Ramsey S. Cotron

ORTHOPEDIC CONSULTATION Patient Name: Ramsey S. Cotron Patient ID: 023672 DOB: 03/15/—- Age: 2 Sex: Male Consultant: Jessie D. Smith, MD, Orthopedics Requesting Physician: Reed Phillips, MD, Pediatrics Date of Consult: 10/01/—- Reason for Consult: Infected Finger. HISTORY: Ramsey is an otherwise healthy 2-year-old Lebanese child who had an injury to the distal failing of his right middle finger the day prior to being seen. The patient is left-hand dominant. The patient was brought to Dr. Phillips of Pediatrics secondary to worsening redness as well as infection of the nail bed.Orthopedics consult was requested on 09/30/—- for possible paronychia. The patient at that time was having no fevers or chills and he was tolerating his antibiotic regiment well. PAST MEDICAL SURGICAL HISTORY: None other than circumcision shortly after birth. BIRTH HISTORY: Normal full-term vaginal delivery. FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: Patient lives with his mother and a sibling, Father deceased. PHYSICAL EXAMINATION: Ramsey is alert, oriented, playful, and in no apparent distress. The patient does have erythema surrounding the tip of his right distal failings, middle finger. There is mild purulent from the area.The area is minimally tender to palpation. The nail appears to be lifting off from the nail bed itself. He has good capillary refill and has good flexion and extension of that finger. (Continued) ORTHOPEDIC CONSULTATION Patient Name: Ramsey S. Cotron Patient ID: 023672 Date of Consult: 10/01/—- Page 2 ASSESSMENT: This is a 2-year-old male with paronychia. PLAN: Follow up with me at 9am tomorrow. Mother was given my pager number should the patient’s condition worsen overnight. I will be in touch with Dr. Phillips. _______________________ Jessie D. Smith, MD, Orthopedics JS: D:10/01/—- T:11/14/2012 C: Reed Phillips, MD, Pediatrics

Evaluating Compliance Strategies Essay

The compliance process is very important in medical billing and coding. After a patient is seen, physicians document the patient’s visit. Medical administrators then post the medical codes of the visit in the practice management program (PMP) and prepare the claim. It is important to prepare claims correctly in order to stay in compliance. A correct claim connects a billed service to a diagnosis. The diagnosis has to relate to the billed service to treat the patient’s ailment. The connection is referred to as code linkage. It is important to correctly link procedures and diagnosis’ because if they aren’t correctly link the payer will reject the claim and will not pay for the services which then makes the patient responsible for payment. To be in compliance, medical insurance specialists need to know each payer’s billing rules stated in each insurance policy. These are subject to change and updated frequently so medical insurance specialists also use payer bulletins, websites, and maintain communication with payer representatives to make sure they are staying in compliance. Medicare also has its own set of rules and regulations. The Medicare National correct coding initiative (CCI) controls improper coding. CCI edits are used by computers to check claims for errors that would lead to improper payment of services. The CCI prevents two procedures from being billed that could not have been performed together. Private payers also have code edits similar to the CCI. Compliance errors sometimes occur. Submitting an improper claim may just be a simple mistake such as a typo, or sometimes it may be a deliberate act of fraud. Other common errors that are sometimes made are truncated coding, incorrect gender or age of the patient, assumption coding, altering documentation, coding without proper documentation, reporting services provided by unlicensed providers, and coding a unilateral service twice instead of choosing the bilateral code. For these reasons there are several billing and coding compliance strategies that have been put in place. One compliance strategy used by healthcare professionals is to carefully define bundled code and know global periods. A medical insurance specialist needs to be clear on what individual procedures are contained in bundled codes and what the global periods are for surgical procedures. Another strategy is to benchmark the practices E/M codes with national average. By comparing the practice reports with national averages, upcoding is able to be monitored. Another strategy is to use modifiers appropriately, and be clear on professional courtesy and discounts to uninsured and low income patients. The strategy that I find the most useful and am in support of is to maintain compliant job reference aids and documentation templates. Job reference aids are a form of a cheat sheet that lists procedures and CPT codes that are most often used by each individual practice. I think that the only way this strategy can be improved is to make sure that the job reference aids are updated frequently when new services are added to the practice, and when codes change or new ones are added. This can be accomplished by keeping track of when codes are updated or changed. There are many implications of incorrect medical coding. An improper claim will get rejected or denied by the payer. When this happens the physician will need to either file an appeal, or correct the issue. If the error can be corrected the claim can be resubmitted, however this is still unfortunate because the process will take longer than if it had been done right in the first place. When coding errors are made due to fraudulent attempts, the person who prepared the claim will lose their job and face legal action. Also, sometimes the physician in charge of the practice will be liable and possibly sued, because he/she is responsible for their employee’s and their actions. Medical coding, physician, and payer fees are all related to the compliance process. Any services performed by a physician will need to be correctly coded so that they can be paid for. Medical coding must be done properly in order to stay in compliance. Physicians must be honest and provide proper documentation of any and all services performed in order for an insurance company to accept a claim and pay for the services that were performed. As long as everyone works as a team, and works in honesty, it is easy to stay in compliance. And by using the strategies I have outlined, compliance is not difficult to follow.

Patriotism and Loyalty

After reading various examples of the word patriotism and its use in that context it seems that patriotism mostly refers to the love or emotional attachment that a person can have to their country or to where they are from or simply to the place that they were born in. While researching online for various examples of patriotism I came to find out that there are different levels of patriotism. One such example of patriotism is that practiced by those that have unconditional love for their country and will blindly follow the countries policies without opposition and will see others that opposed a certain idea as a traitor or being unpatriotic.Other groups of people demonstrate their patriotism by demonstrating it in form of certain symbols like wearing and displaying the flag, singing patriotic songs or the national anthem. There are others that show their patriotism by protesting and criticizing the unjust policies of a nation in order to help keep the nation in check and not blindly follow unjust policies. Accord to the dictionary defines loyalty as â€Å"the quality of being loyal to someone or something. † and loyal as â€Å"giving or showing firm and constant support or allegiance to a person or institution. However many times a person’s loyalty can be in a conflict. For example if a person is loyal to the United States but the new government starts making decisions that the individual does not agree with now he can keep on following without speaking up because of his loyalty to the government as well or he can protest against poor policies because those decisions made by those in power are hurting the United States. In his mind he is still being loyal to the United States by protesting and help shape better policies but by others he may be seen as a traitor.

Role of dividend signalling in corporate finance Dissertation

Role of dividend signalling in corporate finance - Dissertation Example as a major role in corporate finance. The study also provides a detailed research on the impact of dividend announcement on shareholder. Dividend is an important parameter to evaluate investment decision by the investors. So, there is a substantial role of dividend signalling on corporate finance as companies share value of organization through dividend payment.Thus, annual dividend announcement by a company always remains the most awaited news for its shareholders. This paper provides a clear understanding ofthe impact of dividend signalling on corporate finance in theoretical aspect and its impact on shareholders in practical aspect. Chapter 1: Introduction Motivation Firms communicate value and financial well-beings through payment of dividend to its shareholders. Investors generally practice a common activity i.e. â€Å"dividend check in mail† at each quarter when their invested firms declare their quarterly financial results. Dividend is a way of sharing or distribution o f companies’ earnings to the shareholders at a regular basis. Companies distribute dividend quarterly, half yearly or on yearly basis. Regular payment of dividend by a firm shows its sustainable financial growth and it also determines a firm’s future performance and prospect. Dividend payment record of a firm is one of the most important factors for investment decision making for the shareholders and shareholders always expect regular payment of dividend from the companies where they invest. So, a company’s ability and willingness to pay regular dividend payout determines the strong financial condition of the company. Concept of dividend payment was not there in business practice before Securities and Exchange Act was introduced in the year 1934. Companies required a law for mandatory disclosure of financial information. Since the initial time of dividend payment by the limited companies, it has become one of the most important parameter of financial health and also remains one worthwhile yardstick to evaluate a company’s current and future prospect. Mature profitable companies generally pay dividend to its shareholders. However, if a company do not pay dividend that does not mean that the company is not able to generate substantial earnings. Growth companies generally pay dividend. If management of a company thinks that growth opportunity of the company is much better than its investment opportunity available to the new investors or the existing shareholders then the company pays dividend to enhance the investment opportunity of the company (Lonkani & ratchusanti, 2007, p.4). So, dividend is one of the mos

Philosophy of Skepticism Essay Example | Topics and Well Written Essays - 1500 words

Philosophy of Skepticism - Essay Example Being born in the 80s made me very much aware of the traditions, beliefs and fads during that time. My personal interests depended on the interests of the people I live with. If I have lived during the time of slavery, my interest would have been related to freedom and equality. There is no absolute freedom but I have the free will to choose which information and beliefs I would want to base my life upon. I would prefer not to get everything that I ever wanted. Suffering is part of man's life which is destined to be imperfect and man has to strive to make the best out of what we have been blessed with. Man always wants what he does not have. 3. Plato's cave-dwellers discover that the source of their so- called knowledge, their senses has been giving them false information about the world. How reliable are our senses as a source of knowledge Plato rejects the senses as a source of knowledge. Do you agree with him Why or why not In consonance with his theory of Idealism, Plato propounded the view that man, in his present earthly existence is only an imperfect copy of his real, original self, the perfect man, in the realm of ideas. In such a perfect state as pure mind, man knew all things by direct intuition. Thus, according to Plato, man was omniscient, all-knowing, before he came to be born into this world. With his separation however from the paradise of truth and knowledge and his long exile on earth, he forgot most of the knowledge he had. To Plato the ideas are inborn, already present in the mind of man from birth, but these are partly forgotten memories obscured owing to man's life term confinement on earth, in the prison house of the senses. They only have to be revived and recalled. The things that we perceive on earth, according to Plato, are merely shadows, pale reminders of the truths man already knew truly and fully before his terrestrial imprisonment. I disagree with Plato on his idea about the senses. I believe that through sensation and perception, man is able to learn and acquire knowledge and ideas. When we sense something, it can be considered as first-hand information because that is something that can be empirically proven. 4. Does Descartes ever prove in his first meditation that we are not dreaming Why or why not We might appreciate the philosophical viewpoint that Descartes develops to be discernible and defined by the skepticism and cynicism he communicates in the First Meditation. He starts by asking how he can be certain or sure of anything and then develops all kinds of imaginative and outlandish reasons as to why he have to to mistrust his senses. Philosophy ever since has been known a constant skepticism toward knowledge claims, and the very question of how we can come to know anything with certainty has been much argued. Skepticism also informs the mind-body predicament which has come to identify our formation of the human mind. Descartes develops a conception of the mind where the senses and the imagination are also mental faculties. Further, he states that we are essentially thinking things that can be acquainted with our minds clearly and distinctly, but must exert much effort and strive harder to come to an understanding of our bodies. Most significant, he comes up with a very intelligent distinction between mind and body. Mind is essentially think

What is the next thing they target or introduce Essay

What is the next thing they target or introduce - Essay Example To address the problem, and in targeting a larger customer base, the company has embarked on cost cutting as a way of raising money to be used in investment and reaching out to more customers. According to Peters (2014), this can be used to cut costs and improve business. The company mostly targets students as they do not have cars. This puts them at a good position to be potential customers for the company. However, the company has to ensure that it reaches out to the customers otherwise it won’t be able to reap from the customers. The next big thing for the company is cutting continual budget in an effort to remain afloat and also continue to cut routes and schedules for the administration. This is being done to ensure that the company remains afloat and operating on its popular routes. The company is aiming at increasing its returns during the peak season as with little money coming from the government, they need to improve their strategies. They were evaluating an idea of using smaller buses though the idea is not totally feasible at the moment. It is also planning to lease out space to renters to ensure that it gets more

Advanced Corporate Finance Assignment Essay Example | Topics and Well Written Essays - 500 words

Advanced Corporate Finance Assignment - Essay Example Johansson declines to any more talks on a merger. Two days later, Pfizer decides to make its interest on AstraZeneca public. It reaches 2nd May, 2014, when Pfizer raises its offer to  £63bn to AstraZeneca. The offer was attached with the pledge for Pfizer to attach its European operations in and 20% of the merged companys workforce be located at Cambridge for the first five years. Still there was a rejection of this second offer by AstraZeneca. AstraZeneca goes ahead on 6th May, 2014, to publish a strategy update that highlighted its drugs in development. On 7th May, there was a call to issue a stronger reassurance by Pfizer. This followed the unrest over the political pressure of job losses and cut on the UK science researchers. A day later, the former science Minister, Lord Sainsbury accuses Pfizer of being an asset stripper, hence urges that the companys takeover interest should be blocked. On 10th May, Read, in a video, on the official Pfizer website, refers to the merger as a win-win situation and prefers the use of AstraZenecas Cambridge science hub and the UKs science researchers in general. Pascal Soriot, who is the chief executive of AstraZeneca, says the merger would risk lives by delaying drug development. Read then admits that the merger would for sure lead to job cuts and reduced research spending. The chair of this committee then writes to the science minister expressing his concerns over the merger case. On 16th May, there was an increased bid by the labors shadow business secretary to block Pfizer from the takeover. The government officials, on 18th May, agreed to amend the terms of the British governments public interest test. In this light, only ministers were allowed to block takeovers after adequate concerns were raised against the takeover. On the same day, Pfizer raised its offer to  £69.4bn which makes AstraZeneca to be very eager to get back into the negotiations. However, AstraZeneca still rejected the last

Reflection and Research Essay Paper Example | Topics and Well Written Essays - 1750 words

Reflection and Essay - Research Paper Example In this way, more lives would end up being rescued. Nevertheless, many philosophers deviate with the method of killing of one healthy man to save lives. John Harris had tried to imagine an environment where in case anyone was in need of any kind of transplant it could be easily and successfully done2. It does not have to take long while people are in search of the organ. This means no one will ever have to kick the bucket simply because the organ she or he needs seem not reachable in any part of the world. This was a radiant thought considered seriously since the majority will get saved from death, but the fact that one person’s life has to be killed, makes the idea rather inappropriate to be put into consideration. They believe in the existence of a moral difference between killing and leaving to die. They claim that the dying and the existence of a life should be chances that human needs not to interfere with, though they have a duty that makes endurance of the maximum numbe rs of lives possible while dealing with life. It is suggested that the institutions of survival lottery have not gone so far to mitigate the harmful side effects in terms of terror and distress of the victims. Witnesses and the society would be occasioned by the doctors simply by snatching passers–by off the street and disorganizing them for the benefit of the less fortunate. The lottery scheme would give the option of life and death decision to the medical practitioners, and eliminate the possibility of such authority falling into the hands of a human being, though the fear and suffering would still remain. This would be considered a wrong deed biblically since the power of life and death does not reality on human hands. The doctors should do their level best in trying to save a life, but not kill the healthy for the option of the ill. Those that kick the bucket due to lack of organs should be considered to be Gods. There exist some legislative/judicial decisions that create a legal obligation and right in the lottery. The most prominent legislative rule is referred to as a defense of the survival lottery on utilitarian and Lockean grounds3. For the purpose of this concept, the operations will be perfect and that the society can make omniscient decisions and suggest that the use of computers, although the means are considered extraneous. By scheming an essential processing unit algorithm, pitfalls in the scheme would be prevented. The difficulties that arise from the elderly having a high demand for organs would be collected by introducing age into the algorithm. Overdrinking and smoking should be considered. The processor would be planned in order to maximize utility, and each exchange would result in the development just by definition4. Another key point of the second treatise of government is intolerance for arbitrary decision; the survival lottery is random in choosing who will give life to others in scenery. It should be uncovered that the lottery is not arbitrary is random. Finally, Locke requires that either the citizens to be consent to the system, tactically or explicitly through the legislature if the lottery survival is a non-arbitrary the overall preservation of the society with the consent of the majority5. He agrees that a soldier has the responsibility to protect local individuals of a certain boundaries or

Ethics Issue in China Case Report Essay Example | Topics and Well Written Essays - 1500 words

Ethics Issue in China Case Report - Essay Example Hence, the main issue was the difficulty to arrive at a decision on whether the operations in China should continue or not. The ethical stance taken by Levi’s with regards to human rights (arbitrary arrests, poor prison conditions, personal privacy) was not possible to follow in China and hence, it created an ethical problem for the organization. The ethical principles that got violated the most are the principles related to Respect for Autonomy and Justice (Trevino and Nelson, 2011). The ethical principle of Respect for Autonomy is based on the tenet that people should have the freedom to reign over them and also take the decisions that they want to. However, in China, Levis Strauss and Co found this violated their ethical stance because the leadershipin China had refused to ratify the 10 basic guidelines which prohibit the use of forced used of labor according to the International Labor Organization. Similarly, the country has also enforced forced family planning, again prov ing to violate the principles related to Respect for Autonomy. The people did not have much choice when it came to these matters of basic human rights and hence, were forced to comply, thus creating an environment where they could not do want they actually wanted to. The ethical principle related to Justice has not also been upheld with regards to human rights in China. ... Levi Strauss and Co has been known as an organization that has taken a very strong stance against any form of ethical violation. Even though there were speculations regarding entering the Chinese market (China’s stand on many human rights issue was known even before the operations began), the plan to operate from China was implemented in the hope that continued presence of many U.S based organizations can have an impact on the stance adopted by China. However, over the years, Levi Strauss realized that the issues were quite big to be solved just with the help of corporate presence. Hence, the organization was faced with a big question of whether to continue its operations for the profitability or to withdraw its operations based on ethical grounds, something that the organization has always proudly endorsed. The China Policy Group as well as deliberations by the senior management failed to come up with a decision regarding China operations. In the end, the CEO took the bold de cision to bring about an end to the operations in China due to ‘pervasive violation of human rights’. A corporate organization does not merely operate with the sole goal to improve its profitability, but in addition, it also forms a set of ethics that would help it achieve its profitability with the help of certain value system. As Levi Strauss and Co had followed, endorsed and promoted these values for a long time, it is difficult for them to operate in an environment where these values do not have meaning. Hence, it becomes an ethical issue and the organization was forced to weigh out their options between ethical stances versus profitability, ultimately deciding to withdraw its operations. 2. Resolve the case using

Nursing practices on coronary diseases in the UK Essay

Nursing practices on coronary diseases in the UK - Essay Example This is important in the realm of health care, especially when the human aspect is involved in the context of nursing staff. The approach towards management of coronary heart diseases is of utmost importance, as this is one of those medical conditions wherein the treatment circumstances greatly impact the final course of healing. This topic hence entails immense significance and needs to be understood in the context of real-time problems that exist within the treatment mechanism. The research goes upfront with the hypothesis that the nursing care system can play a vital role in treatment of patients with coronary heart diseases. This can largely be speculated due to the fact that it is both an internal and an external condition. Though the internal condition can be taken care of by medicines, the external one largely depends upon the physical environment that is available over there. This is important as this acts as a vector for the study, and gives it the needed direction on order to answer the research question. The said topic was chosen because it gives a very nice converging point for a multitude of study areas, namely internal medicine, external health care, ancillary health services, nursing health care practices and physical atmospheric comforts in healthcare. An all-encompassing issue, this can give an overview about the issue and finally as to what can and is to be doe in the future on this subject. To investigate in detail the aforementioned reason, a number of recent researches on the topic were studied, to evaluate how is this issue being dealt with in real-time. Search engines of the Med-Line and BMJ were consulted for an all encompassing and international perspective on the issue, and the researches subsequently present a very thorough and diverse standing on the subject. Listing of Relevant Literature Following researches conducted on the said topic in the last decade are of significant mention: Coronary heart diseases were once viewed as an inevitable consequence of being infirm and bed-ridden. As it has been recognized that this is not the case, coronary heart diseases have come to be seen much more as an indicator of the quality of care provided, and are consequently high on the political and health agenda. This article provides an overview of the key aspects of coronary heart disease risk assessment and prevention drawn from a variety of national policy documents (Stephen-Haynes, 2004). To study prevalence of coronary heart diseases among functionally impaired patients in the community and evaluate risk factors associated with the development of coronary heart diseases in these patients. Design. Cross-sectional, observational study. Community dwellers served by the Primary Health Care Area of Rincon de la Victoria in Malaga.Participants. All patients included in the Impaired Patient Programme (n=178). Prevalence of coronary heart diseases in our Basic Health Area was 12.9%. The most important sociodemographic characteristic associated with the presence of coronary heart diseases in these patients was the educational attainment of the caregiver. Health variables of the patient were also associated with the risk of developing coronary heart diseases. Results indicate the need of diagnostic protocols with standardised instruments and prevention plans to reduce coronary heart d

Higher education Essay Example for Free

Higher education Essay Ancient philosopher Confucius, who was considered the first professional teacher in China, opened an old-style private school in his hometown. The school enrolled more 3,000 students, and those students just paid a symbolic tuition fee as some crops and meat. The old-style private school has been followed for more than 2000 years. Therefore, the simplest and best way to disseminate knowledge is free education. China had a nine years’ compulsory education but it is not advance with the times now. China should extend years for the compulsory education that free education to senior high school students. With high school free education, students will have equal opportunities to be educated, focus on learning and improving, and improve the standard of living. Let’s look at those benefits of high school free education. Provide equal opportunities Free education of senior high school can also provide equal opportunities as the normal kid to the poor. In the past time, only wealthy people had chance to receive education, but some poor people could not. Now, everyone has right to get knowledge. Free education is a key to open the doors of hope for some smart and poor teenagers. They can have the equal opportunity as the riches to be educated. In the article, â€Å"Free education provides equal opportunities† reported that the government of China had released a newly plan of education that providing equal opportunities in education. The government will expend more power to resolve ingrained problems as extend free education. In many Chinese parents’ mind, if their children have a good and equal beginning in education, it will have a lot of means and benefits for a child’s future (Zhang Jingya, 2010). We can assure that some intelligent and poor students can gain the equal chances through free education. Free education provides some advantages to those people who deserve it and cherish it. In today’ society, everybody wants to have a brighter future, so it is not humanized to lose the better future because of the economic problem. Everyone has the chance to have a comfortable life and the only way to make it come true is to have enough knowledge. If the society can provide an equal chance for the teen that do not have the condition to be educated, they will offer society a better tomorrow. Focus on learning and Improving Free education of senior high school will help the teenagers focus on learning and improving. China promulgated the law on compulsory education in 1986. The government should provide a nine years compulsory education that school should be free of tuition fees and other expenses for all young people. If China extends years for the compulsory education to high school students, it will help some students without worry about the payment of tuition fees and other expenses. They should focus on learning and receiving more knowledge. For example, in the article â€Å"China pledges elimination of rural compulsory education charges in two years†, author says that in some places that particularly in the impoverished rural regions, the law of compulsory education didn’t executed because local government couldn’t cost. Many schools are forcing for continue to collect expenses and charge various miscellaneous fees on their students as voluntary donations, fund-raising for school construction, and after-school tutoring fees (March 5, 2006). Free high school education will help students to pay more attention to learning not the economic hardship of their family. Furthermore, teenagers in senior high school age are about the puberty. That means they are not mature enough in their body and mind. They can’t distinguish the right or wrong in a very advisable way like the adult. As the reason of that, if they give up attending high school because of the economic problem and entering society too early they may lose their way. It is so easy that they make a mistake which will influence their entire life, like involved in a crime. The free education of high school can change this situation. It is better to keep the teenagers in school so they can learn more knowledge and mature their outlook on life. Improve the standard of living Free education of senior high school can improve the standard of living. Francis Bacon said â€Å"Knowledge is Power†. This kind of power should make people’s life more wonderful and colorful because knowledge can produce many things. Free high school education would help more people have higher education. In the article, â€Å"Knowledge Changes Fate†, the author said that knowledge becomes the most significant content of human’s life. It contributes a lot in the economic, welfare and culture of the society. The foundation that supports the movie â€Å"Knowledge Changes Fate† wants to express the theme that the only way to change your fate is to be educated and get more knowledge (Li kasheng, 1999). When people are high educated, they would have more chances to achieve their dreams and plans. Obviously, higher education can help people to win the fierce competition and earns more money. They can live the life better by being successful. When people have higher education, people will think about to improve their personal cultivation after eliminate the struggle for basic needs. As they feel satisfied about their own life, they will do some society works and volunteering and concern more issues which like the society problems and environment problems. Therefore, more free education would have positive and upward influences for the overall quality and minding in the society. Conclusion As all of the content of the essay states, free education of senior high school can advantage our society by many different ways. It can provide an equal opportunity to the teen that cannot bear the cost of education, help the teen to focus on learning and improving, and improve the whole living standard of the society. Although China is a powerful and prosperous country today, our education system still has many leaks need to improve and the most urgent is the free education. If the expectation of free education comes true, China will step in a brand new future. The ancient philosopher Confucius enrolled almost 3000 students and he only charged the tuition fee of some crops and meat as the free education. How the ancient can do this kind of free education, but we cannot? The knowledge is invaluable because it help people to change their whole life. On another hand, senior high school education should be free in China. References China pledges elimination of rural compulsory education charges in two years. (2006). Retrieved March 5, 2006, from http://english. peopledaily. com. cn/200603/05/print20060305_248042. html Jingya, Z. (2010). Free education provides equal opportunities. Retrieved August 6, 2010, from http://english. cntv. cn/program/china24/20100806/100804. shtml Kashing, L. (1999). Knowledge changes fate. Retrieved from http://www. lksf. org/en/project/education/knowledge/main01.

Developing yourself Essay Example for Free

Developing yourself Essay Findings: The CIPD profession map is a tool used to support the profession as a whole to develop products and services, yet it also accelerates the professional development of individuals. The map was created and is used by individuals and organisations; it’s a vital resource if you are working or connected in the HR profession. Whatever sector and/or size of an organisation the professional map is a great help, whether you are a specialist or generalist in talent, reward, learning development, employee relations and engagement. There are three key components to the map, which are: professional areas, behaviours and bands and transitions. The core professional areas show how a HR professional should think and look at tasks, then how to influence the relevant employees to the best outcome. There are then eight further areas surrounding the professional areas and when they are all combined, create the role of a great hr employee. Each area is essential to any business. The eight areas are: service delivery and information, organisation design, organisation development, resourcing and talent planning, learning and development, performance and reward, employee engagement, employee relations and service delivery and information. Once professional HR areas are covered, behaviours are the next vital key to becoming an effective HR professional. There are eight behaviours and they require an employee to be a strong character that leads by example and is confident when advising and influencing all levels of staff from entry to high level. Each behaviour is divided into four bands of professional competence. Each behaviour also lists a number of contra indicators which illustrate negative behaviour. Comment on the activities and knowledge specified within any 1 professional area, at either band one or band two identify those you consider most essential to your own or other identified hr role. Conclusion: A HR practitioner should ensure the services they provide are timely and effective. Different customers have different needs in a HR role and you need to prioritise conflicting needs. Shown below are different customers to  a HR practioner and examples of what needs they may have. Managers look to human resources for sound business advice on how to review, analyse and address people issues. They expect the HR services to be timely and accurate. Supervisors expect human resources to be available on an as-needed basis to help solve people issues. They expect, and frequently demand, help interpreting company policies, expediting personnel matters and preparing or completing paperwork. Most importantly, supervisors expect to learn from their interactions with human resources in order for them to return to their work unit and handle personnel matters. Associates look to human resources to provide, explain or confirm information about company policies and procedures. They expect human re sources to be an empathetic ear to their concerns and to help them solve work-related problems. They expect human resources to anticipate problems and to provide sound recommendations to management. To the applicant, human resources are the company. Applicants expect accurate information about employment opportunities, fair consideration of their qualifications and courteous treatment. An example of how you would prioritise conflicting needs is shown below: When in a HR role a supervisor may need a report by the end of the day completing, a manager may need you to sort a conflict between two members of staff and a member of staff may be dealing with bereavement and is upset. You would then organise how and who or what task is the priority and arrange how it will all be dealt with or completed. In this situation I would delegate the report to another member of staff, I would then arrange a time to address the issues between the two conflicting members of staff then I would then deal with the member of staff with bereavement as I would see them as the highest priority. Then all issues and tasks should be completed/ resolved by the end of the day. This shows how you have an empathetic ear to concerns, you are helping solve work related problems and you are completing tasks under a time scale with organisation and delegation. Communication methods: Employee communication is about the HR aspects of communication from management to employees and of course employees to management. The first aspect is downward communication this is where management communicate to employees the second aspect is upward communication and this is when  employees communicate to management. Managers have to communicate with employees all the time that they are at work it is impossible not to, plentiful communication with employee’s has been shown to be linked to good company performance. Communication could be formal or informal. Smaller company’s often rely on informal methods and have few formal methods of communication with employees. In some cases they prefer to encourage social events for promoting mutual communication. Shown below are some examples of communication: Downward communication: Upward communication: Workforce briefings for all or part of the workforce on key issues Employee attitude surveys Quality circles, regular meeting with all or part of the workforce Suggestion schemes Appraisal interviews Employee forums Newsletters, electronic circular and dvds Project teams With communication you can come across issues these are: Subject What is communicated is the most important issue. HR can send a message to employees only on subjects which they choose to communicate with them. For example, certain information may not be passed on to certain employees because the organisation may not want to disclose this information. Quality You do not want to give too much information as employees may have problems digesting it. You need to make sure the quality of communication is high. Depth The depth of the information must be fit for purpose for example it may be too detailed and confusing for those who it is aimed at as it may have initially been designed for a management circular, re-worked slightly and the circulated to part time workers. Receptiveness Employees should feel that they are being listened to; they may voice their  ideas but feel that they are not listened to, and this would then create a negative effect amongst them and actually demotivating them. Action on their views may or may not be considered a good idea, but employees should then receive feedback on their views. Regularity Employees learn to trust the communication if it is regular and tells them important information. Regular communication means it is less likely rumours which are incorrect circulate in workplaces. A balance must be made between giving people information so regularly that they are swamped with it, and too infrequently so that uncertainty arises. Timing Information may be released when leaked information has already reached employees as rumour and it may then be treated with contempt. Information may be released too early or too late. A good example of this is redundancy information. Employees themselves are sensitive when they read about their own redundancy in the newspaper or see it on the news. You should inform employees of this information at the relevant time so they find out from you first. In the HR role you are likely to have an important role in building managers presentational and communication skills, since operational managers are often appointed mainly for other skills that they have, they may need help in developing their interpersonal skills. HR professionals have people issues at the forefront of their minds, they may advise on where and when sensitive meetings such as appraisals or disciplinary meetings might be best held. HR professionals can act as advisors to individual operational managers on how to communicate to employees on issues such as their pension or legal rights, or alternatively communicate directly with the individual employee’s on such subjects. These matters are of vital importance to employees, for whom areas like pensions and benefits packages are central issues. Getting communication right in these areas is therefor also at the centre of HR professional jobs. HR professionals sometimes have to advise both senior and operational managers on employee’s feelings on different subjects. It is usually the HR professionals who are called on to run or at least source and oversee employee attitude surveys, forums etc. to some extent they may also try to act as employee advocates in order to maintain employee commitment and motivation. HR has a key role to play in improving  communication including by providing training and coaching for other managers and workers which can improve their informal and formal communication. Effective Service delivery is a vital key in a HR role shown below are the key points of how to achieve it to a high standard. Delivering service on time: Delivering service on a budget: Dealing with difficult customers, Handling and resolving complaints: When dealing with difficult customers that may have a complaint or issue there are certain ways to deal with the situation so that it does not escalate and gets resolved. Firstly you need to identify the complaint and get as many facts together as possible. You always need to listen and empathize whilst clarifying that you both understand. Then you would log the complaint and investigate why, who, how and what evidence. Once that is achieved I think it is best to identify an end goal so there is something to aim for and the issue should then be resolved. When trying to resolve the situation always keep the complainant updated with any progress and also make sure you are following the company’s policy and try and keep it to the smallest time frame. Once the situation is resolved I would then try to investigate why it happened and how to prevent re-occurrence. In a HR role I believe you should be committed to treating customers with courtesy and respect at all times, responding promptly to all enquiries made by telephone, email, post, fax, or in person, ensuring accuracy of administration, respecting and maintaining confidentiality, equality of opportunity in employment, updating skills through continuous professional development, regularly and systematically seeking, listening to and acting upon the views of customers. I think a HR function should obtain much more thorough feedback from its internal customers these are line managers, senior managers and employees. This should cover both what they need from HR, and their user experience of current services. Such feedback, as this study illustrates, can generate a clear overview or ‘footprint’ of the HR function in a particular organisation. It can provide fresh insights and help the HR function to focus its efforts in areas that add value to the  business. Bibliography: http://www.cipd.co.uk/cipd-hr-profession/profession-map/professional-areas/service-delivery-information.aspx

Cost Effectiveness of Dialysis for ESRD Patients

Cost Effectiveness of Dialysis for ESRD Patients From 2002-2009 diabetic nephropathies represented 41% of all end-stage renal (ESRD) patients in St. Lucia, which is significantly higher when compared with global distribution. Renal replacement therapy for ESRD is resource intensive, consuming a significant part of the health budget. Financial pressures on the health system continue to increase in the face of the global financial crisis, yet cost-effectiveness studies of ESRD treatment options are not only scarce but nonexistent in the Eastern Caribbean. A retrospective approach to data collection was used and a Markov model of cost, quality of life and survival will be developed to compare hemodialysis and pharmaceutical management of ESRD among diabetics. Micro-costing was used to assess the cost of hemodialysis for ESRD over the 8 year period. While preliminary findings have not identified whether or not hemodialysis for diabetic nephropathy is cost-effective the economic burden of hemodialysis for diabetic nephropathy was signif icant: EC$6.9 million, in St. Lucia for the 8 year period. Pre-emptive procedures need to be considered for the treatment of diabetes to delay onset or progression of ESRD. From a medical as well as fiscal perspective, prevention is the most cost-effective intervention. The health system in St. Lucia needs to focus attention on effective prevention strategies as the mean age among diabetic ESRD patients is 56 years (2.3SD). This age group is representative of a significant part of the countrys labour force and, if left unchecked, could have serious implications for economic development. Introduction End-stage renal disease (ESRD) and its precursor, chronic kidney disease (CKD), are globally emerging as a significant public health problem, with increasing morbidity and mortality as well as economic implications for healthcare (Szucsa et al., 2004). The World Health Organizations 2002 estimate indicated that globally CKD contributes to over 850,000 deaths and over 15 million disability-adjusted life years, with epidemic rise of ESRD in multiple regions in the world (WHO, 2003). The report also predicted that by 2010 more than 2 million people would require maintenance dialysis worldwide, and global estimates indicate that approximately 30% of patients with ESRD suffer as a consequence of diabetic nephropathy (Zelmer, 2007). The economic pressures of ESRD treatment on the collective health system are well documented. Haller, et al. (2011) identifies it as resource intensive, requiring substantial amounts of finite healthcare funds to treat a small percentage of the population. In 2005 alone, care for ESRD patients in Canada represented 1.2% of all healthcare expenditure, despite a 0.092% incidence of the disease (Zelmer, 2007). In St. Lucia, chronic renal insufficiency as a result of diabetes, hypertension, autosomal dominant polycystic kidney disease, and sickle cell disease are the main reasons for starting dialysis treatment in patients with kidney function failure. This is similar to the findings of Perovià ¡ and Jankovià ¡ (2009). In addition to being a chronic disease with significant morbidity impact, ESRD also involves high-cost treatment options (Zelmer, 2007), which are often limited in developing countries such as St. Lucia. Yet cost-effectiveness studies of the modalities of treatment are few and limited, especially in developing countries (Haller, 2011). Previous research has been conducted to identify the economic impact of the estimated health-care costs for ESRD, as well as the cost-effectiveness of various alternatives for renal replacement therapies; however, similar studies have not been replicated in the Eastern Caribbean. The findings are especially relevant to the health system in St. Lucia, as the incidence of diabetes continues to increase in the Caribbean Region (Henry, 2004). Additionally, the recent decision to expand the dialysis service to two new facilities without understanding the scope and magnitude of the total economic burden of ESRD could prove to be challenging. Cost-effectiveness is the fastest growing field in health research and it embodies a form of full economic evaluation that looks at cost and consequence of health programmes or treatment (Muennig, 2008). Cost-effectiveness analysis (CEA) of intervention programmes as a valuable tool employed by decision-makers can be used to appraise as well as possibly improve how the health system operates. Its application allows policy makers to identify which interventions provide the highest value for money and assist in helping to select interventions and programmes that maximize health for the available resources. Health economists are able to purchase the most health under a fixed budget, prioritizing services within the health sector. CEA therefore requires information to indicate the extent to which current and potential interventions are effective for improving population health, and which resources are required to implement the interventions, i.e., costs (Muennig, 2008). Referring to Palmers 2005 definition that states cost-effectiveness studies compare costs with clinical outcomes measured in natural units, like life expectancy or years of diseases avoided, Glassock (2010) noted that the totality of costs may not necessarily be captured. The inclusion of cost means that the design of the study will incorporate cost-unit analysis as a tool to examine the economic impact of dialysis for ESRD patients with diabetes and cost effectiveness to determine the quality adjusted life year (QALYs) or health related quality of life (HRQoL) for that population. The main outcome measure will focus on costs per quality-adjusted life years ($/QALYs), similar to a study conducted in Austria (Haller et al., 2011). Glassock (2010) notes that community willingness-to-pay is the threshold value used to determine cost effectiveness. He goes on to note that these values vary globally, and are estimated at  £30,000/QALY in the United Kingdom, 40,000/QALY in Europe, Aus $5 0,000/QALY in Australia, and US $90,000/QALY in the United States (Glassock, 2010). In the absence of a national threshold value, one can be established using GDP as an objective economic benchmark, (Eichler, et al., 2004). Cost will be viewed from the perspective of direct spending on health care for dialysis, coupled with the indirect costs of productivity losses due to premature death and short- and long-term disability. The impact of mortality costs as the sum of the discounted present value of current and future productivity losses from premature deaths will be measured from an incident-based human capital approach, drawing from a similar study conducted in Canada in 2000 (Zelmer, 2007). Muennig (2008) posits that because it is often difficult to account for all cost, and the time and resource constraints associated with micro-costing, certain assumptions related to costs are often made during cost-effectiveness analysis. This paper serves to examine the cost-effectiveness of hemodialysis among type 2 diabetics in St. Lucia over an 8 year period (2002-2008). Employing the use of CEA, it aims at comparing the cost and effects or outcomes (cost-effectiveness) of hemodialysis for diabetic nephropathy using the comparator of doing nothing, which in this case is the pharmaceutical management of patients with diabetic nephropathy to delay progression of ESRD. The findings will also help to inform those making policy decisions, and may be useful in establishing a set of priorities for further research, prevention programs, and in the planning of alternative treatments to help alleviate that burden. Perspective of the Study Cost effectiveness of dialysis for ESRD patients with diabetes in St. Lucia will be analyzed from a government perspective. This requires conducting cost analysis that measures the recurring direct and indirect cost of providing the service. In the region, specifically in the country under study, health care organizations rarely know the cost of the service provided and rarely employ the tools needed to assess that cost on a regular basis. In a globally operating economic society, economic trends have made it imperative for both profit and non-profit organizations that provide services, including government agencies, to assess the cost of clinical services provided. Finance for health is not infinite and with substantial budget cuts in the health service industry, there is increasing pressure for health care facilities to become more accountable and efficient with the funds allocated to health care (Basch, 1999). Health economics recognises the need for health services to be provided in a manner that is not only efficient but sustainable. Measuring, understanding and documenting the cost of services makes it easier to improve cost-efficiency of these services; it also highlights the funding needs of the sector and by extension, the government. It also provides an opportunity to establish fees for clients that are based on realistic site costs. Previous studies on cost-effectiveness of treatment options for ESRD have compared different modalities of dialysis or transplantation (Haller et al.; Gonzalez-Perez et al., 2005, Yang et al., 2001). Treatment modalities for ESRD patients in St. Lucia are either hemodialysis or pharmaceutical management. The analysis of hemodialysis versus pharmaceutical management to delay ESRD progression hinges on the fact that the current capacity of the Renal Unit in St. Lucia cannot provide dialysis for all ESRD patients. In an interview dated December 14, 2010 with the head of the Nephrology Unit, Victoria Hospital, Saint Lucia, it was indicated that while dialysis is offered, the increasing ESRD population means that patients are placed on a waiting list if they are not able to commence treatment due to unavailability of space (Olivert Dupree, 2010). If a patients prognosis requires immediate dialysis, he is treated at the private facility and the government absorbs that cost. But it is quit e clear that hemodialysis, like pharmaceutical management, is not the optimal treatment option for ESRD; rather, the optimal protocol is transplantation. The health system in St. Lucia is mandated by its objectives to improve the health of the population and consequently needs to ensure that its limited resources are not devoted to expensive interventions with small effects on population health, while at the same time low cost interventions with potentially greater benefits are not fully implemented (Ministry of Health, Human Services, Family Affairs and Gender Relations, 2000). Methods Data Sources The study population comprises of ESRD patients with diabetic nephropathy. Patients were considered depending on whether they received hemodialysis or whether their diabetes was being pharmaceutically managed to delay ESRD progression. Data was collected retrospectively and the study population was selected from the only public Renal Unit which forms part of the general hospital, Victoria Hospital. While there is another Renal Unit in St. Lucia that offers dialysis, it is a part of the private hospital, which did not wish to participate in this study. Of the 111 patients on dialysis, 45 were due to diabetic nephropathy and 19 were actively receiving dialysis at the time the study was being conducted. The nephrologists identified 12 ESRD patients who were not receiving dialysis but were being managed pharmaceutically. All diabetics who are or have been on dialysis with end-stage renal disease for the period 2002-2009 and were receiving dialysis due to diabetic nephropathy were included in the study. Persons were excluded from this study if they were on dialysis prior to being diagnosed with diabetes. The comparator group differed from the hemodialysis group only in the form of treatment that they are receiving, and consisted of all patients with ESRD due to diabetic nephropathy who are not receiving dialysis but whose diabetes is aggressively managed with medication to delay ESRD progression. Other variables were considered in the study and a standard questionnaire was administered to the study population to obtain data on the socio-economic status of individuals. A pool of eight persons from those who were on dialysis for reasons other than diabetic nephropathy served as a pilot test group for the socio-demographic questionnaire. This group was similar to the study population in terms of gender, education, socio-economic status and geographic location (Table 1). Content analysis was used to evaluate the information obtained from the socio-demographic questionnaire. All study participants received a letter concerning anonymity and confidentiality and informed consent was obtained prior to participation. Ethical approval was obtained from the IRB at St. Georges University and the ethics committee of the Ministry of Health in St. Lucia. A literature review conducted relied upon peer-reviewed economic evaluations of dialysis treatment modalities among diabetic patients. Ebscohost and PubMed were searched using the keywords cost-effectiveness, dialysis, end-stage renal disease, and diabetic nephropathy and was limited to articles published in the last 12 years (2000-2011). Some articles, if they were published outside of the selected timeframe, were accepted based on the strength and relevance of their findings. Articles were included if they had the keywords in the subject headings as well as focusing on Renal Replacement Therapy/economics, Renal Dialysis/economics, Hemodialysis Units, or Kidney Failure. If they included the term peritoneal dialysis or hemodialysis they were also selected. Exclusion criteria comprised of non-English articles and those that did not compare treatment options. A total of 379 articles were identified but 31 were selected as being relevant. Models Used Chronic conditions such as ESRD require continuous treatment and as a consequence, the cost-effectiveness of treatment options over a period of time for a cohort of patients employs the use of the Markov model to investigate long term costs and outcomes. The Markov model developed for this study describes the process of care noting that patients began their progression through the model in either of two states, hospital hemodialysis or pharmaceutical management of type 2 diabetes to delay ESRD progression, with death signifying the end of the cycle. Data on health care costs, transition to other health states and quality of life were inputted into the Markov model. Data was obtained from the Renal Unit at the Victoria Hospital, the public health facility. Data on quality of life was obtained using the 15D, a multidimensional, standardised generic instrument to measure quality or health-related quality of life (Sintonen, 2001). The 15D was used since it combines the advantages of a profile and single index score measure that describes the health status by assessing 15 dimensions. The mean score value for each dimension was used to determine the health related quality of life in the study population. The use of the 15D to measure quality of life outcome was reported in terms of QALYs, a measure of the burden of disease that included the quality and quantity of life lived against a monetary value, medical treatment or intervention. The mean score value for each dimension measured by the 15D was used to determine the health-related quality of life of the study population using the scale provided by Sintonen (2001). The findings were standardized against the burden of disease markers identified by the WHO. Costs and Analysis Cost-effectiveness, examined from a governmental perspective, used the clinical records of the Division of Nephrology patient registration and billing systems at the Victoria Hospital coupled with information from published studies on survival and quality of life among diabetic nephropathy patients. The model used included the direct health service costs associated with the treatment options, and an annual cost per patient was calculated for each health state in the model. Direct healthcare costs associated with dialysis use included costing regular dialysis sessions, complications of the dialysis, such as clotting of the fistula or hypotension episodes, laboratory tests and services required as a consequence of dialysis and medication use as a result of treatment. Assumptions were made on the regularity of direct healthcare cost associated with dialysis, such as that involving laboratory testing and blood transfusions. Micro-costing, collecting data on staffing, consumables, capital , and overheads were used to determine the cost of one session of hemodialysis (Table 2). Structured interviews were used to obtain details regarding staff time allocated to dialysis activities, as well as the regularity of other services used as a result of the treatment options. Capital items were identified as the building space allotted to the Unit for treatment, and equipment such as the dialysis machines and air conditioner unit. Costs have been reported in Eastern Caribbean Dollars (EC) presented at the 2008 level and an equivalent annual cost calculated using a 3 percent discount rate over the predicted life span. Muennig (2008) argues that a governmental perspective can include some aspects of transportantion costs. Evidence from the Minstry of Communication and Works and the Transport Board implies that there is no nationally agreed-upon policy for transport costs. There are variations across St. Lucia in terms of mileage costing; therefore for the purposes of our analysis, transport costs are excluded. The study reviewed costs over an 8 year period (2002-2009). This time frame was partly determined by the availability of the data two years after the programme was initiated and the assumptions made with reference to the analysis were tabulated (Table 3). Incremental costs per QALY gained will be calculated by using the estimates of costs and QALYs for each of the two modalities obtained from the model, and the findings were presented as incremental costs per QALY ($/QALY). The threshold value used to determine cost effectiveness of the intervention was established based on the recommendations of the Commission on Macroeconomics and Health, and CHOICE, which uses gross domestic product (GDP) as an indicator to determine cost-effectiveness. They established that an intervention was highly cost-effective if cost per QALY was less than GDP per capita, it was cost-effective if it was between 1 and 3 times the GDP per capita but was not cost-effective if it was more than 3 times GDP per c apita (WHO, 2011). A one-way sensitivity analysis will be used to investigate variability in the data, varying the discount rate from 3% to 5%, then age weights and finally, the disability weights. A final sensitivity analysis of mortality rates will be conducted since the assumption was that the mortality rates for hemodialysis were the same as those of pharmaceutical management of ESRD diabetics. Based on that assumption it becomes important to identify whether any one of these factors, discounted rates, age weights, and disability weights independently affected the data. Multiple linear regressions will be used to identify how the variables and assumptions affected dialysis lifetime. Preliminary Findings Demographic Characteristics The socio-demographic characteristics of the study population are presented in Table 4. According to the modalities compared the mean ages were 52 years (SD 10.06) for hemodialysis patients and 42 years (10.34SD) for patients who were being pharmaceutically managed. Briefly 62% of the patients were male (Figure 1), 40% had completed only primary level education and 20% had received no formal education. Married patients made up 46.7% of the study group and 26.7% were currently employed; but of these patients 80% of them received some form of family support or National Insurance Corporation (NIC) compensation. There was little variation between the groups (hemodialysis and pharmaceutically managed) in terms of employment and education. ESRD, as a consequence of diabetic nephropathy, represents 41% of all patients who have received hemodialysis for the period 2002-2009 (Figure 2). The end of that 8 year period mortality rate among that population is 53% with the average age of death at 57 years and average dialysis lifetime of 3 years. Costs A list of the parameters used to determine cost is presented in Table 2 and total yearly cost for the period is presented in Table 3. The total cost of dialysis for diabetic nephropathy was EC$6.9 million. From a governmental perspective, in 2009 the total cost of dialysis for diabetic nephropathy patients with ESRD totalled EC $1,002,597.23, accounting for approximately 2.27% of all healthcare expenditure for 0.01% of the population. Secondary and tertiary care services accounted for 59% of the total health budget for 2001-2002, 60% for 2002 -2003 and 64% for 2003-2004. Primary care services accounted for 22% in 2001-2002, 22% 2002-2003 and 18% for 2003-2004 (Figure 3). Discussion This is the first study of its kind in the region. It is able to serve as a precursor to further research and therefore is poised to help guide policies on how cost-effectiveness studies are done in the region. Additionally, there will be future application to decision-making in healthcare. While the absence of other studies that compared the treatment modalities used in this study serves as a limitation to this paper, it remains the only viable comparator that was available to the researcher, and being the first of its kind allows it to inform the existing research. The preliminary findings of this paper have significant implications for health and the operations of the dialysis unit. The literature from other studies (Haller et al, 2011; Zelmer, 2007) indicates that the average lifetime on dialysis is 7-10 years, with survial rates lower among senior adults, aged older than 65 years. The inverse seems to be suggested by the preliminary findings, with an average lifetime of 3 years in patients less than 57 years. The deviation may be attributable to younger persons being less compliant with regular dialysis sessions and the strict dietary and lifestlye adjustments that dialysis requires. Further research would need to be conducted to validate these findings. The economic burden of ESRD for diabetic nephropathy is significant: EC$6.9 million, in St. Lucia for the 8 year period (Table 2). While the focus of this study is on the cost-effectiveness of dialysis, the data identified that health services accounted for most of the observed costs. The governmental perspective of the research restricts the papers ability to adequately address the diabetic nephropathy related morbidity and premature mortality among the study population and the substantial burden that it places on society. The early indicators suggest a need for the effectiveness of the programme to be examined against its objectives and how its outcomes compare with other units within the region or the privately operated unit in St. Lucia. In 2006 Government health expenditure per person per year was EC$499.50 (Ministry of Health, Human Services, Family Affairs and Gender Relations, St. Lucia). Yet for that corresponding period, government spending for dialysis per person per year was EC$48,597.81 (Figure 5), for 0.0014% of the population. St. Lucias GDP for that period is estimated as $6,037.00 PPP (EC$16,299.90) and total expenditure on health is estimated as 6.3% of GPD (Table 5). While cost-effectiveness has not been conclusively established, using the threshold value of GDP as an economic estimate to determine cost-effectiveness, a cost-effective programme is one that is between 1 and 3 times the GDP per capita (WHO, 2011). The National Strategic Health Plan 2006-2011 (2006) posits that the Ministry of Healths actions have not been consistent with its declaration of a commitment to Primary Health Care (PHC) as part of its strategy for National Health development. Health spending continues to increase in the areas of secondary and tertiary care and less of the health budget is spent on primary care. The expansion of hemodialysis to meet the growing ESRD population, and an increased incidence of diabetic nephropathy in St. Lucia has implications for the findings of this study. It is important that focus is directed at primary and secondary interventions aimed at reducing cost of diabetic care and consequently complications from diabetes, such as diabetic nephropathy. Primary interventions are the most cost-effective and as such health promotions to reduce risk of developing diabetes, a risk factor for ESRD, needs to become part of the mandate of the Ministry of Health. A policy on chronic diseases develop ed within the primary healthcare plan that currently exists would help guide that focus. The study was limited by the accuracy and quality of the data, which Basch (1999) argues is a recurring problem in developing countries. There are limitations and difficulties in any attempt to calculate the mean cost of a dialysis session, especially in public facilities where cost is subsidized, as every facet of care and cost associated with the session must be taken into consideration. Consequently, assumptions were made on cost for direct and indirect services related to treatment options compared in this study. Assumptions are justified as this is a non-funded research with time constraints and a need to reduce cost drivers. The study was also limited in its perspective as it could not present on national costs from a societal perspective such as the patients ability to work or opportunity costs. Costs from the private facility could not be used as they did not wish to participate in this study. The inability to capture their costs is relevant as they are used by the government to provide dialysis for ESRD patients whose prognosis prevents them from being placed on a waiting list; this cost is incurred by the government. A patient who commenced dialysis at the private facility and transferred to the Renal Unit at the government facility is not distinguished in the patient register. The strength of the research lies in the use of triangulation to gather and analyse data to ascertain their common conclusion, effectiveness based on costs, and QALYs. Decrop (1999) concurs that one of the main ways to avoid the contentious issue of validity and reliability is the use of triangulation. Triangulation involves the use of multiple data sources in the investigation of a research question for justification or clarification, which in this case involved utilizing primary and secondary data, as well as information from the attending physician. Denzin (1978) also claims that triangulation limits personal and methodological bias as well as enhances the studys generalizability. The use of the Markov model is an inherent strength of the study. Gonzalez-Perez, et al. (2005) argue that the models ability to prognosticate relative effectiveness and cost overtime makes it appropriate for modelling chronic treatment options such as Renal Replacement Therapy (RRT). Cost-effectiveness to determine QALYs as well as the use of a standardized instrument to measure QALY also strengthens the findings of the research. The 15D is recognised as generally being a small measurement burden to both respondents and researchers. As an evaluation tool it is highly reliable due to its repeatability of measurements with minimized random error. The results generated are valid because of the degree of confidence that researchers can place in the inferences that are drawn from the scores. Sintonen (2001) posits that as an instrument to measure cost-effectiveness, it is particularly suitable for calculating quality-adjusted life years (QALYs). While the majority of cost-effectiveness analysis of treatment modalities for diabetic nephropathy focuses on the disease at its latent or progressed stage, Glassock (2010) noted that a study by Gearde et al. (2008) identified that early detection of diabetic nephropathy and intensive pharmaceutical interventions are not only cost effective but significantly reduces the risk of ESRD among type 2 diabetics. These findings are replicated in two studies by Keane and Lyle (2003) and Szucs, et al. (2004) who found that Losartan reduced the incidence of ESRD among diabetics. They went on to argue that proteinuria, which is the single most powerful predictor of CKD in type 2 diabetes, is a simple and inexpensive screening test, and early detection can lead to the early administration of drugs that have been proven to reduce ESRD incidence. Mann, et al. (2010) argue caution against population based screening for CKD, and advocate that screening, as a secondary intervention, should focus on at-risk populations. Their study concluded that targeted screening of people with diabetes is associated with an acceptable cost per QALY in publicly funded healthcare systems. Such an approach can be adopted in the health system in St. Lucia. Cost-effectiveness analysis is able to provide valuable insight to prioritizing within healthcare and so the findings of this research will be able to provide evidence to support efficiency in the use of limited resources. Policy-makers would be able to use these findings to review the decision to expand the number of hemodialysis centres in St. Lucia. Further research to identify more cost-effective treatment options would be the first step to improving efficiency of resource allocation. The preliminary findings have not identified whether or not hemodialysis for diabetic nephropathy is cost-effective. The domination of hemodialysis as a treatment modality for ESRD, despite the plethora of studies that have identified it as the least cost-effective of RRTs (Haller, et al., 2011; Just, et al., 2008, Kontodimopoulos Niakas, 2008), provides the health sector with the evidence needed to revise treatment protocols and an opportunity to improve cost-effectiveness of ESRD treatment. This can be achieved by reducing the use of hemodialysis and introducing as an alternative peritoneal dialysis, which has been cited as being the most effective of dialysis options. Just, et al. (2008) caution that the economics of dialysis in the developing world, where labour may be cheaper than the importation of equipment and solutions, may lead to the perception that peritoneal dialysis is more expensive than hemodialysis. They go on to note that this is not conclusive as there is a dearth in economic evaluations in developing countries to substantiate that view. As an alternative, a well developed CKD Care Program is able to significantly reduce the probability of developing ESRD among at risk populations, as well as significantly lower healthcare costs among ESRD patients (Wei et al., 2010). There is a need to expand the services offered by the Renal Unit as well as its coverage to help achieve that end. Conclusion of Preliminary Findings Despite a declared commitment to Primary Health Care (PHC) as a strategy for National Health development, the Ministry of Healths actions have not been consistent with its declaration. Secondary and tertiary care service is posing a great financial burden on the health system, as purported by the preliminary findings of this paper. Evident in the resource allocations for health in St. Lucia, Primary Care Services are allocated a decreasing or stagnant proportion of the health budget, considered against a decreasing allocation of total public expenditure to health. A sustainable health system needs to maximize the use of health resources, creating a more efficient health system that is capable of providing quality health services in a cost-effective manner in order to maximize population coverage. Primary health care needs to become the thrust used to promote efficiency in health as it is recognized as the most cost-effective of interventions. References Basch, P. (1999). Textbook of International Health

Chevrolet Advertising :: Marketing Advertisement

Missing Figures/Works Cited Genuine Chevrolet Advertisers create ads in magazines to catch the eyes of readers and encourage them to want to buy the product. Each advertisement includes claims, warrants, and supports, which make the advertisements attractive. For example, in the attached advertisement for Chevrolet Cavalier, each of these ideas used, makes the reader want to go out and buy this car. In the advertisement, there are many catchy phrases and pictures which make the car look very desirable. Furthermore, the general nature of a magazine such as "People," where the ad is found, it attracts people of all types. As displayed in the Chevrolet advertisements, claims, warrants, and supports are used to attract people of all types. Claims in the advertisements are used to try and get people of all types to notice, admire, and eventually go out and buy this car. There are three different types of claims: policy, fact, and value. The claims of policy in this advertisement are similar to most claims of policy in ads, which are, "buy this product." The claims of policy are created by the pretty picture on the opposite side of the page, and the writing on the ad. In the picture, the pretty mountains and bright sun look very inviting to someone who needs sometime to relax. By the desire to have free time, the busy worker will think that the car will get them some free time. Then, they will want to buy the car. The writing includes lines such as, "Finally. After working for what seems like forever, you have some time to yourself." Although this quote really does not have much to do with the car, it attracts the reader who may want some free time. The claims of fact include the statements about how many miles the car can go before needing a tune up and how it fits a low budget. These kinds of claims can attract people of all kinds, mainly people looking to spend little on a car for themselves or for their children. The claims of value state that this car can take you wherever you want, and that "even though going out during your free time may cost a lot, getting there won't." From these examples of claims of policy, fact, and value, the car looks very attractive to a reader.

Glaciers in Oregon and The Fertile Crescent: Fields and Rivers Essay

Glaciers in Oregon Glaciers are a big part of life in Oregon. Glaciers supply drinking water, they irrigate crops and they help generate hydroelectric power. They are also a tourist attraction in areas that have more mountains. Glaciers are a natural resource that are so rare that people all over the world are trying to get these â€Å"frozen streams.† People want the power of glaciers because they can provide drinking water and people living in the city of La Paz, Bolivia rely on the melting of the glaciers. Glaciers irrigate crops and thousands of years ago people in Russia and Asia knew that dark colors promoted melting. This is how they watered their crops during dry periods. Even though this method has been proven very costly, India has created artificial glaciers to provide people with more water. Scientists have been damming glacial meltwater to help generate hydroelectric power. Glaciers supply drinking water to the community and are running low because they are continuing to melt. Glaciers have drastically changed over time because on average, â€Å"glaciers worldwide have been losing mass since at least the 1970s†. The melting of glaciers has been contributing to the rise in sea level because the glaciers have been shrinking faster in the last decade. Three of the major glaciers in the us have shown an overall drop in mass since the 1950s and 1960s and an accelerated rate of decline in recent years. An ice cap covered Mt. Hood during the Ice Age, from about 1.8 million years ago to about 10,000 years ago. These ice caps covered the Oregon Cascades, a series of mountains in Oregon, with glaciers going down on the east and west sides of the range. These glaciers melted into smaller glaciers as the weather proceeded to get warmer... ...ollapsed, but the Nile continued to grow and Great Britain took control of the Nile in the 19th century. Around 60 years ago the Africans gained control of the Nile. Rivers and fields affected the people who lived in the Fertile Crescent throughout the years because of the fertile soil and water. Many people lived in the Fertile Crescent and prospered from the fertile soil by growing an abundance of crops. Once it was abandoned, the Fertile Crescent became cracked soil and vacant land. Works Cited "Service Interruption." Do Glaciers Affect People? NSIDC, n.d. Web. 10 Dec. 2013. "Glaciers in Oregon | Oregon Encyclopedia - Oregon History and Culture." Glaciers in Oregon | Oregon Encyclopedia - Oregon History and Culture. Portland State University, 2008-2013. Web. 10 Dec. 2013. "Fertile Crescent." Ancient History Encyclopedia. N.p., 2009-2013. Web. 09 Dec. 2013.

Death in the Life of John Donne :: John Donne Poetry

Death in the Life of John Donne Professor Choi Jae Hun 2006-12-07 MA English Literature 2006201044 Yoon Hyeon Jeong Contents INTRODUCTION 2 I. DEATH OF HIS FAMILY MEMBERS 3 II. MARRIAGE AND HIS WIFE’S DEATH 6 III. HIS OWN DEATH 8 IV. SUICIDAL THOUGHTS 9 CONCLUSION 10 BIBLIOGRAPHY 11 Introduction John Donne is one of the most important poets in English literature. To understand John Donne’s poems better, studying his poetic skills such as symbolism, wit, metaphor, and exaggeration are crucial, but the most important subject, death, in his poems cannot be overlooked. John Donne wrote songs and sonnets as well as divine poems and death is often mentioned in his poems. Why did he always think about death? Did he experience death or similar occasions very often in his life? For human beings, death is a depressing image. Humans are afraid of death because we are mortal, so, we often worship the immortality of gods. I think the image of death is darkness and I never thought of death when I was younger, but, John Donne seemed to think about death even when he was relatively young. Instead of researching poems, we can look into the background of John Donne’s family members’ death, his marriage life and his wife’s death, his own death and his suicidal thou ghts. Most people research John Donne’s metaphors in his poems, John Donne’s image of love, John Donne’s thoughts on women and his death in his poems. However, we can examine his personal background which is linked to death, which will make us understand his poems far better and easier. I. Death of his family members John Donne was born in Bread street, London, in 1572. His family was a well-off Roman Catholic family. His father died suddenly in 1576 when Donne was only 4 years old. He was raised by his mother, Elizabeth Heywood. She delivered 6 children, but, 3 children died, so, 3 children, Anne, Henry, Donne were brought up together. Elizabeth Heywood’s family was strict Catholic, so, Donne was educated as a serious Catholic when he was a child. His mother was John Heywood’s daughter who was an epigrammatist and a playwright and Sir Thomas More’s niece. John Heywood (c.1497-c.1580) was an English writer known for his plays, poems, and collection of proverbs. He was born in or near London, but fled to Europe to avoid religious persecution for his Catholic faith and is believed to have died in Mechelen, Belgium. Sir Thomas More (7 February 1478 - 6 July 1535) was an English lawyer, author, and statesman.

Human Rights and Development Essay

Introduction The endless efforts by human beings in formulating perception to respect human dignity resulted the human rights discourse and so was case of development. The inherent intensity of searching ‘better’ for human being to respect the human dignity paves the way for new development concept by integrating human rights norms into development, and thereby making a paradigm shift from other development models. The transition from focusing on material to focusing on human in development reflects the deepening of people understanding about the relations between human rights and development. However, armed conflicts within and beyond the national boundaries have been seriously violating human rights and hampering development process. War around the globe had and still has the same result. People around the globe are reshuffling their thinking on development models to ensure human rights thereby getting a peaceful environment free from war and conflicts. The aim of this paper is to explore the negative relation, if any, between armed conflicts, war and human rights and development assuming as a development model. Linking human rights with development as a development model Human rights are those rights without which a human being cannot live as human being. These rights are indispensable and inviolable, no one is supposed to take away these rights from any individual or groups. These rights are so basic and fundamental that any man or woman gets that from his or her birth and which are founded on human dignity. On the other hand, Development has now become an inter-disciplinary subject or it can be attributed to different political or ideological viewpoints. Development is as much a prerogative of nations as of individuals within nations. Development as comprehensively would be meant†¦Ã¢â‚¬Å"is a comprehensive economic, social, cultural and political process, which aims at the constant improvement of the well-being of the entire population and of all individuals on the basis of their active, free, and meaningful participation in development and in fair distribution of benefits resulting therefrom.† Human rights and development an integrated approach of development as comparatively a new development model generally known as ‘Rights based approach’. â€Å"A rights-based approach is a conceptual framework for the process of human development that is normatively based on international human rights standards and operationally directed to promoting and protecting human rights. The right-based approach integrates the norms, standards and principles of international human rights system into the plans, policies and processes of development.† Linking human rights with peace as antithesis of conflicts and war Journey towards protecting rights of the people and ensuring peace in this globe had an immemorial history. It was so strongly perceived and advocated from the World War I and during and after World War II, which resulted the concept of human rights as it understood today. Perhaps, it was President Wilson of U.S.A. who advocated for rights of the minority as global protection at Peace Conference in Versailles (1919). During World War II world had witnessed the massive violation of human rights and denial of peace. Consequently, international legal and political leaders committed to show respect human rights and to stop wars and conflicts which paved the way for establishing UN as global organization. â€Å"We the peoples of the United Nations determined†¦to save succeeding generations from the scourge of war, which twice in our life time has brought untold sorrow to mankind.† Human beings are in position from where they want to respect the dignity and to avoid the barbarous acts of conflicts and wars by proper understanding and realizing these rights. â€Å"†¦whereas disregard and contempt for human rights have resulted in barbarous acts which have outraged the conscience of mankind.† But after acknowledging the human rights and making commitments through UN, does the world avoid conflicts and war that violate human rights. The answer would certainly be negative though there was no world war since 1946 to onwards. But the world is witnessed of massive human rights violation in Sudan, Congo, Ruanda, Iraq, Afghanistan and different parts of the world. These in the long run violate the human rights. War, conflicts external or internal and unrest are threat to peace and security everywhere which are the conditions precedent for realizing human rights. Thus, war is the antithesis of human rights and vice- versa. â€Å"It is widely believed that the denial of human rights is not only an individual and personal tragedy as it also creates conditions of social and political unrest, sowing the seeds of violence and conflict within and between the societies and nations.† Thus, there is a close relation in observance of human rights and maintenance of peace or vice versa. The Declaration of Principle of International Law concerning Friendly Relations and Co-operation among the states in Accordance with the Charter of the United Nations, which was adopted by the UNGA in resolution 2625(XXV) of 24 October 1970, that postulates â€Å"†¦maintaining and strengthening international peace founded upon freedom, justice and respect for human rights.† Respect, promotion and protection of human rights helps to reduce the conflicts, internal or external and thereby avoiding the war, because by respecting fundamental human rights no civilized nations can support and go for war. Linking development with peace as antithesis of conflicts and war In the context of 21st century, the concept of development has been drastically changed. Now development is perceived in much broader sense than that of previous. Notion of development equating with commodity or economic growth has been changed and now development is perceived as human development, meaning â€Å"the process of enlarging people’s choices.† Thus, there is a close relation between development and peace. An underdeveloped environment is not generally accepted that peace shall be prevailing. For this, to establish such environment, commitments are reflected in UN charter establishing conditions under which justice, respect to international law, to promote social progress and better standards of life in larger freedom, ensuring economic and social development for all would be prevailed. Peaceful environment is very much conducive for development and vice versa, Almost 20 years after the cold war our world is becoming less safe, industrialized countries are facing human insecurity by terrorism. Conflicts by internal groups are also visible in different developing and least developing countries. The world both developed and under-developed is suffering the common problem of insecurity which exposed by among the reasons †¦deprivation, violation of human rights and less development approach by the rulers. Insecurity linked to armed conflict remains one of the greatest obstacles to realize human rights and development. â€Å"Every civilian death linked to conflict is a violation of human rights.† The human security which is the essence of human rights and development has got larger attention across the globe in this era of globalization. The state centric security now turns into the human centric security. Promotion of security helps to ensure the development as well as human rights, and insecurity expose to unrest and under-development and massive violation of human rights. â€Å"Humanity cannot enjoy security without development or development without security, and neither without respect for human rights.† Human being can achieve complete fulfillment of its aspirations only within the just social order. For the stable, peaceful, non-violent environment are preconditions which are more often disturbed by the war and conflicts. â€Å"†¦international peace and security on the one hand, and social progress and economic development on the other, are closely interdependent and influence each other.† Furthermore, there is very close relationship between disarmament which exposes peace as well as development and also prevents armed conflicts and war. â€Å"†¦ [T]here is a close relationship between disarmament and development and that progress in the field of disarmament would considerably promote progress in the field of development.† The costs of wars and conflicts often are not clear to the world community, it just not the violating human rights at once but making many human persons disables for the long time which is contrary to the concept of development. â€Å"Violent conflicts claims lives not just through bullets but through the erosion of human security more broadly.† Armed conflicts and wars all over the world displaced many people which is ultimately a violation of human rights and also a serious impediment of development. â€Å"About 25 million people are internally displaced because of conflicts or human rights violations.† However, some developed nations go for war for resources but ultimately their development doesn’t become as sustainable one. Their internal development get interrupted by drugs, alcoholism, joblessness, economic unrest thereby produce instability, recent USA’s movement of ‘we are 99%’ the occupier of world street and UK’s unrest are glaring examples of non-sustainability of their development. Conclusion Human rights and development share some commonalities, for that reason they have justification to be applied in practical field which can be a very pragmatic way to solve problems that we are facing today. Thus, in the light of above discussion, it shall not be less than just to claim that, human rights and development both are the antithesis of armed conflicts and war, and vice-versa. The promotion and protection of formers discourages the latter, and happening of the latter severely violates and hampers the former. Thus, human rights and development are the contradictory to war and the war, armed conflicts are also opposite to the promotion and protection of human rights, and realization sustainable development. In this same point, the both human rights and development could used as to prevent armed conflicts and war. â€Å"In turn without development, long term enjoyment of human rights and development will prove illusory and war, of course is the antithesis of both.† ——————————————– [ 2 ]. The author completed LL.B. & LL.M. from University of Dhaka. And currently serving as Lecturer, Department of Law. Green University of Bangladesh. [ 3 ]. Preamble, Para-2, Declaration on the Right to Development, 1986, adopted by UNGA. [ 4 ]. Robinson, Mary, A voice for human rights, University of Pennsylvania Press, 2006, p.303. [ 5 ]. Preamble, The UN charter.1945. [ 6 ]. Ibid. [ 7 ]. Bari, Dr.M.Ershadul, Human rights and World peace, The Dhaka University Studies Part-F, Vol.III(1):1-11June 1992,p.2 [ 8 ]. The third preambular paragraph. [ 9 ]. HDR, 1990, UNDP, New York, p. 10. [ 10 ]. Ibid. [ 11 ]. Ibid. [ 12 ]. See for more, Sen, Amartya, Human security now, Commission on human security, New York, 2003, pp. 2- 9. [ 13 ]. Anaan, kofi, Report of the secretary general, UN ,New York,2005,p.6. [ 14 ]. Preamble, Para-6, Declaration on Social Progress and Development,1969,adopted by UNGA. [ 15 ]. Preamble, Declaration on the Right to Development, 1986, adopted by UNGA. [ 16 ]. HDR, 2005, UNDP, New York, p.155. [ 17 ]. Ibid., p.151. [ 18 ]. Annan, Kofi, Official records of the UNGA, forty-seventh session, supplement no-1(A/47/1) para-109.

Haitian Vodou Essay

Vodou, A Haitian religion deeply rooted in colonialism stems from several African sources, which have constructed and maintained a hybrid Africana and European diaspora in the Caribbean. In an effort to preserve African tradition and spiritual belief, slaves in Haiti prior to the Haitian Revolution of 1791, established and developed the heterogeneous religion known as Vodou. As Vodou became a more prominent aspect of slave culture in Haiti the hybridization between traditional Africana religion and European religion fashioned a new system of belief. The fusion of Catholicism from Europe and African religions make up one of the most influential religions in Haiti today, in fact Vodou plays an imperative role in Haitian life. In addition to having a tremendous effect on Haitian religious practices, Vodou also plays a fundamentally important role in driving Haitian politics, economics, community, and social relations. From a student and non-Haitian perspective I seek to obtain knowledge on how Vodou has and continues to play a detrimental role in every aspect of Haitian life. Through analyzing and cross-examination of several texts it appears that without boundaries Vodou is important. Before delving into how Vodou effects nearly every aspect of Haitian culture I would like to first analyze the importance of understanding the roots and origin of a belief and practice that has become such a prominent aspect of Haitian life. In the eighteenth century the slave trade in Haiti ushered in a number of African slaves from various groups. These groups of African people brought with them to Haiti their traditions, beliefs, and lifestyles. In â€Å"Haitian Vodou† of Creole Religions of the Caribbean, the authors state that the slave trade was in fact the European way of â€Å"destroying all cultural connections† to the homelands of the slaves (Fernandez-Olmos and Paravisini-Gerbert 101). European slave owners and slave traders thought it necessary to force European ideals and beliefs onto their slaves, ridding and dismantling the beliefs and tradition of their native land. In this respect the slave trade played a significant role in the creation of Vodou, catalyzing Afro-European syncretism into a new belief system. Vodou began as a way for slaves to hold on to their cultural beliefs, and helped refute the impositions of Catholic religion that the French attempted to employ, as they saw it necessary to condition African slaves to their lifestyle (102). In my opinion Afro-European syncretism is one of the more complex and intriguing religious developments as it pertains to Vodou. In Voodoo Africa’s Secret Power author Gert Chesi describes the fusion of African and European culture stating that slaves brought with them the gods of Africa to the Caribbean where they then blended with the Saints and other Catholic and Christian symbols (Chesi 231). The imposition of Catholic and Christian beliefs by Europeans onto African slaves made it nearly impossible for African slaves to remain entirely devoted to their home land beliefs and traditions. African slaves in Haiti adopted Vodou as a means of maintaining their traditional beliefs, however, Christian and Catholic ideals were still important influential factors in the establishment of Vodou. The spirits often associated with Vodou known, as Lwa are similar to Saints in the Catholic Church. Slaves in Haiti dealt with the pressures of forcibly having to adapt to European religion by integrating their belief system with that of the European belief system. I think that Slaves in Haiti used Vodou as a stabilizing factor in Haitian culture. The ritual and practice that developed through the integration of European tradition with African tradition ensures that African tradition will remain considerably important regardless of the fact that Europeans once tried to dismantle African tradition and impose Western tradition on those slaves living in Haiti. Vodou serves as a mechanism for passing on tradition from generation to generation. In Voodoo: Truth and Fantasy the author states that Vodou has emerged as a vibrant cultural force in twenty-first century Haiti (Hurbon 126). This statement supports the idea that Vodou has and continues to have a role in Haitian life and Haitian culture. Vodou has undoubtedly helped restore an almost lost identity to African slaves in Haiti, and has allowed generation after generation to know and understand the beliefs of the homeland from which their ancestors originated. The foundation of many Haitian affairs may not be solely rooted in Vodou, however, the religion holds weight in many political spheres throughout Haiti. Starting from the moment of its development, Vodou has been politically important to Haiti. In fact, its very creation resulted from various political, cultural, and religious â€Å"struggles for freedom† (33). After analyzing the roots of Vodou it has become quite apparent that Vodou played an important role during Haiti’s revolutionary period. During and before the Haitain revolution Vodou was used as a means of protecting and politicizing the interest of Haitian slaves. From that time forward Haitian people have continued to use Vodou as a political tool to protect their interests and assets. Vodou has indeed been subjected to â€Å"persecution at the hands of both Church and state† leaving many non-believers and outsiders to attribute negative connotations to Vodou as a whole (117). In 1835 Vodou began to publically suffer from political ostracizing under president Jean-Pierre Boyer who passed a penal code that called for the imprisonment of six months to two years for followers of Vodou practicing superstitious act (118). It seems to me that the reason behind the ban on Vodou practices not only stemmed from political issues occurring at the time, but also from past political experiences in Haiti. Hurbon does not mention Boyer’s reasoning behind implementing a penal code, therefore allowing one to speculate whether or not Boyer, although Haitian had ties to France. The reason I bring this point to light is because for one, Jean-Pierre Boyer sounds relatively French and secondly Boyer implemented a code that put restrictions on a religion that has roots deep within African culture. In addition to dealing with the idea of possible imprisonment, if caught practicing Vodou, Haitians also faced the possibility of abandoning and giving up the African culture and belief that was associated with Vodou. In response to government restrictions some Haitians created secret societies in order to keep the bonds of Vodou ritual and ties to kinship in motion. In 1957 President Francois Duvalier also known as â€Å"Papa Doc† started a political rehabilitation for Vodou (118). Duvalier’s involvement in Vodou was for the soul purpose of engaging the Lwa through ceremonies in order to gain the Lwas’ good will and also to spark enthusiasm in those who practice Vodou. Papa Doc’s presidency marked a period characterized by dark magic and sorcery. This period in Haitian history displays the negative aspects often associated with Vodou. In my opinion President Francois Duvalier’s understanding of Vodou curtails from misinterpretation and misuse. Duvalier did not seem to grasp the reasoning behind certain Vodou rituals and ceremonies, using them only as a way to advance himself politically. During Duvalier’s reign Haiti saw tremendous political change resulting from the misunderstanding or misuse of Vodou. On one hand Jean-Pierre Boyer refused to let any one in Haiti practice Vodou because of the negative connotations surrounding the religion. On the other hand Francois Duvalier used Vodou to bolster his political appeal, which dismantled the meaning and reasoning behind the ceremonies and rituals performed by those who practiced and truly understood and appreciated the meaning that those Vodou acts carry. In Creole Religions of the Caribbean, the authors mention that within Vodou practices the chief communicators that draw â€Å"konesans† or connaissance/knowledge are the Oungand and the Manbo (Fernandez-Olmos and Paravisini-Gerbert 107). The Oungand and the Manbo are believed to receive knowledge passed down from the Lwa. The Oungand and the Manbo act as political leaders and have rural political power within their own community because the ability to communicate with the Lwa is looked up to. In Michel Laguerre’s book Voodoo and Politics the author states that Francois Duvalier used the political power of the Oungand and the Manbo to establish legitimacy among those who practiced Vodou (Laguerre 87). Today Vodou can be represented in popular culture as dark, sadistic, and involving many acts of superstition, denying it a position central to Haitian culture. However, despite the misconceptions surrounding Vodou today many religious works are carried out by Haitian elites. This goes to show yet another transformation in Haitian politics, and Vodou’s role in shaping a new system of life. From my examination of the texts that emphasized Vodou’s relationship to Haitian politics I have concluded that Vodou does in fact affect politics in Haitian communities and Haiti as a whole. The relationship between Vodou and Haitian economics is a long-standing phenomenon that has existed prior to the Haitian revolution in 1791 and continues to exist today. The slave trades influence on the creation of Vodou links the existence of the religion and also the economics involved between masters and sellers of slaves. During this time the Haitian economy was being stimulated by the slave trade. As the slaves grew weary, a number of rebellions occurred and Vodou greatly affected the plantation economy that the Haitian people originally were forced into. According to Omos and Gerbert, the economy in Haiti shifted from one of plantation to that of a â€Å"rural economy† of â€Å"subsistent farmers† working their own lands (Fernandez-Olmos and Paravisini-Gerbert 103). Vodou practices and rituals play an important role in shaping and maintaing Haitian economics. The initiation and sacrificial rituals performed by many Vodou sects involve a great amount of â€Å"financial sacrifice† (Fernandez-Olmos and Paravisini-Gerbert 117). From my examination of several texts, including that of Olmos and Gerbet I have concluded that preparation for the many Vodou festivals, initiations, and temple gatherings are intensive and call for many financial sacrifices from those who may already be financially unstable. Animal sacrifice plays an important role in the finances of Haitian people. In Voodoo Africa’s Secret Power the author, Gert Chesi, included various photographs of Haitian Vodou sacrifices and rituals. Many of the photographs throughout Chesi’s book showed the sacrificing of cattle, sheep, and chicken. The cross-examination of various texts did not leave me with much information on the Haitian economy as it related to Vodou, however, I was able to infer that the economic sacrifices made by Haitian people were performed in order to obtain personal advancements or for the betterment of the community as a whole. Some sacrifices were performed to win the protection and trust of the Lwa spirits, and some sacrifices were performed in hopes that the Lwa would shed some rain to strengthen planation production. I think that the Haitian economy and the Vodou religion are dependent on each other. The dependency I see in the relationship stems from the fact that without an economy like the one in Haiti, Vodou would not be as prominent or even meaningful to the Haitian people. The economy as it is creates a buffer for Vodou as a religion. The economy allows for Haitians to use their beliefs and connections with the spirits to envoke hope, or optimism that the plantation life in Haiti will somehow flourish. This claim can be supported through the existence of rituals performed for protection, knowledge, and even rainfall. In Hurbon’s, Olmos’ and Gebert’s, Chesi’s, Laguerre and Michel’s and Smith’s descriptions of Vodou in Haitian culture one thing is for certain, Vodou has and continues to influence communities through and through. In Chesi’s pictorial account of Vodou in Haiti one can see pictures of various ways that the religion is linked to community. In one picture, Chesi captured a ritual being performed near a beach where one individual was having a ritual performed on him (ritual not clear from picture) while dozens of his Vodou community member looked on and supported him. What puzzles me the most is how instinctual and ritualized Vodou actually is. Chesi’s pictures show dozens and dozens of Haitian people flocking to support another Vodou practice, but for what reason? Why do these members feel so indebted to one another? From my observation the answer to this question comes from the simple fact that Vodou needs a sense of community mong its members to remain relevant. It was from the simple yearning to keep tradition relevant that Vodou stemmed, so it appears to me that the idea of community or family has been long standing, even deep within Vodou’s African roots. Hurbon’s choice of words within Voodoo: Truth and Fantasy shed’s lite on the communal aspect of Vodou a little differently. Like Chesi, Hurbon acknowledges the importance of community, even stating that Vodou â€Å"bring families together in large gatherings, a festive way of ensuring that religious traditions will endure† (Hurbon 14). In Hurbon’s text it appears that the family and passing of tradition from generation to generation is in fact important to the survival of Vodou. In my examination of Hurbon’s text it seemed as though Hurbon was promoting a balance of kinship and communal ties. Hurbon states that it is important to have family agreement in order to have a positive communal bond. One aspect of Hurbon’s text was that Vodou was often referred to as â€Å"a cult dedicated to spirits. † Hurbon did not let the wording of her description interfere with the way information was conveyed, however, I found it quiet bias that she would call Vodou a cult. Personally I associate the word cult with negative connotations. It is unclear whether Hurbon planned on conveying Vodou in a negative light, but one thing is for certain a cult describes a group of people or the communal bond that Vodou encourages. In Michel’s and Smith’s book, Voodou in Haitian Life and Culture: Invisible Powers, The authors proceed to explain how the â€Å"magical† or â€Å"superstitious† aspect of Vodou conveys a sense of community among its supporters. The authors show that not only is Vodou practice a family effort, but a community effort as well. Smith and Michel both depict a type of Vodou were literally everyone in a community is involved. From small children to the eldest members of a community, all play an important role in carrying on and performing the tradition of Vodou culture. The elaborate rituals and preparation described by the authors is only made possible through communal efforts. From my understanding of the community in Vodou culture, it appears that only through community and unity can tradition be kept alive. Despite any negative connotations Vodou may have, each author showed how important Vodou is in respects to several aspects of Haitian culture. Vodou is not only a religious matter, but also a political, economic, and social one as well. On May 14, 2013 guest lecturer Carnie Fabious stated, â€Å"Vodou is a way of life. † This statement alone sums up what Vodou was, and what Vodou continues to be in regards to Haitian culture. Fabious’ words show the importance that Vodou plays in all aspects of Haitian life, and demonstrates how relative the religion is to such a vast group of people.