Synopsis of events from an RCA completed on a wrong site surgery Mrs. Jackson is a 58 year old female who entered the hospital via Pre-op admissions on October 28, 2013. She was scheduled for a right knee replacement by Dr. Perez. The OR was busy and behind that morning due to an issue with humidity in the OR that required a maintenance crew to work with the system for one hour before the days scheduled cases could begin that morning. Several of the surgeons were becoming restless and verbal about the delays. Once the maintenance team completed the work on the air handling system, the OR humidity was retested and the OR rooms were re-opened. Dr. Perez insisted that Mrs. Jackson's procedure begin immediately. The nurses rushed the patient into the room. In the rush, the surgeon failed to mark the site of for the procedure. Nancy, the scrub nurse noticed but since Dr. Perez was in such a foul mood, she did not push the issue. Jack, the RNFA noticed that the knee X-rays were not on the x-ray view so ran out of the room, grabbed the x-rays from the desk just outside the room and flipped them onto the screen in the OR. In his rush, he did not use two patient identifiers to ensure the x-rays belong to Mrs. Jackson (they belonged to Mrs. Reick, who was scheduled for a Left TKR immediately after Mrs. Jackson's procedure. Once in the room, both anesthesia and Judy, the OR nurse called for a time out to check the consent, medical record and patient ID for the correct procedure, patient, site, etc. The members of the surgical team were still moving about preparing the 12 trays needed for the procedure. Judy was frustrated when she could not seem to get everyone to stop but she saw that Dr. Perez was "about to blow" so she continued with the time out. All participants in the time out confirmed that the patient was Mrs. Jackson, and that she would be having a Left Knee Replacement; no one checked the consent form. The procedure was begun and the procedure went very smoothly. It was not until the patient was in the PACU that Sam, the PACU nurse realized that the wrong site was completed. Directions As the VP of quality and risk management at the above hospital, you conducted the RCA on the above case. Discuss the following based on the event scenario above: What was the root cause(s) of the wrong site surgery? Which root causes are human factors and which were system factors? Based on the identified root causes, what opportunities do you see for improvement and what actions would you put into place to ensure that this adverse event would never happen again.

QUESTION 4

Case Study (Floor Price/Ceiling Price)

Kuala Lumpur, 30 October 2015: New private sectors are not to defer the payment of
minimum wages, scheduled for July 2016. Therefore, employers have to comply with the
minimum wage ruling without giving any more excuses, said Datuk Seri Richard Riot, the
Human Resources Minister. He mentioned that “There is no turning back on this policy”, as
the national minimum wage was introduced three years back. He said this in his speech which
was read out by Datuk Seri Saripuddin, the ministry secretary-general, at an official
ceremony held for the new National Wages Consultative Council and National Wages
Consultative Committee programme.
The minimum wage, as set in Budget 2016, increased from RM900 to RM1000 for the
private sector in Peninsular Malaysia and from RM800 to RM920 for Sabah, Sarawak and
Labuan. This would be followed by an announcement on the standardized minimum wage
rate. “Several clauses of minimum wages for those paid daily, piece-rated and related matters
will be included in a new Order. The fine details of the cabinet‟s decision will be forwarded
to the National Wages Consultative Council secretariat soon,” said Riot. He also added that
the increase in minimum wages could help to improve the people‟s livelihood, which is the
government‟s commitment.
“We hope the council members will continue to discuss this matter, and to consider the
national interest as the minimum wage policy is an intervention to turn the country into a
developed nation by 2020,” he said.
According to Riot, as of August 2015, 182 employers had been charged in court and action
taken against 122 for failing to obey the minimum wage ruling. After much discussion in the
Cabinet, it is a balanced approach taken by the government based on recommendation given
by the council members, World bank and other stakeholders.
Datuk Seri Saripudin mentioned at a press conference later that there was ample time for the employers to be prepared financially for this change in the minimum wage structure. “The
rates set is acceptable and fair to all”, he added. According to Tan Sri Azman Sha Haron who
was also present, the minimum wage did not differentiate between local and foreign
employees. The president of the Malaysian Employers Federation further commented that there was concern about a large sum of money going out of the country, due to the minimum
wage.

Questions:

i. What is minimum wage? What kind of price control is it known?

ii. How much is the minimum wage in 2015 and 2016?

iii. With the aid of diagram, explain the concept of minimum wage.

iv. Explain the advantages and disadvantages of the imposition of minimum wage.

40. Which of the following supermarket strategies to increase sales would be most consistent with a behavioral economics (versus neoclassical economics) approach? A. Distributing online coupons. B. Providing discounts for buying in bulk. C. Positioning frequently purchased items at the back of the store. D. Offering price matching with other stores.

41. According to behavioral economists, the human brain frequently employs heuristics because: A. people have consciously trained their brains to do so. B. these shortcuts minimize errors in decision making. C. they produce more optimal outcomes than do rational calculations of benefits and costs. D. they save energy and time in decision making.

42. According to prospect theory, what strategy will firms typically employ with regard to pricing and packaging of their goods, when faced with rising production costs? A. Firms will increase both package sizes and prices but will increase prices more to communicate to consumers that the product has greater value. B. Firms will reduce package sizes but keep prices the same, thus increasing the per unit price of the good. C. Firms will keep package sizes the same but lower prices and attempt to cover the higher costs with greater revenue. D. According to prospect theory, the choice of strategy doesn't matter, as consumers are generally able to recognize price increases regardless of what form they take.

43. Josh will receive a salary of $300,000 next year. According to prospect theory: A. Josh will be happy with that amount regardless of what he has made in the past. B. Josh will only be happy with that salary if everyone else around him makes less than he does. C. Josh will only be happy with that salary if his cost of living has not increased. D. Josh's satisfaction with that salary depends on how much he made in the past.

44. Why do credit card companies typically require small minimum payment amounts on their customers' monthly credit card statements? A. Credit card companies are concerned that their customers will be put in financial distress if required to make higher payments. B. Credit card companies want to promote faster repayment, and customers will be encouraged to pay more each month if they're able to pay well beyond the minimum. C. Credit card companies want to increase profits by promoting slower repayment, and actual customer payments will be anchored by the smaller payment requirements. D. Credit card companies actually charge the highest minimum payment they are allowed by law to charge.

21:

Which of the following statements comparing Uranus and Neptune is correct?

Group of answer choices

Neptune has larger diameter and more mass

Neptune has larger diameter and smaller mass

Uranus has larger diameter and Neptune has more mass

Uranus has larger diameter and more mass

22:

Which planets spin backwards?

Group of answer choices

Venus, Uranus, Pluto

Venus, Neptune, Pluto

Mercury, Venus, Jupiter

Mercury, Venus, Neptune

23:

Which comet became famous for being the first observable crash into a planet in 1994, namely Jupiter?  

Group of answer choices

Wild 2

Halley

Shoemaker-Levy

Hyakutake

Hale-Bopp

24:

Uranus’ biggest moon is called

Group of answer choices

Titan

Umbriel

Titania

Triton

Mimas

25:

Which of the following is FALSE concerning the surface features of the terrestrial planets?

Group of answer choices

Venus contains the longest valley called Valles Marineris

Mercury’s biggest crater is called the Caloris Basin

there is a big difference in the appearance of Mars’ Northern and Southern Hemispheres

Venus contains two large continents called Ishtar Terra and Aphrodite Terra

Mars contains the biggest mountain in the solar system called Olympus Mons

26:

The bluish color that makes the atmospheres of Neptune & Uranus so beautiful to the human eye is caused by the interaction of sunlight with what gas?

Group of answer choices

oxygen (O2)

carbon dioxide (CO2)

argon (Ar)

methane (CH4)

helium (He)

27:

Which of the planets have (or had) the large hurricanes called The Red Spot, and Great Dark Spot, respectively  

Group of answer choices

Jupiter, Uranus

Neptune, Jupiter

Uranus, Neptune

Jupiter, Neptune

28:

Saturn is the planet that

Group of answer choices

is the most oblate

has the least surface gravity

has the most eccentric orbit

has the most number of moons

is strongly marked with belts and zones

29:

Which of the planets are named after the Greek God of love, Aphrodite, the God of the underworld Hades, and the god of the sea, Poseidon in that order?

Group of answer choices

Neptune, Jupiter, Pluto

Venus, Pluto, Neptune

Mars, Uranus, Pluto

Mercury, Mars, Pluto

Venus, Neptune, Pluto

30:

Which of the following are the moons of Jupiter?  

Group of answer choices

Charon, Ganymede, Callisto

Io, Europa, Titan

Mimas, Ganymede, Triton

Io, Europa, Ganymede

Io, Phobos, Tritan

Background: During the Summary of Clinical Review for the Premarket Study presented at the FDA, it was noted that a particular model of pediatric left ventricular assist device (LVAD) is prone to thrombus formation at the inlet and outlet valves, and therefore increased mortality may be expected when:

It is implanted at relatively less-experienced centers (<100/year)

Patients present with single ventricle physiology

Patients require pre-implant ECMO support

Nevertheless, FDA determined that the clinical risk benefit profile was acceptable and approved the device as a bridge to transplant (BTT) for pediatric patients when a compatible human heart is not immediately available.

Scenario: A left ventricular assist device is surgically implanted into a 3-month-old patient under general anesthesia at a surgical center that performs an average of 85 such surgeries per year, although the cardiovascular surgeon assigned to this case performs almost all of these surgeries himself. The patient had a compromised immune system prior to the surgery, as she was recovering from a virus and pneumonia induced by a chronic pulmonary edema due to poor cardiac function. This required her to be on both cardiac and respiratory support for two weeks prior to surgery. The surgery proceeded without incident, and the patient was returned to a special cardio-neonatal ICU to recover. The ICU was not staffed over the weekend with the most experienced nurses, as it was a long holiday weekend, and the most senior nursing staff had been approved for vacation well in advance. Therefore, when a pressure alarm in the outlet valve of the LVAD sounded in the ICU, the attending nurse applied suction to the inlet valve, and the thrombus blocking the outlet valve resulted in the infant’s death. The hospital explanted the LVAD post-mortem and returned it to the manufacturer for assessment. The hospital reported the event to both the FDA and the manufacturer of the LVAD (via MDR), and the manufacturer conducted an internal investigation into the situation, using the returned, explanted LVAD. It was determined that there had been an increase in the rate of thrombus formation complaints on the device in the lot numbers of LVADs produced around the same time as the LVAD in question. The manufacturer’s Quality Engineer opened a CAPA. During the CAPA investigation, the engineer determined that the supplier of the outlet valve had been changed recently, and the new supplier had failed its unannounced audit by its Notified Body due to a non-validated metal polishing process. Further investigation revealed that the outlet valve on the explanted LVAD contained metal burrs that could encourage thrombus formation. After completing the investigation, the explanted device was placed into a general (non-biohazard) refuse bin by the engineer investigating the MDR.

Assignment:

List all harms, hazards and hazardous situations in the scenario presented.   Be sure to identify each item as a harm, hazard or hazardous situation.

Business Case – Manchester Business School (Civil Engineering)

The Company (Civil Engineers) consists of two divisions. The divisions are Transportation and Infrastructure. The company sells engineering services to various customers. The following are the bill rates for the various staff classifications:

The two divisions expect to bill the following hours:

• Transportation - 10,000 hours, vice president at 10% of the time, 20% of Senior Engineer time 10% to Associate engineers and remaining to Staff Engineers.

• Infrastructure - 6,000 hours, vice president at 12% of the time, 20% of Senior Engineer time, 5% to Associate engineers and remaining to Staff Engineers.

The Direct Labor costs per hours are as follows:

The utilization (billable ratio to total hours) for each staff member is as follows:

The company has the following other costs:

Assume that there are 2080 hours per year that each engineer can work including vacation and other benefit hours.

Question:

You are an outside third party Human Resources consulting firm and the Manchester Company Board of Directors, CFO and the CPO have engaged your company. The goal of the Board, CFO and the CPO is to improve profitability of the divisions and company. Therefore, to accomplish providing engagement advice to the Board, CFO and CPO the consulting team should answer the following questions during the presentation and in the final report.

1. Prepare a static budget for the company.

2. Assume that the actual utilization came in at the following rates:

3. Based on the above utilization, prepare a flexible budget and calculate the Level 2/3 variances.

4. What recommendations can be made for the upcoming year in budgeting to the CFO for additional profitability and increasing revenue?

5. What approaches would your recommendations to increase the company overall utilization of staff and billable hours?

6. How will your recommendations impact customer profitability or divisional profitability?

7. The company wants to add a new division. It will be the Construction Division with 3 people. Please discuss pros and cons of adding a division and when you might consider not adding the division.

Billingham Packaging is considering expanding its production capacity by purchasing a new​ machine, the​ XC-750. The cost of the​ XC-750 is $ 2.71 million.​ Unfortunately, installing this machine will take several months and will partially disrupt production. The firm has just completed a $ 45 comma 000 feasibility study to analyze the decision to buy the​ XC-750, resulting in the following​ estimates: bullet ​Marketing: Once the​ XC-750 is operational next​ year, the extra capacity is expected to generate $ 10.20 million per year in additional​ sales, which will continue for the​ 10-year life of the machine. bullet ​Operations: The disruption caused by the installation will decrease sales by $ 4.94 million this year. As with​ Billingham's existing​ products, the cost of goods for the products produced by the​ XC-750 is expected to be 71 % of their sale price. The increased production will also require increased inventory on hand of $ 1.08 million during the life of the​ project, including year 0. bullet Human​ Resources: The expansion will require additional sales and administrative personnel at a cost of $ 2.06 million per year. bullet ​Accounting: The​ XC-750 will be depreciated via the​ straight-line method over the​ 10-year life of the machine. The firm expects receivables from the new sales to be 16 % of revenues and payables to be 11 % of the cost of goods sold.​ Billingham's marginal corporate tax rate is 35 % . a. Determine the incremental earnings from the purchase of the​ XC-750. b. Determine the free cash flow from the purchase of the​ XC-750. c. If the appropriate cost of capital for the expansion is 9.7 % ​, compute the NPV of the purchase. d. While the expected new sales will be $ 10.20 million per year from the​ expansion, estimates range from $ 8.30 million to  $ 12.10 million. What is the NPV in the worst​ case? In the best​ case? e. What is the​ break-even level of new sales from the​ expansion? What is the breakeven level for the cost of goods​ sold? f. Billingham could instead purchase the​ XC-900, which offers even greater capacity. The cost of the​ XC-900 is $ 3.94 million. The extra capacity would not be useful in the first two years of​ operation, but would allow for additional sales in years 3 through 10. What level of additional sales​ (above the $ 10.20 million expected for the​ XC-750) per year in those years would justify purchasing the larger​ machine? a. Determine the incremental earnings from the purchase of the​ XC-750. Calculate the incremental earnings from the purchase of the​ XC-750 below​ (with vs. without​ XC?750):  ​(Round to the nearest​ dollar.)

Please note that for all problems in this course, the standard cut-off (alpha) for a test of significance will be .05, and you always report the exact power unless SPSS output states p=.000 (you’d report p<.001). Also, remember that we divide the p value in half when reporting one-tailed tests with 1 – 2 groups.

1. Paste appropriate SPSS output. (4 pts)

2. Paste the appropriate SPSS graph. (3 pts)

3. Write an APA-style Results section based on your analysis. All homework “Results sections” should follow the examples provided in the presentations and textbooks. They should include the statistical statement within a complete sentence that mentions the type of test conducted, whether the test was significant, and if relevant, effect size and/or post hoc analyses. Don’t forget to include a decision about the null hypothesis. (4 pts)

4. If the assumptions had been violated, what would the most appropriate statistical test be? (3 pts)

• Current hospital practice after the birth of a child is to place it with the mother and/or father for a reasonable amount of time. But it wasn't always that way. For a while, babies were whisked away moments after birth and put in the incubator room where they could be kept "safe" and monitored. This unfortunately affected maternal bonding with infants and decreased maternal commitment to the infant's care in some cases. Use principles of evolutionary psychology to explain why this might be predicted. (Hint: consider parallels with male vs female post-natal investment in children)       

• Menopause seems like it violates evolutionary theory. If we are supposed to maximize reproduction, how would cutting off the ability to reproduce accomplish that? Use the concept of inclusive fitness as a way out of that apparent paradox. Why would menopause become more likely the older a woman becomes (assuming reproductive life histories that would have been the norm over most of human evolutionary history)?  

• In many species, males have excess reproductive capacity relative to females (if we consider investment per offspring by each sex). Competition between males for access to female reproduction is often given as a reason why the males of many species also tend to be bigger (or more colourful, or more ornate singers) than females. So what's up with phalaropes? Explain in terms of evolutionary principles.

• Milly, Molly, and Mandy are identical triplets in their 60s who experienced complicated births and had neurological problems shortly afterward. One of them underwent surgery that severed her corpus callosum. Another had a hemispherectomy; one side of her cortex was removed. The third recovered without treatment. They would like to know who had what operation, but their mother refuses to tell them and the hospital records have been lost. They have heard that you know something about psychology, but all you have is the ability to perform some basic tests and to use a simple EEG unit from your meditation practice (sensors on the forehead and just behind the ears). Devise some tests to figure out who had what procedure.  

• You recently had your corpus callosum severed in an attempt to control epilepsy (sorry). If I show an image of a parrot in your left visual field, how might you be able to respond in a way that would show that you recognize it as a clarinet? How would you likely not be able to respond? How might it be different if I showed an image of a pen? Explain. How might it be different if you had the operation when you were 2 years old? Explain.