Equity of Access in the Australian Healthcare System

Equity of Access in the Australian Healthcare System The Concept of Equity of Access in the Australian Healthcare System The Australian health care system is founded on the concept of equity of Access. Discuss this Statement with relation to the concepts of Effectiveness and efficiency and any interrelation that may exist. Introduction: As Stated in National Health Reform Agreement-Equity of Access is the fundamental base of the Australian Health Care System (DHA. 2013a). Effectiveness, which focuses on ratio of outputs to outcomes and efficiency, which defines as achieving maximum outputs with available inputs or resources, these are other elementary component of the Australian Health Care System. Equity, effectiveness and efficiency these represents ideal health care system, which tends be effective and efficient and able to achieve the efficacy (specified outcomes) in a way that maximize access (distribution); Productivity (output) and outcomes within the resource provided (NHHRC. 2009. P.4). Responsibilities like funding, delivery regulation is shared by the national state government of Australia makes the Australian Health Care system universally accessible within the people (AIHW, 2000). Public hospitals community care funding is joined effort of common wealth (i.e. federal government), states territories where common wealth use its revenue and tax to fund most of hospital medical service health research (Common wealth Department of Health age care, 2000). Since 1990’s National State health Minister worked alongside of many health care professional to develop a certain Universal framework to assessing the Australian health system (NHPC, 2000). A new framework for measurement of Australian health performance was inspired from Canadian Health information Roadmap Initiative Indicator framework, which was commenced by NHPC (NHPC, 2001). Equity: Equity in health and health care with context of social objective can be defined in many different ways. As Amarty sen argued, when we talk equity we forget to ask on fundamental question ‘equity of what?’ (Sen, A.,1992). But for the context of our knowledge and study we base our understanding on the definition of culyer wagstaff, ‘the appropriate positive criteria for mormative judgement regarding equity in distribution of health and health care is equality of health status and health care access (Culyer, A.J., Wagstaff, A., 1993). By adding the equality in the process of equity gives the sense of clear fairness to the consumer. But equality is not equity; equality is just simply described as similarity of status, capacity and opportunity. Equity is an ethical value. A unequal opportunity of being healthy associated by people in socially less privileged groups such as poor people, different racial people to others native land, religious ethnic group, women and rural resident is reduced by equity in health ( Braverman, P. Gruskin, S., 2003). Further Braverman et.al stated that the equity in health pursued by eliminating disparities of health that are connected with certain social disadvantage or marginalized or disfranchised community and group within, but may not be limited to the poor. This definition argues for need for the health care services by individuals which is completely result of both of their medical condition and their social condition. As we know the problem of health care system is not only related to the inequity in health. According to Mathews, social, cultural and educational and more or less classical medical causes are related to the poor health of the indigenous Australian (Mathews, C., 2003). Equity of Access: Equity in health has been spoken and written frequently by many economist but they never tends to do or continue to do more consistently, clearly passionately. As Gavin Mooney stated, ‘equity means equal access to equal care for equal needs,’ (Gavin, M., 2003). Since 1960’s quest for equity in health has been major issue and concern to Australian health care system. The introduction of Medibank in 1975 and reinstatement as Medicare in 1984 was the most significant development in term of equity of access after the access of financial barrier (Scotton, R. B., Macdonald, C. R., 1993). The equity of health service and the consultation time frame for consumer of lower socio-economic status and consumer of high socio-economic status doesn’t shorten by breaking and disappearance of financial barrier (Furler, J.S., et.al 2002). The result in context of other dimension of equity is not good. Access of health care (both primary and hospital care) in term of geograp hical equity is significantly different between urban and rural area. Fewer doctors per 1000 population in rural Australia relative to urban area is the best example to describe the complex nature of geographic equity in simple. Rural communities considered access of specialist service, access to hospital service to be a problem due to traveling of significant distance to gain and access those service. Equity of Outcome: Environmental factor and the quality of health care provided equally affects the result of equity of outcomes. Major Policy attention is needed by the appalling health status of our Aboriginal Torres strait Islander population is one of the best example is equity of outcomes. By action in health sector will not remedied the factor Affecting health status, issue of dignity, identity and justice should be the strategy for the improvement of the health status of Aboriginal Torres Strait Islander. Reconciliation is one of the key elements required for progress further (Jackson, L.R., Ward, J.E., 1999). Efficiency: What is efficiency? According to Farrell efficiency is production of maximum amount of outputs from given amount of input or alternatively minimum input quantities producing a given amount of output (Farrell, M.J. 1957). It is referred as to a concrete goal oriented index indicating how well socially desirable health system is achieved desirable. Health Service efficiency is also considered to be great important dimension of quality health because service affordability is affected by it with the context of limited available resources in health care. Efficient service means providing optimal service and care to patient and community rather than maximum care to patient and community; it is about providing greatest benefit with available resource (Brown, L.D., et.al 1992). One of the key criteria for evaluating the health care system is efficiency. According to the economic point of view, efficiency divided into two key elements; allocative efficiency and technical efficiency. Allocative efficiency: To provide best outcomes health care system dependent on distribution and allocation of resources; technical efficiency, effectiveness and priority are involved in the process of best outcomes. The optimized ratio of outputs to outcomes, which is also known as effectiveness is the second key element of allocative efficiency. The priority setting in term of overall ratio of inputs to outcomes is the third and last element of allocative efficiency. Technical efficiency: Flexibility and adaptability to change and innovation of health care system as a whole and as its constituent elements, is known as technical efficiency. Development of casemix measure for hospital services by palmer was a unique contribution both nationally and internationally (Palmer, G.R., et al, 1986; Palmer, G.R., 1991). Over last decades significant improvement in allocative efficiency was achieved after introduction of casemix funding in Victoria in 1993 (Duckett, S.J., 1995). There have been constantly adaptations of new technologies (like drugs, surgical instrument, surgical technique and diagnostic instrument technique) since the development of Australian Health Care system. Over the decades of increase in publication and citation, Australia has been able to build up strong and dynamic medical research system (Butler, L., 2001). Comprise of allocative efficiency technical efficiency gives ‘overall efficiency’, firm can operate on cost or revenue frontier if i t’s able to achieve overall efficiency. Effectiveness: It acts as a key dimension for achieving desirable outcomes with correct provision of evidence based health care service to all who couldn’t benefit, but not to those who would not benefit (Aran, O.A., et.al 2003; WHO, 2000). Donabedian argued then effectiveness is the extent to which attainable improvements in health are in fact attained (Donabedian, A., 2002; Donabedian, A., 1982). In same way Juran Godfrey argued effectiveness to be the degree to the process which result in desired outcomes without any error (Juran, J. Godfrey, A.B., 1999). The ratio of output to outcome is optimized by effectiveness. Out of number of elements, ‘efficacy’ act as one of key component to the certain extent of which health care sector output leads to the ideal outcomes under best ideal condition (Cochrane, A.L., 1972). The major objective is to ensure the actual effectiveness (in term of ratio of outputs to actual outcomes) which helps to move closer to objective. Effectiveness is the dimension of Australian Health Care which explicitly includes time element, so we can evaluate whether the health intervention are primarily achieve the desired and appropriate outcome within the time frame. The interventions are the care must be provided to people most needed is advocated and supported by effectiveness framework. Early detection and prevention performance within a population area is the indicators for the effectiveness. Effectiveness conceptualize framework of health care system as dimension of performance where â€Å"care/intervention/action† achieves the desired result in an appropriate time frame (NHPC, 2001). Norms and specification at central level defines effectiveness to be an important dimension of quality. Effectiveness issue should be handle in local level too, where manager implement norms and work on how to adapt them to local condition. Actual outcomes (effectiveness) for an intervention or system is affected by numerous factor like the care system design, surrounding environment of discharge patient, safety of device manufactured pharmaceuticals used and care quality. Proof of evidence of significant level of preventable adverse events occurring in hospital leading to drastic outcomes can be provided by the quality in Australian health care study (Wilson, R.M.et al., 1995). As stated by McDermott, it is suggested that large number of death related to trauma can be preventable or potentially are preventable, which is has be documented after analysis of care following trauma (McDermott, F.T.et al., 1996). These study shows that there are important effectiveness issues in Australian healthcare system with respect to quality of care and it can be described as inability to provide high-quality care. Interaction between equity, efficiency and effectiveness: The concept of equity, effectiveness and efficiency in term of health input and its outcomes are internationally tackle by WHO and OECD (Organization for Economic Co-operation and Development) to reflect an economic way of thinking. Due to growing concern about safety, service delivery and quality of patient care there have been interesting trends of implicit and explicit link between the concept of equity, efficiency and effectiveness, which is understandable (Berwick, D.M., 1998). As we know second element of allocative efficiency is optimized ration of outputs to outcomes which is also known as effectiveness. Which shows that efficiency and effectiveness are linked and interacted? After the implementation of equity, sick individuals who seek help have their need meet. The value of treatment provided by health service organization is equally distributed to the people in need. With the equity you are not judge or treated and cared on the basis of your fame, fortune, you ability to p ay. When the resource is equally distributes between the need of people then equity taken an affect and when there is the equity then we can evaluate the efficiency and effectiveness of the health care service of that organization or of any country. Conclusion: Health policy where attributes and value plays prominent role, ideological driven problem related to it are inevitable as part of the policy. Perception of problem is affected by attributes and value which plays significant role in policy academics so as to attempt to shape public debate for making rational and reality based perception. There are many problem identified in the context of equity of access in the Australian healthcare system based on efficiency and effectiveness by many writers like Palmer, Wilson, McDermott, Jackson wards, Farrell and many more; even the solution to that problem have been presented by them but we haven’t yet identify the problem and adopted the solution presented by them. But important aspect is that progress are being made and hopefully health care system will experience continuous improvement in near future. References : Australian Institute of Health and Welfare (2000). Australia’s Health 2000. Canberra Australian Institute of Health and Welfare (2008). Australia’s Health 2008, Canberra Arah, O. A., Klazinga, N. S., Delnoij, D. M. J., Ten Asbroek, A. H. A., Custers, T. (2003). Conceptual frameworks for health systems performance: a quest for effectiveness, quality, and improvement.International Journal for Quality in Health Care,15(5), 377-398. Berwick, D. M. (1998). Developing and testing changes in delivery of care.Annals of Internal Medicine,128(8), 651-656. Braveman, P., Gruskin, S. (2003). Poverty, equity, human rights and health. Bulletin of the World Health organization,81(7), 539-545 Brown, L. D., Franco, L. M., Rafeh, N., Hatzell, T. (1992).Quality assurance of health care in developing countries. Quality assurance project. Butler, L. (2001).Monitoring Australias Scientific Research: Partial indicators of Australias research performance. Australian Academy of Science. Canberra Cochrane, A. L. (1972). Effectiveness and Efficiency (Rock Carling Fellowship, 1971).Nuffield Provincial Hospitals Trust. Commonwealth Department of Health and Aged Care, (2000). Australian Health Care Agreements Annual Performance Reports 1998–1999. Canberra: Common Wealth of Australia. Culyer, A. J., Wagstaff, A. (1993). Equity and equality in health and health care.Journal of health economics,12(4), 431-457. Department of Health (DHA) (2013). National Health Reform Agreement. Donabedian, A. (1982). Explorations in quality assessment and monitoring. Vol. 2. The criteria and standards of quality.Ann Arbor, MI: Health Administration Press. Donabedian, A. (2002).An introduction to quality assurance in health care. Oxford University Press. Duckett, S. J. (1995). Hospital payment arrangements to encourage efficiency: the case of Victoria, Australia.Health Policy,34(2), 113-134. Farrell, M. J. (1957). The measurement of productive efficiency.Journal of the Royal Statistical Society. Series A (General), 253-290. Furler, J. S., Harris, E., Chondros, P., Davies, P. P., Harris, M. F., Young, D. Y. (2002). The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times.Medical Journal of Australia,177(2), 80-83. Jackson, L. R., Ward, J. E. (1999). Aboriginal health: why is reconciliation necessary?.The Medical Journal of Australia,170(9), 437-440. Juran, J., Godfrey, A. B. (1999). Quality Handbook.Republished McGraw-Hill. Matthews, C. (2003). Caught in a vicious cycle.Australian Medicine,15(12),16. McDermott, F. T., Cordner, S. M., Tremayne, A. B. (1996). Evaluation of the medical management and preventability of death in 137 road traffic fatalities in Victoria, Australia: an overview.Journal of Trauma-Injury, Infection, and Critical Care,40(4), 520-535. Mooney, G. H. (2003).Economics, medicine and health care. 3rd ed. London: Pearson Education. National Health and Hospitals Reform Commission. (2009). A healthier future for all Australians: Final report of the national health and hospitals reform commission. National Health Performance Committee (NHPC) (2000). Fourth National Report on Health Sector Performance Indicators – A Report to the Australian Health Ministers’ Conference. Sydney: New South Wales Health Department National Health Performance Committee (NHPC) (2001). National Health Performance FrameWork Report. Brisbane: Queensland Health. Palmer, G. R., Aisbett, C., Reid, B., Jayawardena, Y. (1986). The validity of Diagnosis Related Groups for use in Victorian public hospitals: report to the Department of Health, and of Management and the Budget.Victoria, Kensington, University of New South Wales. Palmer, G. R. (1991). The use of DRGs in the management and planning of hospital services.Australian Economic Review,24(1), 62-70. Scotton, R. B., Macdonald, C. R. (1993).The making of Medibank(No. 76). School of Health Services Management, University of New South Wales. Sen, A. (1992).Inequality reexamined. Oxford University Press. Wilson, R. M., Runciman, W. B., Gibberd, R. W., Harrison, B. T., Newby, L., Hamilton, J. D. (1995). The quality in Australian health care study.Medical Journal of Australia,163(9), 458-471. World Health Organization. (2000).The world health report 2000: health systems: improving performance. World Health Organization.

Passiflora :: Botany

Passiflora The species of the genus Passiflora sp. are perennial, shallow rooted, woody vines that climb by means of tendrils (2). Many species are native to South America, primarily southern Brazil through Paraguay to northern Argentina; whereas others are of Old World origin. The Passionfruit, as this genus is commonly called, is not named as one might suppose, for some type of aphrodisiac property. Rather, the plants were given this name by early missionaries in South America on the basis that the flower resembles the different elements of Christ's crucifixion: the crown of thorns (corona); the five wounds (the five anthers); the nails of the cross (divisions of the pistil); the whips and cords (the tendril on the vine); and the spear (leaf). (2) Passionfruit yields fruit that is both sweet and tart in flavor with a light tropical fragrance. (1) It has been a popular food of the people in the Rainforests for many years, and has recently become popular in the United States and other developed countries where it is not native (4). Although there are in excess of 300 species of Passiflora, many of which produce edible fruit, there are only two species that are cultivated for industry-- P. edulis Sims and P. quadrangularis L. P. edulis has two recognized forms. The normal form is f. edulis, better known as the purple passionfruit. The purple passionfruit is slightly egg shaped, ranging in size from 1 1/2 to 2 1/2 inches in diameter that displays a characteristic purple shade when ripe (2). The yellow passionfruit displays a deep yellow shade when ripe and has an unknown origin. Speculations are that it may have been a mutation from the purple passionfruit or perhaps a hybrid between P. edulis and P. ligularis. There is a described variety of P. edulis in Australia that has a natural range of either purple or yellow fruits, leaving the chance that the yellow variety may have been a mutation from a variety such as that found in Australia (3). Common properties of the Passiflora sp. are an ovoid to nearly round shape. The rind is a tough waxy structure ranging from 1/8 to 1/4 of an inch thick. Inside the rind is a cavity with double-walled sacs, containing an orange-colored, pulpy juice as well as up to 250 very small dark brown to black edible seeds. Common growing environments include light to heavy sandy loams of medium texture at a pH of 6.

Essay --

CHAPTER NO 5 Adjustments & maintenance 5.1 Capillary Tube 5.2 Priming 5.3 Pressure Gauge Fitting 5.4 Relief Valve 5.5 Pressure Adjustment 5.6 PD Pump System Flow Diagram 5.7 External Relief Valve Adjustment 5.8 Internal Relief Valve Adjustment 5.9 Motor Lubrication 5.1 Capillary Tube:- A capillary tube is a narrow, long tube of constant diameter. In refrigeration application of capillary tube, the surface tension is not important. Tube length limit from 1.0 m to 6 m and the diameters of refrigerant capillary tubes limit from 0.5 mm to 3 mm. Due to the following two factors the pressure reduction in a capillary tube occurs: The frictional resistance offered by tube walls refrigerant has to overcome. Than that of the liquid the density of vapor is less. As it flows in the tube the average density of refrigerant decreases. The increase in acceleration or velocity of the refrigerant requires pressure drop. 5.2 Priming:- Liquid pumps can lose prime and to get the pump started this will require the pump to be primed by adding liquid to the pump and inlet pipes. Loss of "prime" ...

Jewish American Literature Essay

Jewish American Literature holds an essential place in the literary history of the United States. It encompasses traditions of writing in English, primarily, as well as in other languages, the most important of which has been Yiddish. While critics and authors generally acknowledge the notion of a distinctive corpus and practice of writing about Jewishness in America, many writers resist being pigeonholed as ‘Jewish voices’. Also, many nominally Jewish writers cannot be considered representative of Jewish American literature, one example being Isaac Asimov. Beginning with the memoirs and petitions composed by the Sephardic immigrants who arrived in America during the mid 17th century, Jewish American writing grew over the subsequent centuries to flourish in other genres as well, including fiction, poetry, and drama. The first notable voice in Jewish- American literature was Emma Lazarus whose poem ‘The New Colossus’ on the Statue of Liberty became the great hymnal of American immigration. Gertrude Stein became one of the most influential prose-stylists of the early 20th century. The early twentieth century saw the appearance of two pioneering American Jewish novels: Abraham Cahan’s ‘The Rise of David Levinsky’ and Henry Roth’s ‘Call it Sleep’. It reached some of its most mature expression in the 20th century ‘Jewish American novels’ by Saul Bellow, J. D. Salinger, Norman Mailer, Bernard Malamud, Chaim Potok, and Philip Roth. Their work explored the conflicting pulls between secular society and Jewish tradition which were acutely felt by the immigrants who passed through Ellis Island and by their children and grandchildren. More recent authors like Nicole Krauss, Paul Auster, Michael Chabon, Jonathan Safran Foer andArt Spiegelman have continued to examine dilemmas of identity in their work, turning their attention especially to the Holocaust and the trends of both ongoing assimilation and cultural rediscovery exhibited by younger generations of American Jews. Arguably the most influential of all American- Jewish novels was Leon Uris’ ‘Exodus’. Its story of the struggle to create the modern state of Israel translated into Russian became the inspiration for hundreds of thousands of Russian immigrants to Israel. Modern Jewish American novels often contain (a few or many) Jewish characters and address issues and themes of importance to Jewish American society such as assimilation, Zionism/Israel, and Anti-Semitism, along with the recent phenomenon known as â€Å"New Anti-Semitism. † Two Jewish- American writers have won the Nobel Prize, Isaac Bashevis Singer and Saul Bellow. Bernard Malamud is considered one of the most prominent figures in Jewish –American literature. BERNARD MALAMUD ( 1914-1986). Malamud’s stories and novels, in which reality and fantasy are frequently interfaced have been compared to parables, myths and analogies and often illustrate the importance of moral obligation. Although he draws upon his Jewish heritage to address the themes of sins, suffering, and redemption, Malamud emphasizes human contact and compassion over orthodox religious dogma. Malamud’s characters, while often awkward and isolated from society, evoke both pity and humor through their attempts at survival and salvation. Sheldon J. Hershinow observed: â€Å"Out of the everyday defeats and indignities of ordinary people, Malamud creates beautiful parables that capture the joy as well as the pain of life; he expresses the dignity of the human spirit searching for freedom and moral growth in the face for hardship, injustice, and the existential anguish of life. BIOGRAPHY Malamud was born on April 28, 1914, in Brooklyn, New York, to Russian Jewish immigrants. His parents, whom he described as â€Å"gentle, honest, kindly people,† were not highly educated and knew very little about literature of the arts: â€Å"There were no books in the house, no records, music, pictures on the wall. † Malamud attended high school in Brooklyn and received his bachelor’s degree from the City College of New York in 1936. After graduation, he worked in a factory and as a clerk at the central bureau in Washington, D. C. Although he wrote in his spare time, Malamud did not begin writing seriously until the advent of the Second World War and the subsequent horrors of the Holocausts. He questioned his religious identity and started reading about Jewish tradition and history . He explained: â€Å"I was concerned with what Jews stood for, with their getting down to the bare  bones of things. I was concerned with their ethnically –how Jews felt for they had to live order to go on living. † In 1949, he began teaching at Oregan State University; he left this post in 1961 to teach creative writing at Bennington College in Vermont. He remained there until shortly before his death in 1986. Starting in 1949, Malamud taught four sections of freshman composition each semester at Oregon State University (OSU), an experience fictionalized in his 1961 novel ‘A New Life’. Because he lacked the Ph. D., he was not allowed to teach literature courses, and for a number of years his rank was that of instructor. In those days, OSU, a land grant university, placed little emphasis on the teaching of humanities or the writing of fiction. While at OSU, he devoted 3 days out of every week to his writing, and gradually emerged as a major American author. In 1961, he left OSU to teach creative writing at Bennington College, a position he held until retirement. In 1967, he was made a member of the American Academy of Arts and Sciences. In 1942, Malamud met Ann De Chiara (November 1, 1917 – March 20, 2007), an Italian-American Roman Catholic, and a 1939 Cornell University graduate. They married on November 6, 1945, despite the opposition of their respective parents. Ann typed his manuscripts and reviewed his writing. Ann and Bernard had two children, Paul (b. 1947) and Janna (b. 1952). Janna Malamud Smith is the author of a memoir about her father, titled My Father is a Book. Malamud died in Manhattan in 1986, at the age of 71. WORKS OF MALAMUD Malamud’s first novel, ‘The Natural’ (1952 ) ,is considered one of his most symbolic works . While the novel ostensibly traces the life of Roy Hobbs, an American baseball player , the work has underlying mythic elements and explores such themes as initiation and isolation. For instance, some reviewers cited evidence of the Arthurian legend of the Holy Grail; others applied T. S. Eliot’s ‘wasteland’ myth in their analyses ‘The Natural’ also foreshadows what would become Malamud’s predominant narrative focus: a suffering protagonist struggling to reconcile moral dilemmas, to act according to what is right, and to accept the complexities and hardships of existence. Malamud‘s second novel, ‘The Assistant’ (1957), portrays the life of Morris Bober, a Jewish immigrant who owns a grocery store in Brooklyn. Although he is struggling to survive financially, Bober hires a cynical anti-semitic youth, Frank Aloine after learning that the man is homeless and on the verge of starvation. Through this contact Frank learns to find grace and dignity in his own identity. Described as naturalistic fable, this novel affirms the redemptive value of maintaining faith in the goodness of the human soul. Malamud’s first collection of short stories, ‘The Magic Barrel’, (1958) was awarded the National Book award in 1959. Like ‘The Assistant’, most of the stories in this collection depict the search for hope and meaning within the grim entrapment of poor urban settings and were influenced by Yiddish folktales and Hasidic traditions. Many of Malamud’s best known short stories, including ‘The Last Mohican’, ‘Angel Levine’, and ‘Idiots First’, were republished in ‘The Stories of Bernard Malamud’ in 1983. ‘A New Life’ (1961), considered one of Malamud’s most true-to-life novels, is based in part on Malamud’s teaching career at Oregon State University. This work focuses on an ex-alcoholic Jew from New York City who becomes a professor at a college in the Pacific Northwest. It examines the main character’s search for self-respect, while poking fun at life at a learning institution. Malamud’s next novel, ‘The Fixer’ (1966), is one of his most powerful works. The winner of both the Pulitzer Prize and the National Book Award, this book is based on the historical account of Mendel Beiliss, a Russian Jew who was accused of murdering a Christian child. With ‘The Tenants’ (1971), Malamud returns to a New York City setting in a contrast between two writers—one Jewish and the other African American—struggling to survive in an urban ghetto. Malamud further addresses the nature of literature and the role of the artist in ‘Dublin’s Lives’ (1979). In this work, the protagonist, William Dublin, attempts to create a sense of worth for himself, both as a man and as a writer. Malamud’s last finished novel, ‘God’s Grace’ (1982), studies both the original Holocaust and a new, imagined Holocaust of the future. The novel is a wild, at times brilliant, at times confusing, description of a flood similar to that in the Bible story of Noah’s ark. Malamud continued to place stories in top American magazines. Mervyn Rothstein reported in the New York Times that Malamud said at the end of his life, â€Å"With me, its story, story, story. † In Malamud’s next-to-last collection, ‘Rembrandt’s Hat’, only one story, ‘The Silver Crown’, deals with Jewish themes. Malamud is also renowned for his short stories, often oblique allegories set in a dreamlike urban ghetto of immigrant Jews. Of Malamud the short story writer, Flannery O’Connor wrote: â€Å"I have discovered a short-story writer who is better than any of them, including myself. † He published his first stories in 1943, ‘Benefit Performance’ in Threshold and ‘The Place Is Different Now’ in American Preface. In the early 1950s, his stories began appearing in Harper’s Bazaar, Partisan Review, and Commentary. ‘The Magic Barrel’ was his first published collection of short stories (1958) and his first winner of his first National Book Award for Fiction. Most of the stories depict the search for hope and meaning within the bleak enclosures of poor urban settings. The title story focuses on the unlikely relationship of Leo Finkle, an unmarried rabbinical student, and Pinye Salzman, a colorful marriage broker. Finkle has spent most of life with his nose buried in books and therefore isn’t well-educated in life itself. However, Finkle has a greater interest – the art of romance. He engages the services of Salzman, who shows Finkle a number of potential brides from his â€Å"magic barrel† but with each picture Finkle grows more uninterested. After Salzman convinces him to meet Lily Hirschorn, Finkle realizes his life is truly empty and lacking the passion to love God or humanity. When Finkle discovers a picture of Salzman’s daughter and sees her suffering, he sets out on a new mission to save her. Other well-known stories included in the collection are: ‘The Last Mohican’, ‘Angel Levine’, ‘Idiots First’, and ‘The Mourners’. This last story focuses on Kessler, the defiant old man in need of â€Å"social security† and Gruber, the belligerent landlord who doesn’t want Kessler in the tenement anymore. Malamud’s fiction touches lightly upon mythic elements and explores themes like isolation, class, and the conflict between bourgeois and artistic values. His prose, like his settings, is an artful pastiche of Yiddish-English locutions, punctuated by sudden lyricism. Writing in the second half of the twentieth century, Malamud was well aware of the social problems of his day: rootlessness, infidelity, abuse, divorce, and more. But he also depicted love as redemptive and sacrifice as uplifting. In his writings, success often depends on cooperation between antagonists. For example, in The Mourners landlord and tenant learn from each other’s anguish. In ‘The Magic Barrel’, the matchmaker worries about his â€Å"fallen† daughter, while the daughter and the rabbinic student are drawn together by their need for love and salvation. Malamud’s third story ‘Rembrandt’s Hat’ collection is noteworthy for its consistently pessimistic tone and theme of failed communication in stories such as ‘My Son the Murderer’, ‘The Silver Crown’, and ‘The Letter’. ‘The volume The People’, and ‘Uncollected Stories’ contains an unfinished novel about a Russian Jewish peddler in the American West who becomes a marshal and is kidnapped by Indians. It also includes fourteen stories written between 1943 and 1985. LIST OF OTHER NOTABLE JEWISH AMERICAN WRITERS †¢ Aimee Bender — novelist and short story writer, known for her often fantastic and surreal plots and characters †¢ Saul Bellow, novelist that won the Pulitzer Prize, the Nobel Prize for Literature, and the National Medal of Arts †¢ Bernard Cooper, novelist, short story writer †¢ E. L. Doctorow, novelist †¢ Richard Ellmann, literary critic, won National Book Award for Nonfiction †¢ Barthold Fles, literary agent and non-fiction writer †¢ Emma Goldman, anarchist writer †¢ Joseph Heller, author of Catch-22 †¢ Christopher Hitchens, literary critic and political activist †¢ Irving Howe, literary critic †¢ Roger Kahn. â€Å"The Boys of Summer† 1972 †¢ Jerzy Kosinski, author of The Painted Bird †¢ Emma Lazarus, poet and novelist †¢ Fran Lebowitz, author, known for her sardonic social commentary on American life through her New York sensibilities †¢ Seymour Martin Lipset, political sociologist. †¢ Reggie Nadelson, novelist known particularly for her mystery works †¢ Mark Obama Ndesandjo, author, half-brother of President Barack Obama †¢ Cynthia Ozick, short story writer, novelist, and essayist †¢ Jodi Picoult, novelist †¢ Ayn Rand, novelist and founder of Objectivism †¢ Lea Bayers Rapp, non-fiction and children’s fiction writer †¢ Philip Roth, known for autobiographical fiction that explored Jewish and American identity. †¢ Norman Rosten, novelist †¢ J. D. Salinger, author of The Catcher in the Rye †¢ Gary Shteyngart (born 1972) Russian-born writer †¢ Isaac Bashevis Singer, leading figure in Yiddish literature, won Nobel Prize †¢ George Steiner (born 1929) literary critic †¢ Daniel Stern, novelist] †¢ Leopold Tyrmand, writer †¢ Judith Viorst (born 1932) author, known for her children’s literature †¢ Elie Wiesel, Holocaust survivor and author of 57 books CONCLUSION The situation and the position of the Jewish-American writer have always been different from that of the other ethnicities in America and still remain so until today. One difference is highlighted by a comparison with the African-American writers. The â€Å"marginal† position of black authors has disappeared on the book market in the United States, but the themes of alienation and anger will not vanish as readily from their works. Instead of integration into the Literary and artistic mainstream, black writers and artists wanted, especially since the Black Arts Movement of the 1960s, to arrive at their â€Å"own† forms of literary expression which would have direct relevance for their lives. They wished to answer the question of their relationship to white mainstream culture by implementing a multicultural strategy: their literature is not that of assimilation, but in many ways that of establishing difference, separatism, and cultural resistance. While with the African-American writers there is no sense of the success or even desirability of social and cultural integration into the predominantly white mainstream of American society, many Jewish-American authors felt it as necessary and desirable, and as a result even managed to acquire it. Indeed, a great number of contemporary Jewish-American writers such as Norman Mailer, Saul Bellow, Joseph Heller, Bernard Malamud, Arthur Miller, Philip Roth and others have had literary success. The language employed by these writers is standard American English, they are socially accepted, and their works are read by a wide Jewish and non-Jewish audience. For this reason it is widely considered that their texts form part of a recognized literary canon, and belong to the American literary â€Å"center† or â€Å"mainstream,† as far as this may still be defined today. As much as we agreed to this idea we cannot ignore several facts which underline the necessity to view Jewish American literary productions as shaped by strong ethnic forces, and Jewish American literature as both belonging to and standing out in the multicultural American landscape. BIBLOGRAPHY Books Sanford, Sternlicht Masterpieces of Jewish American Literature Cristina, Nilsson Jewish American Literature: Bernard Malamud, Philip Roth and Cynthia Ozick Websites http://en. wikipedia. org http://www. swiftpapers. com http:// Top of Form.

Dividend Growth Model Essay

1. Dividend Growth ModelThe basic assumption in the Dividend Growth Model is that the dividend is expected to grow at a constant rate. That this growth rate will not change for the duration of the evaluated period. As a result, this may skew the resultant for companies that are experiencing rapid growth. The Dividend Growth Model is better suited for those stable companies that fit the model. Those that are growing quickly or that don’t pay dividends do not fit the assumption parameters, and thus this model cannot be used. In this model, a company may not exceed the market growth rate. In addition, since the dividend growth rate is expected to remain constant indefinitely, the other measures of performance within the company are also expected to maintain the same growth rate. If in the current state, the dividend rate is greater that earnings, in time this model will show a dividend payout greater than the earnings of the company. Conversely, if earnings are growing faster than dividends, the payout rate will converge towards zero. In summary, the Dividend Growth Model works well for those companies growing at a rate equal to or lower than that of the economy and have an established and stable dividend payout. In order to estimate the cost of equity using the Dividend Growth Model, we simply adjust the model’s equation for estimating the price of a stock, given as such:P = D1 / (r – g)Where P = the price of the stockD1 = the expected Dividend in one yearr = the required rate of returng = the expected Growth ConstantBy solving the equation for k we get the following:P(r – g) = D1r – g = D1 / Pr = (D1 / P) + gTherefore in order to estimate the cost of equity through the Dividend Growth Model, we simply add the constant growth rate and the projected dividend yield in one year. 2. Capital Asset Pricing ModelThe assumptions used in the Capital Asset Pricing Model (CAPM) are similar in that they assume an almost â€Å"perfect world† scenario. Initially, CAPM assumes that all investors have the same rational expectations of returns, and that these returns are in line with the best prediction for future returns as based on the available information. It also makes the assumption that the dividends are paid normally, that assets are fixed, and that the market is efficient and in equilibrium with no inflation or change in the interest rate. CAPM additionally makes the important assumption that the evaluated stock is properly priced and that the risk level has been properly assessed. Another major assumption is that there are no taxes, transaction fees, or arbitrage opportunities during the evaluation period. This is a huge assumption which is generally incorrect. Almost all transactions within the market have some sort of tax or fee associated with it. Within CAPM, the required rate of return is found in the following equation:r = rf + B (rm – rf)Where r = the required rate of returnrf = the risk free rateB = the stock’s Beta valuerm = The Market returnIn essence CAPM evaluates a stock based on its risk and potential return compared to a risk-free market portfolio. 3. CAPM and the Modern Portfolio TheoryModern Portfolio Theory is an attempt to balance the risks and rewards of investment portfolios through the use of diversification to lower the risk of the entire portfolio while maintaining high returns. The use of Beta is a key concept in Modern Portfolio Theory. It uses CAPM as its basis to select investments within a portfolio; seeking to mix stocks with both positive and negative Betas to construct a portfolio with a minimal Beta for the group of stocks as a whole. Theoretically, the returns from stocks with both positive and negative betas do not cancel each other out, but rather the portfolio is constructed that the returns are independent of the other stocks held, yet complimentary in accumulation of returns. 4. Estimation of Untraded Stocks. The general standard for estimating the cost of equity of a non-traded  company is through the Market Approach. The basis of this approach is that the stocks of publicly traded companies, engaged in the same of comparable business, are a valid indicator of performance for a non-traded company. Under the Market Approach, there are two commonly used valuation methods; the Guideline Public Company method, and the Merger and Acquisition Method. The Guideline Public Company method consists of finding a comparable company and applying that companies financial data to the non-traded company. A company chosen to provide a reasonable basis for comparison should ideally be in the same industry as the non-traded company. However, if there are no companies with sufficient data available, as company in a similar industry may be selected. A similar industry should be one that had identical investment characteristics such as markets, growth, and product lines. The difficulty in using this method lies in identifying a public company that is sufficiently comparable. According to the American Institute of Certified Public Accountants Statement onStandards for Valuation Services, the following should be considered when using guideline companies:†A. Price information of the guideline company must be related to the appropriate underlying financial data of the company evaluatedB. The valuation ratios for the guideline company and the comparative analysis of qualitative and quantitative factors should be used together to determine appropriate valuation ratios to be applied to the subject company. C. Several valuation ratios may be selected for application to the subject company, and several value indications may be obtained. The appraiser should consider the relative importance accorded to each of the value indications used in arriving at the opinion or conclusion of value. D. To the extent that adjustments for dissimilarities with respect to minority and control, or marketability, have not been made earlier, appropriate adjustments for these factors must be made, if applicable.†The key to obtaining the most accurate results when using the Guideline Company  Method is to use the most comparable company as the guideline company. The closer to the evaluated company in all areas, the more accurate the result. The merger and acquisition method evaluates a company based on actual merger and acquisition transactions that involve entire companies or controlling interests in companies. This method may include companies that were either public or private prior to the control transaction. When using this method, all of the underlying information relating to a particular merger or acquisition may not be known. The motives of the buyer or seller may cause the transaction amounts to be skewed; this will be transparent to the evaluator and can cause an inaccurate evaluation. By using either of the Market Approach methods, it is still a â€Å"best guess† based on the best available information. The more accurate and comparable the comparison study is, the better the resulting evaluation. REFERENCES 1. Booth, Laurence. Time to Pass the Old Maid? http://www.investmentreview.com/archives/1999/spring/oldmaid.html2. Damodaran, Aswath. Dividend Discount Models. New York University, Leonard N. Stern School of Businesshttp://pages.stern.nyu.edu/~adamodar/pdfiles/valn2ed/ch13.pdf3. Citizendium.org. Cost of equity. http://en.citizendium.org/wiki/Cost_of_equity4. Ivkovic, Inya. CAPM – Where Market Theories Converge and Clash. suite101.com. Sep 29, 2007http://investment.suite101.com/article.cfm/capm_assumptions_and_limitations5. Investopedia.com. Financial Concepts: Capital Asset Pricing Model. August 2007http://www.investopedia.com/university/concepts/concepts8.asp6. Wallener, Damir. What is Modern Portfolio Theory?http://www.investopedia.com/university/concepts/concepts8.asp7. The American Institute of Certified Public Accountants (AICPA). Statement on Standards for Valuation Services. http://bvfls.aicpa.org/NR/rdonlyres/672E1DD4-2304-47CA-8F34-8C5AA64CB008/0/SSVS_Full_Version.pdf8. Wise, Richard M. Caveats in Using Guideline Company Transactional Data in Valuing a Business. Quarterly Journal of the Business Valuation Committee of the American Society of Appraisers. Vol. 22, No. 1, March 2003http://www.wbbusval.com/english/pdf/BVR4-Caveats-Guideline-Cos-March03.pdf9. Pratt, Shannon P. Business Valuation Body of Knowledge Workbook, 2nd Edition. ISBN: 978-0-471-27066-9. Paperback. 192 pages. January 2003

Health Care System Evolution

This paper is an overview about the evolution of the US health care system from the Great Depression to the current Health Reform Bill. I will give an understanding to Medicare and Medicaid program, which also will include a history of these two programs. Even though these two programs are a very complex in helping many poor, elderly, people with certain disabilities, and as well as low income pregnant women they are getting the care that they need as well as what they deserve. Health Care System Evolution, Medicare/Medicaid. Without the introduction of Medicare/Medicaid in July 1965 there would be many problems in the United States today. We would probably have disease outbreaks, and a large population without any health cost coverage. I believe that many people would not go to see a doctor because the cost of private medical care would be too expensive. I also believe that if Medicare and Medicaid did not come into existence that there would be mast amount of death in this country. Between the Great Depression through July 1965 health care had numerous debates in this country. In the 1930s a third-party payer health insurance was introduced including Blue Cross and Blue Shield and others to cover the cost of care in the event of illness or accidents. This only helped the people who could afford private insurance. The United States still was in need of helping the poor and uninsured. In the 1930s the Social Security Act supported public health care for just mothers and children. There was still a great demand to help all other uninsured people. After World War II the government supported and idea for public financed health insurance. In 1959 the Department of Health and Human Services helped in providing hospital insurance to Social Security beneficiaries. In the early 1960s Congress passed the Kerr-Mills bill, which helped the elderly that weren’t the poorest but who still needed assistance with medical expenses. President John F. Kennedy helped in the start of the 1965 bill for Medicare and Medicaid. This bill was known as the King-Anderson bill. This amended the Social Security Act and this covered hospital and nursing home costs for people over the age of 65. In July 1965, President Lyndon B. Johnson signed the Social Security Amendment into law. With that signing of this law came the introduction of Medicare and Medicaid. Today Medicare/Medicaid has helped millions of elderly, low-income people, people with certain disabilities, and low-income pregnant women have health care because of this law. This program helps pay for services such as hospitals, physician visits, and preventive benefits. Medicaid and Medicare are two of the most enduring social programs in the US, providing different services to different groups of people. †1 Medicaid is a state administrated program, so each state varies in there program. Medicaid is also based on their income. Unfortunately, if their income is too high they will not be eligible for Medicaid. In 1990 the Omnibus Budget Reconciliation Act that requires state Medicaid care program s to cover the premiums for children ages six to eighteen whose family’s income is between 100-120% the federal poverty level. In 1997 the Children’s Health Insurance Program (CHIP) was introduced. This program helps states to receive federal money for uninsured children whose families are not eligible for Medicaid due to their income exceeds the limit for Medicaid. In 1976 formed the Health Care Financing Administration which is a division of the Department of Health and Human Services, then in 2001 the name was changed to Center for Medicare and Medicaid Services (CMS). Medicare is a social insurance program that provides health coverage to individuals, without regard to their income or health status. †3 Medicare provides health insurance to people over the age of 65, people with certain types of disabilities and people of all ages with kidney failure. The Medicare program is funded two ways, one by people that paid into most of their working lives by payroll tax revenues, and secondly premiums paid by beneficiaries of the Medicare program. â€Å"Medicare has been one of the fastest growing federal programs. 2 Medicare is broken down to four parts, Part A is the hospital insurance and with this part of insurance all persons aged 65 and older are automatically entitled to this benefit. Part A is broken down to inpatient hospital care, skilled nursing facility care, home health agency and hospice care. Part B is a supplementary medical insurance, which is available to people over the age of 65, which people must paid for through monthly premiums. Part C is the Medicare Advantage that is a set of options for health care under a managed care plan. Then in 2006 Medicare put into law a plan for prescription drugs which is Part D. With these two programs in the United States today helps the poor, elderly, people with certain disabilities get the care that they need and deserve. Today with unemployment at all time high and many baby boomers that will be in need of some type of health insurance; the inception of a new health plan became law. In the year 2010, President Obama signed into law the Health Reform Bill. This will give health insurance to all people. This reform will strengthen Medicare benefits by providing lower prescription drug costs and this will also give a chance to the people who didn’t qualify for Medicaid received the care they need. The reform law will help with Medicare/Medicaid fraud as well as stopping the abuse of Medicare/Medicaid to save taxpayers money. Medicare and Medicaid have come a long way from the Great Depression. I know that there are many abuses within the system and with this new reform bill I do hope that this system will change, because everyone deserves that right health care and to be a healthy person.

Promoting the Integration of Therapeutic Touch in Nursing Practice Essay

1. Describe the patient group in the study. English speaking adults with Dx of cancer expected to be on the unit the day following the intervention, whose medical conditions did not preclude their ability to comfortably receive TT or participate in the interview, and were able to give informed consent; 34 patient-participants completed the research process (16 women and 18 men), age range of 22 to 77 with an average age of 52 years 2. What was their health problem? Bone marrow transplant Patients. The focus of the study? Explore the experiences of nurses and patients on an inpatient oncology and bone marrow transplant unit when nurses had time preserved for exclusive offering of TT. 3. Who was providing the care? Two staff nurse-interventionists who were experienced and participated in TT education, and three nurse-interviewers who discussed the TT intervention with patient-participants the day following TT treatment. 4. What was the setting for the care? The study was conducted in an academic medical center on a 26 bed hematology/oncology in patient unit with bone marrow transplantation program. 5. What were the findings? 1) TT is a vehicle for comfort, caring, and presence that creates possibility and healing 2) TT invites a shift from disease-state focus to personhood focus that is freeing and reawakens the essence of nursing 3)TT is an intervention that illuminates the transformative power of nursing theory-research-practice. 6. What were the recommendations? Having a complementary nursing strategy, such as TT, that allows nurses an additional way to offering care that facilitates comfort, assists with anxiety reduction, and enhances sleep is of major significance. 7. How practical/useful is this information to a practicing nurse? I am not sure how practical TT is. First, you would have to have additional staff to allow for the time to educate seasoned nurses in TT and then to perform TT on the patients. You would also have to have the support of the administrative staff. However, I do believe that laying on of hands is an effective therapeutic tool. 8. What I wonder is†¦.. would there be a similar outcome in other specialty areas that patients have not had the opportunity to establish a trusting relationship with the nursing staff prior to TT.