How should INGOs allocate resources?

International Non-governmental Organizations (INGOs) face difficult choices when choosing to allocate resources. Given that the resources made available to INGOs fall far short of what is needed to reduce massive human rights deficits, any chosen scheme of resource allocation requires failing to reach other individuals in great need. Facing these moral opportunity costs, what moral reasons should guide INGO resource allocation? Two reasons that clearly matter, and are recognized by philosophers and development practitioners, are the consequences (or benefit or harm reduction) of any given resource allocation and the need (or priority) of individual beneficiaries. If accepted, these reasons should lead INGOs to allocate resources to a limited number of countries where the most prioritarian weighted harm reduction will be achieved. I make three critiques against this view. First, on grounds the consequentialist accepts, I argue that INGOs ought to maintain a reasonably wide distribution of resources. Second, I argue that even if one is a consequentialist, consequentialism ought not act as an action guiding principle for INGOs. Third, I argue that additional moral reasons should influence decision making about INGO resource allocation. Namely, INGO decision making should attend to relational reasons, desert, respect for agency, concern for equity, and the importance of expressing a view of moral wrongs

Increasing Compliance of Bar Code Medication Administration in the Emergency Room

Purpose: To ensure quality healthcare, it is necessary to provide safe medication administration. The specific goal is the reduction of medication errors in the hospital setting with concentration in the emergency room (ER). Bar-code medication administration (BCMA) has proven to be effective on the in-patient units in the hospitals researched and visited as part of this project, but the issue still remains that the emergency rooms exhibit a decreased compliance rate. The purpose of this Doctor of Nursing Practice (DNP) project, is to reverse the situation in a local community hospital that has a 50 bed emergency room, promoting increased compliance to affect improved medication safety measures. This was done by educating the nursing staff in the emergency room regarding the addition of an application related to verbal orders which increases with high acuity levels. The application will automatically profile the verbal order so that the nurse can use the BCMA and therefore increase compliance. Significance of the Project: “Thirty-four percent of all medication errors in hospitals occur in the administrative phase of the medication process and less than 2 percent of these errors are intercepted before execution” (Voshall, Piscotty, Lawrence, & Targosz, 2013, p. 530). In addition to causing possible harm or even death to a patient when an adverse event occurs, it is also a devastating economic factor. This is a nurse-driven change and to make it a success the nursing staff must perceive that the goals are realistic and that this will improve their practice. To insure a positive outcome it is essential to establish systems standards which are compatible with nursing needs and expectations, and which facilitate development of Information Technology (IT) systems which are supportive of nursing practice (Zadvinskis, Chipps, & Yen, 2013). Methods: Four goals were established for this project that was named: The Medication Quality Initiative. The first was to improve the compliance of BCMA utilization in the ER since they were averaging 70.9% BCMA usage following implementation, and had recently declined to 41.1 percent (RWJUH, 2015). Through careful research of the daily ER patient logs and the weekly data utilization sheets for BCMA, it had been determined that verbal medication orders increase in relationship to the increased patient activity and acuity levels, decreasing compliance. Because of this occurrence medications cannot be profiled in a timely manner and the nurses use work-arounds. The second goal was to meet with the team that consisted of the Chief Nursing Officer (CNO), ER Medical Director, ER Nursing Director, IT, Executive Informatics Nurse, IT Pharmacist, Nursing Educator, and the project preceptor. It was unanimously approved to turn on the application called CARE ADMIN in the Medication Administration Record (MAR) portion of the Patient’s Electronic Health Records (EHR) System so that verbal orders can be immediately profiled. Figure E3, in Appendix E, shows the “Create Order and Document” button which is only available to ER Users of this system to allow the automatic profiling process to take place. For the third goal, this author conducted an in-service program for 52 ER nurses so that they had a proper understanding of this new application, as well as the importance of BCMA compliance. In addition, they were given a pre-survey to determine their overall perceptions and use of this technology. The fourth goal was instituting the project, which was on-going for eight weeks. During that period, the data utilization sheets were reviewed weekly to determine project success and sustainability. At the conclusion of the eight weeks, the staff completed a post-survey to determine their perceptions after having used the new verbal order process. This post survey looked at both pre and post education perceptions. Project Outcome: The overall response was positive. The five levels of nursing practice “From Novice to Expert” related to the core of the emergency room staffing matrix. This was an advantageous time for this project because the mentors were teaching medication administration via the BCMA to new graduates as well as incorporating how to use the verbal order application. The overall consensus was that it does improve nursing practice since it does rapidly profile the medications, thereby improving patient care. Additionally, it has been subsequently, observed that many of the physicians have become more time sensitive in transcribing their medication orders in the computer. Clinical Significance: As a result of this project, it was noted that the percentage of BCMA use has increased. The Director of the Emergency Room will continue to have the nurses utilize the application. The sustainability of this project enhances medication administration in the emergency room. This procedure has become an integral part of the ER orientation to new staff members given by the nurse educator and nurse preceptors

The moral problem of worse actors

Individuals and institutions sometimes have morally stringent reasons to not do a given action. For example, an oil company might have morally stringent reasons to refrain from providing revenue to a genocidal regime, or an engineer might have morally stringent reasons to refrain from providing her expertise in the development of weapons of mass destruction. But in some cases, if the agent does not do the action, another actor will do it with much worse consequences. For example, the oil company might know their assets will be bought by a company with worse environmental and labor practices. Or the engineer might know her position will be filled by a more ambitious and amoral engineer. I call this the moral problem of worse actors (MPWA). MPWA gives reason, at least some of the time, to consider otherwise morally impermissible actions permissible or even obligatory. On my account, doing the action in the circumstances of MPWA remains morally objectionable even if permissible or obligatory, and this brings additional moral responsibilities and obligations to the actor. Similarly, not doing the action in the circumstances of MPWA may also bring additional (but different) moral responsibilities and obligations. Acknowledging MPWA creates considerable challenges, as many bad actors may appeal to it to justify morally objectionable action. In this paper, I develop a set of strategies for individuals and institutions to handle MPWA. This includes appeals to integrity and the proper attribution of expressive responsibility, regulatory responsibility, and compensatory responsibility. I also address a set of related concerns, including worries about incentivizing would-be bad actors, concerns about epistemic uncertainty, and the problem of mala in se exceptions

Computer-Based Test Interpretation Software: Its Effect on School Psychologist Decision Making

The purpose of this study was to assess the utility of interpretative software for school psychological decision making in its role as a decision aid. One hundred two professional school psychologists were provided case data and asked to make a series of diagnostic and prognostic decisions based on the case material. One subject group received case material only and each of the other two groups received one of two variations of the narrative output generated by a computer-based test interpretation software package in addition to the case material. The subjects were also asked which data sources were most influential as they made their decisions. Diagnostic agreement among the psychologists within each group was analyzed by Kendall's coefficient of concordance or weighted Kappa. For each decision there were no significant differences in agreement between those psychologists who had access to the decision aids and those who did not. Chi-square and Freidman analysis of variance results for similarity of diagnosis across groups were mixed with some trends suggestive of greater similarities of decisions among the subjects utilizing different variations of the computer output than among decisions made by unaided psychologists. Further the school psychologists overwhelmingly indicated that test data and behavioral observations were the most influential data sources for their decisions and that computer-based data sources were the least influential . Also there appeared to be no significant relationship between school psychologist professional experience and the perceived influence of the case data sources as well as little relationship between degree of experience in using computers to the data sources considered to be useful in the decision making process. The results were discussed in terms of psychological decision theory. Trends in the data suggested the computer narrative was most effective in situations where it was necessary to discriminate among ambiguous decision choices rather than in more clear cut situations. It was concluded that computer-based decision aids have the potential to debias the decision process, but that definitive changes will not come until the technology is improved and school psychologists become more familiar with the use of computers

Trog Sink and its Hydrologic Effects on Head Waters of the East Blackburn Fork River

A hydrologic model was developed to predict runoff in an urban watershed in Cookeville, TN. In the research area there resides a massive sinkhole responsible for storing and transmitting storm water to the East Blackburn Fork River. The sinkhole is hypothesized to store excess rain water, and release it at a steady rate. Maintaining a higher baseflow discharge well after storms have passed over the watershed. A rain gauge and two stream gauges were deployed to record water level in the sinkhole and at a spring known to be its outlet. ArcGIS Pro software was used to calculate the watershed area and interpret the terrain of the watershed. The hydrologic model HEC-HMS (Army Corps of Engineers) was used to model runoff from a rain event that happened on December 5, 2020. Results showed a normal hydrograph with peak rainfall and a fairly quick return to baseflow estimated at hours compared to the time recorded in field data. Field data showed Trog sink retaining a large volume of water about 8.5ft in height at its maximum, and not allowing the spring to return to base flow for roughly thirteen days. Further research and modeling are hypothesized to display Trog sinks actual retention pattern in a hydrograph and become more synonymous with the field data during the rain events

Gear mesh compliance modeling

A computer model has been constructed to simulate the compliance and load sharing in a spur gear mesh. The model adds the effect of rim deflections to previously developed state-of-the-art gear tooth deflection models. The effects of deflections on mesh compliance and load sharing are examined. The model can treat gear meshes composed to two external gears or an external gear driving an internal gear. The model includes deflection contributions from the bending and shear in the teeth, the Hertzian contact deformations, and primary and secondary rotations of the gear rims. The model shows that rimmed gears increase mesh compliance and, in some cases, improve load sharing

Planning & Partnerships: Obtainable Opportunities for Increasing the Intercultural Competencies of All Library Employees

To expand the inclusivity and diversity of the library’s environment, Musselman Library offers a variety of training and educational opportunities for staff and student employees. Using a variety of formats and partnerships with other departments, these efforts have led to intentional changes in library space, services and equipment available, and hiring practices. Practical examples include highlighting events on campus, hosting short film and reading discussions, and utilizing campus speakers