Influence of Culture on Cross-Border M&A Activity

QUESTION
How does culture influence cross-border M&A activity? Illustrate this relationship using examples, either real (even anecdotal if you have any) or conceptual. How do similar and dissimilar cultures affect pre- and post-merger performance?
ANSWER
1. Introduction
Organizational culture will not be the main focus of the study since its impact on M&A activity has been studied in depth in management literature. A holistic case study of the merger between the German company Daimler-Benz and US firm Chrysler will be used since this is considered a classic example of clash of national cultures. The inductive methodology used in the Daimler-Chrysler case will be initially used in the attempt to separate national culture from organizational culture and study its direct impact on M&A activity. Any findings and conclusions drawn from this case study will be initially tested against any theory provided in management literature. The aim in the end is to possibly come up with a new model explaining the impact of culture on M&A activity, which will be a useful framework for managers in the future.
In this research paper, the focus will be on studying the importance of culture in M&A activity. The objective of the paper is to separate the impact of national culture from organizational culture on M&A activity. The distinction between the two is important since national culture is considered an unmanageable force a firm encounters when it operates in a foreign environment, while organizational culture is a manageable force the firm can manipulate in order to coordinate and integrate activities when working with a potential partner.
Globalization has led to ever-increasing business activity across national borders. This has fueled the pace of cross-border mergers and acquisitions (M&A) in today’s global economy. Culture has been identified as a critical factor which has a significant impact on the outcome of international business activity. Cross-border M&A is an activity that takes place when a company from one country merges or takes over the assets of a company in another country.
1.1 Importance of Culture in Cross-Border M&A
Despite the prevalence of literature regarding the role culture plays in business, in particular cross-border mergers and acquisitions (M&A), it remains a relatively unexplored and underestimated factor in comparison to other theoretical lenses such as synergy or agency theory. It is widely recognized that national cultural differences are to be found in the differing thoughts, actions, assumptions, and a range of behavioral and material artifacts (Hofstede, 2002); all of which are key components of a society. That said, the fragmented and multidisciplinary nature of cultural theory development to date, it has yet to be fully integrated into M&A research and practice. However, there are various instances within the literature that infer assumptions to the effects of culture on M&A. For example, it is often cited as a reason for failure (Cartwright and Cooper, 1992), a costly barrier to be overcome during post-merger integration (Haspeslagh and Jemison, 1991), or a factor that should be included in the pre-acquisition screening process (Prahalad and Doz, 1987). While these examples bestow importance, it is not sufficient evidence to unequivocally prove it as a critical factor in M&A, and to date there is no defined framework or model that seeks to understand culture with respect to an entire M&A process. This is not to say cultural impact is always negative; a recent study by Stahl and Voigt (2008) identified that high cultural differences between two companies could lead to a lesser likelihood of bidder overpayment in an acquisition deal. However, the context of this result was within financial terms rather than the long-term integration process, and as aforementioned, this is not a widely explored area. With this considered, on the basis that culture is a central aspect of national identity, it can be viewed as a key and relevant aspect to any process involving two differing nations or organizations. This does not necessarily imply that any M&A between two differing national organizations will be heavily influenced by culture, for culture is a very broad and subjective concept, and there are varying levels of cross-border M&A; hence, the theory suggests that cultural impact will vary depending on the circumstance.
1.2 Objectives of the Study
The primary goal of this project is trying to figure out the impact of national and organisational culture on cross-border mergers and acquisitions, in the hope that better understanding of the influence of culture can help in avoiding some of the obvious pitfalls, and lead to successful integration which is the ultimate mark of a successful M&A activity. As this is an exploratory study, no hypothesis is put forward as it seeks to find new insights and information in the hope of forming a new theory. This has led to much of the research being in a more qualitative manner, although many questions do lend themselves to quantitative analysis. Measures of national culture provide a good base to look at the cultural issues, and matched-pair studies of companies involved in M&A activity can give good indications of the influence of culture on M&A and what actually occurs during the process. By looking at the level and nature of the increased M&A activity in the last 15 years, from the standpoints of both acquiring company and target firms, insights can be gained as to why the increase in M&A activity has led to mixed results, and how culture may be a key factor regarding this. Being an exploratory study, no specific culture dimension or issue is singled out, rather it looks at broad overall influence that culture may have at the national and organisational levels. A literature review is done on the failures and success stories of M&A activity, and there have been many case studies that offer comparisons such as two companies of different nationalities, one which has succeeded in M&A activity and one which has not. This provides much insightful data for the matched-pair studies and goes towards meeting the goals of this research.
1.3 Methodology
Another belief is that the culture of a society can be described by the values and norms present (Tayeb, 2000). Although it is possible to measure culture directly with various means, indirect measurement is probably the most effective, possibly using a society’s political or legal systems as a function of the culture it represents. Due to the breadth of values, norms, and the multi-level nature of culture, measuring the exact effects of culture on M&A activity is problematic and has only been extensively attempted by the very biggest firms in simulated training exercises. This encompasses a number of variables that would be best done by multiple means and at various levels, to provide a comprehensive understanding of the various issues involved. This too is evident throughout the research, as nearly all the micro-level events that created problems during M&A could always be related back to a difference of values or norms.
The research’s underpinning philosophy is the belief that culture affects behavior. This belief was supported by Yalcintas (1981), Guy and Beddow (1983), and Seth (1986). Yalcintas suggested that M&As were of an international nature and therefore present many problems in terms of differences in national policies, mentalities, and ways of doing business. Guy and Beddow and Seth also suggested that the variables of nationality and culture were of major import in M&A activity and provide one of the better frameworks within which to understand M&A behavior (Guy and Beddow, 1983; Seth, 1986 cited in Cartwright and Cooper, 1993). This belief was held throughout the EFA and case study and remained evident in the various responses received during the research, and some of the contradictions and practical problems that were found; each of which was possible to explain by cross-cultural differences. If we consider Schneider and Barsoux’s argument that cultural variation causes different mental programming, which creates ambiguity in cross-cultural encounters (Schneider and Barsoux, 1997), i.e. different behavioral patterns and an expectancy of behavior between parties in the M&A, the importance of effects of national factors and culture in M&A become more transparent.
II. Essay Summary
2. Theoretical Framework
2.1 Definition of Culture
2.2 Cultural Dimensions
2.2.1 Power Distance
2.2.2 Individualism vs. Collectivism
2.2.3 Masculinity vs. Femininity
2.2.4 Uncertainty Avoidance
2.2.5 Long-Term Orientation
3. Cultural Influence on Pre-Merger Performance
3.1 Cultural Due Diligence
3.2 Cultural Compatibility Assessment
3.3 Communication and Integration Challenges
3.4 Leadership and Decision-Making Styles
3.5 Employee Motivation and Engagement
4. Cultural Influence on Post-Merger Performance
4.1 Organizational Culture Alignment
4.2 Change Management Strategies
4.3 Employee Retention and Talent Management
4.4 Knowledge Transfer and Learning
4.5 Performance Measurement and Control Systems
5. Case Studies
5.1 Cross-Border M&A Success Stories
5.2 Cross-Border M&A Failures
5.3 Lessons Learned
6. Conclusion
6.1 Summary of Findings
6.2 Implications for Cross-Border M&A Practitioners
6.3 Recommendations for Future Research

Investment Risk and Return Analysis

Questions
What is the Expected Rate of Return on an investment and what does it tell us about the probability of the risk involved with a particular investment?
In terms of risk, what are the advantages (and/or disadvantages) of a well-diversified portfolio?
Investments are based on the belief that the rate of return justifies or compensates the investor for the risk associated with that particular investment. The risk associated with this investment is associated with the chance that a loss will be incurred. Or, to put it another way, the greater the chance of a loss the riskier the investment. Therefore, some statistical measures of the risk involved with an investment are necessary before the investment is made.

Answers
1. Introduction
The risk and return analysis is a part of the standard investment decision-making process. It is a process in which we compare the expected returns of an investment with the risk associated with it. The general rule for any investor is that the higher the risk of an investment, the higher the expected return. This rule is critical to the decision-making process as the main objective for any investor is to maximize the return on their investment and minimize potential losses. Risk is a measurable possibility of losing or not gaining value. Whereas, return is the reward for taking the risk. Both of them have the same connotation throughout this chapter as in the higher risk or low-risk investment and its effect on the investment’s potential return. Often investors are not concerned with the risk of an investment in its entirety but more the risk of a poor outcome. In this case, the poor outcome would occur when the actual return on an investment is less than what was expected. A poor outcome may have various implications, for example, an individual expecting to finance his retirement with an investment in stocks might consider a poor outcome to be an investment value less than the financing of a comfortable retirement. A main element in the process of risk and return analysis is determining which investment decisions affect the certainty of expected future cash flows. This is because the analysis aims to compare the expected returns with the risk and if there are no changes to the expected returns of an investment then the risk has no impact. This is unlikely to be the case, for example, currency fluctuations and changes in economic conditions can all affect the expected return on an investment. Therefore a decision by the investor to hold onto the investment, invest in it more or take money out of it should be considered as an investment decision that affects the future cash flows and should be included in the analysis. A decision to include it in the analysis may result in the investment in question showing various rates of return and have a different risk. This decision is known as a marginal decision and the analysis of it using the marginal expected return and the marginal rate of time preference is an important aspect of the general risk and return analysis.
1.1 What is the Expected Rate of Return?
The expected rate of return often represents the mean of a distribution of all possible results and is often a probability-weighted calculation influencing the probability that a certain rate of return will happen. This does not have to represent an actual return at all and could be a guess. For example, an investment in the shares of a relatively new and small company with a chance to take a stake in the market of a big industry leader by a takeover of a likely inflated share price could have an expected return, considering the probability of this happening, of say 20% higher than the market, despite only being issued a dividend rate based on the shares.
The expected rate of return is a crucial concept in investment due to the fact that it measures the profitability of an investment or a business. By totaling up the expected earnings from a provided investment over its whole life, then reducing that figure by the original investment, we get the net profit. But in order to determine the profit and the risk of the investment, we need a way of comparing it with other investments of similar magnitude. This is where the expected rate of return is beneficial. By determining the rate of return, we can compare an investment to others to see if it is more or less profitable. And by using the return and risk as a single measure, we can compare to see which is more or less preferable. This is valuable to individuals and businesses, and certainly to financial and investment groups, such as corporate investors and pension funds.
1.2 Understanding the Risk-Return Tradeoff
The concept of risk is intuitively understood. An investor would prefer to receive a higher future payment with certainty than a lower one or one that may or may not eventuate. Probability of distribution of possible future returns is a determinant of the risk involved. Every investment has a possible range of future outcomes to the investor, some more certain than others. A US Treasury bill is regarded as a nearly risk-free investment because the borrowing of current funds by the government issued any no direct value to the bill holder so the bill can be repaid by any future revenue. However, bonds on the other hand are not as certain in terms of a return as stock it is also an uncertain investment. An example would be General Motors buying back many of its bonds prior to maturity and thus avoiding the interest and the principal repayment because of their uncertain financial position in relation to the bond issue. GM may be willing to buy the bond back at a higher price than it issued it for in which case there would be capital gains to the bond holder. So the bond has still uncertain future outcome for GM and the bond holder.
Investment can be broken down into financial and real investment. Using the tuition fee example, it is a real investment as it is an outlay that is expected to produce future benefits (a higher paying job). Financial investment on the other hand is the purchase of a financial asset e.g. a stock or share with the expectations of future income which will be spent on consumption. Whether you are buying stocks or paying tuition fees both can be considered taking a risk as there is always the chance of receiving all or some of the money paid back in the future. Foregone earnings on an investment have the same value as the income that could have been obtained from the job or unemployment requires no spending of the earnings so it is effectively saving the amount of the job and not earning any more than that amount.
An investment is the current commitment of dollars for a period of time in order to derive future payments that will compensate the investor for: (1) the time the funds are committed to the investment and (2) bearing uncertainty about the future size of those payments. There are two types of investment. You are considered to be an investor if you put aside £20 of your weekly income. Your £20 can be looked upon as capital to be invested in a financial or a real asset. However, not all capital expenditure will be considered an investment from an economic perspective. An economics student paying tuition fees can be effectively thought of as investing in themselves but the payment is not included in investment.
2. Risk Measures in Investment Analysis
2.1 Standard Deviation as a Risk Indicator
2.2 Beta Coefficient and Systematic Risk
2.3 Sharpe Ratio and Risk-Adjusted Return
3. Evaluating Investment Risk
3.1 Advantages of a Well-Diversified Portfolio
3.1.1 Spreading Risk Across Different Assets
3.1.2 Reducing Unsystematic Risk
3.1.3 Potential for Stable Returns
3.2 Disadvantages of a Well-Diversified Portfolio
3.2.1 Lower Potential for High Returns
3.2.2 Limited Exposure to Individual Asset Performance
3.2.3 Potential for Lower Market Timing Opportunities
4. Quantifying Risk in Investments
4.1 Risk-Adjusted Return Measures
4.1.1 Treynor Ratio and Portfolio Performance
4.1.2 Jensen’s Alpha and Manager’s Skill
4.1.3 Information Ratio and Active Management
4.2 Value at Risk (VaR) and Downside Risk Analysis
4.2.1 Estimating Potential Losses
4.2.2 Assessing Tail Risk
4.2.3 Portfolio Optimization and Risk Control
5. Conclusion

Learning Theories and Principles for Advanced Practice Nurses

Question
Which learning theories and principles do you think are most useful to the advanced practice nurse (APN) in providing high quality health care to clients, and why?
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points.

Answer
1. Introduction
The aim of this book is to trace the history of and examine the effectiveness of specific theories and principles for learning. As the first step in our research, a review of the literature on teaching and learning was conducted to understand the full scope of APN’s role as an educator. Much of the research on teaching and learning in advanced practice has been conducted on medical residents and physicians, so we have included literature from the medical field when the education context is pertinent. A small portion of the literature reviewed was found to be specific to advanced practice nursing education, and even less specifically related to nurse practitioner education. Therefore, some literature pertaining to undergraduate nursing and APN relevant clinical teaching was included as principles of learning are often transferable to different educational audiences. Kahn and Nauta state that often times health care providers must act as educators to bring about changes in patient behavior and clinical outcomes. As such, it is important for APNs to not only understand how adults learn but to have a thorough understanding of the teaching-learning process and be competent in specific educational strategies if they are to bring about changes in patient outcomes. This increasing focus on nurse practitioner-led patient education and sustained behavior change led us to include educational literature of learning theories and teaching strategies. Finally, we wanted to learn from the medical education community and other health professions about what has been effective in teaching and learning to apply similar strategies for educators in advanced practice nursing. This information was then used to narrow the scope of our study to select theories and principles that have the most impact and are most applicable to nurse practitioner education. Steps in theory development and testing have been integrated in the examination of specific theories.
1.1 Importance of Learning Theories and Principles for APNs
Learning theories can provide strategies to manage information and critically appraise which resources will be beneficial to their own learning and ultimately improve patient care. Finally, in understanding learning theory, the APN can enhance their own educational role. With the growth of nursing graduate programs, an increasing number of APNs are now in the position to educate future nurses. Knowledge of learning theories, curriculum design, and teaching strategies are critical to this role and fundamental if the educator is to develop competent practitioners who will improve patient care.
Knowledge of learning theory will provide scaffolding to assess individual patients’ learning needs, create an environment that is conducive to learning, build patient motivation, and implement effective teaching strategies. In addition to patient education, learning theory can guide the APN in their own learning. With the rapid expansion of new medical knowledge and virtual explosion of information resources, it is becoming increasingly important for APNs to be lifelong learners.
Knowledge and understanding of learning theories are critical for the APN as it provides the foundation for the strategies and techniques that can be employed to facilitate learning. With diagnoses being more complex, care delivery more diverse, and patient education a common practice, it is imperative that APNs have the skills to enable patients to learn and change behaviors in the healthcare setting.
Descriptive theories describe learning, teaching, and development and are the most concrete of the three. Therefore, they are easier to test through assessment. Prescriptive theories provide strategies or interventions to bring about change in a prescribed direction and have a good chance of being tested. Explanatory theories are so complex that it is uncertain as to whether or not they can be tested (B. Young, 1998).
Learning is an experience of obtaining new knowledge or developing existing knowledge, skills, and abilities and is vital to advanced practice nursing (APN) educational paradigms. Various learning theories attempt to explain this complex phenomenon. There are numerous classifications of learning theories. However, for the purpose of this discussion, the focus will be on three main types: descriptive, prescriptive, and explanatory.
1.2 Purpose of the Study
This research was designed to provide a framework for applying educational theory to an educational program for advanced practice nurses (APNs). Administration of health care is changing dramatically as a result of shifts in demography and policy. This climate requires development of innovative educational programs designed to prepare APNs for new roles in delivering health care to the public. In the last several decades, education has moved from the idea that teaching is simply content delivery to an understanding that learners need to be active participants in the learning process (Knowles, 1980; Eraut, 2000). This change has led to the development of a number of theories to guide the design of learning environments and activities. However, many educators are not familiar with these theories and have difficulty translating them into practice. At the same time, there has been an explosion in research and theory development in the field of nursing education, much of which parallels educational theory outside the discipline. Yet, much of this knowledge has not been consolidated or organized into a framework that is useful for curriculum development. Learning theories and principles are the building blocks for models of effective instruction. We propose that a better understanding of learning theories and principles can help educators develop an innovative curriculum to prepare APNs for complex health care roles in today’s society.
2. Behaviorism
2.1 Classical Conditioning
2.2 Operant Conditioning
2.3 Observational Learning
3. Cognitive Theory
3.1 Information Processing
3.2 Schema Theory
3.3 Problem-Based Learning
4. Social Learning Theory
4.1 Vicarious Learning
4.2 Self-Efficacy
4.3 Modeling
5. Constructivism
5.1 Experiential Learning
5.2 Inquiry-Based Learning
5.3 Collaborative Learning
6. Humanistic Theory
6.1 Maslow’s Hierarchy of Needs
6.2 Person-Centered Care
6.3 Motivation and Self-Determination
7. Adult Learning Theory
7.1 Andragogy
7.2 Self-Directed Learning
7.3 Transformative Learning
8. Application of Learning Theories in APN Practice
8.1 Enhancing Patient Education
8.2 Improving Clinical Decision-Making
8.3 Promoting Evidence-Based Practice

Management and Governance: Ownership and Control, Board Structure and Firm’s Interactions with the Markets PNC Bank

QUESTION
Management and Governance: Ownership and control, board structure and firm’s interactions with the markets PNC BANK
ANSWER
1. Ownership and Control
PNC is a public company and its shareholders have the right to vote on many major decisions affecting the firm. Under the PNC Investor Profile on Yahoo Finance, it is indicated that shareholders have the right to vote on major decisions such as mergers and acquisitions, election of directors, and changes to the company’s charter. With the recent acquisition of National City Corporation, this will be an important time for PNC to maintain shareholder approval for any future decisions. As the right to vote is useless unless it affects an outcome, absolute voting rights are the best situation for the effective use of ownership as a control mechanism. In the case of dual-class stock, the class of stock with superior voting rights has better control than cash flow rights in the same number of shares. This is relevant to PNC as the recent acquisition of National City Corporation has resulted in PNC having issued non-cumulative perpetual preferred shares series B with a liquidation value of $3.7 billion, which carries a higher vote entitlement than common shares. Changes to the company’s charter may dilute voting value and shareholders may protect themselves against this by buying and selling different classes of shares. Measures such as these to protect voting rights are important and PNC shareholders have the right and freedom to hold shares in and to effectively use power to influence the company’s decisions. However, at times, voting rights may also have adverse outcomes for shareholders, so it is important that shareholders have the freedom to sell shares.
The efficiency of stock ownership as a monitoring and control mechanism depends critically on the rights of shareholders to key decisions. McNulty (1966) defines corporate control as the power to influence or make decisions on the allocation of resources by a firm. Shareholder rights, which refer to the right to vote, the right to sell shares, and the right to protect shares against dilution, are an important mechanism in any public company for transferring control from one owner to another and an essential prerequisite for the effective use of ownership as a control mechanism.
1.1. Shareholder Rights
Management rights are the right to access information about the company and to sue the company for a breach of fiduciary duty. The effectiveness of shareholders’ rights in the US can be seen through the court case Smith v Van Gorkom. In this case, the Board of Directors of Trans Union Corporation agreed to a deal to sell the company at $55 per share. In the process, they only discussed the price with the buyer and not other possible buyers. The deal was seen to have breached the Board’s duty of care, and all the directors were sued. This case showed the importance of management rights as the decision by the directors resulted in huge financial losses for the shareholders.
Shareholder rights refer to the powers of the shareholders to make decisions in the company. The decision-making involves voting on certain issues such as the appointment of new Board of Directors, amendments of the corporation’s articles and bylaws, or the decision to merge or sell the corporation. Shareholders’ rights can be divided into two categories: voting rights and management rights. Voting rights give shareholders the right to vote on certain issues, and it is a very important form of participation for shareholders in the decision-making process.
1.2. Voting Rights
Voting rights are the essence of control in the company. There are several different types of shares with different voting rights attached to each type. The most common form of share is known as common stock, differing from non-voting common stock, preferred stock, or dual-class shares. Downtown and Bethem found that the percentage of total votes held by the largest inside blockholder is, on average, 84.9%. While remaining shares are split fairly widely amongst different investors. Inside blockholder being defined as owning at least 5% of company stock. This highlights the immense ownership concentration in the US, as firms tend to concentrate voting rights into the hands of a few key individuals, despite widespread share ownership. Dual-class shares occur when a company issues two different classes of common stock with different voting rights. Bertrand and Mullainathan note that this is common when management is afraid of losing control of decision-making due to investor pressure on particular issues. One such example is Ford Motor Company when, in 2002, it issued a second class of stock with the intention of preserving family control and protecting against the potential threat of a takeover bid. Although this practice is illegal in the UK and most European countries, they found that in the US, dual-class shares are more commonly seen among firms that are in their early growth stages. This suggests that management feels that it is a way of raising finance capital while reducing shareholder interference in company affairs.
1.3. Ownership Concentration
Section “1.3. Ownership Concentration” is the starting point to understand how corporations develop their governance mechanisms. A firm controlled by a single shareholder or a small tightly-knit group of shareholders will have different needs than a corporation with widely dispersed shareholdings. It helps explain the context of governance mechanisms and their needs. If one can understand “who controls the corporation and to what extent,” it will be easier to understand the governance strategy that has been chosen. Shareholders might have been informed about current conditions. PNC already talked about ownership of stockholders that reached 63% shares of the company. Public investors are relieved because they no longer need to inject capital to buy stocks since they feel PNC has had good performance during this time. Shares owned by the public are a short-term program to get some benefits before making long-term investments in the hope that it can be profitable at a certain level. But this is still considering the various possibilities because many retail investors who start to understand the positive performance of PNC have expectations that stocks can still be reached and still have a good price, so they decide to keep the obligations to ensure stocks in the company. While retail investors and other public investors who are planning to buy stocks at this time until the stock price is relatively higher will be affected by the decision to put a premium on consumer direct services and lower the credit. At this time, they still need more time to change the decision because it is still speculation of the company’s stock movements. Now public investors are the most common and have a fairly high influence on the capital, so it must be considered by the company. If considering the role of large institutions, they have different interests. Individually, they are also concerned with policies that provide more benefits because they are indirectly affected and have an interest to repurchase stock at a low level because it consumes a relatively small premium. It is written in this article that about 30% of high-income retail customers are investors who have stock in the company PNC Wealth Management. An affluent investor will respond to a change in the stock price because it will continue to provide advice to other clients, and the level of decision-making will be more stable because it has a relatively small level of risk. High-income PNC customers are still concerned about the credit facilities and cheap loans. Their decision is to sell stock and look back into the movement of stock and interest rates provided. If the decision from stock to find credit facilities is not commensurate with favorable stock bonds, they are very likely to redeem and switch to the purchase of bonds issued by the company. At least changing the trend of holders still expects good stock performance and sees the various decisions still taken by PNC. So there will be much consideration taken by the customer stock or potential new stock buyers to ensure the stock’s performance truly deserves long-term investment. If the decision is still considered effective, PNC can be a good choice to translate stock performance into a debt or financing from another loan. At this stage, stockholders or even a customer can decide to buy stock at a relatively cheap price for a loan will bring a higher level if the company’s performance always brings promise. So, in the various provisions of underlying PNC, it should provide various statements and choices to keep its stock and future investors or new customer stock is still a good choice step in long-term investment. A different story is owned by a public investor. They have an obligation to match capital purchases with quality investments. A long-term investment would be a good choice to still be positive and is also an option to repurchase. It still offers a variety of possibilities for PNC to keep participants, and the expected results can be found in the first paragraph of this article.
1.4. Corporate Governance Mechanisms
Corporate governance refers to the mechanism by which a company is directed and controlled. Boards of directors are responsible for the governance of the company. The shareholders’ role in governance is to appoint the directors and auditors and to satisfy themselves that the board is acting in the best interest of the shareholders and the company. The governance mechanism serves to ensure that the Board is effectively monitoring or managing the top executive. It is particularly important for the owners to make sure that the board has strong monitoring incentives because often the board will consist of the CEO and his cronies. In this case, it is unlikely that the board will act to monitor the CEO who selected them. Ownership & Control PNC exhibits a diffuse ownership characteristic. This can be defined by the fact that no outside investor owns more than 10% of the total shares outstanding. This is particularly important to note in regards to corporate governance at PNC. The level of ownership concentration, in a way, determines the level of monitoring needed. High ownership concentration can often be viewed as a negative as it indicates the CEO might face heavy monitoring and therefore might have less leeway in his decision making. The bank’s decision to include a ‘Lead Director’ is an admission that PNC’s corporate governance failed in the past and a sign that they are concentrating on making sure they don’t make the same mistakes. In the aftermath of the accounting scandal, with one person simultaneously holding the CEO and Chairman position, there is a clear consensus that stronger governance is required and that the board of directors needs to take a more active role in monitoring PNC’s CEO. An internal chief compliance officer and more efficient direct reporting methods to the board are also seen as conscious efforts by PNC to ensure that future errors are quickly identified and do not persist without the board’s knowledge. Although while not specifically related to corporate governance at PNC, the adherence to signing ‘Corporate Integrity Agreements’ issued by the government also illustrates PNC’s desire to move past previous transgressions and towards a more positive public image.
2. Board Structure
2.1. Board Composition
2.2. Board Independence
2.3. Board Diversity
2.4. Board Committees
2.5. Executive Compensation
3. Firm’s Interactions with the Markets
3.1. Regulatory Compliance
3.2. Financial Reporting and Transparency
3.3. Investor Relations
3.4. Market Competition
3.5. Stakeholder Engagement
4. Strategic Decision Making
4.1. Long-Term Planning
4.2. Risk Assessment and Management
4.3. Capital Allocation
4.4. Mergers and Acquisitions
5. Performance Evaluation and Accountability
5.1. Key Performance Indicators
5.2. Financial Performance Analysis
5.3. Internal Control Systems
5.4. External Auditing
5.5. Shareholder Activism
6. Ethical and Legal Considerations
6.1. Code of Conduct and Ethics
6.2. Compliance with Laws and Regulations
6.3. Corporate Social Responsibility
6.4. Legal Risk Management

Employment-at-will and its Protections

Question
Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.
Over the years, there has been much debate over the classification of employment-at-will employees. Employment-at-will is a term that refers to the protection that is applied to the employment relationship, such that the employer or the employee has the right to terminate the employment relationship at any time. There are different modifications to employment-at-will that vary at the state level. With your classmates, please discuss the following:
Does employment-at-will have better protections for employees or employers? Why or why not?
Choose a state and describe its modifications to employment-at-will. Do you agree with these modifications? Why or why not?

Answer
1. Introduction
This doctrine of discharge has been the most controversial of all employment-at-will issues. Its principal contribution has been to narrowly limit lawsuits for wrongful termination. Discharging an employee for a particularly bad reason does not make it wrongful discharge. According to one author, the reason might be “so bad, so hypocritical, or so small minded, that only the judge or the jury can be trusted to a fair decision.” This is not in today’s legal system. While the judge or jury might have the authority to decide the issue, there must first be an establishing a valid claim or cause of action. Employment-at-will supporters believe that the rule adequately balances the rights of employers and employees, without legislative limits on discharges.
The rule in employment-at-will states that if an employee has no specific term of employment, the employer can fire the employee for good cause, no cause, and even cause morally wrong, without being liable for wrongful discharge. The employee is granted the same legal right; he can quit on the spot, for good cause, no cause, and cause morally wrong. In general, the employment-at-will doctrine should not affect the employee’s unemployment compensation rights.
The doctrine of employment-at-will is a legal rule that was established in the nineteenth century. It has been adopted by all fifty states. According to this doctrine, either the employer or the employee may end the employment relationship at any time, with or without cause, giving rise to a claim for damages. Typically, courts have said that the employment relationship can be treated as “at-will” unless the employee can show the existence of an employment contract to the contrary.
1.1 Definition of employment-at-will
The term “employment-at-will” derives from American common law and it means that an employee can be dismissed by an employer for any reason or without having to establish a wrongful cause and without notice, as long as the reason is not illegal (e.g. firing a worker because of their race, religion, or gender) and the employer does not have a contract with the employee which specifies how and under what circumstances termination can occur. The doctrine is compatible with the idea of an unfettered labor market, where firms and workers transact at arm’s length. This is undoubtedly the US labor market in many areas, particularly those involving unskilled workers. At-will employment still exists to a large extent in most American states and is important in promoting economic growth in the nation. This will be elaborated on in section 1.2, which discusses the importance of employment-at-will. The other forms of employment are “for cause” and “for term”. In a “for cause” employment, the employee can only be terminated for a specific reason. This usually only occurs when there is a collective bargaining agreement between a firm and a union. This is due to the fact that unions require employment security for their members, and in return for conceding flexibility in the labor market have negotiated contracts which make it difficult for firms to lay off or terminate employees. The most extreme example of “for term” employment is that of a tenured professor at a university, who has essentially a lifetime employment agreement and can only be dismissed for gross misconduct or financial exigency on behalf of the employer.
1.2 Importance of employment-at-will protections
Courts have often spoken of the doctrine of employment-at-will in terms of a “default rule”. That is, in the absence of an express agreement to the contrary, it will be presumed that the employer and employee intended the employment relationship to be a short-term one, terminable at any time by either party. In this respect, employment-at-will can be contrasted with a contract for a fixed term of employment, where, because of the agreement of the parties, it can be a breach of contract to terminate the employment before the expiration of the term. If it is to be analyzed as a default rule, then the starting point is to examine the respective rights of the employer and employee that will be gained, lost, or compromised by moving away from (or contracting out of) that rule. This naturally leads to the question of just what employment-at-will protections are. An alternative approach to understanding the meaning of employment in terms of default rules is to say that the choice of at-will term or fixed term of employment is itself an exercise of freedom of contract. This approach would require showing that there was some impediment or background factor which made it difficult for employers and employees to contract for short-term revocable employment, and that a change to less restrictive rules was the result of a conscious policy decision. An example of doing this type of analysis in another area of labor and employment law is the work in the US on right-to-work legislation. This showed that the implementation of laws protecting union security employment terms was the result of state action, so that a change to a less union-restrictive regime of employment terms required a repealing or invalidation of the laws. We can barely adopt the approach, but the previous study of default rules still serves as a useful foundation for understanding what employment-at-will protections are, even if the intention was not to move more towards such employment terms.
2. Protections for Employees
2.1 Right to terminate employment
2.2 Protection against wrongful termination
2.3 Legal remedies for employees
3. Protections for Employers
3.1 Right to terminate employment
3.2 Protection against employee misconduct
3.3 Flexibility in managing workforce
4. State Modifications to Employment-at-will
4.1 State X’s modifications
4.1.1 Overview of State X’s modifications
4.1.2 Specific changes to employment-at-will
4.2 Evaluation of State X’s modifications
4.2.1 Agreement with State X’s modifications
4.2.2 Disagreement with State X’s modifications
5. Conclusion

Enhancing Medication Adherence Through Technology-Assisted Therapy Drug Monitoring

1. Introduction
Now there are so many emerging technologies that can help therapy, and one of them is a mobile app. A mobile app has very broad access and is suitable for use in reminder and monitoring systems. It can be an alternative to the reminder systems that have been tried using short message service. This mobile app can provide added value in a reminder system because it can have a direct connection to monitoring. Furthermore, this app might facilitate more patients with a variety of features, for example, a simple reminder with a calendar display, education using video, and a chat with medical personnel.
Enhancing adherence to medication can be done in many ways. The previous meta-analysis showed that adherence could improve significantly using reminding systems. The reminder systems themselves can be tailored to the patient’s problem, for example, reminders for patients who are forgetful or education for patients who do not take the meds due to their beliefs. Although reminding systems have proved to be effective at improving adherence, there was not one patient who did not go back to non-adherence. Patients stop taking their meds because they feel no benefit or the meds cause adverse effects. To detect this, a monitoring system is needed. The monitoring can detect whether a patient is still taking their meds and what the outcome of the meds is. This information can be used as feedback to the patient because the patient is still not aware that what they are feeling now is the result of discontinuation of meds. Detection of the outcome of meds is used as a consideration for doctors whether to adjust or change the therapy that has been done. Taking it a step further, the result of monitoring can also be used as evidence for research on the meds. Although so promising, there was not one study that reported using monitoring systems for meds. This drug monitoring can be a bridge to the continuation of the use of reminding systems.
Adherence to medication is so essential that without it, it can cause serious health problems, even death. There are so many clinical studies that have observed the problem of low adherence to medication and have tried to explain it. One of the studies showed that non-adherence to meds reaches 4% – 23% in developed countries, 2% – 59% in developing countries, and 1% – 50% in developed countries. Another study reviewed adherence to meds in long-term therapy in more detail and concluded that most of the patients stopped taking their meds when the meds showed no benefit for them or when the meds caused adverse effects. Low adherence to medication happens not only in developing countries but also in developed countries with different kinds of health problems and meds. This leads to the necessity of finding any method to improve adherence to medication.
1.1. Background
Improved adherence to medication could save many lives and reduce health care costs. Reasons given for poor adherence are varied. They include patient beliefs about their illness and medication (e.g. what it is, its cause, expected duration and perceived severity), characteristics of the treatment regimen (e.g. complexity, duration and side effects) and also importantly, characteristics of the patient. This is a substantial task for the healthcare professional to identify and try to change in order to improve adherence. High rates of poor adherence led to recommendations to assess patient adherence on each visit. However, patients have been shown to overestimate their adherence and many physicians do not accurately assess their patient’s adherence [4]. A study of orthopaedic outpatients found a 40% discrepancy between physician and patient reports of recommended treatment regimens [5]. A more accurate and convenient method of monitoring patient adherence is needed.
The World Health Organisation recognises that improving adherence to medication is crucial to improving health outcomes. Patients with chronic conditions often do not adhere to their medication regimens. A review of 569 studies examining adherence to long-term medication regimens found that on average 24% of doses were not taken; adherence was 75%; and half of the patients stopped their medication within a year [2]. Poor adherence is a major cause of increased morbidity and mortality as well as a reduced quality of life. A study of 96,000 hypertensive patients found that a 20% decrease in adherence was associated with a 14% increase in the risk of death or MI [3]. It is estimated that increasing adherence to medication regimens would have a greater impact on the health of the population than any improvement in specific medical treatments.
1.2. Purpose
The purpose of this essay is to examine the effect of enhanced therapy and drug monitoring on medication adherence. It will also discuss the use of technology in aiding medication adherence. The focus is on the improvements in adherence resulting from the use of a combined intervention of a modified directly observed therapy (MDOT) monitoring system in conjunction with home-based video in asthmatic children and their caregivers. This intervention has not been discussed in prior studies and the early evidence of its efficacy is encouraging. Asthma is chosen as the model disease because of its prevalence, high rate of hospitalization, and necessity for preventative therapy. With the high usage of inhaled corticosteroids and their known side effects, adherence must make adherence a primary concern in the care of pediatric asthma. This essay will use this ongoing study as a reference in the relationship between adherence and clinical outcome. The evidence from other studies on the effects of adherence on clinical outcome will be cited to show the importance of adherence in the care of chronic illness. Technology has been widely used to monitor adherence, and this essay will examine its effect in comparison to traditional methods of adherence monitoring. This essay will also explore possible future advances in medical adherence and how they may affect clinical outcomes in chronic illness.
1.3. Scope
The scope of this essay is to determine if medication adherence among adults 18-64 years of age with a diagnosis of schizophrenia can be increased through the use of technology-assisted therapy drug monitoring and to identify barriers to use of the technology. Medications to treat chronic conditions have often proven to be effective; however, only if taken as prescribed. Among individuals with schizophrenia, nonadherence to antipsychotic medications can range from 40-89% and tends to be highest during the first few months after initial prescription. Nonadherence with antipsychotic regimens can result in a higher risk of relapse, rehospitalization, and suicide-related events and is also associated with higher total costs of care. Types of adherence measurement in the research included: pill count, self-report, clinician rating, monitoring of appointments, and biochemical measures. The most often used approach to measure medication adherence is a patient self report which tends to overestimate adherence levels. Due to limitations of research designs and cultural differences in validity of adherence measures, it is suggested that multiple measures should be used in adherence research. An interactive Voice Response System was found to be effective in specifically identifying nonadherent individuals and inquiring about their reasons for nonadherence. However, this method does not assess actual medication taking, relies on a landline telephone, and is no longer commonly used. Currently the most effective way to monitor medication adherence is using electronic methods. Assessment of electronic monitoring adherence interventions found a significant but small effect in improving adherence when compared to control groups (OR=1.50, 95% CI 1.19-1.90). Due to the findings of this meta-analysis, our research question, was there a change in adherence to antipsychotic medications among adults with schizophrenia after the use of technology-assisted therapy drug monitoring, is relevant in the determination of more effective methods for improving medication adherence.
2. Importance of Medication Adherence
2.1. Impact on Patient Outcomes
2.2. Economic Implications
2.3. Challenges in Medication Adherence
3. Technology-Assisted Therapy
3.1. Definition and Overview
3.2. Types of Technology-Assisted Therapy
3.2.1. Mobile Applications
3.2.2. Smart Pill Dispensers
3.2.3. Electronic Monitoring Devices
4. Drug Monitoring in Medication Adherence
4.1. Role of Drug Monitoring
4.2. Methods of Drug Monitoring
4.2.1. Urine Drug Testing
4.2.2. Blood Testing
4.2.3. Saliva Testing
5. Benefits of Technology-Assisted Drug Monitoring
5.1. Real-Time Data Collection
5.2. Improved Accuracy and Compliance
5.3. Enhanced Patient Engagement
6. Challenges and Limitations
6.1. Privacy and Security Concerns
6.2. Technological Barriers
6.3. Patient Acceptance and Adoption
7. Case Studies
7.1. Case Study 1: Implementation of Mobile Applications
7.2. Case Study 2: Smart Pill Dispenser Pilot Program
7.3. Case Study 3: Electronic Monitoring Device in Clinical Trials
8. Future Directions and Innovations
8.1. Artificial Intelligence in Medication Adherence
8.2. Wearable Technology for Drug Monitoring
8.3. Integration with Electronic Health Records

Ethical and Legal Challenges in the Collection, Management, and Use of Information and Technologies

Questions
1)  From your perspective what are the major ethical and legal challenges and risks for abuse that we must keep top of mind in the collection, management, and use of information and technologies overall—and in the public arena specifically? 
2)  Suggest guidelines to help prevent unethical uses of data in general and especially in the public sector.

Answer
1. Ethical Challenges
The rapid development of information technology has led to situations of increased uncertainty and the definition on how existing rights apply to new technologies. This has led to a consideration of an information society framework for the protection of the individual in regards to privacy, data security, accountability, and the right to access on the occasion of the widespread collection and identification of personal information.
Privacy is a right that individuals and groups can have control over the extent, timing and circumstances of sharing themselves with others. The freedom from unreasonable and unwarranted intrusion into our private lives is now recognized as a fundamental human right. Data security is the right of individuals and organizations to be assured that their data and the systems processing it are secure and not accessible to third parties. Measures used to ensure data security include confidentiality (limiting access to information), integrity (maintenance of accuracy and consistency of data over its life), authenticity, and privacy.
Concerns about ethical implications of information and technology are spread out within this field, but the main concerns are concentrated around issues regarding individual rights, fairness, accountability, and the impact on society. What information should a person or an organization have the right to keep to themselves? What data about others should they be required to share? What is an equitable distribution of resources and access? How can the rights and interests of various individuals and stakeholder groups be safeguarded? And just who is being well served by information technology?
1.1. Privacy concerns
Privacy is the ability of an individual or group to seclude themselves or information about themselves and thereby reveal information selectively. The essay’s focus on privacy centers on the increasing move by governments and business organizations to use computers to store data about individuals. The computer has led to a growing move towards the use of personal data as computers are very effective record keepers. Using the Internet, vast amounts of personal data can be retrieved and even more personal data can be gleaned, often without the knowledge of the person concerned. This often results in the inference of information about an individual who would prefer to remain anonymous. The storing and accessing of personal data can result in damaging disclosures about an individual. There are numerous ways in which privacy stands to be eroded in the information age. For instance, electronic surveillance using powerful surveillance technologies has great potential for invasions of privacy. Data matching is a technique used to compare two sets of data, such as the list of names on a payroll and the list of names receiving welfare benefits, in order to determine if there is any correlation between the two. If data is stored on an individual in both these sets of data, it is highly likely that there will be a disclosure of personal information in such a scenario. Though data matching can be a useful tool, it can threaten privacy and in some cases can lead to discrimination. National ID cards can also have a dramatic impact on privacy with centralized databases to store personal information. An ID card often becomes a requirement to access services and without it, an individual may be denied access to services to prevent the use of someone else’s card. This may create a situation of ID apartheid for the disadvantaged who are less likely to retain possession of a card. With technology constantly advancing, there are now ID cards being developed with biometric information such as facial details and fingerprints. These details, which are unique to each individual, bring about new privacy issues. High-quality photographic and digital imaging technologies allow for the covert and high-quality capture of someone else’s biometric details, and if this information is ever captured and stored about a person who is unaware, there has been a serious privacy violation.
1.2. Data security risks
Data is a representation of the world. In some cases it is used to model complex systems or to assist in decision making. For example, climate data is used to model future climate states. Market trends are used to make financial predictions. In these cases it is often difficult to verify the data thoroughly and in general, there are many different possible uses of data. Often individual interpretations of data may vary from the actual context or intent of the data. In the case of climate models, it may be impossible to foresee whether or not an interpretation of model output is correct given that climate states are inherently unpredictable and the model itself could contain errors. High impact decisions can be made on uncertain data that can lead to the perpetuation of errors and biases. This is known as methodological bias. In other cases, the data itself may carry biases or other undesirable assumptions. An example would be the use of race as an identifier in medical decision making. Failing to account for social constructs of race and genetic variation can lead to incorrect inferences from the data and ultimately, race may become a deciding factor in choices of treatment. These cases show a variety of ways in which data and its use can lead to biased outcomes. Often the bias is unintended and is usually a result of the neglect of ethical considerations in the early stages of information system design. Owing to this, bias is an issue that overlaps with many other ethical challenges of information and technology.
Another ethical challenge involves data security. In a digital society, the collection, flow, and processing of information is done electronically. This may result in theft, unauthorized access, loss of information, and the like [23]. The security and integrity of data is essential to any information system. For example, electronic health records are becoming a standard feature of medical practices; the information in these records must remain confidential and available only to those with authorized access. Despite this, electronic health records are subject to hacking and other forms of information loss. Data breaches can result in severe consequences for affected individuals and organizations. Loss of personal information can result in identity theft or in severe cases, it may pose as a threat to personal and public safety. The loss of financial information can have harmful effects on an organization’s clients and result in an organization’s loss of revenue. Steps must be taken to ensure that the privacy and integrity of data is maintained. This means that information systems must be resistant to various forms of threat, quick to recover from data loss, and must provide fail-safes for information in transit. Making systems “highly secure” in this context is easier said than done and is not always cost effective or convenient. This is a risk-benefit issue that will be a recurring theme in dealing with ethical challenges of information and technology.
1.3. Unintended bias in algorithms
Mentions about solving the problem of bias in algorithms through ethical behavior might seem naive in the light of quick movements in the nature of production and use of algorithms. Efforts to increase ethical behavior in algorithm design may not solve the more fundamental problem of how to specify what we want, to a system, without having undesirable effects in the real world. This is a problem that is only going to get more acute. As the parts of our lives that we hand over to data analysis increase, the systems being used are going to come to be seen as controlling the opportunities open to people. A famous example, from the early days of web advertising, is that of an optician who discovered that his ads were not being shown to people in high income neighborhoods, because the analysis of who would be willing to spend money on glasses had incorrectly identified the target group. At the time all this meant was that the optician got low rates for ad space, but in general such behavior can have damaging effects and can be hard to identify, especially as it might not be clear to human decision makers what the system is doing. An improperly specified algorithm for sorting CVs according to quality destroyed prospects for minority job applicants in the US by generalizing from the fact that some of the worst CVs were from minority graduates. In other cases, a system can potentiate existing social biases by affecting decisions that are based on its predictions, as is feared in criminal sentencing if judges start to use the output of risk assessment algorithms.
1.4. Potential for discrimination
The development of data science technology for the supporting of decision making, automatically conducted by sophisticated learning software called algorithm, should bring benefits to individuals. In addition, with the employment of data science in numerous fields now will give assessment and decision for individual’s better than hiring explicit human that may involve personal feeling of the assessor. Despite that, algorithm may yield certain decisions that are merely based on sensitive attributes, not because of the relevance with a person’s ability, skill, or other legitimate reasons. Machine learning algorithm is designed to learn from data and optimize an objective function to find a correct answer, thus the relation between an input (data regarding an individual) into an output (assessment or decision) sometimes it’s difficult to be detected and it’s called as indirect discrimination. This is a new problem in comparison to the pre-data science discrimination such as in employment opportunity, housing, provision of goods or services, and education, thus far legislation in United States, Canada and European Union do not directly proscribe indirect discrimination. Simulation study by Mitchell and Brynjolfsson (2019) reveals that altering the vocabulary in job ad postings can influence the click rates of majority group and minority group of race, where the part of minority group can be less interested in the job advertisement. This is an utilization of artificial intelligence to assess potential employees, with machine learning algorithm learning from the ad postings to the behavioral data of potential employees, it’s very likely the algorithm will replicate the ad employer’s message to the assessment result on minority group in hope to find individuals possessed the attributes shown in active ad respondents, which in reality it’s a mind conditioning in order to get job at a disadvantages price. This may eventually cause litigation to the employer if the ad respondents succeed to prove the causation of an adverse action. Another example is a case of race and ethnicity prediction using facial recognition. Although this research aims to help minority group in preventing discrimination and improving health care and social services quality, a tool that simply based on prediction without prevention to avoid creating biased results still has controversial ethical issues. High rate of predictive error can cause classification into the wrong group, and it’s not impossible the researcher release this tool first to the small number of people without noticing the tool’s effectiveness to the actual benefit. Nevertheless, it’s a decline proposal from a vendor who develops a data science system to equalize the prediction error rate with a prevailing rate. This means the system only works to a case with a crime prevalence at certain race, but this raises the question does minority group will forever have a burden for crime prevalence indication and is it true that it will benefit them.
1.5. Lack of transparency in data practices
Whether the data is being shared or analyzed, there is often a lack of clarity or oversight of the data handling and processing chain. Ultimately, many organizations want to keep their data practices undisclosed to gain a competitive advantage, or in some cases, to prevent the implementation of effective public scrutiny or consumer resistance. But often the practice is ambiguous even to those directly involved. Data is a valuable asset and its value is increased when it is shared, however data sharing practices can result in a loss of control over data once it has been released. For example, in the NHS IT outsourcing deals of the early 2000s, it was identified that the contract specifics had been unclear and this had allowed for widespread data sharing and commingling between companies and healthcare organizations, showing that even in a highly regulated industry, lack of clarity in data practices can result in a concession of data control. This loss of control can compromise the individual’s privacy and rights regarding the data in question. Often it is unclear what the data will be used for and whether there is potential for a change of data ownership that might result in future usage that is unrelated to the initial instance of data collection. In contrast to this, some instances of lack of transparency are less a result of unclear intentions and more to do with insufficient technological development in methods for data tracking and monitoring. With the increase in complexity of data storage structures and the rise of distributed systems, it is not always easy for an organization to map the journey of its own data and ensure that it does not lose oversight of its location and usage. While this benefits the data in question as it essentially becomes ‘lost’, this can be a disadvantage for the organization or individual who owns the data, as they may be unaware of any breaches of data protection legislations and their data rights.
2. Legal Challenges
2.1. Compliance with data protection laws
2.2. Intellectual property rights
2.3. Jurisdictional issues
2.4. Liability for data breaches
2.5. Legal implications of data misuse
3. Risks for Abuse in the Public Arena
3.1. Manipulation of public opinion
3.2. Surveillance and invasion of privacy
3.3. Targeted advertising and marketing
3.4. Exploitation of personal information
3.5. Cyberbullying and online harassment
4. Guidelines for Preventing Unethical Uses of Data
4.1. Clear data governance policies
4.2. Informed consent and opt-out options
4.3. Regular data audits and risk assessments
4.4. Ethical training and awareness programs
4.5. Collaboration with regulatory bodies
5. Guidelines for Preventing Unethical Uses of Data in the Public Sector
5.1. Transparent data collection and use practices
5.2. Strict adherence to data protection laws
5.3. Independent oversight and accountability mechanisms
5.4. Safeguards against data breaches and leaks
5.5. Public engagement and participation in decision-making processes

Evaluation Plan for HIT System Implementations

question
To prepare:
Review the case study you chose for your evaluation plan. Consider what viewpoint and research goal you would use to guide your evaluation plan. Although many potential research goals or viewpoints could be selected for your case study, you are only required to choose one goal and one viewpoint.
Research three published evaluations that have been conducted on HIT system implementations similar to the case study you selected.
Answer
1. Introduction
This evaluation plan provides all the details that will show the need and importance of health information technology system in the health industry. This plan will guide the implementation process and support the information system to provide a good service in managing the patient records. This plan will guide the user through the system step by step to achieve the maximum potential of managing patient records by using health information technology. This plan will evaluate the user and system interaction. This exam is going to make sure the health information technology system would be capable of supporting the target users, which are physicians. This exam will also evaluate the data that he wants input and output. This method is related to a before and after study using the same user applying cross-over implementation. Data for system evaluation is subjective and objective to evaluate the ease of use, usefulness, user intention, productivity, and quality of work life expectancy influences on the technology, task, and external variables, perceived mismatches, and completion success. This evaluation would determine the efficiency and effectiveness of managing patient records using health information technology system (Hammill, Ning, Scott; 2000).
1.1 Purpose of the Evaluation Plan
The findings from this evaluation will be used to improve the new EHR system and to prevent any potentially harmful effects with future system changes at this institution or at other healthcare organizations.
The overall goal of the evaluation process is to identify any positive or negative effects associated with the new EHR system and to make recommendations that will enhance its effects on quality and safety. More specifically, we will use a combination of qualitative and quantitative methods to: – Assess the effects of the new system on various measures of healthcare quality and safety – Identify important or unintended changes in work processes by those who use the system – Pinpoint system design and implementation issues that are associated with either positive or negative outcomes – Enhance the understanding of how and why the new system was effective in certain areas and detrimental in others.
The purpose of the evaluation plan is intended to outline the rationale for evaluating the HIT system implementation at a large academic medical center on the east coast. The primary goal of this project is to implement a comprehensive inpatient electronic health record system to replace existing paper and electronic documentation. As with the implementation of any new system, it is important to carefully evaluate the process to ensure that the goals of the organization are being met and to identify any unexpected consequences associated with the new system. This project will use a comprehensive evaluation strategy to assess the impact of the new system on healthcare quality and patient safety. This plan is intended to guide the evaluation process and to ensure that the findings are effectively translated into practice. Given that this is a 5-7 year project with a system that is continually evolving, this evaluation plan will focus primarily on the initial implementation of the inpatient EHR system and has flexibility to adjust the evaluation focus in subsequent years.
1.2 Scope of the Evaluation Plan
Using the AHRQ framework for the National Resource Center of Health Information Technology as a guide, this plan will detail the impact of health information technology (HIT) on a microsystem level. Each process that is being implemented or evaluated will be given an overall assessment to determine a qualitative and quantitative result. This will give an overall assessment to determine if the process is an improvement compared to the previous method. The various permutations can be seen in a fishbone diagram built around the central idea that HIT will improve patient safety and quality at the facility. A time series analysis of specific indicators such as mortality rates, medication errors, turnaround time, and nursing sensitive indicators will be used to provide an overall impact in the microsystem.
The scope of this evaluation plan is to detail various processes that are being implemented in patient information management and assess the utilization of the health information exchange. This evaluation plan will take an in-depth look at the before and after results of a new medication administration system, specifically bar coding. The plan will then shift its focus to assessing the overall impact on the healthcare facility.
1.3 Background of the Case Study
Baylor’s implementation of the Epic Systems HIT took place in several stages from 2003 to 2008. EHR was first activated at pilot sites, then installed at all of the primary care clinics and associated ambulatory practices. These ambulatory systems were integrated with the in-patient EHR at two hospital sites. During this time period, several natural experiments occurred that provide an ideal environment for empirical evaluations of HIT: 1) a new EHR system was installed at one of the two hospital affiliates that had previously been sharing the same system as the other hospital (non-randomized comparative system); 2) within the same hospital, there was a temporary and non-randomized cessation of electronic lab ordering and results retrieval due to catastrophic IT failure; 3) electronic prescribing (e-prescribe) was federally mandated to be phased in between 2007 and 2009 which provided additional bonus payments and penalties for Medicare and Medicaid services.
2. Research Goal and Viewpoint Selection
2.1 Selection of a Research Goal
2.2 Selection of a Viewpoint
3. Published Evaluations on HIT System Implementations
3.1 Evaluation 1: [Title]
3.2 Evaluation 2: [Title]
3.3 Evaluation 3: [Title]
4. Comparison of Published Evaluations with the Case Study
4.1 Similarities in Evaluation Approaches
4.2 Differences in Evaluation Methodologies
5. Development of Evaluation Plan
5.1 Defining Evaluation Objectives
5.2 Identifying Evaluation Metrics
5.3 Determining Data Collection Methods
5.4 Establishing Evaluation Timeline
6. Implementation of Evaluation Plan
6.1 Recruitment of Participants
6.2 Data Collection Procedures
6.3 Data Analysis Techniques
7. Results and Findings
7.1 Presentation of Evaluation Results
7.2 Interpretation of Findings
8. Recommendations and Action Plan
8.1 Proposed Recommendations
8.2 Action Plan for Implementation
9. Conclusion
10. References

Factors to Consider When Starting up a Domestic Aviation Operation

Question
factors to consider when starting up a domestic aviation operation
answer
1. Introduction
When starting up a domestic aviation operation/public transportation service, it is essential to consider all the factors that will affect the operation, whether large or small. This document focuses on the factors the typical air carrier should consider. It is common for one to only think about the certification process and rules and regulations that must be followed to start an air carrier, but these are not the only factors that need to be well understood. Factors concerning the markets to be served, the need for the service, the competitive environment, the economics of the new operation, and the type of operation to be conducted must all be considered. This document is designed to help the new operator understand all these factors and how they will affect the certification process and the operation in general. This document is not a standalone guide to certification or Part 135 operations. It’s simply a detailed explanation for what must be considered along the way. Because the certification process is so involved, many times the operator will lose sight of the operation in an effort to meet FAA requirements. This explains why the author chose to write this document with regards to factors an operator must consider in lieu of the certification process itself. Factors concerning the FAA requirements will sometimes be invoked to better understand how they will affect the given factor, but a detailed explanation on the FAA rules and regulations concerning a specific subject is outside the scope of this document.
1.1. Purpose of the Document
This document is intended for people contemplating starting up an aviation concern. This is a wide ranging audience and the document will not cover every eventuality. A person starting up an operation in a single building at a non-towered airport flying one aircraft needs a far less complex operation than a regional operator flying into a dozen cities. However, this document should provide a framework from which a project plan tailored to the specific operation can be constructed.
This document has been assembled in order to illustrate at a high level the process of starting up a new aviation concern. It is aimed at individuals who want to know what is involved in aviation operations but who do not necessarily have a background in aviation. This document addresses not only the aviation specific issues but also will touch on general business and project management principles.
1.2. Scope of the Document
The document is quite detailed and some aspects may not be relevant to all readers. It is structured in a manner that it can be readily determined what information is relevant and what can be overlooked. The document is broken down into specific aircraft operation phases, being pre-start up, start-up, setting up the initial operation, expansion of operation, and winding down an operation. Each phase identifies key objectives and possible issues that can occur. Readers can determine if the information is relevant to them based on the phases of their operation and how far they plan to take the aircraft operation. This is particularly relevant to operators working for AOCs where various job position changes can mean involvement in different phases of aircraft operation. Although it is recommended that all information is read at least once!
While it is obvious that an aviation operation needs an aircraft to fly, the first stage of planning could be the deciding factor as to why an operation is successful or not. Ambitious aviation operations have failed to get off the ground because of poor planning, a lack of clear objectives, no identified target market, insufficient resource analysis, and so it continues. Though it is preferable to enter the aviation industry with a business already established, these decisions are no less important for an individual purchasing an aircraft for private use. This document aims to cater for aviation operations looking to move into the aviation industry through to the established small aviation enterprise. The intention is to provide guidance on all the various phases of aircraft operation, identifying possible pitfalls and providing solutions.
1.3. Background Information
With an understanding of the costs, commitment, and competition involved, and armed with the right resources and information, starting an airline can be a viable and rewarding venture.
An SIA study has shown that it is very difficult to change a customer’s existing loyalty to an established carrier. This illustrates the high level of competition and threat of substitute products in the industry. Failing to consider some of these aspects can lead to a new airline’s quick demise. New airlines tend to do best where they can meet a demand that is not being fully satisfied by existing services. A market analysis will help to reveal this and will allow a new airline to evaluate where and how it can be competitive.
The aviation industry is known for having a few dominant players. This is due to the effectiveness of mergers and acquisitions. Even some of the smaller airlines are actually subsidiaries of the larger ones. This suggests that competition in the industry is fierce and likely to be directed towards a new entrant. New airlines often fail to fully understand direct and indirect competition. It is also important for these new airlines to understand the needs and limitations of their prospective customers. These are varied and are usually based upon cost, frequency, journey time, comfort, and access.
An aviation company operates aircraft to transport passengers and/or goods. This is the primary source of income for the airline. As one of the most complex and costly industries, it is to be expected that the number of airlines that start up and fail is relatively high. It is necessary to consider the idea of establishing an airline very carefully and to be aware of the numerous costs and potential pitfalls that may be encountered.
2. Legal and Regulatory Factors
2.1. Compliance with Aviation Regulations
2.2. Licensing and Permits
2.3. Insurance Requirements
3. Financial Considerations
3.1. Startup Costs
3.2. Funding Sources
3.3. Revenue Generation
4. Market Analysis
4.1. Target Market Identification
4.2. Competitor Analysis
4.3. Demand Forecasting
5. Operational Factors
5.1. Fleet Selection and Acquisition
5.2. Staffing and Training Requirements
5.3. Maintenance and Safety Procedures
6. Infrastructure and Facilities
6.1. Airport Selection and Negotiations
6.2. Hangar or Terminal Facilities
6.3. Ground Support Equipment
7. Marketing and Branding
7.1. Brand Identity Development
7.2. Advertising and Promotional Strategies
7.3. Customer Relationship Management
8. Technology and Systems
8.1. Aviation Management Software
8.2. Reservation and Ticketing Systems
8.3. Communication and Navigation Equipment
9. Risk Management
9.1. Safety and Security Measures
9.2. Emergency Response Planning
9.3. Contingency Plans
10. Conclusion
10.1. Summary of Key Considerations
10.2. Next Steps

Goals of Drug Therapy for Hypertension and Antihypertensive Treatment

Question
Describe the goals of drug therapy for hypertension and the different antihypertensive treatment. 
Describe types of arrhythmias and their treatment
Discuss Atrial Fibrillation
Discuss types of anemia, causes, symptoms, and treatment options

Answer
Goals of Drug Therapy for Hypertension and Antihypertensive Treatment Types of Arrhythmias and Their Treatment Atrial Fibrillation Types of Anemia, Causes, Symptoms, and Treatment Options
1. Goals of Drug Therapy for Hypertension
Lowering blood pressure with drug therapy in a patient with hypertension is unequivocally beneficial. For every 10 mmHg reduction in mean systolic blood pressure, there is a 40% reduction in the rate of fatal stroke and a 15% reduction in the rate of coronary heart disease and other vascular diseases. These are the findings from a meta-analysis of over 60 hypertension trials. The benefits of reducing diastolic pressure are very similar to those of reducing systolic pressure, and in relative terms, the effects of antihypertensive drug treatment are similar in the elderly and the middle-aged. Available data do not show a clear threshold below which lower blood pressure no longer has benefit, so it is best to achieve the greatest reduction possible, especially considering the variety of antihypertensive agents currently available.
Drug therapy for hypertension has as its primary goal the achievement of a blood pressure level that reduces the risk of adverse cardiovascular events and target organ damage. The delay in progression of hypertension to a level that requires polypharmacy to control or the prevention of established hypertension from getting worse are additional important goals. So the ultimate objective in hypertensive patients is control. Control of blood pressure from an elevated level to a lower level is the major determinant of reduced morbidity and mortality. The specific goals of drug therapy occur within the broader framework of lowering blood pressure, reducing cardiovascular risk, and preventing target organ damage.
1.1. Lowering Blood Pressure
Objective is to perusing this issue is to lower the blood pressure to solve the problem of hypertension. Hypertension is cured by reducing elevated blood pressure, preventing its associated cardiovascular complications, and decreasing resultant morbidity and mortality. To achieve it is to resolve the problem of hypertension. Situation where patients easily get back to their primary condition before treatment due to they stop consume medicine. This condition will not with immediate result, but requires persistent changes of lifestyle and pharmacological treatment for years. Lifestyle modification include weight reduction, high regular aerobic exercise, alcohol reduction, sodium intake reduction, and maintain diet based on DASH (Diet Approach to Stop Hypertension). But this modification has limitations, because it will show the result if done in massive level and takes a long time, so it will not compatible if combined with drug therapy. Pharmacological treatment will base on administration of antihypertensive drugs with various classes, started from the cheapest one, effective, and safe with minimal side effects for long term use. So it tailored to what patients need and can be monitored. Given the J-shaped association between diastolic blood pressure and cardiovascular and renal disease, and fixed small risks of antihypertensive drug treatment, drug therapy is recommended for all patients with stage 1 hypertension and higher. For patients with prehypertension and diabetes, the decision to use drug therapy depends on an assessment of total cardiovascular risk, with drug therapy recommended for high risk patients. This recommendation applies not only to the elderly, but also to older adults with isolated systolic hypertension. Role of antihypertensive drug is to lower the blood pressure, but current evidence also supported the different classes of antihypertensive drug to prevent cardiovascular complication which independent from its blood pressure lowering effect. This unique effect is very favorable for hypertensive patients.
1.2. Reducing Cardiovascular Risk
That’s why risk reduction can be seen as simplifying hypertension-related goals. High blood pressure is oftentimes associated with diabetes and dyslipidemia, and addressing these conditions can have a two-fold benefit. Nevertheless, it is important to remember that if these are not severe and there are no obvious associated target organ damages, it may be more appropriate to change lifestyle and monitor the patient while treating the blood pressure. Nevertheless, if judged to be severe or at high risk of progressing, then drug treatment would be associated with improved prognosis.
Cardiovascular risk is greatly increased when a person has high blood pressure. However, in most cases, it is more efficient to treat the blood pressure itself rather than trying to separately treat the cardiovascular risk. In some cases, the risk may need treating independently, and the best way of identifying these patients is understanding which other risk factors are present and whether these are reversible and can be influenced by drug treatment.
1.3. Preventing Target Organ Damage
Preventing target organ damage: Hypertension, if not controlled, can lead to a number of complications as a result of target organ damage. Organ damage can occur because of ischemia. This is the inadequate supply of blood and oxygen to a particular organ. Ischemia as a result of hypertension is caused by arteriolosclerosis and it can lead to left ventricular hypertrophy, myocardial infarction, heart failure, aneurysm or peripheral arterial disease. Hypertension can cause damage to the heart in a number of ways. It is a major risk factor for diseases of the arteries and the most common cause of aneurysm. High blood pressure can also lead to left ventricular hypertrophy, in which the muscle of the left ventricle is thickened, which can cause heart failure, and also a heart attack. Hypertension is a major contributor to chronic kidney disease. It can cause damage to the small blood vessels in the kidneys and lead to glomerular sclerosis. This is the hardening of the glomerulus, which is the site in the kidney where the blood is filtered. It can ultimately lead to end-stage renal failure. High blood pressure is the most important risk factor for stroke. It can lead to impaired brain function and a major risk factor for dementia. High blood pressure has shown to be an important risk factor in the pathogenesis of retinopathy and macular degeneration. Preventing target organ damage means treating or even reversing the harmful changes that have occurred in the major organs of the body. It is the most important goal in treating patients with hypertension. In a number of the clinical trials, it has been the prevention of target organ damage in which have been the primary end-point. This is because the prognosis and quality of life for patients with diseases due to target organ damage can be very poor and anything that can prevent this would be a great achievement. An example of this is in the Systolic Hypertension in the Elderly Program (SHEP) trial, in which older patients were treated with chlorthalidone to try and prevent stroke. This was found to be successful and the risk of stroke was reduced by 36% in non-diabetic patients and 51% in diabetic patients.
2. Antihypertensive Treatment
2.1. Lifestyle Modifications
2.1.1. Dietary Changes
2.1.2. Regular Exercise
2.1.3. Weight Loss
2.2. Medications
2.2.1. Diuretics
2.2.2. Beta Blockers
2.2.3. Calcium Channel Blockers
2.2.4. Angiotensin-Converting Enzyme (ACE) Inhibitors
2.2.5. Angiotensin II Receptor Blockers (ARBs)
2.2.6. Renin Inhibitors
2.2.7. Alpha Blockers
2.2.8. Central Agonists
2.2.9. Vasodilators
2.2.10. Combination Therapy
1. Types of Arrhythmias
1.1. Atrial Fibrillation
1.2. Ventricular Tachycardia
1.3. Atrial Flutter
1.4. Supraventricular Tachycardia
1.5. Bradycardia
2. Treatment of Arrhythmias
2.1. Medications
2.1.1. Antiarrhythmic Drugs
2.1.2. Beta Blockers
2.1.3. Calcium Channel Blockers
2.1.4. Digoxin
2.2. Electrical Cardioversion
2.3. Catheter Ablation
2.4. Implantable Devices
2.4.1. Pacemakers
2.4.2. Implantable Cardioverter-Defibrillators (ICDs)
2.4.3. Cardiac Resynchronization Therapy (CRT)
2.5. Surgical Interventions
1. Introduction to Atrial Fibrillation
2. Causes and Risk Factors
3. Signs and Symptoms
4. Diagnosis of Atrial Fibrillation
5. Treatment Options
5.1. Rate Control
5.2. Rhythm Control
5.3. Anticoagulation Therapy
5.3.1. Warfarin
5.3.2. Direct Oral Anticoagulants (DOACs)
5.4. Catheter Ablation
5.5. Surgical Procedures
5.5.1. Maze Procedure
5.5.2. Pulmonary Vein Isolation
5.6. Lifestyle Modifications
5.7. Follow-up and Monitoring
1. Introduction to Anemia
2. Types of Anemia
2.1. Iron-Deficiency Anemia
2.2. Vitamin B12 Deficiency Anemia
2.3. Folate Deficiency Anemia
2.4. Hemolytic Anemia
2.5. Aplastic Anemia
3. Causes of Anemia
3.1. Nutritional Deficiencies
3.2. Chronic Diseases
3.3. Genetic Disorders
3.4. Bone Marrow Disorders
4. Symptoms of Anemia
4.1. Fatigue
4.2. Weakness
4.3. Shortness of Breath
4.4. Pale Skin
5. Treatment Options for Anemia
5.1. Iron Supplements
5.2. Vitamin B12 Injections
5.3. Folic Acid Supplements
5.4. Blood Transfusion
5.5. Bone Marrow Transplantation