Ethics and IRB Essay Example | Topics and Well Written Essays - 1250 words

Ethics and IRB - Essay Example Ethics is contrasted with the term morality that frequently relates to how the way a person was raised and the values learned from the culture, parents or religion. Ethics refers to the systematic study of the basis of right or wrong decision. The regulations for protection of human subject in United States provide a minimum baseline through which every person must comply when operating the institutional review board, IRB, when obtaining consent from the research subjects, and when conducting the research. The ethical thought has shaped the regulations, though ethics require more conditions than what regulations require (Steinberg, 2007). Throughout the history of ethics, various theories have been formulated on what ethics ought to be. When these theories are critically examined, the procedure, rules and outlooks of ethics are justified. The major challenge in a practical environment, particularly in medical research, is the translation of the theoretical concepts of ethics into act ion. Regulations will thus come into place and help in accomplishing such tasks (Chamberlain, 2008). Development of the research ethics has evolved over time. Many tragedies have been reported through the research history involving the human subjects. Many people suffered as they participated in the research. The first research experiments on human subjects were the vaccination trial where physicians experimented with either their families, or themselves. Ethically, it is an injustice to abstract them from thinking on regulations away from the ethical context (Juritzen, Grimen & Heggen, 2011). In modern history, the discovery of atrocities by the Nazi physicians pioneered in human subject protection. Some of the experiments were considered inhumane and unethical. The voluntary consent is, therefore, essential when performing experiments on the human subjects and the research risks should be minimized so that it will benefit the society. Ethics Ethics refers to branch of study that d eals with the most appropriate course of action for human beings. It involves systemizing, recommending and the defending concepts of right and wrong behavior. Ethics is a critical requirement in human life since it determines the course of action towards a certain goal or objective. When conducting the nursing research, the researchers should be aware of nursing and research ethics. The decision on what to study, participants, and termination of the interviews and documentation of the results of the case study, should be based on ethical deliberation (Melton, 2004). Ethics is crucial in nursing research since it helps to set the competence boundaries. All nurses conducting research should work within their competence boundaries. Also, ethics enable researchers make informed consent where the information has to be judged to avoid confusing the people. Valid consent for participation in research depends on understanding, and freedom from deception and coercion. The information to the participants should be presented in written form and orally (Chamberlain, 2008). Ethics helps the nurses maintain confidentiality during their research. Confidentiality is an extension for privacy and is controlled by the privacy Act. Participants should trust that confidentiality is maintained for the information they give. Ethics ensure that the participants are free from risks and injuries during the research. This should encompass physical and non-physical wellbeing. In questioning, the researcher is entitled to maintain what is ethical. Ethics also ensures quality where the review committee assesses the ethical implications of the research proposals. Also, honesty in reporting is enhanced where the researcher publishes the process and findings to allow for peer scrutiny

The Bluest Eye by Toni Morrison Essay Example for Free

The Bluest Eye by Toni Morrison Essay Tony Morrison became the prominent American writer of the second half of the 20th century mainly because of her novel â€Å"The Bluest Eye† published in 1970. The family relations, beauty and ugliness, cruelty and love are in the focus of the novel. The novel is narrated by a young black girl, Claudia MacTeer and the reader realizes through her perception the atmosphere in the family of her friend Pecola Breedlove. The family relations in the Pecola’s family are very hostile. The topic of racial inequality is one of the central topics. The Pecola’s mother Pauline hates the entire family because she keeps comparing the life of the white family for whom she works as a maid with hers, watching some kind of ideal in the life of the whites. This is the manifestation of the lost identity of the Blacks, an identity which has been suppressed by the cultural development of America. African Americans and their tragedy of the lost culture are in the center of the novel.   The novel is built on the passionate desire of Pecola to be loved by her family and her school friends. Pecola thinks that the reason of the hostile attitude towards her is her black skin and she wants to resemble the American idols like Shirley Temple. Shirley Temple is just an ideal created by the mass culture, an idol which is a part of American dream. The conventional American perception of beauty is connected with the blue eyes and white skin like those of Shirley Temple. A talented young singer, dancer and actor, she no doubt deserves acclaim for her abilities, but as a cultural representation, she symbolizes far more than uncanny, childhood innocence. Tony Morison studies the position of the blacks in America. She names the things which sometimes are not in public but in minds. American society is divided according to the racial principle and nobody can do anything with it.    The author states that America treats its black citizens like people of a lower grade, pariahs, â€Å"There are several levels of the pariah figure working in my writing. The black community is a pariah community. Black people are pariahs. The civilization of black people that lives apart from but in juxtaposition to other civilizations is a pariah relationship. In fact, the concept of the black in this country is almost always one of the pariahs. But a community contains pariahs within it that are very useful for the conscience of that community.†(The Bluest Eye. Review). American culture has produced an utopian image of America, called â€Å"an American Dream†. It is not bad at all; it indicates, at least the standards to be reached and the goals to be gained.   This collective image is an image of a rich country populated with the nice successful people. There is only one problem in this image. The country is rich and the society is successful, but people personifying this success are narrated with the blond hair and white skin. This is just what great American Martin Luther King said about. The racial inequity is in the very essence of the American society. This racial inequity is indicated not in the hostile relations of the Whites and the Blacks but in a lack of the black standards of beauty. A color of the skin is given by God and it can not define the position in the society. Pecola identifies her personal position in the community with the position of the black community in the American society, i.e. as soon as the Blacks are pariahs in the society; she feels herself a pariah within the community. What is more, she understands the position of the black community in the American society and naively associates it with her personal position in the black community. Her dream of blue eyes is a naà ¯ve attempt to break through the concept of the faceless, i.e. it is a protest against her position of a pariah. Tony Morison intentionally uses a dream of a small girl which would never come true to underline the improbability of such a dream to resemble an American icon Shirley Temple in the same way as black community would never become an equal part of the society. The values of the society imposed on the black children are destructive. Pecola is morally suppressed by the values she accepts. These values are dominant and black children are not able to evaluate them critically. Pecola is destroyed by the cultural values she has to adopt. The white culture influences the personalities of the black people especially young ones. The Anglo Saxon standards of beauty follow the children outside the class. Movie blondes with blue eyes catch their sight from the cinema screens, billboards, newspapers and magazines. There is no place to hide from the bluest eyes. These beauties keep telling the children that if they were white with blue eyes they would achieve success. This destroys the girl’s identity. She mistakenly associates her physical appearance with the wealth and happiness. White mass culture shows white skin, blue eyes and blonde hair in association with wealth, happiness and success and a young girl realizes erroneously that her life is defined by her appearance. Pecola’s admiration of Sherley Temple is one of her personal tragic illusions. The success of the movie star Temple poisons the life of Pecola. The mass culture shows the physical beauty in the context of prosperity. This self humiliation develops the complex of inferiority of the girl. â€Å"Long hours she sat looking in the mirror, trying to discover the secret of the ugliness, the ugliness that made her ignored or despised at school, by teachers and classmates alike, She was the only member of her class who sat alone at a double desk.†( Tirell, Lynne) A utopian desire to resemble an American idol became an obsession for Pecola. â€Å"Each night, without fail, she prayed for blue eyes. †¦Ã¢â‚¬ ¦ She would see only what there was to see: the eyes of other people.†( Morrison, Toni, p.45) Shirley Temple was extremely popular in America during the Depression. She helped to strengthen the spirit of the nation. President Franklin Delano Roosevelt, speaking in 1935, praised Shirley: â€Å"During this Depression, when the spirit of the people is lower than at any other time, it is a splendid thing that for just 15 cents, an American can go to a movie, look at the smiling face of a baby and forget his troubles†( The Bluest Eye, Review). When the nation needs to raise its spirit the value of such idols like Shirley Temple is very high. The Pecola’s aspiration to resemble the American idol drives the girl crazy. She looses the connections with the reality. As soon as the world does not understand her desire and does not want to give her a chance to become closer to her idol she decides to lock in herself and find a piece of mind keeping her dreams in herself without letting them out. The hate of people, ideal dream on the movie star physical appearance, the hostile atmosphere at school and in the family and the rape by her father and the hate of her mother made the girl crazy. But is still dreaming of her ideal. Pecola attempts to create her own imaginary reality opposing the real one. After Cholly raped Pecola the second time, even her imaginary friend is not able to bring the piece of mind for Pecola.   You didnt need me before a truth so threatening and painful to Pecola and so close to the psychological reality that it immediately adds, I meanyou were so unhappy before. I guess you didnt notice me before ( Morrison, Toni, p.205) Her imaginary friend created by her imagination reassures her that she has the blue eyes. Still the attitude of people towards Pecola does not change. Her eyes do not produce the expected effect and Pecola finds the explanation in insufficient blueness of her eyes. The parallel between Pecola and Oedipus of Sophocles is marked by the author (Morrison, Toni, p.196 ). The author introduces Claudia to contrast the Pecola’s perception of beauty imposed by the white culture. The white ideal of beauty neglects the self esteem of the black people. The white idols destruct the human dignity of both adults and children. These idols destruct Pecola completely. Claudia in her turn does not accept these idols unconditionally. The attitude towards the white culture defines the survival of Claudia and the demise of Pecola. It is not the white community that has directly destroyed Pecola, but the black community and her parents. They should have insulated her from the white communitys values and have protected her (Hinda Barlaz). The words of narrator about the destructiveness of the physical beauty and romantic love are given in the context when Pauline, pregnant black American woman was watching history of romantic love in the movie theatre. She broke her tooth then as if recapitulating the comparison of romantic love in the movie with her current position. The image of Jean Harlow from the screen destroys the Pauline’s identity as a woman, her belief in American dream and her own beauty. The broken tooth symbolizes her belief in happiness which is destroyed. Toni Morrison and a great American Martin Luther King, Pecola and Pauline, Hero of the Doctorow’s Ragtime and The Oedipus Rex by Sophocles, all of them have the common feature. They are all looking for identity as well as other best representatives of the humanity. Martin Luther King and Pecola, no matter how strange it may seem had the same dream, a dream of equality for all disregarding the color of the skin. Hero of the Doctorow’s novel and Oedipus Rex were looking for their lost identity. John Lennon joined Great American King in his dream of â€Å"a brotherhood of men† in his â€Å"Imagine†. Martin Luther King was looking for the identity of the black people of America and paid his life for it. Pecola was looking for her own identity and paid her mentality. John Lennon was looking for a â€Å"brotherhood of men† and paid his life for his search. These principles can not come from the outside; they should be in the people’s mind which is an identity. A hero of one Russian classic (Bulgakov, The Heart of the Dog) kept threatening himself, â€Å"there is a devastation in the country!!!† and he got a respond â€Å"this devastation is in your mind†. The same could be said of identity. We create the identity in our minds and then we apply it to the entire society. Bibliography I Have A Dream by Martin Luther King, Jr, Delivered on the steps at the Lincoln Memorial in Washington D.C. on August 28, 1963. Source: Martin Luther King, Jr: The Peaceful Warrior, Pocket Books, NY 1968, available at http://www.mecca.org/~crights/dream.html, retrieved 7.04.2005 Tirell, Lynne. â€Å"Storytelling and Moral Agency.† Toni Morrison’s Fiction: Contemporary Criticism. Ed. David Middleton. New York: Garland, 2000. 3-25. Morrison, Toni. The Bluest Eye. New York: Penguin, 1994. Toni Morrison, The Bluest Eye, Review, available at http://academic.brooklyn.cuny.edu/english/melani/lit_term.html#pv Hedin, Raymond. The Structuring of Emotion in Black American Fiction. Novel 16 (1982): 35-54. Edmund A. Napieralski, Morrisons The Bluest Eye., 1994 Heldref Publications, The Explicator, Fall 1994 v53 n1 p59(4), available at http://www.cofc.edu/~farrells/Farrell/oedipus.html, retrieved 6.04.2005 Hinda A. Barlaz, A Reading Guide to Toni Morrison’s The Bluest Eye, available at http://students.adelphi.edu/learningcenter/pdfs/tonimorrison.pdf, retrieved 6.04.2005 Trudy Mercer. Female Childhood Icons in Toni Morrisons The Bluest Eye, available at http://www.drizzle.com/~tmercer/write/morrison/bluesteye.shtml Chris Booker, The Social Status of the African American Male: 1999, available at http://www.pressroom.com/~afrimale/status99.htm Gibson, Donald B. (1989), â€Å"Text and Countertext in Toni Morrison’s The Bluest Eye†, Taylor, Paul C., Journal of Aesthetics Art Criticism, MALCOLMS CONK AND DANTOS COLORS; OR, FOUR LOGICAL PETITIONS CONCERNING RACE, BEAUTY, AND ,  , available at http://www.lib.tjfsu.edu.cn/ymwx/essay/The%20Bluest%20Eye1.htm Bjork, Patrick B. The novels of Toni Morrison: the search for self and place within the community. NY: P. Lang,1996.

Clinical Decision Support Systems in Healthcare

Clinical Decision Support Systems in Healthcare Melchor Abejon One pressing public health problem and a threat to patient safety are medical errors. Written articles about such incidents have highlighted cases and the amount of money spent. According to the United States (US) News and World Report (2013), medical error is the third leading cause of death in the US after heart disease and cancer with an estimate number of 250,000 deaths annually. Clinical decision making in healthcare is a very crucial process. Though this process will always be flawed, for sure there are ways to make it better. With the advent of the Electronic Health Record (EHR) meaningful use incentive program and the development of Clinical Decision Support (CDS) tools, healthcare organizations along with clinicians are mandated to integrate CDS into their federally certified EHR systems. As the director of clinical decision support at a healthcare delivery system, the purpose of this paper is to: Describe the different approaches to be used that will ensure all aspects of patient care are considered in the development of a CDS system. Identify how the efforts of the CDS team would be prioritized in the development of CDS in the organizations focus areas. Approaches to Developing a CDS System Like in the implementation of any other health information systems, the development and implementation of a CDS system entails an equivalent complexity and hard work. It is an endeavor that requires significant planning and preparation.ÂÂ   Once implemented, it is essential to evaluate and measure its value as an additional asset of the organization. According to Nelson and Staggers (2014), the CDS as a valuable tool can prevent many clinical errors especially when coupled with a computerized information system that enables process improvement measures. Though it is mentioned in the given scenario that the organization has existing CDS, my plan is to re-evaluate the existing systems and processes, and I want to make sure that I would not be missing a single essential step in my project, and have everything taken into consideration as I create a new plan.ÂÂ   Health IT provides a systematic strategic plan for the implementation of CDS which I will adopt for the organization. The strategic plan is composed of five steps as listed and described below: Commence the project with a strong foundation. This initial step includes assessing the readiness of the organization to adopt a CDS intervention; assessing the interest of stakeholders in using CDS to improve outcomes, and as well as assessing the overall capacity of the organization to adapt to the change. My key steps to establishing a strong project foundation are: To identify the essential stakeholders who can contribute to a discussion about using CDS to improve the quality and safety goals of the organization. To establish goals for the CDS by collaborating with the stakeholders to highlight the benefits and barriers to implementation. To determine the readiness of the organization for a CDS initiative. This is a critical process. A key aspect of readiness is understanding how well the organization can adapt to the change. To develop a plan on how to proceed with the implementation. It includes identifying the core members of the implementation team, outlining and refining achievable quality goals, identifying strategic next steps toward achieving the goals, building a shared vision among the stakeholders, and identifying champions of the project. Assemble a CDS implementation team.ÂÂ   My key steps to assembling the implementation team are: To stress the roles of the stakeholders that are required for the success of the project. To seek a clinical champion who possesses the desired characteristics for the role. To collaborate with an outside source who may be able to assist and fill the gaps in expertise in the implementation of CDS. To call for the implementation team to start planning by holding a kick-off meeting. Plan for successful development of CDS, design and deployment. The following are my key steps to assist the organization achieve the capacity for CDS interventions: To select a clinical goal that suits best to the goals and needs of the organization. The end users should agree with the chosen goal. To consult Electronic Medical Record (EMR) vendors and designers about ways on how CDS can help improve the clinical goals and objectives of the organization. It is important to discuss with them and determine the ability of a given CDS intervention to be customized to support the needs of the end-users. To select a CDS intervention that can help achieve the clinical goals and objectives of the organization. Considerations are ease of implementation, effect on clinical quality reporting, implementation of financial incentives, and workflow. To develop clinical objectives and baseline measures for the goals to help measure improvements. Example of this is through the utilization of metrics to measure baseline performance and assess the effect of the intervention. To map out existing workflows and clinical processes affected by the interventions. To develop a system for keeping interventions and CDS clinical knowledge current. This includes identifying people and processes that are involved in the interventions update. To ensure the usability of the CDS intervention by understanding its limits of functionality and possibly request for customization if needed. To test for the CDS interventions usability and effect on workflows. Roll out effective CDS interventions. My key steps are: To create a roll out plan. This includes defining the clinical goals and having the selected interventions assessed and tested. Also, to determine how to implement the interventions in the best way. To communicate the roll out plan to the end-users and stakeholders. This can be accomplished by describing and disseminating to the stakeholders the expected changes to the organizations workflow and processes. To develop a training plan to train users with the new intervention. To ensure that support structures such as people and other resources are in place to provide support during and after deployment of the intervention. Measure the effects of the intervention. This pertains to measuring the impact of the intervention post-implementation and to ensure it is improving the organizations processes and outcomes, and that clinical goals and objectives are being met. My key steps are: To conduct an ongoing assessment of the CDS systems usability. This includes capturing feedback and assessing how well is the intervention being received by the end-users. To collect and report the performance of the intervention against the clinical goals and objectives. To use feedback and measurement results to continually improve the performance of the intervention. To have the end-users get involved in the refinement of the intervention by communicating back to them the changes and by showing them continued support. Bates et al. (2003) published the Ten Commandments for effective Clinical Decision Support Systems (CDSS). This is another important collective approach and consideration in developing and implementing a CDSS for the organization. Listed below are the ten commandments for CDSS: Speed is everything. Speed is what end-users value most and is a top priority. Anticipate needs and deliver in real time. Information should be delivered when needed. Fit into the users workflow. Suggestions are integrated with clinical practice. Little things can make a big difference. In order to do the right things, usability of the intervention should be improved. Recognize that physicians will strongly resist stopping. Rather than insist on stopping, alternatives should be offered. Changing direction is easier than stopping. Example is changing dose defaults; route or medication frequency can change behavior. Simple interventions work best. Guidelines can be simplified by reducing to a single computer screen. Additional information can be asked when you really need it. A guideline will less likely be implemented when more data elements are requested. Monitor impact, get feedback and respond. If some reminders are not followed, either readjust or completely remove the reminder. Maintain and manage the knowledge -bases system. Information and currency of information should be monitored. CDSS Team Efforts and Areas of Focus Payment rates tied to quality measures. A primary consideration when developing and implementing a CDSS is the cost savings for the total system. With the existing reimbursement scheme, the financial commitment to implement a CDSS has become one major consideration to many health care organizations. Insufficient documentation of patients diagnosis has always been the difficulty in maximizing and meeting compliance with reimbursement and external quality agencies. As the director of the clinical decision support, I will summon and coordinate with the team to create a CDS intervention that can improve compliance with billing directives by ensuring systems work harmoniously to capture the correct diagnosis. Having such efficient CDSS in harmonious work with the organizations information systems can ensure delivered care, coded care, and documented care to become the same, thus meeting the meaningful use criteria and aligning with the nations health outcome policy priorities. CDS interventions that meet meaningful use. The stage 2 of the EHR meaningful use requires hospitals and healthcare professionals to implement five CDS interventions that are directly linked to four or more of the Center for Medicare and Medicaid Services (CMS) quality measures. As the leader of the team, I will suggest and work with the team on the implementation of support measures that will monitor health conditions that are of high priority such as stroke, hypertension, cancer and diabetes. Also, the team will aim to develop a CDS intervention that will alert clinicians when a patient is a candidate for colorectal screening. This intervention directly corresponds with the NQF-0034 colorectal cancer screening clinical quality measure. Also, the team will ensure that the CDSS will meet meaningful use by considering the five rights of CDS which are (a) the right information, (b) to the right person, (c) in the right format of intervention, (d) through the right channel, (e) at the r ight time in workflow (Campbell, R., 2016). CDSS in appropriate care services such as congestive heart failure. The team will consider developing a CDS intervention that will assist providers adhere to medical care, practice guidelines and prescribing guidelines. The administration of B-blockers has been demonstrated effective in improving the chance of survival for heart failure patients. The deployment of electronic reminder interventions for the prescription of drugs and appropriate dosing can additionally improve the care and survival for congestive heart failure patients and also in the management of chronic diseases. Other areas for clinical improvement. CDSS has also been proven effective in preventive service processes. As the leader of the team, I will work with the team to implement computer-generated reminders for providers to improve the standard of care in preventive services such as hypertension and smoking cessation counseling, eye and diabetic foot examinations, measurement of lipid levels, and glycosylated hemoglobin and proteinuria testing for diabetic patients. Conclusion The CDSS when coupled with the organizations existing systems such as the EHR and Computerized Provider Order Entry (CPOE) can work harmoniously to provide an effective clinical decision support to improve the quality of care in a healthcare organization. Though challenges may seem formidable, coming up with an effective approach in the development and implementation of such systems can assure positive return in investment overtime. References Bates, D. W. et. al (2003). Ten commandments for effective clinical decision support: Making the practice of evidence-based medicine a reality. Retrieved January 29, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC264429/ Campbell, R. (2016). The five rights of clinical decision support. CDS tools helpful for meaningful use. Retrieved January 29, 2017 from http://bok.ahima.org/doc?oid=300027#.WJC59_krLIV Gross, P.A., Bates, D.W. (2007). A pragmatic approach to implementing best practices for clinical decision support systems in computerized provider order entry systems. Retrieved January 29, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2215068/#bib13 HealthIT.gov (n.d.). How-to guides for clinical decision support implementation. Retrieved January 29, 2017 from https://www.healthit.gov/policy-researchers-implementers/cds-implementation Murphy, E.V. (2014). Clinical decision support: Effectiveness in improving quality processes and clinical outcomes and factors that may influence success. Retrieved January 29, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031792/ Nelson, R., Staggers, N. (2014). Health informatics: An interprofessional approach. (1st Ed.). St. Louis, MO; Elsevier Mosby United States News and World Report (2016). Medical errors are third leading cause of death in the U.S. Retrieved January 29, 2017 from http://www.usnews.com/news/articles/2016-05-03/medical-errors-are-third-leading-cause-of-death-in-the-us

The Great Gatsby: Morality And Gatsby :: essays research papers fc

The Great Gatsby: Morality and Gatsby Morality is a very controversial issue. That is one of the reasons what people are interested in reading about it. Morality can lead to many questions essentially it can lead to the question between right and wrong. In The Great Gatsby Nick Carraway is faced with a constant struggle between right and wrong. Truth is an issue of morality. "It all happened in a minute but it seemed to me that she wanted to speak to us, thought we were somebody she knew." (Fitzgerald 151) Daisy and Gatsby tried to hide the fact that they hit and killed Myrtle Wilson while driving home from New York. Nick Carraway, however, knew the truth and had to decide if he was going to help hide the truth or let Daisy and Gatsby suffer the consequences. â€Å"I don't think that anybody saw us but of course I can't be sure.† (Fitzgerald 151). Gatsby felt that he could hide the car and with it he could hide the truth. The truth is that Myrtle Wilson was killed and Daisy and Gatsby are the ones to blame. They cannot hide that truth. The friendship between Jay Gatsby and Nick Carraway is a questionable one and full of doubt. "He had seen me several times and had intended to call on me long before but a peculiar combination of circumstances had prevented it- signed Jay Gatsby." (Fitzgerald 45-46) The two had lived next door to each other for awhile however, they had never associated. Therefore, along with the invitation to the party there was some suspicion. Jay Gatsby is a very wealthy man. Nick Carraway, although he lives in West Egg, is not wealthy nor elegant. The two are certainly opposites. Gatsby and Carraway are bound to take

Parataxis Of Homer :: essays research papers

Throughout the epic poem The Odyssey, Homer employs a technique called parataxis. This technique is used frequently to identify characters in the book or explaining an event. The poem not only covers the story of Odyssey. The poem not only covers the story of Odysseus, but also touches upon other characters as well. By using parataxis, Homer can briefly tell and describe characters and events. Often, characters are identified by their relationships to others, a great deed they have accomplished, to hardships they have come across.   Ã‚  Ã‚  Ã‚  Ã‚  In describing Odysseus in Book V, lines 97 to 115 of which lines 105 to 110 are paratactical, Hermes says â€Å"you have with you the man who is wretched beyond all the other men of all those who fought around the city of Priam for nine years, and in the tenth they sacked the city and set sail for home, but on the voyage home they offended Athene, who let loose an evil tempest and tall waves against them. Then all the rest of his excellent companions perished, but the wind and the current carried him here and here they drove him.† The original conversation between Hermes and Kalypso had little to do with Odysseus’s journey. Hermes in lines 97 to 115 tells Kalypso that Odysseus’s fate lie not on the island, but back home in Ithaka. The parataxis interrupts the line of conversation to inform the reason why Odysseus arrives here. It gives a glimpse the span of Odysseus’s journey and the fate of his companions before the story is told. In this instance, Hermes identifies Odysseus with the obstacles he has overcome.   Ã‚  Ã‚  Ã‚  Ã‚  At times, a parataxis of a certain character in one part of the poem help explain matters later on. In book XI, lines 281 to 297, Odysseus tells of Chloris, a beautiful maiden. Of those lines, lines 287 to 290 are paratactical, â€Å"Also she bore that marvel among mortals, majestic Pero, whom all the heroes round about courted, but Neleus would not give her to any, unless he could drive away the broad-faced horn-curved cattles of strong Iphikles out of Phylake.† It talks of Chloris’s daughter, Pero and the task that all suitors must accomplish before he can have her hand. Later on in book XV, another character is introduced. He is the son of the man who won Pero. Without mentioning Pero or the task of the suitors in the earlier book, much more explanation would be needed to identify other characters. This parataxis links various character and their stories.

Health Care Essay

Under indemnity insurance, the insurers guarantee payment to any licensed health care provider for all covered services. In recent years, fee-for-service indemnity plans also have grown more similar to man- aged care plans. Traditionally, fee-for-service indemnity plans gave individuals an unrestricted choice of licensed health care professionals. Care providers were free to determine which services were appropriate based on their professional judgment and were reimbursed for all the care they delivered. Today, nearly all fee-for-service plans have adopted some form of the utilization- management strategies formerly associated with managed care, such as preauthorization for hospitalization or referral to specialists. In my opinion the indemnity design will not be around in the next thirty years it is losing favor with employers. HMOs are the most tightly closed of all managed care systems. HMOs typically provide no coverage for out-of-plan services and require health care providers to share the financial risk for the amount of services provided. Data have shown that, at an aggregate level, premiums are lower n communities with a higher penetration of HMO plans and more intense competition among health plans (Stein, 1997). Restricted provider networks and a strong reliance on primary care physicians have been major forces allowing HMOs to keep health care premiums below those of other plans. However, the tradeoff between low cost and limited provider choice has been unacceptable to ma ny consumers, as evidenced by the recent trend toward looser and more expensive forms of managed care, such as PPOs and POS plans (Sisk, Gorman, Reisinger, 1996, Stroul, 1996). This trend is likely to raise premium levels and individual copayments and deductibles in the future. Because of the rising of premiums I predict that within the next thirty years HMOs will slowly fade away. In the mid-80s, legislation allowing insurers to contract selectively with different providers at different reimbursement rates provided a starting ground for the development of preferred provider organizations (PPOs) (Gabel &Ermann 1985). Generally, the term PPO refers to a third-party payer system that contracts certain providers for patient services on a discounted fee-for-service basis. Patients are encouraged to select these â€Å"preferred providers† with economic incentives including broader coverage, and in-network providers gain a larger patient base in return for their discounted services (Gabel & Ermann 1985). Unlike health maintenance organization (HMO) coverage, PPO patients retain the ability to go out-of-network for care. Although patients are responsible for most of the costs in such situations, there is usually a yearly limit on out-of-pocket payments that allows patients who experience severe chronic conditions to access long-term out-of-network specialty care without prohibitive costs. PPOs have made a huge leap in the past two decades as a model for health insurance (Sengupta & Kreie 2011): In 1988, PPOs represented 11 percent of employer-provided health care; by 2005, 85 percent of large employers offered at least one PPO option (Hirth, Grazier, Chernew, & Okeke, 2007). PPO will be around for the next thirty years because it allows PPO patients to retain the ability to go out-of-network for care. Very long paragraph here 2. Debate whether or not private health insurance violates the standard principles of insurance. Don’t start at bottom of page. Start at top of next page PHI began with coverage principally for hospital and physicians’ services. As political debates in the United States continue regarding health insurance, there has been considerable argument and criticism about the overhead generated by the PHI mechanism (Woolhandler & Himmelstein, 1991). From1960 to 2000, the total overhead costs of PHI averaged about 12 percent of premiums, ranging from about 9 to 16 percent. This total includes administrative costs, taxes, profits and other nonbenefit expenses (Lemieux, 2005). The full cost of PHI administration to Americans including insurer’s administrative cost, net additions to reserves, rate credits and policyholder dividends, premium taxes, and carrier’s profits or losses is estimated to be about 15 percent of total national health expenditures. None of this including the formidable â€Å"hidden† costs to providers for filing claims, collecting data on quality of care, and submitting various financial reports to insurers. Private health insurance is made up of the three principal entities, which is commercial carriers, the Blues, and HMOs plus self- funded plans. The important of PHI as a source of financing for personal health care expenditures has increased slowly, but steadily (Williams & Torrens, 2010). Although there is no denying that some government health insurance programs such as Medicare deliver benefits at far less administrative cost per dollar of reimbursement than the PHI industry, health insurance by itself is not always a profitable business for insurers. This is particularly true at the high end of the market, where self-funded administrative-services-only customers generate relatively narrow profit margins for most group insurers. Indeed, the health insurance industry suffered a net underwriting loss in many years since 1976. Health insurance is beneficial for many insurers because it servers as a vehicle for selling other, more profitable products (such as insurance) and because health insurance premiums generate revenues via investment income (Whitted, 2001). A number of health insurance entities (including commercial carriers and the blue) offer insurance coverage for individuals and their families (pPauly & Percy, 2000). Some f the nation’s largest commercial accident and health insurers sell few or no individuals policies. Ordinary individual policies for basic medical (hospital and the physician coverage are extraordinarily expensive. This is because of adverse selection: insurers assume that the individual knows something that the insurance plan doesn’t future health needs. Therefore, the insurer adds on premium can easily reach $5,000 per year, even for HMO plans with extensive cost-sharing provisions. In addition, underwriting guidelines for individuals policies have become increasingly stringent; so many people who might wish to purchase coverage are not able to do so (Saver & Doescher, 2000). . Analyze the evolution of the promotion of health and disease prevention in the U. S. and identify the point at which a clear shift in the thinking in the dominant culture occurred residing in the greatest impact on the health care insurance system in the United States. Organized public health activities in the United States began in local seaport communities and only gradually expanded to state and federal government agencies. The Constitution of the United States reserves to the state all functions such as health not specifically earmarked to the federal government. For most of our country’s history, public health was an activity that was primarily carried out by a local or state governmental agency, and it was only after World War II that it was received as necessary or appropriate to have a federal cabinet-level Department of Health, Education, and Welfare. This development would suggest that our country views public health activities and perhaps health activities in general as a local and state matter; federal government involvement developed mostly after World War I, and mostly because of the abundance of federal tax revenues to be redistributed to states and local governments. The continuing efforts to reduce the size and scope of the federal government and to return basic functions and funds to local and state government in recent years may be seen as a continuation of this general idea (Williams & Torrens, 2010). According to (Williams &Torrens, 2010), organized public health activities in the United States began with the quarantine and isolation of potential disease carriers, moved on to the improvement of sanitation in the environment, then went on to focus on immunization of children and control of individuals with contagious infectious disease. Almost all the activities focused on acute infectious diseases, regardless of their origins. This has given rise to an unofficial and generally unspoken agreement that the primary mission of organized public health efforts in the United States should be toward the prevention and control of acute illness rather than chronic disease. Organized public health efforts in the United States have focused on out breaks of illness such as diphtheria and polio because of the suddenness and the severity of any outbreaks of this illness. The much more serious and public health problems of the United States are no longer-term degenerative conditions such as heart disease, cancer, and stroke. Because of the unfortunate political controversies of the 1930’s around a possible national health insurance program, it would have to be admitted that there has been a relatively guarded relationship between the private medical sector and organized public health agencies throughout the country. As long as the organized public health agencies kept to the more traditional public health role of sanitation, immunizations, and infectious diseases control, their activities were generally supported by the private sector. However, whenever the public health sector became more active in the provision of general health services or in the governance or planning facilities and personnel in the private sector, considerable opposition arose. As a result of this opposition, organized public health agencies have been rather cautious about expanding their efforts beyond the boundaries of what were perceived as â€Å"tradition† public health activities (Williams & Torrens, 2010). It is assumed that public health must protect the interest of the public in obtaining access to appropriate health services of high quality, but that has not been an accept role for organized public health in the United States until now. References Gabel J, & Ermann D. (1985). Preferred provider organizations: performance, problems, and promise. Health Aff (Millwood). 1985; 4(1): 24-40. Hirth RA, Grazier KL, Chernew ME, Okeke EN. Insurers’ competitive strategy and enrollment in newly offered preferred provider organizations (PPOs). Inquiry. 2007; 44(4): 400-411. Lemieux, jJ. (2005). Perspective: Administrative cost of private health insurance plans. Washington, DC: America’s Health Plans. Pauly, M. V. , & Percy, A M. (2000). Cost and performance: A comparison of the individual and the group health insurance markets. Journal of the health politics policy and law, 25,9-26 Saver, B. G. , & Doescher, M. P. (2000). To buy, or not to buy: Factors associated with the purchase of non- group private health insurance. Medical Care, 38, 141-151. Sengupta B, & Kreier RE. (2011) A dynamic model of health plan choice from a real options perspective. Atlantic Econ J. 2011; 39(4): 401-419. Sisk, J. E. , Gorman, S. A. , & Reisinger, A. L. , List all authors here etal(1996). EvaluationofMedicaidmanagedcare: Satisfaction, accessanduse. ?Journal of the American Medical Association (1996) 276:50–55. Stein, R. E. K. , ed. Health care for children: What’s right, what’s wrong, what’s next. New York: United Hospital Fund, 1997. Stroll, B. , ed. (Year) Children’s mental health: Creating systems of care in a changing society. Baltimore, MD: Paul H. Brookes Publishing Company, 1996. Whitted, G. (2001). In S. J. Williams & P. J. Torrens (Eds. ), Introduction to health services (6th ed. ). Albany, NY, Delmar. Williams, S. J. , Torrens, P. R. , (2010). Introduction t health services (7th ed. ). Albany, NY, Delmar. Woodhandler, S. , & Himmelstein, D. (1991). The deteriorating administrative efficiency of the U. S. health care system. New England Journal of Medicine, 324(18), 1253-1258.

Why women failed to gain the vote between 1900 and 1914?

The women's suffrage movements were originaly from the United States during the 19th Century. In colonial America, as elsewhere(Austrialia and new zealand] in the world particularly Britain, civil law did not recognize the equality of men and women. some men thought that many women were a waste and can never be good as men. During 1900 and 1914 a woman had no legal rights. A married women's belongings belonged to her husband, this included earnings as well as all her property and goods. in other words she was like a mere object in the mans hands. To today's standards this is completely outrageous, in today's society women can expect to be treated exactly as the opposite sex when it comes to work and other things. This is abundant in the rise of popularity of woman's football and female boxing. During the 1800, women were expected to be perfect – in those days a perfect lady would be expected to have a pale face, do absolutely no exercise and have very delicate constitution, they where expected to be good hostesses and certainly know their place in society. Women never even received the same level of education as men. ome women nerver even got eduction. They were considered as being too stupid for higher education. However not all women where satisfied with their position in life. They believed that they were stuck in a vicious circle, which if not impossible, would be very difficult to break out of. The earlier years of the 20th centruary in Britian saw a concerted campaign for the right to vote for women. the women's social and political union, otherwise known as the suffragettes, was founded in 1903 by the Pankhurst family. he campaign for the right to vote for women between 1905 and 1914 became increasingly militant as women were prepared to take direct action, such as distruption of meetings, chaining themselves to railings outside 10 downing street, smashing windows and rioting. at one stage the prime minister,s country house was fire bombed. as a result of this many suffragettes found themselves inside holloway prison where they resorted to hungry strikes. the prison aouthorities responded with forcible feeding. There is no simple answer why the suffrage movement failed between 1900 and 1914, instead, a series of long and short term causes. The main point of this essay is to analyze, as well as discuss these reasons in detail. If possible I will put them in order of importance. women where treated very harshly in the 1900 as they were objects in front on mens eyes. when a woman got married all her belongings wer transfered to her husband and they were now the property of the husband. in other words married women were legally dead in the eyes of the law. omen had no property rights, all thier property was thier husbands. all women were robbed off thier self-confidence and self-respect and this made them totalyy dependent on men. No woman could get eduction since no college or university would accept women students but there were 1 or 2 exceptions. the women wanted the vote becouse they wanted to be equaly nown in public as men. wanted there rights. wanted thier belongings. wanted to be rembered for somethin. wanted to have the right to vote and have a saying in the country. anted people to hear what they have to say about how the country is run. The Suffragists were called the shrieking sisterhood, branded as unfeminine, and accused of immorality and drunkenness. Many citizens and a great deal of newspapers where strongly against ‘The National Union Of Women's Suffrage Societies'. Suffragist leaders were often subjected to physical abuse. Suffragist meetings were repeatedly stormed and disrupted by street gangs. On many occasions the speaker at a suffragist meeting would hold a revolver to discourage possible attacks from the audience. However, it was not only men that were against the suffragist movement, many, if not most upper-class women were against the movement, including Queen Victoria. There were many reasons why anti-suffragists felt this way. The anti-suffragists partly based their assumptions on the difference between the male and female physical abilities; they did not discuss the biological difference because they did not believe it was appropriate for public discussion. Instead, emphasis was put on the ‘fragility' of the women claiming that this is what made her ‘unsuited' for the vote. The physical weakness of the female would be potentially dangerous. They argues that assuming she reached the polling place, she might get caught up in a brawl and given the women's natural fragility, she would be the one to get hurt. Beyond these reasons existed the belief that allowing women to vote would jeopardize the nation's security and lead, ultimately, to war. One leader of the anti-suffragists said: â€Å"Allowing women to vote would lead to foreign aggression and war. † The second areas of difference between men and women which the anti's argued, was the issue of morality. A anti who spoke at a hearing in Connecticut on women's suffrage observed that: â€Å"The most convincing reason I have heard was the one offered by Miss Pearson. ‘We want the ballot, and we want it when we want it. ‘ This shows the depth of intelligence. † The anti-suffragists also predicted that if women were given the vote disastrous results would occur. The antis believed that political involvement would put them in situations were the male vulnerability would be exploited. However, above all the anti-suffragists were afraid about the emotional state of women. Men where described as rational and emotionally stable, women were portrayed as ‘high strung,' tense, irritable and irrational. One anti said that â€Å"when women generally vote and hold office, the desire for publicity and love of the limelight will combine to produce a form of hysteria. † Some took this idea further and argued that since all women suffragists bordered on hysteria there was no need to take their arguments seriously. They said that when women vote, she would let her feelings rather then her intellectual concern be the main reasons for their vote Some more eccentric people said that allowing women to have the vote would breed a nation of transvestites and that women could hide extra voting slips in their ‘voluminous sleeves' The position of certain key political parties was also a huge contributor to why women never got the vote between 1900 and 1914. For if women wanted the vote, ultimately if would have been the MP's that they would have had to convince. Many backbench Liberal MP's were supporters of votes for women, but the Liberal leaders were opposed to it. This was because they feared that, if only better-off, property owning women got the vote, these women would vote for their arch rival, the Conservative party. On the other hand, some conservative leaders, liking the prospect of more conservative voters, were quite keen on women's suffrage. But they took no action because their backbench MP's were completely opposed, on principle, to change the role of women. In addition, both parties had bigger worries then female suffrage. Neither party was prepared to adopt female suffrage as party policy, so it never got priority in parliament. In 1903, many suffragists where angry at the lack of success that had come their way, as a result, a lady called Mrs. Emmeline Pankhurst founded a new organization, which was called the Women's Social and Political Union or WSPU in short. The Daily Mail called then the ‘suffragettes' and with them making so many headlines this name became hard to shake off. The suffragettes had the same goal and ambitions as the suffragists, however, they believed that the only way to reach their goal was to become more radical and militant. The suffragettes disrupted political meeting and repeatedly harassed ministers. Asquith, who at that time was a Liberal Prime Minister, came under particularly heavy abuse due to his views on women suffrage. they physically assulted politicans, destroyed paintings in the national gallery and in 1913 emily davison threw herself under the king's horse and was killed. there violent tactics may have lots support for the camaign. After a women's suffrage bill ran out of time in 1908, direct action from the suffragettes began. The suffragettes began making speeches at 10 Downing street, they even chained themselves to railing to stop being moved on, in doing so getting themselves arrested. In that same year stones where thrown thought the windows of 10 Downing street There was however logic behind the violence. The suffragettes believed that the government ignored the calls for women suffrage because there where more important issues. The Suffragettes believed that by becoming more radical and violent the government where forced to listen whether they liked it or not, they believed that processions and petitions, however large, were easily ignored. the goverment di not want to be seen to give in to the violent demandss as this would mak them look weak. There where mixed reactions to the ‘Direct Action' that the Suffragettes employed. Some people where worried, some sympathetic and some were scornful. It was the reaction from the Suffragists that surprised people the most. Many suffragists admired the readiness of suffragettes to go to jail for the cause. When the first suffragette was imprisoned, Mrs. Fawcett put on a banquet for them when they where released. This did not last, for as the Suffragettes got more violent and radical the further apart the two groups got, relationships between then become very strained. The suffragists believed that you cant win the right for a democratic vote by using undemocratic methods, they also believed that the violence would put of the MP's that would have backed their cause. There is no doubt that the increase in violence alienated the support for woman's suffrage. By 1913 many suffragettes where imprisoned. The violence did however achieve one of its goals, it certainly raised the profile of the issue and it could not longer be ignored. But in doing so they damaged the bigger picture, for know there was a reason for their opponents for rejecting woman's suffrage. If the MP's gave in to the violence from the suffragettes what hope will they have when dockers or mine workers riot for higher wages? From 1911 onwards, whenever the issue of woman's suffrage was debated in parliament, there was a bigger majority against women's suffrage. In 1914 Britain declared war in Germany, from August to September many different women's organizations were set up, including the Women's Hospital Corp and the Women's Police Volunteers. This meant that all suffragist and suffragette campaigns had to be halted. I think that the most important reason for why the women suffrage was unsuccessful during 1900 and the 1914 was the fact that, peoples minds at that time where not prepared for such a big advancement, it is true that the suffragettes reduced their chances significantly, but I believe that even if there was no violence the women would have still not got the vote until after the war becouse that is when they really proved themsleves as they helped out greatly in the first world war.