Role Of Health Care Organizations Health And Social Care Essay

Health Care Organizations. The function of wellness attention organisations is really of import in the overall wellness scenario of United States. Health attention organisations are dedicated to supply comprehensive wellness services to the patients. These wellness attention organisations provide the services of doctors, nurses, research labs etc. for the patient. However, it has been forecasted by many economic analysts that the wellness disbursals in United States will see a uninterrupted rush due to the deteriorating economic conditions and the increasing figure of uninsured people. This has compelled the infirmaries and other health care supplying units to restrict their disbursals to such an extent that every citizen, conditions holding medical insurance or non, will hold the entree to quality health care. The restrain of disbursals besides affects the staffing of infirmaries and most of the infirmaries follow the scheme of understaffing of their paramedical staff ( Aiken et al. , 2002 ; Unruh, 2003 ) . The authorities of United States in order to supply greater alleviation and convenience to little concerns in the state is hungering programs and explicating policies to supply them wellness insurances which will cover up to 35 % of a company ‘s insurance premiums. With the offering of insurance increasing up to 59 % this twelvemonth the White House anticipates that over 4 million people will be able to take advantage of this agreeableness. Furthermore the authorities intends to supply full revenue enhancement recognition will be provided to employers who have work force of less than 10 employees who earn less than $ 25,000 per annum. In add-on to this the disposal is besides looking frontward towards the retainment of grandfathered wellness insurance programs as it will supply employers the unsusceptibility from certain cardinal outgos. However on the impudent side little business communities and National Federation of Independent Business has already created an confederation to oppose and turn over the jurisprudence which they claim does non supply them equal alleviation and convenience. Most of them say that the eligibility standards outlined by the authorities is so narrow that many employees will merely be barred from these insurance commissariats. Many people have started traveling towards cheaper insurance programs through which their monthly insurance premium payments will cut down. Already 20 provinces have joined custodies to oppose the jurisprudence that the Obama disposal intends to proclaim. Experts besides suggest that preparation of such Torahs will work adversely for the Democrats in the approaching midterm elections as it provides a comprehendible manifestation of their incompetency and indifference towards an built-in sector of the state. Forces of alteration in US Health attention system The wellness attention state of affairs of United States of America is altering at a rapid gait. Several tendencies combined over the last few decennaries to make greater wellness attention unfairnesss. Both Medicaid and Medicare, for illustration, contributed to aggressively lifting medical costs because they required province authoritiess to reimburse infirmaries and doctors at ‘reasonable ‘ degrees determined by wellness attention suppliers. Predictably, reimbursement was really generous and disbursals grew rapidly. Such skyrocketing medical costs, combined with the general lethargy of the economic system put wellness attention out of range for many Americans. The loss of 1000000s of occupations during the recent economic meltdown added to the turning figure of people without medical insurance. The staying occupations ‘ progressively nonunion, portion clip places in the services sector ‘ offered few, if any wellness benefits. The promotion and invention of engineering in the field of medical scientific discipline has confirmed huge blessings on world. New medical specialties emerged mundane to extenuate a figure of diseases. Pharmaceutical and biomedical companies work indefatigably to develop medical specialties for such diseases, which considered as incurable in the past like Cancer ( Vastag, 1998 ) . United States is one of the most medically advanced states of the universe. Anybody who can afford or hold the proper health care coverage has entree to the best available medical engineering ( Bodenheimer, 2006 ) . Translating new engineering into pattern resulted greater per capita health care outgo ( Bodenheimer, 2005 ) . Thus engineering and invention in the medical field is an of import ground for wellness attention outgo ( Cutler & A ; McClellan, 2001 ) . Harmonizing to the US Bureau of the Census, the fastest turning section of the population in 1990 was grownups and seniors. In the twelvemonth 2000, 36 per centum of the population of the United States was over 45 old ages old, as compared to 30.8 per centum in this class in 1980. Alternatively of being youth-oriented in the hereafter, the United States will go a senior orientated civilization. Health disbursals of a individual increases as his or her age additions. However, experts believe that the factor of aging population contributes really small in the addition of wellness attention outgo ( Orszag, 2008 ) . Harmonizing to the informations provided by Organization for Economic Co-operation and Development ( OECD ) , in the twelvemonth 2003 United States spends about 7.3 per centum of its entire wellness attention outgo on administrative and insurance costs as compared to Canada which spends merely 2.6 % on administrative and insurance costs ( Schoen & A ; How, 2003 ) . Centers for Medicare and Medicaid Services ( CMS ) have besides performed some surveies which show that United States administrative cost for wellness insurance was 14.3 % of its entire wellness attention outgo in 2005 ( Centers for Medicare & A ; Medicaid Services, 2005 ) . Although the alteration of US healthcare scene is non confined to these factors merely but they are some of the major subscribers for the continuously altering healthcare scene. Need for Health and Well Program The first inquiry that pops in head before planing a wellness and health plan for a private corporation is to understand the necessity due to which such a plan is being incepted. By inventing the demand and grounds for the plan any corporation can measure the full issue in greater item and penetration. Furthermore different complications that can be encountered during the class of the full plan can be analyzed in progress and prior to the launching of the plan and out of all these outstanding characteristics it is most of import to happen out a valid ground which can legalize and warrant the demand of such a plan. There are really two dimensions through which we can happen a rational account for such wellness and health plans. The grounds can be biological every bit good as accommodate commercial involvements. Biological grounds include the inauspicious effects of work overload on employee wellness which has become a prima cause of decease for people who develop marks and symptoms of diseases like malignant neoplastic disease, bosom onslaught and shot. Due to work emphasis and huge burden many employees in their several corporations besides develop the wont of smoke. Harmonizing to statistics that were published in 2004 edition of American Medical Journal it was estimated that smoking in the twelvemonth 2000 killed over 435,000 which surged from 400,000 in the twelvemonth 1990. Most of the victims of smoking included people from different corporations who engaged in this harmful and deadly wont due to the work load that they encountered in their corporations. Another really major ground which farther aggravated the demand of wellness plans from organisations included the increasing rate of fleshiness threat. One of the grounds that were held accountable for fleshiness included deficiency of physical activity and vigorous exercising since most of the clip in organisations is spend in forepart of computing machines either making office work or playing video games on computing machine systems. ( Nichols, 2007 ) In add-on to this the quickly progressively and booming concern of fast nutrient ironss through which people can easy buy and entree nutrient has besides proved as an effectual barrier in lending any benefit to their already anaemic province of wellness. It is a clearly understood that a squad of people who is excessively careworn and fatigued to transport his or her ain weight can non perchance afford or manage the duties and load of the work that his or her corporation provides him with and the progressively competitory environment of modern-day corporate industry does non let any topographic point to employees who can non get the better of their weariness or fleshiness syndrome. This really ground links itself to the fact where organisations in the aftermath of researching their corporate societal duties launch plans that cater to the wellness and health of their employees under organisational conditions. Organizations and different corporations in the thick of detecting a new component of marketing through the CSR factor provided their employees with the inducement of originating wellness and health plans for them through which they were successfully able to heighten their degree of trust and repute among their employees and besides boosted their public dealingss by supplying a wholly new run in order to elate their image in forepart of people. Hence the corporate involvements of employees every bit good as of employers led to the origin of the wellness and health plans at an organisational degree. ( Health and Wellness, 2010 ) Current jobs and fiscal defects in the US wellness system United States Health attention plan helps the older and the hapless citizens of the United States. The authorities of United States spends about Eighteen per centum of its GDP in its Healthcare plan, which is highest as compared to the Health attention Systems of other states ( Danzon ) . It is besides to be noted that United States is the lone state, among the developed states, which have about 15 percent population without any medical coverage. Other developed states, on norm, spend 9 per centum of their GDP on wellness attention ( OECD, 2006 ) . Switzerland is at 2nd topographic point in wellness attention disbursement which is $ 4177 per individual. Other industrialised states are non passing more than $ 3200 per individual Unlike other postwar industrialized states, the United States has moved really easy toward comprehensive wellness attention for all citizens. In 1965, Congress established the Medicare plan to function the aged and handicapped, and Medicaid to assist the hapless and institutionalised. For the most portion, nevertheless, United States health care plan has dependent on nongovernmental plans. Peoples have had to happen their ain, private beginning of wellness attention. While this system suit our free-market economic theoretical account and has provided the universe ‘s finest medical intervention to insured patients, it has besides meant that a big figure of Americans have had hapless entree to wellness attention. Although United States is one of the states, which spends batch of money in health care but ‘the consequences are non evident either in Americans ‘ satisfaction with their wellness attention system or in their wellness. Consequences are unsatisfactory in infant endurance, the length and quality of life, and entree to wellness attention, peculiarly for hapless people, and communities of colour. The United States has met merely about 15 per centum of the aims set by Healthy People 2000. While advancement has been made toward the aims in another 44 per centum, Americans ‘ wellness has really deteriorated for approximately 20 per centum of the aims ( e.g. , fleshiness, physical activity, coffin nail usage among striplings ) ‘ ( NCHS 1997, p. 2 ) . United States has experienced steady addition in the wellness attention costs for the last 2 to 3 decennaries. In the decennary of 1980s, US expenditure on wellness attention was $ 253 billion which has increased to $ 714 billion in the decennary of 1990s. Soon, US health care outgo is more than $ 2.7 trillion ( Centers for Medicare and Medicaid Services, 2010 ) . US spend about $ 7, 681 per occupant which is about 18 per centum of the entire Gross Domestic Product ( GDP ) of the state. It is expected that by the twelvemonth 2015 US wellness attention disbursement will make $ 4 trillion and sum to 20 % of the entire GDP The statistics have proved that 60 to 70 per centum of the entire wellness attention outgo of United States is consumed by the 10 per centum of the population. This 10 per centum of population which generates most wellness attention costs are either suffered from chronic disease, disabled or hapless. The undermentioned figure shows the five costliest wellness conditions that cost United States most out of pocket costs. Actually talking, United States does non supply a coherent patient-centered attention for the above mentioned minority group which is one the factors of overall addition in the wellness attention outgo ( Ayanian et. al. , 2000 ) . Harmonizing to the Institute of Medicine, the quality of attention is â€Å" the grade to which wellness services for persons and populations increase the likeliness of coveted wellness results and are consistent with current professional cognition ‘ ( Institute of Medicine, 1990 ) . But at the same clip this plan is besides blamed, ‘for the bounds of its range in supplying wellness insurance to the hapless, its ties to the public assistance system and image jobs, its fluctuations across States, and the financial loads imposed on Federal and State budgets as the plan has grown in range and disbursement ‘ ( Rowland, 1995 ; pg. 272 ) . United States wellness attention system, being a immense system, has besides established inefficiency which proves to be a barrier to the invention of this $ 2.7 trillion industry. This inefficiency, despite all the mechanization and technological inventions, consequences the loss of $ 300 billion, i.e. 15 cents per dollar spent on wellness attention The figure of uninsured is continuously lifting due to several factors. These uninsured people are really likely to populate without proper wellness coverage because of the turning load of wellness attention ( Institute of Medicine, 2002 ) . As consumers are fighting to get by with the mounting out-of-pocket liabilities, the suppliers are seeking to better their falling grosss by revamping their concern processes to diminish the turning bad debt and to better pull off the payments from the consumers. A common perceptual experience is that consumers are unwilling to pay for their wellness attention outgo. However, the study, conducted by McKinsey quarterly, suggested that consumers are normally willing to pay but the charge system inefficiencies, deficiency of funding options and consumer ‘s confusion are the chief grounds of non ‘ payment ( Finn, Pellathy and Singhal, 2009 ) . It is pertinent to province the position of Healthcare Financial Management Association, ‘ In many ways, the state ‘s current health care payment system blocks, instead than supports, the state ‘s wellness ends: The system does non efficaciously reward health or high quality. The system does non promote social benefit such as entree to care. And the system creates fiscal instability by adding cost and complexness to wellness disposal, by honoring high-cost patterns, and by concentrating on expensive sickness-focused intercessions instead than health. ‘ ( Healthcare Financial Management Association, 2008 ) . Stakeholders in Health attention organisation The uninterrupted alterations in the health care field have wholly changed the position of infirmaries and wellness attention organisations and they are now acted more like a concern venture than a societal service organisation ( Shortell, Morrison & A ; Robbins, 1985 ) . This new altering environment has compelled the disposal of wellness attention organisation to take all the concerns of the stakeholders earnestly and now stakeholders are act uponing the personal businesss of wellness attention organizations whether it belong to disposal, fiscal or quality attention issues ( Blair & A ; Fottler, 1990 ) . Although the stakeholders are the same for both non-profit-making and for net income wellness organisations ; however, their power and influence is different depending on the construction of the wellness attention organisation ( Kralewski, Gifford & A ; Porter, 1988 ) . Although there are legion groups of stakeholders, but harmonizing to a survey ( Fottler et al. , 1989 ) , the und ermentioned five are the most influential and powerful. 1. Medical Staff 2. Patients 3. Hospital Management 4. Professional Staff 5. Board of Trustees The penchants of all these stakeholders are different. Medical and Professional staff stress more on quality of wellness attention provided to the patients. Patients are besides concerned about the service and clinical quality but cost of the quality wellness attention is besides one of their major concerns. Hospital direction focuses on the leading, profitableness and cost containment of health care services. Board of legal guardians who have the reins of control of overall infirmary direction attention largely for the profitableness, regular watercourse of hard currency flow and effectual and efficient use of resources. The disposal and executives of wellness attention organisations normally formulate attempt to explicate a scheme which satisfy all the stakeholders because they have overlapping ends and involvements ( Counte, 1995 ) . Recommendation for how best wellness attention could be delivered 1. Determine the gross beginnings available for subsidising the wellness attention coverage farther with a end to cover all the Americans in wellness attention insurance cyberspace ; as all the above treatment show there are 1000000s of uninsured people in America which prove to be an tremendous load on the economic system of United States. There is a demand to cover as many people as possible under wellness attention insurance by mobilising the bing gross beginnings every bit good as by making new resources like taxing baccy, cresting the revenue enhancement exclusion of employer based wellness insurance etc. 2. Create, in order to pool hazards, insurances exchanges at province or regional footing. Such exchanges will be good for those Americans besides who do non take part in employer-based or other group insurance installations. 3. Establish a board with representation of all the stakeholders of wellness attention system. This board determines and updates the wellness attention benefit bundle of United States citizens through province or regional degree insurance exchanges. Challenges for infirmaries It has been estimated that mean cost of a trial is within the scope of $ 200 to $ 400, accompanied with the medical charges of the concerned physician which are $ 10 to $ 15 and if the status is much serious, which is a usual instance with chronic infections, the cost is above $ 300. It has been forecasted by many economic analysts that the wellness disbursals in United States will see a uninterrupted rush due to the deteriorating economic conditions which has sidelined companies to supply any sort of medical benefit to their employees, authorities institutional wellness reform programs is non deadening any fruit and private sector seems excessively intimidated to assure anything that in the long tally erodes its credibleness. Furthermore, the load of the 47 million uninsured people of the state is being sustained on the disbursal of the 253.4 million people that have medical insurance as disclosed by the statistics released by Census Bureau. Harmonizing to analysts the misdirection and the huge pandemonium occupying the wellness sector in the United States is chiefly an result of unprofessional behavior and a manifestation of utmost carelessness in the allotment of fiscal resources which has resulted in an instability between the end product and input being generated by the sector. At present the end product easy surpasses the input and if concrete stairss are non taken to decide the job, the ensuing effects will be badly inauspicious and irrevokable. Clinical attention of patients are become more and more ambitious with the transition of clip. At the same clip infirmaries face troubles in supplying quality wellness attention service in present economic status. In the twelvemonth 2000, harmonizing to American Hospital Association, 1 out of 3 infirmaries showed losingss, 58 % have negative borders on Medicare patients and 73 % reported loss in handling Medicaid patients ( American Hospital Association, 2002 ) . Doctor ‘s Organization Like others in concern, doctors must vie for paying patients. Doctors are no longer in short supply, except in urban slums and remote rural countries, and find themselves in a purchaser ‘s market. Besides they frequently enter pattern with medical school debts of 100s of 1000s of dollars. All this force per unit area conflicts with the doctor ‘s professional moralss to urge medical service to patients without seeking to maximum fees. Agreements with makers of medical merchandises and drugs may honor doctors for ordering or urging merchandises that are more expensive. Doctors might direct patient to wellness attention installations, such as research labs, convalescent places, in which they are fiscal involvement. The function and duty of doctor ‘s organisation is to set up, ‘Performance measures'if done right'have possible to measure physician public presentation, better the quality of patient attention, heighten the coordination and direction of attention, and reward doctors who meet or exceed the benchmarks set by public presentation steps. However, if applied in a bureaucratic, arbitrary, or punitory mode, public presentation measuring can impede quality and injury patient attention, undermine the physician'patient relationship, and cause physician defeat and calling dissatisfaction ‘ ( ACF, 2004 ) . In the new system, payments should depend on the efficient bringing of quality wellness attention services which leads towards the betterment of the overall status of the patients. Role of Nursing Organization Nurses provide attention, non merely for physical unwellness, but besides for emotional, mental, societal and religious jobs to guarantee the complete healing of the patient ( Donabedian, 1988 ) . In the last century nursing has made a phenomenal accomplishment that it has led to the acknowledgment of nursing as a profession and a separate educational subject. Contemporary nursing is now more meaningful and important because of theory-based pattern which shifted nursing ‘s focal point from career to an organized profession. It was research and theory together which produced nursing scientific discipline. Nursing theory fundamentally suggests that nursing should be given professional instruction during which they will analyze a aggregation of interrelated topics which will be applied in their pattern. The cognition may be derived from experimental acquisition or formal beginnings such as nursing beginnings or nursing research. Nursing is a scientific discipline affecting many pe ople environment and procedure in the context of health care. It is the duty of nursing organisation to guarantee that all wellness attention organisations may hold a sufficient PTN ratio. Overburdened nurses increase the chance of foetal mistake happening and diminish the labour cost economy. Statisticss revealed that traveling from 6:1 to 7:1 costs 1.4 extra lives lost per 1000 admittances. There are 38 million infirmary admittances per twelvemonth in the United States ( Agency for Healthcare Research and Quality, 2002 ) , therefore, little addition in PTN ratio, i.e. 7:1 to 6:1, may ensue in significant figure of lives saved. Improvement in Clinical Support Services The American wellness attention system provides first-class intervention for insured patients, but many people have hapless entree to the system, and unfairnesss have late increased due to many factors. The free market attack is seemly non an attack that could be used in a wellness attention system when there is non the engagement of all parties, such as those that are uninsured. It has been reported that the 47 million uninsured Americans without wellness insurance are mostly borne by those with insurance. The undermentioned betterments are recommended in clinical support services: ‘ Rewards the invention in efficient bringing of wellness attention ‘ Establish a well-and firmly funded entity which continuously perform research on efficiency and effectivity of drugs, wellness attention devices, diagnosing and procedures and processs of wellness attention ‘ Federal and State Torahs must be made more consistent and rational ‘ Establish Information Technology substructure in wellness attention in order to ease informations exchange ‘ Create a National wellness attention database which will be available to all the stakeholders and research workers Social and Economic footing for the growing of the Uninsured in America Several tendencies combined over the last few decennaries to make greater wellness attention unfairnesss. Both Medicaid and Medicare, for illustration, contributed to aggressively lifting medical costs because they required province authoritiess to reimburse infirmaries and doctors at ‘reasonable ‘ degrees determined by wellness attention suppliers. Predictably, reimbursement was really generous and disbursals grew rapidly. Such skyrocketing medical costs, combined with the general lethargy of the economic system put wellness attention out of range for many Americans. The loss of 1000000s of occupations during the recent economic meltdown added to the turning figure of people without medical insurance. The staying occupations ‘ progressively nonunion, portion clip places in the services sector ‘ offered few, if any wellness benefits. The Acquired Immune Deficiency Syndrome ( AIDS ) epidemic put an added load on the US wellness attention system. The disease claimed over 80, 000 lives up to 1990. Many of these patients are unemployed, and lack medical insurance, and have unmet demands beyond wellness attention, including guidance services, lodging, and transit. As the disease spreads, the costs of research, intervention, and lost productiveness add up to one million millions of dollars each twelvemonth. For these grounds force per unit area grew for wellness attention reforms in United States. Harmonizing to a study of Institute of Medicine, the future wellness policy must place further the of import maps of the policy, i.e. service, policy development and appraisal. These would besides better the overall quality of different state-owned undertakings. A panel from the platform of Institute of Medicine gave the undermentioned recommendations: ‘that every populace wellness bureau on a regular basis and consistently roll up, assemble, analyze, and do available information on the wellness of the community, including statistics on wellness position, community wellness demands, and epidemiological and other surveies of wellness jobs†¦ ‘ ‘That the public wellness responsibilities of provinces should include†¦ appraisal of demands in the province based on informations aggregation ; confidence of an equal statutory base for wellness activities ; †¦ constitution of statewide wellness aims ; †¦ confidence of appropriate organized statewide attempt to develop and keep indispensable†¦ wellness services†¦ ‘ ( Institute of Medicine, 1988 ) . Reasons for addition in wellness attention costs The steady addition of healthcare outgo coupled with the present planetary economic meltdown and lifting federal shortage makes it really dashing undertaking for United States to finance the wellness attention outgo either through private employers wellness insurance coverage or through public plans like Medicare and Medicaid. This has besides compelled the wellness insurance companies to increase their wellness insurance premium rate. Now the household premium of employer-sponsored wellness insurance has increased by 131 per centum since 1999 ( Kaiser Family Foundation and Health Research and Educational Trust, 2009 ) . Public plans like Medicare and Medicaid portion a major ball of entire wellness attention outgo duty but they failed to increase their per capita disbursement with the same gait as private insurance companies do, i.e. 6.8 against 7.1 per centum between the period 1998 to 2008 ( Altman, Levitt and Claxton, 2010 ) . Invention and Technology The promotion and invention of engineering in the field of medical scientific discipline has confirmed huge blessings on world. It draws the line between the old epoch and the modern epoch of brightness, between human retardation and advancement, between the life of wretchednesss and the era of felicity and cognition, between work forces ‘s foolish beliefs and scientific enquiry and research. The present epoch is the period of rapid alteration and inventions. New medical specialties emerged mundane to extenuate a figure of diseases. These medical specialties cut down the opportunities of coronary arteria disease, coronary artery disease, and bosom onslaught etc. Pharmaceutical and biomedical companies work indefatigably to develop medical specialties for such diseases, which considered as incurable in the past like Cancer ( Vastag, 1998 ) . Biomedical companies besides working on different vaccinums to extinguish diseases like Hepatitis C, which leads to chronic infections and liver failures ( Stratton et al. , 1999 ) . Similarly Curative vaccinum is best for forestalling malignant neoplastic diseases in general and vaccinum for villoma virus is supposed to forestall malignant neoplastic diseases of neck in peculiar. Aging Harmonizing to the US Bureau of the Census, the fastest turning section of the population in 1990 was grownups and seniors. In the twelvemonth 2000, 36 per centum of the population of the United States was over 45 old ages old, as compared to 30.8 per centum in this class in 1980. Alternatively of being youth-oriented in the hereafter, the United States will go a senior orientated civilization ( Way, 2000 ) . It has been estimated that merely 50 % of the citizens under the age bracket of 55 to 64 old ages are in work in developing states as compared to 75 % of 25 to 54 old ages old and this per centum shrinks further in EU states, i.e. merely 39 % . It is besides estimated that aging population of United States will turn about 80 per centum during the period of 2000 to 2025 ( U.S. Census Bureau, 2002 ) . Health disbursals of a individual increases as his or her age additions. However, experts believe that the factor of aging population contributes really small in the addition of wellness attention outgo ( Orszag, 2008 ) . Decision Peoples cope with life ‘s uncertainnesss, particularly mortality and disease, utilizing medical specialty. Medical scientific discipline uses non a sacred but a profane attack covering with the ordinary, platitude and layman. The hapless suffer more wellness jobs than the remainder of the society as a consequence of low quality wellness attention, more life emphasiss, and fewer get bying resources. Functionalists claim that the wellness attention establishment helps keep a strong work force, but conflict theoreticians argue that it has historically shifted the incrimination for sick wellness from the environment to the laden hapless and through medicalization has extended its control over of all time more parts of society. Even today, medical scientific discipline focal points on the person ‘s duties for illness instead than societal causes. The capitalist system causes the wellness jobs, but uses the medical establishments to get away incrimination and even net income from them. Suggested options include more authorities intercession and greater consumer instruction. The American wellness attention system provides first-class intervention for insured patients, but many people have hapless entree to the system, and unfairnesss have late increased due to many factors. This has promoted calls for reforms, including free, cosmopolitan wellness attention which most other modern states offer to their citizens. Many of these states, nevertheless, have retreated from socialized medical specialty because of lifting cost and increasing consumer demands. The free market attack is seemly non an attack that could be used in a wellness attention system when there is non the engagement of all parties, such as those that are uninsured. It has been reported that the 47 million uninsured Americans without wellness insurance are mostly borne by those with insurance. There is a measure of 2.7 trillion yearly for the cost of attention on United States economic system to care for the uninsured and about three 4th of this is paid by the Federal, State and local authoritiess through a assortment of destitute attention payments. The extra disbursals is push away on to the private sector. There are 299 million people in the United States in 2007 and out of that sum there is about 253.4 million that have wellness insurance ( Cover, 2009 ) . The huge bulk of those 202 million had private wellness insurance, harmonizing to the Census Bureau and those Numberss double as of 2009. Numerous factors combined together to make unfairnesss in United States wellness attention system. State and Federal authorities have to reimburse the wellness attention disbursals of people through Medicare, Medicaid and other authorities sponsored plans liberally which grew at a rapid gait due to the crisp addition in wellness attention cost. The present glooming economic status of United States, loss of 1000000s of occupations increased the figure of uninsured people and added more load on the already bowed down shoulders of US Government. In such a state of affairs, it seems instead, farfetched that US authorities will go on to bear wellness attention disbursal of the uninsured and underinsured people. The continuously increasing fiscal liability of supplying wellness attention services to the uninsured proved to be a hinderance which does non let the system to work decently and an hindrance to supply the wellness attention benefit to the meriting portion of the society.

Causes Of The Indian Removal Act Architecture Essay

The Indian Removal Act of 1830 was unfolded was during a clip of contradictions. While it was a period of spread outing democratic establishments, it besides pointed to obvious restrictions of that democracy. States mostly abolished belongings limitations on vote and as the Western frontier was being expanded, it meant more chances of colony for Whites. However, the Western land of promise spelled catastrophe for the Native peoples who lived with the Whites. No 1 better understood the contradictions of this age of democracy than the Cherokees, who adopted many of the white establishments merely to endure from the dictatorship of the bulk and were forced to the West against their will. In this survey, I will reply the inquiry:What were the causes of the Indian Removal Act of 1830 and what were its effects upon the Cherokee state?Before the act, the American authorities sought to educate and incorporate the Native Americans into their civilization, and the Cherokees were an illustration of the successes of assimilation. I will research why there was such a important displacement in American policies toward the Native Americans from assimilation to removal. I will besides discourse the long term effects of the Indian Removal Act that negatively altered the internal organisation of the folks and created cabals within the Cherokee state. I relied on both primary and secondary beginnings to understand both Americans ‘ and the Cherokees ‘ positions on the act. In my research, I discovered the grudges harbored by the Cherokee state when the American policies were changed and implemented. The Indian Removal Act is, without a inquiry, a Cherokee calamity, but it is besides an American calamity. The Cherokees had believed in the promise of democracy by the United States, and their letdown is a bequest that all Americans portion.Introduction:The Cherokees were merely one of the many Native Americans forcibly removed in the first half of the 19th century, but their experiences have a peculiar significance and poignance. The Cherokees, more than any other native people in their clip, tried to follow the Anglo-American civilization. In a unusually short clip, they transformed their society and modified their traditional civilization to conform to United States policies, to carry through the outlooks of white politi cians, and most significantly, to continue their tribal unity. This â€Å" civilisation † policy required a entire reorganisation of the religious and societal universe of the Cherokees. They established schools, developed written Torahs, and abolished kin retaliation. Cherokee adult females became involved in whirling and weaving while the work forces raised farm animal and deep-rooted harvests. Some Cherokee even built columned plantation houses and bought slaves. John C. Calhoun, secretary of war, writes to Henry Clay, Speaker of the House of Representatives on January 15, 1820, â€Å" ‘The Cherokees exhibit a more favourable visual aspect that any other folk of Indians. They are already established two booming schools among them. ‘ † ( Ehle 154 ) . By following the white civilization, the Cherokees hope to derive white regard. Socialization was besides a defensive mechanism to forestall farther loss of land and extinction of native civilization. Even more inexorable Cherokees steadfastly believed that â€Å" civili sation † was preferred to their traditional manner of life. The advancement of the Cherokees astounded many Whites who traveled through their county in the early 19th century. Adding to these accomplishments, a Cherokee named Sequoyah invented a syllabic script in 1820 that enabled the Cherokees to read and compose in their ain linguistic communication. They besides increased the figure of written Torahs and established a bicameral legislative assembly. By 1827, the Cherokees had besides established a supreme tribunal and a fundamental law really similar to those of the United States. Their educated work forces even attended the American Board ‘s seminary in Cornwall, Connecticut, and could read Latin and Greek every bit good as understand the white adult male ‘s doctrine, history, divinity, and political relations ( Anderson 7 ) . The Cherokees exceeded the ends proposed for the Indians by assorted United States presidents from George Washington and Andrew Jackson. In the words of a Cherokee bookman, the Cherokees were the â€Å" mirror of the American Republic. † On the Eve of Cherokee remotion to the West, many white Americans considered them to be the most â€Å" civilised † of all indigens peoples ( Anderson 24 ) . What so caused the Cherokees to be removed? Why were they forced to abandon places, schools, and churches? From demographic displacements to the rise in political cabals, the resulting struggles that originating from the Indian Removal Act of 1830 still affect the lasting Cherokee state today.Causes of the Indian Removal Act:It is of import to acknowledge that the determination of the Jackson disposal to take the Cherokee Indians to set down west of the Mississippi River in the 1830 ‘s was more a reformulation of the national policy that had been in consequence since the 1790 ‘s than a alteration in that policy. In the early old ages of the Republic, ictus of Indian land was a manner of â€Å" educating † Native Americans. First articulated by George Washington ‘s Secretary of War, Henry Knox, on July 2, 1791 in the Treaty of Holston, the policy of prehending native lands was â€Å" that the Cherokee Nation may be led to a greater grade of civilisation, and to go herders and agriculturists, alternatively of staying in a province of huntsmans. The United States will from clip to clip furnish gratuitous the said state with utile implements of farming. † On the surface, the original end of the â€Å" civilisation † policy seemed philanthropic. Making civilised work forces out of â€Å" barbarians † would profit the Native Americans and the new state every bit good as guarantee the advancement of the human race ( Bernard Sheehan,Seeds of Extinction: Jeffersonian Philanthropy and the American Indian, 119 ) . However, the policy represented efforts to wrest the Cherokee lands. Knox and his replacements reasoned that if American indians gave up hunting, their hunting evidences will go â€Å" excess † land that they would volitionally interchange for financess to back up instruction, agribusiness and other â€Å" civilized † chases ( Perdue 25 ) . For this ground, haling the Indians to yield their hunting evidences would really speed up socialization because they would no longer busy the forest when they had Fieldss to till. Thomas Jefferson, who became president in 1801, shared Knox ‘s beliefs. Jefferson ‘s negociating tactics were far more aggressive than anything Knox envisioned as Jefferson ordered his agents to escalate the force per unit area on folks to sell more and larger piece of lands of land. Soon, he let it be known that dainties, bullying, and graft were acceptable tactics to acquire the occupation done ( Anderson 35 ) . Jefferson, with his aggression, simply uncovered that these civilisation policies were non for the benefit of the Native Americans. Rather, the assimilation policy was a cloaked policy of remotion of the Native Americans by the American authorities. It is hence of import to place that the cause of the Indian Removal Act did non arise in the 1830 ‘s, but instead culminated in the early 19th century. However, more immediate grounds did do Congress to go through the Indian Removal Act of 1830 during Jackson ‘s presidential term. The factors lending to the destiny of the Cherokees were the find of gold on Cherokee land, the issue of provinces ‘ rights, and the outgrowth of scientific racism. American speculators coveted the about five million estates the Cherokee Nation refused to sell. White persons desired land for colony intents as belongings was an obvious step of wealth in the South. The Southerners besides desired more agricultural land as the innovation of the cotton gin made cotton a moneymaking concern. In add-on, invasion into Cherokee lands became more pressing with the find of gold on its land in 1829. Besides, the Americans began to encompass a belief in white high quality and the inactive nature of the â€Å" ruddy adult male † in the period after the 1820 ‘s. Many Americans concluded, â€Å" Once an Indian, ever an Indian † ( Anderson 35 ) . Culture, they believed, was innate, non learned. However â€Å" civilized † an Indian may look, he retained a â€Å" barbarian † nature. When the civilisation plan failed to transform the Indians overnight, many Americans supported that the â€Å" barbarians † should non be permitted to stay in thick of a civilised society. Though earlier in his missive to Clay, Calhoun had praised the advancement of the Cherokees, he concludes the missive authorship, â€Å" Although partial progresss may hold been made under the present system to educate the Indians, I am of an sentiment that, until there is a extremist alteration in the system, any attempts which may be made must fall short of complete success. The y must be brought under our authorization and Torahs, or they will numbly blow away in frailty and wretchedness. ‘ † The condescending tone that Calhoun takes to depict the Cherokees reveals the racist attitude of the early 19th century and sheds light onto one of the grounds why Americans urged Congress to take Indians from their fatherlands. In this racialist ambiance of Georgia, another critical cause of remotion was provinces ‘ rights. Although the Cherokees saw their fundamental law as a crowning accomplishment, Whites, particularly Georgians, viewed it as a challenge to provinces ‘ rights because the Cherokee district was within the boundaries of four provinces. The 1827 Cherokee Constitution claimed sovereignty over tribal lands, set uping a province within a province. Georgians claimed that such a legal manoeuvre violated the United States fundamental law and that the federal authorities was making nil to rectify the state of affairs. Sympathetic the Georgians calls was Andrew Jackson, who became president 1829. As a follower of the Republican philosophy of province sovereignty, he steadfastly supported a national policy of Indian remotion and defended his base by asseverating that remotion was the lone class of action that could salvage the Native Americans from extinction. Jackson ‘s attitude toward Native Americans was sponsoring, depicting them as kids in demand of counsel and believed the remotion policy was good to them. To congressional leaders, he assured them that his policies would enable the federal authorities to put the Indians in a part where they would be free of white invasion and jurisdictional differences between the provinces and federal authorities. He sought congressional blessing of his remotion policy and stated to Captain James Gadsden in October 12, 1829 that the policy would be â€Å" generous to the Indians † and at the same clip would let the United States to â€Å" exert a parental control over their involvements and perchance perpetuate their race. † Though non all Americans were convinced by Jackson ‘s and his confidences that his motivations and methods were philanthropic, Congress passed the Indian Removal Act in 1830 that allowed: 1 ) the federal authorities the power to relocate any Native Americans in the E to district that was west of the Mississippi River ; 2 ) the president to put up territories within the Indian Territory for the response of folks holding to land exchanges, and 3 ) the payment of insurances to the Indians for aid in carry throughing their relocation, protection in their new colonies, and a continuation of the â€Å" supervision and attention. †Effectss of the Indian Removal Act:The Removal Act of 1830 left many things unspecified, including how the remotion of the eastern Indian states would be arranged. During Jackson ‘s disposal, one of the most of import Cherokee groups that decided to go forth was led by the powerful Ridge household. At the beginning of the battle against remotion, the Ridge household steadfastly supported Chief John Ross, one of the elective leaders of the folk. Ross and his people besides believed that the Cherokees ‘ old ages of peace, accomplishments, and parts gave them the right to stay on land that was lawfully theirs. However, the Ridges shortly decided that the battle to maintain the Cherokee lands in the East was a lost cause. Major Ridge had been one of the first to acknowledge that Indians had no hope against Whites in war. Two cabals so developed within the folk – the bulk, who supported Chief Ross in his battle to maintain their fatherland in the East, and the Treaty Group, who thought the lone solution was to emigrate to the West. Rather than lose all they had to the provinces in the East, the Ridge party, without the consent of Ross, signed the Treaty of New Echota in December 1835. They treaty conveyed to the United States all lands owned, claimed, or possessed by the Cherokee Nation E of the Mississippi River. Major Ridge explained his determination to give up the Cherokee fatherland stating, â€Å" We can non remain here in safety and comfort†¦ We can ne'er bury these places†¦ I would volitionally decease to continue them, but any physical attempt to maintain them will be us our lands, our lives and the lives of our kids ‘ † ( Gilbert 21 ) . By Cherokee jurisprudence, the folk owned all land in common, no person or minority group had a right to dispose of it. Army officer Major William Davis who was hired to inscribe the Cherokees for remotion, wrote the secretary of war that â€Å" nine-tenths † of the Cherokees would reject the Treat of New Echota: â€Å" That paper called a dainty is no pact at all † ( Gilbert 23 ) . However, on May 17, 1836, the Senate ratified the Treaty of New Echota by one ballot, and on May 23, President Jackson signed the pact into jurisprudence. The deadline for remotion of all the Cherokees from the East was set for May 23, 1838. The Treaty of New Echota was non an honest or just understanding between the United States and the Cherokee state. Even Georgia governor William Schley, admitted that it was â€Å" non made with the countenance of their leaders † ( Ehle 244 ) . However, in January 1837, about six hundred affluent members of the Treaty Party emigrated west, a full twelvemonth before the physical exile of the remainder of the Cherokees. Cherokee remotion did non take topographic point as a individual ejection but alternatively spanned many old ages. In the late summer of 1838, a withdrawal of Cherokees began to go out the stockade where they had been held for many months expecting the long journey to their new place West of the Mississippi. Some Cherokees had voluntarily moved west, though most remained in their fatherlands, still non believing they would be forced to go forth. In 1838, the Cherokees were disarmed, and General Winfield Scott was sent to supervise their remotions. John G. Burnett, a soldier who participated in the remotion described the event stating, â€Å" Womans were dragged from their places by soldiers. Children were frequently separated from their parents and driven into the stockades with the sky for a cover and the Earth for a pillow. And frequently the old and inform were prodded with bayonets to rush them to the stockades † ( Ehle 393 ) . Those forced from their fatherland departed with heavy Black Marias. Cherokee George Hicks lamented, â€Å" We are now about to take our concluding leave and sort farewell to our native land, the state that the Great Spirit gave our Fathers†¦ It is with sorrow that we are forced by the white adult male to discontinue the scenes of our childhood † ( Anderson 37 ) . For Cherokees, the Georgian land had significance far deeper than its commercial value. Their civilization and creative activity tied them to this topographic point, and now they were being compelled to give up their places and March West. Above all, Cherokees lost religion in the United States. In one Kentucky town, a local occupant asked an aged Indian adult male if he remembered him from his service the United States Army in the Creek War. The old adult male replied, â€Å" Ah! My life and the lives of my people were so at interest for you and your state. I so thought Jackson my best friend. But ah! Jackson no service me right. Your state no make me justice now! † ( New York Observer, January 26, 1839, quoted in Foreman 305-307. ) Exposure and weariness during the exile weakened immune systems, doing the Cherokees susceptible to diseases such as rubeolas, whooping cough, dysentery, and respiratory infections. The figure of Cherokees who perished on the Trail of Tears, the name given to the 826 stat mi path taken took them west, is difficult to find. The most normally cited figure for deceases is 4,000, about one one-fourth of the Cherokees, and is an estimation made by Dr. Elizur Butler, a missional who accompanied the Cherokees ( Anderson 85 ) . By his ain count, John Ross supervised the remotion of 13,149, and his withdrawal reported 424 deceases and 69 births along with 182 abandonments. A United States functionary in Indian Territory counted 11,504 reachings, a disagreement of 1,645 when compared to the sum of those who departed the East. Sociologist Russell Thorton has speculated that remotion cost the Cherokees 10,000 persons between 1835 and 1840, including the kids that victims would hold produced have they survived ( Anderson 93 ) . Therefore, the overall demographic consequence was far greater than the existent figure of casualties. When the Ross withdrawals arrived in the spring of 1839 to the Indian Territory, melding with the â€Å" Treaty Party † who left before the physical remotion was a daunting undertaking. Removal had shattered the matrix of Cherokee society, rending them from their hereditary beginnings and agitating their infant establishments of authorities. Civil war burst away as the political chasm brought on by the Treaty of New Echota divided the Cherokee Nation. For more than a decennary, the Cherokee fought this bloody civil war, and a deformed version of the old kin retaliation system reemerged. In June 1839, between six and seven thousand Cherokees assembled at Takatoka Camp Ground to decide the looming political crisis. Chief John Ross insisted on the continuance of the eastern Cherokee authorities for several grounds. The Cherokee Nation had a written fundamental law and an luxuriant jurisprudence codification and authorities, and they did represent a significant bulk. However, the United States saw the Treaty Party as true nationalists, Ross as a scoundrel, and the recent emigres as â€Å" barbarians, † queering all attempts to accommodate the divided cabals in the Cherokee state. When the meeting ended with a via media to be voted on a ulterior day of the month, 150 National Party work forces met in secret and decided that the Cherokees who had signed the Treaty of New Echota were treasonists who had violated the Cherokee jurisprudence forbiding the unauthorised sale of land. Early on the forenoon of June 22, one group dragged John Ridge from his bed and stabbed him to decease. Another party shooting Major Ridge as he traveled along a route in Arkansas, killing him immediately. About the same clip, a 3rd group came to Elias Boudinot ‘s house and divide his caput with a hatchet. Reacting to these Acts of the Apostless of force, the Treaty Party remained opposed to any authorities dominated by the National Party. They held their ain councils and sent delegates to Washington to seek federal protection and the apprehension of the individuals responsible for the violent deaths. Most of the Treaty Party continued to defy the act of brotherhood and bitterly op posed any grant to the National Party, widening the turning political chasm. However, every bit long as the National Party refused to sign the Treaty of New Echota, the patriot Cherokees were refused payment of its rentes and financess by the federal authorities. The comparative prosperity of the Treaty Party members ignited the hibernating bitternesss of the destitute Cherokees who had suffered the torment of the Trail of Tears ( McLoughlin 17 ) . In order to confirm the sovereignty of the Cherokee Nation and to relieve the agony of his people, Ross pressed for a renegotiation of the deceitful Treaty of New Echota. While Ross was in Washington in the summer of 1842, force in the Cherokee Nation escalated as members of the Treaty Party began killing persons who they believed had been responsible for the decease of their leaders. Gangs began to assail and kill other Cherokee citizens, most of whom were identified with the National Party, but became impossible to separate between political force and common offense. The Starr pack, for illustration, coalesced ar ound James Starr, a signer of the Treaty of New Echota. Under the pretense of political opposition, Starr ‘s boies and others terrorized the Cherokee state. In 1843, they murdered a white visitant to the Cherokee Nation and besides burned down the place of John Ross ‘ girl. The force gave the federal authorities an alibi to maintain military personnels at Fort Gibson, decry the inefficaciousness of the Nation ‘s authorities and tamper further in Cherokee personal businesss. The Treaty Party renewed their hope of sabotaging Ross ‘ authorization since federal functionaries tended to fault Ross for the slaughter ( Perdue 156 ) . The letters during the clip of this Cherokee civil warfare reflected the fright and anguish felt by the people. In November 1845, Jane Ross Meigs wrote to her male parent, Chief John Ross, â€Å" The state is in such a province merely now that there seems small encouragement for people to construct good houses or do anything. I am so nervous I can scarce compose at all. I hope it will non be long you ‘ll be at place but I hope that the state will be settled by that clip excessively † ( Rozema 198 ) . Less than a twelvemonth subsequently, Sarah Watie of the Treaty Party wrote her hubby, â€Å" I am so tired of populating this manner. I do n't believe I could populate one twelvemonth longer if I knew that we could non acquire settled, it has wore my liquors out merely the ideas of non holding a good place†¦ I am absolutely ill of the universe † ( Perdue 141 ) . An uneasy peace came to the Cherokee Nation after the United States authorities forced the tribal cabals to subscribe a pact of understanding in Washington in 1846. The Cherokees, under Ross ‘ leading was to be sovereign in their new land. It besides brought the per capita payments so urgently needed for economic recovery of the Cherokee Nation. However, with this pact, the Cherokees were caught in a series of contradictions. Cherokee leaders wanted to convert the white population that they were capable of pull offing their ain personal businesss if left to their ain self-determination. But economically, they were tied to the fiscal assistance of the federal authorities, turning of all time more dependent on American financess. Furthermore, in thick of this â€Å" peace, † the Cherokees could non project aside old frights that continued to stalk them. If Whites could drive them from Georgia, why non from this topographic point? From this fright spawned an attitude of mis giving toward the American authorities that is still present in some Cherokee societies today ( Anderson 115 ) .Decision:The causes of the Indian Removal Policy of 1830 are legion and varied in reading. Some historiographers have equated Jackson ‘s remotion policy with Adolph Hitler ‘s Final Solution and hold even called it genocide ( Peter Farb ‘sThe Indians of North America from Primeval Times to the Coming of the Industrial StateNew York: E. P. Dutton, 1968 ) . Not merely did he promote the geographical separation of Indians and Whites, but 1000s of Native Americans perished in the procedure. Whether or non he advocated this mass extinction of Indians, Jackson on the political forepart was a steadfast protagonist of province sovereignty and could non deny Georgia ‘s rights to the Cherokees ‘ expansive lands. In add-on to the impact on the Cherokee demographics, the Treaty of New Echota caused cabals within the Cherokee Nation that broke truenesss and caused them to return back to old kin retaliation warfare. The bitterness that was fostered between the New Party and the Treaty Party created permanent divisions within the Cherokee state. Furthermore, the Cherokee Nation, before the Indian Removal Act, had prided itself on the fact that it had adapted to white establishments with great grades of success. However, prosecuting in kin warfare, the Cherokees took a measure back in advancement when embroiled in such force that was chiefly caused by the Treaty of New Echota. Furthermore, the Cherokees remained dependent on federal authorities ‘s economic aid when they were seeking to turn out that they could work better as a soverign state. The remotion of the Cherokees west of the Mississippi is one of the greatest calamities in United States history. While the Cherokees have shown unbelievable resiliency in retrieving from the decimating effects of their remotion, the unfairness they faced from deceitful pacts, ethnocentric intolerance, and prejudiced Torahs will forever discoloration America ‘s history.

Foundations of Psychology Essay Example | Topics and Well Written Essays - 1000 words

Foundations of Psychology - Essay Example Through systematic observation of one's own conscious experience, subjects were exposed to different visual stimuli, optical illusions and auditory tones, and then made to analyze what they experienced ("Timeline," n.d.). Functionalism evolved as a reaction to structuralism. This school of thought was greatly influenced by the work of William James, the father of American psychology, and the evolutionary theory of Charles Darwin (Wagner, n.d.[b]). Functionalism was a more systematic and accurate method than structuralism in that the former focused on the purpose of consciousness and behavior while the latter focused on the elements of consciousness. Functionalism gave due consideration to individual differences, with a great deal of impact on education, supporting the view that "children should learn at a level for which they are developmentally prepared" (Wagner, n.d.[b]). According to behaviorism, all behaviors are acquired through conditioning, which happens through interaction with the environment, and behavior can be studied in a systematic, observable manner regardless of internal mental states (Wagner, n.d.[c]). There are two types of conditioning. Classical conditioning is a method whereby a naturally occurring stimulus is paired with a neutral stimulus so that eventually the latter evokes the same response as the former without the presence of the former. Operant conditioning uses rewards and punishments for behavior. Behaviorism does not consider free will or internal factors like moods, feelings and thoughts. The theory does not consider learning that does not use rewards and punishments. The adaptability of an individual in the face of new information is also not considered. Psychoanalysis, founded by Sigmund Freud, focused on the influence of the unconscious mind on behavior (Wagner, n.d.[a]). The six basic assumptions of the psychoanalytic theory are that unconscious mental processes exist, that all human behavior is motivated and purposeful, that past experiences influence current changes and reactions, that personality functioning is very complex and can be understood through the Id, Ego and Superego, that thinking processes involve energy, strength and force, and that human behavior is influenced by interaction with the environment ("Timeline," n.d.). Humanists like Carl Rogers consider people to be basically good or healthy and they see mental health as the normal progression of life; any distortion to this natural tendency is called self-actualization. According to Rogers, people naturally know what is good for them, and what leads them astray is the society with its conditions of worth, often leading to discontent when they do not reach the standards applied to them by others. This disparity between the real self and the ideal self is called incongruity (Boeree, 2003). A healthy individual involves the following qualities: openness to experience; living in the present; organismic trusting, doing what feels right and comes natural; freedom and taking responsibility for one's choices; and creativity. Gestalt psychology evolved in response to the

Frederick Douglass Essay Example | Topics and Well Written Essays - 750 words

Frederick Douglass - Essay Example Colonel Lloyd himself, the boss of Anthony and the wealthiest slaveholder in Maryland whose plantation was known as the Great House Farm had cruel overseers himself who would brutally beat slaves. But the cruelest of the slaveholders in Douglas narrative all was Edward Covey, the famous â€Å"slave breaker† who had the perversion of taking pride in taming the slaves. According to the narrative of Frederick Douglas, â€Å"Mr. Covey had acquired a very high reputation for breaking young slaves, and this reputation was of immense value to him. It enabled him to get his farm tilled with much less expense to himself than he could have had it done without such a reputation† [53]. Thus, this reputation was deliberately concocted by Mr. Covey in order to profit from the slave by making them till his land at a lesser cost under the pain of fear. Douglass also portrayed his masters as hypocrites particularly Edward Covey who had the pretension of righteousness by donning the mantle of Christian religiosity. In Douglass narrative, Mr. Covey was singled out as the exemplar of slave owner’s hypocrisy of pretending to be a good and charitable man but in fact oppresses another human being through slavery and worst, brutally maltreats the slaves with the pride of breaking them. In Douglass words, â€Å"Mr. Covey, he was a professor of religion—a pious soul—a member and a class-leader in the Methodist church. All of this added weight to his reputation as a â€Å"nigger-breaker† [53]. ... It may sound strange but in Douglass eyes, Mr. Covey’s religiosity did not impress him but rather compounded his anxiety as it added to Mr. Covey’s reputation as â€Å"nigger breaker†. Douglass also portrayed slaveholders to be greedy and unjust. This portrayal was present in his narrative in the characters of his favorite tormentor Mr. Covey, the wealthy landowner Colonel Lloyd and his benign master Thomas. Mr. Covey deliberately instilled fear among slaves with his reputation as â€Å"nigger breaker† to short change them in tilling his lands. Colonel Lloyd on the other hand would provide meager allowances to his slaves while overworking them. Thomas is more subtle in his ways of letting Douglass find employment by calking but still, he was unjust to Douglass. He let Douglass work but his earnings in calking goes to Thomas. Douglass bitterly resented this set up with his narrative that â€Å"He received all the benefits of slaveholding without its evils; while I endured all the evils of a slave, and suffered all the care and anxiety of a freeman. I found it a hard bargain. But, hard as it was, I thought it better than the old mode of getting along [84]. But just when he thought that Thomas was different of all the slaveholders in a sense that he do not beat them, he was proven wrong when he came home late from work because the remittance of his earnings was also given late to Thomas. Douglas recalled â€Å"I found him very angry; he could scarce restrain his wrath. He said he had a great mind to give me a severe whipping [84]. Almost unanimously, almost all slaveholders in Douglas narrative were either cruel or unjust except of a little exception in the person of Mrs. Auld who did not maltreat him. In fact, in her kindness, she offered to

The Holistic Assessment Process Based on the Goal of Facilitating Essay

The Holistic Assessment Process Based on the Goal of Facilitating Recovery - Essay Example This paper shall first present an overview of the clinical presentation of the service user. Secondly, it will identify the needs of the service user required to achieve recovery. Lastly, it shall present a critique of my involvement in the assessment process and how this reflected the principles of recovery. Body Overview Mrs. Smith is 46 years old, and was admitted to the mental health unit after she accused her son of apparently spying on her. She also attempted to slash her wrists claiming that there were some implants there placed by government agents spying on her. She is married and has been for the past 20 years and has been a math teacher at a local community college for the past 10 years and before that, has worked as an analyst with the Federal Bureau of Investigation (FBI). She has three children, all grown and she is living with her husband and one of her children. She has an IQ of a genius and has had no known history of any mental illness. For the past ten years howeve r, she expressed that sometimes she has often felt depressed, but did not seek professional mental health. Her husband declares that he also noticed his wife being paranoid about other people spying on them. He also shared that he thinks his wife is sometimes speaking to someone that he could not see, and that when he asked her who she was talking to, she said she was talking to her friend. She also believes that she is secretly working for the FBI and is sending and interpreting coded messages for them. She also believes that as a result of her work with the FBI, Russian spies want to kill her and so she is suspicious of every mail man or stranger that knocks on their door. As a result of her delusions, she was asked to take a sabbatical leave of absence from her work and to seek mental help. She is however in major denial over her mental health, insisting that what she sees and what she believes are all real. Two weeks prior to her current admission, after her husband left for wor k, she locked herself in the house and refused to open it to anyone. She drew the curtains and turned off all the lights. She then went to the bathroom and locked herself, taking with her a baseball bat to serve as a ‘weapon’ to ward off any supposed attackers. Her son came over to check on her and when he could not get in the door, used his key to get in the house. When his mother was not answering his calls, he then checked every room and found the bathroom door locked. He also heard his mother telling him to go away and leave her alone. Worried that his mother is hurt, he kicked the bathroom door open and as soon as he did, his mother started hitting him with the baseball bat. After subduing his mother, he called the emergency services for assistance. She was later referred to the mental health unit after the health professionals considered a possible mental health affectation. Assessment of needs In assessing the patient’s needs, I evaluated her ability to ca rry out her daily activities, mostly in relation to self-care (functional needs) (Velligan, et.al., 2004). I also evaluated her family situation, especially in relation to potential family caregivers who can supervise her care and assist her in her daily activities and support her during her recovery period. I also assessed her psychological health and emotional health, interviewing her and her family while asking pertinent questions relating to her feelings and her ability to cope with stress (Popescu and

Kentucky Fried Chicken Corporation Essay Example | Topics and Well Written Essays - 3000 words

Kentucky Fried Chicken Corporation - Essay Example Thus, it is in line with this that KFC should understand further everything about its strategy development. It should understand the necessary things it needs to know as product of its strategy process. Finally, it should be able to define and understand the specific contexts in which its strategy should be embedded. Global operation is one of the modern trends applied in modern operations strategy (Waters, 2006). This is the reason why Kentucky Fried Chicken Corporation (KFC) had become so aggressive with its global expansion strategy. This strategy enabled KFC to become the world’s largest chicken restaurant chain and in general the third largest food chain in the world (Krug, 2004). In fact, it is known to have around 14,000 restaurants in more than 100 countries including China, Japan, Canada, Great Britain, Australia, South Africa, Malaysia, Mexico, Indonesia, South Korea and Philippines. Franchise and joint ventures are integrated with the whole business system of KFC in order to allow local business people to handle since they know better the external and internal environments of their respective markets. This paper tries to understand more about the strategic operation of KFC Corporation by incorporating various analytical concepts in strategic development and management. The entire analysis is placed in the context of international fast food industry. ... This paper tries to understand more about the strategic operation of KFC Corporation by incorporating various analytical concepts in strategic development and management. The entire analysis is placed in the context of international fast food industry. SWOT and Porter’s value chain SWOT technique SWOT stands for strength, weaknesses, opportunity and threats in which it is a simple management technique which draws information together prior to decision-making process (Murdock et al., 2003). A SWOT analysis is composed of understanding both internal and external factors within an organization prior to knowing its major advantages and disadvantages. It is a non-complex way of identifying specific details in the business operation in order to understand the extent in which an organisation holds its competitive advantage or knowing the necessary steps to be taken further for improvement of the operation. This technique is very relevant in the case of KFC especially among its strate gic planners because they will be given opportunity to outline the internal and external factors affecting the whole operation of the business. Shown in figure 1 below are internal and external factors within the present environment of KFC. This is a good evaluative technique prior to formulating effective strategies because the strategic planners in this case seek to understand both the internal and external factors affecting the business environment of KFC. Figure 1. SWOT Analysis KFC (Internal and external factors) Internal factors Strengths Weaknesses Product offering Brand image/good-tasting and highly accepted recipes Many substitute products in the market Competitive advantage High market share Not culturally

Contributions to Organisation Theory Essay Example | Topics and Well Written Essays - 2000 words

Contributions to Organisation Theory - Essay Example In general, the ideas underlying Taylor’s vision of organization, management, and motivation were based on certain conditions supposed to be constant. These were the presence of a capitalist system and a money economy, the Protestant work ethic and desirability of the increased size for obtaining the advantages of the division of labor and specialization of tasks. While classical writers concentrated more on the formal elements of organization, the next generation of organizational theorists was much concerned with social factors of work and human relations between the workers. One of the representatives of this generation is George Elton Mayo who is known for his active participation in the Hawthorne experiments which were carried out at the Hawthorne Works of the Western Electric company in Chicago in the period of 1924 and 1927. The studies aimed to reveal the effect of lighting on the worker productivity. However, in the process of experiments, there were discovered other factors which contributed to higher productivity of workers under research. The result of the experiment was that Elton Mayo disproved the beliefs of Tayor that a worker was motivated only by self-interest. The investigation was based on the classical approach and researchers were interested in how the intensity of lighting influenced the productivity of women workers. In the process of experiment, it was discovered that the production depends little on the physical conditions. The experiment was continued in another direction.

Mixture and a compound Essay Example | Topics and Well Written Essays - 1250 words

Mixture and a compound - Essay Example Explanation following electrons transfer between the donor and receptor atoms that form cations and anions is also given. Documentation of covalent bonds, their formation details and types, polar and non polar, covalent bonds are briefly mentioned with some examples given. It also expresses how covalent bonds form between atoms of a molecule in a single and from different elements. Keywords: Mixtures, Compound, Element, Substance, Cation, Anion, Atoms, Molecules, Bonding, Covalent Bonds, Ionic Bond, Shared Electrons, Electron, Properties A mixture is a matter of impure substances made of either two or more homogenous pure substances (compounds or elements), brought together physically (Syamal, 2007). The components inside a mixture at a single moment vary relatively; hence, they are not fixed. The key properties of mixtures are that they don’t have fixed properties and that no new substance is formed in the combination; reason being that their property is dependent on combinat ion fraction and nature of the constituents where properties of constituents are similar to those of the mixture. Just as it is formed, its constituents can also be split by physical methods like sedimentation, decantation, distillation and chromatography among others. On the contrary, compounds are pure substances, consisting of two or more components, just like mixtures, but chemically merged together to create a new substance with different properties from its constituents. At any single moment the components of a compound exist in fixed ratios. They have fixed properties without having to rely on constituents’ properties. Its constituents can be split through chemical reactions and not physical methods. Components of a compound are held together by strong covalent bonds unlike in mixtures, whose components are held loosely by weak forces. Elements and compounds are pure substances, but unlike compounds, elements cannot be split further. According to Stoker ( 2012, p.16) à ¢â‚¬Å"a pure substance can be classified as either an element or a compound on the basis of whether it can be broken down into two or more simpler substances by chemical means.† In the event where compounds are heated or broken down, it produces simpler substances that had been used to create it. An element consists of atoms of a homogeneous type that are kept close together by bonds. There exist a hundred and seventeen recognized elements where less than thirty of them, have been developed in the laboratory by bombard smaller units with naturally occurring elements. However, they are radioactive and can easily revert back into their natural existing elements. When a pure substance is broken down, and there exist presence of hetero-atomic molecules, then the substance is a compound since the atoms are different indicating presence of different elements. Elements contain mono-atomic molecules. In chemistry, litmus papers have been used to test the presence of acids and bases wh ich are compounds. While reviewing a sample, qualitative analysis reveals whether it is an element or a compound present in the sample. Examples are electrophoresis used in DNA pattern identification, chemical tests and X Ray Crystallography. Ionic bonds forms mostly between metals and non metals (cations that are positively charged and anions that hold a negative charge). Metals will always react to loose free electrons in the outer shell while non metals gain them. These types of bonds are very

Guilt vs Acceptance Essay Example for Free

Guilt vs Acceptance Essay The power and impact that guilt can have on one’s life can be a positive and negative experience depending on how the individual deals with their situation and whether or not they learn a lesson from their mistake. The novels A Separate Peace by John Knowles and Fifth Business by Robertson Davies share the theme of guilt in their storylines through events and relationships but differ as to how to the characters cope with their reactions through reflection and confrontation. A Separate Peace tells the story of a young boy by the name of Gene Forrester who in an act of jealousy and competitiveness pushes his friend Phineas out of a tree. Fifth Business surrounds the character Dunstan Ramsay, who as a child, ducks a snowball with a rock hidden within thrown at him by his friend Guy. The snowball hits Mary Dempster at the back of the head, causing her brain damage and the premature birth of her baby Paul Dempster. Both plots surround two men who look back at their lives and how a single negative event affects their childhood. What would appear to be an insignificant moment of the past evolves into a lifelong mental scar that poisons the characters with guilt and the desire for acceptance. The novels’ protagonists share encounters in childhood fueled by competitive friendships; however, Gene Forrester accepts responsibility for his actions and is able to move on while Dunstan Ramsay does not and lets his memories and guilt plague his life. The two novels are similar in the aspect that both Gene Forrester and Dunstan Ramsay are involved in childhood incidents that curse them with guilt. In the novel A Separate Peace, Gene Forrester subconsciously moves the branch he and his physically and socially superior friend Finny are standing on. Finny falls and is heavily injured and the casualties lead to his early death later on. â€Å"†¦and then my knees bent and I jounced the limb. Finny, his balance gone, swung his head around to look at me for an instant with extreme interest, and then he tumbled sideways, broke through the little branches below and hit the bank with a sickening, unnatural thud† (Knowles 60). Gene Forrester feels solely responsible for this terrible accident and feels extremely guilty. â€Å"If Phineas had been sitting here in this pool of guilt, how would he have felt, what would he have done? (Knowles 66). In the novel Fifth Business, a rich and jealous enraged friend Percy Boyd Staunton pursues Dunstan Ramsay. When Percy throws a rock concealed in a snowball at Dunstan’s head he ducks and lets it strike the pregnant Mary Dempster. This accident is the cause of the premature birth of Paul Dempster and the destruction of Mr. and Mrs. Dempster’s marriage and family. â€Å"I stepped briskly†¦in front of the Dempsters just as Percy threw, and the snowball hit Mrs. Dempster on the back of the head† (Davies 2). Dunstan feels responsible for Mrs. Dempster’s mental health, Paul Dempster’s physical health, and their ruin as a family. â€Å"I was contrite and guilty, for I knew the snowball had been meant for me, but the Dempster’s did not seem to think that† (Davies 3). Both characters suffer from these self-inflicted negative occurrences and struggle with the realization of what they have done and how it affects those involved. Another similarity between A Separate Peace and Fifth Business is that both Gene Forrester and Dunstan Ramsay have intimate friendships infused with jealousy and competition. These poisoned relationships both ignite the impactful events that occur in their childhoods. Gene feels in constant competition with Finny, who appears to be good at everything. â€Å"That way he, the great athlete, would be way ahead of me. It was all cold trickery, it was all calculated, it was all enmity† (Knowles 53). He is superior in appearance, physical capability, personal stamina and respect gained from popularity amongst the other boys at the school. â€Å"I couldn’t help envy him that a little, which was perfectly normal. There was no harm in envying even your best friend a little† (Knowles 25). Dunstan knows that Boy Staunton wishes to be the best in everything. He aspires to be the most handsome, most successful in a romantic relationship, most successful in a career and most popular. â€Å"Percy Boyd Staunton†¦the only man who accepted his watch with an air†¦it was a fine effect, and as I grinned and clapped, my stomach burned with jealousy† (Davies 97). He feels aggressive resentment for Boy as he lives the life that Dunstan secretly wishes he could himself. â€Å"Boy wore a gorgeous pullover of brownish-red†¦and his demeanor was that of the lords of creation. A pretty girl with shingled hair and rolled stockings that allowed you to see delightful flashes of her bare knees was with him, and they were taking alternate pulls on a flask that contained, I am sure, something intoxicating†¦I was filled with a sour scorn that I now know was nothing but envy†¦I didn’t really want the clothes, I didn’t really want the girl or the booze, but it scalded me to see him enjoying them†¦Ã¢â‚¬  (Davies 113). The two novels capture the intensity of the character’s conflicted relationships with their closest friends as their constant struggle for a balance between hatred and respect fails to cease. The novels A Separate Peace and Fifth Business differ from each other within the main character’s thoughts and reflections on their memories. Gene Forrester accepts jostling the tree limb so Finny would fall, but understands the particular incident as a fragment of the past with no lasting effect on his life. Dunstan Ramsay however, remains attached to his guilt and responsibility for letting the snowball hit Mrs. Dempster and his actions haunt him for the remainder of his days. Gene Forrester revisits his old school and although experiences memories of fear from the past, it is only an echo not a current emotion. â€Å"Looking back now across fifteen years, I could see with great clarity the fear that I have lived in, which must mean that in the interval I had succeeded in a very important undertaking: I must have made my escape from it† (Knowles 10). He has not severed his feelings of regret towards the incident nor does he see Finny’s untimely death as unimportant but instead is able to appreciate his strong connection with this part of his past and can learn from his childhood errors. He understands that the experience matured him and was a crucial step in the climb of growing up. Gene visits the site where Finny fell with confidence and seeks the gratification of knowing that those years trapped at Devon school with an injured friend are behind him. â€Å"This was the tree, and it seemed to me standing there to resemble those men, the giants of your childhood, whom you encounter years later and find that they are not merely smaller in relation to your growth, but that they are absolutely smaller, shrunken by age† (Knowles 14). Dunstan Ramsay on the other hand, does not revisit sites from his past every 15 years but instead dedicates his entire life to the study of Saints and Mary Dempster’s impact on his life. He does not permit himself assessment of his child-self’s mentality during the accident and therefore, is never able to gain the satisfaction of learning from his mistakes. â€Å"Ramsey†¦You have paid such a price, and you look like a man full of secrets-grim-mouthed and buttoned-up and hard-eyed and cruel, because you are cruel to yourself. It has done you good to tell what you know; you look much more human already† (Davies 220). Instead of visiting places of his past or confronting those involved with his childhood, he sees his memories through a haze of anger and anxiety. An event that should have seemed insignificant and even negligible after so many years, is still important to him in his daily life and the emotions he felt 40 years ago have not changed but intensified. The fear and guilt he felt as a child is still fresh in his mind. â€Å"Cursing what seemed to be a life sentence†¦my association with Mrs. Dempster†¦It was as though I were visiting a part of my own soul that was condemned to live in hell† (Davies 182). The two characters, although faced with similar situations, choose different paths for their lives, which separate them from each other. A final contrast between the characters Gene Forrester and Dunstan Ramsay in the novels A Separate Peace and Fifth Business is the difference in their reaction to the event in their past. Both Gene and Dunstan suffer guilt about a single action in their childhood. Gene confronts his emotions and immediately tells Finny what happened, while Dunstan keeps the truth of the event a secret. While Finny is still recovering from his fall, Gene immediately visits Phineas after the accident and tells him the truth. Although he feels he makes things worse, it gives him a peace of mind and helps him to move on. â€Å"Finny, I’ve got something to tell you. You’re going to hate it, but there’s something I’ve got to tell you†¦This is the worst thing in the world† (Knowles 66-67). Gene is able to move past his guilty conscience of causing Finny’s fall and is able to focus his attention to mentally recovering and pushing forward in life. †¦in spite of everything, I welcomed each new day as though it were a new life, where all past failures and problems were erased, and all future possibilities and joys open and available, to be achieved probably before night fell again† (Knowles 105). Dunstan however, bottles up his thoughts and emotions concerning the events that occurred on the night Mrs. Dempster was hit on the back of t he head with a snowball. He does not tell anyone about the stone in the snow until the later years of his life. â€Å"Nevertheless this conversation reheated my strong sense of guilt and esponsibility about Paul, the war and my adult life had banked down that fire but not quenched it† (Davies 136). Dunstan keeps everything to himself and seeks out no help for his troubled mind and the stories and truths that are trapped within it. â€Å"The snow-in-the-snowball has been characteristic of too much you’ve done for you to forget it forever! † (Davies 270). The two outcomes of the two character’s lives is a reflection of how they handle the injury of the innocent and how they come to face the consequences of what they have done. The novels A Separate Peace and Fifth Business both display the lives of men who suffer a great deal in their childhood from unhealthy friendships and a singular bad event. Gene Forrester and Dunstan Ramsay share similarities in the occurrences of their lives but differentiate from each other in how they dealt with it. Gene faces his victim Finny with the truth of the accident, being that he deliberately jounced the limb so his superior friend would fall, and is therefore granted elation from his confession and a peace of mind. Gene matures free of guilt and the residue of the horrific event is but a memory he can briefly recall in his mind but not linger on. Dunstan Ramsey takes a different route, and on a downwards-spiraling path of shame, he lives a solitary life, left to face his childhood troubles every day, making ancient memories a constant reality. He matures with many emotional scars and does not feel any release from his inner torments. In conclusion, the two novels depict contrasting scenarios of self-reproach, one displays a character’s positive liberation of guilt and one shows a character’s negative manifestation of guilt.

Miser to Man of the city in a Christmas Carol Essay Example for Free

Miser to Man of the city in a Christmas Carol Essay Scrooge is not very well like by the Cratchits. You can see this by I wish I had him here. Id give him a piece of my mind to feast upon and I hope hed have a good appetite for it. This shows that he is not liked because he is an odious, stingy, hard, unfeeling man. This make Scrooge feel bad and he learns a valuable lesson. Treat others as you wish to be treated. If he doesnt want to be called bad tempered, money grabbing, old sinner, then we has to be caring and thoughtful. Scrooge every year at his nephew Freds house, is invited to a Christmas party, but always turns it down. Scrooge is not very well liked by the people at the party especially Fred. You can tell this by they invent a new game called yes or no. This shows that Scrooge is talked behind this back and that people do not care if they hurt his feeling. Scrooge feels unwanted and uncared for. You can tell this by One half hour, Spirit, only one. This shows that Scrooge has feeling and he wants to go as soon as possible because he crying and in great disbelief. Scrooges future looks uncertain when he goes into the future and sees him in a corner of the graveyard, unnoticed, uncared for. You can from this point that Scrooge is at the end of his tether. You can tell this by For the first time his hand appeared to shake. This shows that Scrooge has become more and more frightened and knows he must change his future to be cared for and missed dearly. He does not breakdown till this point because he can not change the past and that does not bother him. At the end of all the spirits visiting Scrooge is disappointed himself by being a selfish, lonely, old man. The Last straw is when he visits his own grave. He is already depressed with the entire trauma and another dig in his grave has made him tremble in fear. You can tell this by The Spirit stood among the graves, and pointed down to one. He advanced towards it trembling. This shows that Scrooge is scared of him and wants to change rather than just a person who has just died. Scrooge really wants to change because he doesnt want to be the man in the corner that no one visits. You can tell this by Are these the shadows of the things that will be, or are they the shadows of the things that may be, only. This shows that Scrooge wants to change because of his experiences over the night. He wants to know that if he changes and mingles with people he will not die and nobody will care. He gets more and more distressed because the spirit wont tell him if he can change his shadows of the future. You can tell this by Assure me that I yet may change these shadows you have shown me, by an altered life. He is on his knees, desperately trying to change his future. This tells us from this point onwards Scrooge will be a changed man to avoid distressing death. Scrooge wakes up the next morning a changed man, a generous man. You can tell this by Scrooge regarded everyone with a delighted smile. This shows that Scrooge has took into great account of what the spirits said and gone out to change his future. He is a changed man to the public. You can tell this by If you please, said Scrooge and not a farthing less. A great many back-payments are included in it, I assure you This shows Scrooge as being as kind, thoughtful, caring man rather than a squeezing, wrenching, grasping, scraping, clutching covetous old sinner. Scrooge now respects the poor people more than ever, especially the Cratchits. You can tell this by and therefore I am about to raise your salary. This shows that Scrooge would rather share more of his money to make more people happy than just himself. This is different from the beginning because when the gentleman comes to visit he pushes him away and believes in Laissez Faire. Scrooge has now become a happier and more cheerful human being because he has changed his way of living. You can tell this by they all sit around the table eating Christmas dinner. This shows he is not self-contained, lonely old sinner, but a sociable character and because he changed his actions, Tiny Tim did live and Scrooge and his family say God bless Us, Everyone!

Assessment Of Selected Resorts In Cavite Province Biology Essay

Assessment Of Selected Resorts In Cavite Province Biology Essay Resorts in the province of Cavite are recognized for its reputable recreational waters. These resorts are intended to provide prospective customers with an atmosphere of amusement, entertainment and relaxation. The most common types are beach resorts, swimming pool, and even lakes and rivers which are designed to accommodate individuals, group of peers and family members (Bago and Linantud 2004). Also recreational waters offer activities that are beneficial and substantial to overall health. Recreational waters can be contaminated and polluted by bacteria, viruses and protozoan parasites (Bitton 1999), although the recreational water is normally treated physically and chemically using filtration and chlorination to prevent growth and infection of some bacteria (Montano and Abear 2000). However there are was an increasing number of cases of acute gastroenteritis during this summer and one group of microbes leading to their disease are enteric bacteria. Bacteria such as Escherichia coli and Pseudomonass aeruginosa that are resistant and tolerant to chlorine and were known to cause human misery (Mann 2005). Enteric Bacteria are said to be notorious and dangerous because they cause recreational water illness like acute gastroenteritis, cholera, pneumonia, typoid fever, diarrhea, urinary infection, pneumonia, dermatitis, salmonellosis and otitis external these disease leads to outbreaks (Yoder 2008). Escherichia coli and Pseudomonas aeruginosa are among those bacteria that can thrive in recreational waters and transmitted from swallowing and inhaling contaminated water before the microorganisms can be destroyed by pool water disinfectant (Barwicks et al. 1999). Also their resiliency to grow in some disinfectants like chlorine because they are capsulated bacteria and they possess a versatile metabolic activity, which makes gives them the resistance to a variety of physical conditions (Cappuccino 2005). The presence of these organisms in dicates contamination by pathogenic microorganism. Most waterborne diseases are related to pollution of water resources sources and thus pose an unacceptable health risk for swimmers (Schets et al. 2010). Therefore the need to examine water samples in a microbiological water aspect is essential to ensure safety to swimmers. This study is conducted to support if the selected resorts in Cavite whether chlorinated and non-chlorinate is contaminated with pathogenic microorganism that can lead to potential waterborne diseases. 1.2 Conceptual Framework The water districts ensure the potability of drinking water by increasing the concentration of Chlorine (Yoder 2008). This potable drinking water were also used in resorts. Monthly sampling of water samples in pools render negative in enteric bacteria. However there is an increasing cases of gastroenteritis for the past year. The paradigm of the present study is as follows : Microbial Status in Chlorinated and non- chlorinated waters from selected resorts Water samples from resorts (pools, streams, rivers and beaches) ed The objective of this study is to gather different water samples obtained from selected resorts and determine the microbial status regardless of its chlorine concentration levels. 1.3 Statement of the Problem This study will aim to determine the microbial status in selected resorts in Cavite. To determine specifically the following objectives: 1. What is the microbial status jpresent in chlorinated and non -chlorinated water in selected resorts in Cavite? 2. Is there a significant difference in the total count of enteric bacteria and total bacteria among chlorinated and non-chlorinated waters in selected resorts in Cavite? 3. Is there a correlation between chlorine concentration in the resorts and water samples in lakes, rivers and beaches? 1.4 Scope and Delimitation The study will determine microbial status in selected resorts in Cavite, Province. Water samples will be taken from these selected resorts and chlorine content concentration will be determined using chlorine test kits. It is not the aim of the study to apply antibacterial agent in enteric bacteria recovered from water analysis. 1.5 Significance of the Study This study is designed to find out the microbial status on the selected resorts in Cavite, Philippines. This research hopes to benefit the following concerned population: Resort clientele to be more concerned to the areas that they went to and be prepared since traditional vaccines are not reliable in killing these bacteria because they are risky and are only effective after several years. Resort Administrators and Maintenance personnel for the enhancement of facilities of the swimming pool to promote the preventive measures against proliferation of microorganism which are recognized to be health risk problems and compliance to the water quality standards. Academe who may use this as preliminary information for their future research endeavors and information in survival of bacteria in different environmental conditions. 1.6 Definition of Terms Microbial status this refers to the bacteria present in chlorinated and non-chlorinated waters from selected resorts. Prevalence the number of samples that rendered positive in culture method over the total number of samples. Enteric Bacteria these are large group of gram-negative bacteria that are known to produce disease in the alimentary tract. Enteric bacteria that survived in chlorinated waters of resorts. Resorts it is considered to be swimming pools, streams, river, lakes and beaches with chlorine. Microbial Density- The population or the measurement of the growth of the bacteria. Microbial Plating- This refers technique used to isolate a pure  strain  from a single species of microorganism plating method that will be performed in laboratory. Total Bacteria bacteria other than enteric bacteria. API Kit- This refers to the biochemical test that will determine the isolated bacteria from water samples. Chlorination- this is a water purification method to make water safe to humans and a disinfecting agent that prevents the spread the spread of waterborne diseases Chlorine test kit- This refers to the chemical test that will determine the chlorine concentration level of water. Chromogenic Media This refers to the culturing media that will determine the present bacteria in water. CHAPTER 2 REVIEW LITERATURES 2.1 Conceptual Literatures Recreational water Recreational waters can be classified as fresh water swimming pools, whirlpools and naturally occurring fresh marine surface waters. Infectious disease which can be transmitted by recreational water includes skin, eye and ear infections and gastroenteritis. Consequently the level of microorganism in recreational water are important for indexing their health hazard associated with swimming and since the recreation classification includes bathing, swimming etc. any organism transmitted to humans can be regulated. The best indicators in the assessment of the safety of swimming pool water is to become aware of the types of hazard (microbiological, chemical and physical) that can impact a bathing area. Some researchers emphasize that the microbiological quality of swimming pools are best measure by identifying the bacteria present in that recreational water such as fecal coliform and enterococci, while others consider that the disease and symptoms it brought to the bathers rather than fec al contamination (Martin et al. 1995). (Montano and Abear 2000) cited that the bacteria suggested as indicators of recreational water quality include a wide variety of pathogenic bacteria and non-pathogenic microorganism such as coliform groups, species of Pseudomonas, Streptococcus, Staphylococcus and in rare case Legionella. The presence of single coliform organism is not a ground for condemning water as a unit for human consumption. It is the relative abundance of these organisms, which is important. According to Papadopoulou et al. (2007) cited that non-fecal human shedding (e.g. from vomit, mucus, saliva or skin) in the swimming pool is also a potential source of pathogenic organism. Bathers who are already infected can directly contaminate pool waters with pathogen which may affect other bathers, who come in contact with the contaminated water. Opportunistic pathogens (mainly bacteria) can also be shed from user and transmitted via contaminated water. Also certain free living aquatic bacteria and amoebae can possibly grow not just in pool waters but also with pool components or facilities or on other wet surfaces within the facility which may cause infections or disease. Therefore swimming pools are often associated with outbreaks or incidents of waterborne infection. Murdoch(1975) as cited by Amador and Amante (2001) mentioned that disease contracted from water kill some 25million people, most of them children each year, while many millions more are debilitated by waterborne diseases. Fecal contamination of water can introduce a variety pathogens into water waste, including bacteria, viruses, protozoans and parasitic worms. Waterborne related diseases have been recognized by Classes. Class 1, refers to the true waterborne disease contracted by drinking water. Class 2 are diseases associated with lack of personal hygiene which can be reduced by providing adequate amount of water for bathing and washing. To control such diseases, people should be provided with sufficient water of reasonable quality; achieving a high bacteriological quality is a secondary consideration. Enteric bacteria A large, heterogenous group in the family Enterobacteriaceae, include several closely related genera of short and spore forming, gram-negative rods, facultative anaerobic, that inhabit or produce disease in the alimentary tract of warm-blooded animal. This family are notorious as causes of urinary tract infection and are recovered from a variety of clinical specimens taken from diseased foci other than in the gastrointestinal tract. The enterobacteria are probably responsible for more human misery than any other group.(Smith 2008) Escherichia coli It is a gram negative rod shaped bacterium. It was originally known as bacterium coli. It is widely distributed in the intestine of humans and warm- blooded animals and is the predominant facultative anaerobe in the bowel part of the essential intestinal flora that maintains the physiology of the healthy host. The presence of E.coli is associated with bather-associated illness, but its absence cannot be equated with the lack of risk of illness (Guidelines for Canadian Recreational Water Quality available at http://www.ecy.wa.gov1992). Pathogenicity performs coliform bacilli usually do no penetrate intestinal wall to produce disease unless (1) the intestinal wall becomes diseased, (2) resistance of the host is lowered, or (3) virulence of the organism is greatly increased. Under one of these conditions of coliforms may pass to abdominal cavity or enter into the bloodstream. Once outside the intestinal canal and in the tissues of the body their virulence is remarkably enhanced. Among the diseases that they cause are pyelonephritis, cystitis, cholecystitis, abscesses, peritonitis, and meningitis. They may play a part in the formation of gallstones and are found in the cores of such stones. In peritonitis complicating intestinal perforation the coliform group is joined by such organisms as streptococci and staphylococci. From any focus of inflammation coliform organism may enter the bloodstream to produce a septicaemia. (Smith 2008) Shigella Dysentery caused by the Shiga bacillus (Shigella dysenteriae) is much more severe than that from the other organisms, since this bacillus produces a powerful exotoxin- like substance in addition to an endotoxin. The exotoxin- like substance seems to be liberated by bacterial disintegration, and as a neurotoxin, It acts on the nervous system to paralyze the host. The endotoxin irritates the intestinal canal. The dysentery bacilli are gram negative, nonsporebearing rods that grow on all ordinary media at temperatures from 10 ° to 42 ° C. but best at 37 ° C they are aerobic and facultative anaerobic. Unlike most other members most other member of the enteric group, they are non-motile. In terms of pathogenicity dysentery is a human disease and natural infections of the lower animals do not occur. The incubation period is 1 to 7 days. Epidemic dysentery is primarily an intestinal infection. Unlike typhoid bacilli, the organisms do no invade the bloodstream and are seldom if ever found in the internal organs or excreted in the urine. They are excreted in the feces. Compared to that for other enteric pathogen, the number of ingested shigellas for infection is small, only 10 to 100. (Smith 2008) Salmonella Among the large number of pathogenic microorganisms causing foodborne disease, Salmonella plays an important role. An analysis of Salmonella surveillance data from the World Health Organization (WHO) showed that the reported number of cases increased in 22 out of 49 countries examined. Although the reason for the global increase is not yet clear, investigations in individual countries suggest that it is related to consumption of eggs and poultry that harbour the organism. Besides control measures there is a need for rapid and sensitive methods for the detection of Salmonella (Beumer et. al, 1991). Salmonella is a ubiquitous enteric pathogen with a worldwide distribution that comprises large number of serovars characterized by different host specificity and distribution. This microorganism is one of the leading causes of intestinal illness through the world as well as the etiological agent of more severe systemic diseases such as typhoid and paratyphoid fever. Zoonotic salmonellae are commonly described as foodborne pathogens however; drinking water as well as natural waters is known to be an important source for the transmission of these enteric microorganisms. Salmonella, just like other enteric bacteria, is spread by the fecal-oral route of contamination. This microorganism can enter the aquatic environment directly with feces of infected humans or animals or indirectly, e.g., via sewage discharge or agricultural land run off. Overall Salmonella spp. and subspecies can be found in a large variety of vertebrates. Beside humans, animal sources of Salmonella include pets, farm animals and wild animals; calves, poultry, pigs, sheep as well as wild bird (pigeon) and reptiles can all be reservoirs of Salmonella. Plants, insects and algae were also found capable of harboring Salmonella and might be implicated in the transmission of this enteric pathogen. Taxonomically the genus Salmonella comprises two species namely S. bongori and S. enterica. The species S. enterica is further differentiated in to six subspecies (enterica, salamae, arizonae, diarizonae, indica and houtenae) among which the S. enterica subspecies enterica is mainly associated to human and other warm blooded vertebrates. Enteric fevers, typhoid and paratyphoid fever are severe, contagious systemic diseases caused by the infection of the serovars typhi and Paratyphi. Differently from other Salmonella serovars, typhi and Paratyphi are host adapted and can only infect humans; stools of infected persons are therefore the original source of contaminations for these pathogens. Water contaminated with feces of human cases and carriers is one of the main vehicles of typhoid fever infections. Literature data related to water-borne salmonellae in developing countries relate mostly the typhoid Salmonella serovars. In the less industrialized area of the world, in particular in the Indian subcontinent and South East Asia, typhoid and paratyphoid fevers occur both in epidemic and endemic form, and remain a major public health problem. The burden of typhoid fever worldwide is further compounded by the spread of multiple drug resistant S. typhi. Most of the recent publications on typhoid and paratyphoid fever water-borne infections in developing countries are from the Asian continent. Differently from typhoidal Salmonella strains, non-typhoidal salmonellae, the ubiquitous subtypes found in a number of animal species, are more frequently associated to foodborne than to water-borne transmission. These zoonotic Salmonella serovars tend to cause acute but usually self-limiting gastroenteritis (Levantesi et al, 2011). According to (Smith 2008)The pathogenicity of salmonella is called salmonellosis, the major site of which the lining of the intestinal tract. Because of their toxic properties every known strain of salmonella can cause anyone three types of salmonellosis: (1) acute gastroenteritis of the food type infection.(2) septicemia or acute sepsis with localized complications similar to pyogenic infections, and (3) enteric fever such as typhoid or paratyphoid fevers. Salmonella typhi A short motile nonencapsulated bacillus, S.typhi grows luxuriantly on all ordinary media. It grows best under aerobic conditions bit may grow anaerobically. The temperature range growth is from 4 ° to 40 °C., the optimum, 37 °C. typhoid bacilli can survive outside the body, living about 1 week in sewage contaminated water and not only living but multiplying in milk. They may be viable in fecal matter for 1 or 2 months. They are pathogenic because of their endotoxins. Their pathogenicity causes typhoid fever is an acute infectious disease with continuous fever, skin eruptions, bowel disturbances, and profound toxemia. Except in the first few days, leukopenia is always present in uncomplicated cases, probably because typhoid bacilli depress the bone marrow, where normal production of white blood cells occurs. Leukocytosis in the course of the disease signals complication. (Smith 2008) 2.2 Related Studies According to Brown (2009), gram-negative intestinal pathogens have a diverse population of bacteria of which two of the enteric intestinal pathogens that are of prime medical concern are the salmonella and shigella. The salmonella and shigella are both pathogenic bacteria that cause typhoid fever and human dysentery, respectively. Since the gram-negative intestinal pathogens has a such diverse population it has many genera of species like the Escherichia, Proteus, Enterobacter, Pseudomonas, and Clostridium that exists on large numbers, hence it is necessary to use media that are differential and selective to favor the growth of the pathogens since all of the species can be divided into lactose fermenting and non-lactose fermenting bacteria. Hiriart et al. (2001) worked on the Helicobacter pylori and Other Enteric Bacteria in Freshwater Environments in Mexico City. They observed that all samples analyzed showed the presence of enteric bacteria with or without the presence of H. pylori, indicating that water from these sources is a potential health risk for gastrointestinal diseases. The major positivity of H. pylori coincides with the major positivity of indicator and other enteric bacteria, which are both associated with contaminated water. In another study Marion et al. (2010) worked on the association gastrointestinal illness and recreational water exposure at an inland U.S beach. Relationships between water quality indicators and reported adverse health outcomes among users of a beach at an inland U.S lake was observed to be a significant risk factor for GI illness. . Papadopoulo et al.(2008) worked on the microbial quality of indoor and outdoor swimming pools in greece. They found out that three indoor swimming pools and two outdoor swimming are present with bacteria, protozoa and fungi Such as Multi-resistant Pseudomonas alcaligenes, Leuconostoc, and staphyloccus aureus( isolated from teaching pool), Staphylococcus werneri. Chryseobacterium indologenes and Ochrobactrum anthropic (isolated from completion pools) Pseudomonas aeruginosa, P. fluorescens, Aeromonas hydrophila, Enterbacter cloacae, Klebsiella pneumonia and S. aureus (isolated from the hydrotherapy pool and A. hydrophilla (isolated from the hotel pool) were related to water outbreaks. Schets et al. (2010) worked on the exposure assessments for swimmers in bathing waters and swimming pools. they found out that the swallowed volume or water appears different for men, women, and children, but also in fresh water, seawater and swimming pools also the frequency and duration of swimming do also differ for men, women, and children and in different water types, and provide a basis for the identification of high risk population under specific circumstances, e.g. due to their extended water contact and frequent head submersions, children may be more prone to contract otitis external due to Pseudomonas aeruginosa infections. Certainly a waterborne infection depends on the total bacterial counts, the immune status of the subjects, and polluted waters. The results of the past studies demonstrate the variability of the recreational water quality and the need for continuous monitoring. Chapter 3 METHODOLOGY Research Design This study will use descriptive study design that involves in the identification of enteric bacteria in selected resorts in the Cavite province. There will be 20 sampling sites, 10 from swimming pools, 5 from rivers or lakes and 5 from beaches. In every sampling site there will be a total of 1 sample that will be gathered and it will be replicated into three and a total of 60 sterilized bottles with cover will be used for the 4-month period of experiment that will be done during the summer season and the rainy season. Research Setting The entire study will be conducted for 12 weeks. The identification of total bacteria and enteric bacteria will be done in Biology Research Laboratory of DLSU-D. Research Procedure Water Sample Collection (MicroMed Environmental, 2010) Sterilized 300ml wide-mouthed glass will be used in the collection of samples. Water samples will be obtained from recreational waters. The sterile containers will be plunge into the water surface until 1 foot below. Then open the bottle towards the direction of the current to allow the container to fill. Afterwards, it will be immediately sealed tightly and placed on a cooler to maintain the temperature. The samples will be obtained during the months of april and june of 2012. The chlorine concentration will also be measured using Hach Test Kit for chlorine. Chromogenic Media for Bacteria Undiluted samples will be used in the determination of total bacteria. Briefly one milliliter of sample will be spread plated onto Plate Count Agar. The plates will be incubated at 37 °C for 24 hours. Colonies that will grow will be converted into colony forming units and will be correlated to chlorine concentration and compared to enteric bacteria. For the detection of enteric bacteria the samples will be enriched in buffered peptone water for 24 hours. After 24 hours the enriched samples will be spread plated onto Salmonella-Shigella Agar and Eosin Methylene Blue Agar. Colonies resembling to enteric bacteria will be purified and confirmed using API 20E kit. Determination of the Microbial Count (BioMà ©rieux, 2002) Preparation of incubation box and inoculum will be done for the strip. In the inoculation of the strip, filling both tube and cupule of tests CIT, VP and GEL with bacterial suspension as for the remaining tests fill only the tube and not the cupule. In creating anaerobiosis ADH, LDC, ODC, H2S and URE should be overlay with mineral oil. The incubation box will be incubated for 37 °C for 24 hours. Certain color reactions will happen for the indication of positive or negative result. Data Gathering Colonies in the EMBA and PCA will be characterized using colonial characterization which includes size, form, margin, elevation, consistency, surface and pigmentation (Tabo, 2005). Biochemical test include ONPG, ADH, LDC, ODC, CIT, H2S, URE, TDA, IND, VP, GEL, GLU, MAN, INO, SOR, RHA, SAC, MEL, AMY, ARA, OX. The chlorine concentration will be measured in 0-600 mg/L. Statistical Treatment To determine the correlation between chlorine concentration and total bacteria and enteric bacteria, a simple correlation will be used. All statistical analysis will be conducted in STATA 9.0 with 0.05 as level of significance. APPENDIX A GANTT CHART APPENDIX B BUDGET PROPOSAL Item Volume/Mass Estimated Price (PhP) Quantity Expense (PhP) EQUIPMENTS AND KITS Biomerieux Inc Biomerieux API 20E KIT 100g Pack of 100 20160 13000.00 1 13000.00 Hachs Chlorine Test Strips, 0-600mg/L Pack of 2890200 876.31 1 876.31 AGARS Salmonella-Shigella Agar 50 g 500.00 1 500.00 Eosin Methylene Blue Agar 50 g 500.00 1 500.00 Plate Count Agar 500.00 1 500.00 TOTAL 15376.31 APPENDIX C LETTER TO THE HOSPITAL March 13, 2012 Ms. Teresita E. Guevarra Medical Records Head De La Salle University Medical Center Dear Ms. Guevarra: Greetings in the name of St. John Baptist De La Salle! We are writing to ask permission from you in getting information that we will need for our thesis defense on the upcoming December 2012. We are Human Biology major students from De La Salle University-Dasmarià ±as and we are going to conduct a study regarding the possible prevalence of enteric bacteria in selected resorts in Dasmarià ±as, Cavite. Regarding this, we would like to request for the following information: Reported cases of salmonellosis and acute gastroenteritis in this hospital for the last two years (2010 and 2011) We are hoping for your positive response towards our request. If ever the information we need will not be available today, you may contact us at 09164745448 and 09272546946. Thank you very much for your time. Sincerely, Ron Matthew A. Flores John Paul A. Flores Noted by: ____________________ _____________________ Mrs. Hazel Ann L. Tabo Dr. Carmelita C. Cervillon BSD Faculty, DLSU-D (Thesis Adviser) College Dean, DLSU-D _____________________ Ms Cherry Z. Cuevas, MS BSD Chair, DLSU-D APPENDIX D COLOR REACTION TESTS RESULTS (negative) + RESULTS (positive) ONPG colorless yellow ADH Yellow red/orange LDC Yellow red/orange ODC Yellow red/orange CIT pale green/yellow blue-green/blue H2S colorless/gray black deposit URE Yellow red/orange TDA Yellow brown-red IND Yellow red (2 min.) VP colorless pink/red (10 min.) GEL no diffusion of black black diffuse GLU blue/blue-green yellow MAN blue/blue-green yellow INO blue/blue-green yellow SOR blue/blue-green yellow RHA blue/blue-green yellow SAC blue/blue-green yellow MEL blue/blue-green yellow AMY blue/blue-green yellow ARA blue/blue-green yellow OX colorless/yellow violet LITERATURE CITED Amador RM, Amante PP. Detection and isolation of coliform bacteria in Laguna de Bay Brgy. Landayan San Pedro Laguna; 2001. p.67. Bago CEM, Linantud JF, Ortiz MP. Stability and Profitability of Resort Business in Dasmarinas, Cavite. 2004. P.1-2-ix-29. Barwicks RS., Levy DA., Craun GF., Beach MJ., Calderon RL. 2000. Surveillance for water borne-Disease Outbreaks-united-states ,1997-1998 CDC Brown, A. E. 2005. Bensons Microbiological Applications 9th Edition, McGraw Hill, New York. Beumer, R.R., et al., 1991. Enzyme-linked immunoassays for the detection of Salmonella spp.: a comparison with other methods, Elsevier Science Publisher, B.V. 0168-1605/91 Carteciano JA., 2004. Four Emerging Bacteria: So Tiny, So deadly. National Research Council of the Philippines. Hammer Sr. M, Hammer Jr. M. Water and waste water technology. New Jersey; 2004.p.140 Levantesi, C., et al., 2011.Salmonella in surface and drinking water: Occurrence and water-mediated transmission, Food Research International, doi:10.1016/j.foodres.2011.06.037; Mann, D. Beware of Recreational Water Illnesses, WebMD. [Internet]. 2005 [cited 2011 December 28]. Available from HYPERLINK http://www.webmd.com/fitness-exercise/features/beware-of-recreational-water-illnesses Marion, J., et al., 2010.Association of Gastrointestinal illness and recreational water exposure at inland U.S beach, water research international; Martin, M., et al., 1995.Assessment of microbiology quality for swimming pools in South America. MicroMed Environmental, Inc. [Internet]. 2010 [cited 2012 March 25]. Available from HYPERLINK http://www.igmicromed.com/docs.html Montano JM, Abear R. 2000.Detection of Pseudomonas aeruginosa in relation to microbial population of selected swimming pools in dasmarinas cavite. De la Salle University Dasmarinas. p.52. Schets F., et al., Exposure Assessment of swimmers in bathing water and swimming pools, water research. 2010. Tabo, Norbel A. 2005. Laboratory Manual in Microbiology, Rex Bookstore Inc, Manila. p. 63-67 Yoder JS., Hlavasa MC., Craun GF., Hill V., Roberts V., Yu PA., Hicks LA., Alexander NT., Calderon RL., Roy SL., and Beach MJ.2008. Surveillance for waterborne disease and outbreaks associated with recreational water use and other aquatic facility- associated health events-united states 2005-2006- CDC.