Benefits Of Working With Parkinsons Disease - 1618 Words

People with Parkinson’s disease can have issues with balance, strength, and posture, which can lead to falls. When one declines, it can result in reduced quality of life for the patient. Fear of falling can increase falls. Exercising on a regular basis can help decrease the number of falls with patients who have Parkinson’s disease. Evidence shows benefits when working with physical therapy in an exercise program reduces the number of falls. An exercise routine that improves balance is called speed-dependent treadmill training (SDTT). Patients use a treadmill to improve their stepping pattern, in return, improves their balance. If the patients do not exercise regularly, they may increase their risk of falling. Balance tools are used to see if patients are in danger of falling. Some of the balance tools are the Mini-Best test, Berg Balance Scale (BBS), and Fullerton Advanced Balance (FAB). Using these tools can help the nurses see if there are interventions needed. Outco mes can improve balance and quality of life. Parkinson’s Disease and Preventing Falls Falls are a risk for many people with Parkinson’s disease. â€Å"Previous studies showed a high incidence of recurrent falls in people with PD, ranging from 18% to 65% in a 1-year period† (Almeida et al., 2016, p. 1075). Individuals who have Parkinson’s disease and have issues with gait control have frequent falls. Nurses help care for persons who have Parkinson’s when they enter the care facility. Exercising on aShow MoreRelatedThe Disease Of Parkinson s Disease1648 Words   |  7 Pages Abstract Parkinson’s disease has been cataloged as one of the most serious and slowly progressive neurodegenerative disease that affects a wide array of motor and non-motor aspects that impact the function of a person. Afflicting over four million Americans and the second most common neurological disorder after Alzheimer’s disease, Parkinson’s continues to take its toll on the neurological health of many(Constantinescu et al, 2007 ). James Parkinson, a British physicianRead MoreParkinson s Disease Is A Chronic Neurodegenerative Disorder1128 Words   |  5 PagesParkinson’s disease is a chronic neurodegenerative disorder characterized by degeneration and cell loss of the substantia nigra, which causes disturbances of voluntary motor control [5]. It impairs ones ability to produce movements and is commonly associated with difficulties of daily living. Parkinson’s disease (PD) affects approximately 1.5% to 2.0% of the population over the age of sixty years old [2] and â€Å"†¦ it is estimated that 6 million individuals worldwide are currently living with PD,† [7]Read MoreSymptoms of Parkinsons Disease Essay1373 Words   |  6 PagesSymptoms of Parkinsons Disease Parkinsons Disease is a degenerative disorder of the nervous system. Parkinsons is a disease that may happen in younger people, but the risk mainly increases with age. This is because many of the cellular systems in the brain are difficult to renew by themselves while there are trillions of nerve cells in the brain to compensate for the loss of these cells. For example, in Parkinsons disease the symptoms are caused by the selective loss of a small populationRead MoreMuhammad Ali Knocked Out By Parkinson s Disease917 Words   |  4 PagesMuhammad Ali Knocked Out by Parkinson s disease. † I will never fight again,† said Muhammad Ali after his last fight (Denenberg 70). Researching Ali makes us feel stronger, inspired and sad that Parkinson s took something from him that he loved and enjoyed. The only reason Ali wanted to fight was because someone had stole his new bike from the library when he was twelve. He told the police officer that he wanted to beat up the thief. The officer told Muhammad that he better learn how to fight,Read MoreParkinson s Disease : The Second Most Common Neurodegenerative Disorder1495 Words   |  6 PagesParkinson’s Disease is considered the second most common neurodegenerative disorder. The only disorder that is currently more common is Alzheimer’s disease, which barely trumps Parkinson’s by a small margin. The first article studied the effectiveness of two different exercise programs against a home-based control group with people in the early to mid stages of Parkinson’s. The study was a random ized control trial and lasted for 16 months and compared: flexibility/balance/function exercises (FBF)Read MoreFormulation Manufacturing Issues of Levadopa/ Carbidopa Combinations1543 Words   |  6 PagesFormulation Manufacturing Issues Levodopa/Carbidopa (Sinemet ®) – Synthetic Drug The most effective drug used in the treatment of Parkinson’s disease is levodopa. When Levodopa is consumed on its own, it evidentially causes nausea and vomiting. Due to this factor a combination therapy with the drug carbidopa is essential in the treatment of Parkinson’s disease to avoid side effect. The most popular carbidopa/levodopa pharmaceutical formulation is called Sinemet ®. Carbidopa/levodopa can be foundRead MoreStem Cells And Its Effects On Society910 Words   |  4 Pagesspecific genes. They created the mice using embryonic stem cells and homologous recombination. In 2007, they were recognized by the Nobel Assembly because their experiment proved to be an irreplaceable piece of evidence to understand how various human disease such as diabetes and cancer develop. On November 6, 1998 the first batch of embryonic stem cells that originated from early embryos. Then eleven years later, President Obama signed an executive order to repeal some restrictions on human embryonicRead MoreStem Cells And Its Effects On Society909 Words   |  4 Pagesspecific genes. They created the mice using embryonic stem cells and homologous recombination. In 2007, they  were recognized by the  Nobel Assembly because their experiment proved  to be  an irreplaceable piece of evidence to understand how various human disease such as diabetes and cancer develop. On Novem ber 6, 1998 the first batch of embryonic stem cells that originated from early embryos. Then eleven years later, President Obama signed an executive order to repeal some restrictions on human embryonicRead MoreHow Placebos Can Be Effective Method Of Treatment1268 Words   |  6 PagesKnowing that placebos can be an effective method of treatment, Espay et al. (2015) wanted to see if the price of a placebo would alter its effectiveness. The researchers conducted a double-blind study with twelve patients with moderate to severe Parkinson’s disease. The participants were told that they would be receiving two new injectable dopamine agonists which, despite their large difference in price ($100 and $1,500) were thought to be equally effective. Participants were further told that the purposeRead More Use of Fetal Tissue Research to Cure/Treat Neurological Disorder1012 Words   |  5 Pagesquestions and concerns. I am currently most concerned by the effects of physical damage to the brain. Although we have concluded that behavior is based at the lowest level upon the workings of neurons, it is the actual integration of these neurons that account for behavior. Any damage done to the brain either by disease or other disorders can result in a direct change in not only behavior but also personality and our very concept of self. These are things that are very important to us as human beings

Harriet Jacobs a True Woman - 2422 Words

The nineteenth century was an age of male dominance as well as slavery; even white women were viewed more as property or a burden to men instead of an equal. In concur with male supremacy the cult of true womanhood was practiced, an ideology which was brought forth in the eighteen century stating four virtues which women should abide by, piety, purity, submissiveness and domesticity, in turn they would be grant happiness and power; hardly being the case of either, women were subjected to the control and dependency of their male counterparts. These virtues were taken mostly in attention of the elite white woman, not considering poor white women as well as slaves, who were thought to be less than women; African American women were excluded†¦show more content†¦Women were perhaps naà ¯ve in the sense that they accepted that men were head of the universe. Instead Jacobs refuses to accept Dr. Flint, escapes and not with her benefit in mind but with the hope of freedom for her c hildren. She knows that Dr. Flint would not sell her children if she were there for fear of her escape in search of them, but she figured that if she were no longer around her children would instead be a burden to the doctor and he would eventually consent to selling them. When her children are finally safely in the North and Jacobs is able to flee the south in search of them, her main concern was to find employment and being able to provide for them, she told her daughter Ellis â€Å"I had laid up a hundred dollars and before long I hoped to be able to give her and Benjamin a home, and send them to school.† A woman supporting her children, with no man as head of the household was not viewed as domestic; she was degraded for not marrying and having children out of wedlock. Jacobs gives a new definition of domestic, it may have been too futuristic to people of her era, but today a domestic person is devoted to home life or household affairs. Jacobs did not need to accept Dr. Flint’s attempt to domesticate her or need to conform to the domesticity expectations of needing to be married, she provided for her children even when she had the bare minimal for herself, she always thought of their welfare first even if it meant an anguishedShow MoreRelatedIncidents In The Life A Slave Girl Summary1630 Words   |  7 Pages Harriet Jacobs writes, â€Å"No pen can give an adequate description of all [the] pervading corruption of slavery.† In the book, Incidents in the Life a Slave Girl, Harriet Jacobs recount her time as a slave before escaping the cruelties of slavery to freedom. This quote from the book outlines the intelligence Harriet Jacobs has about the torment in slavery. In the beginning of the book the preface and the editor’s introduction to the book outline Harriet Jacobs story. Both the preface and the author’sRead MoreHarriet Jacobs’ Fight Against Intolerance713 Words   |  3 Pagesâ€Å"My master had power and low on his side; I had determined will. There is might in each† a statement from Harriet Ann Jacobs reflecting her will to overcome the standards of society (97). Harriet Jacobs’ life revolved around slavery from birth to death. Jacobs was a mother of two with determination and insight to make choices to change the way of life for her children. Harriet Jacobs was the first African American women to have her slave narrative published retelling her life story exposingRead MoreEssay about Harriet Jacobs Incidents In The Life Of A Slave Girl1355 Words   |  6 PagesHarriet Jacobs Incidents In The Life Of A Slave Girl The feminist movement sought to gain rights for women. Many feminist during the early nineteenth century fought for the abolition of slavery around the world. The slave narrative became a powerful feminist tool in the nineteenth century. Black and white women are fictionalized and objectified in the slave narrative. White women are idealized as pure, angelic, and chaste while black woman are idealized as exotic and contained an uncontrollableRead MoreEssay Harriet Jacobs Life of a Slave Girl1322 Words   |  6 Pages Harriet A. Jacobs Incidents in the Life of a Slave Girl: Jacobs’s construction of black female empowerment despite the limitations of slavery Harriet A. Jacobs Incidents in the Life of a Slave Girl is an autobiography written under the name of Linda Brent. This autobiography is a detailed account of her life or lack thereof. I use the term lack thereof because Harriet Jacobs was raised by her grandmother due to her mother dying at a young age. Harriet was taught to readRead MoreThe Life Of A Slave Girl By Harriet Jacobs1335 Words   |  6 PagesHarriet Jacobs wrote Incidents in the Life of a Slave Girl (Incidents) to plead with free white women in the north for the abolition of slavery. She focused on highlighting characteristics that the Cult of True Womanhood and other traditional protestant Christians idolized in women, mainly piety, purity, domesticity, and submissiveness. Yet, by representing how each of her characters loses the ability to maintain the prescribed values, she presents the strong moral framework of the African AmericanRead MoreIncidents in the Life of a Slave Girl - Feminism Essays1364 Words   |   6 Pagesidealized as pure, angelic, and chaste while black woman are idealized as exotic and contained an uncontrollable, savage sexuality. Harriet Jacobs Incidents in the Life of A Slave Girl, brought the sexual oppression of captive black women into the public and political arena. br brHarriet Jacobs takes a great risk writing her trials as a house servant in the south and a fugitive in the north. Incidents in the Life of a Slave Girl gives a true account of the brutality slavery held for women. ARead MoreSlavery in America1124 Words   |  5 Pageswas a difficult time for African Americans. But do people truly understand how hard it was for the African American female slaves? Harriet Jacobs goes into detail about her life as a slave and gives the female perspective under the alias Linda Brent in the novel Incidents in the Life of a Slave Girl. She states that everything she says in the book is completely true. There are stereotypes of black women during this time: being looke d upon as sexual objects and being promiscuous. Jacobs’s attemptsRead MoreIncidents Throughout The Life Of A Slave Girl By Harriet Jacobs Essay1475 Words   |  6 PagesMark 01 November 2016 Harriet Jacobs, Incidents in the Life of a Slave Girl In her book, Incidents in the Life of a Slave Girl, Harriet Jacobs is a slave that was born into slavery in 1813 that has decided to share her amazing story of slavery and her struggles to become free. When she was young her parents were â€Å"property† of a really nice lady that allowed her family to have a very comfortable life for a slave family. They were allowed to work for their own money and Harriet did not know that sheRead MoreHarriet Jacobs s Story : The True Meaning Of A Slave s Quest For Freedom1682 Words   |  7 PagesHarriet Jacobs’s story informs the reader of her experiences and transformative tribulations she had to undergo from childhood to adulthood. No one in today’s society could come close to comprehending the amount of heartache, torment, anguish, and complete misery women had to suffer and endure during slavery. However, we can all learn from Jacobs’s heartbreaking story to understand the true meaning of a slave’s quest for freedom and the inalienable bond a mother has for her children. Life was toughRead More Slavery and the Life of Harriet Jacobs Essays1074 Words   |  5 PagesSlavery and the Life of Harriet Jacobs It is well known that slavery was a horrible event in the history of the United States. However, what isnt as well known is the actual severity of slavery. The experiences of slave women presented by Angela Davis and the theories of black women presented by Patricia Hill Collins are evident in the life of Harriet Jacobs and show the severity of slavery for black women. The history of slave women offered by Davis suggests that compulsory labor overshadowed

Decisions Promises Organizations and Society

Question: Discuss about the Decisions Promises Organizations and Society. Answer: Introduction: The current report aims to evaluate the instincts of Matt regarding the reservations about evaluating the bid of Stephanie. The second segment concentrates on evaluating the ethical integrity of Matt regarding the offer of Stephanie. In addition, the valuation of the fundamental principles on the part of Matt in relation to APES 110 Revised Code of Ethics for Professional Accountants has been demonstrated critically. Finally, the report sheds light on advising Matt about the steps to be taken regarding the proposal of Stephanie. Accuracy of Matts instincts: According to the case study, it has been found that Matt has faced a dilemma regarding the approach of Stephanie Birchgrove. This is because the latter has approached the former for a favour. This approach is violating the work ethics of Matt, as per his thought. However, the person does not want to hamper the friendly relationship with Stephanie. This is because Stephanie has promised Matt to overcome his situation of financial crisis. There are certainly some reservations about the situation, since Matt has been working for a rival firm. Hence, lending help to Stephanie would increase risk for the company. As a result, the company might incur monetary losses (Kaplan and Atkinson 2015). In addition, Matt might face legal charges. As a result, it could negatively affect his goodwill. Ethical integrity of Stephanies bid: It is advised to Matt to avoid evaluating the bid of Stephanie. Since this is a criminal offence. Therefore, strict actions might be taken against Matt. In addition, even if Matt adopts utter carefulness while evaluating the bid and switches over to another company, in case, Stephanie wins the bid, it might raise doubts. Theerefore, Matt might lose CPA verification, if found guilty. As a result, it would further aggravate his financial crisis. Violation of the fundamental principles on the part of Matt: As per APES 110 Revised Code of Ethics for Professional Accountants, the integrity principle imposes a compulsion on all the members to maintain the honesty in business and professional relationships. In this context, Mouritsen and Kreiner (2016) stated that adopting dishonesty through conduction of unethical practices might hamper the professional relationships on the part of Matt. Therefore, if Matt agrees to scrutinise the bid of Stephanie, the person would violate the above-stated law. This is because such evaluation would be unethical. Since Matt would be providing out the confidential information of the firm to Stephanie. Conclusion: Based on the above discussion, it could be inferred that Matt would violate the law and break the rules of the organisation, if he evaluates the bid of Stephanie. It might also lead to job loss of Matt. Therefore, it is recommended to Matt to explain Stephanie about his helpless situation. As per the financial situation of Matt, it is suggested to find other ways to deal with the situation by avoiding illegal steps. In order to deal with the financial shortcomings, Matt might apply for a loan from his current organisation to repay the personal loan of $100,000. These above-mentioned steps are recommended to Matt to maintain the ethical integrity and overcome financial crisis. References: Kaplan, R.S. and Atkinson, A.A., 2015.Advanced management accounting. PHI Learning. Mouritsen, J. and Kreiner, K., 2016. Accounting, decisions and promises.Accounting, Organizations and Society,49(C), pp.21-31

The American Government 1865 to Present an Example by

The American Government: 1865 to Present Perhaps it can be said that the strength of the United States of America, as a nation, has always been temporary, in that it is dependent on the capability and proficiency of the President in office. Thus it is more apparent in democracies, where a change in leadership occurs more frequent, and often, much too soon. It is a case where a Presidents term, if found inept, is too long; and a competent one, too fleeting. Need essay sample on "The American Government: 1865 to Present" topic? We will write a custom essay sample specifically for you Proceed The years 1865 to 1900 were pictures of contrasts. President Chester Arthur, who served from 1881-1885, was a champion of the reformation of the civil service through the Pendleton Act of 1883, which protected the government employees from termination due to political grounds (White House.gov). President Arthur likewise enacted, against his partys principles, the Tariff Act of 1883, which lowered the governments tariff rates in order to lessen the huge revenue surplus. President Ulysses Grants term of office, from 1869-1867, meanwhile, was marred with controversies. Although he was generally known to be an honest man, he associated himself with men of questionable character, and whom he had defended, even when their corruption was already evident. The nations economic policies were questionable during his term, and this may have resulted in the Panic of 1873. The Years between 1901 and 1932 were no different. President Thomas Woodrow Wilson, who served from 1913 to 1921, was a leader whose mettle was tested by the First World War. President Wilson never once was in doubt of the eventual result. As was written of him in an article, He had mobilized the entire nationits manpower, its industry, its commerce, its agriculture (Nobelprize.org 1). President Theodore Roosevelts term, from 1901-1909, in contrast, was characterized by indecisions, especially on urgent economic programs. The Meat Inspection Act and the Pure Food and Drug Act, both enacted under his term, were only instigated because of the mounting pressure resulting from the banning of American meat products by the international community. Later revelations by the men directly involved in the authorship of the bills would reveal that President Roosevelt had in actuality, no participation in its drafting, a typical trait of limited governance. President Richard Nixon term, which lasted from 1969 to 1974, was perhaps the most controversial. His Watergate Scandal, which eventually forced him to resign, was just one of the many accusations against his administration. The severity of his administrations corruption can be evidenced in his appointees as well as some Cabinet members confession of guilt concerning Watergate-related crimes. This was a direct contrast to President John F. Kennedys strong administrative style, from 1961 to 1963, which was the first time that the governments budget exceeded $100 billion, and in 1961, had the first non-recession deficit. Americas phenomenal growth in GDP over a sustained period during his term had never been duplicated since. In more recent times, the governance of President Bill Clinton is perceived as being limited, and had been pictured as in the back seat while Congress was the one driving. His failure to implement developments in healthcare had resulted in his partys loss in the Congressional elections during his two-term tenure, save for one. President George W. Bush, from 2001 to 2009, meanwhile, clearly demonstrated strong leadership in the face of adversity. His unswerving decision to wage war against terrorism, and in the process rid of foreign leaders who had shown sympathy to known terrorists groups, for the safety of the American nation, was a national posture never before experienced in American history. Conclusion It has been evident that a nations strength and stability corresponds directly with the competence of its leader. United States, in its long history, had displayed this phenomenon clearly and had, in its downslide, suffered the consequences. Perhaps we should muster the will to learn that history, in its cycle of repetitions, leaves behind lessons for us, the citizens, to utilize and learn from. Works Cited The White House.org. Home page. 29 July 2009 Woodrow Wilson: The Nobel Peace Prize 1919. Nobelprize.org. Home page. 29 July 2009

Characteristics of Perchlorate

Characteristics of Perchlorate Sources of perchlorate Perchlorate is a chemical that occurs naturally, although it may as well be man-made. In addition, perchlorate can also be found in some fertilizers and in bleach. It has found wide application in the manufacture of fireworks, flares, rocket fuel, and explosives1. Many of the sites where perchlorate can be found occurring naturally are, by and large, limited to the arid areas. Such deposits are largely low concentration.Advertising We will write a custom research paper sample on Characteristics of Perchlorate specifically for you for only $16.05 $11/page Learn More On the other hand, man-made sources of perchlorate are mainly highly concentrated in comparison with the natural sources. Sites with high levels of perchlorate contamination are mainly involved in the production, testing, and disposal of perchlorate compounds and solid rocket propellants. Others include industrial production sites that use perchlorate compounds as reagents2. EPA response for regulating and remediation The Safe Drinking Water Act gives the EPA the mandate to regulate perchlorate. Peer review reports by various public health experts and independent scientists as well have played a key role in influencing the decision y the EPA to impose a regulation on perchlorate. The new decision by the EPA would be a reversal of the 2008 preliminary determination3. It takes into account the over 39,000 comments from members of the public regarding multiple public notices on perchlorate3. This action is an attempt to create awareness among interested parties on the decision reached by the EPA on regulating perchlorate. Nonetheless, the action does not in any way try to impose any public water systems (PWS) requirements4. On the other hand, this action has laid the framework for the designing and the development of a primary drinking water regulation at the national level (NPDWR). Following the finalization of the NPDWR, a number of PWSs could be forced to make an effort to abide by the requirements in line with the program required by the regulation5. In addition, the EPA also intends to create a drinking water standard that will take care of about 16 toxic chemicals that have been noted to pose a danger top human health. The aim of the EPA is to continue assessing the health effects of perchlorate, along with the science behind their occurrence in public water systems. Moreover, the EPA intends to embark on a project aimed at examining the affordability and feasibility of treatment technologies aimed at removing perchlorate. The agency shall also assess the benefits and costs of potential standards. Risk potential Sufficient doses of perchlorate can interfere with the normal operations of the thyroid gland. Perchlorate disrupts the transportation of iodide into the thyroid gland, in effect reducing iodide availability that is necessary for the manufacture of thyroid hormones. These hormones are vital for normal growth, metabolis m and development.Advertising Looking for research paper on chemistry? Let's see if we can help you! Get your first paper with 15% OFF Learn More Pregnant women are especially at a greater risk of thyroid hormone synthesis disruption2. Others include the developing fetuses, newly-born infants, young children, and also person with low thyroid hormones levels (Massachusetts Department of Environmental Protection). On the basis of such a potential concern, the EPA has deemed it necessary to propose a formal rule. The process shall entail the reception of feedback from important stakeholders in addition to the provision of any formal rule to members of the public via a comment process 3. It is important to note that exposure to sufficient doses of perchlorate may result in adverse health effects similar to those brought about by iodine deficiency among humans. When there is not enough intake of iodine in the diet, the individual in question suffers from a decline in the synthesis and secretion of thyroid hormone. Based on the severity of such an iodine deficiency, the individual in question can manifest such effects as impairment in behavior, speech, vision, movement, physical development, hearing, and intelligence4. Scientists also contend that sufficient doses of perchlorate can interfere with the ability of the thyroid gland to synthesize hormones vital for the development of both fetuses and infants1. Monitoring data reveals that over 4 percent of public water systems contain detectable levels of perchlorate. In addition, the same data indicates that between 5 and 17 million individuals are at risk of drinking water containing sufficient levels of perchlorate. Standards set by states such as California and Massachusetts In Massachusetts, the MassDEP is in the process of commissioning a drinking water standard. The new standard will ensure that the maximum contaminant level of perchlorate in drinking water does not exceed 2 ppb3. It is i mportant to appreciate that the new promulgation shall be the first veer drinking water standards in the country for perchlorate. Furthermore, the Massachusetts Contingency Plan is also in the process of establishing perchlorate groundwater and soil standards to facilitate the cleaning up exercise of hazardous waste sites. Also, MassDEP plans to adopt a reference dose to facilitate risk assessment at specific sites. The state of California also regulates perchlorate as a contaminant in drinking water1. In this case, 6 micrograms per liter is the recommended maximum contaminant level of perchlorate in the state of California.Advertising We will write a custom research paper sample on Characteristics of Perchlorate specifically for you for only $16.05 $11/page Learn More References 1. California Department of Toxic Substances Control, â€Å"Perchlorate â€Å", Last modified September 1, 2007, dtsc.ca.gov/hazardouswaste/perchlorate/ 2. Isa, Jalil, â€Å"EPA To Develop Regulation for Perchlorate and Toxic Chemicals in Drinking Water.† Environmental Protection Agency, Last modified February 02, 2011, http://yosemite.epa.gov/opa/admpress.nsf/d0cf6618525a9efb85257359003fb69d/634884579f4cc5d8525782b004d81ae!Open 3. Massachusetts Department of Environmental Protection. â€Å" Frequently Asked Questions: Perchlorate†. n.d, mass.gov/dep/toxics/pchlorqa.htm 4. Trumpolt, Clayton et al. â€Å"Perchlorate: Sources, Uses, and Occurrences in the Environment.†Wiley Periodicals, Last modified December 20, 2005, http://yosemite.epa.gov/r10/CLEANUP.NSF/PH/Arkema+Technical+Documents/$FILE/Perchlorate-Sources-Occurance-In-The-Environment.pdf 5. United States Environmental Protection Agency. â€Å"Perchlorate†. Last modified March 06, 2012, http://water.epa.gov/drink/contaminants/unregulated/perchlorate.cfm Bibliography California Department of Toxic Substances Control. â€Å"Perchlorate. â€Å" California  Department of Tox ic Substances Control. Last modified September 1, 2007. dtsc.ca.gov/hazardouswaste/perchlorate/ Isa, Jalil. â€Å"EPA To Develop Regulation for Perchlorate and Toxic Chemicals in Drinking Water.† Environmental Protection Agency. Last modified February 02, 2011. http://yosemite.epa.gov/opa/admpress.nsf/d0cf6618525a9efb85257359003fb69d/634884579f4cc5d8525782b004d81ae!OpenAdvertising Looking for research paper on chemistry? Let's see if we can help you! Get your first paper with 15% OFF Learn More Massachusetts Department of Environmental Protection. â€Å"Frequently Asked Questions: Perchlorate†. Massachusetts Department of Environmental Protection. Last modified June12, 2006. mass.gov/dep/toxics/pchlorqa.htm Trumpolt, Clayton et al. â€Å"Perchlorate: Sources, Uses, and Occurrences in the Environment.†Wiley Periodicals. Last modified December 20, 2005. http://yosemite.epa.gov/r10/CLEANUP.NSF/PH/Arkema+Technical+Documents/$FILE/Perchlorate-Sources-Occurance-In-The-Environment.pdf United States Environmental Protection Agency. â€Å"Perchlorate.† United States  Environmental Protection Agency. Last modified March06, 2012. http://water.epa.gov/drink/contaminants/unregulated/perchlorate.cfm

Simple strategies for clear written communication, The Actuary - Emphasis

Simple strategies for clear written communication, The Actuary Simple strategies for clear written communication, The Actuary For most actuaries, its a love of maths, statistics, probabilities and risk analysis that draws them into the profession. However, once theyve been fully trained in these hard skills, working life throws up new challenges. If youre a consulting actuary, for example, youll often have to explain complex ideas to clients who are not experts in the field. And even if you work in-house, explaining your work to colleagues is a crucial part of your role. So mastering communication is essential. And since these days we use written communication more than weve ever done before, you need to be able to write and to write well. Being able to explain yourself clearly and write in plain English can help you to gain credibility and increases the perceived value of your work. In turn, this will help ensure your clients or colleagues realise that what you do is an integral part of the organisation. Writing is a core professional skill that must be learned and then continually improved. The demands of business writing and the rigours of producing professional reports are very different from the English learnt at school. It should come as no surprise then that the actuarial profession have changed the CA3 Communications syllabus for trainees, in order to focus on writing for a non-actuarial audience. The Institute of Actuaries and The Faculty of Actuaries have introduced a residential course and workbook to help give students support and practice in this type of writing before they take the written exam. They have recognised that many students struggle with this module and they want to ensure that actuaries are able to express their ideas confidently through writing. Employers are also putting more and more emphasis on writing skills. Firms such as Hewitt and Hymans Robertson have commissioned specialist writing-training programmes for their actuarial staff, for example. So what can you do in practice? Well, imagine that you have completed a report on corporate pensions. You need to present it to a client who has staffing issues, an upcoming annual general meeting to prepare for and several other reports to read. The bottom line is that he is only interested in the financial implications of your search. You need to make an impact and ensure that your ideas are fully understood. If you get the communication wrong, you could lose valuable business. Trainees will soon have to complete an orally-based presentations module as part of their exams. But for trainees and qualified actuaries alike, explaining actuarial mathematics to a layperson is not an easy prospect. And the better you can become at communicating your ideas, the more effective you will be as an actuary. Training doesnt end when you qualify and learning writing techniques can make all the difference to your professional life. Here are the top tips for improving your written communication: Put the reader first Presenting complex figures, modelling techniques or probability theories doesnt have to be a daunting prospect. The answer is to think carefully about your audience and avoid a one size fits all approach. Ask yourself the following questions: What is the document about? Who will read it? How much do they already know about the subject? What do they absolutely need to know? How important is the subject to them? How interested are they in the subject? Dont include absolutely everything about a piece of research or a new idea. Instead, pare down to the main points and write them in plain English. This doesnt mean that you need to dumb down or be patronising, though. The message is to be as clear and precise as possible, and this means using technical language where appropriate. Jargon doesnt have to be avoided at all costs. Just make sure that your audience understand the technical terms youre using. (And always bear in mind that they may no less than they care to admit.) The aim is to save the reader time and wasted effort in trying to decipher unclear prose. Try to picture your reader with your document. If youre writing for a trustee, for instance, its likely theyll have to read several reports before a meeting. So, make sure that your introduction grabs the readers attention. Immediately convey your conclusions and recommendations with a concise, powerful executive summary. It doesnt matter whether youre writing a report, memo, letter or speech. Ask yourself what you want the reader to do when they have read the document. If you want them to take an action, you need to be direct. Clarify your main message Always offer a clear viewpoint. Keep asking yourself what you really want to communicate. It can seem like dangerous ground to express an opinion but its likely that your clients will see it as refreshing. Do this by using the active voice. So say, We predict a decline in employee pension provision, rather than Employee pension provision is predicted to decline. Keep it short Keep your sentences short and simple and avoid flowery phrases. There is no limit on the amount of full stops you can use. Aim for an average length of 15-20 words and an absolute maximum of 35. And stick to the rule of one sentence, one idea. Pay attention to structure If youre worried about structuring your ideas, the questions: what?, where?, when?, how?, why? and who? are useful prompts. When you know what you want to communicate, and why, you can then lay out your core idea first, and expand on it in the rest of the document. Proofread every piece of work Its easy to neglect to read through a document carefully once its finished. Dont. If at all possible, leave at least a day before you read it, to put some distance between you and the content. Otherwise youll read what you think it says, not what it actually does. Love, as they say, is blind. Look out for fuzzy thoughts, typos or badly-worded phrases. And make sure that you check the grammar, punctuation and spelling. Microsoft Words spellcheck doesnt know whether you mean peak or peek. Writing the wrong word can completely change your intended meaning and affect how your work is received. Robert Ashton is the Chief Executive of Emphasis.

Strategic Operations Management Essay Example | Topics and Well Written Essays - 3000 words

Strategic Operations Management - Essay Example â€Å"Operational activities are central to the provision of services and /or goods. Every organization provides a product and service combination. A meal in restaurant, a visit to the hospital, buying a pair of Levi 501s, making a pair of Levi 501s, insuring an automobile, staying in an hotel, going to the cinema,; all have operations activities and their management is central to the successful provision of goods and services.† 1 In this example, we are examining the operational activities of a small manufacturing company engaged in the production of automotive components. It is a known fact that small scale manufacturing companies undertake many diverse activities in providing different types of products and services. Modern organizations are complex entities, especially the small scale enterprise, and there will be many different types of operation, both in individual firms as well as across different industries. This clearly reveals that the types of operation vary across different sectors, and there are external factors that influence the organization in many ways. Over the past two decades, leaders of virtually all organizations -- big and small -- have come to understand that external forces can exert more influence over an organization than management itself does. Legislation and public opinion, for example, can greatly expand or restrict what an organization can do and how it does it. As a result, many organizations now try to monitor these external forces, looking for signs where new controversies or new opportunities may be brewing on the business horizon. In today’s competitive and highly sophisticated business world, awareness of those external factors is crucial for a business entity. These factors also determine the sustenance of an organization. Generally speaking, these factors exist both at ‘micro’ and ‘macro’ levels. At a closer micro level, the external elements include suppliers, competitors,

HU300 Unit 7 A Research Paper Example | Topics and Well Written Essays - 1000 words

HU300 Unit 7 A - Research Paper Example It is to be understood as having a â€Å"life† that moves within it (Scruton, 2009, p. 7). Therefore, music is about life and is understood as the universal language. As a universal language of life, music portrays our moods in all aspects of our lives. People listen to music for a lot of reasons: to ease melancholy, to celebrate victory, to complement the feeling of romance and passion, to grieve and to listen to the new single of one’s’ favorite artist. Therefore, music is a way of life, and it forms part of our journey as humans. Music: Representation of Moods and Stages of Life Childhood Years During my childhood years, there was something about male and female groups that I really liked the most. I grew up listening to Spice Girls, Aqua, Boyz II Men, Westlife, and Blue, but most of all, I was notably addicted to Spice Girls. Perhaps, it was all about their stature and fame that I was hooked with their popular hits like 2 Become 1, Wannabe, Viva Forever, and Stop. These songs enlivened my childhood especially that this group also complemented their music with colorful outfits, those that would really dazzle the audience especially the young ones. Moreover, their songs were groovy and had the element of recall which made them easier to memorize. As a child, I would love to hear songs that make me happy, groove, and smile. These songs influenced my childhood in such a way that they became part of my everyday routine. During weekends, I played their CD all throughout the day that no wonder, the CD had tantrums once in a while. Adolescence Stage When I entered high school, the music industry was even livelier. Rock bands, talent search singers, and veteran hit makers continue to make songs for mass consumption, most especially that the Internet was on its hype, and almost all music released or are presently hitting the waves are very much available online. I still adore U2, The Fray, Red Hot Chili Peppers, and The Calling. Notice the shift from being so obsessed with an all-female group to alternative rock bands. Nevertheless, I started to appreciate the music of The Calling. My adolescent music life was filled with vigor with this band on my A-list. My preference to their music was not in any way a matter of ‘going with the flow’ as most teenagers were head-over-heels with rock bands. It was because I recognized this band’s passion to write songs that reflect strong emotions, most notably songs that contain sincere messages about being in-love and standing strong against the odds of being in a relationship. I was magically transported to another dimension of the world when I heard the song ‘Stigmatized’ by The Calling. When one is in the adolescent stage, all you think of is making the most out of life. Surely, one manifestation of living life as if it is the world’s end is by being in love. ‘Stigmatized’ reflects teenagers drive to make a relationship work, despit e all the circumstances stopping the possible romance to bloom. The melody brought by the acoustic guitar and the intense vocal prowess of the lead singer make the song more of a personal conversation rather than a compilation of words and melody. Certainly, this song has been part of my youthful years. Comforting Music There is this beauty not found in every note and lyric of the song but on the general properties of music (Cook & Everist, 1999). Music comforts us through the whole impact of the song and not in every syllable or

Decision-Making Case Study Essay Example for Free

Decision-Making Case Study Essay The current grave state of the economy has had a significant impact on health care across The United States. Massive budget cuts, reduced services, and limited access to care significantly have affected Medicaid patients. Hennepin County Clinic (HCC), a facility that provides health care to Medicaid patients, is dealing with an additional 15% budget cut that will force management to make decisions about which services must be changed or eliminated while still meeting the basic needs of the clients. Stemming from consumers’ increased demands for enhanced quality of care and greater accountability from health care organizations, leaders must engage in decision-making that incorporates evidence from well-conducted research whenever possible. The Informed Decisions Toolbox (IDT), a process of evidence-based decision-making, involves six steps in the decision-making process (Rundall, et. al, 2007). While every step is consequential, step two, the process of gathering evidenced-based sources of information, is the most important tool in decision-making. The IDT plays an important role in increasing organizational accountability, facilitating knowledge transfer within a facility, and contributing to a questioning organization. Step One The first step in the IDT is formulating a question or questions behind the decision. This is done in such a way that will increase the likelihood of uncovering useful research studies. As a manager, one must discover what information is needed to make the best decision. When investigating the needs of Medicaid clients and deciding which clinical services to change or eliminate, it is vital to research information regarding the various services used by these patients. The manager must ask several questions. Do individuals enrolled in Medicaid have unique health needs that differ from the larger population? What are the services most utilized within HCC at any given time? In what ways will service cuts and elimination of resources   affect the clients? What services can be outsourced to other facilities that accept Medicaid? Can the current physician staff be reduced, and the use of nurse practitioners and physician’s assistants be implemented? Step Two After the questions are formulated, step two involves identifying credible sources of information to answer these questions. In an age of abundant technological resources, a large percentage of sources may be found on research-based websites, bibliographic databases, online academic and peer-reviewed journals, books or other publications, and government reports, to name a few (The Center for Health Research, 2011). It may also be helpful for the manager to locate internal information available within the clinic that will tailor to the unique needs of HCC. While the IDT mainly focuses on evidenced-based sources of information, the manager may also utilize supportive colloquial knowledge from and opinions of colleagues, employees, patients, and other health care professionals (Rundall, et. al, 2007). Steps Three, Four, and Five Steps three through five take the collected research and evaluate its accuracy, applicability, and â€Å"actionability.† First, step three emphasizes the accuracy of the research presented. The manager must question if the research is of high-quality, originates from a credible source, presents complete and balanced viewpoints, and comprises reliable and valid measurements (The Center for Health Research, 2011). Step four highlights the applicability of the research. The manager must ask if the research is relevant to his or her question at hand and whether or not it applies specifically to HCC. Step five focuses on the â€Å"actionability† of the research. The manager needs to know how the research is going to be implemented and who exactly is going to do it. Step five also pertains to the implications and importance of the research studied (The Center for Health Research, 2011). Step Six Finally, step six allows the manager to look at his or her organization’s needs and values to determine if the research fits the context of its unique situation. The manager must question if the collected research is adequate to make a useful decision and if there is a single best option, multiple  practical options, or even inadequate evidence to make a decision (The Center for Health Research, 2011). Most Valuable Tool Although every step in the IDT has much significance and step one builds the foundation on which to define the problem at hand, the tool that would be the most valuable is step two, identifying credible evidenced-based sources of information. Health care workers who provide care based on knowledge from evidenced-based studies deliver significantly better care and produce better outcomes (Melynk Fineout-Overholt, 2005). Because of this, the process of identifying these studies is vital to the survival of an organization. The knowledge discovered during research can be a valuable source of strength to the organization by combining it with the unique employee and patient opinions and preferences. This process of searching for information can also contribute to organizational growth through the sharpening of knowledge and skills of decision makers. With regard to HCC, step two is very valuable in deciding which clinical services need to be eliminated primarily because locating appropriate research studies is the foundation of finding the solution to the question. Through the selection of evidenced-based articles, the manager can compare and contrast how other organizations dealt with budget cuts and the solutions they implemented. Accountability Utilizing the IDT greatly affects organizational accountability. Hospital organizations and clinics have to function according to the strict rules and regulations of such agencies as JCAHO and CMS, and at the same time, respond to the ever increasing needs demands of consumers for improved quality of care (Rundall, et. al, 2007). These added pressures force management to make comprehensive, precise, and influential decisions that they cannot formulate with personal knowledge and experience alone. Because of this, management needs to apply the best evidence available in making these consequential decisions. Knowledge Transfer Knowledge transfer aims to deliver research-based information and guarantee its availability for future members within an organization (Pentland Forsyth, 2011). Within health care facilities, it is important for newfound  research evidence to be transferred into clinical practice and policy development. Management and decision makers must communicate clearly to the health care team and make them aware of decisions that are made and how the decisions will affect them. Team members are encouraged to share their understanding with others to expedite knowledge transfer within the facility. Knowledge transfer facilitates shared intelligence, improved employee performance, higher levels of innovation within the organization, and economic growth (Rundall, et. al, 2007). Questioning Organization The IDT affects an organization in a number of positive ways. Most important, it allows the decision-maker and the health care team to reflect on what was learned, what questions still need to be asked, and what should be done differently next time, which is critical to innovation (Buchen Rowley, 2000). Building a questioning culture within an organization inspires team members to search for answers within evidenced-based research studies and improving the lines of communication among members as well. Conclusion The IDT is an exceptional set of tools that assists management and decision-makers in utilizing evidenced-based research in confronting and responding to pressing questions that significantly affect an organization. The IDT plays an important role in increasing organizational accountability, facilitating knowledge transfer, and contributing to a questioning organization. In the case of HCC, the manager utilized the IDT by formulating questions to determine which clinical services to change or eliminate based on the various health care needs of Medicaid clients. The manager identified various credible sources of information to answer these questions, which has been determined the most valuable tool within the IDT. The research evidence was examined to determine its accuracy, applicability, and â€Å"actionability.† Finally, the manager assessed to see if the collected research was both adequate and met the specific needs of HCC, which is what the IDT was designed to do. References Buchen, I, Rowley, L. (2000). The questioning culture: Perpetual state of the art. Performance Improvement, (39)5, 26-30. Melynk, B., Fineout-Overholt, E. (2005). Evidence based practice in nursing and healthcare. Philadelphia, PA: Lippincott Williams Wilkins. Pentland, D., Forsyth, K. (2011). Key characteristics of knowledge transfer and exchange in healthcare: integrative literature review. Journal of Advanced Nursing, 67(7), 1408-25. Rundall, T., Martelli, P., Arroyo, L., McCurdy, R., Neuwirth, E., et al. (2007). The informed toolbox: Tools for knowledge transfer and performance improvement. Journal of Healthcare Management, 25(5), 325-341. The Center for Health Research. (2011). The informed decisions toolbox. Retrieved from http://www.toolbox.berkeley.edu/overview.

Three Varieties of Bathtubs :: Jeffrey Harrison Literature Essays

Three Varieties of Bathtubs Past, present and future are the simplest ways in which humans perceive time. We recognize the past through our memories and our recall of events that already have happened. When looking into the future, we can only look at where we are now in order to guess what our fate might be in the future. Or else we only have our dreams and goals that we look forward to one- day accomplishing. When viewing the present, however, everything around us is not an idea or memory in our head, but a reality that we use our senses to see, feel, touch, smell or hear. We are using our body's functions to live and take in what is around us at the moment. When "living in the present" (as one would say to someone who is constantly aware of the moment and what is around them), there is less chance to miss what's in front of us rather than always looking behind or too far ahead. Jeffrey Harrison, in his poem "Bathtubs, Three Varieties," seems to feel the same way about living in the here and the now. The three varieties of bathtubs Harrison writes about were separated into three stanzas according to their design and their purpose now, in the present. In the first stanza of the poem Harrison describes an old- fashioned bathtub, one that was raised off the floor by porcelain animal paws that extended off each corner. The particular bathtubs that he was describing were no longer serving their intended purpose, but rather were outside in a yard like an old car that was once one's hotrod, now scrap metal. These bathtubs, retired from their original purpose, now just sat through the seasons and let outside forces such as the weather and changes in other living things like the walnut tree carry on without regard to their presence. In the description of these bathtubs, Harrison shows something that although is still here, is part of the past and really does not have a life of its own anymore except just lying underneath the walnut tree. This is very much like a person whose thoughts ar e caught up in the past, because they, too, are still trying to live something that is over and then lose purpose in the present. Harrison also relates these bathtubs twice to sheep, which are commonly viewed as animals that follow each other, never really having a choice or idea of their own.

An offshoot of business process outsourcing Essay

1. (TCO 2) An offshoot of business process outsourcing which requires a greater skill or knowledge of the industry or inner workings of a firm is: 2. (TCO 3) How are the procurement responsibilities divided between the project manager and contract administrator? 3. (TCO 4) What is the difference between the Cost-Plus-Percentage-Fee (CPF) contract structure and the Cost-Plus-Fixed-Fee (CPFF) contract structure? 4. (TCO 5) To assess the impact of a contract on both the buyer and seller, an analysis of exposure can be completed. Categories analyzed in this exposure analysis include all of the following except: 5. (TCO 6) Factors that may affect the BPO agreement structure include all of the following except: 6. (TCO 6) Sometimes a seller is selected based solely on lowest price. However, sometimes this is not always the most efficient or effective way of selecting a seller. What are some of the other evaluation criteria that a buyer may use to help select a seller? 7. (TCO 7) Issuing an RFP to only one vendor may be appropriate when: 8. (TCO 7) Explain the purpose of an RFP. What are some common elements of an RFP? 9. (TCO 8) What is an independent estimate and why should a buyer produce an independent estimate before selecting a seller? 10. (TCO 2) Part 1: Explain the various steps of the project procurement process. Part 2: Using the simple decision of packing and moving your home furnishing from the east coast to the west coast, provide an example of what you would do under each of the six steps of the project procurement process. Part 3: The buyer determines the contract pricing structure during which step of the project procurement process? 11. (TCO 1) Part 1: What are the four contract pricing structures available? Part 2: Describe the appropriate utilization of each and the impact of risk to the buyer and seller. Part 3. What contract pricing structure would you use if you had little to no scope defined? PROJ 410 Midterm Exam 2 1. (TCO 2) A firm should concentrate on its _____ processes while outsourcing its _____ processes. 2. (TCO 3) Explain the difference between a contract  administrator and a project manager in a procurement situation. 3. (TCO 4) What is the difference between the Cost-Plus-Percentage-Fee (CPF) contract structure and the Cost-Plus-Fixed-Fee (CPFF) contract structure? 4. (TCO 5) To assess the impact of a contract on both the buyer and seller, an analysis of exposure can be completed. Categories analyzed in this exposure analysis include all of the following except: ______. 5. (TCO 6) Factors that may affect the BPO agreement structure include all of the following except: ______. 6. (TCO 6) Three commonly used evaluation criteria listed in an RFP are overall cost or financial proposal, reputation, and experience. What can the buyer glean from this information and how can the buyer use it to make a decision on a particular seller? 7. (TCO 7) All of the following are common RFP topics, e xcept: ______. 8. (TCO 7) Explain the purpose of an RFP. What are some common elements of an RFP? 9. (TCO 8) What are the two ways to rank the seller’s proposals before selecting a seller? 10. (TCO 2) Part 1: List and define the six phases of the project procurement management process. Part 2: How could you organize a simple project such as renovating a bathroom into the six steps in the project procurement management process? Part 3: The buyer determines the contract pricing structure during which step of the project procurement process? 11. (TCO 1) Part 1: Discuss the following types of contract pricing: (a) fixed price, (b) cost-plus price, (c) time & materials, and (d) unit price. Part 2: Explain the appropriate utilization of each contract pricing type and the impact of risk to the contracting parties. Part 3: What type of contract pricing structure misaligns the buyer’s motivations with the seller’s? 12. (TCO 3) Identify and describe the benefits that procurement outsourcing will bring to the organization. 13. (TCO 1) Discuss the importance of obtaining support for the process of Business Process Outsourcing. Who would be important to involve and why? PROJ 410 Midterm Exam 3 1. (TCO 2) A firm should concentrate on its _____ processes while outsourcing its _____ processes. 2. (TCO 3) What activities is the contract administrator responsible for in a contract situation? What about the project manager? 3. (TCO 4) What is the difference between the  Cost-Plus-Fixed Fee (CPFF) and the Cost-Plus-Incentive Fee (CPIF) contract structures? 4. (TCO 5) To assess the impact of a contract on both the buyer and seller, an analysis of exposure can be completed. Categories analyzed in this exposure analysis include all of the following except: ______. 5. (TCO 6) The Term, Contracting Party, Integration, Retained Assets, and Performance Standards are all: _______. 6. (TCO 6) List three commonly used evaluation criteria listed in an RFP and explain why a buyer would want this information before selecting a seller. 7. (TCO 8) What is an independent estimate and why should a buyer produce an independent estimate before selecting a seller? 8. (TCO 7) For most customers, requesting multiple bids is the preferred approach because it: _______. 9. (TCO 7) Describe the common sections of the RFP. 10. (TCO 2) Part 1: List and define the six phases of the project procurement management process. Part 2: How could you organize a simple project such as renovating a bathroom into the six steps in the project procurement management process? Part 3: The buyer determines the contract pricing structure during which step of the project procurement process? 11. (TCO 1) Part 1: Discuss the following types of contract pricing: (a) fixed price, (b) cost-plus price, (c) time & materials, and (d) unit price. Part 2: Explain the appropriate utilization of each contract pricing type and the impact of risk to the contracting parties. Part 3: What type of contract pricing structure misaligns the buyer’s motivations with the seller’s? 12. (TCO 3) Evaluate the most common business drivers for outsourcing business processes. Which two drivers would be among the most important? 13. (TCO 1) List and describe the directives to consider the process of outsourcing if you are a senior manager. COPY THIS LINK TO YOUR BROWSER: http://oassignment.com/PROJ-410-Midterm-Exam-03-Sets-1687.htm

Interview with a Doctor

The current American healthcare system and its problems The interview is with Dr. John Tomas who is a surgeon in New Jersey. Dr. Tomas has been practicing medicine for over twenty years so he has a lot of experience in the medical field. Dr. Tomas deals with plenty of people who are from the middle and lower class. Those people are so concerned about the costs of the healthcare bills and they have a lot of trouble handling these costs.. The healthcare discussion should also be seen from a doctor’s perspective and that is why this interview is valuable Dr.Tomas has also a lot of knowledge about the politics of the healthcare system in the United States. He has a personal view of the Patient Protection and Affordable Care Act which is another term for Obama care. 1- What is your view of current American healthcare system? The current American healthcare system has a major problem which is the cost. The cost for the American healthcare system is 2. 5 trillion dollars per year whi ch is much higher than any other industrialized country in the world. The medical expenses on every citizen are $7,960.Other industrialized countries spent average of $3,233 annually per person which is much lower and these people from other countries get more medical valuable care. 41 percent of working Americans have problem with paying their medical bills. Taxpayers don’t receive the service that they actually pay for and a lot of people go easily bankrupt because they can’t afford to pay their medical bills. The American government covers 46 percent of these expenses and that is one of the reasons why we are in a huge debt and it is another factor for the major economic crisis in the United States. -what are the current major problems with the current American healthcare system? I think there are too many regulations in the current American health care system. There are also a lot of politicians and lawyer that get involved in the medical field. When these factors get involved, the insurance costs get higher and the medical expenses become very expensive. Practicing medicine is not pleasurable to me personally anymore because I am afraid to get sued and lose my insurance. All these outer factors that get involved in our field make practicing the profession of medicine much tougher for doctors. -Do you think defensive medicine is good or bad for the American healthcare system? In the United States we have a major problem with regulations that are involved in the medical field. In the United States, doctors have to do a lot of tests and plenty of consultations with other physicians before performing any operation. The reason for that is because the doctors are afraid of the lawsuits that could cause them losing their insurance or even their license. American doctors follow the defensive medicine by doing a lot of unnecessary tests that significantly increase the costs of healthcare.In other countries where there are not too many regulation†™s in the medical field, doctors in other countries do the operations with the same outcomes but in much lower costs. This is obviously an issue and it has its advantages and its disadvantages but the American defensive medicine system is much safer and the foreign medicine system is much cheaper. 4-Do you think that Obama care will lower the costs for the current healthcare system? I don’t think so because when government gets involved in any filed, the cost usually get much higher.Obama care will cost $1. 165 trillion dollars over the next ten years. The government hasn’t been very successful with Medicare or Medicaid which proves my point. The healthcare should stay as a private business that is managed by private healthcare companies. If the government takes over the healthcare system, the country will spend a massive amount of money and the quality of the care will be lowered significantly. 5-Do you think that Americans could have a better healthcare system if t hey follow the socialized healthcare system of Canada and Europe?And what are your solutions for the problems that we have with our healthcare system. I have been to Canada and Europe. I also have a lot of friends who are physicians in these countries. They don’t like what they have there. Patients could wait six months to get an operation in Canada. There are risings costs of medications in Canada and Europe. Those increasing of the cost of the medications make it harder for people to get a good care under the socialized healthcare system. A lot of Europeans countries are going bankrupt eventually and the socialized healthcare system is one of the reasons of that.The solution to our healthcare problem is not going backwards by following a socialized healthcare system. The solution comes with creating more competition between healthcare companies that take advantage of the American people. Even though we had a recession in the last few years, the profit of the insurance compa nies has been increased by 56 percent. Creating the competition between those insurance companies will definitely lower the costs and the medical bills that have been a heavy weight over the shoulders of the American pope.The healthcare discussion is very important because unlike fancy cars or fancy clothes, everybody needs to have healthcare. Plenty of Americans are suffering every day because they don’t have the money to cover the expenses of their medical bills. People go bankrupt because of these expensive costs and that is rare in any other industrialized country. The reason why the cost is too expensive in this country is because there are too many regulations, politics, lobbyists, lawyers and unfairness in our healthcare system.Obamacare could be another disaster for our healthcare system because it is going to raise the costs of the healthcare system and our economy is already in a very bad shape. The most practical solution to our healthcare system is to create a fai r competition between healthcare companies which will significantly lower the costs of the current healthcare system. If I have a second chance to do a second interview, I will also discus the medicine field with the person that I am having interview with because the topic is very interesting.

Yeltsins Critical Inactivity †Government (300 Level Course)

Yeltsins Critical Inactivity – Government (300 Level Course) Free Online Research Papers Yeltsin’s Critical Inactivity Government (300 Level Course) Boris Yeltsin took the office of the Russian presidency in 1991 under a black cloud, following a failed coup against then president Gorbachev. Yeltsin’s presidency has become synonymous with failure and by the question of â€Å"what went wrong?† This question of what has gone wrong during the Yeltsin era is an almost bottomless topic. Yeltsin struggled through his first term from the attempted coup in 1991 to the foolish decision to invade Chechnya in 1994. Still all of these troubles can be contributed to the critical time period immediately following Yeltsin’s coming to power. This time period can be analyzed in three ways. First, in the actions that Yeltsin took. Second, in the actions that Yeltsin did not take. Thirdly, by what steps that Yeltsin should have made. These three things point to a final conclusion. Boris Yeltsin as the new Russian president should have moved quickly to schedule new elections and the adoption of a new constitution. Boris Yeltsin came to power during a tumultuous time in Russian history. In hindsight, the table was set for immense change and he was the only man to do it. He had the popular support of a people that were otherwise up in arms. Yet when studying the events of ten years ago in today’s classroom, little attention is paid to this important question of â€Å"what steps did Yeltsin take?† Why is such little attention paid to this question? Because Yeltsin did next to nothing to create change. In his own memoirs, Boris Yeltsin says, â€Å"the idea of dissolving the Congress and scheduling new elections was in the air, although we did not take advantage of it.† Years later he himself admits to his inaction at such a critical time. At a time when Russia was as vulnerable as they have ever been, their new president chose an attack on an economic front, leaving the reorganization of the government to compromises and political games. This is an evident failure on the part of Boris Yeltsin. So just what did the newly elected president of Russia do at this time? Yeltsin attempted to impose central control on the far-flung territories of the new Russian Federation. However, in this endeavor he was entirely by himself. Whereas Gorbachev had the Communist Party for backing, with its crumble by 1991, Yeltsin was all alone. So without the vast party apparatus and the potent ideology that the Communist Party had provided Russians leaders, this attempt became an administrative nightmare. Therefore all that Yeltsin could do in an effort to form a lasting chain of command was to appoint presidential representatives to be his eyes and ears in the Russian territories following the coup. Yeltsin took all of these steps with the best of intentions, yet they were in too small a scale to provide any change of be of any effectiveness. This leads to the question of what Boris Yeltsin should have done. What he should have done was to scheduled new elections. The Communist Party was the rock that Russia stood upon. It’s membership declined so badly that Yeltsin banned the party in September of 1991. Yeltsin should have also worked to adopt a new constitution. Yeltsin’s memoirs told of his fears that the adoption of new elections or a constitution would only lead to another revolution, as in 1917. Yet this is simply a cowardly excuse on Yeltsin’s part, as the conditions were far from the same as some seventy years earlier. Yeltsin leads the reader to believe that he was not powerful enough to prevent such a catashphrophe. Yet despite everything that had transpired from 1990-1991, the public preferred Yeltsin to his communist opponents in parliament. These were the same men that Yeltsin was afraid of, in a time when he could have used his popularity to reappoint them with non-communist m embers who supported him and adopted a new constitution. However like many world leaders before him, he neglected to take action when it was necessary and sat idle hoping for change instead of going out and getting it. Therefore no one should feel any sympathy for Boris Yeltsin. If they should feel anything at all, pity may be more appropriate. Yeltsin should have acted to revive Russia, but instead he let its reigns slip out of his hands. There were things that he simply did not do. The steps he did take were clearly not aggressive enough. And he seemed totally oblivious to the steps that needed to be taken. What should pain any historian however is Yeltsin’s clear cut ignorance. Hindsight is the most reveling perspective that anyone can have. They can easily see what they should have done, even if at the time it was not at all clear. It is in this one opportunity then that Yeltsin could earn some respect for himself, by admitting that although it did not look like it then, today he realizes that he should have acted on new elections and a new constitution. But he only states that he would not change anything, and thus, buries his own reputation. Research Papers on Yeltsin’s Critical Inactivity - Government (300 Level Course)Appeasement Policy Towards the Outbreak of World War 2Quebec and CanadaBringing Democracy to AfricaAssess the importance of Nationalism 1815-1850 EuropePETSTEL analysis of IndiaResearch Process Part OnePersonal Experience with Teen Pregnancy19 Century Society: A Deeply Divided EraEffects of Television Violence on ChildrenCapital Punishment

Women and World War II - Women in the Government

Women and World War II - Women in the Government In addition to thousands of women who took government jobs in support of the war effort or to free up men for other jobs, women played key leadership roles in government. In China, Madame Chiang Kai-shek was an active promoter of the Chinese cause against the Japanese occupation. This wife of the Nationalist leader of China was head of Chinas air force during the war. She spoke to the US Congress in 1943. She was called the worlds most famous woman for her efforts. British women in government also played important roles during the war. Queen Elizabeth (wife of King George VI, born Elizabeth Bowes-Lyon) and her daughters, Princesses Elizabeth (future Queen Elizabeth II) and Margaret, were an important part of the morale effort, continuing to live at Buckingham Palace in London even when the Germans were bombing the city, and distributing aid in the city after bombing raids. Member of Parliament and feminist, American-born Nancy Astor, worked to keep up the morale of her constituents and served as unofficial hostess to American troops in England. In the United States, First Lady Eleanor Roosevelt played an active role in building morale among civilians and military forces. Her husbands use of a wheelchair and his conviction that he must not be seen publicly as disabled meant that Eleanor traveled, wrote, and spoke. She continued to publish a daily newspaper column. She also advocated for responsible roles for women and for minorities. Other women in decision-making positions included Frances Perkins,  US Secretary of Labor (1933-1945), Oveta Culp Hobby who headed the War Departments Womens Interest Section and became director of the Womens Army Corps (WAC), and Mary McLeod Bethune who served as director of the Division of Negro Affairs and advocated the commissioning of black women as officers in the Womens Army Corps. At the end of the war, Alice Paul rewrote the Equal Rights Amendment, which had been introduced into and rejected by each session of Congress since women had achieved the vote in 1920. She and other former suffragists expected that womens contributions to the war effort would naturally lead to the acceptance of equal rights, but the Amendment didnt pass Congress until the 1970s, and eventually failed to pass in the required number of states.

The School Nurse Essay Example | Topics and Well Written Essays - 1000 words

The School Nurse - Essay Example However, in today's world the school nurse position is not given the resources necessary to accomplish this goal and the role has become so unmanageable and the task so encompassing it may be placing education and students at risk. The number of students taking Ritalin has doubled since 1990 and now exceeds 3 million students (Goldberg, 1). The over worked nurses must medicate these students to insure the proper dose to the correct student. The pervasiveness of lunchtime medication has become so involved and lines of children outside nurses' offices so prevalent, that in Boston, schools are now facing a challenging dilemma; Who should have responsibility for the medicating According to Carey Goldberg, reporter for the New York Times, "...school officials have proposed that individual nurses be given permission to delegate the distribution of their ''meds'' to handpicked, supervised staff members". Many nurses who advocate the addition of higher paid nurses as a solution rather than reducing their roles have discredited the plan as unsafe. However, school officials see it as a reasonable cost cutting measure in this New World of psychoactive drugs. Untrained personnel handing out sensitive and dangerous drugs a re certainly placing the students at an increased risk. School nurses are called upon to walk obese students, insert catheters, and administer diabetic insulin. These are disciplines that call on the highest order of medical training. Food poisoning, infectious diseases, sexually transmitted diseases, and injuries from student violence complicate these situations. The nurse is required to perform the duties of a general practitioner while having the training of a nurse and the attendant pay scale. Still, school systems balk at the possibility of adding more nurses to the staff due to cost considerations. While the National Association of School Nurses recommends that a school system have one nurse per 750 students, the national average is one nurse per 1350 students (Vail). Attending to the students medical needs should be a priority to assure that the system is promoting adequate and fair education, but staffing at a 50% level can not guarantee success of the health of the student body. Obesity is running rampant through the school corridors and nutrition and healthy food have come into the spotlight. Once again, the school nurse is called on to make recommendations and plans to provide a healthy diet and reduce the problem of overweight children. Nutrition is a special discipline and often runs counter to the school's agenda of providing vending machines and a junk food cafeteria. There is more profit in a McDonald's station than there is in a healthy dietary offering. The American Medical Association advocates a proactive approach based on food types and amounts that are to be offered through school lunches ("Expert Committee Recommendations", 8). Dedicated school nurses can not be expected to protect the health of children in the existing political and economical climate of many school boards. They are not trained as nutritionists and do nor serve the political function of being socially

360 Degree Feedback Assignment Example | Topics and Well Written Essays - 250 words

360 Degree Feedback - Assignment Example 360-degree feedback system may however not be effective in assessing result-oriented performance, which are more quantitative such as sales and market share. When compared to the traditional performance appraisal, the 360-degree feedback can be said to be advantageous in how it ensures active participation by major stakeholders including employees themselves (Kaye, 2010). Such participation is enabled because includes an employee self-assessment to start the process. This way, the eventual outcome of the appraisal can be said to be the exact representation of employee performance. The feedback system may however be disadvantageous when an organization has to deal with a very large employee size. This is because such large size of employee and the use of 360-degree feedback may be highly time consuming. This is situation could also delay the turn-around time to get employees assessed. When used to measure ineffective and effective performance, the 360-degree feedback guarantees an in-depth understanding of factors that account for employee performance. This is because of the qualitative nature of the feedback system. but in cases where an employee’s performance is dominated by quantitative and numeric outcomes, the feedback system becomes inappropriate in measuring effective and ineffective

Disaster Recovery Information Case Study Example | Topics and Well Written Essays - 750 words

Disaster Recovery Information - Case Study Example As long as the management’s input is required, their perceptions and expectations must be elicited and their commitment to the process of CSRIT must be acquired to sustain and prolong the operations of CSRIT. Resolve the CSRIT progress strategic plan: The project management and administrative issues such as specific timeframes, project group and presentation of the project group stakeholders, and communication to the management and project team should be addressed when giving thought on how to manage the progress of the CSRIT. Acquire relevant information: The necessary information required to carry out such task can be sought from the stakeholders or business manager and representatives from IT, human resource, public relations, legal department, risk management specialists and security. The information can also be obtained from conferences which offer CSRIT education. Modify the CSRIT vision: This entails clearly defining the goals, expectations, funding, organizational model, mission, objectives and constituency. The visions might also be the bargaining power when acquiring the management’s support and buy-in. After the modification of the vision of the CSRIT, the communication of the same should follow. CSRIT vision should be communicated to the constituency, management, and other person who understands the CSRIT operations after which adjustment deemed necessary are made. Implement the CSRIT: Implementation is done once the constituency and management have agreed to buy in depending on the vision. This entails recruiting and training CSRIT staff, buying equipment and building the essential network system, developing the procedures and policies to guide the CSRIT services, building incident tracking systems, and making the guidelines for reporting incidents.

Confronting Competition In The Tourism Industry

Confronting Competition In The Tourism Industry Europes tourism industry is one of the biggest tourism industries in the world and therefore has all top tour operators based in Europe. Two of the biggest names are Thomas cook and TUI. They have the maximum market share in the Europes tourism industry. The tour operators business environment consists of competitors, macro environments and industry also. Various tools used for the analysis of the business environment are PESTLE analysis, porters five force analysis and industry life cycle. SWOT analysis will be done for industrys analysis and also on how the tour operators in Europe are performing. Environmental Analysis PESTEL Analysis PESTEL helps in understanding the important factors affecting the change. Below is the PESTEL analysis: Political: After the tourist attacks, the government comes up with strict laws on immigration and also restrict the destinations after the attacks which affect the perception and also the perception of the tourist. Also, the taxation policy affects the tourism as they charge taxes on the food and lodging industry which contributes the maximum to the tourism industry. (Baum, T, 1999). Economic: The exchange also affects the tourism in the country and plays the important role.( Davidson AP, Burgess S, 2006). The gap between the Euro and the Pound sterling is decreasing, therefore, there is a possibility that the outbound tourism is affected in Europe which in turn will affect the tour operators. The recession also affected the tourism industry not only in Europe but in other countries also. Socio-Cultural: Tour operators have understood what the customers are looking for; they are looking for a brand, lifestyle and safety. Due to this the tour operator in Europe. The tour operators make customised tour packages to suit the need of the customers. The customers travelling to Europe are looking for the brand names that are doing good in the business and have a name, this is due to the demand of security when travelling to the other country. Technological: The online and internet bookings are increasing day by day due to the easy access of the internet. The online booking companys like expedia.com, hotels.com, etc are giving packages and also the customers can make their own packages. This has highly affected the tourist operators in Europe as they get the business from other countries as well. The internet booking companies are doing well in the business due to the cost saved and also less of manpower requirements. (Douglas, and Derrett 2001). Environmental: The European governments are campaigning for green holidays like farm holidays. The carbon dioxide is the major source of the pollution and the aeroplanes contribute the maximum carbon dioxide to the environment. (Munoz, J. 2005). Apart from this, the health issues like swine flu or influenza cause tourists not to travel to the country. The governments also restrict these countries for travelling. Legal: the European governments are proposing strict norms and laws for the aviation industry in terms of safety and regulations. The opening of new hotels in the country also requires legal permits for the company. Porters Five Force Analysis This identifies the competitors in the tourism industry and all these five forces are linked with each other. The risk of Potential Entrants: The threat of new entrants in terms of tour operators is low because of the high capital investment, brands already existing and have created a niche in the market and people knows about the top players in the industry. It is difficult for the new entrants to establish themselves. (Alford, 2009) The threat of Substitutes: The threat to substitute of tourism or travelling is less as people these days prefer to take a break and travel. They will not substitute travel to any other activities. Also, the European countries are full of greens and have both mountains and beaches which attract the tourists from around the world. (Alford, 2009) Bargaining power of Suppliers: The suppliers bargaining power is high only with the companies who are new to the business or holds small share in the market. However, the bargaining power is not the same with the companies who hold the maximum market share in the tourism industry. Also, the European markets have their own aviation industry which helps in bringing or supplying tourists to the country at the mitigated prices. Bargaining power of Buyers: Since Europe is a big market in tourism industry it caters to both the individual travelling customers and travelling through agencies. In the latter case, the travel agents or tour operators make the packages in such a way that people buy them. The tour operators compose a major and a powerful group for the buyers. Rivalry among the Competitors: The rivalry among the competitors is moderate as they contribute maximum to the market. TUI and Thomas cook are the two top travel operators who have a 21% and 13% market share respectively. The rivalry is only among these two as they both hold the important position in the European market. The other travel operators are not the part of the competition. Appendix 1: Porters Five Force Model for the Tourism Industry in Europe Industry Life Cycle The Industrys life cycle tells about the growth of the product that is tourism in the continent. The life cycle is well telling about the evolution of the tourism industry, its development, decline and the death. Stage one describes the early start of tourism in Europe centuries back when people started travelling from one place to another. The second stage describes the development of the tourism, which again took place centuries back as the need for the shelter and food was recognised by the people in Europe. They built small inns for the travellers and gave them basic meals. (Douglas and Derrett 2001).Thats how the food and lodging industry started in Europe and Europe was the first continent to do so. Slowly and gradually they built hotels and the tourism industry started booming and continuously doing the same with maximum people travel to the continent every year. The decline or downfall was observed during the terrorist attacks in United States of America and Bali. The second time downfall was observed during the recession period in 2008. ( Douglas and Derrett, 2001). However, the industry had seen the growth in last two years as people have started travelling again. The last stage is the death stage which the tourism industry has not yet faced as people are travelling and business is growing. (SÃ ³names, 1998) SWOT Analysis The SWOT analysis of any industry will help it to grow better and maximise the business by identifying the new opportunities and also how to overcome the threats. Strengths: The European people are very warm and have a good sense of hospitality. They are very friendly and helpful also. The countryside of the Europe is very beautiful and magnificent therefore it attracts a maximum number of tourists every year. The hotels and free standing restaurants in Europe offer the best cuisines and wines as compared to anywhere in the world. The tourism industry in Europe has undergone huge investments both in the public and private sectors. ( Porter, M,(1985). In last decade Europe has come up with large accommodation facilities, tourist attractions, and other activities for the tourists and also invested a lot in training. Access to the countries in the continent is easy as there are a number of airlines that offer their services to the tourists to come in the continent. The tourism industry in Europe is well supported by the airline as well as railway industry. Weaknesses: Language plays a barrier in some of the European countries as people are not aware of any other language. The climatic conditions are generally cold and during winters it becomes difficult to access the countrysides and cities. Opportunities: The access to the countries is easy due to the high competition and also the stay is competitively priced therefore there is a possibility that due to high competition people get better deals in European countries, therefore, this factor can force them to travel to the continent. The outbound travel will grow from Asia pacific and Middle Eastern countries as they are planning to have direct flights to the European countries where they do not operate. Also, the Chinese people are now more inclined towards travelling to different countries and continents. More business expansions in the continent as the tourism will grow. (Porter, M,(1985). It is very obvious that the industry will grow from all sides when more money will flow in. Increasing demand for nature tourism. Tourist these days prefer to travel to the countries which are rich in nature and are also eco-friendly. The economy of the countries will increase especially in the less visited countries. Threats: People now prefer short vacations rather than long vacations. People travel only to those countries which are well established and doing good business, however, the countries under developed are left behind. Changing the attitude of the customers in the global recession. Terrorist attacks and health hazards will affect the tourism in the continent as people stop travelling. The economy downfall of other countries will slow the growth of tourism in the European countries.

Fadia Faqirs Pillars of Salt and Leila al-Atrashs A Woman of Five Sea

Fadia Faqir's Pillars of Salt and Leila al-Atrash's A Woman of Five Seasons The portrayal of the Arab woman has always been through several different perceptions. Some believe that these women are weak, dependant and victims of a hyper patriarchal tradition and culture. They live their lives as if caged from one man to another. First it is their father and brothers and then their husbands and sons. It is true that Arab women do live within patriarchal traditions and cultures but the same can be said for majority of the women around the globe. A much more accurate perception can come only through the realization that what popular Western concepts conceive as women liberation and independence does not necessarily apply to every women around the world. One must understand the culture, religion and traditions and history of a people to know what their ideas regarding concepts such as liberation and independence are. In the west for example women were allowed to vote relatively recently compared to Muslim women who were allowed to vote over fourteen hundred years ago, the same could be said for owning businesses and property and the right to a career. One of the most popular beliefs in the Western world today regarding oppression is that women in Arabia are sexually controlled by their men. This has been brought about especially by the concept of the Hijab as being one of the channels to control women’s sexuality and freedom. It can be argued that in various cases this is true but one cannot commit such a grave injustice and put all Arab women under one umbrella and stamp them as sexually oppressed. The fact is that the Middle East is a region where many states, cultures and identities exist. The novels that we have read are a refl... ...nary’s removal to the government, is where her victory lies. Whereas the relationship between Maha and Harb is one of passion and love, Ihsan and Nadia are the complete opposite. Nadia hates how Ihsan looks at her as a woman always and never a person. She struggles to prove her capability of being an individual and forming an identity of her own that is separate and goes beyond Mrs. Natour. She proves that she can ‘think and feel’ for herself and by herself. In the West where we have women out on the streets rallying for equality between men and women, fighting in the armies, present in the workforce, these victories may seem minute. However if one pays close attention to social structures and social norms in different cultures one can realize that this challenging and questioning is as important and holds as much weight as getting equal wages for women in America.

The Vampire Diaries: The Fury Chapter Twelve

Stefan looked at Elena, snow crystals dusting his dark hair. â€Å"What about Matt?† â€Å"I remember-something. It's not clear. But that first night, when I wasn't myself -did I see Matt then? Did I-?† Fear and a sick sense of dismay swelled her throat and cut her words off. But she didn't need to finish, and Stefan didn't need to answer. She saw it in his eyes. â€Å"It was the only way, Elena,† he said then. â€Å"You would have died without human blood. Would you rather have attacked somebody unwilling, hurt them, maybe killed them? The need can drive you to that. Is that what you would have wanted?† â€Å"No,† Elena said violently. â€Å"But did it have to be Matt? Oh, don't answer that; I can't think of anybody else, either.† She took a shaky breath. â€Å"But now I'm worried about him, Stefan. I haven't seen him since that night. Is he okay? What has he said to you?† â€Å"Not much,† said Stefan, looking away. † ‘Leave me alone' was about the gist of it. He also denied that anything happened that night, and said that you were dead.† â€Å"Sounds like one of those individuals who can't cope,† Damon commented. â€Å"Oh, shut up!† said Elena. â€Å"You keep out of this, and while you're at it, you might think about poor Vickie Bennett. How d'you think she's coping these days?† â€Å"It might help if I knew who this Vickie Bennett is. You keep talking about her, but I've never met the girl.† â€Å"Yes, you have. Don't play games with me, Damon-the cemetery, remember? The ruined church? The girl you left wandering around there in her slip?† â€Å"Sorry, no. And I usually do remember girls I leave wandering in their slips.† â€Å"I suppose Stefan did it, then,† Elena said sarcastically. Anger flashed to the surface of Damon's eyes, covered quickly with a disturbing smile. â€Å"Maybe he did. Maybe you did. It's all the same to me, except that I'm getting a little tired of accusations. And now-â€Å" â€Å"Wait,† said Stefan, with surprising mildness. â€Å"Don't go yet. We should talk-† â€Å"I'm afraid I have a previous engagement.† There was a flurry of wings, and Stefan and Elena were alone. Elena put a knuckle to her lips. â€Å"Damn. I didn't mean to make him angry. After he was really almost civilized all evening.† â€Å"Never mind,† said Stefan. â€Å"He likes to be angry. What were you saying about Matt?† Elena saw the weariness in Stefan's face and put an arm around him. â€Å"We won't talk about it now, but I think tomorrow maybe we should go see him. To tell him†¦Ã¢â‚¬  Elena lifted her other hand helplessly. She didn't know what she wanted to tell Matt; she only knew that she needed to do something. talk about it now, but I think tomorrow maybe we should go see him. To tell him†¦Ã¢â‚¬  Elena lifted her other hand helplessly. She didn't know what she wanted to tell Matt; she only knew that she needed to do something. Elena looked at him hard. â€Å"Are you sure?† â€Å"Yes.† â€Å"But-will you be all right? I should stay with you-â€Å" â€Å"I'll be fine, Elena,† Stefan said gently, â€Å"Go on.† Elena hesitated, then nodded. â€Å"I won't be long,† she promised him. Unseen, Elena slipped around the side of the frame house with the peeling paint and the crooked mailbox labeled Honeycutt. Matt's window was unlocked. Careless boy, she thought reprovingly. Don't you know some-thing might come creeping in? She eased it open, but of course that was as far as she could go. An invisible barrier that felt like a soft wall of thickened air blocked her way. â€Å"Matt,† she whispered. The room was dark, but she could see a vague shape on the bed. A digital clock with pale green numbers showed that it was 12:15. â€Å"Matt,† she whispered again. The figure stirred. â€Å"Uh?† â€Å"Matt, I don't want to frighten you.† She made her voice soothing, trying to wake him gently rather than startle him out of his wits. â€Å"But it's me, Elena, and I wanted to talk. Only you've got to ask me in first. Can you ask me in?† â€Å"Uh. C'mon in.† Elena was amazed at the lack of surprise in his voice. It was only after she'd gotten over the sill that she realized he was still asleep. â€Å"Matt. Matt,† she whispered, afraid to go too close. The room was stifling and overheated, the radiator going full blast. She could see a bare foot sticking out of the mound of blankets on the bed and blond hair at the top. â€Å"Matt?† Tentatively, she leaned over and touched him. That got a response. With an explosive grunt, Matt sat bolt upright, whipping around. When his eyes met hers, they were wide and staring. Elena found herself trying to look small and harmless, nonthreatening. She backed away against the wall. â€Å"I didn't mean to frighten you. I know it's a shock. But will you talk to me?† He simply went on staring at her. His yellow hair was sweaty and ruffled up like wet chicken feathers. She could see his pulse pounding in his bare neck. She was afraid he was going to get up and dash out of the room. Then his shoulders relaxed, slumping, and he slowly shut his eyes. He was afraid he was going to get up and dash out of the room. â€Å"Yes,† she whispered. â€Å"You're dead.† â€Å"No. I'm here.† â€Å"Dead people don't come back. My dad didn't come back.† â€Å"I didn't really die. I just changed.† Matt's eyes were still shut in repudiation, and Elena felt a cold wave of hopelessness wash over her. â€Å"But you wish I had died, don't you? I'll leave now,† she whispered. Matt's face cracked and he started to cry. â€Å"No. Oh, no. Oh, don't, Matt, please.† She found herself cradling him, fighting not to cry herself. â€Å"Matt, I'm sorry; I shouldn't even have come here.† â€Å"Don't leave,† he sobbed. â€Å"Don't go away.† â€Å"I won't.† Elena lost the fight, and tears fell onto Matt's damp hair. â€Å"I didn't mean to hurt you, ever,† she said. â€Å"Not ever, Matt. All those times, all those things I did- I never wanted to hurt you. Truly†¦Ã¢â‚¬  Then she stopped talking and just held him. After a while his breathing quieted and he sat back, swiping his face with a fistful of sheet. His eyes avoided hers. There was a look on his face, not just of embarrassment, but of distrust, as if he were bracing himself for something he dreaded. â€Å"Okay, so you're here. You're alive,† he said roughly. â€Å"So what do you want?† Elena was dumbfounded. â€Å"Come on, there must be something. What is it?† New tears welled up, but Elena gulped them back. â€Å"I guess I deserve that. I know I do. But for once, Matt, I want absolutely nothing. I came to apologize, to say that I'm sorry for using you-not just that one night, but always. I care about you, and I care if you hurt. I thought maybe I could make things better.† After a heavy silence, she added, â€Å"I guess I will leave now.† â€Å"No, wait. Wait a second.† Matt scrubbed at his face with the sheet again. â€Å"Listen. That was stupid, and I'm a jerk-â€Å" â€Å"That was the truth and you're a gentleman. Or you'd've told me to go take a hike a long time ago.† â€Å"No, I'm a stupid jerk. I should be banging my head against the wall with joy because you're not dead. I will in a minute. Listen.† He grabbed her wrist and Elena looked at it in mild surprise. â€Å"I don't care if you're the Creature from the Black Lagoon, It, Godzilla and Frankenstein all rolled up into one. I just-â€Å" â€Å"Matt.† Panicked, Elena put her free hand over his mouth. â€Å"I know. You're engaged to the guy in the black cape. Don't worry; I remember him. I even like him, though God knows why.† Matt took a breath and seemed to calm down. â€Å"Look, I don't know if Stefan told you. He said a bunch of stuff to me -about being evil, about not being sorry for what he did to Tyler. You know what I'm talking about?† â€Å"I know. You're engaged to the guy in the black cape. Don't worry; I remember him. I even like him, though God knows why.† Matt took a breath and seemed to calm down. â€Å"Look, I don't know if Stefan told you. He said a bunch of stuff to me -about being evil, about not being sorry for what he did to Tyler. You know what I'm talking about?† Matt nodded. â€Å"So it was your basic crap. I should have known.† â€Å"Well, it is and it isn't. The need is strong, stronger than you can imagine.† It was dawning on Elena that she hadn't fed today and that she'd been hungry before they'd set out for Alaric's. â€Å"In fact-Matt, I'd better go. Just one thing-if there's a dance tomorrow night, don't go. Something's going to happen then, something bad. We're going to try to guard it, but I don't know what we can do.† â€Å"Who's ‘we'?† Matt said sharply. â€Å"Stefan and Damon-I think Damon-and me. And Meredith and Bonnie†¦ and Alaric Saltzman. Don't ask about Alaric. It's a long story.† â€Å"But what are you guarding against!† â€Å"I forgot; you don't know. That's a long story, too, but†¦ well, the short answer is, whatever killed me. Whatever made those dogs attack people at my memorial service. It's something bad, Matt, that's been around Fell's Church for a while now. And we're going to try to stop it from doing anything tomorrow night.† She tried not to squirm. â€Å"Look, I'm sorry, but I really should leave.† Her eyes drifted, despite herself, to the broad blue vein in his neck. When she managed to tear her gaze away and look at his face, she saw shock giving way to sudden understanding. Then to something incredible: acceptance. â€Å"It's okay,† Matt said. She wasn't sure she'd heard correctly. â€Å"Matt?† â€Å"I said, it's okay. It didn't hurt me before.† â€Å"No. No, Matt, really. I didn't come here for that-â€Å" â€Å"I know. That's why I want to. I want to give you something you didn't ask for.† After a moment he said, â€Å"For old friends' sake.† Stefan, Elena was thinking. But Stefan had told her to come, and come alone. Stefan had known, she realized. And it was all right. It was his gift to Matt-and to her. But I'm coming back to you, Stefan, she thought. As she leaned toward him, Matt said, â€Å"I'm going to come and help you tomorrow, you know. Even if I'm not invited.† Then her lips touched his throat. December 13, Friday Dear Diary, I know I've written that before, or thought it at least. But tonight is the night, the big one, when everything is going to happen. This is it. Stefan feels it, too. He came back from school today to tell me that the dance is still on-Mr. Newcastle didn't want to cause a panic by canceling it or something. What they're going to do is have â€Å"security† outside, which means the police, I guess. And maybe Mr. Smallwood and some of his friends with rifles. Whatever's going to happen, I don't think they can stop it. I don't know if we can, either. It's been snowing all day. The pass is blocked, which means nothing gets in or out of town on wheels. Until the snowplow gets up there, which won't be until morning, which will be too late. And the air has a funny feeling to it. Not just snow. It's as if something even colder than that is waiting. It's pulled back the way the ocean pulls back before a tidal wave. When it lets go†¦ I thought about my other diary today, the one under the floorboards of my bedroom closet. If I own anything anymore, I own that diary. I thought about getting it out, but I don't want to go home again. I don't think I could cope, and I know Aunt Judith couldn't if she saw me. I'm surprised anybody's been able to cope. Meredith, Bonnie-especially Bonnie. Well, Meredith, too, considering what her family has been through. Matt. They're good and loyal friends. It's funny, I used to think that without a whole galaxy of friends and admirers I wouldn't survive. Now I'm perfectly happy with three, thank you. Because they're real friends. I didn't know how much I cared about them before. Or about Margaret, or Aunt Judith even. And everybody at school†¦ I know a few weeks ago I was saying that I didn't care if the entire population of Robert E. Lee dropped dead, but that isn't true. Tonight I'm going to do my best to protect them. I know I'm jumping from subject to subject, but I'm just talking about things that are important to me. Kind of gathering them together in my mind. Just in case. Well, it's time. Stefan is waiting. I'm going to finish this last line and then go. I think we're going to win. I hope so. We're going to try. The history room was warm and brightly lit. On the other side of the school building, the cafeteria was even brighter, shining with Christmas lights and decorations. Upon arriving, Elena had scrutinized it from a cautious distance, watching the couples arrive for the dance and pass by the sheriff's officers at the door. Feeling Damon's silent presence behind her, she had pointed out a girl with long, light brown hair. â€Å"I'll take your word for it,† he replied. Now, she looked around their makeshift headquarters for the night. Alaric's desk had been cleared, and he was bent over a rough map of the school. Meredith leaned in beside him, her dark hair sweeping his sleeve. Matt and Bonnie were out mingling with the dancegoers in the parking lot, and Stefan and Damon were prowling the perimeter of the school grounds. They were going to take turns. â€Å"You'd better stay inside,† Alaric had told Elena. â€Å"All we need is for somebody to see you and start chasing you with a stake.† â€Å"I've been walking around town all week,† Elena said, amused. â€Å"If I don't want to be seen, you don't see me.† But she agreed to stay in the history room and coordinate. It's like a castle, she thought as she watched Alaric plot out the positions of sheriff's officers and other men on the map. And we're defending it. Me and my loyal knights. The round, flat-faced clock on the wall ticked the minutes by. Elena watched it as she let people in the door and let them out again. She poured hot coffee out of a Thermos for those who wanted it. She listened to the reports come in. â€Å"Everything's quiet on the north side of the school.† â€Å"Caroline just got crowned snow queen. Big surprise.† â€Å"Some rowdy kids in the parking lot-the sheriff just rounded them up†¦Ã¢â‚¬  Midnight came and went. â€Å"Maybe we were wrong,† Stefan said an hour or so later. It was the first time they'd all been inside together since the beginning of the evening. â€Å"Maybe it's happening somewhere else,† said Bonnie, emptying out a boot and peering into it. â€Å"There's no way to know where it's going to happen,† Elena said firmly. â€Å"But we weren't wrong about it happening.† â€Å"Maybe,† said Alaric thoughtfully, â€Å"there is a way. To find out where it's going to happen, I mean.† As heads raised questioningly, he said, â€Å"We need a precognition.† All eyes turned to Bonnie. â€Å"Oh, no,† Bonnie said. â€Å"I'm through with all that. I hate it.† â€Å"It's a great gift-† began Alaric. â€Å"It's a great big pain. Look, you don't understand. The ordinary predictions are bad enough. It seems like most of the time I'm finding out things I don't want to know. But getting taken over-that's awful. And afterward I don't even remember what I've said. It's horrible.† know. But getting taken over-that's awful. And afterward I don't even remember what I've said. It's horrible.† Bonnie sighed. â€Å"It's what happened to me in the church,† she said patiently. â€Å"I can do other kinds of predictions, like divining with water or reading palms†-she glanced at Elena, and then away-â€Å"and stuff like that. But then there are times when -someone-takes me over and just uses me to talk for them. It's like having somebody else in my body.† â€Å"Like in the graveyard, when you said there was something there waiting for me,† said Elena. â€Å"Or when you warned me not to go near the bridge. Or when you came to dinner and said that Death, my death, was in the house.† She looked automatically around at Damon, who returned her gaze impassively. Still, that had been wrong, she thought. Damon hadn't been her death. So what had the prophecy meant? For just an instant something glimmered in her mind, but before she could get a grasp on it, Meredith interrupted. â€Å"It's like another voice that speaks through Bonnie,† Meredith explained to Alaric. â€Å"She even looks different. Maybe you weren't close enough in the church to see.† â€Å"But why didn't you tell me about this?† Alaric was excited. â€Å"This could be important. This-entity-whatever it is-could give us vital information. It could clear up the mystery of the Other Power, or at least give us a clue how to fight it.† Bonnie was shaking her head. â€Å"No. It isn't something I can just whistle up, and it doesn't answer questions. It just happens to me. And I hate it.† â€Å"You mean you can't think of anything that tends to set it off? Anything that's led to it happening before?† Elena and Meredith, who knew very well what could set it off, looked at each other. Elena bit the inside of her cheek. It was Bonnie's choice. It had to be Bonnie's choice. Bonnie, who was holding her head in her hands, shot a sideways glance through red curls at Elena. Then she shut her eyes and moaned. â€Å"Candles,† she said. â€Å"What?† â€Å"Candles. A candle flame might do it. I can't be sure, you understand; I'm not promising anything-â€Å" â€Å"Somebody go ransack the science lab,† said Alaric. It was a scene reminiscent of the day Alaric had come to school, when he'd asked them all to put their chairs in a circle. Elena looked at the circle of faces lit eerily from below by the candle's flame. There was Matt, with his jaw set. Beside him, Meredith, her dark lashes throwing shadows upward. And Alaric, leaning forward in his eagerness. Then Damon, light and shadow dancing over the planes of his face. And Stefan, high cheekbones looking too sharply defined to Elena's eyes. And finally, Bonnie, looking fragile and pale even in the golden light of the candle. â€Å"I'm just going to look into the candle,† Bonnie said, her voice quivering slightly. â€Å"And not think of anything. I'm going to try to-leave myself open to it.† She began to breathe deeply, gazing into the candle flame. And then it happened, just as it had before. Bonnie's face smoothed out, all expression draining away. Her eyes went blank as the stone cherub's in the graveyard. She didn't say a word. That was when Elena realized they hadn't agreed on what to ask. She groped through her mind to find a question before Bonnie lost contact. â€Å"Where can we find the Other Power?† she said, just as Alaric blurted out, â€Å"Who are you?† Their voices mingled, their questions intertwining. Bonnie's blank face turned, sweeping the circle with sightless eyes. Then the voice that wasn't Bonnie's voice said, â€Å"Come and see.† â€Å"Wait a minute,† Matt said, as Bonnie stood up, still entranced, and made for the door. â€Å"Where's she going?† Meredith grabbed for her coat. â€Å"Are we going with her?† â€Å"Don't touch her!† said Alaric, jumping up as Bonnie went out the door. Elena looked at Stefan, and then at Damon. With one accord, they followed, trailing Bonnie down the empty, echoing hall. â€Å"Where are we going? Which question is she answering?† Matt demanded. Elena could only shake her head. Alaric was jogging to keep up with Bonnie's gliding pace. She slowed down as they emerged into the snow, and to Elena's surprise, walked up to Alaric's car in the staff parking lot and stood beside it. â€Å"We can't all fit; I'll follow with Matt,† Meredith said swiftly. Elena, her skin chilled with apprehension as well as cold air, got in the back of Alaric's car when he opened it for her, with Damon and Stefan on either side. Bonnie sat up front. She was looking straight ahead, and she didn't speak. But as Alaric pulled out of the parking lot, she lifted one white hand and pointed. Right on Lee Street and then left on Arbor Green. Straight out toward Elena's house and then right on Thunderbird. Heading toward Old Creek Road. It was then that Elena realized where they were going. They took the other bridge to the cemetery, the one everyone always called â€Å"the new bridge† to distinguish it from Wickery Bridge, which was now gone. They were approaching from the gate side, the side Tyler had driven up when he took Elena to the ruined church. Alaric's car stopped just where Tyler's had stopped. Meredith pulled up behind them. â€Å"Where are you taking us?† she said. â€Å"Listen to me. Will you just tell us which question you're answering?† â€Å"Come and see.† Helplessly, Elena looked at the others. Then she stepped over the threshold. Bonnie walked slowly to the white marble tomb, and stopped. Elena looked at it, and then at Bonnie's ghostly face. Every hair on her arms and the back of her neck was standing up. â€Å"Oh, no†¦Ã¢â‚¬  she whispered. â€Å"Not that.† â€Å"Elena, what are you talking about?† Meredith said. Dizzy, Elena looked down at the marble countenances of Thomas and Honoria Fell, lying on the stone lid of their tomb. â€Å"This thing opens,† she whispered.