Energy Efficiency – a Replacement to Load Shedding

Load shedding is one of the biggest problem faced by everyone in Pakistan, no matter they are domestic or commercial consumers. Pakistan is facing a serious energy crises and it may get worse if not addressed seriously and promptly. Everyone is curious about the role of government in dealing with this issue and relieving consumers through immediate supply side solutions such as new power sources. Government is playing its role in establishing new power plants and potential of utilizing unleashed sources such as coal and renewable resources i. e. ind, solar etc. Domestic and commercial consumers contribute more than 60% in the total electrical energy requirement of Pakistan. Currently, maximum energy deficit is 5500 MW in summers and immediate solutions are unable to meet this deficit in near future. It is not recommended to a consumer to compromise on comfort by not operating some of the high priority appliances but slight change in behavior may contribute much more than expected. Main electricity demand contributors are cooling and heating appliances used by domestic and commercial users. In order to quantify the impacts of such appliances, research has been carried regarding the usage of air conditioners in Pakistan. Consumers have been suffering from crises in form of load shedding for hours in a day no immediate solution seems to be viable in extended summers. They tend to blame government and utility companies for not reducing load shedding. Energy could be made available for extended hours but a mass level awareness about efficient usage of energy is required. Illegal connections, usage of inefficient and unnecessary appliances at peak demand time has worsened the situation and utility companies seem helpless about it. They are not left with any other option to reduce demand except through load shedding. Air conditioners are one of the major contributors in peak load in summer. They comprise 15% of the total peak load requiring at least 3000 MW for the country. A survey regarding usage of air conditioners was floated as a part of this research and 300 domestic and commercial consumers responded to the survey. One of the conclusions of the survey indicated that 21 0C is the average control temperature for AC in households. From the same survey consumers were asked about the maximum control temperature used in household. The maximum average temperature was found to be 26 0C. In order to investigate the influence of this control temperature on household energy consumption and peak load demand, an experiment was carried out on two similar buildings in Karachi. Two rooms of the dimension of 12 X 16 X 12 ft were used for this purpose. One room was operated at 21 0C control temperature for 24 hours period while other at 26 0C. Observations and results indicated that a total of 0. 45 KWhr saving was recorded in the room having AC operating at 26 0C. If this saving is extrapolated to expected number of air conditioners in Pakistan, then a total of 14. 5 GWhr of electrical energy could be saved in a single day. In terms of power this can easily curtail a total of 607 MW out of peak demand, which is equivalent to some of the largest power plants in the country. If similar energy conservation techniques are applied for refrigerators and other cooling appliances then savings could be of much significant level. Due to ongoing gas load shedding scenario, consumers may start turning towards electrical heating appliances, which may potentially add up in electrical energy demand in near future. Large scale awareness is required at each level of consumption. Peak load shifting, discouraging illegal connections and utilizing energy in efficient way are our few life lines. A single consumer contribution may seem insignificant but as a whole it can contribute towards reduction of significant peak load.

Psycho Dynamic Model of Abnormality Essay

Psychodynamic model of abnormality- the Oral, Anal and Phallic stages of development. Freud suggested that psychological development in childhood takes place in a series of stages that occur throughout fixed periods of time, his theory suggests children develop though psychosexual stages which involve conflict which must be resolved. The Oral stage: This is the first stage of development which occurs at the age of 0-1 years. In this stage the mouth is the source of pleasure for the libido, at this age babies tend to gain comfort by doing things such as biting and chewing toys, breastfeeding etc. Feud also believed that oral stimulation could lead to oral fixation later on in life, for example behaviours such as smoking, biting nails etc. The Anal stage: This stage of development occurs at the age of 1-3 years. The child is now aware that their wishes and needs can bring them into conflict with the demands of the outside world indicating that an ego has developed. In this stage the libido is focused on the anal source of pleasure, conflict tends to come to a head in potty training when parent’s restrictions and going to the toilet in the right place at the right time are imposed on the child, Freud believed over strictness about forcing the child during potty training and cleanliness can cause anal fixation and obsessive behaviour later on in life. The Phallic stage: This stage of development occurs at the age of 3-6 years. Feud suggested that at this stage children become aware of their genitals and the libido is focused on this idea, suggesting that the child becomes aware of emotions such as jealousy, rivalry and fear and erotic attraction. This stage also focuses on the Oedipus and Complex’s. These behavioural types of development were suggested by Freud, the Oedipus complex which focuses on boy’s behaviour and desire to parents, and the Electra complex focussing on girl’s behaviour and desire towards parents. The Oedipus complex: Freud suggested that during the phallic stage young boys and girls go through a stage of desire for their parents, the Oedipus complex outlines the idea that boys develop strong desire for mother, they then Notice a strong bond between parents and Become jealous of father and afraid of the father who might discover the boys true feelings and fearing the punishment of castration is Resolved by identifying with the father. The Electra complex: During the stages of this complex Freud suggested that briefly, the girl desires the father but discovers she does not have a penis which leads to penis envy she then blames mother for her lack and transfer’s love from mother to father, the feelings are then repressed and Resolved by the girl Identifying with mother to become like her.

New Charter School Proposal Assignment Example | Topics and Well Written Essays - 750 words

New Charter School Proposal - Assignment Example However, henceforth first preference will be provided to students from its own school, the Mount Carmel High School. The Mount Carmel High School is being launched as a premium school with modern methods of learning. The school will engage its students in critical thinking, analysis, research and other resources that will markedly depart from the traditional pedagogy teaching alone. The school is open to students of all culture and beliefs without discrimination on the basis of race and religion. Learning by appropriate use of pedagogy, interactive technology, group discussions, and analysis will be encouraged. Students will also be encouraged to be involved in arts, music, and learning a foreign language. The learning curve with consist of the medium that engages the students’ interest from their early days in school. There will be extracurricular activities such as publishing of magazine, elocution, dance, an annual fair for the development of students’ mental faculties. Activities are aimed with the child’s all-round development in view. The school is expecting to start with the 6th grade with 80 students. This grade will be divided into four sections. So the teacher-students’ ratio will be not more than twenty students per teacher at any given time. The curriculum will consist of the key subjects, viz. language, mathematics, science, and social science. English will be the main language. Mathematics will comprise algebra and geometry. Students will have the options of studying the subjects through pedagogy, interactive technology or both. The options to study will be monitored regularly through appropriate tests. The students will be given enough time for learning and evaluations.

Are reason and emotion equally necessary in justifying moral decisions Essay - 5

Are reason and emotion equally necessary in justifying moral decisions - Essay Example A second way of knowing is through personal experience or self-witnessing. The media sources like newspapers and television may or may not always be trustworthy. One needs to use his or her own discretion elaborately before trusting the information. Sometimes we may believe in a certain aspect merely by our personal inspiration or intuition. This is the third way of knowing. Some concepts and ideas take birth in our brains and remain there as a piece of knowledge gained. Sometimes we might just rely on a feeling and an inner guidance that may lead us to the truth or the right path. A fourth way of knowing is by using reason and careful analysis. This is a powerful approach where knowledge may be gained by critically and logically analyzing the other three cases. (â€Å"Measurement, Evaluation & Research: Ways of Knowing†, 2008) Now, when we look at all the ways of knowing, we may conclude that finally each of them is flawed. As far as the first way is concerned, the book or text might consist of misprints and errors. There may be some information, which might differ from one book to another. Personal experience or eye witnessing is also dependent upon optical illusion or error of vision. Personal inspiration or intuition might also become invalidated or reason might not support this personal opinion. Again, reason might be right to one but wrong to another. Hence this way of gaining knowledge is not a valid one. However, Kerlinger provides a different angle to validate the four different ways. The first case, that is gaining knowledge by reading signifies a group’s belief and can be taken as the truth. This is the process of tenacity where the knowledge is common to a certain group. (Kerlinger 1973) In the second case, the personal experience one gains is at least true to the person concerned. The third method may be justified on the basis of personal intuition. Such a way of knowing may be justified on the basis of individual belief and

Online Writing Lab Essay Example | Topics and Well Written Essays - 750 words

Online Writing Lab - Essay Example You, I believe, would also be experiencing the same difficulties with language and culture that all people coming from other countries face during the early days adjusting in the new environment. The matter doesn't get any easier especially for an immigrant coming from a developing and a Muslim country like Pakistan in our case. Locals looking at us with a suspicious eye, jobs not easy to secure, investigation teams just around the corner waiting for us to make a wrong move etc are some of the problems that we have to cope up with. Apart from this there comes the problem of communication gaps that exist between the locals and people like us who use English as a second language. Writing applications, interview letters, and even writing and speaking simple words may elicit negative and undesired feedback due to inappropriate usage of grammar. Sometimes using correct sentence composition may land us in trouble since the usage did not convert to the same context in the local's minds due to cultural differences. Having experienced these issues myself, I have some encouraging news for you about how to avoid landing into tricky situations in front of your peers. Leafing through my computer files yesterday I found my solution to the cultural and language problems I had faced during my initial days in the United States. The solution was a simple Online Writing Lab called 'OWL' for short. An OWL is an always available facility which provides you free writing resources and instructional material on the internet. It is a portal where students, members of the community, and global users can find information to assist them with many writing projects while teachers and trainers can use the material for in-class and out-of-class instructions. Every country has its own set of rules and expectations about the ways to communicate in a business setting. In some countries, they may place less emphasis on written materials and more emphasis on verbal communication. However, in the United States, memos, letters, and emails are important and play a role in creating a person's business reputation. The 'OWL at Purdue' has a special section relating on how Non-Americans should go about writing for a business audience. It includes information on how to approach a topic by getting to the point, to keep the message simple, how and when to use active and passive voice with special emphasis on nondiscriminatory language, and a guide on using verbs rather than keeping the message vague. The best part of the Online Writing Lab is that it provides a teacher-student relationship as in a school yet a completely professional online environment just like in the case of distance learning. You can write a letter for your business purpose, but send it first to your teacher at the OWL from where you will receive instructions and training on how to improve your business writing. As a result you can then send the convincingly written revised letter for the business purpose you initially intended and get a firm response. Not only this, there is a lot more available on their website including basic formatting and referencing styles for business reports, demo letters and memorandums, and writing guidelines. Your reputation remains safe while all the time you learn how to make your writing skills even better. And while your writing skills improve, you are assured that your spoken language gets better. Your convenience is the key here. You can send emails, write letters or memos, and make corrections and revisions all at a

Supply chain management Essay Example | Topics and Well Written Essays - 1250 words

Supply chain management - Essay Example Some scholars revealed that they were unable to find the difference between purchase and supply chain management. Additionally, some marketing analysts have viewed supply chain management as about creating the purchasers creating good relations with their entrusted suppliers. Others argue that supply chain management is not good enough since it does not accommodate all the marketing processes from the industries to the consumers of the goods. The researchers involved these different people to sample their view about the supply chain management as part of the agenda 3. The theory of supply chain management tends to rotate between prescriptions, trend, and description. A major trend identified is the anxiety with the outcome of supply chain management on a variety of marketing functions.The current trend in the market is that supply chain is hastening the corporate theme and there is a lot of proof for this. For instance, some established companies have hired supply chain managers and there has been contest between supply chains rather than between the companies. 3. Christopher, M., (1998), Logistics & Supply Chain Management, Pearson Education Limited, Harlow. The above stated example gives a major problem in the discipline of supply network 4. Most businesspersons use an already established domain related with supplier-buyer behavioral mechanism although it has its own weaknesses. Most of these problems relate management issues, choosing the best supplier of goods among others and these can result from the failure of this field to try the broader concept of

Marketing Plan for Triumph Spares Limited Essay

Marketing Plan for Triumph Spares Limited - Essay Example Our market consist of both the final consumers and the b2b selling. However, it is noted that bulk of our sales are done through b2b channel, and only 20% of our sales is made to small customers through the shop. Therefore, we need to plan a strategy that will help us widen the both sectors and will lead to increase in the profits and revenues.The company has divided its market into two segments:Business Buyers: Here the deals are made with the other business and the company keeps a margin of 50%. This is the segment where the company earns the maximum revenue and almost 80% of its sales are made through this segment. Hence, we need to understand that this segment is most important to us in terms of its size and contribution to the profit. Hence, we need to devise a policy that sustains and grows the revenues earned from this segment. In other words, we can conclude that this is a priority segment for us. We need to look after this segment and need to give it much more importance and attention than the other sector. The sales made in this sector are in bulk and hence we can exploit on economies of scale if we continue to give importance to this sector given the size of this sector.General Public: This is the other market segment; we are currently selling our products to. Here the profit margins are high but the sales volume is very low, so we cannot rely just on this segment. We need to make sure that both the segments are sustained are served together if we need to maximize our profits.

Water Shortage In New Zealand Essay Example | Topics and Well Written Essays - 5000 words

Water Shortage In New Zealand - Essay Example This research report contained valuable information which included statistics (numerical data) as well as textual information such as information about the websites visited for accessing the data on Territorial Authorities in New Zealand and their various policies and approaches with regard to water supply in the country. Hence in order to enable ease of data recording, interpretation, and analysis, the decision to use and design the excel spreadsheet was made. Another crucial task was to ascertain the number of questions to be asked. For this purpose first, a tentative list was prepared and matched against the research objectives. Based on this criteria a final list of questions was shortlisted. This included a range of information on water supply in the country categorized on the basis of territorial authorities (TAs). A total of 70 TAs were shortlisted and questions such as whether the said TA offer advice on water conservation; whether they have a water meter in place, how much a mount of water is supplied to individuals as well as industries; whether the TAs have any plans to implement a water restriction; the existing state of water charge across all TAs etc., and among others. This paper makes a conclusion that the key purpose was to ensure that the questions asked helped in answering the broader research objective. The list of questions compiled was extensive and comprehensive and enabled access to crucial information regarding the state of water supply in the country.

Employee Safety, Health, and Welfare Essay Example | Topics and Well Written Essays - 750 words

Employee Safety, Health, and Welfare - Essay Example Thirty days before the leave, a notice should be given to the employer, or in case of emergency, as soon as possible. Employers can also ask for a medical certificate of the employee, spouse, and son, relative or of whoever has a serious illness that causes the leave. Upon the return of any employee from a leave, his position, benefits, salary and other conditions should still be the same. ( U.S. Office of Personnel Management) Accidents can never be avoided and it comes very unexpectedly. That is why the worker's compensation law was imposed to ensure the medical support that an employee will receive in case of an accident. The worker's compensation law has several benefits available depending on the different factors such as the graveness of the injury, the ability of the worker in his work, the level of his disability whether it will be permanent or temporarily only, the availability of his job, and the need for health assistance. The compensation is usually calculated as two-thirds of the gross average weekly salary of the employee. (Moorehead) One type of benefit includes the medical treatment for the job injury or disease which is only available while recuperating and have'nt reached the maximum recovery. For a case of an intense injury or disease, medical benefits may last a lifetime. The employer is resposible for all the medical expenses of the injured employee including the health services, supplies, medicines, and other necessary care without deductible pay from the employee. Temporary weekly benefits willl be granted while the worker is unable to work because of his injury or disease and will end when he returned to work or when the doctor certifies that he has recovered. The compensation will not be paid in the first week of the temporary total disability unless it resulted a disability of more than fourteen days, but the compensation will be paid from the date of disability. (Moorehead) When an employee has reached his maximum healing but still unable to work, such as when you injure your eyes, back and other body parts that will not function as good as before, permanent partial disability benefits should be granted with the appropriate percentage loss or malfunctioning of the body parts. Limits on compensation depends on the body part that is not functioning well and to the empployee's weekly compensation rate. This is paid together with the temporary total disability benefits. (Moorehead) In case of a very severe injury that it is no longer enabling the employee to be engaged in any kinds of work, a permanent total benefit is entitled to him wherein he will be given a five hundred weeks of compensation plus a lifetime medical treatment for his injury. If unluckily, the employee died within two years of disability, or while the total disability continues or within six years after the accident, the relatives of the diseased employee should receive 66.67 percent of his weekly wages for a period of 5five hundred weeks. (Moorehead) The Occupational Safety and Health Act

Antigone Essay Example for Free

Antigone Essay Evil not only fascinates people in general, but writers as well. In what ways and with what effect has â€Å"evil† been treated in Antigone? In the play of ‘Antigone’, evil appears in many forms. There is the soldier who is a traitor to his nation; the sister trying to prove her love for her family yet ends up breaking the law; the king who so eagerly tries to stop rule-breakers yet he himself neglects his flesh and blood. Here the difference of the two works is seen: The Earth of Mankind gives the impression that characters of power possess evil, whereas in Antigone, evil can be inside all of these opposing individuals. Polyneices, a soldier who fought against his own nation was to be punished as a traitor by not burying him after his death. When his sister, Antigone, goes against the King’s decree and burry Polyneices, she was also seen as a traitor to her country. However their other sibling, Ismene, who sits at home as Antigone fights for her brother’s right, is also said to have performed a crime of being a traitor to her family. Now something we can see from here is that each and every character involved in the story so far possesses evil. This message is summed up by Sophocles in page 204 of the book, in Ode 1, where it says, ‘O fate of man, working both good and evil! ’ What the writer is trying to convey here is more realistic than what is said in ‘The Earth of Mankind’; both evil and good is naturally inside everyone’s mind. It is one’s choice to do which, but performing a crime is inevitable. Everyone has his or her own ‘evil’ deeds, not only the powerful ones. As seen in my previous explanation on who performs evil deeds in the play of ‘Antigone’, we can see that one evil act leads to another, whereas the chain of good doings ends sooner. Eteocles, who was a soldier and a brother to Antigone, fought bravely for his nation and was buried with honor by the King. Although many respect him for his virtuosity, the play didn’t show that further kindness was done because of him. However, when Polyneices betrays his nation and fought against it, a number of people are forced to perform evil in his affect. Antigone had to break the law in order to give him his right of getting a burial. Ismene, who was too scared to go against the decree, was said to be a traitor to her family, as she didn’t come to assist Antigone in her mission. They then cause Creon to imprison the sisters, punish them, which then cause him to have a fight with his son. Creon then causes death of Haimon, and therefore leads to the suicide of the Queen. On page 243, the messenger says, ‘†¦and her last breath was a curse for their father, the murderer of her sons. ’ A number of misfortunes occur as being the result of one act of evil. The play now gives the effect that evil gives more negative outcomes in comparison to good giving positive results. Here, evil is powerful enough to make such a big impact on its surrounding; bigger than the good. Creon sees Antigone as a traitor to his rules, despite her reasons. Creon imprisoned both Antigone and Ismene for the burial of the nation’s traitor, Polyneices, who is their brother. It is true that Antigone has broken the law, but according to her logic, it is more important to follow the rules of the Gods than the King. She feels that the dead, no matter what they did in their lives, deserve respect and be buried, and that it was her duty to do so as Polyneices’ sister. She didn’t care that she is breaking the decree, and may be punished to die, as long as this task is done. Creon, being a non-believer of the Gods in the beginning, thinks that breaking the law is crime, no matter for what purpose. Polyneices was a traitor and he suffers because of himself, thus no one should help him. On page 211, Creon even said to Antigone, ‘An enemy is an enemy, even dead. ’ There is truth in both arguments, and no one can say what is right. Here, the play depicts that the existence of evil depends on how one views it. ‘Antigone’ treats evil as a subjective topic, where it may be seen as a crime from one point of view, but is actually a good deed from another. No evil deed is done without a reason, and the play shows that one should explore, not only what crime has been done, but also why it was done.

Measuring Patient Dependency in Clinical Settings

Measuring Patient Dependency in Clinical Settings Title: Should patient dependency be used to set nurse-staffing levels in general hospital wards? Introduction: In this section, we perform a literature review to discuss patient dependency in clinical settings, and examine how we can measure patient dependency levels. We also discuss whether patient dependency levels should and could form the criteria for setting nurse-staffing levels in the hospital. We will also analyze the other different methods and criteria that can help to determine nurse staffing levels within the clinical setting. Patient dependency levels indicates the requirements of nurses and the extent to which patients will need nurses for their continuous care. Nurse patient ratios are often used to discuss the nurse staffing levels and these figures indicate whether staffing levels have to be increased or decreased. We would aim our discussion of patient dependency necessitating increase in staffing levels and the patient nurse ratio as indicators of nurse staffing both within general hospital wards and at critical care and emergency units. Evidential Information Patient dependency may just form an important part of nursing staff and workload of an individual nurse. Hurst (2005) conducted an important study on the nature and value of dependency acuity quality (DAQ) demand side nursing workforce-planning methods, which are set in the context of nursing workforce planning and development. Extensive DAQ data was obtained from UK nursing workforce in 347 wards, which involved 64 high quality, and 62 low quality hospital wards. The study gives special consideration to workload and quality contexts. New insights have been generated with this study and Hurst emphasizes that poor quality care is more common in larger wards that have fluctuating and unstable workload and nurse – patient ratio. Smaller workloads having consistent and high workload of nursing staff results in inflexible nurse staffing so staff levels and performed duties remain the same. Studies definitely suggest that nursing activity and staffing differences do form an importan t part of defining and contributing to the quality of the wards with higher staffing levels and more consistent work for nurses at high quality wards and lower staffing levels and irregular services with low nurse-patient ratio in low quality wards. From this evidence, it is possible to provide recommendations for nursing management and practice and probe into more accurate relations of dependency acuity quality in DAQ measures. In a study using assessment of patient nurse dependency systems for determining nurse-patient ratio in the ICU and HDU, Adomat et al (2004) point out that a huge range of patient classification systems or tools are used in critical care units to inform workforce planning, and nursing workload although the application of these methods may not always be relevant, complete or appropriate. The systems or tools used for patient classification and categorization were developed solely for the purpose of more efficient distribution of patient across hospital sections, although now the same systems are used for workforce planning, distribution of workload, determining nurse-patient ratio in critical care settings. However these changes can raise a number of issues related to workforce planning, staffing levels and nursing management in general. Adomat and Hewison evaluate the three main assessment systems used in critical care units to effectively determine the necessary nurse-patient ratio t hat can provide the best quality service in the wards. The application of these tools is to enhance the quality of care by keeping nurse-patient ratio at its optimum. The authors suggest that decisions relating to workload planning and determining the nurse patient ratio are dependent on an understanding of the origins and purpose of the classificatory tools that categorizes patients and measures their dependency on care services. Patient dependency and classification systems as well as patient dependency scoring systems for severity of illness are measures indicating mortality and morbidity although Adomat points out that these dependency measure may not be real indicators or determinants of the nurse-patient ratio that help in measuring nursing input. The costs of providing a nursing service within critical care uses nursing intensity measures to give a framework for nursing management and patient care and also determines the exact role of patient dependency in nurse staffing leve ls. However, components of the nursing role and how it determines standards of care have not been fully determined (Adomat and Hewison, 2004). They point out that careful consideration of patient dependency and classification systems may be necessary to plan, organize and provide a cost effective critical care service. In a similar study, Adomat and Hicks (2003) evaluates the nursing workload in intensive care a there is a growing shortage of nurses in these care units. The problem identified in this shortage lies in the method for calculating the nurse/patient ratio using the Nurse Workload Patient Category scoring and classificatory system use in most intensive care units. The nurse-patient ratio is determined by using the patient category or dependency scales and the general assumption is that the more critically ill a patient is, the more care and nursing time will be required for the patient. Many critically ill patients placed on a high level of mechanical care such as a feeding or ventilator tube and in intensive units may however require less direct personal nursing care than patients who are self ventilating or have been considered to have lower levels of dependence. Thus patient dependence may be addressed by means other than direct nursing care and artificial care and support systems may b used instead of nursing staff. These and other factors show that patent dependency may not be a completely relevant measure for determining nurse –patient ratio or nurse staffing levels and many associate factors have to be considered. This study by Adomat and Hicks use a video recorder to document nurse activity in 48 continuous shifts within two intensive care units and helped to determine the accuracy of the Nursing Workload Patient Category scoring system to measure nurse workload. The data obtained from the video of nurse activity was then correlated with the Patient category scale score that was allocated to the patient by the nurse in charge. The results of this study showed that the nursing skills required in these care units were of low skill type despite the needs of care being complex in general. It was found that nurses spent less time with patients who were categorized as in need of intensive care than those in need and in high dependency range in all units. T he findings indicate that existing nurse patient ratio classifications are inappropriate as nurses spend less and less time with critically ill patients. The authors expose the flaws of classification or scaling systems that tend to correlate care with critical illness. They suggest that radical reconsideration of nursing levels and skills mix should make it possible to increase provisions and levels of intensive care providing the right numbers of staff at the appropriate units where patients need them most suggesting more flexible and alternative approaches to the use of nurse-patient ratios. In a similar study discussing relationship between workload, skill mix and staff supervision, Tibby et al (2004) proposes a systems approach and suggests that hospital adverse events or AE are more likely when sub-optimal working conditions occur. Proper working conditions are thus absolutely necessary to ensure the smooth working of the clinical setting. Tibby and colleagues analyzed the adverse events in a pediatric intensive care unit using a systems approach and observational study to investigate the association between the occurrence of these adverse events and latent risk factors including temporal workload, supervision issues, skills mix, nurse staffing and the interactions between established clinically related risk factors (Tibby et a, 2004). The data was collected form 730 nursing shifts and the analysis was done with logistic regression modeling. The rate of adverse events was 6 for every hundred patient days and the factors associated with increased AE including day shift , patient dependency, number of occupied beds, and simultaneous management related issues although these were considerably decreased with enhanced supervisory ability of the nurses. Decreased number of adverse events have been found to be related to the presence of a senior nurse in charge, high proportion of shifts handled by rostered, trained, permanent staff and the presence of junior doctors. Patient workload factors such as bed occupancy and the extent to which the patient needs help and nursing supervisory levels and level of staffing such as presence of a senior nurse have been found to be associated. This study sheds light on the factors increasing or decreasing adverse events and helps in identifying the issues closely related to the need of regulating and optimizing nurse staffing levels. As we have already suggested through a study by Adomat and Hicks, patients in high dependency units may require more frequent nursing care and higher nurse-patient ratios than critical care units where patients may be supported by artificial methods. According to a study by Garfield et al (2000) high dependency units are increasing in the hospitals and becoming more important as part of a hospital’s facilities. Although the optimum staffing ratio for patients is unknown for such units, the Department of Health and Intensive Care Society recommend a level of one nurse for every two patients. Garfield et al recorded Therapeutic Intervention Scoring System scores and Nurse Dependency Scores in high dependency units over 7 months. The results indicated a weak correlation between nurse dependency score and therapeutic intervention scoring system score. The authors argue that a nurse-patient ratio of 1:2 may be insufficient for the management of a high dependency unit and based on t heir findings recommends a nurse to patient ratio of 2:3. Balogh (1992) points out that the literature on audits of nursing care shows a strong relation between the quality of nursing care provided and nursing labour force and staffing issues. Balogh suggests that all assumptions for setting nurse staffing levels on the basis of variations in patient dependency are unscientific and there are moreover no opportunities to use personal judgment in decision-making within hospitals to determine nurse-patient ratios. Balogh points out that such methods for determining staffing levels as well as audit instruments are outdated and insufficient to optimize service levels. The paper highlights the need for greater flexibility, more decision making power, and a more significant role of nurses’ personal judgment in selection and management of appropriate nurse staffing levels in dependency and critical care units. Conclusion: In this review of literature on the exact role of patient dependency in determining nurse staffing levels, we began by suggesting that it is generally believed that the more critical condition a patient is in, the higher the requirements of direct care suggesting that nurse patient ratio should be high in critical care units. This assumption however has been refuted by studies which shows that such clear criteria may not be sufficient for nurse management and staffing level decisions and other factors have to be considered. These include artificial means of life support and other mechanical devices that minimizes the need for manual staffing and reduces a critical patient’s nursing needs. A related study suggested that high dependency units rather than critical care units should be provided with higher levels of staffing although many other factors such as supervisory levels of senior nurses, skills available and already established method of determining nurse patient ratios s eem to be crucial factors. Along with the approach taken by several authors we can also suggest that personal judgment of nurses on the care needed by patients rather than inflexible scaling or scoring systems should be used by hospitals to determine staffing levels, considering patient dependency levels as well. Bibliography Adomat R, Hicks C. Measuring nursing workload in intensive care: an observational study using closed circuit video cameras. J Adv Nurs. 2003 May;42(4):402-12. Adomat R, Hewison A. Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approaches. J Nurs Manag. 2004 Sep;12(5):299-308. Ruth Balogh Audits of nursing care in Britain: A review and a critique of approaches to validating them International Journal of Nursing Studies, Volume 29, Issue 2, May 1992, Pages 119-133 The importance of data in verifying nurse staffing requirements Intensive Care Nursing, Volume 4, Issue 1, March 1988, Pages 21-23 Lynne Callaway and Edward Major Curtis C. A system of measurement of patient dependency and nurse utilization. Aust Nurses J. 1977 Apr;6(10):36-8, 42. Donoghue J, Decker V, Mitten-Lewis S, Blay N. Critical care dependency tool: monitoring the changes. Aust Crit Care. 2001 May;14(2):56-63. Garfield M, Jeffrey R, Ridley S. An assessment of the staffing level required for a high-dependency unit. Anaesthesia. 2000 Feb;55(2):137-43. Hurst K. Relationships between patient dependency, nursing workload and quality. Int J Nurs Stud. 2005 Jan;42(1):75-84. Hearn CR, Hearn CJ. 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