Current Status of Gene Therapy Research

Current Status of Gene Therapy Research Genes, which are carried on chromosomes, are the basic physical and functional units of heredity. Genes are specific sequences of bases that encode instructions on how to make proteins. Although genes get a lot of attention, its the proteins that perform most life functions and even make up the majority of cellular structures. When genes are altered so that the encoded proteins are unable to carry out their normal functions, genetic disorders can result. Gene therapy is a technique for correcting defective genes responsible for disease development. Researchers may use one of several approaches for correcting faulty genes: A normal gene may be inserted into a nonspecific location within the genome to replace a nonfunctional gene. This approach is most common. An abnormal gene could be swapped for a normal gene through homologous recombination. The abnormal gene could be repaired through selective reverse mutation, which returns the gene to its normal function. The regulation (the degree to which a gene is turned on or off) of a particular gene could be altered. How does gene therapy work? In most gene therapy studies, a normal gene is inserted into the genome to replace an abnormal, disease-causing gene. A carrier molecule called a vector must be used to deliver the therapeutic gene to the patients target cells. Currently, the most common vector is a virus that has been genetically altered to carry normal human DNA. Viruses have evolved a way of encapsulating and delivering their genes to human cells in a pathogenic manner. Scientists have tried to take advantage of this capability and manipulate the virus genome to remove disease-causing genes and insert therapeutic genes. Target cells such as the patients liver or lung cells are infected with the viral vector. The vector then unloads its genetic material containing the therapeutic human gene into the target cell. The generation of a functional protein product from the therapeutic gene restores the target cell to a normal state. See adiagram  depicting this process. Some of the different types of viruses used as gene therapy vectors: Retroviruses   A class of viruses that can create double-stranded DNA copies of their RNA genomes. These copies of its genome can be integrated into the chromosomes of host cells. Human immunodeficiency virus (HIV) is a retrovirus. Adenoviruses   A class of viruses with double-stranded DNA genomes that cause respiratory, intestinal, and eye infections in humans. The virus that causes the common cold is an adenovirus. Adeno-associated viruses   A class of small, single-stranded DNA viruses that can insert their genetic material at a specific site on chromosome 19. Herpes simplex viruses   A class of double-stranded DNA viruses that infect a particular cell type, neurons. Herpes simplex virus type 1 is a common human pathogen that causes cold sores. Besides virus-mediated gene-delivery systems, there are several nonviral options for gene delivery. The simplest method is the direct introduction of therapeutic DNA into target cells. This approach is limited in its application because it can be used only with certain tissues and requires large amounts of DNA. Another nonviral approach involves the creation of an artificial lipid sphere with an aqueous core. This liposome, which carries the therapeutic DNA, is capable of passing the DNA through the target cells membrane. Therapeutic DNA also can get inside target cells by chemically linking the DNA to a molecule that will bind to special cell receptors. Once bound to these receptors, the therapeutic DNA constructs are engulfed by the cell membrane and passed into the interior of the target cell. This delivery system tends to be less effective than other options. Researchers also are experimenting with introducing a 47th (artificial human) chromosome into target cells. This chromosome would exist autonomously alongside the standard 46 not affecting their workings or causing any mutations. It would be a large vector capable of carrying substantial amounts of genetic code, and scientists anticipate that, because of its construction and autonomy, the bodys immune systems would not attack it. A problem with this potential method is the difficulty in delivering such a large molecule to the nucleus of a target cell. What is the current status of gene therapy research? The Food and Drug Administration (FDA) has not yet approved any human gene therapy product for sale. Current gene therapy is experimental and has not proven very successful in clinical trials. Little progress has been made since the first gene therapy clinical trial began in 1990. In 1999, gene therapy suffered a major setback with the death of 18-year-old Jesse Gelsinger. Jesse was participating in a gene therapy trial for ornithine transcarboxylase deficiency (OTCD). He died from multiple organ failures 4 days after starting the treatment. His death is believed to have been triggered by a severe immune response to the adenovirus carrier. Another major blow came in January 2003, when the FDA placed a temporary halt on all gene therapy trials using retroviral vectors in blood stem cells. FDA took this action after it learned that a second child treated in a French gene therapy trial had developed a leukemia-like condition. Both this child and another who had developed a similar condition in August 2002 had been successfully treated by gene therapy for X-linked severe combined immunodeficiency disease (X-SCID), also known as bubble baby syndrome. FDAs Biological Response Modifiers Advisory Committee (BRMAC) met at the end of February 2003 to discuss possible measures that could allow a number of retroviral gene therapy trials for treatment of life-threatening diseases to proceed with appropriate safeguards. In April of 2003 the FDA eased the ban on gene therapy trials using retroviral vectors in blood stem cells. What factors have kept gene therapy from becoming an effective treatment for genetic disease? Short-lived nature of gene therapy   Before gene therapy can become a permanent cure for any condition, the therapeutic DNA introduced into target cells must remain functional and the cells containing the therapeutic DNA must be long-lived and stable. Problems with integrating therapeutic DNA into the genome and the rapidly dividing nature of many cells prevent gene therapy from achieving any long-term benefits. Patients will have to undergo multiple rounds of gene therapy. Immune response   Anytime a foreign object is introduced into human tissues, the immune system is designed to attack the invader. The risk of stimulating the immune system in a way that reduces gene therapy effectiveness is always a potential risk. Furthermore, the immune systems enhanced response to invaders it has seen before makes it difficult for gene therapy to be repeated in patients. Problems with viral vectors   Viruses, while the carrier of choice in most gene therapy studies, present a variety of potential problems to the patient toxicity, immune and inflammatory responses, and gene control and targeting issues. In addition, there is always the fear that the viral vector, once inside the patient, may recover its ability to cause disease. Multigene disorders   Conditions or disorders that arise from mutations in a single gene are the best candidates for gene therapy. Unfortunately, some the most commonly occurring disorders, such as heart disease, high blood pressure, Alzheimers disease, arthritis, and diabetes, are caused by the combined effects of variations in many genes. Multigene or multifactorial disorders such as these would be especially difficult to treat effectively using gene therapy. For more information on different types of genetic disease, see  Genetic Disease Information. What are some recent developments in gene therapy research? Nanotechnology + gene therapy yields treatment to torpedo cancer. March, 2009. The School of Pharmacy in London is testing a treatment in mice, which delivers genes wrapped in nanoparticles to cancer cells to target and destroy hard-to-reach cancer cells. Read  BBC article. Results of worlds first gene therapy for inherited blindness show sight improvement. 28 April 2008. UK researchers from the UCL Institute of Ophthalmology and Moorfields Eye Hospital NIHR Biomedical Research Centre have announced results from the worlds first clinical trial to test a revolutionary gene therapy treatment for a type of inherited blindness. The results, published today in the New England Journal of Medicine, show that the experimental treatment is safe and can improve sight. The findings are a landmark for gene therapy technology and could have a significant impact on future treatments for eye disease. Read  Press Release. Previous information on this trial (May 1, 2007): A team of British doctors from Moorfields Eye Hospital and University College in London conduct first human gene therapy trials to treat Lebers congenital amaurosis, a type of inherited childhood blindness caused by a single abnormal gene. The procedure has already been successful at restoring vision for dogs. This is the first trial to use gene therapy in an operation to treat blindness in humans. See  Doctors Test Gene Therapy to Treat Blindness  at www.reuters.com.   A combination of two tumor suppressing genes delivered in lipid-based nanoparticles drastically reduces the number and size of human lung cancer tumors in mice during trials conducted by researchers from The University of Texas M. D. Anderson Cancer Center and the University of Texas Southwestern Medical Center. See  Dual Gene Therapy Suppresses Lung Cancer in Preclinical Test  at www.newswise.com (January 11, 2007). Researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, successfully reengineer immune cells, called lymphocytes, to target and attack cancer cells in patients with advanced metastatic melanoma. This is the first time that gene therapy is used to successfully treat cancer in humans. See  New Method of Gene Therapy Alters Immune Cells for Treatment of Advanced Melanoma  at www.cancer.gov (August 30, 2006).   Gene therapy is effectively used to treat two adult patients for a disease affecting nonlymphocytic white blood cells called myeloid cells. Myeloid disorders are common and include a variety of bone marrow failure syndromes, such as acute myeloid leukemia. The study is the first to show that gene therapy can cure diseases of the myeloid system. See  Gene Therapy Appears to Cure Myeloid Blood Diseases In Groundbreaking International Studyat www.cincinnatichildrens.org (March 31, 2006).   Gene Therapy cures deafness in guinea pigs. Each animal had been deafened by destruction of the hair cells in the cochlea that translate sound vibrations into nerve signals. A gene, called  Atoh1,  which stimulates the hair cells growth, was delivered to the cochlea by an adenovirus. The genes triggered re-growth of the hair cells and many of the animals regained up to 80% of their original hearing thresholds. This study, which many pave the way to human trials of the gene, is the first to show that gene therapy can repair deafness in animals. See  Gene Therapy is First Deafness Cure  at NewScientist.com (February 11, 2005). University of California, Los Angeles, research team gets genes into the brain using liposomes coated in a polymer call polyethylene glycol (PEG). The transfer of genes into the brain is a significant achievement because viral vectors are too big to get across the blood-brain barrier. This method has potential for treating Parkinsons disease. See  Undercover Genes Slip into the Brain  at NewScientist.com (March 20, 2003). RNA interference or gene silencing may be a new way to treat Huntingtons. Short pieces of double-stranded RNA (short, interfering RNAs or siRNAs) are used by cells to degrade RNA of a particular sequence. If a siRNA is designed to match the RNA copied from a faulty gene, then the abnormal protein product of that gene will not be produced. See  Gene Therapy May Switch off Huntingtons  at NewScientist.com (March 13, 2003). New gene therapy approach repairs errors in messenger RNA derived from defective genes. Technique has potential to treat the blood disorder thalassaemia, cystic fibrosis, and some cancers. See  Subtle Gene Therapy Tackles Blood Disorder  at NewScientist.com (October 11, 2002). Gene therapy for treating children with X-SCID (sever combined immunodeficiency) or the bubble boy disease is stopped in France when the treatment causes leukemia in one of the patients. See  Miracle Gene Therapy Trial Halted  at NewScientist.com (October 3, 2002). Researchers at Case Western Reserve University and Copernicus Therapeutics are able to create tiny liposomes 25 nanometers across that can carry therapeutic DNA through pores in the nuclear membrane. See  DNA Nanoballs Boost Gene Therapy  at NewScientist.com (May 12, 2002).   Sickle cell is successfully treated in mice. See  Murine Gene Therapy Corrects Symptoms of Sickle Cell Disease  from March 18, 2002, issue of  The Scientist. What are some of the ethical considerations for using gene therapy? Some Questions to Consider What is normal and what is a disability or disorder, and who decides?   Are disabilities diseases? Do they need to be cured or prevented?   Does searching for a cure demean the lives of individuals presently affected by disabilities?   Is somatic gene therapy (which is done in the adult cells of persons known to have the disease) more or less ethical than germline gene therapy (which is done in egg and sperm cells and prevents the trait from being passed on to further generations)? In cases of somatic gene therapy, the procedure may have to be repeated in future generations.   Preliminary attempts at gene therapy are exorbitantly expensive. Who will have access to these therapies? Who will pay for their use?

Devil In The White City Essay -- Literary Analysis, Erik Larson

Erik Larson’s book Devil in the White City is full of magic and madness that has shaped the society of the late 19th century that is specific to in Chicago. The issues that have been handled through this time frame that are addressed in this book is that how Chicago was known to be the black city at first, and how the city hoped that hosting the World’s fair would increase their reputation. Secondly, the magic of a man named Daniel Burnham that did put the plans of the world fair in Chicago into life and the obstacles that he had overcame. Next, once the world fair was complete, it has made Chicago â€Å"The White city,† by its dazzling designs and attractions that made it memorable. Then, the madness of H.H. Holmes and how his evil deeds has seemed to undermine the world fair and the things that are going on within it with his murders and treachery that does grip Chicago once his evil deeds have been found out. Finally, the events that happened in the world fai r that relate to the issues that occur in the late ninetieth century within the United States. The city of Chicago was in a desolate condition before it hosted the World Fair. The city of Chicago was nicknamed â€Å"The Black City,† (P.11) before they had hosted the 1893 fair that had brought the city into life. Chicago was a city that was ridden with much crime and death to the point where young women could have been tempted to fall under the dangers of this city. Death was more commonplace then Chicago then other cities at that time because of murders that were so frequent in this city. The author does point out that â€Å"You can step from a curb and be killed by the Chicago Limited† (P.12). That fact even struck fear into the people who were visiting Chicago just to have fun or eve... ...gic of Chicago, but also the darkening madness of H.H. Holmes. This analysis of the book covers the city of Chicago being â€Å"the Black City,† before it hosted the World’s fair. Secondly, the glorious magic of Daniel Burnham did make this fair possible who all of his men that he worked with. Next, the city of Chicago when the fair was going on was a grand sight that people around the world would remember in history. Also, the unfortunate sight of the crimes and evil intention of H.H. Holmes had committed, that does put a black eye upon the fair. Finally, The Fair and how it has related to the historical trends of nineteenth century America. The Devil in the White City is an important novel that does tell of a great historical fair and a crime that has happened within the city of Chicago, the events there during that time period would be an important part in history.

Voting Behavior - What Determines Vote Choice? Essay -- Politics Polit

Many political science researchers study the forces that drive the vote. One of the earliest, and most well known, books about election studies is The American Voter. Written in 1960, the book tries to explain a model that describes what drives Americans to vote the way they do. The model suggests that social factors determine ones party identification, which determines one's issue positions and evaluation of candidate's characteristics. These forces all work together to determine how one will vote. This model may or may not still hold true today, as political researchers are not in agreement as to what exactly drives the vote. One thing that does remain true, however, is that factors such as social groups, party identification, issues, and retrospective evaluations all play some part in determining the vote. Although issues play a role in determining vote choice, social forces and retrospective evaluations are the most important factors the American public takes into consideration when deciding who to vote for. Fewer Americans identify with a political party today- in 1992 about 39% of the American public considered themselves as Independents. Before the 1982 election only 35% reported that they were Independents. This suggests that party identification is on the decline despite the American Voter finding that most everyone had a party identification and that their identification did not change much over their lifetime. (Abramson, Aldrich, Rohde, 225) Many people change their opinion about an issue over time, and only feel strongly about a few issues. Because Americans lack the knowledge of politician's positions on issues, and lack opinions of their own for the most part, they rely on other factors when determining who... ...ming. Retrospective evaluations require little knowledge or time and anyone can evaluate the President and the economy fairly quickly. Issues are always going to be important to the few that actively support them, but for the most part we rely on social groups and party identification, or retrospective evaluations when an incumbent is running, to help us decide who to vote for. BIBLIOGRAPHY Abramson, Paul R., John H. Aldrich, David W. Rohde. Change and Continuity in the 1992 Elections. 1995. Washington DC: Congressional Quarterly. Campbell, Angus, Philip E. Converse, Warren E. Miller, and Donald E. Stokes. The American Voter. 1960. New York: Wiley. Erikson, Robert S., Kent L. Tedin. American Public Opinion. 1995. Massachusetts: Allyn and Bacon. Luker, Kristin. Abortion and the Politics of Motherhood. 1984. Los Angeles: University of California Press.

Healthcare Policy And Quality Essay

The essay will examine the management of medicines policy on standards in medication errors by nurses in the hospital environment, the guidelines that nurses must follow when giving medication in order to avoid medication errors. A definition for ‘medication error’ will be given. Further issues to be discussed include; why medication error happens, approaches aimed at minimising medication error and the importance of teamwork , a brief reflection and a conclusion based on the findings will be given. The use of medication process involves different health care professionals as a result , medication error can take place relating to a series of steps in the drug delivery process, and includes the process of prescribing, dispensing, transcribing and administration (Chua et al., 2009 ; Zhan et al., 2006), thereby making room for error to take place. Subsequent to prescribing errors, the administration of medication errors is the most frequent type as they are more likely to r each the patients and the greater chance of causing patient harm (Chua et al.,2009). The legislation of medicines applies to prescribing, supply, storage and administration and it is important to have knowledge of and adhere to this legislation (Nursing & Midwifery Council (NMC), 2008; Royal Pharmaceutical Society of Great Britain (RPSGB) (2009). The medicine management policy on standards in reporting medication errors, near misses and adverse drug reactions was located on the Local Trust’s website and was easy to access. The Local trust is an acute, non-profit, health service. From the policy all staff involved in the prescribing , administration, dispensing and checking of medicine has the responsibility to ensure the policy is implemented and adhered to. In the local trust policy it states any member of staff can report a medication safety incident, near miss or adverse outcome. The local Trust Policy was reviewed in January 2012. The trust will also monitor all medication related incidents and an annual audit will be carried out to assess the effectiveness of the policy. The audit will be undertaken on a random selection of 30 cases of reported incidents. This Local Trust implemented the guidelines for the administration of medicines by the Nursing and Midwifery Council (NMC), 2008 which gives the information a prescription  chart must contain for safe and correct drug administration and gives clear principles for prescribing medicines. If the prescription is clear and accurate, errors are less likely to occur. The guidelines also states: â€Å"In exercising your professional accountability in the best interests of your patients; as a registrant, you must know the therapeutic use of the medicine to be administered, its normal dosage,side effects, precautions and contraindications,be certain of the identity of the patient to whom the medicine is to be administered , be aware of the patient’s plan of care† To appreciate medication mistakes and discuss policies for reducing and reporting medication errors, it is useful to understand the term ‘medication error’. The National Coordinating Council for Medication Error Reporting and Prevention states: ‘ a medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of health professional, patient or consumer’ (cited in Chua et al., 2009 p. 215). Different standards and policies are formed for varied circumstances and situations as well as routine moments (Unver, 2012). One such standard is the Standard for Medicine Management which replaces the Guidelines for the Administration of Medicines 2004, even though many of its principles remain relevant today (Nursing and Midwifery Council (NMC), 2008. This standard points out the various ways of managing medicine for nurses as they are required to take responsibility for their actions and omissions for any errors they make when giving any medicine (Copping, 2005). Usually, medical mistakes do not harm patients (Department of Health (DoH) (2004). Although, the National Patient Safety Agency (NPSA) (2009) gave a written account that in England, less than 1% of the key instance of harm or death in the National Health Institute (NHS) were directly linked to medication error; 155 medical instances gave rise to severe harm and 42 deaths. Standards in the NHS are used to make sure proces ses and procedures are carried out in a uniform and consistent manner to help professionals and patients ( Tzeng et al., 2013). Also , the same process should be carried out in the same way  wherever the site or location and under the same circumstance. This uniformity removes errors from personal judgement and panic decisions during situations which could ultimately lead to the death of people under various circumstances ( Fore et al., 2012). The administration of medication is likely to be based on errors in nursing as under normal circumstances, nurses are involved in the administration process and they spend 40% of their time giving it (Wright, 2013; Unver et al., 2012). Hence some studies have reported high error rates, indicating that nurses are putting patients in danger, when such errors would cause a low or minor risk to the patient (Wright, 2013). It is of great value to establish the cause of errors so that solutions can be put in place to reduce medication error rates. Although there are medication policies, adherence to these policies are low (Kim and Bates, 2012). Prior to medication administration, the following checks should be done : ‘right medication, in the right dose, to the right person, by the right route, at the right time’ (Kim and Bates, 2012) . Despite the guideline established in the administration of medicines using the ‘five rights’, nurses may conduct in a way and give inaccurate assurance that the practice is safe ( Unver et al., 2012). Non-adherence to the ‘five rights’ of medicine administration were observed by Kim and Bates (2012), the observations show that for : wrong dose (1.8%), wrong medicine (13%), wrong time (7.1%), wrong person (5.2%) and wrong route (1.8%). An observation of potential error in the administration of medicine was made during a recent clinical placement in an elderly ward of a local trust. The ward has 30 beds and medicines were supplied in bulk to the ward, though more specific medicines were provided as single items on receiving a prescription by the pharmacy department. In addition, medication orders were written by doctors directly onto the patient’s medication chart without transcribing.The medication was given by nurses by referring to the medication chart. In view of human error, it was noted that the registered nurses on duty worked over 12 hours a day and Tzeng et al., (2013) noted that taking everything into account nurses function is significantly greater when working a regular 8hour shift compared to over 12hours shift. Further circumstances that contributed to medical errors by nurses include;  tiredness which can affect concentration (Copping , 2005), being distracted or interrupted (Wright,2013; Fore 2013), loss of concentration and a belief about limited drug calculation and numeracy skills among nurses ( Ramjan 2011). In addition, Leape et al., (1995) reported other types of medication errors: short of knowledge of the drug, information about the patient, in breach of the rule, slip and memory lapses, transcription errors, faulty drug identity checking, not interacting with other services, not checking the dose, insufficient monitoring , drug stocking and delivery problems Unver et al., (2012) also noted that medication error can also be as a result of systematic factors like heavy workload ; for example, a study carried out by Karadeniz and Cakmakci , (2002) in Turkey reported nurses fatigue was the primary cause of medication errors. Another factor is insufficient training . It has been wel l-known that newly qualified nurses lack of skills in clinical settings affects the occurrence of medication errors. A patient’s circumstance, that is complex health conditions), doctor issue (multiple orders, illegible handwriting) and nurse aspect (personal neglect, newly qualified staff, not familiar with medication and patient) . The avoidance of medication errors is extremely imperative for patient safety (Unver, et al., 2012). In the early 2000s Pape et al., (2005) was the first to initiate the use of aviation’s ‘ sterile cockpit’ code which has gained awareness in the health care to cut down on distraction during clinical tasks. The process included the use of vests and signs. The words ‘Do Not Disturb’ positioned in the medication vicinity were used as prompts to reduce distraction. Members of staff were also asked not to disrupt or distract the nurse doing the medication round of the ward. As a result , Pape’s (2003) study found 63% fewer distraction when using a firm checklist set of rules. Similarly, a study by Federwisch (2008) reported a 50% decrease in the number of staff interruptions, an increase of 50% in the standardisation of medication administration, 15% progress in the time vital to administer medications and 18% increase in on-time medication delivery when nurses wore yellow sashes during medication administration. On the whole, to lessen medication errors, the collaboration among doctors,  pharmacists and nurses is necessary ( DoH, 2004). Doctors must know their shortcoming and recognize their interconnection with other health care professionals (Pedersen et al., 2007), in particular nurse prescribers who help to ease the work of junior doctors. Verification by another nurse is essential as double checking by other nurses in adherence to the ‘five rights’ of medicine administration can help reduce an error (DoH, 2004). Subsequently, pharmacists can lessen the chance of errors by being in attendance on the ward drug rounds and chipping in their drug knowledge (DoH, 2004). Moreover, everyone in the health care team can help reduce medical errors by keeping a reflective journal (Tzeng et al., 2013 ) as a practical self-help tool, though there is a not enough of empirical study to support its valuable effects (Fore, 2013). According to Fore (2013), health professionals can reflect by one or more of the subsequent methods: welcoming feedback from colleagues about strengths and weaknesses; checks on critical incidents to find out what went wrong , why it went wrong and how to avoid a recurrence of an error; use of a diary for self evaluation and recognize knowledge gaps. It is generally accepted that system factors presents itself with medication errors in health care, nurses are the health professionals that frequently encounter and report medications error ( Roughead and Semple 2008). On the contrary, a study by Unver et al ,(2012) points out, more than half of nurses do not give an account of some medication errors as they are frightened of their colleagues’ reactions. As a result , it is important to foster a culture that is less fixed on laying guilt to promote communication and error reporting. The need to reduce medication error is a continuing process of quality improvement (Unver et al.,2 012). According to Sanders (2005) , to establish risk is the first act to undertake, as any other strategy to reduce risk may be inappropriate. This can be made by means of using tools such as audit ( Montesi and Lechi, 2009). The World Health Organisation’s (WHO) (2009) framework for the classification of problem, process and outcomes of patient safety events is a practical base for a framework to learn the circumstances surrounding medication error. In spite of information of under-reporting of medication errors, especially by physicians, (Franklin et al., 2007) incident reporting can produce an awareness into the errors that happen and make easy identification of contributing factors (Malpass et al., 1999a). Moreover, a  UK Government white paper, put forward standardisation of audit as part of professional health care (Montesi and Lechi, 2009). The National Institute for Heatlh and Clinical Excellence(NICE) (2002), defined clinical audit as : â€Å"a quality improvement process that seeks to improve patient care through systematic review of care against explicit criteria and the implementation of change† ( cited in Montesi and Lechi, 2009, p. 3). Clinical audit is a learning tool , which encourages high- quality care and should be implemented regularly and it offers an organised framework for inspecting and judging the work of health care professionals ( Montesi and Lechi, 2009; NICE, 2002). Audit is also a way of measuring and monitoring practice across a well- set of agreed standards and finding mismatches in the written word and actual practice. Similarly, detecting medication errors can also be through a chart review, reporting of incident, monitoring of patients, direct observation and computer monitoring (Montesi and Lechi, 2009). The only technique used for identifying errors of administration of medications is by direct observation ( Montesi and Lechi, 2009). This is done under the observation of a trained nurse by noting the similarity or dissimilarity between what is done in the administration and the original physician orders. In addition to direct observation, reporting systems is another process obtained from pro cedures in high-reliability organisation. On the other hand, reports given to legal services can cause confusion and bring about a connotation of blame (( Montesi and Lechi, 2009). Incident of reporting was first used in the UK by the Royal College of Anaesthetists. According to Montesi and Lechi ( 2009), there are two safety-oriented levels of reports. First, incident reporting where it is required that a the details recorded are concise, legible and a true version of events are recorded and sent to the central organisation , which supplies regular statistical reports and raising concerns about quality improvement. Secondly, voluntary reporting . This process is anonymous, confidential and blame- free.The benefits of voluntary reporting include; the detection of active and hidden system failures, evidence of significant processes and the distribution of a culture of safety ( Stump, 2000). Other methods include; patient monitoring, by interviewing, satisfaction surveys and focus groups. Through this, patients can learn about medication errors. With reference the Local Trust Policy, patients now receive an individualised medicine patient  information leaflet (PIL) detailing their in-patient and discharge medicine by advising them about any possible side effects and dosage information, contact details should more information be required. During placement, it was essential that the ‘five rights’ is followed during a medication round with the nurses. It became fully aware that the ‘five Rs’ is the most thorough way to prevent medication error arising. This policy has helped me establish how and why using the correct procedure helps to minimise administration errors from happening. Not all but most of the nurses at the placement adhered to the guidelines that the policy set out. In conclusion, the essay demonstrated that medication administration errors are still a continual problem that is related to practice in nursing . Nurses are mainly involved in medication administration. They also have an exceptional role of identifying and stopping errors that occur in the various stages. Encouraging patient safety should have a number of approaches that involve more than direct care nursing staff. Another basic cause, is human- factor, therefore a professional education with individuals and system focuses on patient safety matter is essential. Lastly, health professionals accountable for the prescribing, dispensing and administration of medicines must work collectively as team members in the ward environment . The essay also demonstrated how the problem of medication administration error can be dealt with by the National Health Service.

Alternative Investments Essay

Executive Summary: The purpose of the report is to do an in-depth investigation, study and analysis on alternative investments. From the various alternative investments, our team of analyst chose commodities, variable annuities and hedge funds as our subject of interest for the study. Each financial product has its own aims as to cater to the different investment goals to meet the needs of investors. Thus, just by looking at the basis on expensiveness and tax-efficiency, and then from selecting the better one is unwise. We have to look at the overall picture and considering other indispensable factors like risks, liquidity, asset allocation which are equally important. Therefore, our basis of evaluation comprises of various important factors so as to make  a robust analysis. Firstly, commodities are a highly demanded investment which is traded using options and futures contract.. Moreover, they are also an element of diversification that investors can lower their vulnerability to market volatility. Despite its high volatility in its prices, it managed to gain a higher return as compared to stocks and bonds. As commodities have a low correlation with bonds and stocks, it is able to reduce unsystematic risk through diversification. Its high correlation with rate of inflation thus looks favorable in times of crisis and these enable investors to control its asset allocation decision. By using the 60/40 tax treatment, it has shown that it is indeed an efficient method in lowering taxes. Its high commodity market liquidity thus seem promising to investors as it correlates well with it market trading especially in corn, gold and precious metals futures. Moreover, it is advisable for them to allocate 5% to 10% of their investment to commodities so as for better diversification to eliminate unsystematic risk. As it has no or few substitute, it is advised that investor should take note of any unexpected risk involved. Variable annuities on the other hand are tax-deferred with a withdrawal date only after the age of 59 ½. The performance of its sub-accounts affects many aspect of variable annuity. This is so as the performance of varied underlying investments in the sub-account results in non-uniform distribution in its returns. Furthermore, variable annuity is relatively volatile as it returns tend to varies as accordance to the returns of its underlying investments. Thus, granted with a choice of an asset for the underlying investments, investors will choose an underlying asset that is non-correlated to their portfolio holdings. Variable annuity also incurs reasonable costs. However, the main benefit of investing in variable annuity is that it is highly tax-efficient as it is a tax-deferred vehicle. This reduces the tax burden on investors and at the same time creates an opportunity for them to invest in tax-inefficient vehicles before the withdrawal date as no tax is imposed before the date. The downside to investing in variable annuity is that it has liquidity risks. However, it can reduce unsystematic risk significantly due to the investment options for  its sub-account and this important aspect of it also provide investors with the ability to allocate their assets. The primary aim of most hedge funds is to reduce volatility and risk while attempting to preserve capital and deliver positive returns under all market conditions which brings investors an indispensable option to invest in hedge fund. With a low standard deviation of almost zero, hedge funds are highly of an advantage as it does not fluctuate widely within periods. However, volatility is not the only indicator of risk affecting the fund. For hedge funds, the skewness variations are not uniform across styles. While hedge funds offer potential for returns that are not highly correlated with other markets, their unique properties would also mean that they involve a high degree of risk. Its fees are regular thus investors should follow accordingly. Hedge Funds exploit different ways to minimize capital gains and income taxes for investors. With the Tax Exemption for Singapore Resident Funds, it places investment in Hedge Fund at an advantage. Putting their trust in the fund manager’s ability to meet the fund’s objectives, it is then recommended for investors to choose the right fund manager to manage their investments. From the in-depth analysis on alternative investments, we realized that there is no a perfect product to solely invest in. Each alternative assets has its advantages and disadvantages, thus we have to invest in varieties of asset classes but diversified it. There is also the need for proper asset allocation management and the use of investment strategies. Introduction: The continual search to reap higher risk-adjusted returns has led to a number of highly alternative assets to be considered for financial investment purpose. Thus, the growth of alternative investments market is outstanding. According to the 2010 Alternative Investment Survey of U.S Institutions and Financial Advisor, 36% of the institutional investors that are surveyed have $1-10 Billion in asset under management and 29% with greater than $11 Billion in asset under management. In this report, our team of financial analyst has chose to do an in depth analysis on commodities, variable  annuities and hedge funds. Through this report, we are going analyze the aforementioned alternative assets through various important factors namely its returns, risks, costs, other competitive advantages and disadvantages. At the end of this report, we hope to achieve an in-depth evaluation on the attractiveness of each subject of interest and make sound recommendations. Introduction to Commodities: Commodities are raw materials used for producing secondary goods which are transacted in volumes and classified into energy, metals, grains and livestock. Manufacturers in the commodities market purchase commodities needed on a â€Å"spot market† while speculators purchase and sell commodities using options and futures contracts. Commodity markets are real demand and supply markets. Thus with the increasing world population, there is now higher demand than supply for commodities, making commodities a viable investment for both the present and the future. Expected Returns: During inflation, commodities total returns will soar. When making an investment in commodities one can expect returns that are capital return. Commodities have been providing its investors with relatively high returns, exhibiting negative correlations with equities and bonds as well as hedge against risks. Based on the Commodity Price Index for the past year, expected returns were at 0.85%, volatility were at 0.0641 which is considered to be relatively low, while the return-risk was 0.1319. Volatility: Volatility in commodities’ prices fluctuated recently with their highs and lows due to the â€Å"interference† of the commodities market like political disputes and natural disasters. In 1973 to 2007, based on the S&P 500 Index, MSCI Index and Lehman Brothers Bond Index, it has an annualized return of 10.9% and 24.5% annual standard deviation, volatility. Although stocks performed better than commodity, commodities’ volatility was in the peak compares among stocks and bonds. Historical risk return on commodity had remained positive of about 5% during the years. T-statistic, outlining the level of confidence that the risk return is different from 0 shows a  figure of 2.84 which shows that it is higher than stocks and bonds. Distribution of returns [Refer to Appendix]: From the bell-shaped curve, we can surmise that the distribution of returns on commodities is widely distributed and tends to be close to a normal distribution as investors are concern about their real returns as they want to outperform inflation. As compared to stocks and bonds, the returns in commodities are positively skewed. Since returns for commodities investment is right skewed, it means that the amount of returns will be higher than stocks and bonds which are negatively skewed. Returns distribution is very wide as the returns show a greater than 3 excess kurtosis. However, this also means higher risk for investors due to the wide distribution of returns. Correlation with other asset classes: [Refer to Appendix]: From the table, it shows that Standard & Poor’s 500 and the company are closely related in contrast to the other asset classes. GSCI and 1 month T-bills with a correlation value of -0.003, proves that they are independent of one another. It is revealed that commodities futures are negatively correlated to returns of stocks and bonds with coefficients of -0.42 and -0.25 respectively. Therefore, by allocating funds to those assets of negative correlations, it provides the benefits of diversification when facing a stand-alone risk asset class. Fees, Trading and other expenses: There are many fees and expenses that are implied in commodities trading. When trading commodities, investors incur management and brokerage fees, service tax and a possible loss of investments. When a futures contract is purchased, an initial down payment on the total futures price (initial margin) is to be made. The margin requirement is basically a small percentage of the total purchasing price for a commodity. This margin requirement usually adds up to be less than 10%. Liquidity: Commodity market liquidity often correlates well with commodity market  trading profits. Investors can benefit in high commodity market liquidity. It is easier to enter and exit trades. With the high trading volume and liquidity, the statistics of predictive ability of time honored tools like Candlestick patterns formulates tend to be more precise. Commodities that offer good commodity market liquidity include trading in Corn and Gold futures. Each of these trades at high volume and high liquidity. However, they are driven by different factors. Gold and other precious metals perform well when investors are worried about inflation or when there is the threat of economic or political disruption. Corn is determined by supply and demand. Location: The location of where the commodity is produced is not an important factor that an investor should consider as there are similar products that will be sold regardless of where it has been produced. Hence investors’ consideration of location is not required when making an investment. Tax Efficiency: In commodities, it is quite tax-efficient as they follow the 60/40 tax treatment whereby 60% of the gain is taxed as long-term gains and 40% are taxed as short-term gains. Long-term capital gains are capped at 15% which is favorable for high income investors, meaning that 60% of gains will be taxed at 15% while 40% of gains will be taxed at 35% which both equals to 23% for commodities. Thus, it will help investor to save money in tax. Ability to eliminate or significantly reduce unsystematic risk: Investing in commodities does not reduce unsystematic risks. Firstly natural disaster and bad weather may affect a various types of commodities. Another risk is geopolitical risk. This risk occur as world’s natural resources are located in various continents and the jurisdiction over these commodities lies with sovereign governments, international companies, and many other entities. Thus, international disagreements over the control of natural resources are quite commonplace. Negotiations on the extractions are pretty tense as disagreements may easily rise over licensing agreements, tax structures, environmental concerns, employment of indigenous workers, access to technology, and many other complex issues. Ability to control the asset allocation decision: Investors are able to control asset allocation decision in commodities. This is so as commodities are not professionally managed unless you have the intentions to. Thus, investors who wish for professional money managers who specialize in commodity trading to handle their investments, they may turn to ETFs or mutual funds. With that, commodities traders are able to free decisions on the allocation of their assets. It is advisable for investor to allocate more of his investments to other types of investments and allocates 5 to 10% of his investments into commodities due to its volatility. Substitute? Any alternatives that achieve the same objective in a more efficient –less expensive and/or more tax efficient- manner: Commodities have few/no substitutes as they are generic goods that we utilize in our everyday lives. It’s suggested for any investor to take into consideration the unexpected risk such as natural disasters and bad weather. If they allocate most of their investment in commodities and when an adverse event strikes, they would be caught in a difficult position. Commodities have the best advantage against inflation. During inflation, prices of commodities have the tendency to rise. Therefore, as an investor in commodities, you would be able to gain much from the increment of value. Introduction to Variable Annuities: Variable annuities are tax-deferred investment vehicle that comes with a minimal insurance contract so they can qualify for their tax-deferred status. Variable annuities can be immediate or deferred. Once you reach 59 ½, you can begin withdrawing the funds without any penalty. Expected Returns: Variable annuity has no expected rate of returns as its return is based on the marketplace performance. Its fees will be subtracted from the returns. By diversifying assets, a portfolio may have a higher return potential with a lower level of risk than the portfolio’s components would achieve separately. Volatility: The standard deviation indicates the tendency of the returns to rise or fall drastically in a short period of time. Since the return on investment in a variable annuity is directly tied to the performance of sub-accounts that make up investors’ annuity, the fund would exhibit a high standard deviation as each year’s return of the fund may differ from its mean return. This in turn makes variable annuity riskier as it is volatile. Distribution of returns: Return on investment in a variable annuity is directly tied to the performance of sub-accounts that make up investor’s annuity. If the underlying investments are in stock and bonds for example, there’s potential for a greater return. However, this will be coupled with a higher risk of loss including loss of capital which involves the funding options. It means that payments and earnings are not guaranteed. Thus the skewness variations are not uniform as returns varies depending on the instruments it consists of in the underlying investments. Correlation with other asset classes: Variable annuity offers a range of investments options for the sub-accounts. Investors will have to choose a specific one of his interest. Thus, entitle with the benefit of deciding the underlying investments, it enable investors to pick an asset that is low correlated or non-correlated with other assets classes of his portfolio. Thus, variable annuity offers balance and diversification to investors. Fees: Firstly, there is the surrender charge. It is a type of sales charge that will be issued to the customer when they withdraw money from a variable annuity within a certain period (which may vary from six to ten years) after the purchase. It is to pay the financial professional as a commission for the sale of the variable annuity. It decreases gradually over the surrender period, usually 1% less each year. Next, it is the mortality and expense risk charge which is 1.25% per year. It compensates insurance company for insurance risks. Its profit is to pay the insurer’s initial cost of sale of  the variable annuity. Next up is the administrative fees which are charges for record-keeping and other administrative expenses and is charged 0.15%. Trading and other expenses: Underlying Fund Expenses are fees that will be charged indirectly and they are imposed by mutual funds which are the underlying investment options in the variable annuity. Fees and Charges for other features are other miscellaneous fees charged in special features offered in some variable annuities. Such features include stepped-up death benefit and long-term care insurance. Liquidity: Variable annuity has liquidity risk in it whereby the proceeds from the variable annuity may be unavailable at the time of withdrawal or it will be available but at a significantly lowered value. These are attributable to two factors. Firstly, because annuities are designed as retirement vehicles, getting out early can mean taking a loss. Many variable annuities assess surrender charges for withdrawals within a specified period, which can be as long as 6 to 8 years. Furthermore, any withdrawals before an investor reaches the age of 59 ‘/2 are subject to a 10% tax penalty by the IRS (Internal Revenue Service) in addition to any gain being taxed as ordinary income. Secondly, if the holder is in a need for cash and must liquidate his variable annuity, there is a possibility that on the date of liquidation, its account balance is lower than what it was previously simply due to market fluctuations. Location: Annuities are a commonplace in the current world but actually it existed way back during the Roman times. It was then introduced in Europe and the United Kingdom. It made its mark in America in 18th century but was only fully aware of in the 1930s where the Great Depression caused Americans to â€Å"save for a rainy day†. Variable annuities were first created in America in 1952. Today, variable annuities is popular than ever with sales estimated to be USD40.2 billion and are offered in many countries due to its applicability for retirement purposes. Singapore is not excluded in the variable annuities  market as well. Manulife Singapore launched the first variable annuity, Secure Retirement Plus (US$), in 2007 and later introduced Secure Retirement Plus(S$) in 2008. Tax Efficiency: Variable Annuities are tax-deferred. It can help investors save more while reducing their overall tax burden. This provides investors with good opportunity to invest in tax-inefficient vehicles such as bonds and types of equities. However, there will be a taxable amount of 10% IRS penalty with withdrawal before reaching the age of 59 ½ years. This means that investors pay no taxes on the income and investment gains from their annuity until the withdrawal date. They may also transfer their money from one investment option to another within a variable annuity without paying tax at the time of the transfer. At their withdrawal of variable annuity, they will be taxed on the earnings at ordinary income tax rates rather than lower capital gains rates. Ability to eliminate or significantly reduce unsystematic risk: By diversifying, investing in variable annuity does reduce unsystematic risk. Investors are able to make payment purchase and allocate it to various asset classes such as small-company stocks, international government bonds and fixed annuities. Unsystematic risk decreases as the number of stocks in a portfolio increases. It could help to protect the investors against sustained losses in a single stock or sector of the market. Ability to control the asset allocation decision: Variable Annuity has an accumulation phase whereby the investor makes purchase payments in which they can allocate it to a number of investment options. Moreover, it is a flexible investment that allows investors to move their money into more stable accounts such as fixed account to preserve their gains. It also allows investors to have play in the strong stock market. Substitute? Any alternatives that achieve the same objective in a more efficient –less expensive and/or more tax efficient- manner: Exchange  Traded Note (ETN) is an alternative that can achieve the same objective of a variable annuity in a less expensive and more tax efficient way. A variable annuity can cost up to 4% a year in its fees, while ETN only charge 1% fees. Both ETN and variable annuities are tax efficient and there is no negative tax consequence till the ETN is sold. However, while an annuity is passed through death to its beneficiaries, its entire gain will be taxed. The ETN under the current estate tax laws, will be receiving a step up in basis, this makes it more tax efficient than the variable annuity. However, investors of ETN have to assume credit risk as it is an unsecured debt. Thus, we have to look at other equally important factors before deciding the better alternative as just using cost-effectiveness and tax-efficiency does not equate to a robust eva luation. Introduction to Hedge Fund: Hedge fund is a fund that can take both long and short positions through the use of arbitrage, buying and selling undervalued securities, trading options or bonds, and investing in any opportunity in any market where it foresees impressive gains at reduced risk. Its strategies vary enormously especially today with volatility and anticipation of corrections in overheated stock markets whereby many hedge against downturns in the markets. Main aim of most hedge funds is to reduce volatility and risk while trying to preserve capital and deliver positive returns under all market conditions. Expected Returns: Most hedge funds’ goal is to earn a positive return despite how the overall stock market is performing. It is refer to as an absolute return. Absolute return gains and losses of a hedge fund can be measured relative only to the assets in the fund itself and investors do not compare returns to market benchmarks. With the absolute return goal, hedge fund managers often use aggressive investment techniques like short selling and leveraging. Volatility: Standard deviation reports a fund’s volatility which indicates the tendency of the returns to rise or fall drastically in a short period of time. It measures this risk by measuring the degree to which the fund fluctuates in  relation to its mean return, the average return of a fund over a period of time. Since hedge fund seeks absolute returns independent of market movements; the standard deviation for this fund would then be zero as the fund’s return does not differ within periods. Hence it shows that hedge funds are highly at an advantage since the fund with the lower standard deviation would be more optimal as it is maximizing the return received for the amount of risk acquired. Distribution of Returns: By knowing which way data is skewed, one can better estimate whether a data future point will be more or less than the mean. For hedge funds, the skewness variations are not uniform across styles. For instance, when the number of funds increases, the skewness drops systemically and is negative for Fixed Income Arbitrage, Convertible Arbitrage and Event Driven Strategies while it increases slightly. The Kurtosis tends to be concentrated in the -0.5 to +0.5 range. Changes in kurtosis tend to less predictable and differ widely over time and across investment styles. However, diversification within some hedge fund strategies may appear highly attractive in mean or variance terms, but this is much less so when skewness and kurtosis are taken into account as assessing hedge funds based on return and volatility criteria maybe misleading because of the potential underestimation of return volatilities. Correlation with other asset classes: Correlation is interlinked with diversification. Investors aim for a sound portfolio which is achievable through applying diversification. However, traditional assets classes like bonds and stocks are increasingly linked. Hedge funds which performances often highly dependent on the qualities of individual investment decisions or strategies, as opposed to being highly correlated to an overall market, diversify risk thus bringing about high returns. Instead of achieving returns from market activities, hedge funds use unique investing strategies to exploit market inefficiencies that the markets have not perceived. This further intensified diversification which put them at a better stead than traditional asset classes. Fees: Hedge fund consists of 3 kinds of fees. Sales Charge. It is a one-time charge, generally 5% and it’s the front-end load or commission that is charged on the investment amount. Management fee. It varies around 2% and it is charged on an annual basis and imputed into the Net Asset Value of the fund. Performance fee. It varies around 10-20% above the benchmark and it is charged on an annual basis and imputed into the Net Asset Value of the fund. The benchmark can be simply the zero return line or a benchmark like the London Interbank Offered Rate. Performance fees are charged on a high water mark which means investors are only charged for excess returns with reference to the previous high. If investment drop in value, the manager must bring it back above the previous greatest value before they can receive performance fees. Trading and other expenses: Apart from the above fees, investors also need to pay expenses such as the accounting and tax preparation expenses, auditing expenses, costs and expenses of entering into and utilizing credit facilities and structured notes, swaps or derivative instruments. Liquidity: There are two forms of liquidity constraints that are impose on investors which are liquidity dates and lock-up. Liquidity dates refer to pre-specified times of the year when an investor is allowed to redeem shares. Hedge funds typically have quarterly liquidity dates. Moreover, it is often required that investors give advanced notice of the desired to redeem: these redemption notices are often required 30 days in advance of actual redemption. Lockup refers to the initial amount of time an investor is required to keep his or her money in the fund before redeem shares. Lockup therefore represents a commitment to keep initial investment in a fund for a period of time. For Singapore registered hedge fund, MAS guidelines stipulate one regular dealing day per quarter. Redemption of funds usually requires a notice period and it states that redemption proceeds must be paid to the end investor within 95 days from the dealing day the redemption request is accepted. Location: Funds with a regional presence outperform those without one. Risk-adjusted return difference between nearby and distant hedge fund portfolio is about 4% and is significant. A fund’s geographical proximity to the companies in which it invests the closer it is to its investments the greater the chances that the hedge fund will earn high returns. They are better able to take advantage of local information via short selling and the use of derivatives. Direct way for hedge fund to take advantage of local knowledge is to invest in stocks and bonds in their region. Moreover, Singapore is perceived as having a high level of transparency and reliability in business, economic and regulatory affairs. It boasts a stable political structure, well-established judicial system and forward-looking financial authority thus bringing an advantage to investors locally. Tax efficiency: Tax consideration can be a benefit of alternative investments, particularly hedge funds which exploit different ways to minimize capital gains and income taxes for investor. Investors might be worried of being charged at a higher rate for tax. Singapore has in place a tax incentive scheme which exempts offshore funds from tax. Broadly speaking, a qualifying fund will be granted tax exemption provided it is not 100% owned by Singapore investors. There is also Tax Exemption for Singapore Resident Funds. It requires pre-approval from the authorities and although it is aligned to the offshore fund exemption scheme, some additional conditions have been imposed. Ability to eliminate or significantly reduce unsystematic risk: To diversify from stock-specific risk known as non-systematic risk one can invest in a range of stocks with different characteristic. Most investors of such practice regard it as unwise not to diversify into non-systematic risk. However, killing two birds with one stone is a more attractive opportunity to be seized. Thus, we turn to hedge fund. The main idea behind diversifying your non-systematic risk into assets like hedge funds is that any investment with a positive expected return, low volatility and low correlation to the rest of portfolio, will have a great chance of reducing the overall  portfolio volatility which is an additional advantage as compared to diversifying through stocks and bonds. Thus, hedge fund is an indispensable option. Ability to control asset allocation decision: Hedge fund manager has total trading authority over the fund. They are not required to provide investors with information about the underlying holdings of the hedge funds. Thus, there’s a lack of transparency when investing in hedge funds. Investors are putting their complete trust in the manager’s ability to meet the fund’s objectives. As such, investors lose control over their asset allocation. Thus, it is essential to choose the right fund manager to manage their investments. Substitute? Any alternatives that achieve the same objective in a more efficient –less expensive and/or more tax efficient- manner: The primary objective of hedge funds is to reduce volatility and risk while attempting to preserve capital and deliver positive returns under all market conditions. The emphasis here is positive returns under all market conditions and thus this explains fully utilization of specialized and carefully selected investment strategies to achieve that primary goal. There are alternatives which are less expensive and more tax-efficient such as ETFs and ETNs. Both offer similar advantages which are lower fees, lower investment minimums and greater tax efficiency. However, both products have different investments goals. ETFs mirror the indexes they track by holding diversified collection of securities, such as stocks or bonds but traded like stock on an exchange while ETN is an unsecured debt typically issued by an investment bank that mirror index like ETF. Thus, from the way they operate, we are able to conclude that their investment aims just show differences with that of hedge funds.

The Economy of Today Essay Example | Topics and Well Written Essays - 750 words

The Economy of Today - Essay Example If the GDP is freed from the chances being affected by inflation, then constant prices need to be maintained. This also helps us to compare the status between two time periods. The resultant GDP reached is called real GDP (nominal GDP adjusted for price changes). GDP can be measured in three ways: by calculating the gross final goods and services produced within the nation at a given period of time; from the income side, by calculating the income generated at every stage and by summing up the value added at each stage of production. Its identity may be written as: The employment rate is the ratio of employed people to the total population. It is actually the percentage of potential employees actually employed. When a nation has a higher employment rate it is likely that it will have a higher standard of living. It is the capacity of a country to engage its people in work and thus generate income for itself. Unemployment is one of the major concerns of the governments of different nations. Another parameter which duly affects the economy and mainly the GDP is inflation rate which may be defined as the rate of growth of price index. This is equivalent to the rate of fall in purchasing power of money. If P1 is the price level in year 1 and P2 is the price level is year 2 (P2>P1), then the rate of increase in price level (inflation rate) from year 1 to year 2 is calculated by the following formulae: Interest rate in an economy essentially denotes the lending rate of banks. It is the opportunity cost of investing in a certain venture. The gain sacrificed by not investing the same amount in another alternative venture or scheme is the opportunity cost. When an individual X (say) lends money to another individual (Y), he is likely to charge an annual interest which is either equal or more than the return gained by investing the amount in some other venture, possibly the bank. If he charges less then he would be a loser. The households supply the factors

Case Study - New Supervisor Essay Example | Topics and Well Written Essays - 500 words

Case Study - New Supervisor - Essay Example The most pressing issue for George is lack of planned strategy and organized way of working. The work lacks proper documentation of work and records of workers, including their work schedules, attendance and performance details. Hence to monitor the work performance and productivity, George needs to streamline the process and develop strategic plans to organize work schedules. These should be communicated across the employees. He should also define duties and emphasize on disciplined work culture where achieving targets is highlighted. He should also delegate duties so that junior managerial and administrative staff become well versed in the office processes. Most importantly, George must create a pool of talent based on skill and aligned work. This would enable the workforce to organize the schedules for optimal performance. There also needs to be constant communication across management and workforce so conflicts can be resolved early and amicably. From the remaining issues, the top priority of George would be to resolve the issue of Francine who had filed a grievance with the personal department against the assistant supervisor. As there was no organized way of working and office lacked proper records of employees work details, the case of Francine needs to be resolved early as she could easily have EEOC claim. George has huge burden of streamlining the work process and create facilitating work environment. Strong work culture ensures long term sustainable competitive advantage (Armstrong & Baron, 2005). Therefore strong teamwork needs to be promoted. Performance based incentives would be motivating factors for the workforce (Armstrong & Murlis, 2007). George also needs to develop well organized record keeping and documentation of office records. This would help to evaluate performance regularly and motivate workers for incentives and bonus. Moreover, creating talent pool would facilitate better