Banquo and Macbeth Essay

Banquo’s Ghost appearing at the banquet is a graphic manifestation of the guilt that Macbeth feels. Since, Lady Macbeth needs to make excuses for Macbeth’s interaction with the ghost of Banquo means that the ghost is only visible in Macbeth’s eyes. During Macbeth’s coronation banquet, Lady Macbeth pulls Macbeth asides and asks him the reason behind his inappropriate behavior. Macbeth becomes angry because Lady Macbeth robustly accuses him of lying. When Lady Macbeth calls Macbeth a liar he replies, â€Å"If I stand here, I was him†(3.4.89). Trying to convince Lady Macbeth of what he saw, Macbeth has to prove to himself that he witnessed Banquo interrupt the feast. Baquo’s ghost is a figment of Macbeth’s guilt. Macbeth tries to convince himself that he sees a ghost and is not going mad. After realizing he is truly the only one seeing Banquo’s ghost Macbeth comes to the conclusion that â€Å"This [seeing Banquo’s ghost] is more strange / Than such a murder is†(3.4.98-99). Fear cuts deeper than a sword. Similar to his earlier epiphany, Macbeth accepts the fact that Banquo is dead on Macbeth’s account. When Macbeth returns to the table he proposes a toast that, â€Å"I drink to th’ general joy o’ th’ whole table / And to our dear friend Banquo, whom we miss†(3.4.108-109). Now, in a stage of acceptance, Macbeth is able to tame the million thoughts fighting in his head. Macbeth is in a state of denial. To insure himself that he is not going insane, Macbeth tells Banquo’s Ghost that â€Å"Thy bones are marrowless; thy blood is cold / Thou hast no speculation in those eyes / Which thou dost glare with†(3.4.114-116). Similar to when Macbeth tells his wife he saw a ghost, Macbeth tries to remain sane. We are not exposed to our real personality until something really awful happens. Once something bad happens all of the useless things fall away until we are left with who we really are. Work Cited Shakespeare, William. Macbeth. Ed. Barbara A. Mowat and Paul Werstine. Folger ed. New York City: Simon & Schuster, 1992. Print.

Deception Point Page 6

As the PaveHawk settled onto the runway beside the President's plane, Rachel now understood the references to Air Force One being the commander-in-chief's â€Å"portable home court advantage.† The machine was an intimidating sight. When the President flew to other countries to meet heads of state, he often requested – for security purposes – that the meeting take place on the runway aboard his jet. Although some of the motives were security, certainly another incentive was to gain a negotiating edge through raw intimidation. A visit to Air Force One was far more intimidating than any trip to the White House. The six-foot-high letters along the fuselage trumpeted â€Å"UNITED STATES OF AMERICA.† A female English cabinet member had once accused President Nixon of â€Å"waving his manhood in her face† when he asked her to join him aboard Air Force One. Later the crew jokingly nicknamed the plane â€Å"Big Dick.† â€Å"Ms. Sexton?† A blazer-clad Secret Serviceman materialized outside the chopper and opened the door for her. â€Å"The President is waiting for you.† Rachel got out of the chopper and gazed up the steep gangway at the bulging hull. Into the flying phallus. She had once heard the flying â€Å"Oval Office† had over four thousand square feet of interior floor space, including four separate private sleeping quarters, berths for a twenty-six-member flight crew, and two galleys capable of providing food for fifty people. Climbing the stairway, Rachel felt the Secret Serviceman on her heels, urging her upward. High above, the cabin door stood open like a tiny puncture wound on the side of a gargantuan silver whale. She moved toward the darkened entryway and felt her confidence starting to ebb. Easy, Rachel. It's just a plane. On the landing, the Secret Serviceman politely took her arm and guided her into a surprisingly narrow corridor. They turned right, walked a short distance, and emerged into a luxurious and spacious cabin. Rachel immediately recognized it from photographs. â€Å"Wait here,† the serviceman said, and he disappeared. Rachel stood alone in Air Force One's famous wood-paneled fore cabin. This was the room used for meetings, entertaining dignitaries, and, apparently, for scaring the hell out of first-time passengers. The room spanned the entire width of the plane, as did its thick tan carpeting. The furnishings were impeccable – cordovan leather armchairs around a bird's-eye maple meeting table, burnished brass floor lamps beside a continental sofa, and hand-etched crystal glassware on a mahogany wet bar. Supposedly, Boeing designers had carefully laid out this fore cabin to provide passengers with â€Å"a sense of order mixed with tranquility.† Tranquility, however, was the last thing Rachel Sexton was feeling at the moment. The only thing she could think of was the number of world leaders who had sat in this very room and made decisions that shaped the world. Everything about this room said power, from the faint aroma of fine pipe tobacco to the ubiquitous presidential seal. The eagle clasping the arrows and olive branches was embroidered on throw pillows, carved into the ice bucket, and even printed on the cork coasters on the bar. Rachel picked up a coaster and examined it. â€Å"Stealing souvenirs already?† a deep voice asked behind her. Startled, Rachel wheeled, dropping the coaster on the floor. She knelt awkwardly to retrieve it. As she grasped the coaster, she turned to see the President of the United States gazing down at her with an amused grin. â€Å"I'm not royalty, Ms. Sexton. There's really no need to kneel.† 7 Senator Sedgewick Sexton savored the privacy of his Lincoln stretch limousine as it snaked through Washington's morning traffic toward his office. Across from him, Gabrielle Ashe, his twenty-four-year-old personal assistant, read him his daily schedule. Sexton was barely listening. I love Washington, he thought, admiring the assistant's perfect shape beneath her cashmere sweater. Power is the greatest aphrodisiac of all†¦ and it brings women like this to D.C. in droves. Gabrielle was a New York Ivy Leaguer with dreams of being a senator herself one day. She'll make it too, Sexton thought. She was incredible-looking and sharp as a whip. Above all, she understood the rules of the game. Gabrielle Ashe was black, but her tawny coloring was more of a deep cinnamon or mahogany, the kind of comfortable in-between that Sexton knew bleeding heart â€Å"whites† could endorse without feeling like they were giving away the farm. Sexton described Gabrielle to his cronies as Halle Berry's looks with Hillary Clinton's brains and ambition, although sometimes he thought even that was an understatement. Gabrielle had been a tremendous asset to his campaign since he'd promoted her to his personal campaign assistant three months ago. And to top it all off, she was working for free. Her compensation for a sixteen-hour workday was learning the ropes in the trenches with a seasoned politician. Of course, Sexton gloated, I've persuaded her to do a bit more than just work. After promoting Gabrielle, Sexton had invited her to a late night â€Å"orientation session† in his private office. As expected, his young assistant arrived starstruck and eager to please. With a slow-moving patience mastered over decades, Sexton worked his magic†¦ building up Gabrielle's trust, carefully stripping away her inhibitions, exhibiting tantalizing control, and finally seducing her right there in his office. Sexton had little doubt the encounter had been one of the most sexually gratifying experiences of the young woman's life, and yet, in the light of the day, Gabrielle clearly regretted the indiscretion. Embarrassed, she offered to resign. Sexton refused. Gabrielle stayed on, but she made her intentions very clear. The relationship had been strictly business ever since. Gabrielle's pouty lips were still moving. â€Å"†¦ don't want you to be lackadaisical going into this CNN debate this afternoon. We still don't know who the White House is sending as opposition. You'll want to peruse these notes I typed.† She handed him a folder. Sexton took the folder, savoring the scent of her perfume mixed with the plush leather seats. â€Å"You aren't listening,† she said. â€Å"Certainly am.† He grinned. â€Å"Forget about this CNN debate. Worst case scenario, the White House snubs me by sending some low-level campaign intern. Best case scenario, they send a bigwig, and I eat him for lunch.† Gabrielle frowned. â€Å"Fine. I've included a list of the most probable hostile topics in your notes.† â€Å"The usual suspects no doubt.† â€Å"With one new entry. I think you might face some hostile backlash from the gay community for your comments last night on Larry King.† Sexton shrugged, barely listening. â€Å"Right. The same-sex marriage thing.† Gabrielle gave him a disapproving look. â€Å"You did come out against it pretty strongly.† Same-sex marriages, Sexton thought in disgust. If it were up to me, the faggots wouldn't even have the right to vote. â€Å"Okay, I'll turn it down a notch.† â€Å"Good. You've been pushing the envelope a bit on some of these hot topics lately. Don't get cocky. The public can turn in an instant. You're gaining now, and you have momentum. Just ride it out. There's no need to hit the ball out of the park today. Just keep it in play.† â€Å"Any news from the White House?† Gabrielle looked pleasantly baffled. â€Å"Continued silence. It's official; your opponent has become the ‘Invisible Man.'† Sexton could barely believe his good fortune lately. For months, the President had been working hard on the campaign trail. Then suddenly, a week ago, he had locked himself in the Oval Office, and nobody had seen or heard from him since. It was as if the President simply could not face Sexton's groundswell of voter support.

Evaluation of Foreign Modes of Market Entry Essay

Evaluation of Foreign Modes of Market Entry - Essay Example These are export, license and franchise, alliance, joint venture, and wholly owned subsidiary. Each mode will be discussed and analyzed in the subsequent paragraphs. In evaluating, we will find which among these modes would be the best entry strategy for our car manufacturer who wants to take advantage of the low cost of production and seek new market opportunities elsewhere. The company may choose any of these modes to enter a new market and the thing that could constrain them is the degree of control, reasons that could produce different strategies of market participants as discussed below. Exporting increases profitability. Some companies found exporting ideal because of advantages of increased profitability, spreading risks, economies of scale, and enhanced innovation (Dun & Bradstreet). Exporting means a firm’s sales of goods or services produced in the home market and sold in the host country through an entity in the host country (Investopedia. n.d.). Export increases pr ofitability because lifestyles and habits are different from each country, thus it opens up the wider opportunity for products and services much more for products that have reached declining stage in the local market, or demand has diminished. Exports are one of the oldest forms of trade and occur on a large scale basis between two countries that have fewer barriers to trade. The growth of car exports has been observed in China in 2012 reaching 1,056,091 units, an increase of 29% from 2011. Most of their exports go to emerging countries (â€Å"Top Chinese Automakers†.2013). Exporting allows the company to spread the risks US market is swamped with various car models, making it...China is one of the emerging economies today. It is predicted that in the distant future, it will overshadow the United States as a leading economy because these multinationals are eyeing on this country for market entry. My study offers four modes of entry and a richer definition for each mode. Next, I related the advantages and disadvantages for each. Literature review suggests various modes that coincided with my view. Strong findings that I put forward in the study prove that joint venture is the more popular mode of entry; that firms go into a joint venture to avoid too many legal restrictions of the host country and as an easy access. Control is significant in all modes of entry. Weighing things over, exporting has the least degree of control, followed by licensing, alliance, and joint venture while the highest form of control is the wholly owned subsidiary. The decision, however still depends on the ultimate objective of the foreign company in entering a foreign market.

WEstern Civilization prior to 1660 Essay Example | Topics and Well Written Essays - 750 words

WEstern Civilization prior to 1660 - Essay Example By the end of the Greek period, many significant achievements had been made in science and philosophy. Greek thinkers had gained a view of a universe in which the world was round and participated in an intricate dance through the heavens with other bodies named after the gods they revered. Sophistication in mathematics led to the development of geometry which enabled the ancient Greeks to discover even more, including how to determine direction while at sea and scientists were beginning to investigate the elements of earth, air, fire and water (Williams, 1999). Engineers were beginning to understand the physics of the earth’s natural processes and put them to effective use while others were learning more about anatomy and medicine to better heal their sick or, more probably, wounded. However, much of this came to an end when the Greeks were finally defeated by the Romans, who did what they could to remove Greek influence from their provinces. The Greek dependence upon the elephant might have been a simple fluke in history. While they proved to be effective for some time against the Romans, who were unfamiliar with the animal, once the elephants’ weaknesses were exposed, the Romans stopped losing the battles. In one of the first battles in which the Romans immediately drew up into their well-ordered formations so perfect for other forms of warfare, Born (1928) reports how â€Å"the maniples in front were thrown into utter confusion by the crushing weight of the animals: knocked down and trampled upon by them, they perished in heaps upon the field †¦ Most of the Romans were trampled to death by the elephants; the rest were shot down in their ranks by the numerous cavalry† (566). The elephants were used for more than just fighting. For instance, Glover (1948) illustrates how Pyrrhus used elephants extensively in campaigns through his life, introducing the animal to Italy in 280 BC. That they could be quit e effective

Discussion Questions Week 3 Essay Example | Topics and Well Written Essays - 500 words - 2

Discussion Questions Week 3 - Essay Example It also provides training resources for programmers looking to learn the Java language. Sun’s community approach to Java is one of the platform’s greatest strengths. Out of the several labels associated with Java, â€Å"Write one and run anywhere† is by far the most popular. When a Java program is compiled, it does not use operating specific code. It uses â€Å"bytecodes.† All Java applications run inside a Java Virtual Machine. You can create an Java application on a Windows Vista machine that will run equally well on a Linux, Windows 95 or Mac machine. Developers design for Java and not for an operating system. This makes Java very flexible when compared to other programming languages. Variations of the Java Virtual Machine will run equally well on cell phones, PDA and other small electronic devices. In comparison with other languages, Java applications typically used less code. Some Java applications run slower than OS specific programs. This is a small price for operating system independence. Advances within Java’s virtual machine and compiling are closing the speed gap. Java is one of the most secure programming languages within the industry today. (Riske, 2004) Java applications must receive permission to uses computer resources. The very nature of the language prevents events like â€Å"buffer overloads† which are a weakness within C+. Byte security is one of Java’s core defenses against malicious code. Whenever a Java applet wants to run, it is inspected. Byte security verifies that it is a compiled Java program and not a virus or spyware program. Personal Digital Assistants offer several advantages to businesses. The meat processing industry can save money in energy management and heat and cold management and monitoring. (Lovatt, 1999) Meat Plant Energy Modeler, MIHeat, Lamb Freezer MBC are software packages designed to run originally on at best a IBM compatible Pentium I. Java versions of

What economic advantages did the Europeans gain from their conquests Essay

What economic advantages did the Europeans gain from their conquests in the new world - Essay Example The 19th century can be attributed to the big boost in regards to the economic power experienced by the countries within Europe. This is the time that colonization was taking effect. It is during this time that countries such as Britain, Germany, Italy as well as France emerged as powers entailing industrialization and as such, due to this industrialization, the population in respective countries became high and production rose. During this colonialism era, social Darwinism was becoming increasingly popular and as such, it was natural that these four economic super powers were engaging themselves in fierce competition towards survival. The driving force that led to colonization by these countries was to strengthen themselves in an effort towards securing a competitive edge in regard to the underlying competition between them (Milios 2004). The main reason behind colonialism, regardless of the country colonizing, was to exploit their subjects as well as the individuals who were residing within the boundaries of the colonies in an effort towards generation of the colonizer’s wealth in regards to the economy for the colony as well as the corporations of that colony. The push for generation of the economic power is what led to the presence of slavery, particularly in Africa. People within the colonies being colonized became subjected to coerced labor, that is, slavery or a system of labor characterized by indent. Most of the areas, which were being considered vast in regard to the natural habitats, became cleared and as such, they were being transformed into monoculture plantations (Milios 2004). Therefore, this paper will put a focus on the colonialism endeavors in regard to the European countries during their conquest of the new world and thereby establish what economic gain that these countries actually achieved out of this conquest. In addition to this, the paper will also access the driving force that led to the European countries

Dance Critique Essay Example | Topics and Well Written Essays - 750 words - 1

Dance Critique - Essay Example the dancers illuminated and ground break in their distinctive ways and stunning costumes forming â€Å"The Essential Balanchine† for the opening night making it the most thrilling, transcendent and unforgettable one. Socially, Balanchine put prominence on changing into modern form and get rid of the extremes and embellishments of the dance style used during the 19th Century. Additionally, he revolutionizes and redefines the function and place of the ballerina, offering her a daring, innovative mobility style in addition to a sense of freedom and empowerment. Firstly, the kind of costumes worn by many dancers while performing shows a complete change from those used during the 19th Century and this portrays evolution of the dancing performance to the social life of the audience especially young generations as the American school was commonly comprised of young generation. For example, the three ballets were originally choreographed by Balanchine for the school of American Ballet back in 1930-s to act as a class work for students where they could vigorously practice to perfect their dance performances (Walter, 2001). However, the use of stunning dancing costumes can negatively impact the society su ch that some young generations have grown imitating some of the dancers as their role models in terms of dressing, walking and even talking and this has accelerated the incidences of crime in our society such as raping especially to young girls who are going half naked in towns in the name of imitating a particular dancer or artist. Despite a few dislikes in terms of dance setting, costumes and the message of the various dancing rhythms used by dances among the three Ballets, we cannot assume some of the movement skills used by different dancers while performing on the stage. The use of facial expressions/movements, dance steps, and catches are very interesting and cannot go unnoticed by the

News feature story Article Example | Topics and Well Written Essays - 1000 words

News feature story - Article Example He has said that the Migration Occupations in Demand List (MODL) is outdated and has one hundred and six occupations, many of which are less skilled and no longer in demand. The Senator has announced a new Skilled Occupation List (SOL) intended to focus on high value trades and professions and to deliver highly skilled immigrants and crackdown on persons who, through low-value education courses, are in search of permanent residency in Australia. The list will be introduced mid-year and a review of points test used to assess migrants to ensure the selection of the best and brightest will take place. SOL is a critical reform in the overhaul of the skilled migration program by the Government and it closes the door on people seeking to manipulate the migration system. All offshore General Skilled Migration’s applications placed before 1 September 2007 will be withdrawn. These people applied overseas under easier standards, including a less rigorous work experience requirement and lower English language skills. Only persons with pertinent qualifications in occupations that it lists will qualify for independent general skilled migration. Worthy to note is the fact that the new SOL introduction does not change the concessions announced in February that provide generous transition arrangements for current and former international students looking for a visa under the General Skilled Migration (GSM) program.

Research paper about business problems Assignment

Research paper about business problems - Assignment Example Now, in order to solve this problem, I thought, the decision matrix would be the best possible solution. The matrix has been based on the criteria such as quality, price and the time of delivery. The below plotted matrix will be decision based matrix and the further evaluation will follow the matrix. Based on the decision matrix above, it is clear that Supplier 2 is the best from all the aspects and they are also meeting the two criteria of fast delivery and good quality. Based on this analysis, we decided to go ahead with Supplier 2 to get the best possible solution to our problem. The first situation is the case of Kelloggs and General Mills. We need to comment on the revenues generated by the two companies in order to find out which one as an organization is a better performer. The second situation is that where a healthcare organization which has its own medicines, needs to select on a supplier based on the quality, time of delivery and charges of the boxes that are required on an urgent basis. As discussed above, the problem out here lies within the two organization. Kelloggs is a well known brand in the FMCG industry and General Mills is equally popular. Both of the firms have been in the industry for quite a long time, but we have to find out which of the two are performing better financially. The second case is that a healthcare organization where I used to work previously. The organization is going through a crisis situation. They have their own medicines, but they do not have the boxes required to pack the medicines in order to sell it to the patients. In a such a situation, several suppliers have been approached and we have noted down the delivery details of each of the suppliers. Now the problem still remains as to which of, them should we choose for the delivery. Since we need to find the financial performance of Kelloggs and General Mills, the best possible solution is to go through their

The Mixtec Culture Essay Example | Topics and Well Written Essays - 2500 words

The Mixtec Culture - Essay Example As the discussion stresses there is no definite history of the Mixtec, but the furthest that archaeology can trace their history is in the valley of Oaxaca, which was home to three major language groups: the Zapotecs, Nahus, and the Mixtec. History has it that the Zapotecs dominated the valley, while the other two occupied the centre of the valley, although some Mixtecs lived beyond the valley in the west. The Mixtec presence in Oaxaca is traceable to three full centuries before the invasion of Spanish conquest, in the 14th century, seemingly through intermarriage with the Zapotecs. Terraciano explains that a Mixtec lord got into marriage with a Zapotec maiden, and they were given the Culiacan population as a gift after the marriage. This was a contributing factor to the emergence and growth of the Mixtec population in the valley of Oaxaca. Before this event, the two would meet in trading gold and other commodities. However, after the two began co-existing, the Mixtec invaded and too k over the Zapotecs’ capital, bringing back the rivalry between them though it was not long before the Zapotecs got their land and city back.This paper discusses that  the Mixtecs in the early colonial and post-classic periods had an invention of their own writing that was pictographic. They painted on deerskin, paper and cloth before the Spanish conquest came in with their own dictatorial that the images be directed to Spanish officials. This forced the Mixtecs to come up with multicultural forms of communicating to both the indigenous natives and Spanish aliens. To write on the deer hide and paper made from fig tree barks, the Mixtec would apply gesso paste or lime plaster on two surfaces to create the smooth writing surface then sewed them together to form a screenfold manuscript. Such manuscripts could fold back over the other, allowing the two surfaces to be viewed individually. On average, a folded manuscript was the size of a book but after stretching, was about ten metres in full size. These forms of picturesque writings are referred to as codices. The writings usually featured three styles of expression: direct representation of images (logograms and ideograms), phonetic transcription (use of symbols to represent words), and conventional imagery (the use of images to pass an idea or word without using language). All these forms of writing applied throughout Mesoamerica, and were usually meant for public use as they mostly carried information concerning recitations and public performance guides such as music, dances, songs, and drama performances (Terraciano 15-16). The Mesoamerican calendar The Mixtecs had a sacred calendar similar to the other Mesoamerican cultures whose scared calendars had two-hundred and sixty days. This ritual calendar was called the Tzolkin and used to tell the day. In their

Psychology and Research Essay Example for Free

Psychology and Research Essay 1. There are various methods in psychological research, both qualitative and quantitative. Among them are field experiment, which is more qualitative and the statistical survey which, as the name suggests, a highly quantitative approach. Field experiment is a scientific method in research approach where the researchers (psychology-related researchers in this case) examine the participants or the data in the real world rather than doing the research in the laboratory, but all the same, the field researchers have followed the structured approach1 in research. Statistical survey, on the other hand is used to gather quantitative information on a given subject or participant in a population. It involves statistical processes in arranging data for them to be useful information to readers. It is worth noting however that a research rarely relies on a single method alone. Oftentimes, it is a combination of two or more methods to make it/the theory or contention stronger and more reliable. 2. With the psychosis studies and experiences of R.D. Lang, a psychoanalyst and a radical psychiatrist, he was able to observe his patients for real or â€Å"on field† when he developed his research regarding the subject (psychosis). It is a condition when an individual lost contact with the real world. Psychosis is best described by broad diagnostic concepts such as schizophrenia or bipolar disorder, and that these concepts describe brain diseases that are probably inherited. The task of psychology and its related researches on the subject matter aims to identify neuropsychological abnormalities in patients, in the hope that these might provide clues about the aetiology of the presumed brain pathology. Within this method, there is little scope for psychological intervention, as it is assumed that brain diseases are unresponsive to this kind of treatment. Another psychological research is the intelligence test of Binet or the currently evolved Stanford-Binet Scale which is one of the psychologically related tests or research where statistical approach may be applied. This method was developed containing the idea of graded tests series, the concept of intelligence and the conception of the fundamental qualities of an intelligence test. It was originally composed of thirty items in increasing difficulty, with grouped testees either according to age or gender or any other classification that may be applied. 3 This is where the current IQ Tests evolved. 3. When conducting research with human participants, consent and confidentiality4 are the two very important aspects of the study. Consent of the subjects should be obtained first to let them be aware of the entire study and will let them adjust and not to feel deceived. This will also help the researchers and the participants work together in harmony and will facilitate the entire research process. Aside from these, respect is another reason why consent of the participants must be obtained first. Confidentiality, on the other hand, will secure the safety and honor of the subjects/participants and at the same time will protect the reliability and soundness of the research itself. All the ethical concerns mentioned are generally for the respect of human life, as an individual and in order for the psychology profession be respectable as well. No one can respect the profession if in return, it does not know how to value the dignity of humans in the case that the latter be a participant or a subject in a psychology-related research.

Role of Public Sector in Modern Economies

Role of Public Sector in Modern Economies Forces of demand and supply control prices in modern capitalist economies, government intervention has been limited to provision of social services. Prices of goods and services as well as cost of production are determined with minimal government intervention. A perfect capitalist economy can only exist in an ideal situation and since there is no ideal situation, there are always some government controls, rules and regulations in an economy (Pigou, 2006). In general, government controls the performance of an economy through fiscal and monetary policies. These policies are aimed at changing or controlling certain factors in the economy to enhance or limit production. Government participation varies among countries were developing countries need a higher involvement than developed countries (Ceccacci, Marchesiani and Pecchi, 2007) This paper discusses the role of the public sector in modern economies and factors public sector consider when making financial decision. Political stability The government is made up of political class, who control the economies of a country, they play the role of politicians and economic drivers, and however, political situation in the world is not stable. There have been changes and uncertainty in different countries. A country like Kenya in East Africa underwent tribal crashes in 2007 after a disputed election. The crisis affected the economy of the country. In November 2010, Ivory Coast in Central Africa had disputed election a move that have affected the countrys economic performance. In civilized countries like the United States of America, which is the worlds largest economy, the performance of the ruling class affects the economy positively and negatively. A country as China, which has the highest economic growth in the world, has a stable government (Dalton, 2003) from the above discussion, it is clear that one major functions of government is to ensure there is political stability in the country. If the political class maintain s political harmony in an economy then growth and stability in the country is possible. One of the most surprising thing is that to destroy an economy that had been built for many years can take a matter of weeks in case of political unrests. For example, Zimbabwe was among Africans best performing countries, when there were disputed presidential economies in 2009; the country is now ranked as the poorest in the world. Other than local politics, international politics affects country economic, social and political performances. International policies and relations affect how economies conduct their business. There are times that goods from a certain countries have been limited to enter in the international market through tariff and non-tariff barriers (Buchanan, 1987). Maintaining good International relations Foreign ministry in different countries is given the responsibility of maintaining good international relations with different countries. Globalisation and international trade has opened the international market, assisted by transport and communication networks (Quigley, 2000). To ensure that a country participates in international trade effectively and reduce chances of international rivalry, it should ensure that there are good international relations. Switzerland has managed to be the world largest tourism country because of its political neutrality and maintaining of good relations with other countries. Sometime to be competitive, countries engage in economical alliances to be able to negotiate for better teams in the world markets. Such integration includes European Union, East African Community, and Pan African among others (Dietmar, 2000). Other than having a good international relations, it is the role of the government to ensure that its country have a good reputation. It sh ould not be known for negative things like poverty, corruption and inequality. Such reputations are not built by word of mouth by through actions undertaken by the government. Protection of citizens The government has the mandate of ensuring that the constitutional rights of every human being are respected. These rights include rights to protection, where the government provides security to its citizens. Security is from foreign and internal attackers. There are times that the government sets minimum or maximum prices of goods to ensure that consumers are not exploited. On the other hand, the government also sets standards required in a country; this is in the move to ensure that it has protected its consumers against substandard goods and services provided by businesspersons. There was another move made by Chinese government, which has been seen as a new government move where the government aims at reducing the rate of economic growth in the country (Edward, McCaffery and Joel, 2006) Infrastructures The government has the mandate of providing infrastructures like roads and communication networks, which cannot be left in the hands of individuals. These infrastructures ensure that an economy has social resources that can be used by society members without paying for them directly. In time of disaster, the public sector is called upon to assist. This is in case of terror attacks, drought and floods. The government should have adequate machinery and mechanisms to ensure that in case of a disaster, it has assisted its own citizens and sometimes extend the help to other nations. Other social economic factors affect an economy. They include inflation and deflation. The government has the mandate of ensuring that its economy has neither excess funds (inflation) or has limited funds (deflation) (Gabriele, 2009). Leadership and strategic decision-making The government is expected to make strategic decisions, which define the pathway that the country aims to follow over a certain period. This can be yearly or take a couple of years. Every year, governments make financial budgets to be followed when financing various projects in the country. These budgets contain yearly, monthly or projects that take more than one year. Such policies are the ones, which attract international investments in a country. In the 1990s, many countries had Vision 2000, which they wanted to have attained certain economic, social and political goals. In the current 20th century, there are calls to Vision 2020, Vision 2015 and visi0n 2030 among others depending with a country and the goals it has for the economy (Wildasin, 2008) Issues a government need to take into account when financing the activities adopted to fulfil the role set out in (a) above The government control an economy using fiscal or monetary policies. They can be either direct or indirect. The kind of financing adopted, depends with the goal and objective the government want to attain in a particular time. To control the economy effectively, consideration must be made to ensure that the most appropriate measure is taken (Reed and Swain, 1997). Generally, there are factors that government need to consider when financing different projects in the economy they are: The level of economic development in the country or locations The government has the role of setting up infrastructures to be used by the public and private sectors in their efforts to grow the economy. Before certain infrastructures are made, the government need to analyse the project and ensure that it is economically viable. Priority should be given to those places that have potential yet the exploitation of such potential is hindered by lack of infrastructures like roads and communication networks. Investments in infrastructures is an expensive exercise where the government spend public resources to make such infrastructures, they should thus benefit the greatest majority in the country. In developing economies, the government has a more active role where it is expected to make a platform that international and national inventors can built on. Such infrastructures include electricity production plants, transport networks, taxation incentive and communication networks. Some countries like China have had the government cut down its public fin ance expenditure to ensure that the economic growth rate in the country slows down. It has opted to have higher taxation to companies and individuals to ensure that they have low income to spend in economic development (Schulte, 2000). Countries competitive advantage sectors Different countries have different economic potentials; the kind of products that can be produced effectively by a nation varies among different nations. There is need to understand the potential that a country has and investments should be skewed to that direction. For example is a country has a potential in natural resources like oil reserves or good climate, then the government should direct most of its finances to these sectors. This will ensure that high levels of efficiency have been attained for economic development. Absolute and competitive advantages are important when deciding the countries to make economic integrations. There are times that countries produce the same commodities, in such cases such countries can make good economic blocs to negotiate for better prices for their products. They though cannot make good trading partners since they make more the same products (Schumpeter , 1994). The rate of inflation/deflation The rate of inflation in country affects expenditure decision by the government. When an economy is facing high rate of inflation, then the government has the mandate of controlling the economy. Controlling inflation and deflation are monetary issues where the government devises measures to reduce money in circulation (in the case of inflation) or increase money in circulation (in the case of deflation). In inflation, the government can decide to sell government securities like bond and bills at an attractive interest rate where investors will be attracted to buy them and the money in circulation is reduced. On the other hand, it might decide to increase the lending rate to banks through central bank, which will be transmitted, to consumers making the cost of lending money expensive. This reduces the rate of money attractiveness thus, the growth of money in the economy reduces (Sheila, 2004). In the case of deflation, the government devises measures to increase the flow of cash in the economy. If the government decides to reduce central banks lending rate, then banks will be more willing to lend money. This increases the money in circulation curing the deflation (Tresch, 2002). Living standards Different countries have different living standards. It is the dream of leaders to have citizens who have high living standards. To attain this need, the government takes deliberate measures to increase the living standards of its people. Such measures include wide investment in social facilities like public hospitals, building of roads, communication networks and education facilities. There are countries, which have opted to offer free medical and educational facilities to their citizens in the move to have increased living standards. Countries with high living standards do not require much invention of the government in their affairs but those that are underdeveloped and have reduced living standards the government intervention is highly required (Shinnick, 2008). Some government have national libraries, some even mobile ones to ensure that its population has access to information for personal empowerment. Adoption of technology in different sectors has enabled a countries population have higher living standards as people are more informed of their rights that they can fight for (Shoup, 2006) Resources distribution Resources in a country are not equally distributed; there are some parts, which have higher allocation of natural and manmade resources in a country. The in-equally bring about difference in social, economic and sometimes political. The government should ensure that its country have well distributed resources for a harmonious growth in all regions of the country. The differences make the government direct most of its resources to areas that are disadvantaged (Musgrave, 2008). They are given priorities in the efforts to see whether they can catch up with other areas. A country that has high levels of inequality is most likely to be in political disputes from time to time. This is when some people feel oppressed by the system. In the past, social rivalry in countries for example in French revolution, were brought about by inequality and oppression in the economy. To avoid a repeat of such things in an economy, the government should ensure there is equality in the economy. Equality can be brought through indirect measures like education, social amenities, and employment (Moore, 2009). Unemployment level Government has a role in creating employment in its country. If the economy is facing high levels of inflation, then the government must put on measures to ensure that the economy produces job opportunities. For an increased employment creation in country, the government should create an atmosphere where local and international investors feel attracted (Minea and Villieu, 2009). Such measures include reduce taxation, offer incentives to investors like tax holidays , investments deductions and offering land for factory settlements. Other than focusing on international and local major investors, the government can undertake different measures to facilitate small-scale investments through small traders and artisan. Finances can be directed to the areas where the government offer loans to deserving population to starts up their own business . Other than business, there are other individual talents that can be tapped and still create employment. This includes sporting activities and enter tainment industry where the government can support youth to engage in such activities (McGee, 2004). Security situation It is the role of the government to ensure that its citizens are protected from internal and external security threats. The state of security in a country will determine the amount of investment that will be directed to this task. There are times that a country may be threatened of an attack, or the security system in the country is not good. In such cases, the budget for security should be increased appropriately. Different times require different security levels, for example, in times of political unrests, high security is required than in times of harmony in a country, so the amount of investment that a country makes in investment is determined by security level in the country (Martin, 2005). Global environment The international community affects the trend of spending in a government. There are times that international relation and trade may require a government to spend higher than in normal circumstances. Currently with globalisation, the world is facing an increased trade among countries. The trade calls for improved infrastructures, communication systems and security along borders. Although these factors benefit an economy, they require the government to make investments in the economy. To facilitate international trade, the government need to invest in good roads to transport goods produced within the country to the departure ports and those coming from abroad to their destinations (Kabelo,  Khalo and Mafunisa, 2007). Communication is crucial in making trading negotiations and contracts where the government should lay good communication systems. International trade does not just happen without government intervention, there is need to control the flow of goods. Through customs depart ment, the government imposes custom duties and tariffs to some imports and exports in its move to collect revenue and protect internal industries. Through borders, some goods that are harmful to a population can get their way; it is the role of the government to ensure that borders are free from such goods. For border security, revenue collection and national companies protection to be effective, the government has to make massive investment in detecting tools like scanners, personnels to patrol the borders and revenue collection officers. Making of ports is capital intensive and thus before such an investment is made the government should ensure that it has analysed the economic benefit of such a move. For example, the decision to make Suez Canal was for trading purposes, it has assisted North African countries like Egypt, however, maintaining high standards in such an entry is an expensive practice (Jà ¼rgen and Wagner, 2004) Technology Scientific innovation and inventions have resulted to an increase in technology in the world. Efficient technology assists a county to produce goods and services effectively with maximum utilisation of resources. The government has a role to play in technological development and adoption in the economy. This can be through its own adoption of technology in its systems or it can be creating an environment that enables companies to adopt technology. There are times that the government controls the rate of technological adoption in its economy. For example in Kenya, the government is opposing the use of tea plucking machines by tea growing factories since it believes that the number of jobs that will be lost as a result are going to harm the economy. To enhance adoption of technology, the government have sometimes offered incentives to those companies with high technology like tax incentives to facilitate further technology use (Hyman, 2007) Environmental concerns The world is having increased concerns about environmental damage. International bodies have enacted rules and regulations to be followed in its efforts to reduce environmental damage. Such international regulations include Kyoto protocol on green gas emission where signatories were expected to reduce their production of green house gasses (Howard, 1992). To facilitate moves that protect the environment, the government is involved in different activities that aim at corporate and to individuals. It has put on measure that reduces the amount of emission from industry. Such measures include taxation on carbon emission, having national environmental control policies and programs, offering tax incentive and facilitating technology adoption (Bradford, Auerbach and Shaviro, 2000). The rate of investments in a country The investment environment in countries determines the rate of investment in a country. When the environments are not attracting investments, then the government has to undertake strategic measures to ensure that it has facilitated investments. This can be through targeting certain industries, which are crucial for investment decisions in a country, and enhancing their capabilities in attracting investments (Gstoettner and Jensen, 2010). For example, the energy sector is important for economic development and attracting investment. The government can control prices in such an industry and cover the deficit. This will make investors attracted by the low rate of production cost offered by such moves. In countries like China, the government have used this consideration to devise measure that reduces the rate of investment. There are times that the government becomes the investor in come strategic industries, which are considered low income generating. This is in the move to ensure that all essential products and services are available in a country (Blanca and   Wodon, 2006) Economic deficits and Balances of payments There are times that a country may be facing economic and balance of payments deficits. The deficits harm an economy, the government requires to take strategic decisions to ensure these deficits are cured. In cases of economic deficits, it means that a government will not be able to finance all budget activities in a particular year or periods. It may be forces to offer some government bonds and bills, which are offered at a cost to the public. It may also decide to sell its products to raise money to finance its deficit. The right move to make in such case is determines the decision made by the government (Bastable, 2003) International trade brings about balances of payments (B.O.P.). For a healthy economy without a deficit in balance of payment, then imports should be of a lower cost than exports. To facilitate an increase export, or reduce importation, the government have a role to play. In facilitation of exports, the government offers incentives to exporters to increase their exportation. These incentives may be subsidies in production. To discourage importation, the government can increase taxes charged to imports and empower local companies to produce goods that were otherwise imported. When a country has a healthy balance of payment, its currency is strong making its goods and services competitive in the international markets (Arye, 2003) Conclusion Modern economies are mostly capitalists, where forces of demand and supply determine prices. Government intervention in these economies is minimal but important. Government intervenes in economies to facilitate an appropriate economic growth rate and protect citizens from violation of their constitutional rights. It uses monetary and fiscal policies to control the economy. Before making an investment decision, government consider economic, political, social, global and environmental implication of such decision. Maintain political stability in a county is an important role of the government. The right decision to make is one that results to increased welfare of majority in the country.

Quality Care In The NHS

Quality Care In The NHS 1. What is meant by quality in the phrase quality of care? Quality, broadly speaking, is a subjective measure of excellence and when applied to health care, quality can be understood as systems and provisions of care said to be free from defects, deficiencies, and significant variations. Within the NHS, this encompasses the provision of high quality primary, secondary and community care in which the interests of patients are protected through a comprehensive set of nationally aligned policies. Lord Darzi defines quality of care as clinically effective, personal and safe. How is this achieved? Within the NHS, quality is achieved through robust regulation, inspection, standard setting, change management, community and patient advocacy, alongside continual assessment of clinical competency (Leatherman and Sunderland, 2003). Quality is about effectiveness of care, from the clinical procedure the patient receives to their quality of life after treatment. The Equity and excellence: Liberat ing the NHS white papers assertion is that to achieve our ambition for world-class healthcare outcomes, the service must be focused on outcomes and quality standards that deliver them. Leatherman S, Sutherland K, (2003) The quest for quality in the NHS: a mid term evaluation of the ten year quality agenda. London: The Stationery Office, 2. In 2008, the Department of Health published the report High quality care for all: NHS Next Stage Review final report. 30 June 2008. (a) Please summarise the main approaches to improving quality proposed by the report (b) compare and contrast these approaches to those described in Gwyn Bevans editorial (quoted from above). The Department of Health report approaches improving quality by: High Quality Care for All proposes that all providers of NHS healthcare services should produce a Quality Account: an annual report to the public about the quality of services delivered. The Health Act 2009 places this requirement onto a statutory footing. Stringent regulation from bodies with increased statutory powers. The Care Quality Commission will have new enforcement powers. NICE will be expanded to set and approve more independent quality standards. New Quality Observatories will be established in every NHS region to inform local quality improvement efforts Strategic health authorities will have a new legal duty to promote innovation. This will be twinned with a portal to share evidence-based, best practice among clinicians and other NHS staff. Devolvement of power to ensure the involvement of clinicians in decision making at every level of the NHS. The introduction of medical directors and quality boards feature at regional and national level Increasing patient information and choice will be introduced in the first NHS Constitution. Patient information will include the systematically measure and publish information about the quality of care from the frontline up. Individualisation will become the key to the way in which patients are handled with a personalised care plan. Noting that one size doesnt fit all. Incentivisation of care outcomes will include a new best practice tariff and the paper suggests this will make funding reflect quality of care. Partnership will be embraced, utilising local authorities, with the services offered personalised to meet the specific needs of their local populations Prevention not just treatment will be paramount with focus on improving health as well as treating sickness. Bevans editorial evaluates the internal market systems that have been tested within the NHS according to the Audit Commission and the Health Care Commissions paper Is treatment working? Suggesting that despite the core intention of the internal market models to improve quality and efficiency of services for patients, as Black insists, there is little evidence to suggest that this has resulted from past models or alternatively the scrapping of the internal market when Labour came to power in 1997; i.e. formation of foundation trusts, increased commissioning autonomy, patient choice or the incentivisation of health outcomes (payment by results). The NHS internal market models aimed to keep healthcare costs low by forcing providers to compete for patients not compete on the basis of quality. A stark contrast in rhetoric is seen in the proposals that are raised in the report, where marketization is the key driver of systemic improvement in quality of care. The High quality care for all: NHS Next Stage Review final report shows the need for a more market-orientated strategy: a patient choice-led approach to hospital funding, the removal of barriers preventing the use of private health providers to carry out NHS work, and the devolution of management and budgetary control from Whitehall to local communities. It appears reform is circular and the report bears a resemblances to pre-1991 measures where received funding was based on local populations. While the Report is indicative of the need for a tripartite arrangement for achieving quality, with stakeholders as informants and agents for change, Bevan argues that the internal market model proposed, although attractive, relies on the assumptions that purchasers can be effective commissioners and that failing providers will be removed from the market. The centrepiece of the White Paper reforms and Operating Framework is the handing over of decisions on care, treatments and commissioning solely to GPs, ultimately creating a stable internal model where there will be a quality equilibrium. GPs will be burdened with the challenge of acting as a middleman between the patient and provider, ultimately as a gateway to funding and care. They with fundamentally be dismantling the current monopoly of care provision. Their decision making will be accountable to local communities and a board. This new buyer position is thought to remove duplication of population care commissioning and streaml ine decision making to where the Government foresees a natural place to put this responsibility. Propper et al, (2003) noted that in 1991, the Conservatives created a set of buyers, funded by central government, who were free to purchase health care for their populations from both public and private sector suppliers. Public sector suppliers were therefore not given direct funding, but were set to compete with each other, alongside a small private sector, for contracts from these public buyers. The autonomy of Foundation Trusts as buyers, in Bevans opinion, has led to a free market of care with little standardisation, with the private sector benefitting from the poor levels of governance most. Bevanss editorial suggests this may have benefit to the population because so much healthcare cost is driven by decisions that GPs make and should not be guided by ministerial change. Unviable providers will be pushed out of the market by new entrants, creating a self-regulated, internal market. The White Paper suggests there is evidence that health systems work better where budgets and spending power are moved as close to patients as possible. Providers will be paid according to their performance. Furthermore, that a bottleneck on the road to driving the quality agenda is linked to ministerial involvement in the day-to-day running of the NHS. This new public management gives GPs greater autonomy, placed them at arms length from the government, interlinks purchasing and providing functions, and increases competition with quality in mind. GPs will be responsible for all aspects of performance; acting as bureaucratic gatekeepers for all care needs their patients, and potential scapegoa ts for ministerial politicking. As it stands, effectiveness of this system is being hindered by hierarchical bureaucracy and political micromanagement on both a local and national level, including politically driven reforms with each new government. The report suggests the forced autonomy of GP Consortia, comparatively to Bevan whom notes the earned autonomy system, in which, the independent health care inspectorate awarded each NHS provider an annual star rating of zero to three stars. Providers that scored well on the star ratings gain small financial bonuses but win much greater operational freedom, and the ability to apply to become an independent not-for-profit NHS foundation trust status. Autonomy was the incentive as this gave managers more choice. At the other end of the spectrum, providers that score zero stars are placed on special measures, and if progress is not soon forthcoming, their management is replaced. Bevan suggests that measures of Provider performance (cost, equity of access, outcomes, patient satisfaction etc.) have proved difficult to progress forward and that only patients acting as consumers has left a marked change on the system. I think it is questionable whether in the short term, GP buying powers wi ll drive quality in a market in which there are few providers. The 2008 DH report takes note of such and relays the importance of an individualised service in which patient information to inform choice will breed quality. Patient choice and measures of satisfaction will simultaneously puts more pressure on providers to increase performance of measured care outcomes, which in turn become incentivised by cash rewards. They foresee GP consortia, evaluating Services considered to be sub-standard and withdrawing them from service if patient satisfaction and quality care outcomes are not met. Propper, C., Burgess, S., and Gossage, D. (2003).Competition and quality: Evidence from the NHS internal market 1991-1999. Unpublished paper, University of Bristol. 3. As one of the accompanying papers to the White Paper Liberating the NHS, the DH has recently published Transparency in outcomes a framework for the NHS.http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_117583 Please summarise the main approaches to improving quality proposed by this consultation. The NHS Operating Frame is an accountability framework which should, if followed, ensure that the NHS Commissioning Board works to deliver better healthcare outcomes. This will be through measures that are valid, reliable and sensitive to change, notably evidence-based outcome measures, not process targets. The outcomes and incentives emerging from the frameworks will be organised around 5 national outcome goals /domains that cover all treatment activity for which the NHS is responsible. Outcomes appear to be related to feasibility, cost of improvements and pre-existing data sets. Quality of care as advocated by Lord Darzi in realised in three of the domains; patient experience, safety and effectiveness. The domains fail to include outcomes of access/equity, expediency in service or efficiency, which seems to underlie previous national reforms imposed by the Labour Government in 1997. The Operating Framework fails to identify purposeful ways of addressing deficiencies and poor outcom e performance. Incentives and regulation are suggested but may not be drivers. Each of these five areas will have: outcome indicators improvement areas according to evidence (collected data, patient surveying of experience, etc) Quality standards, developed by NICE, will inform the commissioning of all NHS care and payment systems. Measuring and reporting on outcomes will focus the attention of clinicians and managers on how well they are doing, where the gaps might be between actual performance and the high aspirations of those who use the NHS. I dont believe all the outcomes are necessarily reliable measures of quality. In Domain 2, for example, there is a focus on functional outcomes and qualities of life for long term illness, which may lead to patients to receive care they do not want. A great deal of the outcomes will be developed through incrementalism, for example those related to compassion, dignity and respect as indicators of the quality of care. The measured outcomes should represent the overall quality of healthcare provided by the NHS, as well as being responsive to population need and demand. The outcomes should also be attributable directly to the actions of health care provided within the NHS, to enable accountability. Best practice should be identified and used as a basis for ensuring that the framework itself does not propagate practice that in itself leads, however indirectly, to inequalities. Key to the five high level outcome/domains is the need for a whole system approach in aspiring for complete transparency, effectiveness and patients exercising appropriate choices, alongside a need to balance local priorities. Seven principles underpin the framework which are intended to improve the quality of health care, these are: Balanced between need and demand Accountability and transparency Internationally comparability Patient and clinician centred environments and service delivery. Excellence and equality promotion Adaptability and focus on outcomes that can be forged in partnership with other public services. International comparability The Health Secretary will be able to hold the new independent NHS Commissioning Board to account for securing improved health outcomes, and measuring the outcomes that are most important to patients and healthcare professionals. These will be backed up by authoritative, evidence-based quality standards that will ensure everyone understands how those outcomes can be achieved Based on past experience, what do you think are the likelihoods of success of this latest initiative? Please ensure that you consider these in the context of the likely challenges for the NHS over the next few years. (Please cite references if referring to evidence of the impact of previous initiatives). The attention of policymakers is always firmly fixed on the future and rarely on documented measures of progress to assess the impact of one set of reforms, before the next wave of organizational change. Political values dominate empirical evidence for reform. With such levels of political uncertainty, it is hard to evaluate if in five years time, a general election will lead to a change in leadership and new Health Minister. With this in mind, change often does not necessarily make best use of available resources, skills and knowledge. The direct influence of research evidence on decision making is often tempered by factors such as financial constraints, shifting timescales and decision makers own experiential knowledge (Elliott 1999). With devolvement of power to local government, there is need for a precise balance to be struck between strategies based on choice and competition on the one hand, and local voice and democratization on the other. On its own, I dont think the NHS reforms will create a patient-led system. It is the people, the leaders and staff of the NHS, who will make or break the change process. Central to this, is the way in which the White Paper reforms will radically change the way in with GPs work collaboratively with providers to better the health and social care of the population they serve. Reorganisation will ultimately mean GPs will have to create new organisations and learn new skills. This will take behavioural change that is likely to be unwelcomed, as theres a shift towards increased paperwork and decreased patient time. GPs have shown considerable levels of apathy towards working reforms and changes in service delivery in the past, including contracted hours. For example, previously published opinion has indicated that the medical profession were predominantly opposed to the package of NHS reforms outlined in the Working for Patients and were especially opposed to the administration of hospital s by self-governing trusts (Lister, 1990). GP consortia will be exactly that, self-operating. As the Operating Framework enters its live consultation it will be important to gather evidence as to strength of feeling with which those opinions, either for or against various aspects of the NHS reforms are held. Reform is costly, since managers and other NHS professionals invest a huge amount of time and effort with each re-organization. The NHS faces the need to make cost savings of  £15-20 billion over the next four years. It is faced with the challenge to create better health outcomes with less resources. Moving to the new system, maintaining control of day-to-day services, and implementing these savings is going to require skilled management. This at time when the NHS is shedding much of its management workforce and when managers have been under political attack. Introduced in 2004 as part of the General Medical Services Contract, the QOF is a voluntary incentive scheme for GP practices in the UK, rewarding them for how well they care for patients. the higher the score, the higher the financial reward for the practice. The very suggestion that this was voluntary implies that not everyone welcomed such change. The introduction of a free market, in which providers can tender for supplying a service as opposed to an internal market, could serve to drive efficiency savings and quality of care. However, accountability and patient choice would require considerably management and information sharing across GP consortia. Department of Health. Payment by Results. London: DoH, 2002. 5. One of the differences in the current UK coalition governments approach to improving quality, compared to previous governments, is in the use of targets. Targets are defined by the DH (DH 2004) as: Targets refer to a defined level of performance that is being aimed for, often with a numerical and time dimension. The purpose of a target is to incentivise improvement in the specific area covered by the target over a particular timeframe. List the possible benefits of using targets to improve health/health services and then list the potential disadvantages of using targets. Use examples (either from your experience or from what youve heard on the media) to illustrate your points. On balance, are you for or against publication? The benefits of health/ health services targets include: Supports priority setting Promotes consistency Improves commitment and fosters accountability Guides allocation of resources Milestones for incremental improvements The disadvantages of health/ health services targets include: Priorities may be misdirected and are often politically engineered Not always evidence based Hard to measure/quantify Not always related to health care outcomes Often cost related, not need related. Clouded by bureaucracy Often incentive driven ie pay to treat. One such health target in the Labour Governments Health Policy, the four-hour target, imposed in Accident and Emergency Departments has received mixed reviews. It was just one of a range of centrally imposed standards, most of them designed to speed up treatment. With such a target, volume of patients being treated and the expediency of their treatment is implied to be of greater importance that the quality of care or health outcomes of patients. The Guardian, (2010) reports In opposition Lansley had been critical of the way that targets distorted the behaviour of doctors, saying in the case of AE that people should be treated in relation to the severity of their injury not an arbitrary time limit. 6. The current government is strengthening the role of the regulator. Please summarise the role of the Care Quality Commission (CQC). What challenges do you think the CQC will face over the next few years? In April 2009, as the result of passing of the Health and Social Care Act 2008 (2008 Act), the outcome-based regulator, Care Quality Commission (CQC) was officially established. Their primary role is to act as an independent regulator of the quality and capacity of health and adult social care. They are responsible for registering, reviewing and inspecting health, adult social care and mental health services to judge the clinical quality of healthcare. Regulation directly relates to the quality of care experienced by people, so called end users, who use the services and align to the Coalitions vision of a user-centred, integrated service with a strong focus on quality (CDC, 2010). Indeed, when services fail to meet the health and safety legal requirements of their compulsory registration, action against them is taken through strict enforcement powers. In the next few years, as we transition from one governance model to the next, exchanging power to a local level, improvements must be closely aligned to quality and substantial, evidence-based research. Research grants are being cut and it is likely public sector research, including health research, will suffer as result of such austerity. The CDCs broad remit to oversee NHS organisations is not limited to particular service areas or functions, like that of many of the existing regulators. They may find themselves over extending and unable to fully engage with the public in a transparent and meaningful way. As quality of care is embedded to offer assurance and to deliver improvements over time, there is potential for major disruption to be caused by the scale of the change management discussed within the White Paper. The CQCs model of regulation puts user involvement and community level accountability at the core of their actions. Though this is consistent with the changes implied within both the White Paper and Operational Framework, there is still considerable ambiguity surrounded where responsibility will lie across all regulated services, especially with the introduction of GP consortia. Until this is resolved and clarity found, ambiguity will only be escalated by poor engagement of stakeholders and insufficient information dissemination through the crucial transitional points. As patterns of service provision change, consistently identifying providers and commissioners, and then allowing for local communities to hold them to account for the services they provide may prove difficult. Once established within a professional capacity, the CDC will need to be aware of the information on outcomes and how it should be presented in a format that is accessible and meaningful to influence patient choice. Furthermore, in their role as an advocate of patients, as a consumer champion, the CDC will also be required to ensure that people who use services understand the care choices available to them and are involved in making decisions about their own care and support. The CDC (2010) note that Patient and public involvement in health organisation will be strengthened by the creation of HealthWatch England a new independent consumer champion within the Care Quality Commission. As a so called consumer champion, this suggests end user expectations may be heightened. Questions must be asked of how HealthWatch England shall be regulated.

Elements of Comedy in The Simpsons Essay -- TV Television

Elements of Comedy in The Simpsons The TV show, "The Simpsons" is considered by many to be one of the greatest animated shows ever made. Incredibly popular with people of all ages, creator Matt Groening combined numerous elements of humor to produce a truly original program. His goal is to never repeat the same joke twice. The year 2000 will mark the 10th anniversary of the show (which adds up to a lot of original jokes), and highlights its achievement as primetime TVÕs current longest running series. In addition, "The Simpsons" was selected to be the feature presentation at the Sixth Annual U.S. Comedy Arts Festival in Aspen, Colorado. There, members of the cast will re-enact a previous episode in front of a live audience. "The Simpsons" is watched specifically for its humor. Never before has a TV show combined so many elements of humor together and still contained enough original ideas to run 10 seasons. Although some people do not care for "The Simpsons" humor, the show still has a significant following. One of the reasons "The Simpsons" is so popular is that the show addresses a wide variety of stereotypes through its characters. People can relate to the stereotypes. Many of the characters are recognizable by name from week to week, and those that arenÕt either take the form of a stereotyped profession, or the typical John Q. Public. The result is rather amusing as everyone from the nerdy scientist to the ambulance-chasing lawyer makes appearances. Another reason "The Simpsons" has lasted so long is that much of its comedy comes from takeoffs and parodies of other shows or movies. Most viewers are familiar with a substantial number of old shows or movies, s... ...jokes that never would have existed otherwise: exchanges between characters, comments on society, and various events in the show all take an ironically-humorous twist. This type of humor is a defining characteristic of the show. Combined with the other aspects, "The Simpsons" will truly go down as a classic series of all time. Works Cited Carlisle, Henry C., ed. American Satire in Prose and Verse. New York: Random House, 1962. Feinburg, Leonard. Introduction to Satire. Ames, Iowa: The Iowa State University Press, 1967. Groening, Matt. The Simpsons A Complete Guide to Our Favorite Family. Ed. Ray Richmond. New York: HarperPerrenial, 1997. Kim, James, and Cade Whitbourn. The Simpsons. "Matt Groening." 1998. School of Media and Communication. 23 Nov 2002. http://mdcm.artsunsw.edu.au/Students98/WhitbournC/innovate1/creator.html

Sappho And St. Teresa De Avila :: essays research papers

Day by day women are faced with obstacles simply because of gender. In the plays we have read women are faced with obstacles but overcome them. Women in the past were expected to be submissive and not object to the men’s decisions. The world today has changed its face. No longer are women quiet. Sappho and her work is a good example in our readings to represent today’s day and time. Her poems seem contemporary, very modern. The Descent of Inanna ,on the other hand, is a prime example of works we’ve read that represent the past much more.   Ã‚  Ã‚  Ã‚  Ã‚  I strongly believe that each generation is a product of the previous generation, and during the Ancient World, women were not expected to write. They were submissive and their religious superior had the final say. Sappho broke these rules and went against the odds. She wrote and produced wonderful work that everyone can relate to during any time period. Although religious leaders successfully destroyed a great amount of her work, the few parts and pieces that survived still describe things of today in such short lines and phrases. “At noontime'; is a good example of this. It describes the sun and its’ heat and the cricket which till today “sets up a high-pitched singing in his wings.'; “If you will come'; is another example. “At noontime'; is simple to say it relates to today’s world, the sun will always be hot the cricket will always live, but the customs and traditions of people do and Sappho still describes customs from her t ime that live today. “If you will come'; tells of things that generally a person would do for visitors. It says, “ If you will come I shall put out new pillows for you to rest on.'; In just these few lines so much is said. This can be taken as literally taking our new pillows for a visitor to sleep on and rest after a long drive to your home. It may also mean that the host is making the visitor feel at home by welcoming him with open arms. Nevertheless, this poem describes customs that a person would do now. For these reasons Sappho’s works are the most modern in our readings.   Ã‚  Ã‚  Ã‚  Ã‚   The Descent of Inanna is quite the opposite of Sappho. It describes Inanna going into the “underworld'; a place that we do not relate to as easily as a worldly location.

The Devastation of the Indies and Movie The Mission Essay -- Devastati

The Devastation of the Indies and Movie The Mission The Mission and Bartolome De Las Casas' book, The Devestation of the Indies Although The Mission and Bartolomà © De Las Casas' book, The Devastation of the Indies portray events that took place over two centuries apart, similar features and effects of colonization are apparent in each account. Slight differences in viewpoints are evident, such as The Mission's portrayal of the natives in a more humane fashion, but this goes along with the evolution of time and the current trend of being politically correct. In other words, people today have broader views on issues, are more unbiased in their reasoning, and are careful not to offend others. Whether efforts to conquer land happened in the sixteenth century or will happen in the future in say the twenty-second century, by definition of conquer alone, defeating, suppression, and a complete overpowering, has taken place and will continue to in the future. (Merriam-Webster's, 1997, p. 245). The Devastation of the Indies was written in the middle of the sixteenth century in response to De Las Casas' outrage about the horrific treatment of natives in the New World. De Las Casas first came to the New World on Colon's second voyage. At one time De Las Casas did own slaves himself, but his experiences over time in the New World, led him to new ways which included getting rid of his slaves. His mission became one of letting others, especially those in his European homeland, become aware of the cruel treatment of the natives by the European colonizers and he began a crusade for the abolition of Indian slavery and the general improvement of the natives' lives. (http://www.funkandwagnalls.com) De Las Casas' book is a first-hand acco... ..._reviews/1986/ 11/117159.html. October 2, 1999. iii. "Enlightenment, Age Of." http://www.versaware.kidsreference.lycos.com /encyclopedia /low/ articles/e/e007001089f.asp. October 3, 1999. iv. "History of Nicaragua." http://www.rnw.nl/racism/nicaragua/html/facts.html. October 3, 1999. v. "Las Casas, Bartolomà © De." http://www.funkandwagnalls.com/encyclopedia/low/ articles/ 1/1015000292f.html. October 2, 1999. vi. Merriam-Webster's Collegiate Dictionary: tenth edition. Springfield, Massachusetts: Merriam-Webster, Inc., 1997, p.245. vii. Mueller, Rose Anna M. "Teaching beyond the Quincentennial," Hispania 76 (3), September 1993. found at http://www.millersv.edu/~columbus/data/art/ MUELLER1. ART, October 2, 1999. viii. "Reviews: The Mission (1986)." http://www.amazon.com/exex/obidos/ts/vide†¦ 120X/ref= pm_dp_ln_v_1/002-4226867-6742623. October 2, 1999.

Letter To My Children

As I lay awake in bed with Carol by my side, sharing my insomnia, it occurred to me, totally out of the blue, that Neo had opened up for me a new world of understanding, which is to say that my conversation with him had led me to the realization that there was a way out of my conflicts here and now.   I was being selfish aforetime: it occurred to me.   Although I could not go to the Vatican all the way from America in order to express my new understanding of Christianity – rather than to pose questions that the authorities on religion there were not expected to appreciate – I could express myself before my children, as though nakedly.But what would I teach them?   I certainly did not wish to confuse them by sharing my conflicts.   Neither did I desire for them to catch on my negative emotions surrounding the wonderful truths I was learning my entire life.   One such negative emotion was my slight fear of various authorities on religion because I could not get over my miserable misunderstandings with them.   I understood that the authorities on religion are meant to be peacemakers, and yet I could not see eye to eye with them on many issues of peace, which, in my awareness, is often a result of increased knowledge and new understanding of faith.These misunderstandings, I knew, were tormenting me alone, while they slept soundly night after night.   I recalled then the words of Jesus, virtually unaware at the time that Carol had started to sing in bed a song from the film, Evita:Blessed are the poor in spirit: for theirs is the kingdom of heaven.Blessed are they that mourn: for they shall be comforted.Blessed are the meek: for they shall inherit the earth.  Blessed are they that hunger and thirst after righteousness: for they shall be filled (Gospel  of Matthew, Chapter 5, Verses 3-6).Did I have to share myself with the various authorities on religion in order to find peace?   I did not believe so.   All the same, my torment was asking me to somehow stand in front of the whole wide world and declare myself to be a true seeker of truth.   Then, and only then, I thought, would I find peace.   However, it was impossible for me to stand on the stage before the entire Christian world and declare myself to be true.   As soon as I realized that my mind was straying away from my children, I said â€Å"Yes.†Ã‚   Carol asked me right away, â€Å"What?†   Ã¢â‚¬Å"Oh, nothing,† I said.   â€Å"I am enjoying your song!†Ã‚   Carol continued singing from that point on.I got back to my reflections through insomnia.   I thought that I knew that I could die very soon, and I did not have the kind of oneness Jesus experienced with God Almighty to know when.   I could express my understanding to my children – yes I could do that, I thought again – and my children in turn would develop their own understanding of religion based on my teachings and their own experiences in lif e.As I lay in bed reflecting on the new questions that had perhaps occurred to me through supernatural inspiration, it did not take me long to figure out what exactly I would be teaching my children and how.   I would write a letter to them, directing Carol to deliver it to them only  when they have all reached maturity at the same time.   I would not want one child wanting to know more than the others at any given time.   I would like them to grow in spirituality altogether.   I did not want them to have to go through the experience of single handedly dealing with the problems of realizing the truth as I did.   I did not want them to feel as alone in the world as I felt.But perhaps I would eventually leave the letter in Carol’s hand to decide when to give it to each of my kids, I thought.   I was â€Å"hungering and thirsting after righteousness.†Ã‚   I knew that expressing my understanding of the religion to my children would grant me a sense of complet ion from the Almighty – somehow.   I did not know how He worked on such completions.By the time I had reached this point in my train of thoughts, I realized that Carol had gone to sleep.   Her singing was over and done with; she was snoring, in fact.   I suddenly realized a sense of greater freedom in my thoughts.   Increased confidence was aroused to boot.   Although I knew that Jesus had said, â€Å"Blessed are they that have been persecuted for righteousness’ sake, for theirs is the kingdom of heaven† (Matthew, Chapter 5, Verse 10), I neither had the strength nor the courage to stand before the world and discuss my concept of religion.   I should have had the courage, I thought, but sadly, I did not.   I then realized that perhaps this kind of courage is unnecessary, given that Jesus had also said: â€Å"Agree with thine adversary quickly, lest haply the adversary deliver thee to the judge, and the judge deliver thee to the officer, and thou be cast into prison† (Matthew, Chapter 5, Verse 25).Was Jesus right there with me to teach me something of the essence?   How was it that verses from the Gospel of Matthew were appearing in my self without notice, and perhaps out of context?  I got out of bed then, with the awareness that I had the courage to teach my understanding of Christianity to my children, even if I could not teach the whole world.   Yet I did not want to express my entire self to my children.   I only believed that they had a right to know the basics that I was working with.   I believed in their right to question religious practices of the world.   I also trusted that they would eventually find the truth using the tools I would provide them with.I turned on the lamp on my desk.   Carol moved a little in bed, responding to the click of the lamp.   Fortunately, she did not get up to ask what I was up to.   I did not want to bother her at all, and so I sat down to write, as though in a wh isper:â€Å"Dear children,  Ã‚  By this time you must be old enough to feel the need to know God.   You will be exposed to many practices in the Church†¦.†Ã‚  I gave up writing at this point, tore the page in half, and took a fresh sheet of paper to begin again.â€Å"Dear Children,  For I say unto you, that except your righteousness shall exceed the righteousness of the scribes and the Pharisees, ye shall in no wise enter into the kingdom of heaven.â€Å"’Ye have heard that it was said to them of old time, Thou shalt not kill; and whoever shall kill shall be in danger of the judgment:â€Å"’But I say unto you, that every one who is angry with his brother shall be in danger of the judgment; and whosoever shall say to his brother, Raca, shall be in danger of the council; and whoever shall say, Thou fool, shall be in danger of the hell of fire.â€Å"’If therefore thou art offering thy gift at the altar, and there rememberest that thy brother h ath aught against thee,â€Å"’Leave there thy gift before the altar, and go thy way, first be reconciled to thy brother, and then come and offer thy gift’† (Matthew, Chapter 5, Verses 20-24).I comprehended what I was doing.   Comparing the Pharisees and the scribes to the majority of religious authorities in the world, I was directing my children to go to the scriptures whenever they require guidance from the divine authority.   I did not have another way of teaching them the truth.   I wanted to say that they must never go to any religious authorities except the scriptures in the process of seeking truth; and that they must be good to each other, no matter what.I had written the words of Jesus in my memory with great enthusiasm.   And I did not doubt that my children could – given the right direction – show equal respect to the word of righteousness.   Yet I doubted whether I should tell them everything about the Church as it existed in the world today.I gave a moment of attention to Carol at this point.   She was snoring, fast asleep, and looking lovely.   I thought with tenderness that her children were mine, and I had a right to teach them whatever I felt I must.   I did not have to mention the Church and the circumstances surrounding my role in it that very day.   It was not important, given that the circumstances surrounding the Church were expected by me to change, perhaps drastically, in the years of my offspring’s maturity.I went back to my letter.   Without explaining myself in it, besides the purpose of my letter, I felt that I had to write something else I remembered from the Gospel of Matthew:  Ã¢â‚¬Å"’At that season Jesus answered and said, I thank thee, O Father, Lord of heaven and earth, that thou didst hide these things from the wise and understanding, and didst reveal them unto babes:â€Å"’Yea, Father, for so it was well-pleasing in thy sight’ (Chapter 11, Verses 25-26).Confident in my writing, I continued:  Ã¢â‚¬Å"My dear children, after reading the above scriptures you must be thinking that perhaps I felt in my years in Church that these are some of the most perfect verses in the Gospels.   As a matter of fact, I did not think so.   And the only reason I am writing you today is that I want you to learn how to trust yourselves in seeking the truth.   The scriptures are the best guidance I can offer you now.   Hold on to them, learn from them, and do not mind questioning the practices of others  when you do not believe them to be correct.   This is, in my opinion, the best attitude to take into maturity.   Let us leave the rest in God’s hand.  Ã¢â‚¬Å"Your loving father on earth.†

Han China and the Roman Empire Comparison Essay

Han China and the Roman Empire Comparison Essay Whereas Han China (202 BCE- 220 CE) and the Roman Empire (~800BCE- 476 CE) were thousands of miles away from each other, they had many similarities and differences. Some of the similarities include peasant rebellions, while the differences are such as woman’s rights and their views on manual labor. Peasant rebellions were very important to the societies of Rome and China. The dynasty of Han China itself was formed by a peasant rebellion lead by Wu Ti. Their counterparts in Rome suffered through periods of slave revolts.These shaped these societies dramatically. One of the many differences of these two empires was woman’s rights. While Han China was a highly patriarchal and believed woman were the â€Å"lowest of the low† on the social scale, Rome saw woman still as lesser being, but still had some importance. I believe this is because Rome, unlike China, had more than one god, including goddesses. These woman of a h igher power influenced Rome in a way as to see women in a new way, not as scum. Thus making these two cultures different.Another important difference between Han China and the Roman Empire, were their views on manual labor. In Han China, Confucianism supported the manual labor of farmers and other peasants. Meanwhile in Rome, their idea was that manual labor just took away from the slaves. Even with their differences, both Rome and Han China laid the foundation for major religions like Christianity, Daoism, and Confucianism. Those religions are still ruling the world today. They also created lasting legacies that we consider today as Classical Civilizations.

Paradise Road- Creative Essay

I didn’t have to, but I did. It was an order, what other choice did I have? I was merely a low level officer; the power was in Hiroto’s hands. She broke the camp rules, outside dealings, but did she? It was medicine to save innocent women, innocent women who have been caught up in a war for power, which has resulted in the women becoming the powerless, and me the powerful. Each day I have to dig deep, keep on digging I tell myself, for reasons to be here; pride, family honour, dignity for my people, remember what father said; Japanese are the ones who made the Europeans rich, yet for hundreds of years the Europeans looked down upon us, now it’s Japan’s turn, still, my moral conscience has clouded my mind to the atrocities that I have seen, a short time ago I was a teacher of a class with half Japanese and half European, and they couldn’t see any differences, they looked to the inside, why can’t these officers look to the inside, morality in c hildren is a quality that is needed now, yet I see the children in the camp being bashed by that brute Tomiashi, I want to help, but Japan is now powerful, Japan must prevail. I passed the fuel to Tanaka, my hand trembling, I wanted to latch onto the bottle, throw it away, throw all this away, is this how far we have come, is the power really worth this? Ablaze, my eyes cloud while I have to control myself not to react, I must be strong in front of these European women, the powerful are not weak, they have oppressed me, although I cannot see it, them crying is the first instance of any reminisce of human emotion since I left my teaching job in the village, I didn’t want to leave the students, but the European students had fled with their families and we had instilled in our minds that the powerful nation would prevail, but is power worth this? I feel the confusion and anguish drop over me like a sheet of cold rain that chills you to your spine, this is wrong, this is wrong, but it’s for the great nation, we will be powerful, my stomach feels queasy. Days pass, although I feel no time as my soul feels extinguished, another lady†¦she merel y spoke, she merely spoke I whisper to myself, this is becoming too much, but I tie her to the posts, and insert the sharp bamboo into the ground, she has disrespected the Emperor she must honour the flag, stuff the emperor I say to myself, as I watch this innocent women struggle in the Sumatran sun as she fights to stay upright and avoid being impaled. Let me run over, let me free her, please! I tell my heart, I plead with my heart, but my brain prevents me, it’s for the nation, we will be powerful, but somehow that ideology is not what drives me to watch on, I am emotionless while watching this torture being committed, stuff the emperor, I clench my fists. The choir lady runs over with water, God bless her, humanity! It was not to be, Tomiashi yells and I have to intervene, emotion takes over me, â€Å"I’m sorry† I tell her â€Å"I’m sorry†, now I know that my heart and my mind are as one, no amount of power is worth this, this innocent women should not be here, she should be at home with her loving family, as should I, she’s so beautiful, I miss her, my wife†¦ it is only good luck that it is not her who is baking in the sun, my mind is made, stuff the emperor. Japan loses, Captain Tanaka and the other leading officers talk about the dishonour, the poverty that Japan will now endure, I look out the window of the officers’ quarters, and see the women smiling and cheering while Colonel Hirota tells them the news, they are now the powerful, and I am the powerless, I smile. By Fergus Neal Statement of Intention Upon taking a wider viewing of the film and seeing the obvious conflicts at play, I forced myself to look deeper and see the not so obvious conflicts that are omnipresent in the bystander characters. I chose to write a creative piece from the perspective of one of the guards who only features shortly in the film, has no name, but can be noted for saying a small but intriguing â€Å"sorry† to Daisy when she attempts to give Susan water, as if the emotion is starting to come to effect within him, and in citing this I chose to write a creative piece on his perspective and the inner conflict as well as conflict with the whole situation that he has faced that has culminated in him showing humility and apologizing to Daisy for not being able to allow water to be given to the tortured Susan. I chose to write in a formal way, but with a creative sense of writing present throughout which allowed me to delve deeper and actually place myself in this man’s shoes. My piece is for the audience of my teacher and fellow class mates as they should be able to comprehend the ideas that I am trying to convey through having seen, and understood the key aspects of the film. The purpose of this creative piece is to demonstrate how conflict occurs between the powerful and powerless,  but also how those in power may experience their own internal conflict in looking deeper into power and how it can cause a sense of inner conflict in relation to that person’s values.