The Transformation of Shakespeares Macbeth Essay - 911 Words

The Transformation of Macbeth From the beginning of the play, Macbeth undergoes a complete change in character--from a virtuous nobleman into a monster. He has a tragic weakness--ambition--which, when released, draws him into a web of evil and corruption that finally leaves him with none of the noble human qualities he possessed at the beginning of the play. Before being transformed into a murderous monster, Macbeth is a model Scottish noble. He shows great loyalty and devotion to both King Duncan and his country in his fight against the Scottish rebels. He also fights with great courage, which he draws from knowing that he serves a good and virtuous cause. He is modest when confronted with his achievements, in†¦show more content†¦From here, it is easy for him to continue sinking deeper into evil by later having Lady Macbeth and her son killed. Shortly after the murder of Banquo, the dead noble appears at Macbeths feast. The terror of seeing Banquos ghost makes Macbeth more paranoid and insecure than ever, which leads him to seek answers from the three Witches. After watching the apparitions and learning that no woman-born man can harm him, he repeats his earlier mistake of believing the prophecy. When Malcolm and Macduff lead an army into Scotland, Macbeth believes he is invulnerable and has no reason to fear them. This mistak en belief in his invulnerability leads to his final destruction when he is confronted by Macduff. He scoffs at Macduffs vow to kill him, thinking such an attempt is futile, so he is completely unprepared to hear his nemesis declare Macduff was from his mothers womb untimely ripped,--and to die at Macduffs hand. Once he has decided to illegitimately pursue the crown of Scotland, Macbeth remains evil and unprincipled until his death. His thoughts and actions are dominated by greed and ambition. Once he has ascended to the crown, another facet of his evil--ruthlessness--is displayed. Driven by a dangerous persecution complex and by pressure from Lady Macbeth, he orders the assassination of Banquo and Fleance and of Lady Macduff and her son. TheShow MoreRelated Shakespeares Macbeth - The Transformation of Macbeth and Lady Macbeth2861 Words   |  12 PagesThe Transformation of Macbeth and Lady Macbeth      Ã‚   In the play Macbeth, by William Shakespeare, the characters  Macbeth and Lady Macbeth decide, in a great fit of ambition, to kill King Duncan.   Later in the play we see the same two characters undergo a transformation in their personalities after murdering the King.   Macbeth begins the play as a noble soldier and gradually changes into an ambitious and murdering tyrant.   Lady Macbeth begins as a strong, ambitious woman who dominates her husbandRead More The Transformation of Macbeth in William Shakespeares Play Essay823 Words   |  4 PagesThe Transformation of Macbeth in William Shakespeares Play Macbeth, once a noble and courageous warrior is transformed into an egotistical and ruthless tyrant. In the play Macbeth, by William Shakespeare, Macbeth encounters a transformation which brings him the crown, as well as his death. However, this transformation reached the point it did because three motivational factors. Throughout the tragedy the Three Witches (along with the prophecy), Macbeths himself, and Lady Macbeth wereRead MoreFactors Contributing to Macbeths Transformation in Shakespeares Macbeth1912 Words   |  8 PagesIn the play Macbeth, the main character, Macbeth transforms from a gallant war hero to a tyrannical murderer. As soon as Macbeth enters this life filled with tyranny his fate is doomed to a tragic downfall. Throughout the play, Shakespeare makes Macbeth responsible for his actions but Shakespeare also uses other characters as influences upon him which gives the character of Macbeth only partial responsibility for what he has done. In the scenes which lead up to the murder of Duncan, ShakespeareRead MoreLady Macbeths Transformation into a Guilt Ridden Woman in Shakespeares Macbeth671 Words   |  3 PagesFrom murder to greed Macbeth portrays a story of how a human’s flaws can be elevated to a point where they are no longer flaws but a person’s way of thinking and acting. A lot of the characters evolve from doing what they think is right to doing what their heart desires. Throughout the play, Lady Macbeth changes from an evil mastermind to a guilt ridden woman because Shakespeare shows how a person’s actions affect their personality by having selfish desires turn into a person only driven by powerRead MoreThe Supernatural Evil Within Lady Macbeth in Shakespeare’s Macbeth1561 Words   |  6 Pagesspecific genders. With this in mind, Shakespeare’s Macbeth heightens the supernatural evil possessing Lady Macbeth as she condones murder for her own selfish ambition, while in Shake speare’s time women were regarded as peaceful and full of feminine sympathies. This anachronism with the reality of Shakespeare’s day, illustrates the immense sense of wickedness and abnormality emphasizing her character’s influence on her husband and the plot of the play. In contrast, Macbeth appears to some extent a more acceptableRead MoreEssay about The Transformations of Lady Macbeth and Hamlet646 Words   |  3 PagesThe Transformations of Lady Macbeth and Hamlet In William Shakespeare’s tragedy Macbeth, we experience a completely different Lady Macbeth at the beginning of the play, than we do as the play unfolds. Lady Macbeth is the perfect example of a character playing a dramatic role reversal. At the beginning of the play, her character was that of a strong, controlling wife, whose goal was to make her husband commit a murder in order to become king. Lady Macbeth ends up going crazy and having a nervousRead More Lady Macbeth of Shakespeares Play, Macbeth Essay1000 Words   |  4 PagesLady Macbeth of Shakespeares Play, Macbeth Lady Macbeth is the most interesting and complex character in Shakespeares play, Macbeth. She is, in fact, the point on which the action pivots: without her there is no play. The purpose of this essay is to describe Lady Macbeth’s role in the play and discuss why this makes her the most fascinating character. Her evil doings are the main reasons why she dominates the plot so greatly. These include the following: considers Macbeth to be a wimp notRead MoreEssay on Symbolic Meaning of Blood in Macbeth by William Shakespeare513 Words   |  3 PagesShakespeare, in his work Macbeth, uses many forms of imagery to grasp the attention of the audience. His particular use of blood imagery is highly prevalent in Macbeth, a play set during the tumultuous 11th century – a century filled with unrest and uneasiness (as seen in the unification of Scotland, and the famous Norman conquest of Britain in 1066). Shakespeare’s use of blood follows a circular motion; it begins as a representation of honour, and progresses into one of guilt, then evil and finallyRead MoreWilliam Shakespeare s Macbeth And Richard IIi906 Words   |  4 Pagesconsequences. F or example, Richard III, also known as The Tragedy of King Richard the Third and The Tragedy of Macbeth exemplify two kings that are willing to do anything to achieve ultimate power, the crown. It is Richard and Macbeth’s ambition that drives them to commit the murderous acts within the plays. Though different figures, each share a common goal and a similar defect. Both Macbeth and Richard suffer from deformity; Richard’s physical deformity and Macbeth’s psychological deformity becomeRead More Why Macbeth becomes Ruthless in Shakespeares Macbeth Essay1039 Words   |  5 PagesMacbeth is a tragedy of a Scottish general who dramatically â€Å"transforms† from being a noble and dutiful soldier to a ruthless butcher. This is a direct consequence of the supernatural world, his wife’s manipulation and persuasion, and Macbeth’s own ambition. One of the main factors that influenced Macbeth’s transformation was the impact the witches and the super natural world had on him. It is an important theme as in Shakespeare’s day, the audience strongly believed in the existence of witches

The African American Civil Right Movement - 1040 Words

The African American Civil right movement in the late 1950’s and throughout the 1960’s was a powerful fight for equal opportunities to the basic rights and privileges outlined by the US government. During this movement thousands of African American individuals and those who believed in the power of the movement, battled against the piercing white supremacy through various tactics including grass root movements. The grass root movements in the 60’s was characterized by organizations of individuals fighting for equality on the behalf of the African Americans, ultimately shaping American history. Such movements helped to raise awareness on a political level, of the injustice all African American’s endured. Grassroots activist during the 60’s were able to organize marches, rallies and protests in order to mobilize and strengthen the Civil Rights Movement. Grass rooting activism during the Civil Rights Movement in the 60’s shaped American History by aiding in the abolished laws restricting African American’s freedom to vote, the abolishment of segregation in school, and the passage of the Civil Rights act outlawing discrimination. As the Civil Rights Movement began to take root in the late 1950’s, many grassroots activist worked towards the creation of many freedom schools in the South to encourage the continuation of the fight for equality. As tension began to grow between those fighting in the Civil War Movement and those opposing it, many activist were looking for ways toShow MoreRelatedThe African-American Civil Rights Movement1295 Words   |  5 Pages The African-American Civil Rights Movement is arguably the largest and most successful push towards toward change in American history. The movement was influenced by some of the biggest figures in American history as well, led by Martin Luther King Jr. and influenced by others such as president Kennedy and Johnson. Amongst the numerous protests and powerful speeches during the Civil Rights Movement perhaps the most prominent is the series of three marches in 1965 known today as the â€Å"Selma to Montgomery†Read MoreThe African American Civil Rights Movement1450 Words   |  6 PagesThe African American civil rights movement was a long journey for African American nationwide. The success involved many people, hardships and time in order to advance the African American community in America. The purpose of the movement was to achieve their rights, cease discrimination, and racial segregation. During the start of the African American civil rights movement, Africans Americans still were faced with Jim Crow laws which segregated them from whites. Under the Jim Crow laws AfricanRead MoreAfrican Americans And The Civil Rights Movement1260 Words   |  6 PagesAfrican Americans have fought for equality for a long period of time against desegregation and racism. It was an era where blacks couldn’t have the same rights as a white individual. African American were treated with hate and anger. The Civil Rights Movement is embodied in dramatic recorded speeches. Speeches like â€Å"I have A Dream†, the â€Å"Black Revolution†, and â€Å"Black Power’ and Coalition Politics. These speeches were written by great leaders. Martin Luther King Jr, Malcolm X, and Bayard RustingRead MoreAfrican Americans And The Civil Rights Movement1624 Words   |  7 PagesDuring the early 1950’s and 1960’s, the civil rights movement defined how African Americ ans progressed from being considered second class citizens to a unified demographic who became more endowed to handle the high tensions between them and the white segregationists. After World War II, protests began to rise between the 1950’s and 1960’s. The large number of blacks that served in the military or worked in the war industry saw that they had a greater place in the world than they had been given inRead MoreAfrican Americans And The Civil Rights Movement1623 Words   |  7 Pages African Americans were brought to America during the colonial days by Britain, before the civil war, as slaves. They were the foundation of slave economy, being auctioned off and sold, with no thought given to their opinions, families, or lives. Throughout American history, African Americans have slowly fought their way towards where they are today. Their fight has developed into the Civil Rights Movement in the 1900s. Many historians would agree that the start of the Civil Rights Movement happenedRead MoreThe African American Civil Rights Movement756 Words   |  4 PagesAnother significant circumstance was the African-American civil rights movement in US in those years. Until the age of eighteen, he had never thought about ethnicity or cultural differences. After 1968, African-American movement turned to be seen in Milwaukee. He met with Father Grouppi*, but he did not support him and his followers. For a long time, he had not appreciated the African American civil rights movemen t. Moreover, he would think that this movement aggravates the racial segregation in societyRead MoreAfrican American Civil Rights Movement1594 Words   |  7 Pagesblack power movement in American Civil Rights Movement. Violence is a physical force intended to hurt someone. Politics is a platform where the wellbeing is thought for the citizens and in America the politics and laws have been placed in order for the betterment of the American citizens. In this essay I will unravel many factors arguing whether violence is legitimate or whether it is a mean that is necessary to a more equal nation mostly focusing on the American Civil Rights movement and the blackRead MoreAfrican American Civil Rights Movement1525 Words   |  7 PagesFollowing World War I, a new, militant spirit of resistance and activism burgeoned among African-American citizens across the United States. Empowered by the sense that blacks had played a crucial role in the conflict, the descendants of freedmen returned home to fight for their own rights only to find persecution; this dire situation called for immediate, decisive action. During the interwar years, African Americans in the southwest Georgia Black Belt fought for community empowerment and, through theRead MoreAfrican Americans And The Civil Rights Movement Essay2200 Words   |  9 Pagesequal rights. A perfect example of racial brutality was the summer of 1955 when Emmett Till was brutally murdered by two white men. This murder case promptly seized the attention of millions and modified the history of the United States. The Emmett Till murder case established itself as a defining event in the United States history because it became a spark to the Civil Rights movement, transformed people’s hearts and minds into realizing how dangerous segregation was, and it proved how African AmericansRead MoreAfrican Americans And The Civil Rights Movement1531 Words   |  7 Pagesstates for African Americans in the 1960, although it has been nearly 100 years since the Emancipation Proclamation. African Americans were still segregated from classrooms, restrooms, theatres, etc. due to â€Å"Jim Crow† laws; and in 1954, the â€Å"separate but equalà ¢â‚¬  doctrine was struck down by the U.S. Supreme Court. For hundreds of years African Americans fought for their civil rights, desegregation, and basic human rights. One significant movement in history that was major for the Civil Rights Movement

Night Creature Crescent Moon Chapter 14 Free Essays

string(16) " I guess I had\." Adam licked my chin, nuzzled my neck, then captured my rain-puckered nipple in his mouth and gently bit the tip. I decided his hair didn’t matter. Right now, neither would an earthquake. We will write a custom essay sample on Night Creature: Crescent Moon Chapter 14 or any similar topic only for you Order Now I had questions, yes. But they weren’t going anywhere and neither was I. I’d save them for after I’d had sex with a perfect stranger. Well, not exactly a stranger. I skimmed my palms over his biceps. But damn close to perfect. He didn’t speak, which was fine with me. I wanted sex, not chatter. His body slid along mine as he went to his knees and lifted my shirt Mouth hot against my damp skin, he traced my rib cage, then swirled his tongue around my belly button. The rain beat down on us both. I had a sudden urge to feel the droplets everywhere, so I pulled the tank top over my head and tossed it aside. He looked at me and smiled – the first smile I’d ever seen on his face – and my heart did a funny sort of stutter. Why did he have to be so beautiful? Reaching up, he tugged the end of my hair. â€Å"Come.† I cast a confused glance at the house. â€Å"Nah, cher, right here. I wanna see your red hair against de grass. I wanna be inside you with de rain comin’ down.† Suddenly I wanted that, too. My knees gave way, and I joined him on the ground. As I lay back, I expected an unpleasant, damp chill. But I was as wet as the earth and the afternoon as hot as the sun. When he dragged at my jeans, I merely lifted my hips and let them go. Somehow he managed to lose his pants, too. No doubt he’d had a lot of practice. I pushed that thought out of my head. Who he’d done in the past, even what he’d done, had nothing to do with this. The sky swelled above us, heavy with clouds and the rain. The wild vegetation shielded us from anyone who might walk by. As if there were anyone but the two of us this far into the swamp. The thought made me bold. I wasn’t Diana Malone; I was merely a woman who wanted a man. This man. And she could have him. No one would ever know. His hard, clever hands skimmed over me, both insistent and reverent, arousing even as they soothed. His breath brushed my breast as he licked a drop of water from the curve. â€Å"You’re so wet,† he murmured, the rumble of his voice a sensation all its own. â€Å"Are you as wet here,† a finger traced my hip, my thigh, â€Å"as you are here?† My legs fell open, expecting that clever finger to discover the answer. Instead he slid down my body in a movement so fast, it left me gasping, even before his tongue swept into me. â€Å"Mmm-hmm,† he said. â€Å"Wet both inside and out.† I wanted to protest. I’d never been much for oral sex, which always seemed so personal – maybe because it was. I barely knew this man. But when I shifted uneasily, he grabbed my hips in his big, hard hands and held me still as he continued what he’d started. Within seconds I was beyond protest, tongue-tied. Thank goodness he had no such problem. My body tightened, quivered, and he entered me in one smooth movement. As I was already convulsing, the press and release, the enticing rhythm of flesh into flesh, skin against skin, caused a desperate moan to escape. Horrified, I bit my lip, choked it back. He gazed at me, the clouds swirling behind his head, both the trees and his hair whipping madly in the wind. â€Å"Don’t stop, cher. Make all de noise you want. No one’ll hear you way out here. Besides,† he flexed his hips and stroked me deeper, leaning down to nuzzle my neck, his now-wet hair tickling my cheek, â€Å"I’m not gonna quit until you scream.† â€Å"Th-that might take a while.† I wasn’t much of a screamer. â€Å"A man’s gotta do what a man’s gotta do. I don’t care if it takes all night.† He began to move again, murmuring encouragement, telling me to touch him, take him, fuck him. The latter disconcerted me, but something in his voice, a note of desperation, a tiny quiver of need, made the word less a profanity and more of a plea. I did as he asked, clenching around him as the tremor in his voice spread through both his body and my own. I felt him come as the rain swirled around us, and I got so caught up in the depth of sensation, the scent, the sound, the feel of him and me together in the half-light, that I forgot I’d already had one orgasm and went ahead and had another. I forgot a lot of things while I lay there, Adam’s head on my shoulder, his body still buried in mine. He shifted, sprawling half on the ground, half on me, his cheek pressed into my breast, his breath tickling my still-aroused nipple. He traced a lazy finger across my belly. â€Å"You do that a lot?’ I stiffened. â€Å"Are you insinuating that I’m loose?† â€Å"Loose?† He raised up on one elbow, using the hand that had been caressing me to shove his hair out of his face. His bracelet caught the light of the moon and turned from bronze to silver and back again. â€Å"You felt pretty tight to me.† His fingertips skimmed the curls between my thighs, and my skin danced. â€Å"What I meant was, come twice in ten minutes.† My face went hot I wasn’t sure what to say. Was that slutty? I’d been with one man before today. I’d loved him with all of my heart. We’d had a good sex life. The best. I’d never wanted anyone else. Until now. Suddenly I felt as if I’d betrayed my best friend. I guess I had. You read "Night Creature: Crescent Moon Chapter 14" in category "Essay examples" I started to get up, reach for my clothes. Adam yanked me back, and when I struggled he rolled his body on top of mine, capturing my legs between his and pinning my wrists above my head with one hand. The other held my hip still as I tried to buck him off. â€Å"You keep that up, we’ll go again. I’m game.† I could feel that he was. How could he be aroused so fast? What was he, superstud? Dumb question. â€Å"Don’t be embarrassed, cher. You think a man doesn’t want a woman to come every time he touches her? I liked it.† I had, too, but I wasn’t used to discussing sex in such detail with my body still humming from his. I wasn’t used to discussing sex at all. I’d learned the facts of life in the locker room of my private girls’ school, and to tell the truth†¦ they’d gotten a couple of things wrong. â€Å"Where you come from that you make love like a wild thing and get all red in de face when you talk about it?† â€Å"Lover I blurted. This hadn’t been love, at least not for me. Not for him, either, I was certain. He didn’t seem like the kind of man who fell in love. â€Å"Figure of speech,† he murmured, his voice trilling down my body, leaving goose bumps in its wake. â€Å"Find another,† I snapped, unreasonably annoyed at his cavalier attitude. Though why, I had no idea. I wanted him to be that way. I couldn’t bear anything else. â€Å"You’d rather I say ‘you fuck like a wild thing’? How about ‘screw’? ‘Bang’? ‘Boink’? None of them seemed de right word at de time.† My lips trembled, and he stared at me, horrified. Then I burst out laughing. I couldn’t help myself. † ‘Boink’?† He smiled, too, then shrugged, the movement making his slick chest rub against mine in new and enticing ways. â€Å"See what I mean? Not de right word.† The laughter had been good, had made me feel almost closer to him than the sex had. Almost. Rain dotted my cheeks, sparkled in his hair. Suddenly my hands were free, and I drew a finger down his face. â€Å"There’s so much about you I don’t know.† Amusement fled as wariness took its place. â€Å"There are things you don’t wanna know.† He rolled off me and to his feet in a quick feline movement. Leaning over, he dug his cigarettes out of his pants, then glanced at the still-dripping sky. â€Å"Did you kill someone?† I hadn’t meant to ask that, wasn’t sure why I had. Like he was going to tell me. The pack of cigarettes crunched as his hand clenched, then he took a deep breath, and as he let it out, his muscles relaxed, his fingers unfurled, and the shiny crumpled paper thudded to the ground. â€Å"You know I have.† I blinked. â€Å"Wh-what?† â€Å"Why you ask if you don’t want to hear? I was in de army. I did what I had to do.† â€Å"I wasn’t talking about the army.† Slowly he turned, his eyes eerily light in the encroaching night. â€Å"What were you talkin’ about?† Adam might feel comfortable standing in the swamp buck naked, but I didn’t I reached for my shirt, drew it over my head, and started hunting for my underwear. â€Å"A detective came to see me.† Had it only been this morning? â€Å"There was a man killed in the swamp.† â€Å"Another animal attack,† Adam murmured. I found the white scrap of cotton and shoved my legs inside. My jeans were soaked. I debated trying to put them on and decided against it â€Å"Not an animal this time.† I looked up. â€Å"Guy was strangled.† Adam’s face revealed nothing; however, he didn’t seem surprised. â€Å"You think I did that?† â€Å"Did you?† â€Å"Who was this man? Why would I kill him?† I didn’t know the answer to either question. â€Å"The detective wants to talk to you.† â€Å"He can want all he likes.† â€Å"You aren’t going to talk to him?† I asked. â€Å"When I get around to it.† â€Å"He seemed pretty determined.† â€Å"He’ll have to be a lot more than determined to find me out here.† He had a point. I jerked my head toward the shack. â€Å"This is where you live?† â€Å"Yeah.† â€Å"Why?† He lifted his brows. â€Å"Why not?† â€Å"You’ve got a perfectly good house, if you’d only take care of it.† Adam’s face became shuttered. â€Å"I hate that place. I wish it would rot, but de damn thing never will.† His vehemence surprised and confused me. â€Å"You moved out here because you hate the house, not because you – ?† I stopped abruptly. His mouth quirked. â€Å"You heard I lost my mind, huh? Why you come here if you think I’m nuts?† I hadn’t come here – actually I had, but not the way he meant; I’d followed him. Or at least I thought I had. â€Å"Why were you watching me at the mansion?† He’d been leaning over, reaching for his clothes, giving me an eyeful of his terrific backside. At my question, he stilled for just an instant. If I hadn’t been admiring the view, I wouldn’t have noticed. â€Å"Watching?† He straightened, but he didn’t face me. Instead, he seemed to be scanning the swamp. â€Å"By the cypress trees. When I called out, you left, so I followed you. Didn’t I?† â€Å"Mmm,† he murmured, then scooped up his clothes, my jeans, and grabbed me by the arm. â€Å"I’ve had enough of de rain. Let’s go inside.† I hung back, uneasy, uncertain. â€Å"Why did you lead me here?† He stared at me from behind the tangled curtain of his hair. â€Å"I’m a man. Why you think?† For some reason the idea that he’d led me into the swamp for sex annoyed me, which was stupid. I hadn’t followed him for a tour of the area. I wasn’t that delusional. We were mature adults who were attracted to each other. There was no reason we shouldn’t act on that attraction. Just because Adam gave voice to the truth shouldn’t make me feel slutty and guilty and bad. But I did. â€Å"I should go,† I said. â€Å"Not tonight.† â€Å"But – â€Å" He kissed me, lips, tongue, teeth, and I forgot again. Where I was, who I was, the other questions I wanted to ask. He lifted his head, and his gaze flickered to the swamp, then back to mine. â€Å"Stay with me. At least until de storm ends.† I found myself nodding, even though I got the distinct impression he meant something other than the wind, the rain, and the thunder. How to cite Night Creature: Crescent Moon Chapter 14, Essay examples

Workflow Design Tools in the Health Information Management

Question: Define each of the following work design tools and provide an example of how/when each might be used in health information management: workflow diagram, process flowchart, top down process map, swimlane diagram and use case. Answer: Definition and Example of workflow Diagram A workflow includes repetition of all activities of the business enabled by the systematic organization of resources in transformation of materials, services and process information. It involves all the operations in a sequence declared as work of a group, staff or more than the complex mechanisms. Workflow considers as the representation of real work. The flow show as the documents of the services of health care being transfers from one to another. It identifies all the hurdles by improving the full utilization of resources (Sharp and McDermott, 2013). Example: In data analysis of health care, a workflow can be used to represent the steps in a clear sequence that makes the complex data analysis involves data manipulation and data search steps. Process flowchart Definition and example Flowcharts help in visualizing all the steps in the process. It is use to search one source of a problem or more than one with an identification of its solutions/ improvements. Process flowcharts are used to show the relation in between the major parts of the system (DeRosier, Stalhandske, Bagian , Nudell , 2011). Groups and the whole departments is accountable for taking the charge of the process and complete task. The whole process shows through the flowchart. All individuals works under the process flowchart consider as players. Sequential thinking helps in identifying the steps in the process flowchart. Flowchart shows graphically with the help of rows and columns corresponding to the attached work units example- Nursing (Lighter, 2010). All steps of the flowchart are arranged properly in a sequence. In first step, place the card in the column / row that parallel to the player account for it The second step should be placed along within the process to clear and show that it will occur later. The flowchart of nursing shows below (Source: Public Health, Nurses only visit https://www.hrsa.gov/publichealth/business/healthit/toolbox/HealthITAdoptiontoolbox/index.html) Top down process map definition and example The top down method is known as the parking lot list. The main process steps are consider from the top and then all the sub processes are mentioned below efficiently limited the level of the detail present. Parking lot lists are always mentioned in hierarchical nature and clears the concept that how all the steps are mentioned on the map (Huser, Rasmussen, Oberg, Starren, 2011). A step mentioned below the process step is at the low level in the hierarchy than the step placed on besides the previous step of the process. This method is stated as weak because one level of the hierarchy has no link with the other maps. Example in health care- This method adopted to recognize the safety hazards for the patients in the quality and safety in health care. Mapping Level Detail Hierarchical Multiple flows Organization structure Icons Logic operators Flow time Citations Top down Swim lane diagram definition and example A swim lane diagram workflow uses the blocks showing all the steps use in the process. Diagrams consist with all the rows and the columns represent areas performing different functions. Functional area represents individual who has the responsibility for completing the steps. Each one represents different types of responsibilities. Steps uses in the block shown in the chronological order. It all seems easy when it comes for the overall process (Sharp and McDermot, 2013). Example: The details of the swim lane workflows show the process of the medical pre- authorization. Many health insurers need the medical procedures before rendering the services. From left to the right, each swim lane shown as a accountable party like insurer, member and provider. Each square box shows as a task in the process before starting of the next step. Use case definition and example Use case is imperative technique that is use at a large scale in modern software engineering since their formal introduction done by the scholar. It is a sequence of all interactions done in between the user and the system that make capable the user to meet his goals. Example- Collect all information on present medications, allergies and intolerances related to medication Make changes in an existed medications needs to be continued Communicate all information at discharge to the care at the next level References Huser, V, Rasmussen, LV, Oberg, R, Starren, JB. (2011). "Implementation of workflow engine technology to deliver basic clinical decision support functionality". BMC Medical Research Methodology 11: 43. doi:10.1186/1471-2288-11-43. PMC 3079703. PMID 21477364. edit Lighter, DE. (2010). Process orientation in health care quality. In: Moore C, editor. Quality management in health care: principles and methods. 2nd ed. Sudbury, MA: Jones and Bartlett Publishers. p. 43-101. DeRosier, J, Stalhandske, E, Bagian , J, Nudell , T.(2011). Using health care failure mode and effect analysis: The VA national center for patient safetys prospective risk analysis system. Jt Comm J Qual Improv. 2002 May; 28(5):248-267. Sharp, A and McDermott, P.(2013). Workflow Modeling: Tools for Process Improvement and Application Development . Norwood, MA. Fisher, Layna. (2012_. Workflow Handbook. Lighthouse Point, FL. https://www.futstrat.com/books/handbook06.php

Religious world view Essay Example

Religious world view Essay The term world view also referred to as world outlook is used to mean the wide world perception held by individuals concerning the world. It refers to the beliefs and ideas which individuals use to interpret the events that happen in the world thus enabling them to interact with the world. It is a consistent and central sense of existence which provides an outline for the generation, sustainability and application of knowledge. From a religious point of view, world view is termed as the commitment or an essential orientation of an individual’s heart that is usually expressed through a story and also in sets of presuppositions which may either be partially true, true or false and which one holds unconsciously or consciously either inconsistently or consistently regarding the primary construction of reality. This provides the basis on which individuals live, have being and move on. A religious world view believes that there is supernatural power which influences the eventual rea lity (Heylighen, para 1-2).Religious world viewAs mentioned above, a religious world view refers to an individual’s insight or outlook of the world in regard to a supernatural being. A religious world view believes that there is a supernatural being commonly referred to as god who controls the events which happen in the universe. There are different religious views held by different religions around the world. However, despite the varied religious believes, all religions believe that there is a god, a deity, a universal spirit or divine entity that controls the universe. Another common believe is that this divinity did establish eternal moral order (during creation) that is known to people partially. As such, religious people believe that it is their duty to follow such eternal moral dictates from the supreme god. The religious world view also believes that human conduct (of following the moral dictates of the deity or god) have far reaching effects or impacts which stretches even after a person’s death (Futrell, para 3).Each religion as mentioned above have its own believes and world outlook which differs from other religions. There are about five identified religious world outlooks currently which includes the pantheistic tradition composed of Hinduism, mysticism, Buddhism, transcendentalism and new thought. Under this world view, it is believed that there is one divine essence who is behind all the realities of live. Nature is thought to be infused with spirit which surrounds it and it (spirit) manifests itself as matter or nature in the physical world. This world view also believes that matter is the one which evolves bodies the bodies in turn evolve minds, the mind then progresses to become the soul and the souls ultimately return to their source which is the spirit. As such, people are spiritual beings who have human experience which evolves consciously as they take the journey to spirit from matter. Meditation, Zen or yoga’s are the tools which enables the mystical union between human beings and he divine essence. Spirituality under this religious world view entails letting go of the human â€Å"false self† which is associated with ego and personality which is socially adapted which enables one to experience his or her true self which have the divine essence. Individuals’ divine essence results into respect and love for all human beings (Xplorehl, para 2-3).The second approach of religious world view is the polytheistic tradition which is made up of Taoism, shamanism, Hinduism, Wicca, primal religion and druidry. This outlook believes that there are a number of gods, metaphysical levels and spiritual energies in the universe. These spiritual energies or the â€Å"gods† manifests themselves usually in deep structures referred to as archetypes or mythic symbols. The archetypal images as well as the energies are often experienced in trance states, dreams, imagination, story telling, art, danc e and music. The energies are used for serving and healing through rituals or magic. Under this view, spirituality entails living a well tempered and balanced life which the spheres, energies and gods are in harmony. In essence, people live according to the guiding spirit and wisdom of nature enjoying intimate partnerships of beauty and love (Futrell, para 5).The third form of religious world view is the henotheistic tradition which is made up of the early Judaism, some post modernists and some Native Americans. This outlook argues that there are various gods although there is one supreme and high god. The supreme god is the ultimate reality which all people should respect and worship. Spiritualism entails taking all the sacred traditions and offering them to the supreme god in worship and reverence. Another religious world outlook is the monotheistic tradition which is composed of Christianity, Islam and Judaism. This outlook believes that there exists one true god who is infinite and is the creator of the universe. His nature is righteousness, love, holiness, mercy, compassion, kindness and just. He is perfect. Spirituality refers to the receiving of prophetic revelation word as well as redemptive salvation. Ideally, people seek to love god with their whole being as well as loving other people (Xplorehl, para 6).The last religious world outlook is the atheistic tradition which is made up of the humanism, agnosticism, romanticism, rationalism and existentialism. Under this outlook, it is believed that there is no god and in case he exists, people cannot know about it. People are believed to be capable, free and responsible to develop collective and personal potential while in the world without any help of divinity. Spirituality under this outlook means constant renewal of human spirit composed of fairness, sympathy, duty and self control. In essence, people are dedicated to realizing their potential through creativity which in turn leads to body, heart, mind and spirit development for the greater service of the community.Religious world view principles entail faith, divinity, spirituality and life after death. For a world view to be considered to be religious, it must have the above elements. As discussed above, all the religious world view apart from atheism believe in a supreme being that forms individuals’ basis of their faith. The Supreme Being is thought to control the universe and is believed to be powerful and omnipresent demanding for reverence. In some instances, there may be more than one Supreme Being or gods who control different events around the universe. Also, people are thought to contain some spiritual or immortal aspect like the supreme beings and that eventually, individuals or human beings become spiritual beings after their death. According to the religious world view, morals and virtue which guides human beings originate from the supreme beings and it is the duty of every man to fulfill them for him to find happiness and joy (Nishida Dilworth, pp 90).Significance or importance of learning the religious world viewHuman beings in themselves are said to be incomplete and requires the aid of a â€Å"supreme being† to help them find meaning of their existence. Despite the different outlooks of religious outlook, almost all of them apart from the atheistic outlook acknowledge that there are spiritual beings who govern the human beings’ morality and behavior. One main importance of learning the religious world view is that it helps a person to understand why different individuals behave in a particular manner and why they value certain activities. As mentioned above, a religious person’s way of life is guided or dictated by his or her believe about the universe. Different people have different religious world outlook which are different and understanding them is vital as it would enable one appreciate other people’s believes and also to respect them. Every individ ual has his or her own world outlook which conflicts with his or her neighbors’ world outlook. To ensure harmony is maintained, each person must respect the other peoples believes and outlooks. Most people have a religious world view although such views conflicts which have contributed to the rivalry which exists between different religions. An understanding of the different religious world outlook is thus essential as it helps an individual to live at peace with himself as well as his colleagues (Heylighen, para 6).Another importance of learning religious world outlook is that it helps in explaining some of the mysteries which exists in the universe. Human mind is limited in its understanding and as such it tends to attribute that which it cannot comprehend to a supreme being who is said to be all knowing and almighty. Despite the fact that most individuals claim not to be religious, most of them have religious world outlooks which dictates their way of life. Learning about religious world view helps us to live within the human limitations comfortably as this view gives us meaning to our lives as well as the universe. Religious world view regarding a divine intervention helps an individual to attribute that which he or she is unable to perform to this divine person or being thus eliminating mental torture which comes with human limitation. It also helps one understand why one believes in certain things which usually do not seem to make sense in an ordinary setting as well as the in the universe (Blackford, para 4).Learning about religious world view is also important in that it gives a person strength and courage to face difficult times and trying moments. Religious worldview believes in supreme power which enables individuals to face calamities with renewed strength in the hope of that their supreme being is able to help them. Faith is one strong attribute which enables a person to push through trying moments. It also helps one to fully exploit his or her potential in life. Having faith in the help of a supreme being who is well able to do all things helps individuals to become or exploit their potential which is beneficial not only to them but also their communities and the world at large (Xplorehl, para 8).Challenges to religious world viewIt is essential to understand that people who are opposed to religious worldview do not necessarily hate religion. On the contrary, they are well learned on issues regarding different religions and were at one time themselves religious people. Most of them even practice different religious believes before forming their world view. One of the biggest challenges of the religious world view is that it does not substantially elaborate or enlighten individuals on the existence of the Supreme Being. In all the religious world views, none of them explains clearly the nature of the Supreme Being or even states in a quantifiable manner where this being lives. Divinity is explained through mysteries w hich are at times difficult to understand and cannot be proven. This approach thus lacks scientific reasoning behind it which poses a major challenge to this world view. Science is used to explain the existence of different things and why things happen the way they do unlike religious world view which assumes that a divine power controls the universe (Nishida Dilworth, pp 124).Another challenge to the religious world view emanates from the various religious believes individuals have in regard to divinity. Different religious groups as mentioned above hold different believe which makes it ambiguous and inconsistent. If the Supreme Being was a reality, then he would manifest in a similar and consistent manner to all religious people. The conflict which exists among different religious world outlooks has posed a major challenge about the viability of this world view (Blackford, para 7).ConclusionA world view held by an individual is important as it help him or her to relate well with other people as well as the nature. Different world views project the different perceptions people have regarding the universe and all the events which take place in it. Most of the people have religious world views which form the basis of their faith, spirituality and actions. Most religions believe in the existence of a supreme being who controls the universe. All the mysteries and events which are beyond human understanding are attributed to this divine power. Despite the fact that there lacks uniformity in religious world views unlike the non religious world views, they have contributed largely to the peaceful co-existence of people especially those having similar religious world views.

Fun and Simple Mothers Day Activities for School

Fun and Simple Mothers Day Activities for School Moms are magnificent! To help celebrate all the things these wonderful women do, we have compiled some Mothers Day activities. Use these ideas to help your students show their appreciation for the terrific women in their lives. Fun Fact: Mothers Day dates back to the early 1800s. President Woodrow Wilson was the first to annually recognize this day as the second Sunday in May. Bulletin Board This show-stopping bulletin board is the perfect way to show appreciation to your students mothers. Title the bulletin board Moms Are Special and have the students write and illustrate why they think their mom is special. Add a photo and attach a ribbon to each students piece. The result is a stunning display for all of the moms. Tea-rrific Moms A perfect way to celebrate Mothers Day is to treat all of the mothers to a tea party to show them how terrific they are. Invite each mother to the classroom for some afternoon tea. Have students make each mother a card. On the card write, You are...and in the middle of the card, Tea-rrific. Tape a tea bag onto the inside of the card. You may wish to compliment the afternoon tea with fun appetizers, such as mini cupcakes, tea sandwiches or even croissants. Sing a Song Teach your students a special song to sing to their mother on Mothers Day. Here is a collection of the top songs to sing for the mothers. Write a PoemPoetry is a wonderful way to have your students express their love and appreciation for their mothers. Use the following word list and poems to help your students come up with a poem of their own. Use this list of words to help you create a poem, worksheet or creative writing activity.A collection of classic poems to print and attach with a gift or craft. Printable and Homemade Cards Cards are a wonderful way for children to express their feelings and show their mothers how much they care about them. These cards are great when youre short on time; just simply print out, have your kids decorate or color them and then sign their names.

Contemporary and International Marketing Case Study

Contemporary and International Marketing - Case Study Example The company employed some new initiatives when shifted to Stoke On Trent. Like Montrose corporate range. Company has two new brands namely Montrose crystal and Tutbury crystal eponymous. The former product aimed at corporate and gift sections. While the later aimed basically on consumer market and hand crafts. The products have standards and also personalized. Personalized means to engrave name or certain other information on it. Bespoke items are also available. Bespoke products are those products which have some other shape than the normal shape. Also it is exclusive according to the requirement of the customer. The Montrose crystal is less complex than the traditional designs of Tutbury crystal. It has lesser number of cuts. But overall it is more contemporary. The quality of the crystal can be judged by the sparkle and glare. It is not easy to judge the quality of crystal. The content of lead is less in Montrose range than the Tutbury crystal. Tutbury Crystal invests 60% of its sales to the direct factory work 30% to the organization and rest 10% to the retailers. The company is now providing facilities to create shape of their own choice through internet. These products are almost 10% cheaper than their competitor like Waterford. The other competitor in his field are Royal Brierly and Royal Doulton. The detail of distribution of its sales is like 60% is the breakdown price. 10% profit before tax and approximate 8% is the overhead cost 15% is direct labor cost and 6.67% for the material. Its middle east turn over is of about 95%. Tutbury crystal is now looking for its expansion in other countries. This will expand the business and increase its sales and market capitalization. This expansion is also called market entry mode. The entry scheme should be properly designed or it may even cause a big loss to the company. Their are some points which should be kept in mind before entering into another country. These includes the export strategy, the investment strategy and the contractual strategy. If they are designed properly keeping the keen observation about the market of any other country then it will be easy for the company to jump into the market of that company with cheaper rate and equal quality. These categories help to assess the characteristic of product and its power to capture the market. The national market is independent of other national market. There are many factors that influences the global market. There is a lot of competition in global market. The position of company in any national market effects the image in other country also and this cumulative process causes the company to successfully capture the global market. The fight for the leadership on a worldwide position is in

Relationship between health & lifestyle and Health & safety Essay

Relationship between health & lifestyle and Health & safety - Essay Example The other relationship is on food. Food can play a significant role in the individual enjoyment of robust health. At the same time, food can be a key factor in influencing ill health. One of the important roles of food is the provision of proper nutrients required by the body (Cooper, Hodges-Mameltzis and Thorpe 4). However, malnutrition may occur due to both under or over-consumption of food. Lack of access to basic nutrients may lead to ill health and poor well-being of the individual. The lack of proper nutrients in parts of the world has led to an increased epidemic of chronic non-communicable diseases (Cooper et al 4). A proper nutrition helps in prevention of some of the major diseases in the body. Nutrition has also been shown to relate to diseases such as diabetes, hypertension, cardiac diseases, and cancer (Ministry of Health 1). Certain lifestyles such as smoking and alcohol taking have a profound impact on health. Excessive indulgence in cigarettes and alcohol may lead to addiction (NHS 1). Addiction is challenging as it affects individual health. Moreover, indulgence in alcohol makes one uncontrollable and most likely to engage in unprotected sex (NHS 1). Therefore, such individuals are at risk of getting sexually transmitted diseases (NHS 1). Such individuals are also likely to get the unwanted pregnancy. Additionally, regular drinking may lead to liver diseases, heart attack and weight gain (NHS 1). Weight gain, on the other hand, may lead to obesity-related to diseases such as diabetes.

Q (VE1) or Q (VE2) Research Paper Example | Topics and Well Written Essays - 250 words

Q (VE1) or Q (VE2) - Research Paper Example a mean, ethics (how we are trained to handle any situation) is plainly the cause of the achievement of the ‘average’ feeling of happiness (happiness does not have a measure but either a lack or presence of it) (Aristotle 10a). Some of the moral virtues that Aristotle listed in his work include joy, pity, envy, confidence, appetite, friendliness, emulation, and more feeling-related human attributes. They are all considered to have an average, unlike such feelings as happiness and anger that stand as distinct feelings and can only be described by way of how they are expressed and not how much of them we can assess. If I were the shepherd in Plato’s story (Plato par 1-7), I would consider it ethical to wear the ring because the powers that come with it are bound to bring me a feeling of protection and, subsequently, happiness. The ethical dimension to it is the ability to acquire the average feeling of satisfaction knowing the power I

A critical analysis of Liquidity, Profitability and Efficiency

A critical analysis of Liquidity, Profitability and Efficiency the industry average of current ratio is 2.2:1.company A is showing better current ratio of 2.63 as compared to industry average of 2.2 which mean that the company A bears a greater ability to paid its bills . Company B and C have less current ratio as compared to the industry average which means that the performance of these companies are not up to standard however company Cs current ratio is slightly greater than the industry average which shows that the performance of company C is satisfactory. The industry average of quick ratio is 1.5 whiles the average quick ratios of companies A B and C are 1.99, 1.54 and 1.71 respectively which shows that the said companies posses a greater ability to pay their bills however only the company D quick ratio is slightly less than the industry average ratio which is 1.48 which mean the company needs to review its liquidity plans . PROFITABILITY The industrys average of ROCE is 15% and the average ROCE of companies A Is 19.3%, company B is 21.26%, company C is 28.24% and company D is 31.13 which means that the companies are earning a good return on their capital employed. Company C and D gross profit ratios are 53.14% and 56% which are comparatively better than the industrys average of 48% however company B gross profit ratio is 48% which equals the industrys average but company A GP ratio is 43.75% which is less than the industrys average. It is suggested that the company A should reduce its cost of sale or increase its sales revenue. The industrys average of operating profit ratio is 40% unfortunately company A and B both have low operating profit ratio which are 33.75% and 38.28% respectively which indicates that both companies A and B has low control in their operating expenses on the other hand companies C and D have better operating profit ratios which are 46.63% and 48.73 showing that the management of both companies bears a good control on their expenses. EFFICIENCY Companies A B and C have high stock turn over which are 63.88, 75.43 and 71.22 all three companies exceeds the industrys average of 35 days which means that there could be a problem in their demand and supply due to which companies inventory is not easily converted into finish goods hence there are not able to effectively sale their products. Note: Company D stock turn over ratio cannot be calculated because of unavailability of required data. The industrys average of total turnover ratio is 0.9 time and in this regard all the four companies have good total turnover ratio which are 0.95, 0.93, 1.01 and 1.06 showing the good return on their assets. INVESTMENT There is no such parameter by which one can compare the earning per share with the industrys standards. However we can compare EPS among the four companies that EPS of companies C and D are 0.98 and 0.88 is comparatively good than the companies A and B of 0.54 and 0.56 respectively. As far as the position of best company is concerned company D is said to be the best company because of better ROCE 31.13 which means the company is earning highest profitability, EPS 0.88 indicated earning per share is very good and dividend cover 3.68 the shareholders of the company receiving handsome dividend. ANSWER 1 (B) Company D shows a good charm for the shareholders because its earning per share is higher is 0.88 as compare to other companies like A and B but slightly less to company C which EPS is 0.98 however company D also have better dividend cover of 3.68 which depicts that it is paying its shareholder more than any other said company pay however company C once again a big rival in payment of dividend has a dividend cover of 3.38. On the other hand management of company D plays a remarkable role in utilising the shareholders funds hence reducing the long-term liabilities option because of less long term liabilities company D also has to pay less amount of interest on these loans as compare to other companies. Therefore it is suggested to invest in company D from shareholder perspective. ANSWER 2(a) ANSWER 2 (A) CRITICAL ANALYSIS The net present value is a discounted cash flow approach to capital budgeting. The net present value (NPV) of an investment proposal is the present value of the proposals net cash flow less the proposals initial cash outflow. If an investment projects net present value is zero or more, the project is accepted, if not, it is rejected. In this case of Tridad ltd the NPV is -6384.24 which means the value is less than zero therefore the project is not viable for the company. ANSWER 2(B) The internal rate of return is 13% ANSWER 2(C) If a refinancing option (overseas loan) were to be taken then there are many risks that the company might face like FINANCIAL RISKS: forex risk hedges overseas government policies WAYS TO DEAL : There are couple of ways which can be use to deal with the said financial risks Loan with fixed interest rate Buy futures which will give the company assurity of the expected future cash outflow- Reduces uncertainty and any cash problems that could be used due to this. ANSWER 3(A) Proposed profit 91,552 Proposed profit 78,832 Break-even hours 1,393 Break-even hours 1,574 Break-even Sales 208,955 Break-even Sales 340,000 ANSWER 3 (B) Boris Plc has an operating profit of 91552 in scenario 1 and 78832 in scenario 2 at the sale turnover of 345600 and 497664 in scenario 1 and 2 respectively. For achieving the break-even at least 1393 hours in scenario 1 and 1574 hours in scenario 2 have to be sold out so that variable cost can be observed. Break-even techniques are based on marginal costing therefore fixed cost plays a significant role companys operating results and performance. In the long haul fixed cost needs to be fully observed hence absorption costing approach is critical to be planned in the long term decision making plan.

Letters Home :: Creative Writing Essays

Letters Home The vid screen is dark and ominous, as if it holds secrets that is not for the likes of men to know. John Poldeck, a middle aged, balding man of forty-eight steps forward toward screen and console to activate the beast, this oracle of silicon, plastic, and glass. Today John is hoping for word of his son Kirk, of whom nothing had been heard of since he left for UNDF Marine Corps training at Camp Lejune, South Carolina, a beacon for the phony tough and crazy brave looking for ill conceived adventure and glory. At least that was John’s opinion on the matter. As a mid level market analyst for the transnational ABSCOM John was used to battles fought with market shares, balance sheets, and stock options. For the forty years since the birth of the revamped United Nations war and the conductors of war, the military, had been a dying business. John could still remember the eager look on Kirk’s face when his son had uttered words like, duty, honor, patriotism, words which seemed as alien to John as the worlds the UN exploratory fleet claimed to have found. â€Å"For Christ’s sake John will you turn on the damn console? What the hell is wrong with you today?† John glanced at June, his wife of twenty years and counting. Her dark skinned face was a sharp contrast to his pale complexion, and anger, tinged with concern for her son, clouded and darkened her visage even more. He looked at his wife without comprehension. â€Å"What?† June sighed, and then in a kinder tone, â€Å"The console John. I know you’ve been angry ever since Kirk left for the Marines, hell you’ve been mad ever since he first brought up enlisting. A fool’s errand you called it. Perhaps you’re right. All I know is that he might have sent us a letter today.† A fool’s errand. I remember when I said that John thought. That had been a nasty episode, one of many that had occurred during one of the endless fights he had had with Kirk over this business of enlisting. Try how he might he could never convince his son that business was where the opportunities were. Kirk had then coldly informed his father of his contempt for the Transnationals that now ran everything on Earth, including the UN, and his contempt for anybody connected to them.

Beethoven Biography

Beethoven, who was a great composer and pianist of German origin was born in the 1770 and died in 1827. On the same note, he is grouped among the very influential composers and played a very great role in Western classical music especially due to the fact that he existed during the transition period between the famous classical and romantic eras (Beethoven: biography, 2001).Although he was born in Bonn which was the capital city of Cologne, currently known as Germany, he later migrated to Vienna where he got occupied in studying as well as learning to play piano.It bears noting that though he developed a hearing problem, this did not deter him from his music career since he continued to perform and compose even after becoming completely deaf. Although he did not live for long, he made notable contribution in the field of music. With this background, this paper will objectively describe his biography, laying more emphasis on his life history as well as his major accomplishments. 2. 0 Background InformationBeethoven was born in the family of musicians since his grandfather Lodewijk van Beethoven was also a musician of Flemish origin who was employed as a bass singer and ended up becoming a music director (Ludwig van Beethoven (1770 – 1827)). More to that, his grandfather still had a son by the name Johann van Beethoven who was also talented in music since he was employed as tenor in the same place with his father. The son used to teach violin and piano lessons part time as a means of supplementing his income. Johann married a lady by the name Maria Magdalene and the two became the parents of the famous Ludwig van Beethoven.Although studies record that the parents of Beethoven had seven children, it is only Beethoven together with two younger boys who survived past infancy stage. He was the second born in the family and even though his exact date of birth is not known as there are no records, it is assumed that he was born 16th December 1770. This is due to the fact that it is evidently known that he was baptized on 17th December 1770 and by then children were being baptized a day after birth (Lane, 2005). Moreover, most studies indicate that he used to celebrate his birthday on 16th December.Beethoven talent in music was discovered quite early in life and his father who was a music teacher was the first person to start teaching him how to play keyboard. Although his father used to teach him, he still had other local teachers like Tobias Friedrich who taught him how to play piano, Franz Rovantini who taught him how to play violin as well as Gilles van den Eden. In the year 1779, Beethoven began to study music seriously with the help of Christian Neefe who helped him compose and publish his first composition in the year 1783.He was first employed in the year 1784 at Court Chapel although before then he used to work as Neefe assistant without any pay. He was later appointed as an assistant organist and the people who used to work closel y with him like Maximilian Fredrick noticed his talent in music and encouraged him to pursue further studies in music. Although studies illustrate that Beethoven had attempted to travel to Vienna in 1787, he was forced to go back to Bonn to take care of his siblings especially after his mother’s death.His father who was becoming a worse alcoholic day by day could not be trusted with caring for the family, this is denoted by the fact that he used to do it through a court order. However, in the year 1792, Beethoven travelled back to Vienna through the help of Elector. At Vienna, he trained under Haydn and managed to compose lots of work that was not published even though the works displayed his development in the music career. Similarly, these works by then indicated that he had learnt a lot from Haydn’s since they displayed a lot of Mozartean flavor.Nevertheless, Beethoven did not first concentrate on composing but on learning to play piano under the instruction of Hayd n as well as playing violin. He was also occasionally taught on Italian vocal composition style by Antonio Salieri for some few years. Even though after sometime Elector ceased to finance him, he continued to stay in Vienna because some people from the same place who had noticed his talent in music continued to support him financially (Crowest, 2009, p. 120). 3. 0 Beethoven’s Music CareerBeethoven’s Music career began to flourish in 1800. It is noteworthy that his first music performance at Vienna was in1795 after which he planned for the publication of his initial compositions, piano trios of Opus 1 which were dedicated to his patron. He continued to compose in many forms such as symphony, quartet and string. Although his works were greatly influenced by Mozart and Haydn, he emerged to be unique due to his music development, his use of modulation and texture, as well as his unique characterization of emotion.Beethoven was not only a composer, but a music teacher as we ll. Further studies indicate that he also taught Ferdinand Ries who became a composer and went a head to write a book entitled ‘Beethoven Remembered’ which explained about their encounter. Carl Crenzy who was a music teacher was also a Beethoven student for two years from 1801-1803 (Ludwig van Beethoven (1770 – 1827)). Just at the height of his career, Beethoven developed a hearing problem which was quite discouraging since he could no longer be able to appreciate music.Even if the exact cause of the problem is not known, it has been assumed that the problem was attributed by lead poisoning, syphilis, his habit of immersing his head in water in order to stay awake and typhus. However, the doctor’s report indicated that it was as a result of distended inner ear. The evidence of his deafness is not only from his works which record his written conversation with his friends, but also from a large collection of his hearing aids which have been preserved in Beet hoven House Museum in Bonn. He completely become deaf at 1814 but still continued with his music career (Davies, 2001, p.234) and (Udvarhelyi, 2003). Much as Beethoven used to obtain money from his compositions and his performances, he also depended heavily on financial help from his patrons like Prince Lichnowsky and Archduke Rudolph who was the last born son of Emperor Leopold II. As years progressed, he continued to develop his career and by 1810, he had managed to be recognized as a great composer. However, due to family and personal as well as financial problems, a slight decline was noted in his music career. He also had numerous illicit love affairs which may have contributed to the decline of his performance.In addition, he also started to experience ill health and his brother who was also ailing died in the year 1815. Albeit during this time he was still composing, his health did not stabilize and in 1825, he became bedridden. Nonetheless, he composed the fifteenth Quartet and still compiled the sixteenth, fourteenth and the thirteenth quartet while still in poor health. In 1826, his health deteriorated further (Kinderman, 1997, p. 238). Further studies illustrate that he latter died in 26th March 1827 and his funeral service which took place in the Holy Trinity Church was attended by more than ten thousand people.Beethoven was buried at Wahring cemetery located in Vienna, but latter his remains were exhumed in 1862 for study purposes. Further studies indicate that the exact cause of his death is not known although it has been projected that he might have died of infectious hepatitis, syphilis, lead poisoning, Whipple’s disease or Sarcoidosis. However, the analysis that was done after his body was exhumed point out that he could have died from excessive lead poisoning administered by his doctors (Beethoven: biography, 2001). 4. 0 Beethoven Major AccomplishmentsBeethoven’s composition represents several music genres and also contained a v ariety of music combinations. He wrote a total of sixteen string quartets, five string quintet, seven works for piano trio, five string trios and a lot more works containing a variety combinations of wind instruments. In addition, he also wrote nine symphonies and nine concerti and some vocal works with orchestral accompaniment. The first and the second symphonies and the first set of the six string quartets as well as some few other works were written in his early life when his music was greatly influenced by Mozart and Haydn (Kinderman, 1997, p.284). Most of the major works of Beethoven that identified him as a hero was written when he started experiencing hearing problem. Such works include the six symphonies, the very last piano concertos, five string quartets, Fidelio which was his only opera and some piano and violin sonatas. In his last stages of life, he began composing works that displayed high personal expression, formal innovation and his intellectual depth. His very last works include the last five quartets, ninth symphony and the last five piano sonatas.However, there are some of his works which were still very significant and may not have been recorded or published. 5. 0 Conclusion Whereas studies indicate that Beethoven managed to become one of the renowned giants of classical music, some of his character traits did not display a vey strong personality. For instance, his deafness made him to contemplate suicide and was frequently described as an impatient as well as a highly irritable person. He had some close friends who stayed by his side especially during his illness which led to his death.However, most studies indicate that he found it quite hard to get along with people the main reason why he was never legally married. His works remain to be a strong indication of his contribution in music arena. References Beethoven: biography. (2001). Retrieved July 10, 2010, from http://www. lvbeethoven. com/Bio/BiographyLudwig. html Crowest, F. J. ( 200 9). Beethoven: With Illustrations and Portraits. Charleston: BiblioBazaar, LLC. Davies, P. J. ( 2001). Beethoven in person: his deafness, illnesses, and death.West Port: Greenwood Press. Kinderman, W. (1997). Beethoven's Childhood . Berkeley: University of California Press. Lane, W. (2005). Beethoven's Childhood . Retrieved July 10, 2010, from http://www. lucare. com/immortal/childhood. html Ludwig van Beethoven (1770 – 1827). (n. d. ). Retrieved July 10, 2010, from http://library. thinkquest. org/22673/beethoven. html Udvarhelyi, G. B. ( 2003). Beethoven in Person: His Deafness, Illnesses, and Death (review). Bulletin of the History of Medicine , 77 (1), 196-197.

Nudibranch Facts

Nudibranch Facts Enchanting to both divers and scientists, colorful nudibranchs (pronounced nooda-bronk and including Nudibranchia, suborders Aeolidida and Doridacea) inhabit the sea floors of oceans all over the world. The unattractively named sea slug comes in a fantastic array of shapes and neon-bright colors that they themselves cannot see. Fast Facts: Nudibranchs (Sea Slugs) Scientific Name: Nudibranchia, suborders Aeolidida and DoridaceaCommon Name: Sea slugBasic Animal Group: InvertebrateSize: Microscopic to 1.5 feet longWeight: Up to just over 3 poundsLifespan: A few weeks to a year  Diet:  CarnivoreHabitat: On seafloors all over the world, between 30 and 6,500 feet below the water surfacePopulation: UnknownConservation Status: Not Evaluated Description Nudibranchs are mollusks in the class Gastropoda, which includes snails, slugs, limpets, and sea hairs. Many gastropods have a shell. Nudibranchs have a shell in their larval stage, but it disappears in the adult form. Gastropods also have a foot and all young gastropods undergo a process called ​​torsion in their larval stage. In this process, the entire top of their body twists 180 degrees on their foot. This results in the placement of the gills and anus above the head, and adults that are asymmetrical in form. The word nudibranch comes from the Latin word nudus (naked) and Greek brankhia (gills), in reference to the gills or gill-like appendages which protrude from the backs of many nudibranchs. They also may have tentacles on their heads that help them smell, taste, and get around. A pair of tentacles called rhinophores on the nudibranchs head have scent receptors that allow the nudibranch to smell its food or other nudibranchs. Because the rhinophores stick out and can be a target for hungry fish, most nudibranchs have the ability to withdraw the rhinophores and hide them in a pocket in their skin if the nudibranch senses danger. Amin Benhameurlaine  / Getty Images Species There are over 3,000 species of nudibranchs, and new species are still being discovered. They range in size from microscopic to over a foot and a half long  and can weigh up to just over 3 pounds. If youve seen one nudibranch, you havent seen them all. They come in an astonishingly wide variety of colors and shapes- many have brightly colored stripes or spots and flamboyant appendages on their head and back. Some species are transparent and/or bio-luminescent, like the Phylliroe. Nudibranchs thrive in an enormous variety of underwater environments, from shallow, temperate, and tropic reefs to Antarctica and even hydrothermal vents. cbpix/Getty Images Suborders Two main suborders of nudibranchs are dorid nudibranchs (Doridacea) and aeolid nudibranchs (Aeolidida). Dorid nudibranchs, like the Limacia cockerelli, breathe through gills that are on their posterior (back) end. Aeolid nudibranchs have cerata  or finger-like appendages that cover their back. The cerata can be a variety of shapes- thread-like, club-shaped, clustered, or branched. They have multiple functions, including breathing, digestion, and defense. Habitat and Distribution Nudibranchs are found in all the worlds oceans, from cold water to warm water. You might find nudibranchs in your local tide pool, while snorkeling or diving on a tropical coral reef, or even in some of the coldest parts of the ocean or in thermal vents. They live on or near the sea floor and have been identified at depths between 30 and 6,500 feet below the ocean surface. Diet Most Nudibranchs eat using a radula, a toothed structure that they use to scrape off prey from the rocks they cling to; some suck out the prey after predigesting its tissue with selected enzymes, rather like a wasp. They are carnivorous, so that prey includes sponges, coral, anemones, hydroids, barnacles, fish eggs, sea slugs, and other nudibranchs. Nudibranchs are picky eaters- individual species or families of nudibranchs may eat only one kind of prey. Nudibranchs get their bright colors from the food they eat. These colors may be used for camouflage or to warn predators of the poison that lies within. The Spanish shawl nudibranch (Flabellina iodinea) feeds on a species of hydroid called Eudendrium ramosum, which possesses a pigment called astaxanthin that gives the nudibranch its brilliant purple, orange, and red coloration. Some nudibranchs, like the Blue Dragon, create their own food by eating coral with algae. The nudibranch absorbs the algaes chloroplasts (zooxanthellae) into the cerata, which acquire nutrients by photosynthesis using the sun to sustain the nudibranch for months. Others have evolved other ways of farming zooxanthellae, housing them in their digestive gland. Behavior The sea slugs can see light and dark, but not their own brilliant coloration, so the colors are not intended to attract mates. With their limited vision, their sense of the world is obtained through their rhinophores (on top of the head) and oral tentacles (near the mouth). Not all nudibranchs are colorful; some use defensive camouflage to match the vegetation and hide, some can change their colors to fit, some hide their bright colors only to bring them out to warn off predators. Nudibranchs move on a flat, broad muscle called a foot, which leaves a slimy trail. While most are found on the ocean floor, some can swim short distances in the water column by flexing their muscles. Some even swim upside down. Aeolid nudibranchs can use their cerata for defense. Some of their prey such as Portuguese man-of-wars have a specialized cell in their tentacles called nematocysts that contain a barbed or venomous coiled thread. Nudibranchs eat the nematocysts and store them in the nudibranchs cerata where they can be used late to sting predators. Dorid nudibranchs make their own toxins or absorb toxins them from their food and release those into the water when needed. Despite the unsavory or toxic taste they can present to their non-human predators, most nudibranchs are harmless to humans, except those like Glaucus atlanticus which consumes nematocytes and so may consider you a predator and sting. Reproduction and Offspring Nudibranchs are hermaphrodites, meaning that they have reproductive organs of both sexes. Because they cant move too far, too fast and are solitary in nature, its important for them to be able to reproduce if the situation presents itself. Having both sexes means that they can mate with any adult that happens to pass by. Nudibranchs lay masses of spiral-shaped or coiled eggs, which are for the most part left on their own. The eggs hatch into free-swimming larvae which eventually settle onto the ocean bottom as adults. Only one species of nudibranch, the Pteraeolidia ianthina, exhibits parental care by guarding the newly-laid egg masses. Nudibranchs and Humans Scientists study nudibranchs because of their complex chemical makeup and adaptations. They have rare or novel chemical compounds which possess anti-microbial and anti-parasitic traits which may aid in the fight against cancer.   Studies of nudibranch DNA also offer assistance in tracking ocean conditions relative to climate change. Threats These beautiful animals dont live very long; some live up to a year, but some only for a few weeks. The global population of nudibranchs is currently unassessed- researchers are still discovering new ones each year- but field observations such as that conducted by Endangered Species International suggest that many species are becoming rare, due to water pollution, degradation, habitat loss, and biodiversity decline associated with global warming.   Sources Bertsch, Hans. Nudibranchs: Sea Slugs With Verve. The Slug Site, 2004.Cheney, Karen L. and Nerida G. Wilson. Quick Guide: Nudibranchs. Current Biology Magazine 28.R4–R5, January 8, 2018.Epstein, Hannah E, et al. Reading between the Lines: Revealing Cryptic Species Diversity and Colour Patterns in Hypselodoris Nudibranchs (Mollusca: Heterobranchia: Chromodorididae).  Zoological Journal of the Linnean Society.zly048 (2018).King, Rachael. Is It a Worm? A Snail? No...Its a Nudibranch!. Southeast Regional Taxonomic Center, Marine Resources Research Institute, South Carolina Department of Natural Resources.Knowlton, Nancy. Citizens of the Sea: Wondrous Creatures From the Census of Marine Life. Washington, DC: National Geographic Society, 2010.Lewis, Ricki. Celebrating National Sea Slug Day. PLOS Blogs: Diverse Perspectives on Science and Medicine, November 1, 2018.Nudibranchs and other sea slugs. New Heaven Reef Conservation Program, 2016.

Music Lyrics being Nonviolent essays

Music Lyrics being Nonviolent essays Rap music can be considered a style of art, and a way for the artists to express feelings through their words on paper. However, there are quite a few rap artists that get criticized for their lyrics. In my essay, I want to discuss why rappers use certain lyrics in their music and why people shouldnt believe that it causes violence among the younger generations. People shouldnt censor the music just because of violent, vulgar and abusive messages it promotes to the world. I believe in my own mind, that there is a reason for these types of lyrics that rap artists use and I will simply explain those reasons Rap has been called one of the most important music forces to emerge in two decades. Its pounding beats and staccato rhymes exploded on the streets of the urban America in the early 1980s and since have become the theme music and lyrical heart of the vibrant youth culture called hip-hop ( SIRS 1993). There are many different types of rap artist. There are some that talk about money, some talk about righteousness, and the list goes on and on. Every rap artist had their own way of expressing themselves. There are those that talk about sex, drugs, and violence who receive the negative attention( SIRS 1993). People, think this so- called gangster rap is a bad influence on children in the world and that it promotes violence and that it also is abusive to women. Delores Tucker, head of national congress of black women has been among those pressuring different record companies to stop distributing gangster rap music. There were other significant names that participated in this action. Names like Senate Majority leader Bob dole, and former education Secretary William J. There are some rap artists that have been openly criticized for their lyrics. Rappers like Lil Kim, Too Short, Snoop Doggy Dogg, and a member from Too Live Crew, named Luke Skywalker. These rap arti...

American Studies Movie Review Example | Topics and Well Written Essays - 500 words

American Studies - Movie Review Example The title of the film, as well as the term used to describe its characters, is disturbing, although it is the term that circus performers have traditionally used to refer to themselves. There is much about the film that is disturbing, and not just because it is a horror film. Joan Hawkins (1996), in her discussion of the film, treats the two most obvious identify features, disability and gender. Because identity is more complicated than that, however, I would include race, although I agree with Hawkins’ interpretations. As Douglas C. Baynton (2001) has rightly points out, â€Å"Disability has functioned historically to justify inequality for disabled people themselves, but it has also been done so for women and minority groups† (33). I would say that the characters in â€Å"Freaks† consider themselves a race of people, the membership of which depends upon their status as people with disabilities. When the freaks decide to accept the trapeze artist Cleopatra into their community, even though she is â€Å"normal,† they perform an elaborate, religious-like ceremony to commemorate it.

Exam questions Essay Example | Topics and Well Written Essays - 5000 words - 1

Exam questions - Essay Example The Discounted Cash Flow ("DCF") technique is the most commonly used valuation method that accounts for the "going-concern" value of the Company. The cash flow projections are derived from (a) assumed revenue generation on product sales, less (b) operating costs and debt repayment on capital investments (not including interest payments), plus (c) an estimate of the Company's residual value at the end of the 3 to 5 year period. These projections are then discounted back to the present by the risk-adjusted, weighted-average cost of capital. This cost of capital accounts for interest payments and/or equity returns expected by investors in the Company over the projection period. Venture Capital Valuation Techniques Sophisticated investors such as VCs, institutional investors and corporate investors generally begin the valuation analysis by examining management's cash flow projections to test the underlying assumptions and business model. Once the investor has developed a certain comfort level in the projections, a variety of techniques are used to determine the percentage ownership the investor will require. Each of these methods start with the management's projections under the DCF technique, but ignore management's application of its assumed discount rate to the present in order to value the Company. Instead, the VC investor imposes its own ROI, as indicated in each of the methods described below - to meet its own investment parameters irrespective of management's analysis of the cost of capital. By applying its own ROI, the investor can then determine the percentage ownership it will require to reach this ROI assuming a certain market valuation for the Company. Where these VC valuation methods differ from the DCF method is in (a) the difference...Once the investor has developed a certain comfort level in the projections, a variety of techniques are used to determine the percentage ownership the investor will require. Each of these methods start with the management's projections under the DCF technique, but ignore management's application of its assumed discount rate to the present in order to value the Company. Instead, the VC investor imposes its own ROI, as indicated in each of the methods described below - to meet its own investment parameters irrespective of management's analysis of the cost of capital. By applying its own ROI, the investor can then determine the percentage ownership it will require to reach this ROI assuming a certain market valuation for the Company. Where these VC valuation methods differ from the DCF method is in (a) the difference in the discount rate, or ROI applied by the Company and by the investor, and (b) the use all VC methods employ of P/E ratios to determine market valuation of the Company at the end of the projection period (equivalent to the methods used under the DCF technique

Reflective paper Essay Example | Topics and Well Written Essays - 1000 words

Reflective paper - Essay Example Similarly, developments in the fields of Humanist theories, Learning theories, Cognitive theories, and behavioral theories have also opened new horizons of knowledge for the psychologists in dealing with their clients. This paper reflects on the major human development theories and analyses how far they have contributed in identifying and resolving the mental, Psychological, behavioral and physical problems of clients. To begin with, one can never undermine the contributions made by the Psycho Analytic theorists in understanding human development and problems associated with the developmental stages of clients. G. Stanley Hall, who tried to make a detailed study on Darwin’s evolutionary theory attempting to correlate childhood with previous ages of mankind, made his greatest achievement in his child centered research. His seminal book The contents of children’s minds, published in 1883, tried to resolve the history and the means of progress of mankind by the findings of what children know and when they learn it. Hall also accepted Sigmund Freud’s sexuality theory and believed that the sexualized energies of boys have to be promoted, channeled and managed. He is known as ‘the father of adolescence.’ Though his work has been considered outdated his ideas are still applicable in education, scouting and team sports. (G. Stanley Hall (1844-1924)). Similarly, psychologi sts draw conclusions from Hall’s theories have which facilitated in identifying adolescent problems and in treating them. Hall’s theories are widely applied in the field of special education and they have proved to be highly beneficial in offering â€Å"individualized services for adolescents in grades 6-12 who have experienced depression, withdrawal, low self-esteem, socialization problems, learning disabilities, post traumatic stress disorder, or self-injurious behaviors† (G. Stanley Hall School). The term psycho analytic theory is originated with study of the great psychologist

The Blind Side Essay Example for Free

The Blind Side Essay ‘Our surroundings can be both threatening and comforting. Discuss in relation to the behaviour of Michael Oher in the film.’ Some settings we encounter in our lives are both familiar and dangerous to us. John Lee Hancock shows this particularly well through the character of Michael Oher in ‘The Blind Side’. Settings such as the Touhy house, the Christian school and the suburb of Hurt Village, where Michael’s mother lives, serve as examples of these contradictory places. Briarcrest Christian School is a place where Michael originally feels threatened, but becomes a place of comfort for him as the movie progresses. When he first moves to the school, Michael does not know anyone, and is daunted by the lack of diversity in the students. He does not seem to understand the work, or wish to do it, and his teachers do not try to help him. This is evident in his poem ‘White Walls’, which is found in the rubbish by one of his teachers. In his writing Michael outlines that â€Å"[he looks] and [he sees] white everywhere, white walls, white floors, and a lot of white people.† Here Hancock refers to Michael’s race and how lonely he feels at the school. Michael also says that he ‘[has] no idea of anything [the teachers] are talking about’ and that they ‘[expect him] to do the problems on [his] own’, implying that he is not confident with working independently. The scene where the teachers hear his poem is when things start to change. They realise that Michael needs help, and start to provide him with it; letting him take tests orally and giving him extra support. The teachers discover that ‘Michael Oher is not stupid’ and his grades start improving. This implies that he does want to learn, and is becoming more acclimatised to the work and school. Through his friendship with SJ, he becomes more socially accepted and school is no longer so lonely for him. As the film progresses, Michael grows to be comfortable at the school, and with his grade improvement, feels like he belongs with his peers. Another place Michael finds both comforting and threatening is the suburb where he grew up. He lived there with his mother during his early childhood, and yet ironically it is one of the places where Michael is most likely to be hurt. He feels a sense of duty to his mother, and returns to her despite.

Strategies to Develop Patient Centred Care

Strategies to Develop Patient Centred Care Sneha Praveen MIS Practicum Final Report Analysis of online patient reviews and its effect on healthcare providers Introduction With the advent of social media, online forums have become a major platform where users share their views and these platforms affect all the involved stakeholders sometimes positively and sometimes adversely. Word of mouth has become an important tool for publicity and sometimes a bad review posted without ulterior motives can do much damage. Most of such reviews and posts that we read on platforms like twitter, Facebook and online forums affect our decision making as we tend to trust judgment of others. But healthcare as an industry is still not very patient centric and not enough importance is given to patient’s opinion. This case is even more valid in the context of USA as there is no official channel for patients to leave their reviews and experience about a healthcare provider. This is very surprising as all other industries food, retail, and consumer industries revolve around what customers have to say and millions of dollars are spend on â€Å"customer satisfaction†, whereas, healthcare industry still relies on their processes without bothering to collect feedback from patients they serve. The main reason accredited to this could be that as payers, insurance companies and as service providers, physicians play the most important role. Patients in this context are mere subjects of treatment who are assumed to be not very vigilant of their own health condition. But is this situation same all around the world? And if not, then US healthcare needs to adapt and learn from such countries to improve its care and service quality. One such online forum implemented in the United Kingdom is â€Å"Patient Opinion†. This forum acts as a bridge between patients and healthcare providers to help improve the healthcare quality provided by National Health Service (NHS) to its citizens. In this paper, I will analyze data collected from patient opinion forum and present by findings answering how USA can benefit from a review outlet like Patient Opinion and how this forum has helped NHS to improve their quality and service. Why Patient-Centric Care: It is well proven that any industry benefits from customer reviews and helps in reducing cost and improve service. Slowly, healthcare needs to move towards Patient-centered care which supports active involvement of patients and care givers. It means being responsive to patient’s preferences, needs and feedback to ensure that service quality improves and slowly there is more involvement of patient in healthcare delivery and design. [1] A patient centered care has below attributes [2]: Whole-person care. Coordination and communication Patient support and empowerment Ready access Autonomy A patient centered care focus on guiding patients by giving them information about options and risks. It means considering patient’s preferences and background and valuing their feedback. According to 2001 Institute of Medicine a focus on patient centered care is one of the factors constituting high quality health care. Source: http://hcca-act.blogspot.com/2011_11_01_archive.html The current system is physician centered which means that effective care is defined by physician’s standards and skills instead of centering on patient’s satisfaction from the service rendered. For example- orthopedic surgeons use the Harris Hip score to judge the success of a hip replacement. This was designed solely by physicians and does not include any feedback from patients to include their satisfaction from the procedure [3]. Thus, it is impossible to correctly define the output of any model in healthcare until the patient experience has been taken into account for. What Patients Want Most tools that we use to judge patient satisfaction or outcome of a medical service cannot be accurately quantified. Also, the success metric for a medical care varies from physician and patient’s point of view. An example of such tools was administered by Steward.et al in 2000 where many physician-patient interactions were audio taped and patients rated these conversations. After analysis, it was deduced that patients recovered faster, had better emotional health and perceived the care as satisfactory if the care was patient-centered. The faith of patients on their healthcare providers increased when there emotional needs were taken care of by the physicians leading to less number of diagnostic tests and fewer referrals. A similar methodology can also be used to study physician empathy. Researchers at Jefferson University developed the Jefferson scale to test physician’s empathy where physicians rated their own empathy but this scale could not be used to judge patient satisfaction. Thus, a new scale called Jefferson Scale of Patient’s perception of Physician Empathy was used which judges patient’s rating of physician’s empathy which correlated to patient’s satisfaction. Mostly what patients want is a relationship of empathy with physicians, who can help them communicate with the problem and develop a personal relationship with them. The perception of care is different from physicians and patient’s point of view and we need to move our focus from â€Å"what’s the matter† with our patients to â€Å"what matters† to our patients. [1] Hindrance in achieving true patient centric care One of the most crucial factors stopping US in achieving true patient centric care is the current reimbursement system and focus on physician practice model. There is no measure in US to gauge the quality of care, empathy and relationship of a physician with patients. Reimbursement is not correlated to these factors, instead it is based on per patient encounter. Due to this, primary care physicians focus on increasing the volume of patients and reduce the time spent with each patient. Most physicians are in a hurry and under stress which leads to misdiagnosis, useless tests and referrals, decrease in quality of care and a very formal relationship between physician and patients. [6] Next important factor is that physicians employed by hospitals are incentivized or prized depending on number of patients that they bring but there is no measure to the quality of care they impart. The volume of patients precede quality because the financial benefits are huge e.g.- Each lab tests physicians’ order, each referrals they make, benefits hospitals in terms of huge monetary benefits which in turn becomes a basis of primary care physician’s salaries. Thus, understandably what drives physicians is to employ methods to increase volume of patients, decrease time spent with each patient and other ways to monetize each patient-physician interaction. [3] The third hindrance is hospitals hiring generalists called hospitalists to provide care to patients with the goal of reducing patient days per admission. This might lead to improve in care for a certain amount of time but the reason behind hiring such individuals is not to improve patient care but instead to benefit hospitals financially. The Patient Centric Approach model Patient Centered Medical Home Patient Centric medical home helps address the patient centric approach by emphasizing on high quality patient care and lower the healthcare cost. They reorganize primary care practice by recognizing the importance of patient’s experience and works on system based approach to transform health services being offered. PCMH centers their service on elderly with acute care needs, patients with physical disabilities and with specific preferences in terms of culture and values. The care offered is comprehensive and designed to meet patients’ needs including physical and mental attention, chronic care and long term assistance like help in performing daily ablutions for patients with functional limitations. [8] Accountable Care Organizations ACOs have been set up with the goal of ensuring high quality of care is given to patients at the right time to prevent medical errors and reduce medical costs. Mostly ACOs are formed by group of doctors and hospitals who voluntarily come together to serve Medicare patients. [9] The basic promise that ACOs hold is to have patient centered care and treat patients with empathy, care and work towards avoiding unnecessary costs and develop a personal relationship with patients. Thus, government should incentivize formation of more ACOs to ensure more patient- centric approach. Strategic IT investment IT is the obvious answer to increase efficiency, reduce medical errors and improve quality of care in US. Though there are many facets of IT that can be used, use of Electronic Health Records (EHR) and Electronic Medical records (EMR) are the most important tools to use. EMRs are digitized version of patient record keeping for a physicians. EMR has been instrumental in reducing medical costs overtime by enabling better interactions between departments and monitoring patient’s visiting time and medical information. Patients can also log on and know about their health records and be better prepared. EHRs stores patient’s records so that if needed emergency departments can access it before giving them any medicines. This saves the cost of duplicate tests because all the data needed to prescribe medicines are present in EHRs. Feedback and review model: Patient Opinion Patient opinion was founded in 2005 and is the leading feedback platform for healthcare in UK. They allow patients to write their reviews/ stories about their experience and tag the particular provider. Other users can then favorite the post if they have experience the same thing. Patient Opinion also has an analytical engine which does sentiment analysis for each hospital and show what areas need improvement and which departments received positive reviews. The hospitals can read these reviews posted about them and respond to the complaints and praises. This helps them to improve their quality of care and address the issues raised by patients. Patient Opinion is a social enterprise and a NGO which is independent of NHS but share the same values. It is funded through user subscriptions, healthcare providers and healthcare Commission. Providers subscribing to Patient Opinion get the access to all patient feeds and can respond to the reviews. Though, use of patient opinion by patients is free. Patient Opinion is available across England but not (yet) the rest of the UK. It covers all acute trusts. As of today, 600 hospitals are registered with patient opinion and working together to improve the healthcare quality in UK. [5] How Patient Opinion fits the review model: It allows patients to give feedback on their health services and to see what others are talking about. It also acts as a platform to hear and respond to reviews and complaints posted by patients. They can compare their ratings with other hospitals and find out which of their departments are doing good and bad. All the opinions are reviewed before publication and editorial policies are public. The critical reviews are marked and directed to the healthcare providers while maintaining patient identity. Below are some feedback posted by patients for â€Å"King’s Mill Hospital† over a period of 2 weeks: Taking â€Å"King’s Mill Hospital† as our example for this study, let us look at some figures which help us better understand the Patient Opinion model: *Data collected is for the month of April: Analysis: Analysis: As of now, for the entire Patient Opinion database, feedback opinion so far is around 50% positive, 30% mixed and around 20% critical. Below is data of number of posts till date: In the last month, of all the posts, 53% had a response from hospital staff and 6% of responses actually lead to change. The numbers do look small but in the larger picture, it is an incremental change which slowly is changing the face of UK healthcare. Conclusion: Patient centric healthcare is the answer to the problems of rising cost and low quality of healthcare in USA. A patient centered communication gives more satisfaction to patients and increase their faith on the physician and treatment. Emotional health is better when patients feel that they have a personal equation with their physicians and their preferences, culture and values are being considered while treatment. It is very important to increase emphasis on physician’s empathy towards patients and introduce feedback model to increase efficiency of hospitals. Patient Opinion is bringing change into the healthcare scenario of UK by making patient reviews an important tool of decision making. Hospitals are responding to these reviews, trying to make amends and improve the quality of care. Currently, healthcare of USA is financially driven and patients are not treated as a valued customer. In future, if we want the healthcare cost to go down and expect better service, it is very important to bring the focus on patients and build the system around them. References: [1] Jo Anne L. Earp, Elizabeth A. French, Melissa B. Gilkey: Patient Advocacy for Health Care Quality [2] Bechtel, Christine.If You Build it, Will They Come? Designing Truly Patient-Centered Health Care.Health Affairs [3] http://healthaffairs.org/blog/2012/01/24/patient-centered-care-what-it-means-and-how-to-get-there/ [4] Moira Stewart, Judith Belle Brown, Allan Donner, Ian R. McWhinney, Julian Oates, Wayne W. Weston, John Jordan, The Impact of Patient-Centered Care on Outcomes [5] https://www.patientopinion.org.uk/info/about [6] Improving Patient Opinion Mining through Multi-step Classification, Lei Xia, Anna Lisa Gentile, James Munro, Josà © Iria [7] http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx [8] Ensuring That Patient-Centered Medical Homes Effectively Serve Patients With Complex Health Needs, AHRQ [9] http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/ [10] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC64755/