Cost Vs. Care Essay

Cost by Day 3 your analysis and assessment of the ethical and economic challenges related to policy decisions such as those presented in the Washington Post article. How does this type of situation contribute to the tension between cost and care? Substantiate your response with at least two outside resources. Cost and Care in the US Kovner and Knickman (2011, p.280) suggested that health economist in the US used various methods to the measured value created by healthcare, the standard measure is the quality adjusted life years (QALY). The two factors whose product results in the QALY are 1) measure of the patient’s quality of life on a scale where 0.0 is essentially death, and the 1.0 is perfect health, and 2) the number of years the treatment will extend the person’s life. Applying QALY in the Provenge is by multiplying the value that is $93,000 with the number of extended months that are four. The product is $372,000 per quality adjusted life year. Provenge is just one of the expensive drugs that is utilized in the US and paid by government and other insurance. Herper (2010) reported that the most expensive drugs cost more than $200,000 a year. These are those that treat rare diseases, mostly genetic, which inflict to less than 10,000 patients. Example is the drug, Solaris, which cost $409,500 a year. This is a monoclonocal antibody drug that treats the paroxysmal nocturnal hemoglobinuria. Another drug is Elaprase that cost $375,000 a year. This medicine treats an ultra-rare metabolic disorder called Hunter’s syndrome. The article also mentioned that the high cost of medicine is necessary to support the few patients who will ever need. I believe that for this reason, the cost for this drug is justifiable, but not in the case of the Provenge. American Cancer Society (2013) suggested that prostate cancer occurs mainly in older men; six cases in ten are diagnosed from ages 65 and older and rarely before age 40. While National Cancer Institute stated that the estimated new cases of prostate cancer in the United States in 2014 are 233,000 and estimated deaths are 29,480. These data defines that prostate cancer medications shouldn’t belong to the most expensive medication. At present, there is a $7,535 per capita spending in the US per year (Milstead, 20, p. 194). Emergence of expensive medications that will be approved by the government will increase this number. The government needs to develop programs that wi ll cut this cost  without sacrificing the necessary treatments needed by patients. One program can be giving incentives to companies that do researches and come up with an alternative and affordable drug for prostate cancer such as Prostvac-TRICOM, Ad/prostate-specific antigen vaccine Ad5-prostate-specific antigen and the DNA/prostatic acid phosphatase vaccines (Lubaroff, 2012). Ethically, everyone should be treated equally in healthcare. The four principles that are relevant for health care are respect for persons, beneficence, nonmaleficence and justice (McAdams, n.d.). The government uses the principles of respect for a person, beneficence and justice in approving expensive treatments and medications. The US government gives their respect by performing their duty as the healthcare provider and having a goal of 21st health care excellence. It provides beneficence by being kind and providing healthcare programs to below the poverty population; on individual with a particular disability; on veterans and their family; and, on the ageing population. It practices justice by creating a law that healthcare facility/agency cannot deny a treatment in emergency setting; and by sharing the cost of healthcare. Summary Cost versus care will always be a debate in the politics area. If we base all our actions through the principles of ethics, all necessary treatments should be delivered in the health system of the government. All patients should receive interventions for the treatment of disease and to prolong life as they wish to be. That is the reason we have the POLST, the Advance Directives and the Informed Consent. The government’s role is to source funding from everywhere to meet the needs of the patients. Funds may come from the shares of cost, from the co-pay, from the deductible, from the out of pocket, from the stocks and bonds, from â€Å"sin â€Å" taxes and other forms of taxes, and from other sources of investment for health funds. The government, at the same time, should regulate the companies or individuals that take advantage of the private, company and government insurance that demand a higher price of service or products. References: Cancer Society. (2013). What are the key statistics about prostate cancer? Retrieved from the http://www.cancer American.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statisti

Importance of Time Essay

Time is said to be eternal. It is said that it has neither a beginning nor an end. Yet men are able to measure it as years, months, days, hours, minutes and seconds. They have also given meanings to the words – past, present and future. True, time has a meaning. It moves.Yet time is said to have no holiday. It exists always. Every movement of creation is linked with time. One cannot grow paddy in a month nor can a child become an adult in a year. Everything is fixed . Time is a free force. It does not wait for any one. It is commonly said that time and tide waits for no man. Time is money. A minute not usefully spent is an eternal loss. You can never get back the lost minute. One has to strike the iron when it is hot. The time flies and never returns. If you waste time it wastes you. To utilize time fruitfully, we must take concrete steps as to how we are going to use it and what we are going to do with it. There is a proverb which says that killing time is not a murder; it is a suicide. It means, by wasting time one is not harming others. On the other hand one is harming himself. A man who is a part of nature cannot complain against time. Time is powerful. It conquers all. Men are only to obey it. Man cannot say that he has nothing of his own. Time which is valuable is all his own. If you are not on time and miss the train, you miss it fore-ever. So also the time, once you miss it, it flies off. You can never catch it. Hence it is called fleeting time. Let us learn to use our time fruitfully. This is the key to success because time can create us or destroy us. It all depends on how we utilize time.

Discussion DB 5 Essay Example | Topics and Well Written Essays - 250 words

Discussion DB 5 - Essay Example Given below are the three products for which the consumer demand has been found decreasing for the recent years. Carbonated soft-drinks Until the recent years, the per capita consumption of carbonated soft-drinks has been increasing at a high speed in the established markets. However, the demographic trends have caused the products to reach at their decline stage. Throughout the established countries, teenagers and youngsters contributed the most part of consumers for soft drinks. The decline of popularity in these countries can also be attributed to the decreasing birth rates and ageing populations, for the condition would reduce the demand for the carbonated soft-drink products. The number of people most likely to consume carbonated soft-drink products declined to a very low level in the established markets. Another important problem is the society’s increased focus on â€Å"health and fitness, well-being, and their anxiety about obesity†; for example, Coca-Cola has b ecome the victim of this phenomenon recently (â€Å"Coca-cola innovates†, 2010). Toilet soaps The consumer demand for the toilet soaps has gone down to its lowest point. Firms find it difficult to move their toilet products, especially soaps out of the market.

Contemporary Fashion Marketing Trends Assignment

Contemporary Fashion Marketing Trends - Assignment Example The paper "Contemporary Fashion Marketing Trends" analyzes the trends of the Contemporary Fashion. This paper explores the contemporary fashion marketing trends that will be prominent in the next 5 years, particularly in the global fashion industry. Over the next five years, some fashion trends will be influential, especially in the international platform. They will be influential in the sense that technology will play a key role in all aspects of fashion marketing. In essence, the digitization of the fashion marketing industry will revolutionize the industry in the sense that most customers will get the latest fashion updates via online platforms. Although technology has revolutionized the fashion industry on a significant scale, the next five years will see the globalization of the fashion industry. Customers and prospective customers will receive all the information that they require through digital platforms. The contemporary fashion industry players will also conduct most of the ir marketing via digital platforms in order to reach a global clientele. Social network will be more influential in the fashion industry in the next five years that it is today. When it comes to sustainability, the contemporary fashion marketing is set to evolve in line with the highly dynamic world and fashion market. As the world advanced into the 21st century, more industries, including the fashion industry, are becoming environmentally conscious. It means that any contemporary or future fashion marketing.

Classical Opera and Popular Music Essay Example | Topics and Well Written Essays - 1250 words

Classical Opera and Popular Music - Essay Example The combination of sound and rhythm are particularly important in music as they enable people to relate to music and drive out the desired intention. Historically, music has been used to make life lively, entertain people and pass messages to the community. Music has gone through stages from the simple forms of art to the complex technologies that are used today to come to compose and record songs. This paper will discuss the evolution of music from the classical opera style to the modern popular music, and elaborate on the similarities and differences of the two music forms. Classical opera was introduced by the Greek and Roman societies, and was related to their scientific and cultural practices of the time. During this time, there were no inventions in drama and music (Naxos). However, religion and tradition had great influence on music of the day since during occasions related to the two there were performances that highlighted music. Classical opera is a form of art that incorpo rates lots of orchestral, lyrical and theatre techniques. Classical opera evolved over time and combined dissimilar genres to be become a form of music. Although it was performed on stage by using the stage, acting and costumes, the words in the operas were sung in order to make the audience more attentive so that they could get the message being passed and enjoy the performance. In classical operas, there existed two forms of singing, recitative and aria types of dialogue. Recitative operas consisted of harmonic conversation that was not accompanied by melody and the aim of this singing was coming up with a plot. Aria reefers to music that was accompanied with a melody and emotional attachments meant to capture the eyes and ears of the audience. In the early nineteenth century, the two forms were joined to form the arioso style, which combined melody and singing. Another component of opera is musical accompaniment, which was used to set the mood for the performance, and this enable d the audience to connect the scenes in the opera. Classical Opera music first came into existence from performances called ‘intermedi’, which were started to celebrate important events such as weddings or holidays (TheatreHistory). The performances were accompanied by simple musical accompaniments that had single lines of melody for catching the attention of the audience. This practice was known as monody and had originated from a prior style known as madrigal, which was a form of singing that used a polyphonic strategy but became outdated. The performances of this age of opera were undermined by some irrelevant scenes, and this stunted advancement of drama and music. A German composer, Christophe Gluck came in to help people fix music into lyrics and he played a significant role in the advancement of opera. This made performances to be dramatic since there was a relation between the performance and the musical background. This purged the recitative opera and music was used for expression. One of Gluck’s compositions was the Orfeo ed Euridice, which was a tragic based mythology from Greece that is still performed in cinemas today (Fuller). In this composition, he made action important in performance since they could help people associate with the scenes. The audiences were prepared for the later scenes from the preceding scenes and this significantly improved drama. The other famous opera is the Magic Flute in which singing was accompanied by dialogue, and this enabled

ICT in Tourism and Hospitality Sector Essay Example | Topics and Well Written Essays - 5000 words

ICT in Tourism and Hospitality Sector - Essay Example This essay is to evaluate the extents to which use of ICT has been embraced in the tourism and hospitality industries especially in small and medium enterprises. The paper will identify the various applications or innovations of information and communication technology that have been integrated into the mentioned industries and how they have helped in improving operations. This essay will point out the major areas of ICT advancement by use of a case study of one of the companies operating in the said industry. The selected case study is the Galle Fort Hotel in Sri Lanka. The hotel is a world recognized hospitality destination with a simplicity that has won the hearts of many people visiting the Galle Fort tourist attraction in the country. The beach hotel is owned by an Australian family with a total of 13 guest rooms and has won many awards among them the 2007 UNESCO heritage conservation award and the world travel award 2009 for being the country’s leading boutique hotel and many others. The hotel has embraced the use of ICT and has a fully functional website. This paper will closely examine its ICT use through the various applications it has employed in order to help it in the day to day operations. From early times, Sri Lanka has been a major tourist attraction for visitors across the globe. The Galle Fort Hotel is one of the best boutique hotels in the country. The hotel is built on the fortified old town of Galle that was founded by the Portuguese in the 16th century. This points out to how it has been set out on a historical and world heritage site. To turn this around whilst ensuring that the area retains its rich historical and cultural heritage is definitely a great challenge. However, the hotel has adopted the use of ICT as evidenced by its presence in the internet through its official website and other social networking sites like face book.

The relationship between Benedick and Beatrice in the Play and the Essay

The relationship between Benedick and Beatrice in the Play and the Film of Much Ado About Nothing - Essay Example Two other characters stand out as important elements in the dramatic development of the play. Beatrice is a fiery, outspoken cousin of Hero, who is intended no doubt to provide a contrast to Hero’s gentle and quiet character. Benedick is a witty and disrespectful courtier who so far has not consented to be romantically tied to any woman. Claudio and Hero are the unwitting victims of deception, showing one potential reaction to this turn of fate, while Benedick and Beatrice are examples of an entirely different, and more feisty response. As the title of the play suggests, it all comes right in the end, but the main point of the play is to explore the different paths that can be followed in leading two individuals to the traditional â€Å"happy ending† scenario of the Elizabethan comedy genre. Love wins out in the end, despite the posturing of the human characters in the play, and this is the main message that both film and play project. Benedick and Beatrice are like male and female versions of the same character type. They predictably get into arguments with each other, partly to amuse their friends, but partly also because they have so much in common with each other, and make such equal and entertaining sparring partners. While Hero and Claudio play the role of the star crossed lovers, whose path to true love is interrupted by villainous subterfuge, Benedick and Beatrice represent a lively contrast, as two arch enemies who are brought together by the same villainous plotting. This criss-crossing plot device is an example of Shakespeare’s complex commentary on the shifting roles of the sexes in Elizabethan England. One of the features of Branagh’s film that has attracted much critical attention is the fact that there is a mixture of British and American actors in the film, with a consequent erratic mix of accents. This was no doubt a consequence of UK/US collaboration on the production side, but also a reflection of marketing aspirations which were truly global. The kind of Shakespeare being produced here is deliberately international, with an ironic kind of inter-textuality that appeals to a post-modern audience. The casting of comic superstar Denzel Washington as Don Pedro, for example, adds modern layers of connotation to the original meanings intended by Shakespeare himself. Seen in this light, the relationship between Benedick (Kenneth Branagh) and Beatrice (Emma Thompson) appears as a commentary on relationship issues faced by modern globetrotting professionals. Certainly Emma Thompson’s Beatrice is reminiscent of the articulate, at times even stridently feminist, modern wom an who will not succumb to traditional notions of female subordination in marriage. Don Pedro’s comment to Beatrice â€Å"In faith, lady, you have a merry heart† (Act 2, Scene 1, line 293) underlines the potential that she has to lighten every scene and distract attention from her inner loneliness to her outer display of wit. There is more to Beatrice than meets the eye, and only in the presence of Benedick does she truly shine. This chemistry between the two characters is brought out to perfection in Branagh’s film, as the two often stand back to back, facing away from each other and firing off remarks into the surrounding crowd of onlookers. They studiously avoid intimate contact at first, but everyone knows that they are a fine match for each other, romantically as well as intellectually. The underlying tension between the two sets up a slow burning suspense that carries on throughout the play and film until it reaches its fulfilment in the closing scene. The

Reaction paper on religious Tolerance Article Example | Topics and Well Written Essays - 1000 words

Reaction paper on religious Tolerance - Article Example per will analyze the opinions expressed by two prominent authors on religious phenomenon and tolerance and explain their profound influence on my understanding of concepts like religion, morality and tolerance. In his article titled ‘This Is a Religious War: September 11 was Only the Beginning’, the author Andrew Sullivan expresses his opinions on various issues related to religion, inter-faith clashes and religious fundamentalism. Many of my opinions on religious phenomenon and tolerance have in fact been shaped on Sullivan’s views and arguments. Sullivan says that in principle, faith is a form of conflict with reason, which in effect implies that it is in conflict with science. He further says that the only ultimate truth is god and that science can never disprove this true faith as it rests on truth. Science or reasoning can thus never find reason for conflict with this truth. I also find his interpretation of religious evolution as an interesting observation on human civilization and development. The belief that god created the universe does imply that any explanation on its formulation cannot find reason to contradict its creator, in other words find fault with any faith as all of them reconcile to the truth that will always remain beyond our fullest perception and understanding. Sullivan undoubtedly encourages religious tolerance by taking a harsh stand on fundamentalism across all religions. He not only criticizes the justification of violence as a means of achieving religious ends, but also despises fundamentalism as an obstacle in introducing doubt into the faith and its reluctance to encourage human reason. In fact, the cornerstone of religious tolerance is to rid oneself of exclusion and pride and to treat mystery as the primary reality behind any religious pursuit. While this may uphold truth that cannot be proven empirically, it nevertheless does not provide room for any hatred against other faiths. In January 2008, the noted psychologist

Project Proposal Essay Example | Topics and Well Written Essays - 2000 words

Project Proposal - Essay Example This project proposal tries to prove the critics wrong and assert that a coffee shop developed in Kuwait can become internationally significant with its line of products. In Kuwait, a US born coffee shop called Starbucks International is among the leading coffee vender shops (Fullerton, 2005). The main advantage held by Starbucks International is the specialty it offers to its customers, making it a unique coffee shop. In essence, for a coffee shop developed in Kuwait to flourish, it has to offer unique services, and this differentiation of products will result in its popularity nationally, and Kuwait being among the top tourist destinations it will eventually gain global recognition. Currently, there are hundreds of coffee shops in Kuwait, which is a challenge to any ambitious individual or group that intends to go into the coffee shop business. Mission The coffee shop company has to set a clear mission that will see it create a humble place, unique enough to ensure comfortable soci alizing of customers, a relaxed environment that is destruction free as they enjoy their coffee (Giovannucci and Ponte, 2005). The company intends to reach out to the world through opening of numerous branches that offer the same services at affordable prices. In addition, it will work towards investment of the profits realized so as to keep faith with its employees and shareholders (Giovannucci and Ponte, 2005) Problem Definition According to Golding and Peattie (2005), going into the coffee shop business will mean that the company comes with suitable strategies to ensure production of quality coffee that is unique from the other coffee shops. Different people have different preferences and tastes; thus, since the company intends to have branches worldwide a study will have to be conducted on coffee preferences and tastes of different people in influential markets. As Fullerton (2005) argues, the task faced is to investigate and come up with ways in which a coffee shop can be devel oped in Kuwait and extend its services across the world. Topic Relevance According to Golding and Peattie (2005:158), Arabs are fond of coffee, which forms a basis for the development of a coffee shop in an Arabic country. In addition, with the current Freedom of Movement, Arabs are all over the world. This does not mean that Arabs are the only target market since many other non-Arabic people love coffee (Holmes, 2004). The coffee shop, once in place, expects to fetch revenue approximating from ?500,000 in the first year of its operation to ?800,000 by the fifth year. According to Holmes (2004), the company will have to maintain its gross profit margin above 50% and maintain reasonable expenditure in its operations for it to achieve these targets. Research Objectives The new coffee shop has its business objectives just like any other business would have (Giovannucci and Ponte, 2005). In its birth year, the company’s expectations are; i. To be named by the customers and/or loc al restaurant guide as the best coffee shop locally. ii. Maintain a gross profit margin that is above 50% so as to realize its profit targets. iii. Realize immediate profits right from the first month of its operation. iv. Capture a local market of over 50,000 people in the first month of

Classroom Management Considerations to Promote Inclusion Essay Example for Free

Classroom Management Considerations to Promote Inclusion Essay In order for a classroom to be truly inclusive classroom management considerations have to be addressed. Will the classroom atmosphere be conducive to learning for all students and how will the climate be modified or adapted to meet these needs? How will classroom goals and rules be established and are they visible and clearly stated in the classroom? Are academic standards clearly stated and visible in the classroom? Does the teacher effectively utilize differentiated instructional strategies for all students? Is the classroom arranged in a manner to accentuate student learning, for example: how are the desks arranged, is there a student seating plan in place, are bulletin or display boards cluttered and distracting, are there technology resources available to the students in the classroom? Are the teachers utilizing flexible co-teaching models in the classroom and is planning time scheduled to create effective lesson planning? These are questions one must ask his or herself in order to create a truly inclusive classroom. Language and discourse in the classroom also plays a role in creating an inclusive atmosphere, the relationship between the teacher and student, the student and his or her peers is part of the social climate of the classroom and must be positively modeled by the teacher. The teacher must find a way to assess and re-assess instructional strategies so that instruction is real-world based and encourages various extensive and engaging learning opportunities for the students. The teacher also has to teach and model positive coping strategies for stress and should remain non-judgmental in their classroom and behavior management approaches. The following is a short list of some modifications or adaptations that can be made in the classroom: †¢ Preferred seating †¢ Pre-printed notes for the class †¢ Visual aids such as graphic organizers like a KWL chart †¢ Choice of assignments †¢ Extended time to complete tests †¢ Fewer questions for classwork or homework †¢ Modified grading utilizing a rubric †¢ Reduce distractions †¢ Teach study skills and coping strategies †¢ Use flashcards †¢ Use of technology to facilitate instruction such as reading and math software to reinforce and teach pre-requisite skills †¢ Visual schedules †¢ Use of manipulatives †¢ Visual communication aids

The Primary Music Curriculum Education Essay

The Primary Music Curriculum Education Essay My research is based on the primary music curriculum and about the teaching between the music specialists and the classroom teachers. I collected many data from books, articles, from an observation in a school and from my experience as a student who I was. To start with in the late nineteenth century the educational forum, the National Education Association, included a music section which music was recognised to be in the primary education (Jones and Robson, 2008). When then the National curriculum was determined it was compulsory for all the children in primary schools to attend the music curriculum which was a supplemented part of the school curriculum. In the music curriculum the three main musical skills are performance, listening and composing. Through the performance the children will be able to practice their voices in singing parts and perform different songs in their instruments. Through the listening they will be able to develop their audibility by hearing different sounds and songs and experiment with these. Also through the composing they will be able to develop their creativity and make different music patterns using some musical ideas. The primary music curriculum represented in key stage 1 which is the years 1 and 2 and key stage 2 which is the years 3 to 6. In key stage 1 the children should be able to recognise and identify musical materials and use them to describe an atmosphere or a dramatic situation (Swanwick, 1992). In this age the children start study music with so simple and interesting methods. Moreover during key stage 1 the children listen carefully and respond physically to a wide range of music. Also they play different instruments and they sing songs from memory using their fantasy (The national curriculum for England, 1999, p. 16). They experiment with simple musical instruments like recorder and some percussion and learn the songs with a specific way in order to remember the lyrics and make some movements. The children also learn the difference between the melody and the rhythm and how to experiment with these in their own compositions. As Swanwick (1992, p. 16) states the children in key stage 2 should be able to distinguish melodic and rhythmic devices found in songs and instrumental pieces and try to use them. During key stage 2, the children sing songs and play instruments with increasing confidence, skill and awareness of their own contribution to a group or class performance. Also they can improvise their own musical compositions and explore their thoughts and feelings for music from different cultures (The national curriculum for England, 1999, p. 18). The aim of the music curriculum is to make the children acquire some useful knowledge and also to feel confident and independent. For example the children until the end of year 2 in key stage 1 will learn to sing with a sense of the shape of the melody and perform simple melodic or rhythmic patterns keeping to a steady pulse (Music Teachers guide, 2000). By the end of year 4 in key stage 2 the children are able to perform different rhythmic patterns again but now with some notes included and also to improve their own compositions. Moreover until the end of year 6 in key stage 2 again, the children will learn to recognise the relationship between the sounds and perform by ear and from simple notations. Also they will have the opportunity to describe or characterise different kinds of music that they listen to with music vocabulary (Music Teachers guide, 2000). The music specialist has of course more knowledge in music than the classroom teacher, because he studied it and he made music training for many years in order to be worthy to teach to the students anything about music. This is also supported by Steinel (1990), who notes that certified music specialists have spent a minimum four years plus several precollegiate years training in music (Byo, 1999, p. 113). According to Hoffer (1961, p. 46), music specialist must be the leader in the classroom due to his advantage that he completed high music training. In my view it is a bit unfair the music specialist to be in a lower stage than the classroom teacher, because they do not have the same level in music knowledge. The music specialist is better to design the structure of the music lesson according to his own knowledge as he knows to organise it better from his experiences. This is also supported by Hoffer (1961, p. 46) who states that without the structuring efforts of the specialist no r eal musical progress will take place throughout the school. Through this, he wants to tell us that music specialist is very important for the music in schools, because he is the most suitable to organise an effective music lesson with a good structure. Moreover the music specialist is more able to teach some instruments to the students due to the knowledge and his experience that he has from his music training. As Hope and Lehman (1995) note, music specialists receive comprehensive training in music performance and theory (Byo, 1999, p. 114). So through the performance aspect, the music specialists can experiment with different instruments and be familiar with them in order to be able to teach them to the students with a good teaching method. Also if there are music specialists at primary schools the lessons will operate with more confidence and the students will understand better the meaning of music and acquire abilities and knowledge in everything; playing instruments, singing, about the history and theory of music through teachers experience and abilities. As Hennessy (1998) also states, music teachers with many years training are very important in primary schools for their specialist skills and knowledge, because they give mor e emphasis to the curriculum and they follow it on the right way. It seems that music specialists can follow exactly the curriculum without change something and accomplish to deliver it effectively, because they are expert in it and they also know what teaching methods have to use and when each one. According to Picerno (1970) the classroom teachers feel they can teach to the students about the music literature, some songs and plan a program for the music lesson. Also the classroom teachers feel that they cannot teach about conducting, music theory and music history and it is better the music specialists to teach these skills. (Picerno, 1970). I agree with this statement, because the classroom teachers do not have so high standards as music specialists in order to be able to teach the music in depth. They can just teach simple elements in music such as different kinds of songs and activities which have also help from Music Express scheme. Music Express scheme is a guide for non-specialized teachers in order to have help on what they can teach and how. Through the observation, I noticed that the classroom teachers learn from different readings and guides and then teach just the basic from the music curriculum. Hoffer (1961) notes that some persons believe that classroom teachers are able to teach at least some important things about the music curriculum, but they need the help of the specialists with some workshops and advices. According to Gamble (1988, p. 26) the classroom teachers provide the fundamentals of learning that students use later throughout their lives. This is right but I think it is apply just if the classroom teachers have help and support from a music specialist to give them some important guidance. Also Hoffer (1961, p. 45) states that some experiences have shown that classroom teachers even with the workshops, they cannot teach single-handedly a completely satisfactory music lesson. In my view Hoffer is right and not the people, because it is logical that it is impossible for the classroom teachers to know everything about the music curriculum, because many years of experience are required and also further knowledge in music education especially practical in a universit y or a college. Nevertheless there are some classroom teachers that wish not to teach music which is natural and they do it just because it is in their obligation to be able to teach all the subjects. In this case it seems that these teachers cannot teach music with success, because every teacher must like and find interesting the subject that he teaches in order to make the students also to be interested and concentrated on it. In contrast with music specialists who like to teach music and this is implicit and also this is the proof that they study it so many years and they teach it with so affection. This is also supported by Hoffer (1961, p. 45) who notes that some classroom teachers have extra music training and are proficient in teaching the subject but some others have no ability or interest in teaching music. This means that some classroom teachers may have the music knowledge that a music specialist has and some others may have anything, because they do not like to accomplish with this subje ct. Moreover Rainbow (1971, p. 1) states that the teacher who teaches music must be able to infect his students with his enthusiasm. So the teacher must like music in order to be able to teach it to the students effectively and also to take out his feelings about music and make the students to feel the same. Both Hoffer and Rainbow mention the same statement and it seems to agree with my own view; that if the students see their classroom teachers during the music lesson to express a bad feeling about music or that they do not want to teach it, then the students will ignore the lesson and will not be interested. But with music specialists this will not happen, because they all like music and teach it with very enthusiasm. Classroom teachers it seems that due to the non-training about music education who have, feel that they cannot teach music and they have lack of confidence. They do not know if they teach on the right way or not and if the students are able to understand what he teaches them. This is also supported by Jeanneret (1997, p. 37) who notes that from a research that she did in some countries like Australia, Great Britain and North America, the classroom teachers are responsible to teach music in their classrooms and they have a negative attitude towards music and lack of confidence to teach it. In my view a good point for the classroom teachers to teach music is that they know better the students; their character, their preferences because they are all the day together and they can teach them better regarding their interests. This is also supported by Mills (2005) who notes that the students can learn more things by a classroom teacher who knows them will rather than a teacher who is expert in music, but he does not know how the students work and their personalities. So this is a disadvantage for the music specialists who see the students just once a week and they cannot come close enough to them in order to know what they like to listen or how each student like to work. According to Hoffer (1961, p. 45) if the classroom teachers do not contribute in the music lesson, then the music program will become detached from the rest of the school curriculum. From that angle, he is right, because all the subjects are taught from classroom teachers and if the teachers leave out music is like ignoring music as a subject or considering music as a subject of less importance. According to Hennessy (1998), classroom teachers think that they cannot teach music, because they have no background in music education and they cannot read music. Hennessy (1998, p. 14) also mentions that these teachers usually have the abilities to play by ear, improvise and accomplish better with pop, folk or jazz styles. Personally I find my self disagree with this, because the classroom teachers are not in the position to teach music so well, if they do not have just a bit background of music education or if they do not attend a music workshop before. It seems these to be important, because they have to receive the main elements of music and some good teaching methods in order to be able to deliver the music curriculum to the students and have a successfully music lesson. According to an Ofsted report (Making more of music: Improving the quality of music teaching in primary schools, 2009, p. 3) the classroom teachers are able to provide a good music teaching when they are suppor ted effectively. It seems that the author wants to states that if the classroom teacher has help and useful guides from the music specialist, then he will be able to teach music well. This is a difference between a classroom teacher and a music specialist. The music specialist can teach music curriculum alone with his own mind, experiences and knowledge, but the classroom teacher needs a support to be able to starts and complete his teaching. Mills (2005, p. 28) notes that good teaching leads to students learning. By this, she wants to tell us that there is no importance if the teacher that teaches music has a music degree; if is the music specialist or the classroom teacher. The most important is that anybody from these teachers who teach music must do it very effective. According to Hennessy (1998) the classroom teachers are able to teach until year 4, because the music curriculum is easier to teach it at this stage, but in years 5-6 the music specialists are more able to teach it, because it is more complicated and more musical experience is required. The classroom teachers are able to teach during the beginning years, because except from a music guide to help them, they can also experiment easier and simple with the teaching and also using their fantasy. In later years this is difficult, because the standards go up and the music curriculum has more challenges towards the teacher. So a music specialist is more necessar y to teach it, because he can infect to the students his music knowledge through his experiences and his abilities to the music activities. To conclude, my own view is that music specialists can teach music more effectively than the classroom teachers at primary schools due to their experiences, their skills, their knowledge, their music training courses and the confidence they feel when they make in practice all of these. They know how to organise the music lesson better and how to teach each part of the lesson such as the performance, the listening and the composing in order to have a formative lesson and the students to be interested and familiar with music. Nevertheless I believe that the classroom teachers if they have a bit background about music and with the help of music guide, they will be able to teach music as well but until an extent. This is because they have the advantage that they know the students very well and they teach them based on the general progress of the students and they also help each student separately to improve his skills. Personally when I was a child in primary school my teacher was a music specialist and I gained a lot from her. That is why I believe that music specialists can teach music very effectively. She helped me to acquire the fundamental things which I had to know in music in that age and also to be interested in music. She taught me how to play some instruments, to sing, to learn some important elements of music such as the rhythm, notation, melody and different others. She did not know me and the other students very well, because she was seeing us just two days per week, but she was able to teach us music and also all the students were attend the lesson very carefully. Of course I am not sure if this happens with all the music specialists. As I mentioned above some authors state that this happen with the classroom teachers and that is an advantage for them to teach music better. So I think it is depends on the character of the teacher if he/she can teach music well and from his teaching m ethods except from his knowledge about music and not if he is a music specialist or not. The most important is the teacher; either the music specialist or the classroom teacher to transmit to the students his love and interest about music in order the students to be able to participate easier in the music lesson. All the weight and the organisation of the lesson is based on the teacher, because it depends on him if the lesson will be effective or not.

The Truth about the Morning-After Pill :: Birth Control Pregnancy Papers

The Truth about the Morning-After Pill During her freshman year at Northeastern University, 19-year-old Jennifer Grant* thought college was just about doing minimal homework, going to parties, and meeting new people. She looked forward to every weekend when she was invited to parties with upperclassmen. Sadly, her world fell apart when she was raped by another student who was an acquaintance. Scared and confused from the experience, she turned to her friends for help. â€Å"They mentioned rumors of this ‘morning-after’ pill that would help you from getting pregnant,† Grant said. She wanted to go to the Lane Health Center, but it was Sunday and she knew it was closed. She looked on the Internet for information on what she thought was a â€Å"magic pill† and discovered she could still take it two days later. On Monday, she walked into the Lane Health Center and after waiting a few minutes, she was assisted by a nurse. After she nervously explained what had happened, she said she was given a survey that contained a series of medical questions. In addition to the emergency contraception pill, a pregnancy test was administered and she was tested for sexually transmitted diseases. "They did everything they could to help me and make me feel comfortable,† Grant said. â€Å"The only thing on my mind was, ‘I can’t get pregnant!’† The emergency contraception pill (ECP), most commonly known as â€Å"the morning-after pill,† is a back-up birth control method that is used after unprotected sex, contraceptive failure, or rape. It prevents pregnancy from occurring, however, it is not a method for abortion nor does it protect against sexually transmitted diseases. ECPs do not necessarily need to be taken the â€Å"morning-after.† They can be taken up to 120 hours after unprotected sex but the sooner it is taken, the more effective it is. According to Pamela Harris, the Health Promotion & Planning Coordinator at Lane Health Center, if it is taken within the first 72 hours after unprotected sex, the risk of pregnancy is reduced to a 15 percent to 25 percent chance. There are several different kinds of ECPs available. The most commonly used is Plan B. At Lane Health Center, Ovral, Lo-Ovral, and Levlen are other kinds of ECPs that are provided. ECPs are easy to use and are orally ingested. With Plan B, two doses are taken; one as soon as possible and the other about 12 hours later.

Teacher Quality in Education Essay -- essays papers

Teacher Quality in Education Teacher quality has a major influence on how the students will learn and perceive the information given. As time has gone by, teachers have gone through many things that can help them become better teachers. There are tests in which to certify them and to make sure that they can teach to their best ability. In some cases, even if a teacher is certified they might not be fully interested in their teaching so the students might not be getting the full attention that they need and they might not be working to the best of their abilities. They feel that if the teacher isn’t showing interest, then why should they. Teacher burnout is something that occurs in teachers when they become disinterested in their teaching. All of these things are major factors in teacher quality and this essay will prove how these aspects lead to either positive or negative teacher quality. Throughout history it has been a long process in getting teachers to be certified. â€Å"In 1858, the superintendent first authorizes that teachers need to be certified. In the year of 1873, the state board of education created an examination that teachers needed to pass in order to be certified within the school systems. In 1876, the board of education of cities of the first and second class were authorized to certify teachers. In 1893, the state board of education authorized to substitute credit from approved colleges for examination in those subjects as qualification for the certification of teachers. In 1909, the state board of education authorized to issue certificates to high school graduates completing high school normal training courses and passing a state examination. In the year of 1915, the legislature set Bachelor degr... ... 8, 2003. http://npin.org/pnews/2001/pnew1101/int1101d.html This article states that how a teacher teaches their students affects their abilities in and out of the classroom. The article also gives ideas on how parents can get involved and make sure that the kids are getting the best education that they can. Klicka, C. (2003). The Myth of Teacher Qualifications. Obtained from the internet on November 8, 2003. http://www.hslda.org/docs/nche/000002/00000214.asp This article is stating the things that help to make a teacher more qualified to teach. It also says that even some qualified teachers should not be qualified because they aren’t putting their greatest effort into it. No Author Stated. (2002). Teacher Certification. Obtained from the internet on November 8, 2003. http://www.kckps.org/disthistory/state_school_history/tchr_certification.htm Teacher Quality in Education Essay -- essays papers Teacher Quality in Education Teacher quality has a major influence on how the students will learn and perceive the information given. As time has gone by, teachers have gone through many things that can help them become better teachers. There are tests in which to certify them and to make sure that they can teach to their best ability. In some cases, even if a teacher is certified they might not be fully interested in their teaching so the students might not be getting the full attention that they need and they might not be working to the best of their abilities. They feel that if the teacher isn’t showing interest, then why should they. Teacher burnout is something that occurs in teachers when they become disinterested in their teaching. All of these things are major factors in teacher quality and this essay will prove how these aspects lead to either positive or negative teacher quality. Throughout history it has been a long process in getting teachers to be certified. â€Å"In 1858, the superintendent first authorizes that teachers need to be certified. In the year of 1873, the state board of education created an examination that teachers needed to pass in order to be certified within the school systems. In 1876, the board of education of cities of the first and second class were authorized to certify teachers. In 1893, the state board of education authorized to substitute credit from approved colleges for examination in those subjects as qualification for the certification of teachers. In 1909, the state board of education authorized to issue certificates to high school graduates completing high school normal training courses and passing a state examination. In the year of 1915, the legislature set Bachelor degr... ... 8, 2003. http://npin.org/pnews/2001/pnew1101/int1101d.html This article states that how a teacher teaches their students affects their abilities in and out of the classroom. The article also gives ideas on how parents can get involved and make sure that the kids are getting the best education that they can. Klicka, C. (2003). The Myth of Teacher Qualifications. Obtained from the internet on November 8, 2003. http://www.hslda.org/docs/nche/000002/00000214.asp This article is stating the things that help to make a teacher more qualified to teach. It also says that even some qualified teachers should not be qualified because they aren’t putting their greatest effort into it. No Author Stated. (2002). Teacher Certification. Obtained from the internet on November 8, 2003. http://www.kckps.org/disthistory/state_school_history/tchr_certification.htm

President Gerald Ford Essay example -- Biographies

President Gerald Ford Outline I. Introduction II. Early Life III. Presidency IV. Conclusion V. Bibliography Introduction Ford may not be the most important president during his time, but he did more than some presidents did for the people. One of them was raising their spirits and hopes for the people to the government. He helped people gain confidence in their president again after losing confidence with Nixon. He set new records and started getting the United States on its feet again after having a very hard time in the past. He started his presidency with an oath on August 9, 1974 which he said - "Our long national nightmare is over (4, page 422)" which started his presidency. Early Life Ford had a more interesting early life than he had during his presidency. He was born in Omaha Nebraska on July 14, 1913. He wasn't always called Gerald Ford, his original name was Leslie Lynch King Jr. His parents were Leslie and Dorothy King. When his parents got divorced while he was two, his mother married a man named Gerald R. Ford from whom he got his most widely known name. Together, they moved to Grand Rapids Michigan (1, Page 1). During his High School years, he was the most popular Senior having been a great athlete and competing within 5 sports, his best being Football. Being good at Football, he got a M.V.P, a scholarship to Michigan with a Football scholarship and was offered a contract by the Green Bay Packers and the Detroit Lions. He finally took a job as assistant Football coach at Yale. While at Yale, he became interested in law and asked to take courses. He was soon invited to learn law in the college and didn't gr... ...cans were at this time. Now Gerald Rudolph Ford Jr. now spends the remaining years of his life in California and is an active Republican Member. (4, Page 147) Conclusion As you have read in the above pages, Ford was an important man who has changed history for the good. He might not of done much to make him as famous as other presidents such as Kennedy, Reagan or Abe Lincoln, but he did raise the spirits and sights of many millions of Americans for the Good. Bibliography 1. Prodigy "Ford, Gerald" Grolier Encyclopedia 1992, pp. 1-3 2. Hartmann, Robert T. Palace Politics New York - Robert T. Hartmann Press 1980 3. Carter, Douglas "Power in Washington" Newsweek, November 21, 1966 pp. 29 4. Bumann, Joan and Patterson, John 40 President's Facts Ohio, Willowsip Press 1981

Courtroom Visit Essay

The Judiciary’s role is to give everyone fair access to the courts to solve legal problems fairly and efficiently, decide justly the guilt or innocence of anyone charged with a crime, and interpret the laws and protect the rights and liberties guaranteed by the Constitutions of California and the United States. Criminal court is where you go when the state believes you have committed a crime and it files charges against you. The Criminal Court has jurisdiction over infraction, misdemeanor and felony cases. The Criminal Court conducts trials, motions, arraignments, preliminary hearings, probation hearings, mental health proceedings, and other types of criminal proceedings. In this essay I will be discussing my visit to the Orange County Courthouse in Santa Ana on March 26, 2014 and my observations of the criminal proceedings in Department C58. In the courtroom were the public defenders, the district attorneys, private attorneys, court clerks, a court reporter, a bailiff, a resident probation officer, the judge, in custody defendants, out of custody defendants, spectators in the audience and when needed an interpreter. The defendants were charged with a variety of different crimes including petty theft, drunk in public, under the influence of a controlled substance, possession of paraphernalia and more serious crimes including possession of a controlled substance for sales, possession of a fire arm, commercial burglary, forgery, fraud and counterfeiting as well as probation violations. The judge took the bench at around 9:30 am and started with the defendants that were charged with misdemeanor offenses. The judge called each defendant’s name; each defendant would step up to the podium, the judge then gave notice of the charges the defendant was currently being accused of. On several occasions the judge called the name of a defendant that was not present, she then issued an arrest warrant for the defendant, revoking their current bail, in some cases a new bail was set but the majority of the warrant’s had no bail amount. For the defendants that were present out of custody the judge would offer the defendant a sentence for the charges and asked for the defendant’s plea to the charges. If the defendant wished to plead not guilty to the charges, which commonly occurred, the judge then appointed the public defender’s office to represent the defendant for the  matter. In several cases the defendants were charged with a misdemeanor including under the influence of a controlled substance (HS 11550 a), possession of paraphernalia (HS 11364), petty theft (PC 484 a) and drunk in public (PC 647), these defendants provided the county with a sample of their DNA, they were required to pay a $75 collection fee and then charges against them were dismissed. After the judge completed the misdemeanor cases she moved on to the felony cases, which were more complex. Just like with the misdemeanor cases, the judge would call the name of the defendant and have them step up to the podium, she would then give them notice of the charges against them and ask if they were able to afford an attorney if they were not able to do so she then would appoint the public defender’s to represent the defendant. The cases that I observed were in a variety of different stages of the criminal case proceedings. Theses stages included arraignments, pre trials, preliminary hearing and sentencing. In most of the cases the judge would calendar the case for a further date. In these cases the defendant is notified of their constitutional right to a speedy trial and in order to set the case for a continuance the defendant had to agree to waive this right. The defendant’s that decided to plead guilty to their charges were notified of their constitutional rights that they would be giving up by pleading guilty to the charges these rights included the right to a jury trial, their right to a speedy trial and their right to confrontation. The judge sentenced the defendant’s to a variety of sentences including fines, restitution, diversion programs, classes, county jail time, probation and state prison. The defendant’s that were in custody and were sentenced to jail time the judge would notify the defendant of his actual credits and his good time and give the defendant how many credits he/she had towards their sentence. If the defendant’s sentence included probation, the defendant had to agree to the terms and conditions of their probation and the judge reviewed the rights that they were giving up to be placed on probation, including the right to own a fire arm and the defendant’s search and seizure rights. In conclusion, I found my courtroom visit to be great learning  experience. More specifically after visiting the courthouse and seeing our criminal justice system firsthand, I feel that I have a greater understanding of the different topics we have been learning about in class including the different stages of the criminal court proceedings, the constitutional rights each person has when charged with committing a crime and the different people involved with the criminal courts.

World Religions – Buddhism

The idea of a â€Å"union of opposites† pervades Taoist writings and exerts a tremendous influence over the root philosophical concepts of Taoism, encompassing issues which may be considered metaphysical or even mystical, but also influencing issues of applied ethics and personal behavior.The idea of conjoined opposites begins at the root, metaphysical level of Taoist thought which asserts that â€Å"being and non-being give rise to each other†; a stark departure from Christianity which posits that God is eternal and so has always been (Chen, 1989, p.  55).This metaphysical assertion continues from the macrocosmic (universal) to the microcosmic (personal) levels, where opposites are seen to give rise to the world of motion and being: â€Å"The difficult and easy complement each other, The long and short shape each other, The high and low lean on each other, Voices and instruments harmonize with one another, The front and rear follow upon each other† (Chen, 1989 , p. 55).Following up on the universally derived union of opposites from a macrocosmic level, the Taoist asserts a union of opposites, also, within the self and in regards to personal conduct: â€Å"the sage manages affairs without action,† and therefore should practice â€Å"creative quietude† in pursuit of personal wisdom and even ambition. The idea that opposites are, in nature, united through the Tao means that moral divisions are also damaging and artificial.The true sage accomplishes merit † without claiming merit† and since â€Å"he does not claim merit, His merit does not go away† (Chen, 1989, p. 55). Such seeming paradoxes are often difficult for Westerners to understand The idea that the universe itself could be comprised of a union of opposites, rather than a pervading and omnipotent single-Creator is not compatible with idea of Christianity which elevates a dualistic vision of the universe with good and evil at odds with one another and a single, benevolent God.Taoism seems to reflect a much more organic and complete of vision, at least in my opinion although the extension of Taoist philosophies into western religion is probably not something which will happen any time soon, such a â€Å"union of opposites† would provide a rich synthesis of spiritual and philosophical ideas. References Chen, E. M. (1989). The Tao Te Ching: A New Translation with Commentary (1st ed. ). St. Paul, MN: Paragon House.

A Stitch In Time Saves Nine Essay

There is no doubt that a stitch in time saves nine. It means that man must do something at the very early stage. This proverb in its literal sense applies to holes in our clothes which may be easily mended at first, but, if they are left unmanned, grow bigger and bigger, until they cannot be repaired without a great deal of sewing. What is true of torn clothes is true of boots, boxes, houses, ships, walls, bridges, in a word, of everything that needs mending, I may quote a striking illustration of the truth of the proverb from my own observation. A beautiful pier was built at great expense by Government many years ago on the stormy west coast of Scotland, to defend the harbor of a fishing village. The great stone of which it was composed were bound together by clamps of iron, and it looked as if it could defy the utmost fury of the waves. Nevertheless, in one of the violent storms that visit that iron bound coast, as little damage was done to the most exposed part of the structure. When I first saw the pier there was to be seen in it only a hole of moderate extent, that could have been repaired without much labor. But somehow the breach was left untended, and naturally grew bigger year by year until, on the occasion of my last visit to the town, half of the pier had sunk in ruin under the waves, and it was evident that to repair it would cost as much as the building of a new pier. The expediency of the stitch in time is exemplified not only by the destruction of material fabrics, the rents in which are neglected, but also in medicine, politics, and in intellectual and moral education. How often has a doctor to tell his patient that, if he had been consulted earlier he might have affected an easy cure, but that now more drastic remedies must be employed. A literary man, for instance, suffers from indigestion due to overwork and wasn’t of exercise. A short holiday in the country might restore him to good health if only he took it in time. But he has important work to do and is averse to taking any rest before he has finished it. So he goes on working until the symptoms become so threatening that he finds himself compelled to consult a doctor. To his surprise he finds that entire change of diet and absolute idleness for a long period of time are now needed to cure a disease, the progress of which might have been arrested with every little trouble at an earlier stage. It is the same with the body politic. The best politicians see in good time evils which, if allowed to go on unchecked, will swell to  alarming dimensions. Thus the just discontent felt by the people of France on account of the privileges enjoyed by the clergy and nobles might have been appeased by remedial legislation, but, as the cure was delayed, the feeling of disaffection went on gathering force, until at last it could no longer be extinguished and produced the horrors of the French Revolution. That no revolution has taken place in England for the last two hundred years is due to the fact that English politicians have been willing to anticipate rebellion by timely reforms. The same is true in our daily life. If anything is done at the very early stage, much energy can be saved for the same purpose.

Health Law and Regulations Essay

Health care is high on the list of the most regulated entities. Regulated by the government, the health care sector is also regulated by different private bodies. The Joint Commission on Accreditation of Health Care Organizations (JCAHO) together with the National Committee on Quality Assurance (NCQA) and different medical specialties form part of the private health care regulatory entities that collaborate with the government. Health care regulation is focused on three main roles; cost control, quality control, and access expansion and control. These three functions are subdivided into objectives covering each aspect pertaining to the health care area. While the regulatory program exists to accomplish the three above-mentioned objectives, the implementation of each objective affects one another. Example, quality control causes a reduction of access, and increases the cost because of an increase in demand. Despite the interdependence of these objectives, health care regulation does not indulge competition amongst the regulatory bodies. Important in the regulatory industry are those who engage each other with the same goal towards improving the health care. A majority of the health care regulatory federal agencies in America are comprised within the Federal Department of Health and Human Services (DHHS). The American constitution directs all health care regulators to obey the set legal process as their activities contain the potential to limit or breach the rights of health care. Health care is a high level of bureaucracy and extensive legal procedures. Regulators are provided a notice for their proposed regulation with findings to support it, after which the sector under regulation is allowed to contest or appeal the proposal. The legal process is appealed in every health care procedure, whether if it’s to test a new drug, suspend a practitioner’s license, or a regulation on  environmental standards. The Affordable Care Act (ACA) is a health care regulation signed into law on the 23rd of March, 2010. The law’s main focus had been to increase the affordability and quality of American health insurance. Its policies were focused on lowering the rates imposed on the uninsured through the expansion of both the private and public insurance covers. It had also aimed to reduce the health care costs incurred by the government along with citizens. Barely seven days after its enforcement had a new health care law come into effect with amendments to the ACA. On March 30, 2010, the president of the United States signed into law the Healthcare and Education Reconciliation Act of 2010. The law had been enacted by the 111th US congress (Blackman, 2013). The ACA has advantages as disadvantages, and has been at the forefront of political criticism since its enactment. Its strongest opponents have cited it to be punitive of the high-end earners to cushion the middle and lower classes. It has also been reported to weigh heavily on the nation’s wage bill. In a nutshell, the ACA is designed to cover the majority of American’s health care insurance. However, the regulation’s cost factor has proven unsustainable without economically hurting the high earning entities. The effect of ACA’s implementation has caused an overall negative economic realignment as various entities strive to remain afloat; working hours have been significantly downsized by various corporations in anticipation of unsustainable insurance compliance. The ACA regulation is seen as an economically crippling element in America’s overall economic composite. The enormous tax burden shouldered by high earning entities is evidenced to trickle down to the middle and low income earners which resultantly deduces the benefits intended for these groups in an even more severe way. To begin with, although the ACA provides affordable or free health care insurance to tens of millions of American populations, funding is raised through taxes. With a hike in taxes for health care funding, earning populations are left with less to spend. The American middle and low income groups are even more affected by the adverse effects as inflation sets in to recover the growing deficit induced by the regulation’s implementation. The ACA had been endorsed as an affordability initiative but the repercussive costs have indicated the regulation as a costly affair across the board. Insurance players report certain clauses in the regulation as detrimental to the process. An example is the regulations directive for insurance to extend their coverage even to sick uninsured people at no extra cost. The resultant effect has been the rise in insurance premium costs which further complicates the insurer’s role in the initiative. Nearly all the beneficial aspects within the regulation are countered with contradictory challenges that undermine its purpose. While Medicaid is expanded by the regulation to cover an estimate 15.9 million citizens below 138% of the property level, the cost is met by state and federal funding which further imposes an immense measure of tax escalation. The regulation however features more benefits than limitations with regard to women initiatives. The ACA grants up to 47 million women access to health care services comprising wellness and preventative care. Additionally, the law prohibits women paying more than men for health care services as had been the case prior to enactment (Blackman, 2013). The ACA regulation started 157 new agencies, boards and programs to oversee the efficient implementation of the law alongside regulating health care spending. Although there are negative cost implications associated with the huge oversight entities provisioned in the regulation, proponents argue these costs to be necessary in controlling the unaccounted health care expenditure (Blackman, 2013). Employment in America is currently readjusting to comply with the regulation’s 2015 implementation phase requiring all employers to provide an insurance cover on their employees. The resultant effect to this change has been two faced; small business have been employing part time employees full time to comply with the 2015 mandate while large businesses have been reducing part time working hours to avoid paying the employees insurance when the phase is implemented. The ACA is illustrated as a complex employment factor with many jobs feared to be lost as many new ones are created. Notably, the regulation projects an  outcome where employees will freely leave their respective jobs without fear for losing retirement benefits affiliated to health care. Accordingly, the regulation aims to decrease employees working hours while maintaining and creating new employment opportunities. Despite the employment benefits highlighted within the ACA, many citizens remain skeptical of the upcoming 2015 employer-insurance phase. Dissenting political sentiments are pitching the impending reforms as a negative aspect of the ACA enactment set to diminish numerous job opportunities. Federal and private health care regulation remains as an important component in the broader sense of the health industry covering every single aspect entailed in human health. The quality, cost and access control objectives are characteristic to every health related industry. With regard to personal experience, I have on several occasions observed medical licenses revoked for certain practitioners following a legal process to dispute the quality displayed by the practitioners in context. The two mentioned above 2010 health care regulations contain a complex and mostly long term agenda aimed at bettering the quality of health care services in America. The current challenges are largely short-term and should not be invoked to undermine long-term benefits. A healthy debate is however essential to ensure minimized negations throughout the implementation process. References Top of Form Blackman, J. (2013). Unprecedented: The constitutional challenge to Obamacare. Bottom of Form

The Musicals History Essay Example | Topics and Well Written Essays - 2000 words

The Musicals History - Essay Example It became a very popular genre in American cinema. Production houses making musical films sprouted and soon it was a thriving industry. Warner Bros' The Jazz Singer in 1927 was among the first musicals that deviated from mere entertainment to a strong statement. Along with the strong appeal of music in the film, the narrative struck a chord with the Americans. This was a story of a young Jewish musician who breaks with his father and runs away to pursue his dream and emerges a roaring jazz singer. This was the time when jazz singing was not entirely free of stigma as its origins (in late nineteenth century) were believed to have been the brothels of New Orleans that provided music dancing as well as sex (A Passion for Jazz Musical History and Education The American movie-goers lapped it up. In a way it also helped jazz singing come out of the shadows it was under. This reflected an eagerness in the public mind to through off the shackles of genteel society and explore new frontiers of morality. Warner Bros' success spurned it on as one of the leading production houses of America. There was good deal of money involved and it soon incorporated a rigid structure in its functioning churning out films that grossed more than anything before. It had on its rolls a regular list of directors who were dedicated to the studio and picked up directing positions by turns. In order to curtail budget of the dazzling lights and costumes that were the hallmarks of musicals, there was a special technique adopted at this studio, low flat lighting concealed the not so flashy costumes. Busby Berkeley was one of these directors. There were three films that were released in quick succession in 1933 by Warner Bros, all three choreographed by this man, 42nd Street, Gold Diggers of 1933 and Footlight Parade. These musicals are considered to be milestones both in American cinema as well as in the musical scenario per se. So what was behind their spectacular success This period is considered as one of the darkest in American History, the Great Depression. With large scale unemployment reigning across the country, the mood was indeed sombre. The American people had started questioning the virtues of hard-core capitalism on the political front as well as the prevailing codes of morality.The public yearned for strong leadership, someone who show them the way out of the economic mess. The release of the three Berkeley films coincided with the coming of Roosevelt as the new American President. He brought in the New Deal encompassing a range of economic reforms. He was a champion of liberalism and also a hero to the diverse ethnic communities like the Afro-Americans, Jews etc. To the common man he sold the virtues of honesty, hard work, and justice. Although musicals were being written off as 'escapist' entertainment by critics, there were certain elements that were born out of the prevailing spirit of that time, virtues that fed the public disposition. "Mark Roth puts forward a simil ar theory; he notes

The UK Economy Research Paper Example | Topics and Well Written Essays - 3250 words

The UK Economy - Research Paper Example â€Å"One fundamental change causing rising inactivity is the dramatic weakening of demand for unskilled labor since at least the mid-1970s. This is mainly due to technological change, which has favored the more educated – for example, computer use – and, to a lesser extent, globalization – exports from countries with many unskilled workers†. Changes that affected the UK market considerably much vast for describing the changes that have happened throughout the recent recession, it is positive to appear at the relative positions of each group previous to this. Several groups are significantly better than others. The changes in the economic conditions of the UK market are in the various forms and they are like the changing the labor market, changing organizations and the changes in the education and the skills.Employment in the UK is characterized by age, gender, ethnicity as well as physical fitness, a growth of workforce in the United Kingdom for the last century has been so unstable, for example considering the graph shown below, which illustrates the employment rate based on age and gender in the year 2007. This trend affects organizations labor as one of the factors of production. This clearly reflects the pattern of employment in the UK.The figure above shows employment rate for men and women in London by age, as seen, working age women have a lower rate than men i.e. 63% and 77% respectively, where as employment rate of women with children and that of women without children is the same.

Assignment #7 PKG 381 Example | Topics and Well Written Essays - 250 words

#7 PKG 381 - Assignment Example st part of sustainability is based on reducing the wastes that a company produces to the environment and at the same time changing the company to become completely sustainable in the future. Industries that would have the most positive environmental impact when they are engaged into sustainable practices include oil and gas industries, fertilizer, paper, motor vehicle and other industries that uses chemicals and release chemical wastes to the environment. These industries would have the most positive impact to the environment in case they engage on sustainable practices since through such practices, they will reduce lot of pollution they cause to the environment. At the same time, such industries are known for releasing some of the most harmful gases as well as minerals to the atmosphere. Such gases like carbon monoxide, sulphur dioxide and others are very harmful when inhaled by humans. At the same time, they form part of the ozone gases that cause the greenhouse effect to our environment, leading to global warming. Heavy metal such as Lead are also released by industries such as fertilizer industries, to the nearby drainages that empty their waters to the water stream s used by humans. Such metals are harmful to human lie as they cause cancerous conditions in

Discuss the ethical issues in the Monsanto case Essay - 1

Discuss the ethical issues in the Monsanto case - Essay Example The company in the recent times has been involved in dictating on what the world consumes. The company has continued to generate many biotech crops. The company however has generated controversies in the world due to the issue of production of biotech crops that are produced and increasing the control of food supply by huge corporations. The company before getting involved in seed technology was involved in production of chemicals. Production of crops and new seeds through biotechnology by the company has predicted doubling of food production in the future meeting the food demand of the growing population. Food security will be maintained by the company. The company has also formed coalitions with other public researchers and charitable organization to focus on green revolution to allow conservation of the environment with production of more food and inventions to satisfy food need of the population. The organization has made itself to be in the leading dealing with advancement in global fight against hunger. Working with other organization in poor nations, the company helps to reach needy farmers. Moves that are made by the company is seen to be parallel to the commercial sales that are made by the organization. The organization upholds its principles by encouraging farmers that are in the poor nations and do not concentrate much in improving those in the wealthy nations. In the sales of the organization, sales of seeds and chemicals that are of high prices are done to countries that are wealthy (Forrestal, 2007). These products are sold to farmers in poor countries in low prices. The organization has been encouraged by the department of agriculture in the United States and the government to incorporate public institutions, foundations and academics to determine how the production can be improved to make food abundant globally. The company before getting involved in seed technology was involved in production

Describe the impact of a risk event on business relationships Assignment

Describe the impact of a risk event on business relationships - Assignment Example They are strategic risks that are inadvertently linked with the nature of operations and administrative procedures of any particular industry. Other multilateral dependencies that can impact business partners or link in a business chain include accidents between cars in the importing procedures, fire, theft, and vandalism and water damages (Jolly, 2003). Being a transporter with a reputation of delivering on time and within budget, traffic can be a considerable hindrance to the performance of duties. Such a reputation is highly dependent on the status of traffic unless the transporter has a dedicated means of business that is not shared by others in the same business. Depending on the embedded culture of business continuity, a business organization can be categorized as risk taking or having zero tolerance. It is from such cultures that a business’ continuity is ensured and the impacts of accidents, such as those arising from transport procedures, can be

Law assignment (a legal case brief assignment )

Law (a legal case brief ) - Assignment Example The main point in issue before the appellate court was whether the trial court was justified in holding that the irregularities would not â€Å"give rise to any concern that the accuseds’ right to a fair trial might be prejudiced.†2 Relevant provisions of the law3 are as follows Prior to the enactment of the Jury Act, analogous provisions were s. 621 and s. 622 of the Criminal Code4. Section 621 provided that the jury â€Å"must not separate† and that no person was â€Å"allowed to speak to or communicate with any of them without the leave of the court until they are discharged†. In the matter of Webb & Hay5, â€Å"it was unanimously held† by the High Court â€Å"that the test to be applied for determining whether an irregular incident involving a juror warranted the discharge of the juror or the jury was whether the incident was such that, notwithstanding any proposed or actual warning of the judge, it gave rise to a reasonable apprehension or suspicion on the part of a fair-minded and informed member of the public that the juror or jury had not discharged or would not discharge their task impartially.†6 In the present case, the appellate court took exception to the opinion of the trial judge â€Å"Subsection (4) of Section 53 †¦ requires the Court to focus not so much upon perceptions as upon the reality of prejudice, or likely prejudice, to a fair trial.† The appellate court cited the joint judgment in Jackson and Le Gros.7 The appellate Court gave five irregularities and quashed the convictions and ordered retrials. It was held that the jury should have been discharged even though there was no real danger of bias or of inability of the jury to arrive at a verdict uninfluenced by the irregularities. It was also held that the judge should have considered not only the likely prejudice on the part of the jury to be influenced, but by the perception amongst fair-minded and informed members of

Collaborative Learning in E-learning Essay Example | Topics and Well Written Essays - 1250 words

Collaborative Learning in E-learning - Essay Example In order to ensure that collaborative learning is effective, asynchronous online discussions have been perceived as an efficient way for learners to participate in high quality discussion and intrinsic cognitive collaboration. This is because asynchronous online discussion gives learners enough time to reflect on their friend’s findings and contribution and reason about their own contributions before sending them off to their friends. Collaborative learning looks forward in fostering the argumentative quality discussions among learners in order to improve personal knowledge acquisition. In order to ensure efficiency of the collaborative learning, it is significant to apply additional instructional direction, which may assist learners to use the advantages of asynchronous communication or interaction for argumentative knowledge acquisition. For instance, knowledge construction via collaborative discussion is vital since collaboration methods sequence, define, and assign learnin g activities to distinct learners and can in turn facilitate activities such as construction of arguments during discussions. Collaborative learning in E-learning is rooted in constructivism. It intensively focuses on how productive peer collaboration can be stimulated and sustained in computer-mediated environments and how these collaborative activities facilitate learning. The use of Computers in learning will aid in providing sentence openers to ESL students, software-embedded collaboration scripts and representational guidance in order to improve the quality of online argumentation or moderation among students. In order to make collaborative learning effective, ESL students are encouraged to meet in groups. This increase explicitness due to persistence of textual messages on computer screen, more defined in expressing arguments due to lack of nonverbal communication

Siemens Bribery Scandal Essay Example for Free

Siemens Bribery Scandal Essay Automobiles are now an indispensable way for citizens to go out for working and shopping. Cars have shaped the development of motorization, which leads to the increase in private car use. As a result of automobiles’ growing popularity, a network of roads is built to satisfy the need for car travelers. Therefore motorization finally stimulates urban sprawl, which is the spread of cities into impoverished and rural areas on the periphery of cities. Urban sprawl obviously has led to some serious social and environmental problems such as inequality in society and climate change. Several organizations support to develop advanced technology in order to restrict urban sprawl and decrease greenhouse gas emissions while some experts disapprove of this opinion. This essay will argue that technological solutions just reduce social and ecological pressure to delay the consequence. The reasons why it is impossible that technology can absolutely cope with these problems also will be explained in the essay. In terms of surroundings, at present technology is not perfect enough to protect the natural environment and to deal with the greenhouse effect throughout the world. According to Gonzalez (2005), urban sprawl promotes automobile industry and gasoline manufacturers, which eventually increase carbon emissions. The extensive use of private cars causes rising greenhouse gases, which create global warming. In addition, negative ecological influences can directly cause public health problems such as asthma and lung diseases (Freund and Martin, 2005). Although technology can partially reduce certain environmental strain, it may also create some additional problems (Gonzalez, 2005). For an instance, nuclear energy can indeed reduce carbon emission though the waste in a nuclear power plant can also pollute the environment. Moreover, Gonzalez (2005) stresses that scientists at present do not develop any technology to completely cope with climate change. It may take a long time and considerable resource to find an effective technological method. Thus, there is no efficient technology to deal with ecological problems like global warming. With respect to problems in society, technology cannot prohibit main reliance on automobiles. Motorized urban expansion brings severe social problems, such as food supply threats from loss of farmland, transport injustice and health problem. Urban sprawl increases reliance on automobile transport, which means more car owners, more frequent and longer trips and, therefore, more greenhouse gas emissions. Except harmful gas exhaustion from vehicles and annoying noise, dominance of private cars still does harm to citizens’ health, because the drivers exercise less and become fat. The crowded traffic degrades the shared space and makes squares and parks useless (Martin, 2007). It may be true that clean and energy-efficient automobile can be manufactured in science and technology. However, such technologies cannot stop the growth of travel distance (Martin, 2007). Furthermore, Martin (2005) claims that there is no or few technology available for problems of land consumption and the degradation of public space. Therefore, technological solution cannot categorically handle some serious problems such as the deterioration of public space and loss of farmland. Technological methods are expected to work out problems in society and environment. However, social and ecological injustice cannot be addressed by technology. People in poverty who are unable to afford personal cars have to live in the fringes of the city which has inadequate public transportation and infrastructures just like supermarkets and hospitals (Martin, 2007). In general, the edge of the city is industrialized, where factories emit harmful gases and let out waste into nearby rivers. Thus, the poor’s health problem is more serious than the citizens in the inner city. With different circles of people supplied with separately various resources, the imbalance between classes results in societal polarization, fragmentation and segregation (Martin 2007). As a result of inequality, people who want to have a better life migrate from rural area to urban area because of well-paid jobs in the city. More facilities and houses need to be constructed so as to fulfill the demand of increasing people in the centre of city. Construction of homes and commercial buildings in urban peripheries also consumes a lot of energy. Therefore uncontrolled urbanization leads to land consumption and loss of farmland, which decline the food production. In some way, technology can manufacture economical and fuel-efficient automobiles with shoddy materials so that the poor can afford this kind of car, whereas, it cannot cope with the gap between the rich and the poor. In addition, technological methods cannot intervene in collective civilization such as culture and social cohesion. Thus, social and ecological inequality cannot be intervened by technology in any way. To sum up, this essay has analyzed how motorized urban sprawl leads to social and environmental problems. The essay also explained that technological solutions are incapable of solving the ecological and social problems originating from urban sprawl due to the lack of core technology. Even if the competent technology appeared, it would be too late to solve these problems. The technology cannot stop people from relying on cars to go out. Public health problems are also one of the main consequences of increasing car use and industrialized countryside. Technology solutions ignore the underlying causes of global warming- urban sprawl. It is necessary to limit the expansion of cities and to efficiently use the limited area. Otherwise, environmental degradation could not be reversed at all. Governments should pay more attention to urban sprawl even give up some financial and political policy. No. of word: 890 References: Freund, P., Martin, G., â€Å"Fast Cars/Fast Foods: Hyper consumption and its Health and Environmental Consequences†, Frontiers of Sociology, The 37th World Congress of the International Institute of sociology, Stockholm, Sweden, 5-9, July 2005. Gonzalez, G.A (2005), â€Å"Urban Sprawl, Global Warming and the Limits of Ecological Modernisation†, Environmental Politics, 14:3, pp. 34-362. Martin, G., 2007, â€Å"Motorization, Social Ecology and China†, Area, Vol. 39:1, pp. 66-73.

Managing People and Organisation Essay Example for Free

Managing People and Organisation Essay The purpose of this report to analyze the current situation in Shenzhen Filtroil and propose specific recommendation for the successful future management of Shenzhen Filtroil and its employee team. And work out detailed implementation plan. The report includes 5 key parts: 1. Analysis of external environments (PEST) and internal environments (SWOT) in which Shenzhen Filtroil operates. Key implication for people and organization in this sector. PEST and SWOT (Appendix). 2. Analysis the organization structure and organization culture of Shenzhen Filtroil. Key implication of this analyze for the successful future management of Shenzhen Filtroil and its employees. 3. Taking in to account national culture differences, analysis of leadership and management styles and capabilities as well as the employee team in Shenzhen Filtroil. Key implication of this analyze for the successful future management of Shenzhen Filtroil and its employees. 4. Recommendation for best of four options for the future, offered by Leahman and Randolph, and explanation why has made this choice. 5. Specific recommendations for the successful future management of Shenzhen Filtroil and its employee team. Include detailed implementation plan. (Appendix). The following key recommendations for the successful future management of Shenzhen Filtroil and its employee team: * Keep Core groups of workers * Keep Core business * Create Flexible Labor Force * Workers can be transferred to different activities and task * Take into account cultural differentiation of China and US management style * Change management style Part 1. Analysis of external environments (PEST) and internal environments (SWOT) in which Shenzhen Filtroil operates. Key implication for people and organization in this sector. PEST and SWOT (Appendix) For External and Internal environments we will use the Concentric Circle Framework depicts three levels of analysis necessary to the understanding of management of people and organizations in Shenzhen Filtroil. MACRO: Analysis of the global external environments in which Shenzhen Filtroil operates

Does Palliative Care provide a peacefull death

Does Palliative Care provide a peacefull death Palliative care was traditionally considered something done just for the dying patient and patients with cancer, but times have changed. Today it is a form of care that can be administered to not just someone facing the end of life, but also to people with terminal illnesses. At the end of life many patients will receive palliative care and comfort measures which are intended to keep the patient comfortable with pain medications, turning, suctioning, oral care, etc. Comfort is something all nurses want to achieve for their patients. Comfort also means different things to different people; therefore it is difficult to gauge and deciphering concrete ways to provide comfort is not easy. In the acute care setting, researchers have focused solely on physical comfort care interventions for end of life, but research for interventions for overall holistic comfort care measures are lacking. This paper demonstrates that because comfort is the top priority for a dying patient receiving palliative care, holistic comfort measures that take care of the body as a whole should be achieved to ensure maximum comfort. The purpose of this evidence-based literature review was to explore health care providers and patients views on palliative and comfort care at end of life, examine current comfort care and palliative care practices and evaluate whether palliative and comfort care measures allow the patient to have a peaceful dying experience. Research indicated that the patients care needs to be individualized, that patients should be assessed, and personalized interventions implemented to ensure a holistic comforting dying experience. Palliative care order sets are helpful, but they are just a guideline or tool to help provide consistently good quality care. Hospice has been known for their excellent holistic comfort care for the dying patients, hospitals would benefit from learning some of their interventions and modifying them for use in the hospital. Some comfort interventions include music therapy, hand massage, utilization of visual analog scales such as the faces, and guided imagery to measure comfort. These methods are some of the ways hospitals can utilize the findings from the research into daily practice to ensure quality holistic patient comfort is achieved. Research Question Does the use of Palliative Care and comfort measures during End-of-Life provide the patient a more peaceful death experience? Relevance to Nursing Practice Research supports the need for providing holistic comfort measures using palliative care during end-of-life care. Registered nurses working in the acute care hospital setting along with Advanced practice nurses (APNs) and palliative care physicians should utilize the many other specialties such as integrative medicine to ensure holistic patient comfort. Palliative order sets are a great tool to help manage pain and anxiety levels but each patients comfort care needs to be individualized to fulfill their needs. Registered nurses need to make sure the patients comfort needs are addressed, so that the patient may have a peaceful dying experience. This Literature review advocates that holistic patient comfort during end-of-life is achieved by attending to its many physical, mental, and social states. Therefore, a nursing definition of comfort can be described as the physical and/or mental state of relief or contentment achieved as a result of holistic nursing interventions, which ensure a satisfying, peaceful, good dying experience. Review of Literature In Comfort Measures: A Qualitative Study of Nursing Home-Based End-of-Life Care, Waldrop and Kirkendall (2009) used a qualitative study method to survey employees from a 120-bed suburban, nonprofit nursing home. The researchers goals were to explore how their staff recognized a dying patient and to identify applicable standards of palliative care. The sample consisted of 42 employees, including nurses, chaplains, social workers, nursing assistants, housekeepers, and administrators. Employees in various roles were interviewed to provide multiple perspectives on the dying experience. The survey was a 30-minute interview conducted in a quiet location of the nursing home away from the nursing unit (Waldrop Kirkensall, 2009). An affiliated research assistant or investigator who has had training in conducting interviews and qualitative data analysis conducted the interviews. The interviewer asked the employees open-ended and objective questions about frequency and standards of care for dying patients and their families. All interviews were audio taped, transcribed by a professional transcriptionist, and labeled with a letter number combination (e.g., N[urse]-1). The transcripts were entered into Atlas ti software for data organization and management (Waldrop Kirkensall, 2009, p.720). The survey identified physical, behavioral, and social factors as the three main indicators of impending death. Physical indicators included altered breathing patterns (including apnea), anorexia, or increase in pain; behavioral indicators included mood changes and diminished activity level. Social indicators sometimes included withdrawal from interaction with staff or family (Waldrop Kirkendall, 2009). During the survey, the staff explained that comfort care is initiated when patients began to exhibit these signs. At this nursing home, standard order sets were not used and comfort care measures were described as being very patient-individualized and holistic. Comfort care includes an interrelationship of symptom management, family care, interpersonal relationships, and interdisciplinary cooperation in which each member of the healthcare team participates in the care of the patient, according to their scope of practice (Waldrop Kirkendall, 2009). The survey revealed that health care employees deliver comfort care in different ways. The study has several limitations including that it was conducted in only one nursing home, lacked direct physician perspectives, lacked family and resident opinions, and a possible response bias. This studys findings identified the need for more comparison studies to explore standards of care in other facilities. It also raised the questions whether or not palliative care includes comfort measures and how palliative care is defined across the healthcare settings (Waldrop Kirkendall, 2009). By further comparing nursing homes that use different models of care, comfort care standards and/or improvements can be made. This survey was conducted in a nursing home setting, but its results reflect on hospital end-of-life care. At the present time, the standard of care for dying patients in hospital settings usually consists of pre-printed order sets that are not individualized to the specific needs of the patient. This study promotes use of the holistic, individualized care approach to ensure a more satisfying and comforting dying experience. Jarabek, Cha, Ruegg, Moynihan, and McDonald, (2008) began a study within the Internal Medicine Residency Program at Mayo Clinic in Rochester, Minnesota. The researchers hypothesized that standard palliative order sets within a hospital setting would enhance physician comfort with managing 4 aspects of end-of-life care, pain, secretions, agitation, and dyspnea. A 5-question, pre-intervention web-based survey regarding physician comfort in diverse aspects of palliative care was given to 144 internal medicine resident physicians before the release of the palliative order set, which would later be used within the hospital. Each question included a 5-item Likert response scale, ranging from 1, very comfortable to 5, very uncomfortable(Jarabek et al., 2008). Three months later, an educational e-mail was sent to all house staff and faculty addressing end-of life-care along with the initiation of the order set, which consisted of physical ailment provisions. Another 3 months was spent allowi ng staff to use and or work with the order sets at which point a post-intervention survey was performed. Results of the post-intervention survey were that 88% had utilized the palliative order sets and 63% stated that they felt increasingly comfortable with palliative care (Jarabek et al., 2008). There was an overall 10% increase in resident comfort regarding the 4 aspects of palliative care with the initiation of order sets, but no change in social or communication-related comfort (Jarabek et al., 2008). One weakness of the General comfort Questionnaire (GCQ) is that each item is scored on a scale of 1 to 6 and not weighted based on importance to the patient. Some items are more significant than others in determining overall comfort level and the patients score on the GCQ as a whole may not be an adequate indicator of their overall comfort level. For example, if a patient answers 1, strongly disagree to the statement my body is relaxed right now, the patient will get 1 point for th e question, but if they score high on the rest of the GCQ, the results could show an overall high comfort level even though the patient is really uncomfortable and in pain. The GCQ is a very useful tool because it can be given to patients verbally if they are weak or lack dexterity. Because the survey addresses all aspects and levels of comfort it is a valid tool for nurses to use to make interventions to provide holistic patient care. The survey concluded that palliative order sets can increase physician comfort in providing care to patients during end-of-life, but it also revealed that the order sets do not address the psychosocial needs of the patient when providing comfort care. Although physicians find comfort in having order sets as guidelines for end-of-life care, they are only guidelines and open communication needs to be initiated between the health care team and the patient to ensure all the comfort care needs of the patient and family are met in a holistic way so that the y may have a peaceful dying experience. Teno et al., (2004) evaluated 1578 adult patients with different, chronic illnesses end of life experiences by surveying the decedents loved ones and determining whether their perspectives on quality end-of-life care were influenced by the environment where the patient spent their last 48 hours of life. A survey was devised from a conceptual model for patient-focused, family-centered medical care and the calculation of scores and psychometrics of the measures were taken from an online tool formulated by Brown University. Within 9 to 15 months from the time of death a close family member or informant whom was listed on the death certificate was surveyed and was asked about the quality of care their loved one received during their last 48 hours of life. Five different domains were used in the survey, including whether healthcare workers provided patient physical comfort and emotional support, supported collaborative decision-making with the physician, treated the patient with respect, attended to family needs, and provided coordinated care with other healthcare workers or facilities (Teno et al., 2004). Teno et al., (2004) concluded that 69% of the decedents site of death and last place to receive care was in a hospital or nursing home setting, 31% home, 36% without nursing service, 12% home nursing, and 52% home hospice. The survey showed that family perceptions of the quality of care were different according to where their loved one last received care. Families of patients who were in nursing homes or had home health had a higher rate of unmet needs for pain (Teno et al., 2004). Over half of the families in hospital or nursing home settings reported unmet emotional needs. In addition, 70% of families receiving home health care reported inadequate emotional support in comparison to 35% in families who utilized home hospice care. Patient and family respect was also a concern to families and varied in different settings. Only 68% of nursing home residents families felt they had been treated with respect and consideration compared to the 96% of families receiving hospice care (Teno et al., 2004). Survey participants felt that physical symptom management was adequately managed so it was comparably equal throughout all patient settings. Although families did not experience a difference in pain or dyspnea management in comparison to other nursing services families who used hospice services overall, 71% reported excellent care (Teno et al., 2004). The survey suggests that although patient care settings such as hospitals, home health, nursing homes all try to provide comfort care during end-of-life that it can be inadequate in meeting the emotional needs of the patient who is dying and their families. The survey supports the hypothesis that hospitals and other care settings need to start utilizing holistic comfort measures similar to the measures hospice incorporates to achieve psychosocial and emotional patient satisfaction and a comfortable dying experience. Kolcaba, Dowd, Steiner, and Mitzel (2004) identified the need for comforting interventions for patients at end of life that are simple, easy to learn and administer, and require minimal effort on behalf of the patient. Bilateral hand massage is a good intervention because it is noninvasive, easy to do, does not take long, and relies on caring/healing touch (Kolcaba et al., 2004). The purpose of their study was to determine empirically if a bilateral hand massage provided to patients near end of life twice per week for 3 weeks was associated with higher levels of comfort and less symptom distress. Thirty-one adult hospice patients from 2 hospice agencies participated in the study. Each patient was English-speaking and expected to remain alert and oriented for the duration of the trial, 13 months. Data collectors who were unknown to the patients called the homes of the patients, explained the study, and then scheduled an appointment for a research visit. Data was collected at the patients homes and at the hospice centers(Kolcaba et al., 2004). After informed consent, participants were randomly divided into the treatment group (with 16 patients) and the comparison group (with 15 patients). All participants were asked to complete a modified General Comfort Questionnaire (GCQ), tailored for end-of-life patients, once a week for 3 weeks. After completing the questionnaire each week, the treatment group then received the hand massage intervention twice a week for 3 weeks. The comparison group received the intervention once at the end of the study period. The researchers concluded that there was no significant difference between the treatment and comparison groups in regard to enhanced comfort or decreased symptom distress over time (Kolcaba et al., 2004). However, comfort did increase some in the treatment group even as the patient approached death. The study also revealed that the hand massage seemed to allow more time for therapeutic or face to face communication allowing the patients to talk about how they feel and their feelings on transitioning to death, and patients receiving the intervention reported it to be a personalized experience something they could engage in that feels good, and family members were appreciative of the care and attention their loved one was getting (Kolcaba et al., 2004). Because this intervention is easy to learn and requires minimal time for the caregiver to do and minimal effort for the patient it is an excellent intervention that can even be taught to the family. This study identifies interventions t hat can be used within the hospital setting and any other setting to enhance comfort during end-of-life. Nurses and family members can use this intervention to increase communication by using caring touch, which provide psychosocial care and therefore holistic comfort for the patient. Bakitas et al., (2009) using project ENABLE {[Educate, Nurture, Advise, Before Life Ends]} combined with a nurse-led intervention with ongoing assessment, coaching, symptom management, crisis prevention, and timely referral to palliative care and hospices hypothesize that patients newly diagnosed with advanced cancer if exposed to this intervention right away would become informed, active participants in their care, and would experience an improved quality of life, mood, and have better symptom relief. The study protocol and data and safety monitoring board plan were approved by the institutional review boards of the Norris Cotton Cancer Center and Dartmouth College in Lebanon, New Hampshire, and the Veterans Administration (VA) medical center in White River Junction, Vermont. All patient and caregiver participants signed a document confirming their informed consent.(Bakitas et al., 2009). Participants completed baseline questionnaires when they were enrolled and then completed a fol low-up one month later. Using a stratified randomization scheme patients and their caregivers were randomly assigned to the interventions or usual care group. One of 2 advanced practice nurses with palliative care experience conducted 4 structured educational problem solving sessions first one lasting 41 minutes and sessions 2 through 4 approx 30 minutes each and at least monthly telephone follow-up sessions until the participant died or the study ended (Bakitas et al., 2009) The advanced practice nurse began all contacts with an initial assessment by administering the Distress Thermometer, an 11-point rating scale recommended by the National Comprehensive Cancer Network guidelines. It identifies sources of distress in the 5 areas of practical problems physical problems, family problems, spiritual, emotional problems or religious concerns. If distress intensity was higher than 3, the advanced practice nurses then identifies the sources of distress and checks to see if the participan t would like to problem/solve to take care of their issue. The nurse then covers the assigned module for that session. The participants clinical teams are responsible for all medical decisions and inpatient care management, however the advanced practice nurse was readily available by telephone for the participants and they could also facilitate ancillary resources. The participants also were able to participate in group shared medical appointments (SMAs), which are led by certified palliative care physicians. The usual care participants were allowed to use all oncology and supportive services without restriction. Follow-up questionnaires were mailed every 3 months until the patient died or study completion in December 31, 2007. Quality of Life was measured with a 46-item tool called the Functional Assessment of Chronic Illness Therapy for Palliative Care. It measures the participants physical, social, emotional, and functional well being along with the concerns of a person whom has a life-threatening illness. Of 1222 screened, 681 were eligible and were approached and 322 were enrolled (47% participation rate). There were a total of 134 participants in the usual care group and 145 participants in the intervention group. A systematic review of specialized palliative care identified 22 trials (16 from the United States) between 1984-2007 with a median sample size of 204, half exclusively with cancer patients. There was lack of evidence due to contamination, adherence, and recruitment etc. The trial addressed these issues and contributed to the increasing evidence that palliative care may improve quality of life and mood at the end of life. In our study, intervention participants higher quality of life and lower depressed mood may be attributed to improved psychosocial and emotional well being. Mood is a determinant of the experience of quality of life and suffering despite a mounting burden of physical symptoms(Bakitas et al., 2009). However, while patients in the intervention group had improvement in these outcomes, we conservatively planned our original target trial enrollment of 400 based on a significance level of .01. Statistical inferences based on this stringent critical value would lead to the conclusion that there were no statistically significant differences between groups in quality of life or mood(Bakitas et al., 2009). A number of limitations were found in the study, first there was limited racial and ethical representation in the study, which recognizes the need for duplicate studies with more diverse populations. Second, the interviews were conducted by telephone, in-person interactions (such as those seen in another successful outpatient palliative care intervention study may have produced a more robust effect, particularly in reducing symptom intensity(Bakitas et al., 2009). In person consultation was not often feasible for the debilitated population whom usually live more than an hour away from the cancer center. More re search is needed on optimal care delivery systems for this population(Bakitas et al., 2009). The researchers concluded that compared with participants receiving usual oncology care those receiving a nurse-led, palliative care-focused interventions that takes care of the patient holistically provided at the same time with oncology care had higher scores for quality of life and mood, but did not have improvements in symptom intensity scores or reduced days in the hospital (Bakitas et al., 2009). Characteristics of Comfort Even though nursing scholars have extensively researched and described various aspects of comfort, perceptions of the characteristics of comfort vary from personal perspectives and situations. After reviewing literature and research relevant to achieving comfort, it is clear that its characteristics extend beyond its physical attributes and are indeed a state of ease, relief, and transcendence (Kolcaba Kolcaba, 1991). To achieve holistic comfort at end-of-life there needs to be patient participation to enhance comfort with the use of comforting interventions. Kolcaba et al. (2004) described a peace of mind with a reduction in undesirable dying symptoms as important indicators of comfort while researching the efficacy of hand massage in hospice patients. Nursing interventions at end-of-life should be individualized to the patient to meet their comfort needs, as comfort is vital in palliative care. Novak et al. (2001) postulated that comfort consist of holistic properties which includ e a soothing environment, social support, conflict resolution, and spiritual harmony. Waldrop et al. (2009) also proposed similar qualities he studied comfort measures in a nursing home setting and described comfort care as the combination of the integration of symptom management, family care, interpersonal relationships, and interdisciplinary cooperation. Comfort in this study was a result of holistic interventions focused on achieving enhanced patient comfort, thereby allowing a good death (Waldrop et al., 2009). Application of the Literature to Practice Findings from the literature and research support the need for providing holistic comfort measures using palliative care during end-of-life care. Registered nurses working in the acute care hospital setting along with Advanced practice nurses (APNs) and palliative care physicians should utilize the many other specialties to ensure holistic patient comfort. Palliative care nurses (PCRNs) are an excellent resource to consult for any questions regarding end-of-life care. Registered nurses need to make sure the patients comfort needs are addressed; they need to talk with the patient and their families to get a better understanding of their comfort level expectations. Palliative order sets are a wonderful tool with which to help manage physical discomfort, but Registered Nurses should assess the environmental, psychospiritual, and social comfort needs in order to create adequate interventions to help achieve enhanced holistic comfort. To achieve the physical aspect of comfort during end-of-life care pain medication can be prescribed, and to help relieve anxiety, ativan may also be given. Music is also a relaxation therapy that may also have a calming effect and can be encouraged to help bring relaxation, peaceful environment, and help the patient to forget their illness for a short time. To facilitate the psychospiritual aspect of comfort care the Registered nurse can consult a chaplain, social work, or a family therapist who can help the family and patient address the feelings of grief, fear, anxiety, and help promote resolving of family issues, which ultimately assists the patient in overcoming any negative feelings to gain closure and to achieve peace. The hospital room can be stressful, room lighting, dà ©cor, and music can be modified to help provide a more peaceful and soothing environment to relax and reflect during their last hours. The social aspect of comfort may be fulfilled by consulting social servic es to help provide support by addressing any communication issues within the family and helping the patient and their family fined courage and strength in times of need and despair. Using feedback from all the aspects of holistic comfort care is important in promoting consistent and continuous comfort during the patients dying experience. Registered nurses must determine the wishes of the patients for achieving comfort and using the many interventions the nurses should evaluate ad make adjustments accordingly. Providing holistic comfort care is an integral part of palliative medicine and it is continuously being changed to fit the needs of the patient and their families, and therefore is an excellent way to approach end-of-life care in the acute care setting of a hospital. Conclusions The research presented reveals while palliative care order sets provide a helpful guideline or tool which reassures health care providers in giving consistent good quality care, patients care needs should be assessed and individualized orders and interventions should be implemented to ensure a peaceful and comforting dying experience. Hospice care settings have been shown to provide excellent holistic care for dying patients and they have also been shown to show compassion to the family as well. The comfort interventions from these facilities can be modified for application in the hospital for use in the acute care setting. Holistic comfort care interventions include hand massage, music therapy, or the utilization of a visual analog scale the faces to measure comfort. These are some of the ways hospitals can utilize the findings from this research into daily practice to ensure quality holistic patient comfort is achieved and ultimately a peaceful death.