Wu zholiu's orphan of asia and taiwanese students studying in japan Essay - 1

Wu zholiu's orphan of asia and taiwanese students studying in japan - Essay Example ndaries of history and literature and through a discussion of comparison between Taiwanese and Japanese literature try to understand the effect that history has on literature. Orphan of Asia was written by a writer facing the crisis of identity that was just as common to any other Taiwanese. The book was written during 1943, two years before Taiwan attained independence. The book belongs to the period when Taiwan was a colonized country, and it generates just as much empathy for Taiwan as a literary work describing Hiroshima and Nagasaki event would generate. Belonging to a period when Taiwan, Japan, and China indicate much more openness in their relationships, the literary work forces its readers to think about human nature and their unending quest to gain power. The literary works also lay before us the option of choosing a peaceful and non-discriminatory path in contrast to the one that leads to capturing power (or rather power capturing us). The work also indicates how different people can be within their own country. Some people prefer to remain loyal to the serving master and thus gain their master’s ‘blessings’ while other prefe r to do what’s right which often goes against the way of the master. However, the only thing binding the people is their nationality in the same way that the thread binding Westerners and Easterners is ‘being human’. Wu Zhouliu was born in 1900 and after completing his education in a kÃ… gakkÃ…  (public school), he went to Taipei Teachers College. Later he joined a kÃ… gakkÃ…  as a teacher but left the job because of discrimination against Taiwanese. He went to China and became a reporter for a newspaper, he was afraid to come back to Taiwan as the Japanese officials suspected him. However, during the Pacific wars he had to return to Taiwan, as he feared Chinese wrath. He was not able to live peacefully as long as Japan continued its colonization. He died in 1976, because of a serious cold condition, at the age

Human Trafficking Essay Example for Free

Human Trafficking Essay Human trafficking is a very prevalent issue in today’s societies throughout the world. Human trafficking is the illegal trade of human beings for the purposes of commercial sexual exploitation or forced labor. The extremely high demand for sex and cheap labor are two of the leading factors in the expansion of human trafficking. Despite efforts from various individuals and organizations, millions and millions of men and women are illegally traded each year. Many agree that human trafficking is a horrific injustice but fail to acknowledge the underlying conditions that enable the growth of this industry. The various reasons most individuals fail to think deeper than the surface issues to address the underlying issues are discussed in depth in The Sociological Imagination by C.Wrighr Mills. Until the underlying issues are acknowledged and corrected, more and more humans will be illegally traded. According to The Sociological Imagination, many problems of society are overlooked because the issues do not directly impact the individual’s life. Many individuals do not make the connection between their own life and the big picture, in this case the relevance of human trafficking. They fail to see that although human trafficking may not directly impact one’s life, the illegal trade of humans may indirectly impact their life. The humans illegally traded, not only face sexual and labor exploitation but many are forced into marriage. Others are forced to become street beggars or child soldiers. In some of the worst cases the humans trafficked are killed and their organs are sold on the organ black market. Individuals not aware of these alternate forms of human trafficking usually fail to see how common it is and do not see the indirect impact human trafficking may have on their life. Another condition enabling the construction and expansion of human trafficking on the global scale are the efforts to stop human trafficking are being concentrated on the wrong principles. Organizations like SafeHorizon, Called to Rescue, Coalition Against Trafficking in Women and Deborah’s Gate all focus on rescuing individuals from trafficking or helping individuals assimilate back into society after being trafficked. I acknowledge these are very useful tactics but these organizations are only addressing the victims after they have been traumatized instead of addressing the underlying issues of why there is human trafficking and developing ways to prevent it. Some of their efforts should be transferred to implementing procedures or strategies that prevent individuals from becoming victims instead of for after they become victims. The corruption of government officials and police force in countries where human trafficking is most prominent, also play a large role in the growth and expansion of human trafficking in certain regions. Bribes are taken so certain businesses are not investigated or raided. These businesses are known to illegally trade human beings but they are allowed to continue their illegal actions. Authorities are aware certain individuals are partaking in human trafficking but merely look the other way. Until this changes or the corrupt government officials and police officers are removed from power, the number of humans illegally traded will continue to rapidly grow. But even honest government officials and police officers face difficultly in combating human trafficking. Human trafficking is such a lucrative business because of the high demand for sex that even when authorities are able to apprehend individuals who are trading humans illegally, new individuals pop up and pick up where they left off. Another obstacle authorities face is that many individuals who are involved in human trafficking operate at such a small scale, it is very difficult to know about their actions. Numerous individuals illegal trade humans in small rural homes or small businesses and keep their actions very discrete. Authorities trying to end human trafficking face almost insurmountable odds. The Sociological Imagination touched on the idea that individuals feel trapped by the problems of today. They are unable to look beyond the immediate troubles and issues. Humans are too consumed with the struggles off everyday life to invest time in correcting large-scale social injustices. Individuals feel as if their vision and powers are limited to the smaller scale of their jobs, family and neighborhood. This idea is another condition enabling the construction and expansion of human trafficking on a global scale. If one feels as if they are powerless and cannot change or do not have the time to change large scale issues, then change is not brought about. One individual can make change no matter how big or small the injustice they are trying to combat is. Until one internalizes and begins to believe they can make a difference, their efforts usually are consumed by irreverent problems of everyday life. Another condition enabling the construction and expansion of human trafficking is that many individuals are distracted from the larger social injustices. The media chooses which stories to shed light upon and in turn decide the importance of issues. If an individual is exposed to the same story numerous times, they are inclined to believe that story is more relevant and important than a story that receives less coverage. Some forms of media purposely give more coverage to celebrity drama or irreverent issues to distract individuals from the larger issues. The larger issues can more easily be swept under the rug if â€Å"the people† are not addressing them. If the horrors and alarming statistics of human trafficking where displayed in the media more often, people would be more inclined to correct the conditions that enable the construction and expansion of human trafficking. The Sociological Imagination opened my mind to the conditions that prevent individuals from dealing with the troubles and issues that matter. Individuals are seldom aware of the intricate connections between the patterns of their own lives and the course of the world. Because they do not make this connection most individuals cannot cope with their personal troubles in an efficient enough way to be aware of the structural transformations that lie beneath them. Sociological Imagination is having the ability to grasp reality by putting everything into perspective to make sense of the non-sense by thinking below the surface. Until more individuals possess this sociological imagination, things will not change.

Cardiovascular Disease

Cardiovascular Disease Cardiovascular Disease Introduction This paper utilizes qualitative data drawn from a series of focus group discussions with patients living with coronary heart disease which explored their understanding of and adherence to a prescribed monitoring and medication regime. These findings are drawn upon in order to contextualize, from the patients perspective, the outcomes of the Departments of Healths Coronary Heart Disease National Service Framework strategy. The paper focuses attention on the consequences of this regulatory approach to clinical and risk management for those patients already living with coronary heart disease. Case Study Patient is 59 yrs old and had a myocardial infarction 2 years ago. He is obese, a smoker and poorly motivated. The case exemplifies many of the difficulties that frequently arise in managing cardiovascular disease, and suggests potential avenues for improving outcomes through the application of a disease management programme. The Coronary Heart Disease National Service Framework By the mid 1980s, it had been generally accepted by most clinicians that there was strong evidence to support the existence of a linear relationship between cholesterol levels and cardiac mortality (Shaper et al. 1985, Stamler et al. 1986), and that therefore lowering total cholesterol levels would reduce the risk of individuals developing coronary heart disease. This opened the way to the process of establishing a recommended cholesterol threshold level at which treatment should be instigated (Leitch 1989). Since then, the trend has been towards setting ever-lower threshold targets for treatment for those designated as being at high risk of developing coronary heart disease and for those already living with the disease. In 2000, the Department of Health published its Coronary Heart Disease National Service Framework which set out 12 standards for the prevention, diagnosis and treatment of the disease (Department of Health 2000). The National Service Framework standard Number 3 recommended that GPs identify and develop a register of diagnosed patients and those patients at high risk of developing coronary heart disease. Dietary and lifestyle advice (what the document terms ‘modifiable risk factors) was to be offered to these patients, and their medication reviewed at least every 12 months. It was also recommended that statins be prescribed to anyone with coronary heart disease or having a 30% or greater 10-year risk of a ‘cardiac event, in order to lower their blood cholesterol levels to less than 5 mmol/l or by 30% (which ever is greater). These recommendations were vigorously promoted when they were incorporated into the new General Medical Services contract that came into operation in 2003. The relative performance of an individual Primary Care Organization in meeting each of these indicators attracts points on a sliding scale that are then converted into payments for individual GPs. In relation to the management of patients with coronary heart disease, higher payments are received if a Primary Care Organization increases the percentage of patients with coronary heart disease who have their total serum cholesterol regularly monitored, and whose last cholesterol reading was less than 5 mmol/l (Department of Health 2004a). The most recent Department of Health progress report on the National Service Framework argues that the massive growth in statin therapy since 2000; ‘. . . is one of the most important markers of progress on the NSF, and was directly saving up to 9,000 lives per year (Department of Health 2005: 19). Statin prescriptions have been rising at the rate of 30% per year since 2000, and in 2004/5  £750 million was spent on statins, equivalent to some 2.5 million people on statin therapy in England (Department of Health 2005). In July 2004, low doses of statins became available over the counter without prescription for the first time, for those at moderate risk. The Public Health Discourse(S) Of Cardiac Risk The application of risk discourses in the field of public health (or more precisely the ascription of health risk to particular behaviours) as conceptualized within those elements of the risk literature most influenced by Foucauldian notions of governmentality, are seen as serving to construct the socially recalcitrant as distinct from the responsible citizen (Foucault 1977, Turner 1987, Lupton 1995). In a similar way, Dean (1999) argues that once risk has been attributed to particular health behaviours, the distinction is then drawn within public health policies between ‘active citizens who are perceived as able to manage their own heath risks, and ‘at-risk social groups who become the object of targeted interventions designed to manage these risks. Two distinct dimensions or approaches to the conceptualization and public health management of cardiac health risks also emerge from an examination of the ‘guiding values and principles which inform the Department of Healths Coronary Heart Disease National Service Framework (Department of Health 2000).While one approach (described below as the ‘epidemiological model of risk) largely conforms to the individualized ‘at-risk discourse, a second discourse (described below as the ‘social model of risk) which is much more concerned with health risk at a social and material level can also be discerned within the National Service Framework. These two distinct and arguably competing discourses of risk point to a complexity in current public health policy that might not be anticipated from a reading of the governmentality literature alone. The first conceptualization of cardiac risk within the Coronary Heart Disease National Service Framework is one that can be termed the ‘social model of health risk. This model essentially reflects a socio-economic understanding of the determinants of population health, and draws attention to the importance of addressing material, social and psychological risk factors in addition to the known biological factors in heart disease. In the National Service Framework, this social model is reflected in the endorsement (albeit at a rhetorical level) of an interventionist role for the state in addressing these wider determinants of the disease: ‘The Governments actions influence the wider determinants of health which include the distribution of wealth and income. A wide range of its policies will have an impact on coronary heart disease including social and legal policies and policies on transport, housing, employment, agriculture and food, environment and crime (Department of Health 2000: Section 1, Para 17). There is also an explicit acknowledgement that these risk factors disproportionately disadvantage particular sections of society, demonstrated in the higher incidence of coronary heart disease among the manual social classes. It is also acknowledged that there is inequity in health service provision; ‘. . . there are unjustifiable variations in quality and access to some coronary heart disease serv ices, with many patients not receiving treatments of ‘proven effectiveness (Department of Health 2000: Section 1, Para 13). This formal acknowledgement of the governments role in addressing the wider social and economic influences on cardiac health risk could to some degree be said to conform to Becks (1992) notion of the ‘risk society; wherein many of the health risks faced by the population are a consequence of unchecked scientific and industrial ‘progress. Beck asserts that in response a greater public awareness or ‘reflexivity of risk has emerged which reflects a shift from ignorance or private fears about the unknown to a widespread knowledge about the world we have created. The question of whether a reflexivity concerning the social and environmental factors associated with cardiac risk can be discerned in a patients own discourses of cardiac risk is something that will be explored in the discussion below. The second risk discourse emergent within the National Service Framework (Department of Health 2000) is one which reflects a predominantly epidemiological understanding of health risk. In this model, the relative risk of an individual developing heart disease is based upon a calculation of the mean values associated with certain ‘lifestyle behaviours such as smoking, diet and exercise that are drawn from aggregated population data for heart disease incidence. This is a statistical approach that all too often perceives such calculated health risk factors as being realities or causative agents in their own right, often with little acknowledgement of the social and material context of these health behaviours. Nevertheless, it is on the basis of this epidemiological model of health risk that the Department of Health has confidently set national guidelines that now require General Values and principles underlying the CHD National Service Framework Nine stated values underlying development of national policies for CHD Provision of quality services irrespective of gender, disability, ethnicity or age. Ready availability of consistent, accurate and relevant information for the public. Consideration of health impact in regard to social and legal policies and policies on transport, housing, employment, agriculture and food, environment and crime. Public health programmes led by health and local authorities to ensure targets for CHD are met. Reduction in health inequalities. Resources will be targeted at those in greatest need and with the greatest potential to benefit. Evidence-based. CHD policies are to be based on the best available evidence. Integrated approach for the prevention and treatment of CHD in health policy, health promotion, primary care, community care and hospital care. Maintenance of ethics and standards of professional practice. Recognition of the importance of voluntary organizations and carers at home in addressing CHD. Four stated principles underpinning the CHD NSF . Reducing the burden of CHD is not just the responsibility of the NHS. It requires action right across society . The quality of care depends on: ready access to appropriate services ii. the calibre of the interaction between individual patients and individual clinicians iii. the quality of the organization and environment in which care takes place. . Excellence requires that important, simple things are done right all the time. . Delivering care in a more structured and systematic way will substantially improve the quality of care and reduce undesirable variations in its provision. Practitioners to identify and monitor ‘high risk patients and to prescribe the recommended drug treatment regime. It can be argued that this regulatory or ‘managerialist approach to clinical decision-making constitutes a challenge to the discretion that has been traditionally enjoyed by general practitioners in relation to the clinical management of patients. This second ‘official discourse of health risk could be seen as indicative of the regulatory and surveillance forms of governmentality identified within Foucauldian social theory. From this perspective, those social groups whose health behaviour or lifestyle are seen to fall outside the acceptable bounds of self-management then become constructed as ‘at-risk. These are social groups who are seen to, ‘deliberately expose themselves to health risks rather than rationally avoiding them, and therefore require greater surveillance and regulation (Lupton 1995: 76); once identified these groups and individuals then become subject to various health promotion or ‘health improvement initiatives. Implicit in such forms of governmentality as applied within health policy interventions designed to manage risk are a set of assumptions about the nature of human action predicated on the notion of the ‘rational actor model. Jaeger, Renn, Rosa and Webler (2001) have argued such models of rationality operate at three levels of abstraction. In its most general form, it presupposes that humans are capable of acting in a strategic fashion by linking decisions with actions. That is, human beings are goal-orientated who have options available from which they are able to select a course of action appropriate to meeting these goals. The second level of abstraction which the authors term the ‘rational actor paradigm, and which is the level at which rationality is probably understood by policy-makers, contains the following assumptions: all actions are individual choices; individuals can distinguish between ends and means to achieve these ends; individuals are motivated to pursue t heir own self-chosen goals when making decisions about courses of action/behaviour; individuals will always choose a course of action that has maximum personal utility, that is it will lead to personal satisfaction; individuals possess the knowledge about the potential consequences of their actions when they make decisions. Finally, that rational actor theory is not only a normative theory of how people should make decisions about in this case health behaviour, but is also a descriptive model of how people select options and justify their actions (Jaeger et al. 2001: 33). Many of these rational actor assumptions underpin and inform the Coronary Heart Disease National Service Framework. Such assumptions manifest themselves in a seemingly unproblematic approach to the promotion of ‘risky health behaviour change which plays down the influence of culture, habitus and the material basis of group socialization. This uncritical rationality also threatens the sustainability of the National Service Framework strategy in other ways. The social psychological and sociological literature see the notion of ‘trust as constituted through two dimensions, the deliberative or rational and the affective or non-rational. As Peter Taylor-Gooby (2006) has pointed out in his work on the problematic of public policy reform, the rational deliberative processes associated with the achievement of greater efficiency in the provision of public services have unwittingly served to undermine the non-rational processes that contribute to the building of trust in public institutions and in public sector professionals. In this context, the National Service Framework will need to build trust both in terms of the presentation of the biomedical evidence for the effectiveness of statins and other cardiac drug interventions, as well as the more affective elements associated with the belief that the national targets are designed with the best interests of patients in mind rather than being driven by financial considerations alone. Significantly, given its centrality to a ‘disease management strategy, neither the Coronary Heart Disease National Service Framework (Department of Health 2000) nor the NHS Improvement Plan (Department of Health 2004b) which sets out the governments priorities Coronary heart disease and the management of risk 363 for primary and secondary healthcare up to 2008, attempts to define the use of the term ‘risk, and by extension ‘higher risk. Nevertheless, the conception of risk that shapes the practical interventions proposed within both these strategy documents is clearly the epidemiological one that is described above. In the past, such public health interventions have been largely concerned with bringing about health behaviour change, however now the strategy would appear to be less focused on encouraging greater responsibility for the ‘self management of cardiac risk and more on ensuring compliance with clinical management regimes of monitoring and drug treatme nt. Optimising Care Through Disease Management In the last 15 years, there have been dramatic advances in the pharmacotherapy of heart disease, most notably the introduction of angiotensin converting enzyme (ACE) inhibitors. (Jaeger et al. 2001: 33) Unfortunately, numerous studies have suggested that ACE inhibitors are substantially underutilised in heart disease patients. Moreover, there are a multitude of factors which may confound heart disease management heart disease virtually never occurs in isolation, and comorbidities such as hypertension, diabetes, coronary artery disease, chronic pulmonary or renal disease and arthritis occur frequently. The presence of these comorbid conditions may interfere with heart disease management in several ways. In PATIENTs case, pre-existing renal insufficiency may have contributed to her intolerance to ACE inhibitors. In addition, her use of NSAIDs could promote salt and water retention and antagonise the antihypertensive effects of her other medications. (Jaeger et al. 2001: 33) Multiple comorbidities may also result in polypharmacy, which, in turn, may compromise compliance and lead to undesirable drug interactions. Adherence to dietary sodium restriction is often problematic (as in patients case), particularly in older individuals who are either not responsible for preparing their own meals, or who rely heavily on canned goods and prepared foods. Depression, anxiety and social isolation are common in patients with heart disease, and each may interfere with adherence to the heart disease regimen or with the patients willingness to seek prompt medical attention when symptoms recur. Similarly, the high cost of medications may limit access to therapy in patients with restricted incomes. Physical limitations, such as neuromuscular disorders (e.g. stroke or Parkinsonism), arthritis and sensory deficits (e.g. impaired visual acuity), may compromise the patients ability to understand and comply with treatment. Finally, cognitive dysfunction, which is not uncommon in elderly heart disease patients, may further confound heart disease management. Impact on Clinical Outcomes Despite the widely publicised effects of ACE inhibitors, b-blockers, angiotensin receptor blockers and other vasodilators on the clinical course of heart disease, morbidity and mortality rates in patients with established heart disease remains very high. heart disease is the leading cause for repetitive hospitalizations in adults, and in 1997 Krumholz et al. reported that 44% of older heart disease patients were rehospitalised at least once within 6 months of an initial heart disease admission. Remarkably, this rate was no better than that reported in several prior studies dating back to 1985. (Krumholz et al. 1998) From the disease management perspective, it is important to recognise that the majority of heart disease readmissions are related to poor compliance and other psychosocial or behavioural factors, rather than to progressive heart disease or an acute cardiac event (e.g. myocardial infarction). Thus, Ghali et al. reported in 1988 that 64% of heart disease exacerbationswere attributable to noncompliance with diet, medications or both and that 26% were related to environmental or social factors. Similarly, in 1990 Vinson et al. (Vinson, 1995) found that over half of all readmissions were directly attributable to problems with compliance, lack of social support, or process-of care issues, and these authors concluded that up to 50% of all readmissions were potentially preventable. More recently, Krumholz et al, reported that lack of emotional support among older heart disease patients was a strong independent predictor of adverse outcomes, including death and hospitalization Rationale and Objectives The above considerations provide the rationale for a ‘systems approach to heart disease management. The objectives of this approach are as follows: To optimise the pharmacotherapy of heart disease in accordance with current consensus guidelines. (Vinson, 1990) To maximize compliance with prescribed medications and dietary restrictions. To identify and respond to any psychological, social or financial barriers that might interfere with compliance with the prescribed treatment regimen. To provide an appropriate level of follow-up through telephone contacts, home visits and outpatient clinic visits. To enhance functional capacity by providing an individualized programme of exercise and cardiac rehabilitation. To enhance self-efficacy by helping the patient and family understand that heart disease can be controlled, largely through the patients and familys efforts. To reduce the frequency of acute heart disease exacerbations and hospitalizations. To reduce the overall cost of care. The Disease Management Team Although the composition of a disease management team may vary both from centre to centre and from patient to patient, a suggested list of team members are given below: nurse coordinator or case manager dietitian social services representative clinical pharmacist physical therapist/occupational therapist exercise/rehabilitation specialist  · home health specialist patient and family primary care physician cardiologist/other consultants. Each team member provides their own unique expertise and/or perspective, and these are then woven into an integrated package tailored to meet each individual patients needs, expectations, and circumstances. Importantly, not all patients will require the services of all team members, and it is therefore essential to identify a team leader. In most cases, this will be the nurse coordinator or case manager, who, in addition to being the patients primary contact person and educator, is also responsible for coordinating the efforts of other team members, including the selective activation of appropriate consultations on an individualized basis. In addition to the team itself, several other components are essential for effective disease management. First, the patient and family should be provided with comprehensive information about heart disease, including common etiologies, symptoms and signs, standard diagnostic tests, medications, diet, activity, prognosis and the role of the patient and family in ensuring that heart disease remains under control. This information should be provided in a readily understandable patient-friendly format and several patient-oriented heart disease brochures are now commercially available. In addition to these materials, the patient should be given a scale (if not already owned) and a chart to record daily weights, an accurate and detailed list of medications supplemented by medication aids if needed (e.g. a pill box), and specific information about when to contact the nurse, physician, or other team member in the event that questions or new symptoms arise. In this regard, the importance of establishing an effective one-on-one nurse-to-patient relationship cannot be overemphasized, as this interaction will often be critical to the early diagnosis and effective outpatient treatment of heart disease exacerbations. Patient Perspective While the above studies indicate a beneficial effect on costs, hospital readmissions, etc., they do not address concerns related to the patients perspective on this interdisciplinary care. What issues are important to the patient, and what the advantages are to the patient of participating in an heart disease disease management programme? In recent years, it has become increasingly evident that it is insufficient to merely provide high quality medical services. In a competitive market, it is essential that the patient is also satisfied with the medical encounter, both in terms of the process of care as well as the clinical outcomes. Healthcare is an industry, and like all industries, customer satisfaction is critically important. However, unlike most industries, which deal with a tangible product, the healthcare industry deals with a multifaceted service, the myriad qualities of which are difficult to quantify. As a result, the assessment of patient satisfaction is often complex, and the development of a valid and universally accepted instrument for measuring patient satisfaction has been elusive. Despite these problems, several patient satisfaction questionnaires have been developed, (Garg, 1995) and these have been helpful in defining those issues which are important to patients, and in identifying specific concerns that patients often have with respect to current approaches to healthcare delivery. (Garg, 1995) Factors which have been consistently shown to play a pivotal role in determining patient satisfaction include: communication, involvement in decision- making, respect for the individual, access to care and the quality of care provided. (Philbin, 1996) Not surprisingly, problems in each of these areas are frequently cited as factors which diminish patient satisfaction. Several components of the heart disease disease management system will be of direct assistance in answering patients questions and helping her cope with this new and frightening diagnosis. In particular, the nurse case manager will establish an effective rapport with the patient and her family, and provide an ongoing source of information and emotional support. The patient education brochure and other printed materials will help answer many of Patients questions and assist in relieving some of her anxieties. The nurse, clinical pharmacist and physician (s) can provide detailed information and teaching about the medications used to treat heart disease, and the dietitian can directly address the dietary questions and provide an individualized diet that takes Patients current dietary practices and food preferences into account. The social service representative can assist patient with any financial concerns she may have, make provisions to ensure an adequate social support network, and serve as an additional source of emotional support. The physical therapist or exercise specialist can help in providing recommendations about activities and in the development of an exercise or rehabilitation programme. The nurse case manager, social service representative, home care specialist, and physician will provide assistance to patient in making the transition from the hospital back to the home environment, and they also will ensure a high level of follow-up care. Perhaps most importantly, the comprehensive care provided by the disease management team will reassure patient that she truly is being cared for, and that all of her needs and concerns are being met. Invariably, this will lead to a high level of patient satisfaction. In addition, in the case of patient there is good reason to believe that implementation of a disease management programme at the time of her initial hospitalization may have eliminated the need for a second hospitalization. (Young, 1995) To the extent that patient might have to pay for some of the costs of readmission (e.g. deductible or copayment), the disease management programme would also save her money, a benefit which is universally viewed in a favorable light. And finally, based on compelling data from recent clinical trials, optimizing Patients medication regimen should translate not only into an improved quality of life, but also into increased survival. Conclusion In summary, heart disease management systems provide a win-win-win situation. They are a ‘win for the providers, because they improve clinical outcomes and quality of life. They are a ‘win for the payors, because effective disease management programmes decrease health care expenditures. And they are clearly a ‘win for the patients, who reap multiple benefits, including improved quality of life and well-being, enhanced self-efficacy due to a greater sense of health control, improved exercise tolerance and functionality, increased survival (as a result of more optimal utilisation of heart disease medications), and, in some cases, reduced out-of-pocket expenditures. References Department of Health (2000) National Service Framework for Coronary Heart Disease (London: DoH). Department of Health (2004a) GMS Statement of Financial Entitlements (SFE) 2004/5 (London: DH). Department of Health (2004b) The NHS Improvement Plan: Putting People at the Heart of Public Services Cm 6268 (London: The Stationary Office). Department of Health (2005) The Coronary Heart Disease National Service Framework: Leading the Way-Progress Report 2005 (London: DH Publications). Foucault, M. (1977) Discipline and Punish: The Birth of the Prison (London: Allen Lane). Garg R, Yusuf S, for the Collaborative Group on ACE Inhibitor Trials. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA 1995; 273: 1450-6 Ghali JK, Cooper R, Ford E. Trends in hospitalization rates for heart failure in the United States, 1973-1986. Evidence for increasing population prevalence. Arch Intern Med 1990; 150: 769-73 Jaeger, C., Renn, O., Rosa, E. and Webler, T. (2001) Risk, Uncertainty, and Rational Action (London: James James/Earthscan). Krumholz HM, Butler J, Miller J, et al. Prognostic importance of emotional support for elderly patients hospitalized with heart failure. Circulation 1998; 97: 958-64 Leitch, D. (1989) Who should have their cholesterol concentration measured? What experts in the United Kingdom suggest. British Medical Journal, 298(6688), 1615 1616. Lupton, D. (1995) The Imperative of Health: Public Health and the Regulated Body (London: Sage). Philbin EF, Andreou C, Rocco TA, et al. Patterns of angiotensin-converting enzyme inhibitor use in congestive heart failure in two community hospitals. Am J Cardiol 1996; 77: 832-8 Redfern, J., MacKevitt, C. and

Shakespeares As You Like It - Importance of the Secondary Characters

As You Like It:   The Importance of the Secondary Characters  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   As You Like It, by William Shakespeare, is a radiant blend of fantasy, romance, wit and humor. In this delightful romp, Rosalind stands out as the most robust, multidimensional and lovable character, so much so that she tends to overshadow the other characters in an audience's memory, making them seem, by comparison, just "stock dramatic types". Yet, As You Like It is not a stock romance that just happens to have Shakespeare's greatest female role. The other members of the cast provide a well-balanced supporting role, and are not just stereotypes. Characters whom Shakespeare uses to illustrate his main theme of the variations of love are all more than one-use cardboards, as they must be fully drawn to relate to life. Those characters most easily accused of having a stock one-dimensionality are those inessential to the theme but important to the plot and useful as convenient foils, such as Duke Frederick and Oliver de Boys. The assertion of the question deserves this quote: "You have said; but whether wisely or no, let the forest judge."   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There is no doubt, either in the critical or play-going mind, that Rosalind is the "grandest of female roles" (Hazlitt). She encompasses a multitude of character brushstrokes, from the love struck maiden to the witty arch tongue to the steel-backboned princess to the fiery Wise One (Hazlitt). To add to the demands of the character Shakespeare adds in an exterior sex change and further makes Ganymede pretend to be Rosalind to Orlando. Though this kind of "boy acting a girl acting a boy acting a girl" kind of transmogrifications were not uncommon upon the Elizabethan stage, the kind of mind and acting portrayed ... ...bits of character that are definitely not stock, as in Charles' original concern for Orlando and Sir Martext's refusal to be made a fool of by Touchstone. These make them more than stock, but they are still as cardboard when compared to Rosalind.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   As You Like It contains as many characters as there are in life, but Rosalind is used as the vehicle for the Ideal. Her main supporting characters are full of life, and though not as much as Rosalind, it is still life for all of it. The less important characters have to be more one-sided to keep the plot uncluttered, but sometimes the one-dimensionality jars, as with Oliver. Rosalind's vibrancy would overshadow any other character, for to produce an Othello opposite her would create a conflict that this greatest of comedies does not need. Works Cited: Shakespeare, William. As You Like It. Bevington

The AIDS Epidemic Outbreak

Who would have ever thought that a disease, possibly brought to America by infected African monkeys, would affect the country forever? This is exactly what happened in the late nineteenth century when the Acquired Immune Deficiency Syndrome (AIDS) was introduced to America. The unpredictable epidemic caused a huge outrage for years to come. The outbreak of the HIV virus, AIDS, in the early 1980†³s resulted in medical research, public misconceptions, and ultimately growing awareness. Appearing first only in homosexual men, AIDS was an unfamiliar virus to the entire United States. Reports of unknown and unexplainable symptoms caused much confusion among patients and even doctors. In 1981, the first reports explained that 41 homosexual men in the San Fransisco area had â€Å"†¦ a rare and often rapidly fatal form of cancer† (Altman n. p. ). After years of researching these cases and millions of others appearing later in the decade, scientists discovered that it was not cancer they were dealing with. They called it HIV (Human Immune Virus) which leads to AIDS (Acquired Immune deficiency Syndrome) that â€Å"†¦ rogressively destroys the body†s ability to fight infections and certain cancers† (ARIC n. p. ). With minimal research there was nothing to initially â€Å"combat† the virus; but, thanks to time and funding, there were some drugs that seemed to help stop the spread of the virus in ones body. These anti-retroviral drugs still don't constitute as cures ! for the virus, but have definitely helped and continue to help patients live longer (ARIC n. p. ). Since a vaccine to â€Å"†¦ evoke an immune system response that will prevent infection or disease development† still has not been found, other treatments have been tested. Accupuncture, stress management, hypnosis, exercise, good nutrition, and an overall positive attitude all seem to alleviate symptoms even if they are not proven cures of the virus (Packer 78-88). Although AIDS is a life threatening disease, there were many people living with it by keeping healthy and staying safe. Scott Fried had not tried any of the aniviral drugs; however, practices such as taking 80 herbs and vitamins a day, staying physically fit, visiting the doctor every three months, and being happy have kept him alive with the virus for thirteen years (Fried speach). Most victims have not lived as long as he which is why AIDS has lead to some extensive research. Investigators supported by private and public funds continued to search for a cure or even an explanation of HIV/AIDS for two decades because like the â€Å"b! lack plague†, AIDS has killed off millions of people in a short time. Also like the black plague did, AIDS carried with it a long string of misconceptions. In the Middle Ages anyone carrying the â€Å"black plague† was to be avoided. Similarly, the public would often avoid people with AIDS. There were fabrications that AIDS could be caught by another human being from sneezing, coughing, hugging, kissing or even any â€Å"casual contact† ; so, people stayed away from those who were infected by AIDS. Another lie was that AIDS was caused by something magical or mystical (Taylor 23-24). Though some were overly careful of â€Å"catching† the virus, others were not careful enough. Since the initial outbreak was among gay men it was simply assumed that only gay men could be affected. Then reports of IV drug users having the disease still seemed to eliminate the chance of the common person being infected. Next, hemophiliacs and people who had had blood transfusions were reported followed by blacks, Hispanics, lesbians, straight women and finally white, heterosexual, males. Still everyone said â€Å"It can†t happen to me,† until it did (Fried speech). This assumption that AIDS only affected few amounts of people and only minorities was the basis of all misconceptions about that virus. People did not believe the virus could have any impact on their lives; but, it did impact everyones lives directly and or indirectly. Now that â€Å"AIDS is the second leading cause of death in the United States among people aged 25 to 44†³ (ARIC n. p. ), the misconceptions have been proven to be false. Although it was statistically correct that 66% of people infected by AIDS were homosexual males, 24% were IV drug users, and only 4% were heterosexual males or females (Packer 17) it was still a fact that AIDS can affect anyone. After years of research and statistical reports there were finally people relaying these messages to the public. Motivational speakers, like Scott Fried, continue to reach out to teens and adults about AIDS and sex. Information about these subjects can also be found easily, not only at hospitals or doctors† offices; but in books, magazines, pamphlets, and even on the internet. Conducting a simple search on http://www. yahoo. com came up with 164 â€Å"category matches,† 1,206 â€Å"web site matches,† and 237,000 web page matches. This means that HIV/AIDS appears at least 238,370 times on th! e world wide web and it shows that AIDS in an important component of modern life. Not only are people becoming aware of the AIDS epidemic, but they are becoming aware of sexuality through learning about AIDS. Before the outbreak of this fatal virus sex was only spoken about discretely. Now even kids are being made aware of the dangers of sex and spreading HIV. In this way HIV/AIDS had a positive affect on the country. People are aware of the facts and probably make better decisions. Some experts have said that AIDS will remain the way it is now and others predict it growing into a â€Å"huge epidemic† (Taylor 28). Hopefully due to this expansion of knowledge and recognition, he AIDS virus will not spread as quickly and infect as many people as it has in the past. HIV positive, homosexual, male, Scott Fried, said, â€Å"Ironically one of the blessings that HIV/AIDS has brought me is the abundance of love. . . † and perhaps that is true. Pertaining to the eighties and the early onset of the virus, AIDS caused much more commotion than love. However, every cloud has a silver lining and the hysteria has finally cleared up some myths. It has opened up the public to not only HIV/AIDS awareness, but sexual cognizance as well.

External Analysis of Kraft Foods Essay

Kraft is the number one manufacturer of snacks in the U. S. and the world’s number two food company (Kraft Foods SWOT analysis, n.d.). Our goal is to maintain and improve those statistics. Results of the Porter’s 5-Forces There is a low threat of entry of new manufacturers. The food industry is already glutted with companies who rival Kraft. ConAgra ($11.62B revenues in 2012), and Nestle ($93.06B) represent the top across-the-board rivals. The Kellogg Company (13.65B) also holds 34.2% of the cereal market (Kraft Annual Report, 12/31/2011). There is a low availability of substitutes. The devastating drought in the U. S. has caused enormous drops in the supply of crops and animals. With diminished supplies when demand is high, suppliers bargaining power is also medium to high. Poor economic conditions coupled with heightened sensitivity to nutritional values have given customers a medium bargaining power (Lempert, P., 12/21/12). Results of the PEST analysis Political unrest in Egypt forced Kraft to suspend operations there (IUF newsier 2012). Likewise, the takeover of the Cadbury company and subsequent closing of the major plan in England have spawned much negativity toward Kraft (Chellel, Kit 5/23/2011). America’s middle class has shrunk by ten percent in the last 40 years and unemployment means consumers are being very cautious with how they spend their money (Lempert, P., 12/21/12). Shopping trends are focusing on health concerns and especially obesity (Kraft Foods SWOT analysis, n.d.). Over the net grocery shopping is becoming more popular (Lempert, P., 12/21/2012). With the advent of Facebook and Twitter, jilted employees, their families, and others who perceive unfairness dramatically weaken a company’s revenues with a few keystrokes. (Kraft Annual Report 10K 12/31/2011). Opportunities and Recommendations Kraft has the opportunity to re-configure marketing and packaging to tap further into the huge health and wellness market. They can educate the public about the advantages of healthy snacks. Kraft should promote the use of different individual pre-packaged and/or frozen items to make or supplement meals as opposed to buying a whole dinner. The consumer can be educated about the nutrition and time savings associated with a-la-carte items which can be used in conjunction with or in addition to a main dish. Kraft has the opportunity to re-examine the proteins in their products. Because of diminished supply of meat, alternate protein sources should be investigated. I feel the greatest concern right now is regaining and maintaining the Kraft name and reputation. It is imperative to keep the Kraft brand associated with good foods and healthy snacks. By implementing these changes, the company can go forward with even better bottom line results. INTRODUCTION In this report, I have analyzed the effects of Porter’s 5 forces upon Kraft Foods Industry. I have documented sources to validate those effects. The information presented is the latest available. I have also done a PEST analysis using the information gleaned from the previous sources as well as other references. I have given impressions concerning Kraft Foods Company from both an internal and external viewpoint. In conclusion, the recommendations for the company should result in better overall performance. Porter’s Five Forces Threat of Entry (low) There is a limited threat that more manufacturers will start up in the food industry. It is cost prohibitive pursuant to start up, marketing, advertising, and building brand loyalty. There are a sufficient number of competitors for Kraft Foods already. Especially at this economical slow down, no formidable threats seem likely (Food Retailing Industry, 2012). Rivalry (high) Kraft Foods has a high degree of competition rivals. ConAgra ($11.62B revenues in 2012), and Nestle ($93.06B) represent the most across-the-board rivals. Other peer groups with partial product competition and their 2011 revenues include: âž ¢ Campbell Soup Company (7.88B) âž ¢ The Coca-Cola Company(47.60B) âž ¢ General Mills, Inc.(17.12B) âž ¢ H.J. Heinz Company (11.62B) âž ¢ Hershey Foods Corporation(6.64B) âž ¢ Kellogg Company (13.65B) which also holds 34.2% of the cereal market, âž ¢ PepsiCo, Inc.(65.70B), and âž ¢ Unilever N.V. Hillshire (4.09B). (Kraft Annual Report 12/2011) (Morningstar KRFT competitors 2011). Substitutes (low) Kraft is the number one manufacturer of snacks in the U. S. and the world’s number two food company (Kraft Foods SWOT analysis, n.d.). Growing your own, buying fresh foods, and eating out would be alternatives to Kraft’s processed foods. For most consumers, time and money constraints would preclude these alternatives. Because of the slow economy and high rate of unemployment, many consumers are turning to home cooked meals rather than buying a complete processed meal (Reports, Statistics and Analysis (2/2/12). Bargaining Power of Suppliers (medium to high) According to Phil Lempert, the supermarket guru, the devastation of the drought in the United States in 2012 has caused exponential upsets in the food industry. There were enormous losses of both crops and animals. Because of this situation, suppliers have less produce and can demand higher prices. Higher prices of groceries have forced the consumer to take note of how much food is being wasted. They are investing those grocery dollars in good snacks and healthy meals (Lempert, P., 12/21/12). Bargaining Power of Customers (medium) Poor economic conditions have necessitated smarter use of grocery dollars. The grocery shopper wants quality products for a reasonable price. Pre-packaged whole meals have given way to more home cooking (Reports, Statistics and Analysis 2/2/12). Improved technology is adding to the clout that customers have. Baby boomers and millennials are using apps to search out similar products at better prices. Health concerns mean consumers are reading labels and demanding to know where their food comes from. (Food Retailing Industry 2012). There is little involved for the consumer in switching brand loyalty. Customers are commanding a heftier share of bargaining power than previously because of instant information about prices and alternatives. PEST Political In 2011, political upheaval in Egypt forced Kraft to suspend operations there. Of the 300 workers, 250 had joined to form a Union. In 2012, the new government instituted a social allowance which Kraft refused to pay resulting in a 3-day sit-in. Kraft fired five board members hoping to eliminate the union. This has caused much negativity toward Kraft. (IUF newswire 2012). Kraft Foods bought out Cadbury and executed some perfectly legal but questionable tactics in doing so. The takeover and subsequent closing of one of the main factories in England left many people with anger and bitterness against Kraft (Chellel, K., May 23, 2011). Both of these incidents give a glimpse into how inner company workings become front-page news. Government and political entities necessarily interact with corporations all the time but when the reputation of the company is damaged, it takes a long time to recover. Economic Environment The worst U. S. drought in 50 years has caused a significantly reduced supply of raw products. America’s middle class has shrunk by ten percent in the last 40 years and unemployment means consumers are being very cautious with how they spend their money (Lempert, P., 12/21/12). The world economy is also in a down slope. Sociocultural Environment The public demands for healthier foods and snacks has increased. Baby boomers and millennials (those born between 1982 and 2004) want better control of what they eat, where it came from and its nutritional value. They are more health conscious than any other generations of peoples. People in general are focusing on health concerns and especially obesity (Kraft Foods SWOT analysis, n.d.). With high unemployment and decreased disposable income, cooking at home has replaced purchasing whole meal packages (Lempert, P. 12/21/2012). Technological Environment Technology, especially the internet, has radically changed the lives of everyone. Today’s consumer is constantly on the move and looking for ways to save time and money. Some of that may be achieved by utilization of an app that lets the consumer compare values and prices of similar products. Over the net grocery shopping is becoming more popular (Lempert, P., 12/21/2012). In Kraft’s 2011 Annual Report, they recognize the impact of social networks such as Facebook and Twitter. Even more damaging than public media, unhappy customers can breed negativity with rumors and innuendoes (Kraft Annual Report 10K 12/31/2011). Overall Impressions Concerning the Company’s Environment Opportunities The cost of grains and meat will be constantly rising forcing grocery prices up over the next few years. Coupled with the growing nutritional and health concerns, Kraft has the opportunity to re-configure marketing and packaging to tap further into the huge health and wellness market. They can educate the public about the advantages of healthy snacks. Because money is tight and many people are returning to home cooking, Kraft has an opportunity to promote the use of different individual pre-packaged and/or frozen items to make or supplement meals as opposed to buying a whole dinner. The consumer can be educated about the nutrition and time savings associated with a-la-carte items which can be used in conjunction with or in addition to a main dish. Kraft has the opportunity to re-examine the proteins in their products. Because of diminished supply of meat, alternate protein sources should be investigated. Threats The Cadbury debacle and the politically-based problems in Egypt have produced much negative press about Kraft. When the reputation of the company is damaged, it takes a long time to recover. Even though Kraft ranks high on the national and global storefronts, a tarnished reputation causes consumers to re-think brand loyalty. . Even more damaging than public media, unhappy customers can breed negativity with rumors and innuendoes. With the advent of Facebook and Twitter, jilted employees, their families, and others who perceive unfairness dramatically weaken a company’s revenues with a few keystrokes. Conclusion Kraft continues to be a leading snack and processed food corporation. I feel their greatest concern right now is regaining and maintaining their reputation. It is imperative to keep the Kraft brand recognition associated with good foods and healthy snacks. By implementing these changes, the company can go forward with even better bottom line results. REFERENCES Chellel, Kit (5/23/2011) eFinancial News. Kraft vs. Cadbury: A bittersweet deal. Retrieved 2/3/13 from http://www.efinancialnews.com/story/2011-05-23/kraft-cadbury-bittersweet-deal. External analysis for Kraft Foods, (June, 2011) Retrieved 2/4/13 from https://docs.google.com/document/d/19liGjGKT76-tSjr_lz1M47bLd99BDFBJlSvHv5BYhzw/preview IUF newsier (2012) Kraft Egypt removes union leaders who called