Confronting Fear in Heart of Darkness and Apocalypse Now :: Movie Film comparison compare contrast

Confronting Fear in Heart of Darkness and Apocalypse Now    Inherent inside every human soul is a savage evil side that remains repressed by society. Often this evil side breaks out during times of isolation from our culture, and whenever one culture confronts another. History is loaded with examples of atrocities that have occurred when one culture comes into contact with another. Whenever fundamentally different cultures meet, there is often a fear of contamination and loss of self that leads us to discover more about our true selves, often causing perceived madness by those who have yet to discover. The Puritans left Europe in hopes of finding a new world to welcome them and their beliefs. What they found was a vast new world, loaded with Indian cultures new to them. This overwhelming cultural interaction caused some Puritans to go mad and try to purge themselves of a perceived evil. This came to be known as the Salem witch trials. During World War II, Germany made an attempt to overrun Europe. What happened when the Nazis came into power and persecuted the Jews in Germany, Austria and Poland is well known as the Holocaust. Here, human's evil side provides one of the scariest occurrences of this century. Adolf Hitler and his Nazi counterparts conducted raids of the ghettos to locate and often exterminate any Jews they found. Although Jews are the most widely known victims of the Holocaust, they were not the only targets. When the war ended, 6 million Jews, Slavs, Gypsies, homosexuals, Jehovah's Witnesses, Communists, and others targeted by the Nazis, had died in the Holocaust. Most of these deaths occurred in gas chambers and mass shootings. This gruesome attack was motivated mainly by the fear of cultural intermixing which would impurify the "Master Race." Joseph Conrad's book, The Heart of Darkness and Francis Coppola's movie, Apocalypse Now are both stories about Man's journey into his self, and the discoveries to be made there. They are also about Man confronting his fears of failure, insanity, death, and cultural contamination. During Marlow's mission to find Kurtz, he is also trying to find himself. He, like Kurtz had good intentions upon entering the Congo. Conrad tries to show us that Marlow is what Kurtz had been, and Kurtz is what Marlow could become. Every human has a little of Marlow and Kurtz in them.   Marlow says about himself, "I was getting savage (Conrad)," meaning that he was becoming more like Kurtz.

Absorption and Variable Costing

CHAPTER 8 ABSORPTION AND VARIABLE COSTING Learning Objectives 1. Explain the accounting treatment of fixed manufacturing overhead under absorption and variable costing. 2. Prepare an income statement under absorption costing. 3. Prepare an income statement under variable costing. 4. Reconcile reported income under absorption and variable costing. 5. Explain the implications of absorption and variable costing for cost-volume-profit analysis. 6. Evaluate absorption and variable costing. 7. Explain the rationale behind throughput costing. . Prepare an income statement under throughput costing. Chapter Overview I. Product Cost and Fixed Manufacturing Overhead A. Absorption-costing income statements B. Variable-costing income statements II. Reconciliation of Absorption- and Variable-Costing Income A. No change in inventory levels B. Increase in inventory levels C. Decrease in inventory levels III. Overall Evaluation of Absorption and Variable Costing IV. Throughput Costing Key Lecture Concepts 1. PRODUCT COST AND FIXED MANUFACTURING OVERHEAD Product, or manufacturing, costs are comprised of direct materials, direct labor, variable manufacturing overhead, and fixed manufacturing overhead. The basic difference between absorption and variable costing is the treatment of fixed manufacturing overhead. * With absorption (full) costing, all costs related to the manufacture of a good are product costs. Therefore, fixed manufacturing overhead attaches to the units being made and is carried in inventory until the product is sold. * Absorption costing results in the preparation of a traditional income statement. Absorption costing is considered GAAP and is acceptable for tax reporting. * Under variable costing, product cost is comprised solely of variable manufacturing costs. Fixed manufacturing overhead is viewed as a cost of being ready to produce, not an actual production cost (i. e. , the cost will remain constant no matter how many units are manufactured). * Fixed manufacturing overhead is treated as a period cost and expensed immediately. * The income statement highlights cost behavior and is presented in a contribution margin format. Variable costing is useful to managers, as it dovetails nicely with cost-volume-profit analysis. 2. RECONCILIATION OF ABSORPTION- AND VARIABLE-COSTING INCOME * The difference between the two approaches is the timing of when fixed manufacturing overhead is shown on the income statement: when the product is sold under absorption costing and when incurred under variable costing. * The two methods will usually produce different income figures. * No change in inventory: production = sales * Under variable costing, all fixed manufacturing overhead is expensed.With absorption costing, the period's fixed overhead flows through to cost of goods sold. * Absorption-costing net income equals variable-costing net income. * Increase in inventory: production ; sales * Under variable costing, all fixed manufacturing overhead is expensed. With absorption costing, a portion of the period's fixed overhead flows through to cost of goods sold and a portion remains on the balance sheet in inventory. * Absorption-costing net income is greater than variable-costing net income. * Decrease in inventory: sales > production Under variable costing, all fixed manufact uring overhead is expensed. With absorption costing, as units manufactured in a prior period are sold, an amount greater than the current period's fixed overhead flows through to cost of goods sold. * Absorption-costing net income is less than variable-costing net income. * The difference between absorption- and variable-costing income figures can be reconciled as follows: Income difference = Inventory change in units x Fixed overhead per unit The difference is likely to be very small over a lengthy time period.3. OVERALL EVALUATION OF ABSORPTION AND VARIABLE COSTING* Pricing decisions * Absorption-cost proponents argue that fixed manufacturing overhead is a necessary production cost. Excluding this element from the inventoried cost of a product will understate the good's cost, which is troublesome for companies that use cost-based pricing techniques. * Variable-cost proponents argue that variable cost is better for pricing decisions. Any price above a good's variable cost results i n a positive contribution margin for the company. Many firms use variable costing for internal-reporting purposes. Given that absorption costing must be employed for external financial reporting, companies can use both methods by making several simple end-of-period adjustments. 1 If a company operates in a just-in-time environment, inventories are kept very low and there will be little change in inventory from period to period. Thus, the income differences between absorption and variable costing will normally be insignificant.4. THROUGHPUT COSTING Throughput costing assigns only the unit-level spending for direct costs as the cost of products or services. * A unit-level cost is incurred every time that a unit of product is manufactured. * All costs other than the throughput cost are considered to be operating expenses of the period. * Proponents of throughput costing argue that this procedure eliminates the incentive to produce excess inventory because all non-throughput costs are e xpensed regardless of manufacturing volume.

The Latest Developments of Air Transport

The commercial airline industry has grown from a few aircraft to that of a multi-billion pound industry. The Boeing 707 began a revolution in air travel when it entered service in1958.It was the first commercially successful jet aircraft. Since then aircraft manufacturers have strived to provide larger and more economical planes to aircraft companies. The basic appearance of commercial airliners has not changed much for over 50 years. Nevertheless, there has been a considerable increase in innovations and new technology within the aerospace industry. Advancements in engine efficiency, aerodynamics and new materials have all led to a significantly lower operating cost per seat mile of commercial aircraft. There have been a number of significant innovations, especially on the Boeing 787, the latest wide body jet to enter service. Composite materials are now been used in the commercial aircraft industry. The Boeing 787 is primarily constructed from composite materials. They are used in most primary structures, particularly the fuselage (see fig1). By using a unique one piece composite barrel construction, (See fig 2) the 787 eliminates the need for any fuselage lap joints, doubler longitudinal skin splices. This has a dramatic reduction in weight and drag. In addition, it also significantly reduces the amount of maintenance and inspections required. Panel construction in aircraft such as the Boeing 707 requires additional joints, fasteners and splice plates, resulting in increased weight and inspections. An example of a composite, which is used on the Boeing 787 is carbon laminate. It comprises of layers of carbon fibre that are impregnated with a polymer. Free Online Dictionary, Thesaurus and Encyclopaedia.. 2011. [ONLINE] Available at: http://www.thefreedictionary.com/composite+material. [Accessed 20th Novemberr 2011]. The use of composite materials ensures many advantages. They are lighter, stronger, do not corrode or fatigue, resist impacts better and are easier to examine during an inspection, compared with aluminium. Minor damage can be repaired at in less than an hour. Fig1 Corpu, (2007), plane [ONLINE]. Available at: http://www.google.co.uk/imgres?q=composites+on+aircraf [Accessed 01 December 11]. Fig 2 New Airplane, (2007), 21st Century Fuselage Construction [ONLINE]. Available at: http://www.newairplane.com/787/design_highlights/#/VisionaryDesign/Composites/OnePieceBarrelConstruction [Accessed 01 December 11]. The most critical expense areas for aircraft fleets are fuel, maintenance and its residual costs. New aircraft have been designed and manufactured to lower these costs. Maintenance tasks have been reduced by 30 per cent, and inspections are required less frequently. A good example of this is the 787 which does not require its first heavy maintenance check until after 12 years of service. Another advantage of using composite materials, especially in the wing structure is that it gives aircraft such as the 787 a higher aspect ratio than previous aircraft, resulting in a higher Coefficient of Lift. A lighter aircraft will reduce fuel costs and therefore have a positive effect on the range equation. Advancements in aerodynamics have led to an increase in the overall efficiency of aircraft, becoming more fuel efficient by reducing drag. Components such as winglets and wingtip fences decrease vortices created at the wing tips which cause aerodynamic drag. Winglets | Airbus, a leading aircraft manufacturer. 2011. [ONLINE] Available at: http://www.airbus.com/innovation/proven-concepts/in-design/winglets/. [Accessed 24th November 2011]. Raked wing tips create a greater degree of sweep on an aircraft wing. This enhances the wings efficiency, by increasing the aspect ratio of the wing, therefore decreasing the amount of lift induced drag produced by the aircraft. This kind of drag can be reduced by up to 6%.with the implication of raked wing tips. Blended winglets can be attached to the wing giving a level curve in place of a sharp angle reducing interference drag at the wing. Wikipedia. 2011. Wikipedia. [ONLINE] Available at: http://www.wikipedia.com. [Accessed 24th November 2011]. Riblet technology is a surface modification which consists of minute streamwise ridges and valleys, it has been proven to reduce local turbulent skin friction by up to 6 % . Houghton, E.L, 2003. Aerodynamics for Engineering Students. 5th ed. Oxford: Heinemann (book publisher). On the Boeing 767 double drooped slotted fowler flaps are used, whereas on the later 787 a simple hinged flap with drooping spoilers are used creating smoother wing technology. This results in a decrease in fuel consumption, weight, smaller fairings and fewer parts therefore reducing maintenance. Www.cdti.es/recourses/doc/eventosCDTI/Aerodays(2011) [pdf ]. [Accessed 24th November 2011]. Recently Airbus has completed the first flight of its A320 test aircraft equipped with ‘sharklet' wing-tip. The sharklets can cut fuel burn by up to 3.5% over the current configuration with wing-tip fences and increase the maximum take-off weight by up to 3 tonnes. The engine with the higher value of specific impulse (Isp) is more efficient because it produces more thrust for the same amount of fuel. A higher or more favourable L/D ratio is typically one of the major goals in aircraft design. Using these higher values will obviously increase the range of an aircraft. The latest propulsion systems have advanced, improving the economics of aircraft. Early jet airliners had turbojet engines. These engines operated well at high altitudes and speeds, but had had a high fuel burn rate. When the turbo fan engine was introduced it could move a greater amount of air at lower speeds, than the turbo jet engine, as it had a large fan attached on the front. By enclosing the fan inside a cowling, the aerodynamics was better controlled. This reduced fuel consumption, compared to a turbojet. The next-generation engine technology is provided by Boeing's engine partners, General Electric and Rolls-Royce. The latest engines being the Rolls Royce Trent 1000 and the General Electric GEnx. These engines incorporate a bypass ratio of about 10, compared to the first turbo fan engines having ratios of about 7. The higher bypass ratio allows the engine to be quieter, with significantly reduce fuel consumption. This lowers cost for the 787 operators and reduces emissions, lessening the environmental impact of the aircraft. Chevrons on the nacelles significantly reduce shock cell noise in the aft cabin. Both the Trent 1000 and the GEnx engines are interchangeable at the wing of the 787. This reduces operating costs and gives the 787 liquidity and strong residual value. Both the Rolls Royce Trent 1000 and the GEnx eliminate the engine bleed air system and associated pneumatic system. This improves the reliability and efficiency of the aircraft by further reducing fuel consumption and maintenance costs. The electric system improves efficiency by removing only the power actually needed during each phase of flight. The aircraft have a health management system which monitors the electrical systems, improving the aircrafts productivity. General Electric recently delivered a new innovation in technology producing advanced composite material fan blades .The process results in a 100% defect-free, carbon-reinforced epoxy blade , which means no voids in the fibres. In order to accomplish this, advanced sensor and data acquisition systems were used. This technology will continue to be used on wide-body aircraft of the future, Resulting in lower cost, and greater efficiency. Duncan, Tom, 2010. Engines of Today. Commercial Airliners, 2, 8. An innovation to watch out for in the near future is the use of Titanium aluminide turbine blades. Titanium aluminide’s low density means that a turbine blade will be about half the weight of a blade made from a traditional nickel alloy blades. Reducing the density and the weight of an aircraft engine has huge benefits. Materials of the Future – Online Stuff – Science Museum London . 2011.. [ONLINE] Available at:http://www.sciencemuseum.org.uk/onlinestuff/stories/materials_of_the_future.aspx. [Accessed 16 December 2011] Using the range equation you can calculate the range of an aircraft, if you have the value of the following components. R = distance flown (m) u = velocity (m/s) Isp = specific impulse (s) L/D = lift-to-drag ratio (dimensionless) Winitial = gross aircraft weight at the start of cruise (kg) Wfinal = gross weight at the end of cruise (kg) Houghton, E.L.H, 2003. Aerodynamics for engineering students.. 5th ed. Great Britain: Heinemann (book publisher) The engine with the higher value of specific impulse (Isp) is more efficient because it produces more thrust for the same amount of fuel. A higher or more favourable L/D ratio is typically one of the major goals in aircraft design. Using these higher values will obviously increase the range of an aircraft. The appearance of aircraft has not changed much over 50 years because when it was first designed the cone shaped fuselage with wings attached had good design and technology features. The process of designing and producing a new aircraft is very expensive and risky. There is enormous economic risk along with a large investment and liability risk. The (you bet your company curve) plot below shows the cumulative gain or loss in an aircraft project during its life. It was recently estimated that a new large airplane project at Boeing would take 20 billion dollars to develop. Origins of Commercial Aircraft. 2011. Origins of Commercial Aircraft. [ONLINE] Available at: http://adg.stanford.edu/aa241/intro/origins.html. [Accessed13 December 2011] Aircraft manufacturing companies are not likely to take risks on projects that rely on unproven technology. This is the reason that innovative concepts are not likely to be tried out on the next generation of commercial airliners and why aircraft such as the 787 look so much like the Boeing 707. Customers of commercial aircraft manufacturers can sell their planes which are basically the same appearance as 50 years ago. There is not enough financial gain to design an aircraft with a different appearance. In addition, passengers may prefer to board an aircraft that consist of a tube with wings rather than an aircraft in the shape of a large triangle. The new 787 Dreamliner is a prime example of how innovations in new airframe and propulsion technology can lead to a more efficient aircraft. From innovative composite materials to aerodynamics to propulsion technology the 787 has become 70% more fuel efficient than the 1950s-era four-engine Pratt & Whitney JT3D-powered Boeing 707s. This has considerably increased revenue potential through significantly better performance, improved fuel efficiency and lowered maintenance decreasing operating cost per seat mile of commercial aircraft.

Intelligence Agencies and Just War on Terrorism Essay

America and its allies face Ð ° world that has become more and more dangerous with its weapons of mass destruction and Ð ° shadowy world of terrorists more than willing to use them. The wisdom of the past does not have the prescience or universal insight to deal with this new threat. America and its allies must change direction if they wish to respond to the challenge in an effective manner, even if it means employing policies that seemed dubious in the past. The state is called to protect its citizens in Ð ° Machiavellian world, filled with depravity and compromise. The church is called to submit to the superior wisdom of those who have the special intelligence, experience and expertise to handle the current crisis. Our forefathers came from Europe to settle in Ð ° wilderness that was not always hospitable. Death was imminent, and survival was uppermost on all their minds. The settlement in Jamestown, after the death of Powhatan, suffered an unprovoked attack at the hands of the Native Americans in 1622, in which some 375 settlers were massacred. The immediate response was to make Ð ° perfidious treaty with the natives and then starve them by burning their crops late that summer. It was Ð ° matter of survival. It was either ‘us or them’. (Amit 2003 127) â€Å"The same policy was followed by the Puritans of Massachusetts when the Pequot Indians, Ð ° most war-like people, presented an imminent threat in the mind of these settlers. Rather than wait around to die, they proceeded to attack them first, killing in one horrific conflagration of Ð ° Pequot fort some 4oo men, women and children. The exact motives behind the massacre remain unclear, but no doubt survival was uppermost in their minds. Today the situation that confronts the American people is not so different. It is similar to that of their ancestors in many ways and direr in regard to the number of lives at stake. one can debate whether the times have ‘waxed worse and worse’, but it is beyond question that the times have proved ‘more and more critical’ with their weapons of mass destruction (WMD) and the ever-increasing number of potential users. The nation of Israel felt this threat in 1981 when it conducted Ð ° pre-emptive strike against an Iraqi nuclear reactor. The United States roundly condemned the action at the time, but with the threat now facing them from this and other rogue nations Ð ° new policy has emerged. The nefarious intentions of the Iraqi regime are apparent to most observers. It appears as if this regime plans to continue the production of WMD and deliver these weapons themselves or distribute them through the shadowy world of terrorist networks to designated targets in this clandestine manner. The signs of the times are all around us. Iraq already has violated over fifty UN resolutions to date. The UN inspectors revealed that Saddam was vigorously working on Ð ° stockpile of WMD—chemical, biological and nuclear, and by the mid-9os he began to deny them access to his supply. He already has used these weapons against his own people and waves of foot soldiers in his war with Iran. He has pledged on Ð ° number of occasions to bring destruction upon the United States, and even planned the assassination of its former president, George Bush. He has subsidized and continues to support terrorist groups throughout the region, including Hamas and Islamic Jihad according to seized Palestinian documents. His relation to terrorism is Ð ° matter of grave concern. â€Å"(Rahul 2002 37-44) It provides Ð ° special channel to deliver and promote his wicked designs, Bin Laden has called it Ð ° ‘religious duty’ for his minions to obtain and use WMD against the infidels, but he knows that his terrorist network needs help. It is only in the movies that Dr No is able to create the facilities to manufacture and deliver WMD. In the real world of terrorism, the capacity to make and utilize these weapons requires the help of Ð ° government. Aum Shinrikyo, Ð ° Japanese cult, tried to kill thousands of commuters with Ð ° potent nerve agent but managed to kill only Ð ° dozen after spending somewhere around thirty million dollars. The loss of these lives was tragic but much less than expected and displayed the complexity of operations using these agents. The cult was not able to produce the chemical (sarin) in sufficient purity and resorted to using Ð ° most primitive delivery system—carrying it on Ð ° train and piercing bags of it with tips of umbrellas. Ð  government working with Ð ° terrorist organization would produce Ð ° more lethal combination. 3 In light of this threat, it appears as if the only long-term solution is to eliminate the regime in Baghdad. Some would argue that there is no need to rush into war. But one wonders how realistic this option is in view of the track record of the regime. Is it realistic to believe that Iraq would comply with inspectors? It did not the first time around, not in toto, would the UN impose the necessary sanctions and penalties if it did not? Or would it ignore certain closed doors and cave in as it did before to Iraqi demands? And even if unmolested, would the inspectors catch the regime in its lies, knowing that it is likely to play Ð ° shell game and was given four years to hide its weapons? (Bruce 2003 44) Donne’s fatalistic maxim succinctly defines the essential context that modern intelligence services function within, and the variables determining their relative fortunes. Their experiences suggest that they are very human institutions largely shaped by the vagaries of circumstances beyond their control, not to mention misfortune and luck. As refined information used by the state to further national goals and policies, intelligence is directed, collected, analyzed and disseminated (the ‘intelligence cycle’) within the milieu of international politics. Intelligence work must therefore function within the ‘anarchical society’ of Great Powers. 1 Equally significant is the extent to which intelligence functionaries serve at the mercy of their policy masters. The intelligence officers themselves, in their various professional incarnations, are the ‘desperate men’ in this formulation, striving as they do to carry out their risky and/or problematic duties in the face of inertia and outright opposition on the part of rivals, enemies, and occasionally their own countrymen. It is unlikely that any intelligence service in history has ever completely escaped subjugation to such restrictive bondage. â€Å"As mentioned in the previous chapter, the war on al Qaeda should be Ð ° deliberate broad-front attack. It is already that in practice, but the rationale for sustaining this approach is less established and troubles are certain because such Ð ° strategy requires relating the efforts of multiple agencies, subagencies, and even nations, and it sometimes necessitates rapid action. This would seem to require two enhancements of capability which may at first seem contradictory, but they are complementary and equally important. â€Å"(Paul 2002 31) These facts hold particularly true for the office of Strategic Services mission in London, America’s critical liaison and operational intelligence outpost during the Second World War. Expanding to Ð ° peak of 2,800 personnel in 1944, OSS/London was originally established in October 1941 with the arrival of Ð ° single representative, followed by Ð ° staff nucleus the day after America’s entry into the war. Eventually consisting of contingents from the four major OSS branches-Research and Analysis, Secret Intelligence, Special operations, and X-2 (counter-intelligence)-the mission served as Ð ° focal point for Anglo-American intelligence relations in the decisive theatre in the war against Germany. The London mission was at the heart of OSS relations with British intelligence, and as such it personified the essence of that connection in the Allied war effort. The Allied invasion of Europe ensured that OSS/London, more than any other OSS outpost, would have the greatest opportunity to perform Ð ° decisive role in the intelligence war. Other OSS missions would also make important contributions, notably in Cairo, Algiers and Italy; but these were ultimately secondary theatres, while in the Pacific and Asia, OSS never acquired the sound relationship with the military necessary for intelligence operations. London was at the heart of the Allied war effort, and at the heart of the Anglo-American alliance itself. While intelligence exchanges with the Soviet Union have been documented by Bradley F. Smith, London was the ‘big league’ in Allied intelligence during the war. Many significant matters were accordingly played-out there, offering detailed examples of intelligence services in action. The experiences of OSS in London therefore illuminate the process by which America was introduced to the various components of intelligence and clandestine work, and how well American intelligence performed in its own right. As the presumed precursor to the post-war US Central Intelligence Agency, OSS further invites study in order to understand the antecedents of America’s Cold War intelligence service. The significant Anglo-American context of the evolution of modern American intelligence moreover suggests that the Anglo-American ‘Special Relationship’ had an intelligence component that was manifested most strongly and clearly in OSS/London. (Bruce 2oo3 75) The mission thus provides Ð ° case study of how US intelligence matured and became institutionalized within the context of the larger Anglo-American political-military alliance. This analysis accordingly examines an aspect of that alliance and of intelligence history in particular, that has not yet been explored in any comprehensive detail. It is part of Ð ° current historiographical review of the significance of intelligence services in military and international affairs. It specifically examines OSS/London within the context of Anglo-American relations, as well as the evolution of both modern American, and Allied, intelligence during the Second World War. The general research approach blends what has been termed the American and British ‘schools’ of intelligence scholarship. The more historical nature of British intelligence studies has been noted by Kenneth G. Robertson, while Roy Godson’s ‘Intelligence: an American View’, in Robertson’s British and American Approaches to Intelligence, distinguishes between this historical methodology and the more conceptual or theoretical nature of American studies (for example, Sherman Kent’s Strategic Intelligence for American World Policy). British diplomatic historian D. C. Watt has therefore identified these approaches as two distinct schools of intelligence study, though Ð ° recent noteworthy British contribution to the theoretical school is Michael Herman’s Intelligence Power in Peace and War, which surveys the interrelationship between post-war structures, tasks, and effectiveness. This study for its part demonstrates the influences of both schools by linking theoretical concepts to the role of intelligence ties within the larger wartime Anglo-American alliance. (Neville 2004 45)

Importance of Computer Literacy Essay

Introduction Patient safety is described by the US Institute of Medicine as â€Å"the freedom from accidental injury due to medical care or from medical error† (Mansour, 2012). With that being said, patient safety has long been a major issue for hospitals. In the past many patients have been injured during hospital stays, some being injured severely with death being the result. With the growing trend of lawsuits, hospitals were becoming more and more vulnerable to financial liability when patients were injured on their grounds. No one wants to be responsible for the injury or death of another individual. This is why many hospitals have begun doing their own independent research as well as looking at the research from other patient safety organizations. Patient safety goals are being put into place by organizations such as The Joint Commission, as well as falls reduction campaigns being implemented by the individual hospitals. While regulatory agencies like The Joint Commission require hospitals to identify who is at risk for a fall, and gives minimum standards to go by, it is up to the individual hospital to go beyond these required interventions to reduce the risk of a fall occurring within their facilities. Some ideas to prevent falls include the implementation of a new Clinical Nurse Leader position, purposeful hourly rounding, as well as sensors for beds to ensure they are in the low position. Topic One of the first ways to prevent falls in patients is to identify who is at risk. According to the United States Department of Veteran Affairs, the major intrinsic, or physiology-based, risk factors for falls include; altered elimination, cognitive impairment, sensory deficits, altered or limited mobility/gait, and impaired balance (2009). Contributing to these risk factors are, for example, medications that act on the central nervous, circulatory, digestive, or urinary systems; age-related conditions that affect sensory organs; history or fear of falling; and fluid and/or electrolyte imbalances (United States Department of Veteran Affairs, 2009) For most hospitals, there is a list of questions that nurses are asked used in documenting about patients on a daily basis to determine the ever changing status some patients have while hospitalized. These questions make up what is called The Morse Falls Scale. A Morse Falls Scale must be done each day, and with any condition change, to determine a patients risk for falling. The Department of Veteran Affairs also states â€Å"A score of 0-24 indicates no risk for falls. A score of 25-50 suggests a low risk for a fall while a score of greater than 51 indicates a high risk of falling†(2009). To determine the score a person will have several questions must be asked such as: Does the patient have an IV? Is the IV a saline locked or does it have medications infusing? Has the patient fallen in the last three months? How does the patient ambulate? Are they on bedrest, use the nurse to assist, do they have a weak gait, or do they have an impaired gait? Are they taking diuretics/sedatives/tranquilizers? Is the patient over the age of 70? Are they oriented to their own ability or do they forget their limitations? (2009). Answering the aforementioned questions may seem tedious and like busy work however it is very important in the implementation of effective interventions for at risk patients. Now that you have identified who is at risk and how at risk they are, it is imperative to quickly implement the necessary interventions to prevent those at risk from becoming a statistic and more importantly keep them safe from harm. Even those individuals, who are alert, oriented and are at a low risk for falls should still have preventative measures taken to prevent an accidental fall. One of the leading causes for falls in this group is from hospital staff not lowering the bed down after attending to a patient. Also it is important to keep the patients call button within reach at all times, and educate the patient to call for assistance when needing to get up. Make sure the patient has all of their possessions within reach. For some it might be advisable to turn on a night light at night. For even alert patients, waking up in the middle of the night in a strange place can lead to a fall. Non-skid slippers are another way to prevent falls. Make sure your patients are wearing those any time they are out of bed. Side rails at the head of the hospital bed must be kept up on any patient who is hospitalized, but especially on those patients who are over 65 years of age or those receiving narcotics or sedatives (2009). Patients who are at a slightly increased risk for a fall should have the same interventions taken to protect them as a person with a low risk, but additional interventions are also needed. Rounding on patients is supremely important for many reasons, one of which is decreasing falls. (Tucker, Bieber, Attlesey-Pries, Olsen & Dierkhising, 2012). It is usually during these rounding times you will find noncompliance within patients of this category. If you go into a room and find a patient who is at moderate risk up and out of bed, reeducation is required and in some cases it may be beneficial to turn on the bed alarm to prevent them from getting up again without assistance. It is important to use judgment here when deciding to implement the bed alarm or not (National Guideline Clearinghouse, n. d. ). Take into consideration things such as are they hooked up to a central line, suction, is there a chest tube? Typically when patients insist on getting up without help and have various kinds of tubing hooked to them it is recommended to implement the bed alarm for their safety (National Guideline Clearinghouse, n. d. ). Patients who are at a high risk for falls should have all previously discussed interventions taken along with additional interventions, such as having signs posted so all staff knows that a patient is at risk for a fall. A yellow arm band should also be placed on the patient to alert all staff of the patients risk for falls. There is also no question that these individuals should have a bed alarm activated. If possible it’s always a good idea to have these patients close to the nurses’ station (National Guideline Clearinghouse, n. d. ). Having them closer to the nurses’ station improves the response time for when or if the bed alarm does go off. Having patients closer to the desk also given the staff a better opportunity to more closely monitor the patient. When it is not an option for a patient to be moved closer to the nurse station, it may be advisable for the patient to have a one to one sitter. In many cases families will be more than willing to stay with a patient to help make sure they do not get out of bed without assistance. If this is not possible a hospital staff member, usually a nurse assistant, will need to stay with the patient. Most all hospitals have moved away from using restraints. The liability had become too great for hospitals and staff to continue such a practice. As previously alluded to one important tool most facilities have adopted is hourly rounding. Studies have shown that by hourly rounding and addressing the 4 P’s, which are pain, potty, position, and possessions, reduces the amount of falls that occur in an inpatient setting (Ford, 2010). It is also a great way to make the patient feel safe. According to the research done by Beverly Ford in 2010, patients who see that someone from the faculty is coming in to their room each hour to check on them feels that they are being taken care of and safe. More often than not a patient will avoid using the call bell because they do not want to bother their nurse. (Tucker, et al. ,2012). Particularly with these patients it is important to see them as often as possible and at a minimum once an hour. Studies have shown that one factor in reducing the risk of falls is to have the bed in the lowest position when leaving the room. (Tzerg, Prakash, Brehob, Devecsery, Anderson, Yin. ,, 2012). Studies have also shown that 26. 5% of patients who fell during a hospital stay fell from their beds. 3. 6% fell over the bed rails, footboards, or headboards. (Tzerg et al. ,2012). If the bed is raised from the lowest position it dramatically increases a patient’s chance for falling. According to research done in 2012 by Tzerg, et al, the appropriate height of a hospital bed in the horizontal position is the patients’ knee height. For women the average keen height is 19. 49 inches and in men it is 21. 3 inches. (Tzerg et al, 2012). There is also research to suggest that a bed height sensor should be placed on all hospital beds to ensure that a bed is not left in the up position. Many hospitals have started implementing a new nursing position that helps bridge the gap between nurses with a heavy patient load and the patient who needs closer monitoring. According research The Clinical Nurse Lead (CNL) position has been created at the encouragement of several agencies such as The Joint Commission and Accreditation of Healthcare Organizations. (Stanly, Gannon, Gabuant, Hartranft, Adams, Mayes, Shouse, Edwards, Burch, 2008). In the Fall of 2006 the first CNLs graduated from 12 different masters nursing programs across the united states. â€Å"With a heightened awareness these new graduates went out into the workforce to improve healthcare quality and patient safety, national indicators have been identified and they are being used to determine the quality of care being provided to patients† (Stanly, et al. , 2008). While not the answer to improved patient safety, studies have shown that implementing the position, especially on surgical units has improved the level of care received by patients while hospitalized (Stanly, et al. ,2008). There is no question that falls more often occur in the older population. Medicare has taken a huge interest in this factor and many questions are now being asked. Some of the questions being asked involve things such as what were the risk factors leading up to the incident, how did the incident occurred, what interventions were taken to prevent, and what was the response time after it occurred? (Liang, Mackey. ,2011). Because of the association of falls with mortality and disability, especially in the elderly, several studies have investigated the incidence of falls and the associated risk factors. In 2011 research done by Liang and Mackey reported The Centers for Disease Control and Prevention estimation of approximately one third of people 65 years of age and older fall each year, with many of those falls taking place in hospital settings. In October 2008, the Centers for Medicare and Medicaid stopped reimbursing for hospital-acquired conditions, or events, that should never occur during hospitalization (Liang, Mackey. ,2011). The guiding premise on why these â€Å"never events† should not occur is because there is a sufficient evidence base to prevent those events (Liang, Mackey. ,2011). If a patient experiences one of these events during their hospitalization, the hospital will not be reimbursed for the treatment costs associated with the event if the patient’s insurance is provided through Medicare or Medicaid. With the already serious losses most hospitals take each year, they simply cannot afford to have more revenue lost. This pay-for-performance initiative includes some patient outcomes that are considered to be nursing-sensitive, for example, injuries from falls. This phenomenon of hospitals not receiving reimbursement based on patient outcomes is a relatively new phenomenon for nurses in acute care. This is why hospitals are being serious and taking a hard stands on patients’ safety while in their care. Summary While there is defiantly a trend toward improvement to increase patient safety while hospitalized, it is obvious that there is still a long way to go. Nurses more than ever are using their role as a patient advocate to find new and insightful way to reduce risks for falls. Implementing falls precautions before there is a fall is one of the best ways to avoid an incident. Keeping beds in low position reduces the risk for the alert and oriented patients to fall. Implementing unit standards, researching and revising things that needs to be addressed are highly important for patient safety initiatives to be effective with a hospital setting. Continued research is also needed. Hospitals and patient acuity are both changing almost on a daily basis. It is up to those in the medical profession to avoid becoming stagnant and continue to grow in an effort to protect our patients from harm. REFERENCES Ford, B. M. (2010). Hourly rounding: a strategy to improve patient satisfaction scores. MEDSURGE Nursing, 19(3), 188-191. Retrieved from http://ehis. ebscohost. com. ezproxy. gardner-webb. edu/ehost/pdfviewer/pdfviewer? sid=02fda96b-2386-46ab-a942-0c65dcde3704%40sessionmgr113&vid=6&hid=124 Johanson, L. S. (2008). Interprofessional collaboration: nurses on the team. MEDSURGE Nursing, 129-130. Retrieved from http://ehis. ebscohost. com. ezproxy. gardner-webb. edu/eds/pdfviewer/pdfviewer? sid=bfbb16e7-99ab-43bb-8aed-c12cfa010014@sessionmgr14 Liang, B. A. , & Mackey, T. (2011). Quality and safety in medical care what does the future hold. Quality and Safety in Medical Care, 135(11), 1425-1431. doi: 10. 5858/arpa. 2011-0154-OA Mansour (2012). Current assessment of patient safety education. British Journal of Nursing, 21(9), 536-543. Retrieved from http://ehis. ebscohost. com. ezproxy. gardner-webb. edu/eds/pdfviewer/pdfviewer? sid=d98ff6b9-b7e2-4057-a870-c1fdf160b65d%40sessionmgr14&vid=5&hid=20 National Guideline Clearinghouse | Prevention of falls (acute care). health care protocol. (n. d. ). National Guideline Clearinghouse | Home. Retrieved from http://www. guideline. gov/content. aspx? id=36906&search=falls+prevention#top Stanly, J. M. , Gannon, J. , Gabuant, J. , Hartranft, S. , Adams, N. , Mayes, C. , Shouse, G. M. , Edwards, B. A. , & Burch, D. (2008). The clinical nurse leader: a catalyst for improving quality and patient safety. Journal of Nursing Management, 16, 614-622. doi: 10. 1111/j. 1365-2634. 2008. 00899. x Tzeng, H. M. , Prakash, A. , Brehob, M. , Devecsery, D. A. , Anderson, A. , & Yin, C. (2012). Keeping patient beds in a low position: an exploratory descriptive study to continuously monitor the height of patient beds in an adult acute surgical.

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