or ask for a transfer of the patient to another healthcare unit (if the case is urgent). In Rashid hospital, urgent case admission is directed to the emergency department. The admission in this department is different from the outpatient admission. In the next section, we are going to overview admissions procedures in the emergency department. 3.3. Admission through the emergency department This type of admission is different from the outpatient admission because patient must access directly to health due to the urgency of his/her case of illness. It can be defined as housing the patient in the hospital to provide special interventional procedure(s) or definitive treatment. We can distinguish three types of patients in this admission. First, the unstable patients who will suffer irreversible damage or loss of life if not admitted immediately. Second, the stable patients who are the patients that requires urgent treatment or interventional procedures(s) that cannot be accomplished on an outpatient basis. Third, patients are not suffering loss life or serious damage if not admitted [21]. In the emergency department, the emergency physician has to observe and to investigate to know if the patient needs admission and to refer the patient to the on call physician. The emergency physician and on call physician will decide about the required screening and diagnostic tests after examining/before admitting the patient. The emergency department must inform the case management about the admission, provisional diagnosis and level of care needed and check for the availability of bed. If there is no available bed in the selected department, the case manager can admit the patient temporarily in another department where bed is available (with adequate equipment). But if there are no available beds throughout the hospital, the case manager has to refer patient to another hospital. The patient flow in Rashid hospital can be presented as the following figure [10]: Bed flow in hospital 3.4. Rashid hospital departments At Rashid Hospital it exists many specialized medical and paramedical departments all equipped to receive all kinds of patients and also patients from neighboring hospitals. The existing specialities in this hospital are: Psychiatry Cardiology Gastroenterology General surgery Hematology Infectious disease Respiratory Neurosurgery Traumatologie Geriatric 3.5. Conclusion Rashid Hospital aims to provide an outstanding service to all outpatients and patients that are admitted through the emergency department. This aim cannot be achieved if the hospital has not the adequate capacity in terms of hospital bed and human resources (physicians and nurses). At the same time the hospital must run in profit to ensure the future of its activity. In this study we will try to answer this important question of hospital capacity planning in order to determine both the level of beds and the number of resources that Rashid hospital needs to satisfy the random demand. Chapter 4 Hospital capacity planning 4.1. Introduction The capacity is defined as the quantity of service that the health care institution must provide to satisfy patients need. Capacity management is related to the control of the impact of demand variability on the management of the health care institution. It concerns the good coordination of resources through the management of medical equipments, human resources and bed occupancy. Hospital capacity has long been an indicator of the importance of the hospital structure and for budget allocation [18]. The capacity planning is a component of the internal hospital supply chain. This planning is usually used to help hospitals, to do well their objectives which are: Trying to avoid an underestimating of the number of beds, planning for the future maintain a good service quality, optimize resource use, satisfy the requirements of internal and external security. 4.2. Bed capacity management In hospitals, capacity planning usually focuses on the total capacity of beds, the capacity of the surgical system, the allocation of beds for different services, equipment capacity, the ability of auxiliary services, and the number of staff and their competence [11]. Before we plan capacity in a hospital, the following issues must be clarified [1]: The length of the planning horizon (operational, tactical and strategic) The level of the provided care (primary, secondary) The type of care (provided to inpatient and / or outpatient) The quality, cost and types of available resources (physicians, nurses, technicians, rooms, beds, medical equipments and all what constitute an input for health) The hospital capacity depends not only on the number of beds, but also how these beds are used. The hospital capacity can be influenced by several factors: The geographic distribution of patients: each locality has its own hospital. The type of resources currently in use: a patient who wants to have a particular diagnosis by the nearest hospital must visit the hospital where it exist the necessary equipment. availability of nurses, physicians, and support equipment in the hospital Hospital bed management may affect cost, quality and accessibility of care. The daily management of beds is closely related to the management of the hospital. To properly determine the capacity of beds, we need to track the activities of hospital patients (admission, assignment, stay and leave) [12]. The essential role of the hospital bed manager is to ensure balance between supply and demand for hospital beds. Bed management has a long-term component, which is the choice of the overall number of beds as well as sharing among different departments, and a short-term component for the daily bed allocation to patients. We conclude that hospital beds are important measure to determine the hospital capacity. The bed management does not only affect the overall capacity but it also impacts on cost, quality and accessibility of care [8]. 4.3. Models for hospital bed capacity management Many models were elaborated to determine the optimal number of beds inside a hospital. The simple and the most used models to evaluate the adequate capacity of a hospital department are based on the following index: N = (length of stay * number of patient)/number of days = number of patient per day / number of days The transfer between departments and the randomness of some of the index parameters are not considered in the above model. To overcome this shortness in the index model more elaborate stochastic models can be used. These models can be used for the short term (daily problem), the long term (monthly problem) or even for the case of a disaster. The Queuing models are short term models that are usually related to the operational level of the hospital capacity planning. These models characterize the relationship between the number of beds, the average occupancy levels and the number of patients transferred from one department to another based on the arrival time of patients, the nature of patients transferred from one unit to another and the period of use of each type of bed by the patients. [13]. The simulation models have the ability to consider the results of a decision on an item without carrying out the experiment on the actual item [9, 19]. They represent an artificial reproduction of what will happen when random parameters change their values. Sally C. Brailsford [16] proposed a simulation model to plan for the capacity of an intensive care in hospital using software called SIMUL8. Nowadays, the health sector, an increasingly privatized sector, seeks to find an effective planning of his resources for the long term. Taking into account the benefit t and also the quality of offered service. The medical ethics and money profit are two conflicting criteria. Multiple objective programming is a model that can deal with several criteria. Chu and Chu [6] proposed a goal programming model for hospital beds allocation in Hong Kong. The model takes into account the constraints of location, the demand constraint and constraints related to manpower. Black and Carter modeled the problem of allocating physicians to hospital department using a linear goal programming model [3]. The model focuses on the number of cases handled by a physician taking into account that the hospital must be able to generate enough revenue to cover fixed costs and variable production. 4.4. Conclusion The models developed for the hospital bed capacity planning problem are mostly categorized as stochastic models. These models are suitable for short and medium term. In this study, we are more concerned with the long term. This is way we focus on multiple objective programming models to plan for the bed capacity in Rashid hospital. Chapter 5 The model In this document, we follow Ben Abdelaziz and Masmoudi model to determine the optimal bed capacity in Rashid hospital [2]. The model was first developed for bed capacity planning in all public Tunisian hospital to evaluate of missing beds. 5.1. Notations l: specialty in a hospital department, . We have two kinds of specialties. Those called primary health specialties for which we cannot transfer the patient to another hospital and secondary healthcare specialties that in case of no hospital bed available can be transferred to another hospital. : A subset of primary healthcare specialties that can be served by the same hospital bed (for which we are using the same equipment), . : A subset of secondary healthcare specialties that can be served by the same hospital bed, . : the set of specialties that may be served by the same type of nurses , : the set of specialties that may be served by the same type of physician , 5.2. The parameters : Existing beds in specialty in the hospital, . : the number of beds that can be added in the specialty in the hospital, . : ratio of nurses per bed, i.e. the number of nurses needed to serve one patient in the specialty l, . : ratio of physicians per bed: The number of physicians needed to serve one patient in the specialty l, . : the stochastic yearly demand for the specialty in the hospital where express the random demand. 5.3. Decision variables : number of beds in the specialty in the hospital. 5.4. Constraints of the model Maximum and minimum number of beds in the hospital The demand for the set of specialties in the hospital must be satisfied The demand for the set of specialties must be satisfied otherwise transferred to another hospital (1) where express the number of vacant beds in the set of specialties and the number of missing beds in the set of specialties . 5.5. Objective functions The first objective function is to minimize the cost of adding and managing new beds where is the daily cost of creating and managing an additional bed of the specialty in the hospital during the period of investment. The stochastic constraint (1) is related to the satisfaction of the demand in secondary health care specialties. This transfer generates an additional cost (transfer cost). We have to use a recourse approach to get certainty equivalent constraint. In a recourse approach a penalty in the objective function is generated when the solution does not satisfy the random constraint. Here the penalty is the transfer cost. The expected transfer cost is where is the expected transfer cost. The third group of objective functions is to minimize the number of nurses in the groups of specialities in the hospital The fourth group of objective functions is to minimize the number of physicians in the groups of specialities in the hospital 5.6. The final model The final model is expressed as the following multiple objective stochastic program 5.7. Conclusion To solve the above multiple objective program, we need to transform it into an equivalent mathematical program. This transformation must be done following the problem hypotheses. In the next chapter, we will review these hypotheses and we will provide a suitable transformation of the program (P) into its certainty equivalent program. Chapter 6 The certainty equivalent program 6.1. Introduction The program (P) is a stochastic program as it presents two stochastic constraints (P.5) and (P.6) and a multiple objective program as it has several objective functions to minimize. To solve a multiple objective stochastic program, we need to transform it into its certainty equivalent program, under predefined approaches. In the next sections and using a chance constrained approach for the constraint (P.5), a discretization technique for the constraint (P.6) and a goal programming approach to deal with the two objective functions (P.3), and (P.4), we are going to build such a certainty equivalent program to the program (P). 6.2. Chance constrained approach The chance constrained approach transforms the random constraint into a deterministic constraint by considering as feasible solution those satisfying the uncertain constraints with a predefined level of probability [4]. Therefore, under a chance constrained approach, the following stochastic linear constraint where , and are random variables, will be transformed into the following deterministic constraint where is fixed level of probability. It means that a feasible solution must satisfy the uncertain constraints for all scenarios with a probability of occurrence higher than . The constraint (P.5) expresses the satisfaction of the demand on primary health care specialties (the demand on these specialties cannot be transferred to another hospital). It is difficult and not justified to satisfy the demand for all scenarios and especially scenarios with a small probability of occurrence. In the following, we propose a chance constrained approach to deal with the constraint (P.5). Therefore, the demand on the primary health care specialties Ar must be satisfied with a given fixed probability level as follows (3) The constraint (3) is a chance constraint. Using the model hypotheses, the random daily demands are normally distributed with a mean of and standard deviation of . Note that, Then, we can rewrite the chance constraint (3) as follows 6.3. Discretization approach We must satisfy almost surely the constraint (P.6). In stochastic programming, the normal distribution is approximated by a discrete distribution and then the constraint (P.6) can be rewritten as follows: The total recourse cost and the monthly transfer cost for secondary health care specialities are transformed using the discretization of the normal distribution of demands as follows: 6.4. Goal programming approach Charnes and Cooper [5] are the first to introduce the goal programming approach which is essentially used to transform multiple objective linear program into a linear program. This transformation consists on these steps: First, to fix a target values for some or all objectives (called also goals) Second, to transform the objective functions to constraints and third minimizing the difference between objective functions value and these goals. Using a goal programming approach, the following objective functions can be transformed to constraints as follows where and are the negative and the positive difference, respectively, between the fixed goals and the achievement , and the new objective function to optimize is expressed as follows where and are weights of the negative and the positive deviation, respectively. The objective functions (P.3) and (P.4) minimize the number of nurses and physicians in each hospital. As the actual number of nurses and physicians can not be reduced, a goal programming approach is used to deal with objectives (P.3) and (P.4) where goals must be equal to the number of nurses and physicians already working in hospitals. Let us denote by and the number of nurses and physicians, respectively, who already work on the specialty in the hospital. We denote by and the goals for the objective functions (P.3) and (P.4), respectively, and are expressed as follows where is the number of nurses in shortage in the group of specialties in the hospital, is the number of nurses in excess in the group of specialties in the hospital, is the number of physicians in shortage in the group of specialties in the hospital and is the number of physicians in excess in the group of in the hospital. From these goal constraints the additional cost that gives monthly salary of new nurses and physicians is as follows: where is the nurse salary per month in the group of specialty in the hospital and is the physician salary per month in the group of specialty in the hospital. The monthly salary of nurses and physicians who work in hospitals is fixed. Now, as all objective functions represent yearly expenses, we propose to combine all cost objectives which are the yearly transfer cost, the yearly cost of creating and managing new beds and the yearly salary of new nurses and new physicians, into a single objective function expressed as follows: 6.5. The certainty equivalent Finally, under a chance constrained approach and a goal programming approach, the certainty equivalent program to the multiple objective stochastic program (P) is expressed as follows: (CE) 6.6. Conclusion The chance constrained and the goal programming approaches are used to generate the certainty equivalent program. Their use is motivated by the problem hypotheses. In the next chapter, we are going to test the model using real data from Rashid hospital. Chapter 7 The experimental study In this chapter, we discuss the results obtained by the previously presented model for hospital bed capacity planning using data from Rashid hospital. The data was obtained from the administration of the hospital and is related to a recent period (2009-2011). The quality of results here is highly linked to the quality of the input data. We are going in the following to report some of the data given to us as well as the model output. 7.1. Model parameters From the Rashid hospital we collected data related to the following parameters: Number of patients / specialty New admissions/ day Discharges / day Stay of every patient Number of Physicians / specialty Number of physicians / team Number of teams / specialty Number of hours worked by each physician Number of patients assigned to each team / day Number of nurses / specialty Number of beds / specialty A description of the system of operation of each specialty. In this document we cannot disclose the information that was given to us. We refer the reader to the manuals that the hospital published yearly and that are related to his yearly activity. 7.2. Lingo 12.0 To solve the linear programming (CE), we used the commercial software Lingo 12.0. Recently Lingo was ranked by INFORMS (www.informs.org) as one of the most valuable package for linear and nonlinear mathematical programming problems. For the mixed integer linear program (CE), Lingo uses a modified Branch and Bound algorithm [17]. 7.3. Hospital beds The Rashid hospital must have 467 beds in the total. It means that 15 supplementary beds must be added to the hospital. The number of optimal beds in each speciality is presented in the following table: Specialty Current number of beds Optimal PSYCHIATRY 46 46 CARDIOLOGY 74 74 GASTRO 9 9 GEN.SURGERY 84 84 HEMATOLOGY 4 4 IDU 23 23 RESPIRATORY 22 22 NEUROSURGERY 39 44 TRAUMA 104 114 GERIATRIC 47 47 TOTAL 452 467 Table 1: number of optimal beds Only two specialities require additional beds. These specialities are the Neurosurgery where 5 beds must be added and the trauma speciality which requires 10 additional beds. This difference between the optimal number of beds and the current beds is also represented with the following histogram: 7.4. Nurses The Rashid hospital needs to hire 3 additional nurses to the hospital to cover the demand. The optimal number of nurses per specialty is represented in the following table: Spec. Current number of Nurses Optimal PSYCHIATRY 12 14 CAR

The American Constitution and Drug War Essay -- American Government, L

The consensus with regards to drug laws favors more stringent and draconian laws, with the attempt to stifle use and punish crime. There are many claims used against drug legalization, such as, moral degradation, crime, the destruction of inner cities; along with families, diseases, such as AIDS, and the corrupting of law enforcement. When one examines the effects of prohibition, one has to inquire: has the cost been worth it? Certainly, an argument for the abolition of prohibition doesn’t include the favoring of drug use, but merely recognizes the vain and utopian attempt to control individual choices. Along these lines, the unintended consequences of these attempts may preclude any benefits. Further, one has to wonder: are these laws—at the federal level—constitutional or not? This paper will examine the issue of drug prohibition from a constitutional standpoint, an economic perspective, and the societal effects these laws have. The Constitution of the United States is the supreme law of the land. While this statement seems axiomatic, it’s essential to discern the explication and implication of this with regard to the drug war. It’s been assumed that whatever the federal government passes is by the fact itself constitutional, notwithstanding the Supreme Court. However, to the dismay of some, this statement is blatantly false. The Constitution was ratified on the condition that only the powers the federal government would possess were the ones specifically delegated to it by the states. This is reinforced by the 10th amendment (Mount, 2010). This view stipulates that the federal government is limited and defined; and, for the government to garner new powers, the correct approach would be through Article V’s amendment process. ... ...this construction of the words â€Å"necessary and proper,† is not only consonant with that which prevailed during the discussions and ratification of the constitution, but is absolutely necessary to maintain their consistency with the peculiar character of the government, as possessed of particular and defined powers, only; not of the general and indefinite powers vested in ordinary governments. (Tucker, 2010) To take a step beyond these powers would cripple the constitution and thus cripple our democratic principles and process. In order for changes to be made—which there have been—the proper arrangement would be the amendment process. If it took the Eighteenth Amendment in 1919 to outlaw alcohol, it would seem logical and constitutional to outlaw drugs (Vick, 2010). In sum, any laws at the federal level that outlaw drugs, based on these facts, are unconstitutional.

Sport Utility Vehicles :: SUVs Transportation Automobiles Essays

Sport Utility Vehicles In recent years the market for SUVs, Sport Utility Vehicles, and pickup-trucks has increased significantly. In fact, â€Å"more than 40% of consumers say they are considering buying an SUV for their next vehicle, the highest of any segment,† (Halliday 1-2). As the name implies, Sport Utility Vehicles were originally intended as means of transportation in places where normal cars would not function well, such as off-road. Pickup-trucks were also designed for a practical purpose, hauling materials that would not normally fit in a car trunk. Has the dramatic increase in sales of SUVs lead to a dramatic increase in the number of people driving off-road? No. Has the dramatic increase in the sales of pickup-trucks lead to an increase in people hauling large objects? No. The majority of SUV and truck owners purchase their vehicles because they believe that they are safer. The question arises how safe are SUVs and trucks really? SUV and truck safety can be broken down into t wo categories, the safety of the driver of the SUV or truck and the safety of any other motorist who collides with an SUV or truck. What kinds of people would want to buy an SUV or a truck? Well the practical answer would be people who want to off-road or haul large equipment, but that is not the largest group of SUV and truck consumers. Most SUV owners buy SUVs because they feel as though they are more protected in case of an accident. This is a proven fact â€Å"SUVs, vans, and pickups appear to be more aggressive and may be more crashworthy than cars. Effects of pickups are most pronounced. Drivers in pickups face less risk of serious injury than car drivers,† (Toy / Hammitt 7-8). This is a very valid point. Force is equal to mass times acceleration. If a car and an SUV are traveling at a relatively similar speed and they collide, the vehicle with more mass, the SUV, will always win. This obsession with feeling safe is resulting in the size of SUVs and trucks reaching ridiculous proportions. The new Ford Excursion is too large to fit into many normal sized parking spaces. Every year trucks and SUVs get bigger in an effort to be the â€Å"safest† vehicle on the road.

Sound Essay -- Hearing Papers

Sound It may be commonplace to point out that acoustic reality and perceptual reality are different. In a live performance situation, for example, no matter how still the audience, the environment will be full of sounds extraneous to the music. If a tape recorder were positioned somewhere in the midst of such a situation, and if a segment of the resulting tape were submitted to digital sound analysis, the results would highlight the difference between what one heard during the performance (what is presumably captured on the tape), and what analysis confirms the tape actually contains. Sound analysis reveals the behavior of sound in the physical world. In this case, analysis would show that soundwaves from all the sound sources in the environment -- the various instruments of the performance, perhaps the stirring of the audience, or the sound of vehicles passing beyond the confines of the performance context -- the multitude of acoustic elements that make up each of these sounds do not rema in conveniently grouped by source. Rather, the components of all these sounds mix together, combining into a single, very complex waveform which is represented on the tape and revealed through analysis. This is because sound waves are additive, like waves in water, multiplying in quality rather than quantity. In the simplest possible terms, what digital analysis uncovers are the acoustic features of the sounds captured by the tape recorder; what are actually heard are the perceptual features of the same sounds. The acoustic and perceptual characteristics of sound are not the same, nor in many cases is there a one-to-one correspondence between them. Parameters of Sound In a very general sense, sounds in a normal environment consist o... ...on provided by either form of presentation is an approximation at best, limited by the resolution capabilities of both the digitizer and the analyzer, as well as by the fineness of detail possible in the graphic display of the software. It is also important to be cautious in considering which details of the visual representation of a sound sample are salient to the sound as perceived; often the picture of a sound will include clearly visible elements which are acoustically present in the sound but too short in duration, or too soft in intensity to register perceptually. A useful maxim in this regard is the following: If a discrete element is filtered from a sound with no difference to the resulting tonal sensation, then the element is unimportant to the final percept and need not be considered in interpreting the data, no matter how blatantly it appears in analysis. Sound Essay -- Hearing Papers Sound It may be commonplace to point out that acoustic reality and perceptual reality are different. In a live performance situation, for example, no matter how still the audience, the environment will be full of sounds extraneous to the music. If a tape recorder were positioned somewhere in the midst of such a situation, and if a segment of the resulting tape were submitted to digital sound analysis, the results would highlight the difference between what one heard during the performance (what is presumably captured on the tape), and what analysis confirms the tape actually contains. Sound analysis reveals the behavior of sound in the physical world. In this case, analysis would show that soundwaves from all the sound sources in the environment -- the various instruments of the performance, perhaps the stirring of the audience, or the sound of vehicles passing beyond the confines of the performance context -- the multitude of acoustic elements that make up each of these sounds do not rema in conveniently grouped by source. Rather, the components of all these sounds mix together, combining into a single, very complex waveform which is represented on the tape and revealed through analysis. This is because sound waves are additive, like waves in water, multiplying in quality rather than quantity. In the simplest possible terms, what digital analysis uncovers are the acoustic features of the sounds captured by the tape recorder; what are actually heard are the perceptual features of the same sounds. The acoustic and perceptual characteristics of sound are not the same, nor in many cases is there a one-to-one correspondence between them. Parameters of Sound In a very general sense, sounds in a normal environment consist o... ...on provided by either form of presentation is an approximation at best, limited by the resolution capabilities of both the digitizer and the analyzer, as well as by the fineness of detail possible in the graphic display of the software. It is also important to be cautious in considering which details of the visual representation of a sound sample are salient to the sound as perceived; often the picture of a sound will include clearly visible elements which are acoustically present in the sound but too short in duration, or too soft in intensity to register perceptually. A useful maxim in this regard is the following: If a discrete element is filtered from a sound with no difference to the resulting tonal sensation, then the element is unimportant to the final percept and need not be considered in interpreting the data, no matter how blatantly it appears in analysis.

Plato and Gettier on Knowledge Essay

Plato in one of his most famous earliest dialogue Meno tried to provide a new way of explaining how we humans ‘acquire’ knowledge. The common notion of the ancient Greeks and even to our times on how we acquire knowledge is the characteristic of knowledge to be taught and learned. Knowledge in a sense is an outside entity that resides outside ourselves. We learn outside of ourselves through our environment or other people that try to teach us. However, the events and flow of discussion in Meno had convinced Plato to provide a new framework that will be able to discuss how we acquire knowledge. Plato’s basic discussion says that knowledge acquisition is more in fact a matter of recollection rather than learning. We acquire knowledge and ideas from the inside of ourselves and not through the lessons outside ours. Plato rooted this from the belief of the priest and diviners and even philosophers to the immortality of the soul. The soul had existed since time immemorial making it able to know everything it needs to know. Whatever knowledge and ideas had already been embedded on the soul because of immortal existence. However, as the soul transfer from one body to another body because of the mortality of the human body, Plato argued that as the body withers and dies, all the knowledge are forgotten and put into background. From here, Plato would argue for the knowledge acquisition to be a matter of recollection and remembering of the knowledge and ideas already possessed by the soul. Plato believed that whatever we know is a recollected and remembered idea of the soul’s former existence. This concept was explained by Socrates to Meno with the help of Meno’s slave. Socrates called the slave and asked some questions regarding geometry and the measurement of some shapes. Socrates tried to ask some questions that direct the slave to answer them rightfully. It is important to note the slave is uneducated in the classical sense. However, through Socrates’ questions, he managed to enable to direct the slave towards right answers. This had help to prove to Meno that the soul already possessed the knowledge and opinions about everything. For Plato, this knowledge can be accessed by examining ourselves and with yourself or someone asking the right questions that will redirect you to the knowledge and ideas inside your soul. Knowledge is defined in its justification, truth and being a belief. After discussing the nature of knowledge and how we can acquire it, Socrates and Meno moved on to discuss to define opinion and its relevance on the affairs of man. The task is simple, to define opinion (true opinion) and to contrast it to knowledge. Primarily, Socrates acknowledged the role of a good opinion in the human affairs. He did not disregard it completely but rather understand its use in some cases. In fact, he acknowledges the inclination of virtuous men to rely on their true opinion to do good things. However, Socrates clearly undermines opinion; even they are good when it is contrasted to knowledge. For Plato, an opinion does not last long and easily withers in contrast to knowledge that has the capability to last eternally. The main difference lies on the presence of a rationality and grounds on knowledge and its absence of an n opinion. He used the example of a statue. He stated that the statue with that is tied in a good foundation will be able to last longer compare to a statue that is not tied. For Socrates, though an opinion can produce the same awe to an observer, it is a natural tendency for humans to ask the question of why and how. These questions cannot be answered by an opinion because of its absence of ground. In this sense, knowledge exceeds an opinion. This definition of knowledge that is characterized by Plato which is defined as a justified true belief had dominated from the ancient Greeks up to the mid-late 20th century. The general belief that knowledge for it to be referred as knowledge must be able to satisfy three basic characteristics, which is (1) justification (2) truth (3) belief was questioned by Edmund Gettier’s paper entitled â€Å"Is Justified True Belief Knowledge? †. This short paper that had managed to provide a doubt to the long tradition in epistemology that considers knowledge to be a justified true belief. Edmund Gettier provided to two cases or examples will put in to question the long era of this ancient belief. He presented a case in which the three conditions are present namely justification, truth, belief yet unable to be count as knowledge because of the play of other factors. In Gettier’s examples which were referred as Gettier’s cases, the three criteria were only made possible by some elements of luck and chance which clearly invalidate it to be knowledge. This put an ‘end’ to a long tradition of considering knowledge by the virtue of three elements of justification, truth and belief. Though the paper of Gettier did not provide an alternative view or solution to his problem, responses on his paper can be summarized to the attempts of many philosophers to look or find out for the fourth criteria that will make the definition of knowledge. Works Cited Plato. Grube G. M. A. (trans) Cooper, John (rev) Five dialogues. 2002. Hacket Publishing Company Inc. IN. Print Gettier. Edmund. Is Justified True Belief Knowledge? Web.

Self Ananlysis Test

Self Analysis Report Behaviour in Organizations Submitted by: Ajitha Katakam (PGP25249) I. WHAT ABOUT ME? A. Personality Insights 1. What’s My Basic Personality? Extraversion Agreeableness Conscientiousness Emotional Stability Openness to Experience 2. What my Jungian 16-type personality? (ISTJ etc. ) 3. Am I type — A? 4. How well do I handle Ambiguity? 5. How creative am I ? 7 11 8 10 10 INTP 105 (A-) 28 -5 Attach Value Filled Questionnaire 34 55 -3 B. Values and Attitude Insights 1. What do I value? 2. How involved am I in my job? 3. How satisfied am I with my job? 4. What are my attitudes towards workplace diversity? C.Motivation Insights 1. What motivates me? Growth needs Relatedness needs Existence needs 2. What are my dominant needs? Achievement Affiliation Autonomy Power 3. What rewards do I value most? 4. What is my view of the nature of people? 5. What are my course performance goals? 6. How confident am I in my abilities to succeed? 7. What’s my attitud e toward achievement? Fall Reward 8. How sensitive am I to equity differences? 9. What’s my job’s motivating potential? MPS 10. Do I want an enriched job? 3. 9 18 11 15 16 Attached 23 10 45 17 45 16. 3 14 16 14 D. Decision Making Insights 1. What’s my decision-making style? IntuitiveRational 2. Am I procrastinator? 3. How do my ethics rate? 18 Attach your results 34 35 Attach your results 89 E. Other 1. What’s my emotional intelligence score? 2. What time of day am I most productive 3. How good am I at personal planning? 4. Am I likely to become an entrepreneur? II. WORKING WITH OTHERS A. Communication Skills 1. What’s my face-to-face communication style? Dominant Dramatic Contentious Animated Impression Relaxed Attentive Open Friendly 2. How good are my listening skills? -1. 1 -0. 6 0 1 0. 2 -0. 4 -0. 4 -1. 2 -0. 5 42 B. Leadership and Team skills 1. What’s my leadership style? People Oriented Task Oriented 2.How charismatic am I? Managemen t of attention Management of meaning Management of trust Management of self Management of risk Management of feelings 3. Do I trust others? 4. Do others see me as trustworthy? 5. How good am I at disciplining others? 6. How good am I at building and leading a team? 12 16 15 13 14 12 4 53 17 81 31 Reward Coercive Legitimate 2. 2 1. 7 4 10 9 C. Power and Conflict Skills 1. How power-oriented am I? 2. What’s my preferred type of power? Expert Referent 3. How good am I at playing politics? 4. How well do I manage impressions? Self-promotion Ingratiation Exemplification Intimidation Supplication 5.What’s my preferred conflict-handling style? Competing Collaborating Avoiding Accommodating Compromising 6. What’s my negotiating style? 4. 5 4 74 1. 75 1. 25 1. 25 1 1 18 16 10 15 14 21 III. LIFE IN ORGANIZATIONS A. Organization Structure 1. What type of organization structure do I prefer? 2. How willing am I to delegate? 3. How good am I at giving performance feedback? St rengths Weaknesses 52 63 2 2 25 4. 86 24 31 67 67 139 3. 04 B. Careers 1. What’s the right organizational culture for me? 2. How committed am I to my organization? 3. Am I experiencing work/family conflict? 4. How motivated am I to manage? . Am I well-suited for a career as a global manager? C. Change and stress 1. How well do I respond to turbulent change? 2. How stressful is my life? 3. Am I burned out? FIRO-B Inclusion Expressed Wanted Total 2 1 3 Control 5 2 7 Affection 2 4 6 Total 9 7 16 SPIRO SUMMARY SHEET PARENT Nurturing Supportive OK Styles 8 Rescuing Not-OK Styles 9 Under-Developed OK Ego States Operating Effectiveness Quotient Dominant Style Backup Style 7 10 6 3 13 6 Prescriptive 13 Task Obsessive 10 Bohemian 5 Aggressive 8 Sulking Regulating Normative Problem Solving ADULT Creative Innovative CHILD Reactive AdaptiveConfronting Resilient ? 45 Rescuing Supportive ? 43 Prescriptive Normative 58 Problem Solving Task Obsessive 70 Innovative Bohemian ? 100 Confronting Aggressive ? 33 Sulking Resilient IV. SOME PERSONAL INFORMATION (a)Name: Ajitha Katakam Age : 23 Gender:Female (b)Education B. Tech (Metallurgy and Materials Science) (c) CGPA: 6. 91 (d) Annual Family Income: 5 lakhs (e) Work experience: 22 months Roll No. : PGP25249 What do I Value? What Rewards I value most? How do my ethics rate? How good am I at personal Planning? Personality: My Big Five scores indicate moderate scores on all the five factors.The Jungian type is INTP which suggests that I am socially cautious, enjoy problem solving and highly conceptual. My score of 105 on the type- A test shows that I am A- suggesting I have a few traits of type- A personality. I can tolerate ambiguity but I am not creative. My most important terminal values are Pride in accomplishment, lasting friendships and Happiness where as my most important Instrumental values are Truthfulness (honesty), Assertiveness and Education & intellectual pursuits. I have moderate job involvement, low job satisfa ction and am pessimistic to work place diversity.My motivation for growth, relatedness and existence are high and on the same level. My dominant need is for achievement and the least is for affiliation. I am flexible in my perception of others, have strong course performance goals and strong self-efficacy. I have a very low job motivating potential and moderate response to job enrichment. My score on procrastination is towards the lower side suggesting I do not postpone or delay often. Though my ethics in some areas are concurrent with the majority they differ in most areas. I have EQ close to strong Emotional Intelligence and am proactive.I am an intermediate person having no particular preference between morning and evening. I need improvement in personal planning. Working with others: My low scores on all communication styles suggest my lack of dominant style and moderate listening skills. My leadership style is people oriented, however task oriented leadership is also comparable . I am fairly charismatic. I have low trust in others but I am perceived as trustworthy. I have some deficiencies in disciplining others and I am in the second quartile relating to building and leading a team.I have a high Mach score and good political skills. My preferred types of power are expert, legitimate, referent and my preferred conflict handling style is competing. I do not use impression management techniques but have good negotiating style. Life in Organizations: I have no clear preference between mechanic and organic design. My delegation skills need substantial improvement and I have significant self perceived weakness. I have a slight preference for informal, humanistic, flexible and innovative cultures. I faced moderate work/family conflict.I am highly motivated to perform managerial functions but my potential for success as a global manager is slightly low. I have low susceptibility to stress induced illness. I am not comfortable with turbulent changes and need to re -evaluate my priorities to avoid burnout. FIRO and SPIRO: My FIRO scores indicate low expressed affection, inclusion and moderate control. In the wanted category, I scored moderately on affection and low in inclusion and control. SPIRO scores indicate I need to improve in parent and child states.