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What is depression, and how is it related to sadness?

Depression is connoted as a serious and common medical disease that negatively impacts the way one feels, acts, as well as thinks. It is observed that depression has a significant association with sadness due to the actuality that depression causes one to feel sad as well as interest as pertains to the activities initially enjoyed (Abraham & Kneisl, 2016). The actuality that depression engenders physical and emotional problems also considerably contributes to sadness and reduces the potentiality regarding an individual to operate effectively.    

What are the causes of depression?

Despite the actuality that the exact cause regarding depression is not known, it is observed that there are various factors that are associated with its development (Abraham & Kneisl, 2016). Ideally, depression arises due to the combination of current events as well as personal factors. In regards to the personal facets, it is observed that family history has a significant impact on the development concerning depression. Abraham and Kneisl (2016) assert that depression has the potentiality of running within families and as such as some individuals are have a more genetic risk. Personality is another aspect of the personal factors which has an impact on the development concerning depression. In relation to this, it is evident that some individuals are vulnerable to depression due to their personality more especially if they exhibit low-self esteem and are self-critical. Critical medical conditions are associated with considerable worry and stress which can in turn influence depression more especially while managing chronic pain.
What are the common symptoms of depression?

Depression is associated with various symptoms which exhibit variations based on the degree of severity. One of the symptoms that characterize depression encompasses the lack of pleasure and interest in activities which one initially enjoyed (Duggal, 2016). The manifestation concerning a depressed mood is another symptom that a person with depression is likely to demonstrate. Thoughts regarding death and difficulty in concentration as well as decision-making are other symptoms that are associated with depression. At the same time, people that have depression are likely to exhibit symptoms such as, feeling worthless and having sleeping problems (Duggal, 2016). Variations in appetite and the loss regarding energy are other signs and symptoms observed in individuals that have depression.
What therapies exist to treat depression?
Depression is a mental disorder that can be treated. Ideally, there are three main facets associated with the management concerning depression which encompasses drug treatment, psychotherapy, and support (Duggal, 2016). In relation to drug treatment, it is observed that there are various medications that can be utilized in treating depression which encompasses tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) (Duggal, 2016). Psychotherapies are also regarded as the first-line treatment option for mild scenarios regarding depression. However, in severe and moderate cases, it is observed that they can be employed alongside other treatments.

What are the most constructive and destructive ways of communicating with a depressed person?

One constructive approach of communicating with a depressed individual is to assess them to determine what would be influencing their depression (Duggal, 2016). As well, it is important to make them comprehend that a psychotherapist is there to aid them in solving their needs.  Nonetheless, compelling an individual to talk regarding their concerns is regarded as a destructive approach to communication.


Abraham, I., & Kneisl, C. (2016). Depression (3rd ed.). Philadelphia, PA: W.B. Saunders.

Duggal, H. (2016). The complete guide to self-management of depression (3rd ed.). Cengage: New York.


Student’s Name

Institutional Affiliation


The analyses of the consequences and costs of any conflict are centered on either interstate or civil conflicts. However, the 9/11 terrorist attack has shown to intensify the interest concerning the costs of terrorism, a form of conflict and violence that is directed to civilians or noncombat who are generally not associated with a political object of the perpetrators. Though terrorism in the U.S may be perceived as a particular tactic applied in both external and internal conflicts, its costs have been separately studied. Direct costs of terrorism are those that have immediate losses related to the attack, including lost wages/layoffs, sustained injuries, destroyed goods, and reduced commerce. While most of the losses due to terrorism cause significant property damage and casualties, the indirect costs cause the highest cost. They are the subsequent terrorism losses, including higher insurances, increased compensation to victims and states affected, security costs, and expenses on counterterrorism. This essay explores the cost and extent of terrorism in the U.S.

The extent of terrorism in the U.S

The U.S has, for seventeen years, been at war in Afghanistan and fifteen years in Iraq. Subsequently, U.S has also far longer been active in Somalia, whereby it has spread operations in dealing with extremist and terrorist threats in a broad continuum of conflicts in South Asia, North Africa, sub-Saharan regions, and South East of Asia. In event after event, the U.S has shifted beyond counterterrorism to counterinsurgency as well as from momentary and small force of antiterrorism to constant military presence. According to Cordesman (2018), the line between counterinsurgency and counterterrorism has continuously shown to be so blurred that no significant difference can be depicted. Based on the fact that the database for terrorism events only date back in 1968, every study pattern regarding terrorism ought to commence in 1968 as well (Sandler, 2014). Reports assert that terrorism escalated from 1968 to around the mid-1980s, with almost 500 cases every year (Sandler, 2014). As Sandler (2014) highlights, the incidents fell from about 100 to 200 events every year since the mid-1990s, except for 1995 and 2001. The most comprehensive terrorist incident database, the Global Terrorism Database (GTD), was founded in the U.S and still maintained in the country. 

Combining this with the fact that U.S media extensively covers terrorist incidents than any other event, dated back in the 1970s, is a clear depiction that the country has the complete leading record of terrorism in recent decades (LaFree, 2010). The annual death toll resulting from terrorism in the U.S since 1970 showed a downward trend until the year 2001, where it raised to four times higher with approximately 3000 fatalities in the September 11 attack (LaFree, 2012). In recent history, the September 11 attack that hit New York stood out as the largest fatal terrorist case worldwide. LaFree and Dugan (2007) assert that, based on these fatalities, terrorism has been perceived to have been relatively higher in the 1970s, comparably slight in the following decades except for 1995 and 2001. Reports have brought out that for the past five years, U.S has had a small though a constantupsurgein terrorist fatalities. In most of the years, terrorism caused at most 50 casualtiesevery year, and in some of the years, no fatality occurred (LaFree and Dugan, 2007). With the 2001 attack exemption, terrorism accounts for less than 0.01% of the fatalities experiences every year in the U.S since 1970 as compared to 120 fatalities caused by road accidents every day in the country (Filigrana Villegas, 2019). Nevertheless, the costs of terrorism are still felt in the U.S.

Direct costs

Loss on human capital and economic output

The direct costs of terrorism are the loss of capital, both human and non-human. According to Tavor (2011), the estimated loss of capital (human and non-human) in the U.S range between $25 and $60 billion, which the physical resourcesamounts to 0.2% of the country’s economy and 0.06% of the U.S valuableresources or assets. The U.S has suffered a loss of its economic output due to terrorism. For instance, Navarro & Spencer (2001) found out that the country experienced a loss of $47 billion in its economic output and a loss of $1.7 trillion of its stock marketcapital. Nevertheless, the short-term impact on economic behavior uncertainties tends to vary based on the adept offsetting responses. 

Losses on industries 

Terrorism impacts specific industries and regions in the U.S that have been proved to be a substantial cost. Particularly, sectors like tourism, transport (airline and shipping, postal services, insurance industries, as well as any other related activities like lodging. For instance, exemplifying the September 11 terrorist attack, the Bureau of Labor Statistics found out that it caused job layoffs as well as separations. Data has shown that a minimum of 125,000 employees was laid off for not less than 30 days due to the attack (Keith, 2004). Keith (2004) explained that the figure underestimated the full extent of layoffs related to terrorism in the U.S, whereby it causes a layoff of at least 50 employees in over 30 days, excluding layoffs for smaller firms or lesser durations. Losses caused by terrorism on insurance industries in the U.S are estimated to range from $30 billion to $58 billion, whereby the primary uncertainty that is acquired from a reimbursement on liability insurance (Lenain, Bonturi& Koen, 2002). When Hurricane Andrew occurred in 1992 in Florida, it caused approximately $21 billion in insurance losses (Lenain, Bonturi& Koen, 2002). However, though Hurricane Andrew caused the biggest historical insurance event, the insured losses occurring from the terrorist attack on September 11 were even higher. That means some industries like the insurance sector may either be directly or indirectly impacted.

Indirect costs

Cost on military spending and security 

One indirect cost of terrorism in the U.S includes that on security, which is estimated to be equivalent to a terrorist tax. Becker (2001) found out that the long-term security and waiting costs for airlines tend to escalate the costs by approximately $11 billion every year (Ito & Lee, 2005). Therefore, constant terrorist costs in the country would add up to 11% of the air travel cost as well as impose approximately 0.1% economic cost of GDP.Additionally, terrorism has been reported to lower investment and subsequently lowering the capital stock, which results in almost 0.2% of the GDP in the long-term. Burke (2008) also estimated that the cost of terrorism on U.S business has escalated to as much as $151billion, which includes figures for insurance, logistics, travel, and transport, information technology, workplace security, and costs of employees. A study by Navarro and Spencer (2001) found out that terrorist tax added up to $41 billion, tallied from a microeconomic cost. Besides public spending on security, private security in the U.S has also shown to rise. Though there is limited data on the cost private sectors incur on security in the U.S, it is estimated to be approximately $40 billion every year (Lenain, Bonturi& Koen, 2002). Almost half of this spending comprises security guards, a single category, and protective service workers, while the rest is composed of computer security, surveillance cameras, guard dogs, and alarm systems. Lenain, Bonturi, and Koen (2002) brought out that this substantial amount compares to what the country spends on state, federal, and local police officers. Terrorism caused a constant increase of 1% of the GDP on military spending and an increment of 0.5% on the employment of the labor force by the U.S government (Lenain, Bonturi& Koen, 2002). The security spending of private sectors has also remained constant at o.5% of the GDP (Seidenstat, 2004). Therefore, one of the major costs of terrorist attacks in the U.S is felt on security and military expenses.

Government support for terrorist victims

The cost of terrorism extends to the government aid on victims. The U.S has established robust policies and laws to offer the victims of both state and federal crimes with obligatory rights and services in the justice process. Additionally, state and federal initiatives allow terrorist victims to acquire the reimbursement of expenses that are crime-related, for instance, treatment for psychological and physical injuries as well as burials. The state and federal agencies aid the terrorist victims throughout justice prices and assist them in accessing services such as counseling and referrals, compensation claims, travel, and lodging for witnesses outside the town and court proceeding information. An example of cost encountered in the aid is the $50 million set aside by the Office for Victims of Crime (OVC), U.S. Department of Justice from the CVF funds in the Antiterrorism Emergency Reserve (AER) (Sacco, Congressional Research Service & United States of America, 2016). AER funds programs administered by the OVC to support terrorism victims. International Terrorism Victim Expense Reimbursement Program incurs cost such as Medical expense amounts to $50,000, mental health up to $5,000 for one year, funeral or burial up to $25,000, property loss, repair, and replacement amounting to $10,000 and $15,000 for miscellaneous (OVC, n.d.).The reimbursements are dependent on the state; for instance, California has a set maximum compensation of $63,000 and $25,000 for Virginia (OVC, n.d.). The government reimburses terrorist victims for expenses not planned for in other resources like private insurances. This means that less resources are used for productivity enhancement.

Resource diversion towards counterterrorism 

The cost and consequences of terrorist events in the U.S is also measured from costs incurred in counterterrorism efforts. These include the resources diverted to anti-terror activities. The Council of Economic Advisers (CEA) contends that the U.S has increased spending on security, including armed forces, which is associated with slowing down economic growth. This is because more labor and capital are redirected to security production and, therefore, away from final demand production. According to Lenain, Bonturi, and Koen (2002), the terrorist cost approximately $20 billion (0.3%) of the GDP in non-farm sectors reduced the total U.S factor productivity in the year 2002 and a reduction of 0.3% in later years (Congressional Budget Office (CBO).  Diversion of resources towards counterterrorism is a hindrance to other more constructive project in the U.S such as health.


In conclusion, though the extent of terrorism in the U.S has shown to reduce since 1970, with an exemption of 1995 and 2001, the cost of terrorism has been substantial. For instance, the death toll has shown a downward trend since 1970, with the exemption of the 2001 attack, which raised the death toll to nearly four times that of 1970. However, the effect or costs of terrorism in the U.S are still felt in the current operation of the country though concentrated in very few sectors. The cost of terrorism in the U.S are either directly or indirectly felt. Though the direct costs of terrorism are devastating, the indirect costs of terrorism have been reported to cause a higher cost in the U.S. The direct costs are on human and non-human capital and to some extent related industries; particularly, in industries of tourism, food services, transportation through airline and shipping, financial markets and insurances. Government support for the victims is also a cost incurred, whereby a particular amount depending on the state is set aside for compensation of victims are and locations hit. Lastly, the U. undergoes a cost in counterterrorism, whereby it diverts the resources from more production projects to security activities like military forces



Becker, S. Murphy.(2001) Prosperity Will Rise out of Ashes. The Wall Street Journal.

Burke, R. (2008). International terrorism and threats to security: Implications for organizations and management. International terrorism and threats to security: Managerial and organizational challenges, 3-33.

Cordesman, A. (2018). Terrorism: U.S. Strategy and the Trends in Its “Wars” on Terrorism. Retrieved 19 October 2019, from https://www.csis.org/analysis/terrorism-us-strategy-and-trends-its-wars-terrorism.

Filigrana Villegas, P. (2019). The Environmental and Population Health Impacts of Road Urban Transportation in the Puget Sound Region, WA (Doctoral dissertation).

Ito, H., & Lee, D. (2005). Assessing the impact of the September 11 terrorist attacks on US airline demand. Journal of Economics and Business57(1), 75-95.

LaFree, G. (2012). Generating terrorism event databases: Results from the global terrorism database, 1970 to 2008. In Evidence-based counterterrorism policy (pp. 41-64). Springer, New York, NY.

LaFree, G. (2010). The global terrorism database (GTD) accomplishments and challenges. Perspectives on Terrorism4(1), 24-46.

LaFree, G., & Dugan, L. (2007). Introducing the global terrorism database. Terrorism and Political Violence19(2), 181-204.

Lenain, P., Bonturi, M., & Koen, V. (2002). The economic consequences of terrorism.

Keith, D. (2004). In the Name of National Security or Insecurity: The Potential Indefinite Detention of Noncitizen Certified Terrorists in the United States and the United Kingdom in the Aftermath of September 11, 2001. Fla. J. Int’l L.16, 405.

Navarro, P., & Spencer, A. (2001). Assessing the Costs of Terrorism. Milken Institute Review4, 17-31.

Sacco, L. N., Congressional Research Service, & United States of America. (2016). Federal Assistance for Victims of Terrorism Or Mass Violence: In Brief. Congressional Research Service.

Sandler, T. (2014). The analytical study of terrorism: Taking stock. Journal of Peace Research51(2), 257-271.

Seidenstat, P. (2004). Terrorism, airport security, and the private sector. Review of Policy Research21(3), 275-291.

Tavor, T. (2011). The impact of terrorist attacks on the capital market in the last decade. International Journal of Business and Social Science2(12).

(OVC), O. (n.d.). ITVERP: What Is Covered? | OVC. Retrieved 19 October 2019, from https://www.ovc.gov/itverp/expensecovered.html

Can cangliflozin improve renal outcome and associated nephropathy in patients with DM2 and CKD

DM2 and CKD?


Diabetes mellitus type 2 (DM2) disease is a leading killer disease in the world. This disease has been associated with a number of health conditions, including kidney failure. Chronic kidney disease (CKD) is a common condition associated with diabetes mellitus type 2 can also contribute to an increased risk of mortality as a result of cardiovascular conditions.

The prevalence of diabetes type has been on the rise in recent times, with the disease being the major cause of kidney failure It us predicted that by the year 2035, a tune of up to 6 million people will be diagnosed with kidney failure as a result of diabetes mellitus type 21. Canagliflozin, which is an oral SGLT2 inhibitor, has been tested in a number of studies as to whether it can contribute positively to the health status of patients with DM2 and CKD. Trials of canagliflozin have been done, and it is supposed that canagliflozin can improve renal outcomes amongst patients with CKD and DM22.

Literature Search Strategy:

In a study carried out by (Perkovic et al 2019)3, selected patients with DM 2 and CKD were sampled to be administered with canagliflozin. A randomized research method was used, whereby each patient was to be given canagliflozin of 100 mg daily. Before the actual study was conducted, every patient was treated with a system blockade.

Additionally, as another requirement in preparing the patients, each one of them was to receive a stable dosage of an inhibitor that converts angiotensin, also called angiotensin-receptor blockade. The blockade was to be received at least four weeks before the process of randomization would start. Patients who were suspected to have kidney failure that was not related to diabetes type 2 disease, or who had initially been treated for kidney disease using immunosuppression, or had those that undergone kidney transplant procedures were not included in the study.  

Results/Literature Analysis:

The outcomes of this study was expected to be as follows: severe kidney damage that would include a 30 days dialysis process, kidney transplant, augmenting the level of serum creatinine, death from cardiovascular disease or renal problems. Apart from these, all other outcomes were considered exploratory4

To ensure safety during the process of the study, health and safety independent committees were formed to oversee the whole process. Evaluations for safety included carrying out an assessment of volatile situations and carrying out laboratory tests. Renal and cardiovascular safety considerations were overseen by another independent safety and health committee whose members were oblivious of the assignments of each group5.

A promising study was carried out to establish the effect of canagliflozin on the renal outcome in patients with DM2 and CKD.  However, due to safety concerns, the study was halted early, according as the committee in charge of health and safety planned it. Only patients with diabetes mellitus type 2 disease and with hemoglobin presence of 7 % to 12 % (severe kidney failure conditions) were considered.

The participants who were enjoined in this study included both males and females of a median age of 30. A total of 4401 patients took part in the study. There were two trial groups; the canagliflozin group and the placebo group.

The approximated risk for the primary expectations was 30 % in the placebo group. Event rates for the canagliflozin group were 43.2, while those of the placebo group were 61.2. In the placebo group, the death risk from renal causes was observed to be 34% lower than it was observed with the group. The approximated death risk from acute kidney failure was observed to be lower by 32%. At the same time, the canagliflozin group exhibited a lower prevalence of cardiovascular problems, and consequently, lower hospitalizations. For amputations of fractures, both groups were observed to be similar, with very small difference margins6


Amongst the patients with DM 2 and CKD, the canagliflozin group was observed to exhibit a lower risk of cardiovascular problems (43.2 per 1000 patient – years) while with the placebo group the risk was (61.2 per 1000 patient-years). The risk of getting the cardiovascular disease and kidney problems was observed to be a little higher with the placebo group.

For the secondary outcomes, patients in the canagliflozin class exhibited a reduced risk as deaths resulting from cardiovascular problems, stroke death, or hospitalization. The general risk for acute kidney problems and doubling of serum creatinine or death as a result of kidney failure was observed to have reduced by 34 % in the canagliflozin group compared with the placebo group. With the risk of cardiovascular problems, there was but an insignificant difference between the two groups. The risk of death from any cause was 0.83. 

Due to the lower risk associated with taking of canagliflozin, it is strongly recommended for patients with cardiovascular problems as a result of diabetes mellitus type 2 and acute kidney failure. According to the evidence that has been presented above, I would recommend to Dr. Wilson that he addscanagliflozin to his regimen as evidence has shown that it will do his patients only good. Indeed, canagliflozin can improve renal outcomes that are associated with nephropathy in patients having DM2 and CKD.


I would like to take this chance to appreciate everybody who positively contributed to the success of this study. More especially, I thank all the patients, safety committee members, trial teams and statistical officers for being caring enough to expend their precious time in this study.


  1. Jardine, M. J., Mahaffey, K. W., Neal, B., Agarwal, R., Bakris, G. L., Brenner, B. M., & Edwards, R. (2017). The Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study rationale, design, and baseline characteristics. American journal of nephrology46(6), 462-472.
  • Penno, G., Garofolo, M., & Del Prato, S. (2016). Dipeptidyl peptidase-4 inhibition in chronic kidney disease and potential for protection against diabetes-related renal injury. Nutrition, Metabolism and Cardiovascular Diseases26(5), 361-373.
  • V. Perkovic, M.J. Jardine, B. Neal, S. Bompoint, H.J.L. Heerspink, D.M. Charytan, R. Edwards, R. Agarwal, G. Bakris, S. Bull, C.P. Cannon, G. Capuano, P.-L. Chu, D. de Zeeuw, T. Greene, A. Levin, C. Pollock, D.C. Wheeler, Y. Yavin, H. Zhang, B. Zinman, G. Meininger, B.M. Brenner, and K.W. Mahaffey, (2019)Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. vol. 380
  • Perkovic, V., de Zeeuw, D., Mahaffey, K. W., Fulcher, G., Erondu, N., Shaw, W., …& Neal, B. (2018). Canagliflozin and renal outcomes in type 2 diabetes: results from the CANVAS Program randomised clinical trials. The Lancet Diabetes & Endocrinology6(9), 691-704.
  • Perkovic, V., Jardine, M., Vijapurkar, U., &Meininger, G. (2015). Renal effects of canagliflozin in type 2 diabetes mellitus. Current medical research and opinion31(12), 2219-2231.
  • Weir, M. R. (2016). The kidney and type 2 diabetes mellitus: therapeutic implications of SGLT2 inhibitors. Postgraduate medicine128(3), 290-298

Project Management-Winsome Manufacturing Company


Winsome Manufacturing Company manufactures and trade in plastic storage containers. During the previous meeting, there was introduction of new products that were proposed and it was projected that they would be launched in approximately 9 months’ time. The product would be room sized outdoor plastic containers. Even though this product will receive some competition from other similar company products, it has been decided that it will include additional features to outcompete these competitors. The product is estimated to produce higher profits, explore untapped markets and establish a foundation for other products to be introduced. Furthermore, it will unite employees to work together towards a common goal. This analysis will provide a project management of this project to include project stakeholders and sponsors and how they will be involved in the project, project management and communications required for the project. Finally the project charter will be highlighted showing various details for the project’s expectations.

First off, stakeholders are individuals with authority emanating from their financial contributions or political support for the project at hand. They can either be an individual or an entire organization engrossed into the project to gain profit thus positive or negative project results will also affect their investment returns. It is the duty of the project managers to identify stakeholders since it’s their obligation to address the stakeholders’ expectations from the projects (Roeder, T. 2013). It is also their duty to manage each stakeholder’s influence to the project so as to make it a success.

For this project at hand, the stakeholders are individuals having an interest to profit from the company’s product by putting their investments in the products initial phase (Roeder, T. 2013). The stakeholders’ participation will largely involve financial aspects that will stir the projects being publicised through advertisements and are occasionally invited to provide suggestions in product’s design since any fresh idea is welcomed.

Any sponsor funding the project will not only fund it but also champion its development. Stakeholders will in addition serve as the projects spokesmen/women, guide it through the process of selection, participate in the early phases and assist in its growth towards success. On other instances, they can be involved in empowering change, providing reviews and critical analysis and participate in high risk decisions (PMI, 2010). 

Sponsor of the project are expected to be individuals operating under marketing departments because they have knowledge and experience of where and how to attract resources and negotiate with the project management team and higher management about the project’s whereabouts (PMI, 2010).

The project management office under the organization bestows upon the project manager the responsibility of attaining the project goals. These managers have numerous tasks and priorities apart from being flexible, a strong leader, great negotiator with excellent judgement and equipped with knowledge of project management practices. All information pertained by the project and every perspective entailed should be well understood by the manager responsible for its success. Another role that they must oversee is communicating with their team members, their sponsors, and stakeholders and providing feedback to the organization management (Aston, B. 2017).

Project managers must be an employee within the production or marketing department since they are to accomplish the set goals and objectives within the time limits and have knowledge in product development. It is because the end results must be professionally developed to be customer oriented and make them satisfied by the end results. The result expected from the project is a strong room-sized storage container which must appeal customers’ needs. 

Abilities, skills and experiences which are considerably expected for the project manager during each phase of this project’s life-cycle include;

  • Fundamental skills – Are talents which are significant so as to develop a foundation for oncoming developments in the project
  • Personal management skills – These include skills like behavioural and attitudes that are necessary to propel one’s self-confidence and individual growth.
  • Teamwork skills – Are important abilities that are necessary to guide and participate with other workers towards a common goal. It is also essential for each and every member of the project team (Aston, B. 2017).

The life cycle of the project contains a number of phases where the required talents of the project manager also differ. These include;

Project Initiation – The project manager has to handpick candidates from his team with excellent and relevant experience in regards to technology that concerns the project at hand.

Project planning – The manager has to develop a comprehensive breakdown of the process of every task entailed in the projects’ start to finish.

Project execution – Here, the manager with his/ her team synchronize themselves and with available resources to implement the plans and undertake all project activities in harmony with the proposed plan aforementioned (Westland, J. 2007). Any deliverables produced will be the output from all processes accomplished as described by the management plan of the project in addition to any other framework related to the said project.

Monitoring and controlling – This entails processes executed to monitor the execution of the project to unveil any potential threats early enough in order to allow timely corrective measures, and manage the execution process. The main benefit of this is that managers can observe and measure project performances thus identifying deviations from the initial plans (Westland, J. 2007).

Closure – At this juncture, the project manager is supposed to be fine-tuning little issues to ensure this project has a successful finish. The highlighted of this phase is a written formal project report that comprises a number of elements. These are: Final product’s formal acceptance (by client), Weighed critical measurements i.e. comparison results between initial customer requirements and the completed products delivered, experience acquired and the formal project’s termination notification to organization’s management (Westland, J. 2007). 

The Project Charter

This document issued by the sponsor authorizes the project enabling the project manager to utilize resources for project execution to completion. Since it entails project inputs and outputs, it must describe products and services deliverable by the project where in this situation a room-size storage container will be produced. The project management plan will be delivered by this project charter stating the project’s execution, monitoring and control. This will also include a project overview which evaluates its entire duration (Milošević, D. 2003). By manufacturing and producing these storage containers, the problems of storage by customers will be solved by Winston Manufacturing Company however ramifications of ignoring this project will result in losses to the company since their competitors will outcompete their present products with such products denying them the profit share of the market.

This project which was a request by the marketing department manager was initiated due to the need by customers for a bigger storage capacity for their own goods. Over the past two years, these customers have expressed their need for more room for storage since their current space for storage are in form of their own homes which are limiting their potential. This business opportunity once addressed will result into more returns, sales outlets, add-on products and satisfied clients.  Similarly, consequences of ignoring this project translates to loss of revenue due to already present competition and unsatisfied clients due to purchasing expensive products form the competition

Finally, Winsome Manufacturing Company should have a keen eye on their competition to guarantee they are the only company with unique products by developing unique features which are not duplicated by others.  The project managers, stakeholders and sponsors have a big role to participate in this project and should be on the same page with every step of project’s progress.  The project charter and anticipated outcome are dependent upon the input by the whole team involved in order to ensure it becomes a success.


Aston, B (2017) 7 Essential Project Management Skills, DPM. Retrieved from http://www.thedigitalprojectmanager.com/project-management-skills/

Milošević, D. (2003). Project management toolbox: Tools and techniques for the practicing project manager. Hoboken, N.J: J. Wiley & Sons.

Project Management Institute (PMI) (2010) Executive Engagement: The Role of the Sponsor. Retrieved from http://www.pmi.org/-/media/pmi/documents/public/pdf/business-solutions/executive-engagement.pdf

Roeder, T. (2013). Managing project stakeholders: Building a foundation to achieve project goals.

Westland, J. (2007). The project management lifecycle: A complete step-by-step methodology for initiating, planning, executing and closing a project successfully. London: Kogan Page.

Crisis Management Plan


An earthquake is a natural disaster which causes a lot of destruction and harm. It occurs when there is an abrupt release of energy from the crust of the earth. This results to a seismic wave being created. This shakes the ground or displaces it (Friedman, 2002). Accordingly, the earthquake causes trees, buildings and other structures to collapse and people being injured in the process among other destructions. Such a crisis often gates individuals and organizations unaware and these results to magnified destruction and loss. With a crisis management plan in place, the loss and destruction of the earthquake could be reduced significantly.

Resource management

In such a situation or in any other crisis, the management could be blamed in case people unnecessarily lose lives as a result of the managements or the organizations actions.  This could be serious and result to the organization being boycotted and finally, grinding to a halt. To avoid such and to ensure that lives are protected and suffering is reduced, the management ought to consider an ethical approach to crisis management. In the case of an earthquake crisis management, the organization management will develop an ethical corporate culture. A set of core ethical value will be established. The core ethical values will include trustworthiness, responsibility, care, citizenship, respect and fairness. With that in place, a detailed ethics program will be implemented. The managers and employees will be accorded some ethics training. An ethics officer or some ethics professional will be utilized to deliver the lessons. An ethical leadership will then be given

The management will also ensure that during cases of emergency, there is a good plan that will ensure the patients are given efficient and effective treatment. For instance, when an emergency occurs, a simple triage will be adopted.  Basically, the patient reception will be made very flexible to accommodate the situation in the most effective way. Flexibility or effective management will also be applied to medical and other supplies during such an incident. An effective channel of communication will be provided so that the suppliers are well directed and the needs and demands are matched. The facility will also collaborate with medical training institutions, the government and the general public with regard to personnel resources in case of an incident.

Chain of Command

To ensure that there the emergency-management operations are effective, there should be a good functioning system of command-and-control. The organizational structure of the incident command system will include: Planning, operations, logistics and finance who will report to the incident commander. Accordingly, representative from the following services will be included.

Hospital administrationSecurity
Human resourcesNursing administration
Infection controlPharmacy
Waste managementEngineering and maintenance
Respiratory therapy 

With relation to communication, there should be an effective and efficient one. This will enhance good collaboration, trust, informed decision making, public awareness and cooperation.  In readiness for the natural disaster, there will be a creation of a public spokesperson with the duty of coordinating the communication s of the organization with the authorities, media and public. A press conference location will be allocated. The communications will be approved by the incident commander. The hospital staff will be briefed of their roles in case of an incident. An effective collection, processing and reporting mechanism will be put in place. The information such as the decision of patient prioritization such as triage methods will be communicated to the stakeholders. Put up a backup communication system in place.

Importance and implementation of community communication, involvement and coordination

It is important to communicate and implement community communication, involvement and coordination to decision making process effective, through idea sharing, utilize the benefits of team work and basically ease the situation. In such cases, emotions are usually high. Individuals and institutions may begin blaming each other and a general undesired state may occur (Friedman, 2002). To ensure that that is overcome and the crisis management is effective, community communication is crucial. Any doubts or dangers among other vital communication are passed on to the community.

Community involvement is important as it ensures that operations during the emergency are undertaken in the right manner to produce the right impact. For example, the patients could be members of the community. As such, community could be the best place from where the healthcare personnel can get information about a patient that is not able to talk due to injuries. From such information gathered form the community, the nurse and other medical practitioners will make informed decision that will result to the patient being treated appropriately or rescued. The community could be important when manpower resources are needed.

Policies for personnel management and safety

A policy that ensures the safety of personnel management will be in place. The safe places when the crisis takes place ought to be identified. The safe places are such as under the table or away from the windows. There will be a bi-yearly practice of drop, cover and hold-on in the various safe places. The practice will include dropping under a table and holding one of its legs then protecting the head. This will be done for the purpose of making such a response automatic. There will also be a plan that the workers should follow in case of an earthquake. The plan will involve

  • Instructing the employees waiting in the safe place until the tremor ceases
  • In case they have to leave after the tremor ceases, they will be instructed to should be using the staircase while watching out for debris.
  • For those who will be outside, it would be safe to remain outside
  • looking out for fires

The workers will be informed of the plan and earthquakes often discussed with them. First aid training will be done .Basically; the policy will be in alignment with the federal emergency management agency with regards to people/property protection in cases of emergency (Osha.gov, n.d.).

Steps for supply chain management

  • When disaster occurs, the needs and resources should be recognized  with the help of rapid damage assessment
  • In case of external assistance, request should be made basing on the resources that are not available within the zone. Consideration should be in place for the required shipment time, and planning for the other needs that will not be met.
  • The management should then get prepared for the reception of large amounts of donation from all over


Friedman, M. (2002). Everyday crisis management: How to think like an emergency physician. Naperville, Ill: First Decision Press.

Osha.gov, (n.d.).Occupational Safety and Health Administration: Earthquake preparedness and response. United States Department of Labor. Retrieved 12/6/2017 from https://www.osha.gov/dts/earthquakes/preparedness.html

Healthcare Medical Record Policies

Health Care Medical Record Policies

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Health Care Medical Record Policies Part I

The Healthcare environment is an indispensable requirement for every human life. The medical technology deals with procedures and instrumentation which are designed for the principle purpose providing the public with quality health care. Therefore, the medical record plays as a powerful tool which enables the treating physician to keep track of the medical history of their patients and recognize patterns or problems which might assist in determining the course of healthcare provided (Sharpe, C. C. 1999).

The purpose for the medical records therefore is to describe the constituents of the electronic and paper medical record in order to provide support to the patient’s diagnosis while justifying treatment, care and other services provided.  The medical record has to be maintained for each and every patient served by the healthcare facility, where with varying automation levels, some records could be maintained in paper format while others electronically. It is crucial that every medical facility has in place a formalized for maintaining their records since all the records have to be organized systematically and readily accessible.


Every medical record entry, inclusive of electronic and handwritten/ paper records, must be completed, timed, dated and legitimate/ legible also authenticated by the individual in charge for evaluating and providing the offered services in consistency to policies and procedures of the hospital/ medical facility.

The Content of the Medical Record

The medical record content which contains electronic and written documentations should be able to allow the physician/ professional account for major source of information and support for their medical decision making.

  • The medical record contains patient demographic information such as: name, date of birth, their address, sex, their legal status, ethnicity and race, communication and language needs, and any representative legally authorized.
  • The medical record contains patient’s clinical information like; purposes for treatment, their original condition and/or diagnosis and diagnosis established in their course of treatment, medication prescribed/ ordered, any allergies or undesirable drug reaction to medication or food, medication administered and prescribed when patient is discharged and treatment goals among other clinical information.
  • In order to provide treatment and care, the medical record contains; any documentation on communication with the patient (e.g. mail, phone calls), advance directives, information generated by patient, informed consent prior permission.

A key constituent of the maintenance of medical records is handling of corrections, amendments and any deletions. Any individual documenting the medical records has to have authority or be credentialed to document following the policies defined by the facility. The individuals should have competence and be trained in the facility’s essential practices and legal standards of documentation.

  • Entries must be made immediately in the event of a confirmed observation. It’s crucial for timely input of patients’ medical records and each entry inclusive of day, month year and time associated with it.
  • It is thus illegal and unethical to pre- or back-date any entry. Dating should be done for the accurate time and date of inputting the entry.
  • Each entry has to be linked to the residence in practice, providing their name and medical record number, and authenticated by the medical author, that is, it should not be edited and signed by any other individual other than the author.

When making corrections to a paper medical record, accepted principles are accomplished through the use of one like strike through to allow future reference of the original content. It’s important that the author of this alteration dates and signs his/her revision. Electronic health records medical records on the other hand require more consideration. Records originated from electronic records with corrections or amendments have to specifically make out any delays, corrections or amendment while also providing a dependable means for vividly recognizing the original content, including the authorship and date for every modification on the records.

Health Care Medical Record Policies Part II

Ownership of the medical record

The medical records (electronic or paper documents) are to be possessed/owned by its author (practitioner or physician) and not by the patients. Alternatively, the medical record’s information belongs to the patient and therefore should be accessible by the patient or their legal representative upon their request (Heller, M. E., et al 2009). Although the practitioner or physician still has the overall say to avoid any access to specific pieces of information, particularly information which contain likelihood of causing substantial harm to either the patient or any other person. 

A patient has a legal right to seek court protection in case of wrongful use of the physician’s discretion having their own initiative for challenging the physician to denial of access. The original medical records cannot be removed from the medical facility, except when authorized by a court order or when required by law. Therefore, the medical personnel and other professionals in the healthcare facility are accountable for documenting the medical records within the proper and mandatory time frame in their support of patient care.

Policies/procedures for the release of records

Physicians and practitioners have constantly encountered immense complexities whenever they want to release medical records in response to Health Insurance Portability and Accountability Act (HIPPA) of 1996. So as to uphold confidentiality of patients and conform to government regulations, the following procedure and policies will ensure that confidential medical records’ are transferred according to all essential guidelines when released.

Health Care Medical Records will only be released upon the patient’s written request. This request has to be followed in accordance to Uniform Health Care Information Act 70.02 RCW (Washington (State). 1970). The Medical Healthcare facility shall only release records which were generated the facility’s practitioners/ physicians and preserved within the facility. Records from other facilities will not be released.

The requirements to be met for valid authorization in order for medical records release are; Written document signed and dated by the patient, which exclusively recognizes the patient, healthcare provider (practitioner/ physician) making this disclosure and exclusively provides information to be released. The document provides name, contact information, and affiliated institute of the individual/ entity who would be the recipient of this information. Before processing the request, the patient’s Identification has to be verified by the information provided in order to verify the appropriateness of information appealed for release. The request is then completed if its content meets the facility’s requirements. If not the application is returned to the requestor together with a description explaining need for more information needed.

Ways to maintain confidentiality

 In harmony to the Confidentiality of Medical Information Act (CMIA) (California Civil Code Sections 56-56.37, n.d.) and Information Practice Act attending to security and privacy of medical information the confidentiality of medical information in the facility shall be reserved. The following controls and principles should be executed in every location of the medical records within the healthcare facility.

  • Only the individuals having authorization/permission by the director shall have access to the information.
  • The service provider must date and sign the information recorded like consent to service, diagnose, and treat and any follow up prior to storage of the information.
  • The medical information records shall be put in a locked room or files while the electronic records protected by passwords when not in use.
  • Each of the medical facility shall be reviewed yearly on their record management practices to guarantee filing, storage and utility of the medical records in a conduct which provides standard confidentiality.
  • Back-up of the medical records electronic data shall be reserved in a secure off-site locality.


California Civil Code Sections 56-56.37(n.d.) Confidentiality of Medical Information Act (CMIA). Retrieved from http://www.ucdmc.ucdavis.edu/compliance/pdf/Confidentiality%20of%20Medical%20Information%20Act%20(CMIA).pdf

Heller, M. E., & Veach, L. M. (2009). Clinical medical assisting: A professional, field smart approach to the workplace. Clifton Park, N.Y: Delmar Learning.

Sharpe, C. C. (1999). Medical records review and analysis. Westport, Conn: Auburn House.

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Washington (State). (1970). Washington appellate reports. Olympia, WA: Court of Appeals. Retrieved from http://apps.leg.wa.gov/rcw/default.aspx?cite=70.02

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MMHA 6600

Self-Assessment and Effective Leadership

Self-assessments are valuable tools that enable leaders to learn more about themselves, including how temperament and unique preferences influence their interactions with others. There are a variety of assessments available to promote self-reflection. For this Assignment, you are required to complete the DiSC Classic 2.0, but you are also encouraged to take or review additional assessments (e.g., Myers-Briggs, Keirsey Temperament Sorter, a 360-degree evaluation) on your own. As you engage in this learning process, it is important to remember that everyone—regardless of temperament type—experiences challenges and opportunities with leadership.

To prepare for this Assignment:

  • Reflect on specific instances in which a leader has had a powerful impact on you. These leadership examples may be ones that you consider unsuccessful, as well as those you consider successful; they may be from the health care industry, as well as from other fields. Consider the behaviors that you observed and how they relate to leadership characteristics and styles as well as values.
  • Complete the DiSC self-assessment and review your results. Be sure to save a copy of your results for future reference. Note: To access the DiSC Assessment, go the go the MyWalden main Menu, located on the top left and then go to Academic Resources > Explore All Resources.
  • Consider how the leadership examples you have identified and the statements in your DiSC profile relate to one another. What insights does this give you with regard to the following:
    • How you, personally, evaluate leadership effectiveness
    • Your own leadership strengths and preferences
    • Potential challenges or areas in which you need to strengthen your leadership skills and competencies

The Assignment

In a 2- to 3-page paper, address the following:

  • Provide two or more leadership examples that are personally meaningful.
  • Evaluate your leadership strengths and preferences, as well as potential challenges and areas for development. Be sure to refer to specifics of your DiSC profile, as well as insights from the Learning Resources.

Note: The paper should be 2–3 pages, not including the title and reference pages. Your Assignment must be written in standard edited English. Be sure to support your work with specific citations from this week’s Learning Resources and at least three additional scholarly sources. See the rubric for additional requirements related to research and scholarly writing