What does Kek dream of at the end of Part 1?

His new bedroom at home and the school he is about to go to

Kek is a refugee from Sudan, where he lost his family and has to start a new life in America. Vocabulary: Define the word refugee.

A person that is forced to leave their home due to war, disaster, etc.

A person who chooses to leave their country to start a new life

A young person who is doesn’t understand the English language

Review of Home of the Brave Part 1

7.012 Employee Health The Center provides a safe working environment for all employees through a collaborative effort with them and the organization’s infection control program to identify infectious conditions that may put staff, patients and visitors at risk. Health evaluations, immunity testing for measles, mumps rubella and chickenpox, tuberculosis screening and immunity testing for hepatitis B and if not immune either signs declination form or accepts 3 dose vaccine series. (Rrefer to the Employee and Occupational Health Section policy Chapter 3.21) It is the center’s policy to monitor Health Care Associated Infections (HAI) in patients and personnel working in the Center as part of its ongoing program in Infection Prevention and Control. Staff should be encouraged to stay home when they have signs and symptoms of an infectious disease. If a staff develops signs and symptoms while at work, the person of other personnel and patients who may have been exposed to a staff member with a communicable disease should be taken into consideration. Patients and personnel can be told that they were exposed to a certain disease without disclosing the index case’s identity. In addition we work together to provide an annual influenza vaccination program that includes all staff who have patient contact, and licensed independent practitioners. Environmental Rounds - Environmental rounds are performed daily by assigned staff members, ie. “safety officer”. Feedback on opportunities for improvement is given to the Infection Control Coordinator and QAPI committee and then reported to the board Education – Employee education includes: General information about infections Techniques for prevention, surveillance, investigation and control Review of policies and procedures related to infection control: (See attachment B, policy and procedure reference list) Employee health practices; refer to Administration 3.16 Orientation and Training Offer of Hepatitis B vaccination & post exposure evaluations Annual TB skin testing Provides access to influenza vaccinations. Educates staff and licensed independent practitioners about influenza vaccination; non-vaccine infection control measures (such as the use of Droplet Precautions); and diagnosis, transmission, and potential impact of influenza. Annually evaluates vaccination participation and non-participation in the influenza immunization program and reports to Department of Health.

Abstract The main focus of this research is to discuss the perspective of the teamwork and its impaction organizational performance and success. Also highlight the Meanings of Team and its work sprit towards batter organizational performance and specific to its impact on the success of organization that provided the basis for this research study. In this research study a thoroughly focus was on organization and teamwork. The aim of this research is to deliver a participative view of teamwork in the organization, and also discourses the major issues and emphases on the recent work that opens the basis to move research onward. There is much worth in taking a more focus on the essential areas of teamwork. The team signifies the spirit and working capacity of the employees as team to bring organization to the success. The various explanations, definitions, processes, dimensions, team size and benefits etc. regarding the above topic teamwork and organizational success is highlighted. Keywords: Teamwork, Success, Organization, Performance, Work Groups, Employees Introduction It is indeed human beings have learned in their beginning of life to work together as (Team) that have made such a remarkable developments as unique specie. Human beings have experience throughout their social history, lived, loved, grow younger to older and worked together in groups said West M.A. (2012).The mutual social knowledge of living and functioning together creates connection among people, society and families. When work is done cooperatively as a team it can achieve extremely extra work than individually. Team can be defined as in the human society to live, to work and to play and to cooperate with others for particular task. According to John W. Newstrom et al (1993) “team is the process of assessing performance of workers, passing information and exploring methods to increase performance”. If observe closely, one can discover the instances of The Government: Research Journal of Political Science Supplementary Edition Vol. III 88 The Government social (teams) they are functioning either effectively or ineffectively everywhere; organizations, schools, work place, home etc. “Coordinating the events of people is like sand house, making by using a sole particles of sand” expressed Belbin, R. M.(2010). Moreover it is one of the general myths that the skill of team member is more important than their vigor, attention and determination for the tasks. Another widespread myth is that the team members are not alone accountable for the achievements or failures of their tasks the truth is that the members are the small parts in the teams and their individual abilities effect on the various results in team. The working relationships exist among team that might sight these relationships at different levels of involvement or relationships among the members as they move towards the degree of communication, integration and commitment increases. Terry L.G. et al (1980) expressed that “The skills are essential if members have to work together efficiently in complex situations, only development of skills and relationships, involvement on the task regarding the particular task might be selected for reaching at target that is considered as a definition of a team”. Team often perform higher when they work together with sprit that enable them to achieve a collective goal at the workplace, it is not only benefits to the organization also affects the workers confidence and success. Cooperating on various tasks reduces workloads for all team members and enables them to share duties or ideas. Work as a team is the part of everyone's life, as one is a member of a family team, staff team, school team, and community teams etc., so as to understand how to work effectively as a team member. Especially there is a need when task is threatened with increasingly many problems for example; the energy problem has effects on organization, family life, and social development and the multi-dimensional nature of many problems require a scientific skill based problem solving approach. Terry L.G, et al (1980) expressed that “The skills, competencies and efforts of team by setting priorities the team can have better impact on the problems solving such efforts can reduce work load, work duplication, and produce a result better than separate efforts”. There are some processes of teamwork by adopting those the objectives can be achieved easily. Le Pine, et al, (2008) identified10 teamwork processes that fall in three categories following are those. TEAMWORK PROCESSES TRANSITION PROCESSES •Mission analysis •Goal specification •Strategy formulation ACTION PROCESSES •Monitoring progress toward goals •Systems monitoring •Team monitoring and backup behavior •Coordination INTERPERSONAL PROCESSES •Conflict management •Motivation and confidence building •Affect management Team Work 89 Teamwork process reduces the work stress on every member which permits members to complete given important task of organization; teamwork offers members an opening to pledge with each other. Also it develops relations between the members who start a teamwork they usually sense appreciated on productive accomplishment of task. It may be cited one of the best instances of surgical team; where surgeon is assisted by his team; nurses, anesthetist and experts etc., everyone knows that their success depends upon the teamwork. In addition they are devoted to the aim that is human life it is easy to succeed with best teamwork. The important role of manager is the team building, trust building, confidence building, in the team to achieve the task. In the Situation where all team members contribute the task, it develops the positive relationship in the team that improves the trust of team members.“Functions effectively members of team must be flexible, committed, trusting each other and help to each other’s in the progress and the achievement of goals” Expressed Plamínek (2008). The accountability of every member in the team must be increased so that they do not let each other down therefore they do their best for the achievements of their teams. In contrast, working alone on a task the pressure is generally high in team in those cases of small confidence impacts fewer on members. Team consists on members who always vary from each other’s in skills, knowledge and abilities but working together that is an opportunity for them to gain skills and knowledge from each other’s that they had never before. Working alone on a task is a challenge and using the ideas of each other brings them to come up with a mutual resolution and the achievement of the task. Nowadays theoretical development and research has rested largely a new trend that is emerging within the organizations as an essential process of teamwork. Teamwork has brought a new move in the research and development to the inputs and outputs that bound, constrain and impact on the team processes within organizations said Ilgen, D.R. (1999). The world is changes fast, any one set of instructions can’t be sufficient, changes needs flexible members, teams and organizations so as to be effective on task. This paper suggests that in teams members must use the exclusive human abilities. Cannon B.et al (1995) has précised dimensions of teams into three categories: Team dimensions 1-Cognitions: include associations, task team-mate characteristics, team mission, objectives, norms, and resources, team role interaction patterns, skills, roles, and team orientation. 2-Skills: consist on adaptability, shared situational awareness and mutual concept to conflict resolution. 90 The Government 3-Attitudes: symbolize motivation, collective potency, shared vision, team cohesion, mutual trust, collective orientation and importance of. Teamsize Researchers have given different approvals about the best size of team as Katzenbachetet al (1993) suggested that the teams should comprise on a dozen or so members which are enough to achieve a task. Although seven is the best size of the team in the organizational practices said Scharf, A. (1989). Several views of researchers are expressed in the literatures and it is difficult to decide which better is because their opinions are based on their own observations. The team size matters in the proper output and performance however from an empirical research it is also difficult to decide the suitable team size and what to accept. This study suggests that team size has a practical link with efficacy such as few or many member shave impact on the performance but size matters. Proper size of team improves the performance maximum stated Campion M. A et al (1996).These different results are expected due to the fact that appropriate team size is required for task, environment and situation where team works. However, larger teams can also experience coordination problems that delay performance. Sheppard, J. A. (1993) expressed that the question of best team’s size is a complex one; more research is required on this topic to explain the impact of team size on given definite task. Literature Review Across many different organizations and industries teamwork is focused to increase the performance of employees’ their unity and also create work culture. Organizations those regularly develop new ideas or products using a project-based approach and assemble teams in order to focus responsibilities to achieve the object. Researchers have given dissimilar meanings of “teams”. Dyer W.G. (2007) said that “teams are groups of people who trust in cooperation, if members are expert the success of goal is more possible”. It is essential due to the problemsolving cooperation added from many minds of team members working on a resolution of problems. Team members contribute their thoughts together to make exclusive plans for dealing with problems and this unity enhance the result due to interaction, trust and teamwork. Teamwork means a "work done by several companions with each doing a part but all subordinating personal prominence to the efficiency of the whole" Merriam, (2012). In addition combined employees are expected less hostile to each other and accepting more of each other’s decisions. Unity of employees can increase the flow of work in organization. When employee’s working together as a team, they learn from each other that awareness is based on their personal experiences and from coworkers; Team Work 91 employees from different departments may acquire knowledge from each other. The main object for organizations is to hold the team effort to achieve output and quality; team is a key to achieve quality productivity. According to Maddux et al (2003) “some of the organizations have major benefits from the use of teamwork which are showed in the following chart: Benefits of Teamwork 1 Improving quality of work life for employees 2 Reducing absenteeism and increasing turnover 3 Increasing innovation and change 4 Improving organizational adaptability and flexibility A real team is mostly one where members are allowed to take decisions that how to complete task. That authority enables them to control the work process, decreases the outside control and increases the sense of duty for work. Team always feels superiority on workplace and they rely on each other’s being there. Plamínek (2008) said that “affiliation with teamwork gives member a sense of belonging, interaction and recognition of success”. These actions support to remove the sense of loneliness of team member in organization. Effective teams can also improve efficacy through communication and trust between the team members, quality of work and decrease in absenteeism contribute to positive impact on team. Involving employees in teamwork helps the organization remain open to new ideas.“The world of organizations is shifting individualism is out and collectivism is in, power is out, empowerment is in.” stated G. M. Parker (1998). This study discovers the experiences and difficulties of teamwork that employees and organizations are facing nowadays due to big transformation and enlarged globalization. In recent years a remarkable amendment has been emerged in the belief of team working organizations. The modern study has explored that the scope of teamwork have been appeared in system rooted in belief, and employees accept changes that denoting a modern organizational system. The organizations which are responsive to the changes appear to achieve greater satisfaction. Although it may be suggested that, the managers should assess the values and beliefs of their employees to play more dedicated role in the development of organization by making sprit to face the modern challenges. Organizational cultural is much significant and it has the excessive impact on the performance of organization and employees’ but it is quiet arguable topic that the culture of teamwork can be developed according to the requirement. It is difficult to specify the relationships and to assess the reliable set of values to use as they believed symbol across the entire organizations. This review study focus that 92 The Government there is a great influence of organizational culture on the assumptions, values, and beliefs on the individuals’ considerations, actions and performances and so is vice versa, through learning, and training process. However the researchers believe that the organizational setup aids to unite employees of diverse cultures and dissimilar social backgrounds, traditions and have their own beliefs to work. Creating a positive teamwork culture it has several diverse aspects are goal setting, conflict resolution, empowerment, ability to accomplish tasks, measuring output and consideration for other teamwork cultures stated Pack L, et al April 27, (2012). Team work in the organization delivers employees the wisdom of unity; understand to each other’s, and reducing conflict. In addition teamwork in organization inspires employee for impartiality by affirming that no one is ignored in the organization and all treated equally. It is known that a team in organization is bound and sincere to work with dedication to bring the success. If the employees are committed and recognize the teamwork values and its benefits, as a part of the organization they can contribute a lot to the achievement of organization. One can finds the informal instances of team at these level, family, society, community, tribe and work groups etc., and formally team appears at the level of departments, functional groups, and other organizational units. The employees feel a greater sense of achievement for being a part of an organization, if they attain team work, having freedom to work not forced. The system gives best performance to achieve recognition and credit from their managers and it will increase their effort that helps them to contribute the organizational performance. Each team batter knows about their role and how to achieve tasks. The true spirit of teamwork gives benefit to organization in maintaining its standard by which it becomes identified. The team defines its specialty, and the way it is doing task that is perceived by the organization as well as its managers and it is secured by appreciation. Employees identify what they believe; that exist in their belief system and those understandings call them to change their views to develop and raise attention towards batter performance. The literature contains sufficient definitions of teamwork and the word team is used to denote a set of generally developed as to learn collective values, attitudes and cooperation to work. The study praises that the teamwork is mostly related with the team success for instance, Wagner (1995) described that “in the team individual is less valued and group is more valued, with”. It is found in the study that individualismcollectivism both regulates the relationships between team size, standing, and cooperation that have better effects on the cooperation of individualists rather than the cooperation of collectivists. Team Work 93 Conclusion The main concentration of this research paper is to examine more in-depth the fundamental of teamwork and its effectiveness to achieve the organizational goals. Teamwork provides vast amounts of knowledge and information, cultural differences each of these building a culture of teamwork and the skill to make the valuable solutions of the problems. To work efficiently, team members need a good understanding of how to do their job, to achieve goal and for that a basic way to ensure understanding is training, then they have to be motivated to do a job. Team is a vital activity of organization, when organization desires to perform sound it has to be confident that team functions effectively. Consequently it is compulsory to know how team performs, what manners within a team happen, and how they make decisions. If there is knowhow of teamwork events, it can be effective for the tasks that they have to accomplish. Organizations build up their own culture through tradition, history and structure these values can be accepted by team workers of an organization. The values and assumptions are the vital tools of organizations and are used as guidance for team. These have to do mostly with the basic dignity and worth of all members of team and the ability, necessity for them to solve the problems and work for the positive change. Through this review study is concluded that there is a good impact of teamwork on the organizations doings and success. Subsequently in recently developed literature there is a great focus amongst the social scientists and scholars’ in their discussion on the above topic teamwork. The above study is also an evidence of little effort to assess the significance of teamwork in organizations success. teams in organiz

Why and How Managers Plan Importance of planning The planing process Benefits of planning Planning and time management Types of PLans used by managers Long term and short term plans Strageic and tactical plans Operational plans Planning Tools and Techiqunes Forecasting Contrigency planning Scenario planning Benchmaking Use of staff planners Implementing Plans to Achive Results Goal setting Goal management Goal alignment Participation and involvement Planning Def: The process of setting objectives and determining how best to accomplish them Planning at Eaton Corporation “Making the hard decision before events force them upon you, an anticipating the future needs of the market before the demand asset itself Objectives and goals Identifity the specific results or desired outcomes that one intends to achieve Plan Def: A statement of action steps to be taken in order to accomplish the objectives (goals) Steps in the planning process: Define your objectives Determine where you stand vis-a-vis objectives Develpo premises reagrdsing future conditions Analyze alternatives and make a plan Implement the plan and evaluate results What are the benefits of planning Improves focus and flexibility Imporves action orteitation Imporves coordination and control Imporves time management Time Managment Personal time management tips Do say “no” to request that distract you form what you should be doing Dont get bogged down inn details that can be addressed later Do screen telephone calls, emails and meeting request Dont let drop in visitors, text messaging use up your time Do prioritize your important and urgent work Dont become calendar bound by letting other control your schedule Do follow priorities; do most important and urgent work first Some 77% of mangers in one survey said that digital age has increased th number of decisions they have to make 43% said there was less time available to make these decisions Types of plans used by Managers What is teh time horizon Long term vs Short term Long term Look three or more years into teh future Short term plans Typically cover one year or less However: the increasing environmental complexity and dynamism of recent years has severely tested the concept of “long-term” planning Plans are subject to frequent revisions Most executives would likely agree that these complexities adn uncertainties challenge how er actually go about planning and how far ahead we can really plan At the very least we can conclude that there is a lot less permanency to long term plans today and that tey are subject to frequent revision Managment reaeracher Eillot Jaques believes tha people vary in their capability to think with different time horizons Types of Plans used by Managers (3 of 5) Strategic plans Set broad, comprehensive and linger term action directions for teh entire organization or major division Vision Clarifies purpose of the organization and what it hopes to be on the future Typical plans Specify how the organizations resources are used to implement strategy Tactical plans in business often take the form of functional plans Functional plans Incidate how different component within the organiztion will help accompnlish the overall strategy Production plans Finacial plans Facilites Plans Logisitc plans Marketing plans Human Resource Plans Operation plans Describe short-term activities to implement strategic plans Policies: Are standing plans that communicate guidelines for decisions Ex: Policies on office romances: The media is quick to report when a top executive or public figures runs into trouble over an office affair. Are there ant policies on office romances? Employer polices on office raltioshiis vary. One survey find teh following: 24% prohibit relationships among employees in the same department 13% prohibit relationships among employees who have the smae supervisor 80% prohibit relationships between supervisors and subordinates 5% have no restrictions on office romances Procedures: Are rules that describe actions to be taken in specific situations Budgets: are single use plans that commit resources to projects or activities Zero based budgets: allocate resources as if each budget were brand new There is no guarantee that any past funding will be renwer. All propsales, old and new, must compete for available funds at teh start of each new budget cycle Forcasting Attempts to predict the future Qualitaive forecasting uses expert opinions Quantitative forecasting uses mathematical models and statiscal aanylsis of historical data dna surveys Contingency planning Identify alternative course of action to take when things go wrong Anticipate changing conditions Contain trigger points to indicate when to activate plan (or a specific course of action) Scenario planning A long term version of contingency planning Identifying alternative future scenarios Plans made for each future scenario Increases organizations flexibility and preparation for future shocks Benchmarking Use of external and internal comparisons to better evaluate current performance Adopting best practices: things people adn organization do that lead to superior performance Staff Planners Experts who assist in all steps of the planning process They help bring focus and expertise to a wide variety of planning tasks Important: Communication between staff planers landline managers is essential for teh success of teh planning process Goal Setting - Always set SMART goal The solution: Goal Aligment Between Team Leader and Team Member Jonintly plan: Set objectives, set standards, choose actions Individually acy: Perform tasks (member), provide support (leader) Jointly control: Review results, discuss implications, renew cycle x4 Collective effort and commitment Participatroy planning Includes in all planning steps that people who will be affected by the plans adn askedd to help implement them Unloacks motivational potential of goal setting Management by objective (MBO) promotes participation Participation increases understanding and acceptance of plan and commitment to success Participatory planning - Number of people involved in teh decision making process Amazon is intensely focused on what it does. It believes in creating tight single-threaded teams, also known as “2 pizza team.” Data and Decision Making What are some of the important competencies managers must have today? Delegate Marketing and technology Manager must have Technological competency Ability to understand new technologies and to use them to their best advantage Information competency Ability to locate, gather, organize and display information for decision-making and problem solving Analytical competency Ability to evaluate and analyze information to make actual decisions and solve real problems What is the difference between Data and Information Data Raw facts and observation Information Data made useful and meaningful for decision-making Important concepts Big data Exists in huge quantities and is difficult to process without sophisticated mathematical and analytical techniques Data production today Bernard Marr is an internationally best-selling author. He helps organizations improve their business performance, use data more intelligently Data mining The process of analyzing data to produce useful information for decision-makers Management Analytics The systematic evaluation and analysis of data to make informed decision Information drives management Bad Data Refers to information that can be erroneous, misleading, and without general formatting The challenge: Can er use the data that is available in the “Big Data” Needs to be valid Can not trust everything out there Being ethical Look at the trends Data is structured and unstructured Data BIg Data = Structured + Unstructured Information Drive Management decision making What are the characteristics of useful information Easy to access If its credible Accurate Characteristics of useful information: Timely High quality Complete Relevant Understandable What about bad data It's not credible Miss information If it is not structured/ organized Bias based on opinions Confusing If its updated Bad data Refers to information that can be erroneous miss What are some examples of Management information system Business intelligence -BI Information systems to extract and report data in organized ways that are useful to decision-makers Executive dashboards Visually update and display key performance metrics (or Key Performance Indicators -KPIs) and information on a real-time basis Information needs in organization External Environment Information exchanges with the external environment Gather intelligence information Provide public information Information needs within the organizations (internal Enviroement) Information exchange within the organization Facilitate decision making Facilitate problem-solving Managers as information processors Continually gather, share and receive information Now as much electronic as it is face-to-face Always on, always connected How many people telecommute at least once a week 70% of people globally work remotely at least once a week, Work at home after covid 19 our forecast Our best estimate it that 25-30% of the workforce will be working form home multiple days a week by the end of 2021 As of 2023, 12.7% of full time employees work from home, while 28.2% work a hybrid model Managers as problem solvers Problem-solving The process of identifying a discrepancy between actual and desired performance and taking action to resolve it Ishikawa Fishbone diagram To identify the cause of problems Decision A choice among possible alternative courses of action Performance threat Something is wrong or has the potential to go wrong Performance opportunity The situation offers the chance for a better future if the right steps are taken Problem-solving approaches or style - from textbook Problem avoiders Inactive in information gathering and solving problems Problem seekers Proactive in anticipation of problems and opportunities and taking appropriate action to gain an advantage Problem solvers Reactive in gathering information and solving problem Managers - can approach problems in a systematic or intuitive manner Systematic thinking approaches problem in rational, step-by-step and analytical fashion Intuitive thinking approaches problems in a flexible and spontaneous fashion Multidimensional thinking- applies both intuitive and systematic thinking Managers face structured and unstructured problems Structure problems Are ones that are familiar, straight forward, and clear with respect to information needs Program decisions apply solutions that are readily available from past experiences to solve structured problems Know how to solve them Familiar Know what we are dealing with Unstructured problems Are ones that are full of ambiguities and information deficiencies Nonprogrammed decisions apply a specific solution to meet the demands of a unique problem Commonly faced by higher-level management Crisis decision making A crisis involves an unexpected problem that can lead to disaster if not resolved quickly and appropriately Ruled for crisis management Figure out what is going on Remember that speed matters Remember that slow counts, too Respect the danger of the unfamiliar Value the skeptic Be ready to “fight fire with fire” Managers make decisions with various amounts of information Certain environment Offers complete information on possible action alternatives and their consequences Risk environment Lacks complete information but offers probabilities of the likely outcomes for possible action alternatives Uncertain environment Lacks so much information that it is difficult to assign probabilities to the likely outcomes of alternative Ex: Certain and uncertain environments: The worldwide Governance Indicators for over 200 countries, comparing distinct environments (Canada-Brazil) Step 1-Identify and define the problem Focuses on information gathering information processing and deliberation Decision objectives should be established What are some common mistakes in definding problems? Common mistakes in defining problems Defining the problem too broadly or too narrowly Focusing on symptoms instead of causes Choosing the wrong problem to deal with Step 2- Generate and Evaluate Alternative Courses of Action Potential solutions are formulated and more information is gathered, data are analyzed, the advantages and disadvantages of alternative solutions are identified Common mistakes: Abandoning the search for alternatives too quickly Step 3- Decide on a preferred course of Action Two different approaches Behavioural model leads to satisficing decisions Classical model les to optimising decisions Behavioural Model Rationality is bounded because: There are limits our thinks capacity Available information (incomplete) Time constraints Step 4-Implement the decision Involves taking action to make sure the solution decided upon becomes a reality Managers need to have the willingness and ability to implement action plans Problems: Lack of participation error should be avoided Step 5 - Evaluate Results Involves comparing actual and desired results The positive and negative consequences of the chosen course of action should be examined If actual results fall short desire results, the manager returns to earlier steps in the decision-making process At all steps, check ethical reasoning Ask these spotlight questions Utility Does teh decision satisfy all constituents or stakeholders Rights Does the description respect the rights and duties of everyone? Justice Is the decision consistent with the canons of justice Caring Is the decision consistent with my responsibilities to care? Issues in decision-making How do errors happen? Heuristics: are strategies for simplifying decision-making Availability Bias: Bases a decision on recent information or events Representativeness bias: Bases a decision on similarity to other situations Anchoring and Adjustment Bias: Bases a decision on incremental adjustment from a prior decision point Framing error: Tring to solve a problem in the context perceived, positive or negative Confirmation Error: Focusing on information that confirms a decision already made Escalating commitment: Continuing a course of action even though it is not working Creative Decision making Creativity is the generation of a novel idea or unique approach that solves a problem or crafts an opportunity Big C: Creativity occurs when extraordinary things are done by exceptional people Little C: Creativity occurs when average people come up with unique ways to deal with daily events and situations The three types of situational creativity drivers Chapter review What are objectives and goals? The specific results or desired outcomes What are the 5 characteristics of great (SMART) goals? Forecasting - Attempts Qualitative forecasting uses options Quantitative forecasting uses mathematical models and statistical analysis of historical data and surveys Scenarios-Oracle’s crystal ball combines qualitative and quantitative methods

Chapter 22 Antihypertensive Drugs Hypertension Defined (JNC-8) Pharmacology Overview 7 main categories of drugs to treat HTN Adrenergic drugs (old friend) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blockers (CCBs) Diuretics Vasodilators Direct renin inhibitors A. Adrenergic Drugs: 5 Subcategories and where they act A1. Adrenergic neuron blockers (central and peripheral)- we won’t talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined α and β receptor blockers (peripheral) A2. Peripherally Acting Adrenergic DrugAlpha1 Blockers (we’ve met these) Doxazosin, prazosin, alfuzosin Block alpha1-receptors which causes BP to decrease Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels Main Use: benign prostatic hyperplasia (BPH) Alpha1 Blockers REMEMBER Tamsulosin (Flomax)* is an α1 blocker BUT *Tamsulosin is not used to control BP, just for BPH. A3. Centrally Acting Adrenergic DrugsAlpha 2 agonist Clonidine and methyldopa 1- Stimulate alpha2-adrenergic receptors. in the brain Decreases sympathetic outflow from the CNS which decreases NE production 2. Stimulate alpha2-adrenergic receptors in kidneys remember alpha 2 opposes alpha 1 Dilates peripheral blood vessels → lowers peripheral resistance → Results in decreased BP So ….Clonidine (Catapres) Used primarily for its ability to decrease blood pressure in an urgent setting Also use in opioid withdrawal as previously discussed Oral (multiple times a day), and topical patch formulations Do not stop abruptly as it may lead to rebound hypertension In reality, Clonidine and methyldopa Not prescribed as first-line home antiHTN drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness MIGHT be uses as adjunct drugs after other drugs have failed, in conjunction with other antiHTN such as diuretics A4. Adrenergic Drugs Selective Beta 1 Blockers Metoprolol, Atenolol Reduction of HR through β1 receptor blockade (remember adrenergic blocking of this receptor???) HR results in BP Cause reduced secretion of renin = BP A4. Adrenergic Drugs Selective Beta1 Blockers Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks β1 receptors and produces vasodilatation, which results in a decrease in SVR High doses loses selectivity and blocks both β1 and β2 Less sexual dysfunction All BB- Do not stop abruptly; must be tapered over 1 to 2 weeks A4. Adrenergic Drugs NONSelective Beta Blockers Propranolol Acts equally on β1 and β2 Other uses include situational anxiety associated with public speaking, test taking As mentioned on previous slide, nebivolol at high doses becomes beta nonselective A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade) Examples are carvedilol (common) and labetalol (not as common) A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Carvedilol (Coreg) Widely used drug that is well tolerated Uses: HTN, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors Contraindications: severe bradycardia or unstable HF, bronchospastic conditions such as asthma, and various cardiac conduction problems Adrenergic Drugs Indications - HTN But also for Glaucoma (topical) BPH: doxazosin, prazosin, and terazosin (2 for 1) Management of severe HF when used with cardiac glycosides and diuretics Contraindications Acute HF- have to stabilize first MOAIs- yeah doesn’t everything interact with MAOIs? Peptic ulcers Severe liver/kidney disease Asthma (with beta blockers) Adrenergic Drugs: Adverse Effects Orthostatic hypotension 1st-dose syncope Rebound hypertension with abrupt discontinuation Most common: Dry mouth, drowsiness, constipation, sedation Interactions- always check for specific drug interactions Can cause additive CNS depression with alcohol, benzodiazepines, opioids Question #1 When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? Hypotension Hyperkalemia Oliguria Respiratory distress Answer A Hypotension This is a key point in patient education These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. B. Angiotensin-Converting Enzyme Inhibitorsaka ACE Inhibitors or ACEi Large group of safe and effective drugs Currently are 10 ACEi Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic, loop diuretic, or Calcium Channel Blocker (CCB) You need to understand the basics ACE Inhibitors: Review RAAS ACE converts angiotensin I, formed through the action of renin, to angiotensin II Angiotensin 2 is a potent vasoconstrictor and also induces aldosterone secretion by the adrenal glands Aldosterone stimulates sodium resorption (H20 follows Na Both act to raise BP which causes kidneys to reduce renin production ACEi= Great drug to treat HTN BUT contraindicated in pregnancy (2nd,3rd trimester due to fetal renal damage) and breastfeeding first few weeks after birth B. ACE Inhibitors - PRIL Lisinopril (Prinivil) super common, often the 1st drug Enalapril (Vasotec) also common Captopril (Capoten) great if liver disease present Benazepril (Lotensin) Fosinopril (Monopril) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Primary Effects of the ACE Inhibitors Prevent Na (and H2O) resorption by inhibiting aldosterone secretion (volume reduction) (GO BACK TO RAAS DIAGRAM) blood volume decreases work of the heart preload, or the left ventricular end-diastolic volume which is important in HF ACE SUMMARY OF ACTIVITY 1) Prevent vasoconstriction caused by angiotensin 2 (2) Prevent aldosterone secretion  less sodium and water resorption Cardioprotective Effects of ACEi They slow progression of left ventricular hypertrophy (ventricular remodeling) after MI so considered cardioprotective ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF Renal Protective Effects of ACEi ACE inhibitors: reduce glomerular filtration pressure by volume reduction Cardiovascular drug of choice for patients with diabetes since it helps protect kidneys by reducing pressure. Sometimes used low dose for kidney protection with DM without HTN B. ACEi Enalapril (Vasotec) Only ACEi available in both oral and IV Enalapril IV does not require cardiac monitoring Oral enalapril: prodrug (metabolized in liver) Improves patient’s chances of survival after an MI Reduces the incidence of HF B. ACEi Captopril (Capoten) Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day so this limits its use Not a prodrug so good for patient with liver disease Question #2 A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her provider has never told her that she has hypertension. What is the best explanation for this order? The doctor knows best The patient is confused This medication has cardioprotective properties This medication has a protective effect on the kidneys for patients with diabetes Answer D ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. Question #3 A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? Clonidine Prazosin Diltiazem Captopril Answer D Captopril Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. ACE Inhibitors: Adverse Effects *Dry, nonproductive cough, which reverses when therapy is stopped. This is a class effect Dizziness- Note: First-dose hypotensive effect may occur Headache & Fatigue Possible hyperkalemia ** Angioedema: rare but potentially fatal Not safe in pregnancy-are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage C. Angiotensin II Receptor Blockers(ARB) Considered an alternative to ACEi Less likely to cause a dry cough and hyper K+ that is common with ACE inhibitors Angiotensin II Receptor Blockers: Mechanism of Action Go back to RAAS diagram! ARBs affect primarily 2 places 1. Vascular smooth muscle - blocks vasoconstriction 2. Adrenal gland -Selectively blocks the binding of Ang 2 to certain Ang 2 receptors inhibiting secretion of aldosterone Lowers volume retention and BP Angiotensin II Receptor Blockers -ARTAN Losartan (Cozaar)- very common Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) C. ARB Losartan (Cozaar) Beneficial in patients with HTN and HF Used with caution in patients with kidney or liver dysfunction and in patients with renal artery stenosis ***Not safe for breastfeeding women and should not be used in pregnancy (Cat C 1st trimester, Cat D 2nd-3rd trimester), potential fetal toxicity Appear to be equally effective for the treatment of hypertension and well tolerated ARBs less likely to cause cough and hyperK+ but can still happen Evidence that ARBs are associated with lower mortality after MI than ACE inhibitors Never take ACEi and ARBs at the same time* 5. Calcium Channel Blockers (CCB) Primary use: HTN, angina, some dysrhythmias Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: Relaxed blood vessels to the heart Decreased peripheral smooth muscle tone Decreased SVResistance Decreased BP E. Diuretics First-line antiHTN in JNC 8 guidelines Decreases fluid volume The results from diuresis: preload, Peripheral resistance Overall effect  Decreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for HTN Ie hydrochlorothiazide (HCTZ), chlorthalidone We will discuss diuretics further in the chapter on diuretics F. Vasodilators Directly relax arterial or venous smooth muscle (or both) Results in: Decreased SVR Decreased afterload Peripheral vasodilation Indicated for treatment of HTN May be used in combination with other drugs F. Vasodilators Hydralazine (Apresoline) Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients F. Vasodilators Sodium Nitroprusside (Nitropress) *Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies. Contraindications: severe HF, known inadequate cerebral perfusion (especially during neurosurgical procedures) F. Vasodilators Adverse Effects Hydralazine: dizziness, headache, tachycardia, edema, dyspnea, N/V/D, vitamin B6 deficiency, rash Sodium nitroprusside: hypotension, bradycardia, decreased platelet aggregation, rash G. Direct Renin Inhibitors Aliskirin (Tekturna) Blocks the RAS pathway at the point of activation. Inhibiting renin production prevents the downstream production of Ang II (potent vasoconstrictor) Adverse effects: N/V, severe hypotension, hyponatremia, hyperkalemia… Contraindicated in patients with DM taking ACEi or ARB Miscellaneous Antihypertensives Eplerenone (Inspra) Newer class of drugs called selective aldosterone blockers (remember RAAS?) Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain Indications: routine treatment of hypertension and for post-MI HF Contraindicated if serum potassium levels are high (above 5.6 mEq/L) A Special Form of HTNTreatment of Pulmonary Hypertension Sildenafil and Tadalafil Commonly used for erectile dysfunction Used for pulmonary hypertension but with different trade names Sildenafil: Revatio* (Viagra for ED) Tadalafil: Adcirca* (Cialis for ED)

News Opinion Sport Culture Lifestyle Show more Books Music TV & radio Art & design Film Games Classical Stage ‘Hollywood doesn’t do very much of that business, they have the nice sign, and everything’s good, but they don’t do very much,’ said Trump. View image in fullscreen ‘Hollywood doesn’t do very much of that business, they have the nice sign, and everything’s good, but they don’t do very much,’ said Trump. Photograph: Lucy Nicholson/Reuters Film ‘I’m not trying to hurt the industry’: Trump softens tone on movie tariffs California governor Gavin Newsom announces a $7.5bn tax incentive scheme as Trump’s announcement of 100% tariffs on films ‘produced in foreign lands’ is mocked by Jimmy Kimmel and Fallon Andrew Pulver Tue 6 May 2025 11.24 BST Share Donald Trump appears to be softening his tone after widespread dismay in Hollywood and further afield at his bombshell announcement of 100% tariffs on films “produced in foreign lands”, saying he was “not looking to hurt the industry”. In remarks reported by CNBC, Trump said he was planning to discuss the plan with film industry leaders. “I’m not looking to hurt the industry, I want to help the industry.” He added: “So we’re going to meet with the industry. I want to make sure they’re happy with it because we’re all about jobs.” Trump also took aim again at California state governor Gavin Newsom, saying the film industry “has been decimated by other countries taking them out, and also by incompetence, like in Los Angeles, the governor [Gavin Newsom] is a grossly incompetent man, he’s just allowed it to be taken away from”. Trump added: “Hollywood doesn’t do very much of that business, they have the nice sign, and everything’s good, but they don’t do very much.” Trump’s talk of film tariffs makes no sense, but it’s already doing damage – to Hollywood Peter Bradshaw Peter Bradshaw Read more Newsom responded with a statement saying: “Governor Newsom continues to champion California’s iconic film and television industry – recognising it as a cornerstone of the state’s economy, one that sustains hundreds of thousands of good-paying jobs across every sector around the state.” “His plan to more than double the state’s film and television tax credit reflects a commitment to keeping production here at home, supporting workers and maintaining California’s global leadership in entertainment. If the President announces a proposal with more details, we will review it.” Newsom had earlier responded to Trump’s announcement by proposing a $7.5bn federal tax incentive scheme, saying in a statement to Variety: “Building on our successful state program, we’re eager to partner with the Trump administration to further strengthen domestic production.” Tax incentive schemes in the US currently operate on a state-by-state basis, and Newsom had announced a plan in April to boost California’s to $750m. California senator Adam Schiff also condemned Trump’s tariff proposal while backing calls for a federal tax credit scheme, saying in a statement: “Blanket tariffs on all films would have unintended and potentially damaging impacts, [but] we have an opportunity to work together to pass a major federal film tax credit to re-shore American jobs in the industry.” Late night TV hosts Jimmy Kimmel and Jimmy Fallon also joined the chorus of dismay and bafflement at Trump’s plan. Commenting that Trump was “now aiming his wrecking ball at Hollywood”, Kimmel questioned whether foreign-made movies were a “national security threat” as Trump claimed. “I don’t care where they’re made. I really don’t. I guess it’s what the late, great Hannibal Lecter would’ve wanted. Sonic, the illegal immigrant hedgehog, is a national security threat and he must be stopped!” Kimmel also mocked actor Jon Voight’s role in Trump’s thinking, saying: “This is where he reportedly got the tariff movies idea – from Angelina Jolie’s 86-year-old father she won’t talk to. What a great idea. Next year, The White Lotus is gonna be set at a Hampton Inn.” Fallon also took aim at Trump’s implication that foreign locations were somehow taboo, saying: “Gonna be fun seeing the next Lord of the Rings filmed in Bayonne, New Jersey,” adding: “If you don’t like that, you can also watch Emily in Des Moines [instead of Emily in Paris]. It’s just as charming.” Explore more on these topics Film Film industry Donald Trump Trump tariffs Gavin Newsom Jimmy Kimmel Jimmy Fallon news Share Reuse this content Most viewed Live German parliament votes again on Merz’s bid to be chancellor after humiliating first round – Europe live Trump and Carney to meet at White House in closely watched encounter Mushroom lunch’s sole surviving guest details deadly meal and its aftermath as trial of Erin Patterson continues ‘It’s the misogyny slop ecosystem!’ How Candace Owens and the American right declared war on Blake Lively Wisconsin woman missing for more than 60 years found ‘alive and well’

Reasons why do teenagers are beginning to smoke a. Teenagers do it, due to peer pressure. b. They follow the example of adults who smoke. c. They are responsive to attractive cigarette advertisements. d. They are tempted to satisfy their curiosity. e. To look like their adult counterpart. Smoking is said to be the leading cause of lung cancer and chronic lung diseases. There are many different chemicals and substances in tobacco smoke that injure the cardiovascular system, hence the development of heart attacks. There are no perfect plans or technique for quitting smoking. However you can follow the succeeding approaches. a. commit yourself to quit smoking b. set a date to put a stop to smoking c. list the reasons why you want to stop smoking. d. review periodically all the harmful effects that smoking does to your body. e. involve other people, like your families, friends why you would want to stop smoking and ask for their support. f. change your routine, before the urge to smoke strikes, start activities that make smoking physically difficult to perform. Now, let’s compare the smokers for non-smokers: Home Economics and Livelihood Education 7 Seibo College 59 Body of smokers Vs. Body of non-smokers Smokers Non-Smokers Restless Wiser and positive thinker Have more facial wrinkles Smoother complexion Prone to absenteeism and tardiness More active and energetic Money is wasted due to costly cigarettes Money is spent wisely Lack of self-confidence, insecure Confident of himself Prone to cardiovascular diseases Healthier and feel better Dull sense of taste Sharper sense of taste Now, you can focus on the many benefits of putting a stop to smoking.  Your senses of smell and taste can improve.  You can breath easier.  Your smoker’s cough will become to disappear.  You will notice an improvement in your stamina.  Your risk of heart attack will begin to decrease and other related diseases. Home Economics and Livelihood Education 7 Seibo College 60 If you have any questions,

THAT'S ENTERTAINMENT Big movies on a small budget. Do you need millions of dollars to make a movie? No. Do you need millions of dollars to make a successful movie? Most people would answer 'Yes' to that question. But would they be right? We're used to hearing about really expensive Hollywood films. The 1997 Oscar-winner Titanic cost $200 million to make, and more recently, Spider Man 3, one of the most successful films of 2007, had a budget of more than $250 million. To be successful, however, a film doesn't need to be as expensive as the big Hollywood blockbusters. An example of this is the 2010 movie Monsters, which cost less than half a million dollars to make. Monsters is set in Mexico and is the story of two people trying to escape from aliens and get back to the USA. The film won several awards and got very good reviews from many film critics-for example, the website Moviefone put Monsters at number 3 in its list of the best sci-fi films for 2010. How did they make the film so cheaply? First of all, it only took three weeks to film, and the film crew was just seven people in a van. Secondly, the man who made the film, Gareth Edwards. decided to film it with digital video, which is cheaper than the usual 35mm film. (The film equipment cost only $15,000 altogether) There is also the fact that they used real locations, not a studio. And the cast of the film were Edwards himself and two friends of his all the extras in the film were people who were just there, and they weren't paid. Most importantly, Edwards did most of the production work himself. He spent eight months editing Monsters and then five months creating the special effects. And he did it all at home on his computer, using non-professional software. The amazing thing is that the final film looks nearly as professional as big, fancy Hollywood productions. Not everybody liked Monsters, of course. One person said: "That's 90 minutes of my life that I'll never get back. But overall, it was very well received. And at least it wasn't expensive to make.

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