Polite Society Gone with the Wind in A Good Man is Hard to Find :: A Good Man is Hard to Find

Polite Society Gone with the Wind in A Good Man is Hard to Find A Good Man is Hard to Find is consistent with Mary Flannery O'Connor's view that contemporary society was drastically changing for the worse. O'Connor's obvious displeasure with society at the time has often been attributed to her Catholic religion, her studies in the social science field, and the fact that the celebrated lifestyles of the elite southern whites were "Gone with the Wind." Evidence of society's "demise" is woven into the story, and presented through an interesting generation gap. The grandmother is representative of godliness and Christianity which O'Connor apparently believed to be more prevalent in the "glamorous" Old South: The old woman settled herself comfortably, removing her white cotton gloves and putting them up with her purse on the shelf in front of the back window. The children's mother still had on slacks and still had her head tied up in a green kerchief but the grandmother had on a navy blue straw sailor hat with a bunch of white violets on the brim and a navy blue dress with a small white dot in the print. Her collar and cuffs were white organdy trimmed with lace, and at her neckline she had pinned a purple spray of cloth violets containing a sachet. In case of an accident, anyone seeing her dead on the highway would know at once she was a lady. (2148) The parents pay little attention to the grandmother and when they do, they are often quite rude. The unruly children are representative of the breakdown of respect, and discipline, and are consequently a forecast of future generations. The Misfit represents evil. At one point the Misfit likens himself to Christ, in that they both were punished for crimes they did not commit. Christ accepted death for the sins of all people, however, and not only did the Misfit not do that, but he also killed other innocent people. Near the end of the ordeal, the grandmother recognizes the shirt the Misfit has put on as her son's shirt.

Total Hospital Information System Hospital Selayng

1. 0 Hospital Information System (HIS) – Overview 1. 1 Definition Hospital Information System (HIS) is an integrated information system which spans through the organization crafted to manage clinical, administrative, financial and operational functions of a hospital. HIS strives to achieve the most effective support for patient care and administration through various different electronic data processing and analyzing tools (Ismail, et al. , 2010). HIS serves as a platform to provide the required information to each level of the management at the correct time, in the correct form, and in the correct place, contributing towards improved decision making. HIS plays a pivitol role in planning, initiating, organizing and controlling the operations of the subsystems of the hospital and thus equips an organization with synergy and integrity required for it to function. More importantly, HIS also enhances patient care and comfort by offering personalized suggestions for care and enables a hospital to move from retrospective to a concurrent review quality (Ismail, et al. 2010). 1. 2 Global Trend in Hospital Information System (HIS) In early 2009, the market value of Hospital Information Systems (HIS) market was $7. 8 billion worldwide and this figure has been predicted to leap to an alarming $18 billion by 2016. The boom is primarily driven by governments’ dynamic motives and hospitals continually trying to increase workflow effi ciency Hence, hospitals are confident that embracing HIS will result in increased efficiency and reduced medical errors, which later translates into uplifting the quality of care provided to patients (Global Data, 2010). Growing evidence has demonstrated that the current systems fail to deliver adequately safe, high standard, efficient and economical healthcare. This can be curbed through computerization, with electronic medical record (EMR) as the fundamental component. This has resulted in clinicians and healthcare organizations around the globe scrutinizing into adopting more EMR technologies in their respective hospitals. France, UK, US, Canada, Finland, Denmark, Australia, New Zealand and several other countries have proposed plans to construct a fully intergrated computer-based hospital infrastructures with the electronic medical record systems laying the cement work. In the Asia-Pacific region alone, umpteen successful HIS implementations have taken place in various hospitals such as in Japan, South Korea, Singapore and Malaysia (Global Data, 2010). 1. 3 The Malaysian Outlook The federal government had adopted a national-level strategy to create a paradigm shift in the nation’s healthcare system. The Federal Government aims to revamp the healthcare system so as to produce a county of healthy individuals and communities through the adoption of information technology (IT). Major projects which has been undertaken include Multimedia Super Corridor Telehealth Project and MSC Telehealth Blueprint (1997) (Malaysianmedicine, 2004). Dr. H. M. Goh, secretary of both Malaysian Health Informatics Association and Asia-Pacific Association for Medical Informatics mentioned that it is impossible to provide good, safe and efficient healthcare ignoring IT, thus the the cost of healthcare would rise. He also stated that without computerisation, we won’t be able to retrieve timely information. ( Malaysianmedicine, 2004). Following this, Malaysia has witnessed several significant developments in the health care sector. One such eminent development is the establishment of total hospital information systems in Selayang Hospital (Malaysianmedicine, 2004). 2. Overview of organization – Selayang Hospital 2. 1 Brief History Located along the Kepong Selayang road of Gombak District, Selayang Hospital is a 960-bedded hospital which has been in operation since 1996. Selayang Hospital (SH) is the pioneer in being the paperless and filmless hospital in Malaysia. Though classified as a government hospital, it has sophistication of a luxury private medical center with a leading-edge on technology. The need for this ultra-modern hospital came about as Hospital Kuala Lumpur (KLH) was already bursting to its limits with its overworked staffs. Organized and accurate documentation and archiving was impossible with mislaid or missing patients' records. This had resulted on KLH being entangled in legal matters. Increasing number of patients expressed their displeasure and quality of patient care was deteriorating. These circumstances surged MOH to come up with SH project with proper incorporation of HIS (Yook, 1999) 2. 2 Clinical services at Selayang Hospital Among the services offered at Selayang Hospital are Gastroenterology, Hepatobiliary, Cardiology, Nephrology, Urology, Hand and Micro and Surgery. All the rest are categorised under secondary services, outpatient services and supportive services. The core business of Selayang hospital is providing a exclusive tertiary referral services to patients across Malaysia and a broader range of clinical services to customers who rely on Selayang Hospital as their regional or local hospitals. High quality specialist services in a large number of other fields is also a highlighted aspect of this hospital (Yook, 1999). 2. 3 Vision The Selayang Hospital project was designed by the Ministry of Health (MOH) in accordance with the Malaysia’s Vision of 2020, where the country would become a developed the country's Vision for Health was formulated proposed a national health policy. Besides, it was particularly mentioned in the Seventh Malaysian that there will thirty three paperless public hospitals launched in Malaysia. More specifically, eight of these hospitals will be using Total Hospital Information System (T. H. I. S), Selayang Hospital being one of them (Yook, 1999). 2. 4 Mission The mission of Selayang Hospital is to be a role model for Malaysian hospital, in using innovative, dynamic and cost effective technology and delivering a friendly, caring, compassionate and humanistic service. This wiIl be achieved through teamwork in partnership with the community to provide quality care to the satisfaction of our customers (Yook, 1999). 2. 5 Organizational Structure Patients at Selayang Hospital are of top priority so the structure is designed to maximize patients/customers' satisfaction with emphasis on staff efficiency. The Board of Directors (BOD) with the assistance of Total Hospital Information System and a Medical Advisory Board committee oversees the hospital overall operation. There are five distinct divisions in the hospital administration. The total medical and non-medical staffs amounts to 1090 people. The BOD is accountable to the State Health Directors (Image could not be retrieved) (Yook, 1999). 3. 0 Total Hospital Information System (THIS) in Selayang Hospital Selayang Hospital, the pioneer paperless and filmless hospital in Malaysia, uses Total Hospital Information System (THIS) for its fundamental operation. THIS combines aspects of clinical, administrative and financial management, enabling continual data flow between separate areas (Ismail, et al. , 2010). THIS would aid in meeting the objective of enhancing productivity, effectiveness, efficiency, quality and safety. THIS facilitates communication between care providers through sharing of information, enables automation of work processes, integration and interfacing with other components of HIS in addition to providing clinical decision support and maintaining a permanent record as a medico-legal requirement (Abdollah, 2011). For the incorporation and functionality of THIS, Selayang Hospital had opted to vendor solutions like Cerner for electronic medical record, Seimens for radiology department, Spacelabs for critical care unit, Oracle for materials management, finance and administration and Microsoft Office for internet and intranet usage (Li, 2010). Figure 1 depicts the system architecture as well as the technology partners that associate to Selayang Hospital (Abdollah, 2011). Figure 1 : Information Technology System Support and Technology Partners in Selayang Hospital (Abdollah, 2011). Figure 2 illustrates the structure of THIS in Hospital Selayang. Selayang Hospital incorporates clinical, administrative as well as financial processes as their total hospital information system within their hospital operations. There are various information system being deployed to cater specific needs and wants of patients and care providers as described in the following sections (Abdollah, 2011). Figure 2: Structure of Total Hospital Information System in Hospital Selayang (Abdollah, 2011) 3. 1 Types of Hospital Information System 3. 1. 1 Electronic Medical Record (EMR) Clinical Information System (CIS) is thought of as the system that mediates direct patient care. Within it, also lies the mechanical framework for capturing, storing and displaying the data generated by all clinical care activities. A defined portion of patient-specific collected from disparate sources by care-providers working in the various clinical services is put together as the Electronic Medical Record (EMR). EMR essentially provides for the recording of the following groups of data: a. profile of the patient b. information gathered regarding the patient’s illness, allergies and health status c. ctivities performed on the patient d. events that occurred (planned and unplanned) e. results or findings emanating from these activities and events (numeric, text or images) f. communications between care providers i. e. instructions, opinions, referrals and advice g. decisions and plans both immediate and long term (diagnosis, treatment plan) This consolidation is essential for the availabililty of future data for tracking puposes which in turn governs clinical management and patient data mining, in addition to report generating (Abdollah, 2011). EMR largely benefits government and health care providers. The need and requirement to document is both professional and legal as documentation enables care providers to communicate with each other thus facilitating continuity of patient care. Thus, in the form of the EMR, documentation satisfies the legal requirement of maintaining a record of events. It is accessible from multiple access points and units within the hospital and selective access outside the hospital. This largely reduces the time taken to retrieve medical records. Hence, the time taken to retrieve patient records are reduced. This would pave the way for increased productivity and quality of care. In the mean time, it would contribute towards better knowledge in clinical practices. Besides that, administrative benefits include easier report generation, better organization of clinical information, enhanced claiming and ordering processes, reduced billing timings which translates into providing better service to patients. Futhermore, THIS improved clinical decision making and disease management, patient education in addition to better documentation, increased time allocated per patient, and rejuvenated perception of care and quality of a healthcare institute. The incorporation of DSS into drug management, result generation and disease management are essential in good clinical practise. On the other hand, for researchers and policy makers can utilize EMR to device long term strategies for towards development country’s health care and proper allocation of resources (Haslina and Sharifah 2005). The workflow process such as the improvement of data inputting by avoiding duplications of data’s, reduction is transcriptions costs as well as improved communication is also benefited by Selayang Hospital due to the successful implementation of EMR (Erstad, 2003). Hence, in a nutshell, implementation of EMR such as improved decision making, disease management enhanced records and has made it possible to eliminate the use of papers for medical records. As a result, medical records become more trustworthy and easily comprehendable. Figure 3 : Electronic Medical record system . Source : http://level8systems. com/page. php? 3 3. 1. 2 Patient Management System (PMS) This system encompasses Patient Registration, Client-Resource Management and Charging, Billing and Payment system. For example, during patient registration, a identification number unique to that particular person is issued. This would act as the Medical Record (index) Number (MRN). It allows data regarding a single patient to be kept in a single record, shared between systems and used for subsequent visits and encounters without the need for repeated data acquisition and entry of static data. Staff job assignment is be part of the Client Resource Management System. It should enable all categories of staff to be allocated to work areas, rooms, wards, cubicles, beds, machines etc. according to dates and work shifts. Care providers need to sign in to confirm that they are available. The system should allow for constant updating of staff assignment. The Patient Tracking facility through PMS would also provide real-time status display and reports on attendances, location of patients, status of service provision and discharges Next, The Charging-Billing System would be able to calculate charges based on factors according to policies set by the hospital. It would be able to charge differently based on the service delivery such such outpatient service, emergency service and Inpatient service in addition to scrutinization by financial class. Figure 4 illustrates a typical Patient Management System software which stores and updates patient records. Hence, PMS enables patient’s records to be compiled and accessed in an organised manner. Besides that, subsequent processes like patient administration, clinical support tools and generating reports also is made easy. In addition, it also enables quicker diagnosis with proper relevant treatments available (Netripples, n. d. ). Figure 4: Typical Patient Management System. Source http://hpathy. com/software/hompath-classic8. asp 3. 1. Picture Archiving and Communication System (PACS) Pictures Archiving & Communication System (PACS) is majorly used in medical imaging unit. X-ray, echocardiogram, ultrasound machines capture digital images of a patient’s clinical condition. These images are sent to appropriate destinations using this system. It can be imagined as a pipeline network which carries water, which in this case are the images. Every laboratory at Selayang Hos pital is equipped with a high-end resolution computer screen to view these images captured from the machines. This service is provided by Siemens in Selayang Hospital. With the help of PACS, images are viewed on screens rather than the conventional x-ray images which are as bulky as a spreadout newspaper. More importantly, PACS reduces the radiation exposure in both patients and care providers. This leads to a healthier working environment; better image distribution; timeless retrieving of data and images; image quality improvement as well as easier handling of images Dr. Zaharah (n. d. ). Thus it can be understood that PACS is not a stand alone system but a subsidiary support system of Radiology Information System (RIS) described in next section. 3. 1. 4 Radiology Information System (RIS) The Radiology Information System (RIS) is a system, which enables care providers who to capture, store and distribute images by interacting with the machines that produce these images and also the clinicians who request for the images. The Radiology Information System (RIS) is a system, consists of the following major functional areas: 01. Ordering of examination 02. Scheduling of appointments for examination 03. Creation of work lists 04. Tracking of examination and reporting status of cases 05. Image Tracking and Management 06. Clinical Result Reporting, 07. Storage and retrieval of reports To summarise, RIS which belongs to the radiology department, is a huge database which can be used to perform x-ray imaging, echocardiograms, computerized axial tomography (CAT) scans, positive emission tomography scans (PET) and magnetic resonance imaging (MRI) tests when necessary ( Dr Zaharah , n. . ). The RIS creates and schedules the patient order for an image study. The RIS allocates a unique accession number to the order, sends a message to the PACS and the imaging modality to maintain accuracy in patient demographic details (Figure 5). Figure 5: Integration of RIS and PACS in acquiring and processing of images Source:http://www. pukkaj. info/NewsArchive2007/SendingradiotherapyimagestoPACS/tabid/1111/language/en-GB/Default. aspx) In a fully functional THIS system, RIS must be a high degree of integration between with EMR, PACS and PACS. In this sense PACS is a sub-set of RIS. Radiology images are considered as part of each patient`s EMR. Images need to be treated just like other patient data. Images as data are managed by Picture Archiving and Communications System (PACS). RIS is also linked with scheduling system to schedule appointments for patients. Figure 6 shows the schematic representation of functions and relationship between RIS, PACS and EMR (Abdollah, 2011). Figure 6: Schematic representation of functions and relationships between RIS, PACS and EMR (Abdollah, 2011). 3. 1. Pharmacy Information System (PhIS) Pharmacy Information System (PhIS) operates in the pharmacy department for numerous activities which includes clinical screening, inventory management, prescription tracking etc. PhIS are elaborate computer systems that were structured to meet the needs and wants of a pharmacy division to function effectively and efficiently. Pharmacists will be able to overlook how medications are used in a hospital usi ng insights from this system (Biohealthmatics, 2010). Clinical screening is one of the most important usage of PhIS. Drug interactions, allergies and all plausible drug-related disorders can be monitored using the assistance of PhIS. When a prescription is issued, the system checks for all possible interactions between all the drugs prescribed together to a patient at one time or with any particular food, reported allergies to the drug, and even if the sufficient and appropriate dosage has been given based on the individual’s body mass index (BMI), age, and other physiological factors. Instant alerts and warning messages are displayed if adverse drug interaction is detected (Biohealthmatics, 2010). Inventory Management is a another major component of the PhIS. Pharmacists need to know the drugs available, usage pattern and balance of stock. This inventory can be separate from or be a part of the Procurement and Storage Information System of the hospital’s integrated Management Information System. Continuous inventory monitoring is an essential requirement of a pharmacy in order to ensure that drugs never goes out of stock. Besides, multiple dispensing locations and manual inventory keeping is not only tedious but can also lead to inaccuracy in inventory management (Biohealthmatics, 2010). In addition, prescription management for both in patients and outpatients is also a vital segment of PIS. For instance, when the issued prescription arrives to the pharmacy, the orders are checked and matched against available drugs in the pharmacy and then dispensed accordingly to respective patients. More interestingly, prescriptions that passes through the system that can track the physician prescribing the drug, date of prescription, to whom was it prescribed and when was it was dispensed. Automated label printing which bears directions on how medication should be followed is also possible (Biohealthmatics, 2010). Besides, patient drug profiling can also be achieved through PIS. These are patient profiles and holds particulars of their present and previous medications history, known allergies, family history and other parameters. These profiles are also during clinical screening. A physican who prescribes a particular drug to a patient would be able to instantly see the patient’s profile and decide on whether or not this drug is appropriate (Biohealthmatics, 2010). Figure 7 shows a typical pharmacy information system modal provided by Siemens. This includes relevant information such as patient name, name of the drug, route of administration, dosage and frequency of administration. PIS works hand-in-hand with EMR to detect contraindications due to drug allergy, streamlines workflow in addition to assisting billing and charging in administrative and financial system. Figure 7: Pharmacy information system modal by Siemens Source:http://www. medical. siemens. com/siemens/en_US/rg_marcom_FBAs/files/presskits/SiemensMAC. pg 3. 1. 6 Laboratory Information System (LIS) Laboratory Information System (LIS) manages all the laboratory faculties which includes clinical chemistry, parisitology, hematology, immunology and microbiology in terms of receiving orders, performing tests and producing results. It also provides modules for sending laboratory trials order to the appliances through its multiple instrument interfaces so that the results can then be anal ysed instantly and a reports can be generated. Patient management is an important aspect of LIS. Patient particulars such as the date of admission, consulting doctor, and respective reference number would be maintained by this system. Data pertaining to the patient’s samples including the consulting doctor, corresponding department, specimen type, method of collection and the technician-in-charge of the collection can also be monitored (Nationmaster Encylopedia, n. d. ). In summary, LIS is used for processing and storage of information generated by medical laboratories. EMR, PMS as well as order management system are customized in order to allow interferences between LIS which supports in-patient as well as out-patient services. Moreover, the system produces barcode sample labels which are therefore used for acknowledgment of test samples. In Selayang Hospital, there are around 150 barcodes readers that are being widely used daily (Abdollah, 2011). 4. 0 Impact of Total Information System (THIS) 4. 1 Benefits of Total Hospital Information System (THIS) Total Hospital Information System (THIS) is an enterprise-wide system which spans the organisaton, designed to enhance clinical outcomes, operational efficiency and to improve financial management for healthcare industry. THIS serves as a secured and dependable meticulously integrated system that allows hospital officials to record, store and selectively disseminate clinical and other patient related information to appropriate entities (Netripples, n. d. ). T. H. I. S. provides effective solutions to hospitals which plan on reducing the administrative burden and clinical transactions, in addition to providing compassionate services to their patients. On a typical day in Hospital Selayang, the inpatient admissions reach 150/day whereas outpatient visits would reach upto 1000/day amounting to 250GB of patient records. T. H. I. S has enabled effective management of such high flow of patients, data storage, processing and retrieval. Figure 8 illustrates the daily usage of T. H. I. S shows the heavy reliance and interdependance between Selayang Hospital and the information systems. Figure 8: Daily Utilization of T. H. I. S (Abdollah, 2011). With the presence of THIS, most of the patient care demands can be met because it computerizes the process of collecting, arranging, filing and retrieving patient information. Furthermore, world class patient care can be provided by the hospital when equipped with good decision support system from THIS. Additionally, T. H. I. S. benefits in various other methods such as comprehensive patient record keeping, much lesser paperwork, quicker information sharing means between various departments, more flexible organization, reliable and timely information and adequate inventory management. A user satisfaction survey conducted in 2003 among staffs of Selayang Hospital revealed that T. H. I. S was appreciated and well received among nurses and doctors followed by allied staffs and clerks as depicted in Figure 9. (Abdollah, 2011) Figure 9: User satisfaction survey 2003 (Abdollah, 2011). Productivity wise, Selayang Hospital has evidently shown higher productivity after the successful implementation of Total Hospital Information System (T. H. I. S. ). As Selayang Hospital had incorporated T. H. I. S. from the start of its operation, studies analysing the effectiveness of T. H. I. S. before and after implementation is not possible. However, a comparative study comparing T. H. I. S. n Selayang Hospital with a traditional government hospital, Hospital Klang is currently being carried out. Few early findings from this study shows implementation of T. H. I. S. has managed to reduced time taken for admission by 40%, patient stay by 10% and discharge processes by a remarkable 70%. Qualitative benefits of this system highlighted in this study include easy availability of data, bett er patient record management and improved workflow (Abdollah, 2011). The ability of Pharmacy Information System (PIS) to keep track of the entire drugs inventory within the hospital is commendable. The PIS head manager is also able to make orders when an alert is raised on a particular drug. This therefore ensures proper inventory management and that all drugs are always in stock. In addition to the privileges that pharmacies’ will get through the implementation of T. H. I. S, doctors of the hospitals are also able to reap off its benefits as well. For the clinicians, EMR and PMS aid in clinical management of patients. A medical officer no longer requires the doctor-in-charge to be physically present but still can receive consults from him/her utilizing EMR and PMS. All these systems has indeed helped Selayang Hospital to manage the hospital effectively with efficient decision making. Moreover, T. H. I. S. aids hospital administrators whereby it significantly improves operational control. Lastly, in addition to enhancing patient care, T. H. I. S also increases the profitability of the respective organization. In summary, there are a number of direct benefits of THIS in hospitals. The most important advantage of this system is the ability to meet patients’ demands in a timely manner owing to the automation involved in data collection. Other uses include great reduction in paperwork and more efficient patient particular collection and management. Considering the unwavering benefits from implementation of Total Hospital Information System, it will soon become a necessity in terms of hospital management. 4. 2 Ethical Concerns The number and the magnitude of challenges faced by healthcare organizations are unprecedented. Selayang hospital is no different. Increasing financial bruden, rising public an payer expectations and increasing number of consolidations have placed these hospitals under immense stress. Heavy usage of information systems have provided record-keeping which is otherwise impossible. However, this leads to rapid and easy access to medical records raising issues of privacy against expediency (Boyle, 2001). In Selayang Hospital, these issues are handled with utmost priority. Patients’ privacy and confidentiality is protected through several measures. Only authorised users are allowed to access these information. Authorised users who are found to be misusing their access would be tracked in audit trails and stringent disciplinary actions would be taken against them. Therefore, patients are assured of their personal data protection (Abdollah, 2011). 4. 3 Drawbacks and challenges of Total Hospital Information System (THIS) Like any other information system implementation, in T. H. I. S. , users’ resistance to change is one of the major concerns. This is largely related to individual acceptance of IT application particularly by doctors and nurses. Though this is now not an issue in Selayang Hospital, failures in HIS has been repeated reported over the years. Unrealistic goals, complex user-interface, lack of clarity on the functionality required and lack of sensitivity to the local systems were some of the key reasons contributing towards failure of THIS in many fledgling hospitals (Cassels, 1995). The developing countries face even deeper problems such as inadequate electricity supply, lack of proper infrastructure, unsustainable funding, and the inadequate educational levels of the hospital staffs who are likely to be the primary users of the system rather than doctors in these countries. Other concerns include slow response time, absence of easy login-procedures, and tedious data entry (Chandrasekhar and Ghosh, 2001). Selayang Hospital though comparatively better in IT receptiveness, initial reluctance was present. Even today, reluctance to change and accept an IT application especially the EMR system in a conventional society still persists. Appropriate strategies like IT training and incentives need to be deviced to make both patients and hospital officials more receptive towards these systems (Haslina and Sharifah 2005). 5. 0 Future Plans Following these victorious execution of T. H. I. S, Selayang Hospital is currently looking a step ahead into developing a entirely automated Pharmacy Information System (PIS) with Decision Support System (DSS). Besides, management is also emphasizing on improving reporting and data analysis, enhance clinical documentation module with decision support and introduce mobile computing function to facilitate better hospital management (Abdollah, 2011). 6. 0 Conclusion It is beyond doubt that T. H. I. S has been the backbone in assisting hospital administration to ensure Selayang Hospital runs smoothly. However, without the staunch commitment from top management, physicians and other users and adequate number of IT professionals, this success would have remained as a dream. Thus, information systems only when coupled with good recipience would prove beneficial. 7. 0 References Abdollah, 2011. Hospital Information System in Selayang. [Booklet] September 2011 ed. Selayang Hospital Information Technology Department. Biohealthmatics, 2010. Pharmacy Information System, [online] retrieved from http://www. biohealthmatics. com/technologies/his/pis. aspx [accessed on the 2nd October, 2011] Boyle, P. 2001. Organizations ethics and healthcare: principles, cases and practical solutions. San Francisco: Jossey-Bass. Cassels, A. ,1995. Health sector reform: key issues in less developed countries, Journal of International Development [online] retrieved from http://www. ncbi. nlm. nih. gov/pubmed/12290761/ [accessed on the 3rd October, 2011] Chandrasekhar, C. P. and Ghosh, J. , 2001. Information an d communication technologies and health in low income countries: the potential and the constraints, Bulletin of the World Health Organization, Vol. 79, No. 9, [online] retrieved from

Discrimination Against Women in the United States Essay

All around the world people are being discriminated; some are discriminated because of their race, while others are because of their gender, such as women. In today world, it is no different than it was 10,000 years ago. Women are still sold into prostitution, forced to marry someone they don’t love, have no right for abortion or birth control, have little or no access to education, and have to fully rely on men. This is not fair at all, women should have right’s, they didn’t before here in the United States, but now they do (even though it still exists here). If women can have right’s here in the United States they should be able to else ware. In all discrimination against women is unfair, and unjust, because here in the U.S it is†¦show more content†¦In fact they probably can’t get a job at all. You might be thinking that the men just work harder, but in fact this happens even when women work harder than the man. It even happens when wo men have a higher position than a man; the man might actually get paid more even though that is rare. Not only is this against the law, but also one thing people actually ignore is that discrimination against women does affect our own economy. It is considered that gender discrimination is costly for all economics. The Center For Economic and Policy Research designed a growth model by choosing values to fit the boundaries. The guideline economy represented the economy of the United States. CEPR then figured out the output cost of an increase of discrimination. The findings showed that 50% of the in gender discrimination resulted in a decrease of income of around a quarter of the original income. In the end it was determined that for several countries a large portion of the difference for outcome is due to gender inequality. So basically CEPR proves that the gender inequality does affect the economy in a negative way. With this negativity in the economics than the U.S may no longer be the 5th best economy in the world. However if we find a way to completely stop discrimination than possibly this number can actually go up and eventually is the best economy in the world but right now with discrimination still going strong , weShow MoreRelatedEssay on Where Are Womens Rights?1616 Words   |  7 PagesWhere are Women Rights? Did not God create everyone equal and gave them his or her rights? Did God ever say that people should treat every human differently based on his or her gender? Who does not know about gender discrimination? Gender Discrimination, which is also called sex discrimination, was gone in the twentieth century right! This is not true. Gender discrimination still exists today around the world in many countries including the United States. 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The Civil Rights Act of 1964 originally did not include gender in the bill’s wording. Were it not for a backhanded comment made in jest by a backward congressman, women would not have been afforded equal rights protection in employment (Freeman, 1991; 2004). President Harry Truman inaugurated the legal Civil Rights Movement. Though people of color had long been yearning andRead MoreOn The Parchment Of Bias928 Words   |  4 PagesParchment of Bias Women have expressed their political allegiance long before the dawn of modern era. However, the quest for equality has always been undermined by the male dominance throughout the history. Even in the most developed countries like the United States of America, women were not entitled to the same rights and privileges as men. â€Å"In Minor v. Happersett, 88 U.S. 162 (1875), is a United States Supreme Court case in which the Court held that the Constitution did not grant women the right to

Lolita vs. Frankenstein Free Essay Example, 1500 words

The novel Lolita consists of multifaceted themes such as love, pain, sex, puritanical ideas, art, psychology, exploitation, use of language and so on. The basic content of this novel is the desire for sex that permeates all throughout the story and the author knits together the other themes into it very nicely. The strong passion of Love is the basic instinct of sex that is displayed on various forms on this novel. A close reading of the text reveals that almost all the characters in the novel are seeking for love and this tends many to underestimate the book as pornographic. Here the characters, both Humbert and Charlotte, are seeking love but not from each other. For instance, Humbert looks love from the young girl Lolita, the mother of Lolita, while Charlotte seeks love from Humbert. In the same way, one can also come across multitudes of themes in the book Frankenstein too. The basic theme of Frankenstein is most widely accepted as ignorance is bliss. The novel also posses chall enges to many conventional precepts about the nature and one’s beliefs of god through science and technology. We will write a custom essay sample on Lolita vs. Frankenstein or any topic specifically for you Only $17.96 $11.86/pageorder now The author mixes the emotions of love, hatred, guiltiness, romance, sadness and so on into the novel extremely well. Frankenstein and his cousin Elizabeth loved each other with the permission of his parents. He wanted to marry her after the completion of his study in Germany. â€Å"Tears gushed from the eyes of the Elizabeth† as she is unable to control herself when her lover Frankenstein leaves her (Shelley 67). Here the author mixes up the emotion of sadness, sorrow, and the affection and the pain of separation very effectively. The narrative style of both the novels also deserves one’s attention. The novel Frankenstein starts with the communication between Captain Robert Walton and his sister passing across letters. These letters consist of the story of Frankenstein and his creature as Frankenstein describes it to Robert. The novel Lolita, on the other hand, is totally a record of Humbert Humbert. He always lives in his fictional world and he spends his maximum duration of time in different sanitariums. He has undergone a mental treatment that made him hungry for teenage girls. The narrative structure of Lolita is as similar as Frankenstein because the main characters of both of the novels are conversing theirs past behavior to future occurrences as a form of confession. For instance, utterances like â€Å"I was born in 1910. In Paris† (Nabokov part 1: 2) and â€Å"I am by birth a Genevese. † (Shelly, 39) depicts similarities in the narrative styles even though different motives prompt the characters.

Increased Levels Of Physical Activity - 2932 Words

During increased levels of physical activity, the human body responds by altering various cardio-respiratory variables to supply the skeletal muscles with an adequate amount of oxygen and nutrients to sustain the increased metabolic demand. If individuals engage in frequent exercise, the cardio-respiratory system and targeted skeletal muscles become stronger and more efficient relative to individuals that do not engage in exercise. It was hypothesized that at rest athletic individuals would have a lower resting heart rate and at peak performance athletic individuals would have a higher VO2 and a-v O2 difference with a lower TPR, compared to non-athletic individuals. Both male and female subjects, between the ages of 20-23, were placed into two groups based on their weekly amount of time engaging in exercise (Group 1 being zero hours per week, and Group 2 being more than ten hours per week). These cardio-respiratory variables were measured as each subject, sitting on a cycle ergometer , went from rest to peak performance. It was found that athletic subjects did not differ significantly from non-athletic subjects for any of the tested cardio-respiratory variables. However, it was seen that both the respiratory and cardiovascular systems displayed an increase in efficiency for athletic subjects compared to non-athletic subjects. This increased efficiency is not only beneficial for exercise performance, but also for sustaining and improving a healthy life.Show MoreRelatedCardiovascular and Metabolic Diseases779 Words   |  3 Pagesbaseline measurements [20]. Thus, increase in physical activity will decrease cardiometabolic risk factors [8]. Several studies indicate a positive correlation between physical activity and decreased cardiometabolic risk markers [2,4,11,16]. However, we now know that an individual who is getting the recommended physical activity per day can still have a large amount of sedentary time. Cardiometabolic risk has been shown to increase in relation to increased sedentary time, but decrease with breaks inRead MoreHome Message For Children And Parents863 Words   |  4 Pagesneed to engage in 60 minutes of physical activity a day, in order to enhance their health and well-being (Gabbard Rodrigues, 2008; Canada Sport for Life, 2005; Oliver et al., 2007). However, this message is more aimed at the parents of preschool children, because it is their responsibility to ensure that their child is participating in an adequate amount of exercise (Klesges et al., 1990). Parents have demonstrated a positive correlation to the physical activity of their children (Klesges et alRead MorePsychological Benefits of Exercise1746 Words   |  7 PagesIntro: Physical activity, in its many forms, has been shown to have many positive affects on the body and mind. The many benefits include: 1) helping to stimulate the mind, 2) increasing feelings of well being, 3) reducing cholesterol, 4) helping to regulate blood pressure, 5) reducing feelings of anxiety, 6) improving quality of life, 7) reducing symptoms of Alzheimers and Rheumatoid Arthritis, and 8) reducing levels of visceral fat which lowers the risk of developing type II diabetes. Many ofRead MoreA Single System Research Intervention Essay1475 Words   |  6 Pagesother computer-related activities. Throughout his work activity, he rarely moves from his desk for 8 to 16 hours, depending if he works overtime. Due to the participant’s work schedule, the amount of time spent in sedentary behaviors outside of work (i.e. watching television, playing video games and iPhone) also increased due to his lack of motivation and energy. The participant describes having stiff and achy muscles, feeling tired, and not motivated to productive activities in and around his homeRead MoreEssay about How Physical Activity Can Improve on Overall Health764 Words   |  4 Pages How Physical Activity can Improve Overall Health and Personal Development Benefits Of Physical Activity nbsp;nbsp;nbsp;nbsp;nbsp;The benefits of exercise extend far beyond weight management. Research shows that regular physical activity can help reduce your risk for several diseases and health conditions and improve your overall quality of life. Regular physical activity can help protect you from the following health problems. Heart Disease and Stroke nbsp;nbsp;nbsp;nbsp;nbsp;DailyRead MoreAchieving Better Health For The American Population1501 Words   |  7 Pagesconditions of the American population ensures the increased quality of life. People eat for various reasons with the fundamental reason being for survival purposes. However, the issue of eating to live and living to eat affects people in different manners as most people develop poor eating habits that affect the body’s nutritional intake and affects their health. Being healthy involves careful considerations of what one is eating and engaging in activities that contribute to better healthy lives thatRead MorePhysical Activity versus Extra Sleep700 Words   |  3 PagesPhysical Activity versus Extra Sleep Obesity and overall health can be affected by both the amount of sleep you get, and with the amount of physical activity you do. Increasing your physical activity and the intensity you perform the activity will help fight obesity and improve your overall health. When a person loses weight their overall Active Energy Expenditure (AEE) is reduced, but with a reduced body weight people tend to be more physically active which will overcome the reduced AEE (BonomiRead MoreExercise And The Efforts Of Self Efficacy And Increase Health Behaviors1579 Words   |  7 Pagespsychologists, and that is can daily physical activity be incorporated to not only change someone’s self-efficacy but also health behaviors? The proposed experiments that have been researched look at different ways to assess an individual’s self-efficacy when exercise is increased. The current hypothesis mentions that students who exercise more frequently will show a higher self-efficacy towards personal goal s or even challenges. Now exercise and daily physical activity have been shown to create a wideRead MoreThe Incidence of Childhood Inactive Behavior Growing at an Alarming Rate1750 Words   |  7 PagesIntroduction/Overview It is accepted that the incidence of childhood inactive behavior is increasing at a disturbing rate. The physical activity level and health behavior of the youth population has the capability to be a valuable instrument in countering this undesired behavior and the obesity pandemic as well as lowering all-cause mortality (Tudor-Lock et al., 2011). According to the center for Disease Control and Prevention, childhood obesity rates have doubled among children since 1980 (McNamaraRead MorePhysical Activity And Motivating Games : Be Active And Get Your Own Reward1601 Words   |  7 PagesCP5607: Advanced Human computer Interaction Physical Activity and Motivating Games: Be Active and Get your Own Reward Introduction: This paper acquaint with how to live a healthy life style by the host of electronic screens and the use of an adaptive persuasive technology, which introduces bursts of physical activity into a sedentary activity: Computer playing games. Healthy life styles has become a new agenda in people’s daily lives. The author explicitly stated how to motivate themselves by playing

Johnny tremain free essay sample

Read to find out how Johnny and other characters play important roles in historical events. BACKGROUND Time and Place Bostonians responded with outrage to the closing of their port and the arrival of British soldiers and warships. The Committees of Correspondence that Sam Adams began in the early asses evolved to play an even more active role. In September 1774, all the colonies except Georgia sent representatives to the First Continental Congress in Philadelphia. The Congress decided on a boycott of British goods and promised to stand together in defense of Boston.One result of this promise was the forming, arming, and training of Leonia militias. The Congress also prepared a summary of its complaints for King George. The king, however, was not interested in reviewing these complaints and sent more soldiers and ships to Boston. Did You Know? Colonial militiamen had no uniforms and had to supply their ovum guns and ammunition, as well as food and other accessories. Many had learned to shoot while hunting for food or fighting Native Americans in the countryside.As you read, follow the progress of events by noting the main actions of the characters listed below. Paul Revere Sam Adams and John Hancock A silversmith and a rebel. He eventually becomes a spymaster for the rebel event and fights bravely in the Revolution. Continue as leaders of Patriot movement; in March, leave Boston for Concord to attend Provincial Congress Johnny Arab An apprentice to Mr.. Alphas, a silversmith. After his hand is burned by some melted silver, Johnny starts working at the Boston Observer and apart of the rebel movement A printers apprentice at the Boston Observer.Arab becomes a friend to Johnny. He participates in many rebel Acts and movements, including the Sons of Liberty and the Boston Observers. Dove Dry. Warren One of Alphas apprentices, He is fired and goes to work as a stable boy for Colonel Smith. A skilled surgeon that offers to give Johnny back the use of his thumb by cutting away the scared skin Colonel Smith General Gage A high-ranking British officer who employs Dove as a stable boy and leads the assault on Lexington and Concord. How is later wounded.A general that replaces Governor Hutchinson as the person in charge of Boston, General Gage, to the surprise of the townspeople, is not as strict as they expected him to be. Responding Personal Response Think about Esther Forbears statement that she wanted to give Johnny room enough to change and grow. Do you think she succeeded? Why or why not? Way think she did. She gave him a lot of places to fit in and to come out as he wanted to be in the end. Analyzing Literature Recall and Interpret 1 . What are some ways that the Patriots prepare for war?How would you describe the mood between Bostonians and the British troops occupying their city? Well the Patriots prepared in the form of minute men and acts of defiance. Such as the Boston tea party 2. Explain how the Minute Men learn Of the British armys actual battle plans. What do these efforts reveal about the Patriots commitment to independence? Johnny takes his job as a spy hanging out at the African Queen. Dove lets slip that he has been ordered to polish Colonel Smiths campaign saddle rather than his usual saddle.Johnny pieces together that the Brats are going to attack Lexington and the Minute Men are alerted. This small band of patriots are willing to flight the mighty British army for independence. 3. Summarize what happens after Johnny finds Arab at Lexington. At the end of the novel, what decision does Johnny make about his future? What does this decision reveal about his values and character? By this point in the story, Johnny has come full circle. He no longer shies away from physical pain or ark, as he did in the early chapters set at the Alphas house.He is also able to think rationally about his behavior rather than surrendering to his first impulses; he is stoic about Arabs death and agrees to the operation because he knows that doing these things will be better in the long run, even if they are difficult now. Responding Analyzing Literature (continued) Evaluate and Connect 4. How does the author create suspense during the final chapters of the novel? Throughout Chapter Eleven, Johnny remains in the dark about Arabs fate. The emotional anguish he experiences from not knowing shows that one f wars greatest costs is the psychological toll it takes on the living. . According to Johnny, at sixteen he is A boy in time of peace and a man in time of war. Do you agree with this statement? Do you think more is expected of young people when a country is at war? Explain. Yes, Johnny is just a teenager. In times of peace, he can go about his business with a limited amount of responsibility. Unfortunately, at sixteen, he is also expected (and wants) to fight for the independence of his country. He is a boy fighting in a mans war because he is needed. Literature and Writing Battlefield Report Imagine you are a reporter for either the Observer or for a British newspaper.Write a news report about the Battles of Lexington and Concord. Remember to cover the facts by answering these questions: Who? What? When? Where? Why? How? Though a news report should be unbiased, you will want to consider your audience. For example, a London audience would be more interested in the brave deeds of its own troops than in those of colonial troops. Share and compare your report with those of your classmates. Extending Your Response Literature Group as Though the Battles of Lexington and Concord are historical events, in the evolve you learn of them largely through Johnnys personal experience.With your group, review the text. Try to distinguish between Johnny s experience Of events and the objective events themselves. How might the events in the novels final chapters be different without Johnnys presence? Review your response to the Focus Activity on page 20 as you discuss these questions. Share your ideas and conclusions with the members of another group. Performing: Impersonation When Billy Dates impersonates a drunk and sneaks out of Boston, he succeeds on the strength of his acting ability. Try your hand at impersonation. Choose a character and a passage of dialogue from the book. Using minimal props, try to re-create your characters personality with body language and tone of voice. Share your impersonation with class members. Can they tell who you are? Save your work for your portfolio. Johnny Terrain Johnny Terrain is full of real-life people who changed their world-?and ours-?with their Ideas and actions. Which of these people did you find most fascinating? Why? In your opinion, which ones played the most important roles in the historic events of the American Revolution?

Travel and Tourism in Society Tourist Experience

Question: Discuss about theTravel and Tourism in Society for Tourist Experience. Answer: Introduction This study focuses on providing tourist experience by highlighting the scientific description of culture and people with their habits, customs and the mutual differences in Batam, Indonesia. Thus, this study covers the trip details and the literature review in regards to this study topic. Moreover, this study also analyses the destination, trip as well as the motivation with the help of the proper theories and models. The Trip Itself The major and the most important aspect of this trip is to be familiar with the culture, customs as well as the people of a certain place (Miller, 2016). This trip was planned for visiting Batam in Indonesia, which is referred to the place of combination of island and municipality. It is an industrial boomtown, a part of a free trade zone and an emerging transport hub. Figure 1: Geographical Map of Batam, Indonesia (Source: Nahman, 2013) Ferry has been chosen as the mode of transport to travel the Island, Batam from Singapore as the ferries are available almost in every hour and it takes 50 minutes to reach Batam. The overall experience to travel Batam, Indonesia is good. The transport system from Singapore to Batam is well-available and comfortable enough. On the other hand, this island is a very good place to visit (Evans, Stonehouse Campbell, 2012). There are several tourist spots located in Batam such as Sentosa, Waterfront City, Galang Island and many others. Literature Review Ethnography Ethnography is study for the cultures as well as people, which is made in the systematic manner. It has been designed for exploring the cultural incidents where the researcher can make an observation regarding the society from the viewpoint of the subject of the study. According to the viewpoint of Hammersley, (2013), Ethnography was pioneered in the cultural, social as well as biological branches of anthropology as the presentation of the empirical data on the human cultures as well as societies. Howe, it is also famous in the social sciences in general. The ethnographic method is mainly utilized over the range of several distinct disciplines by primarily the anthropologists but also by the sociologists occasionally. According to Pink, (2013), Ethnography is the study of the socio-cultural aspects, meanings as well as the processes within the cultural systems. Ethnography is the iterative process to learn episodes and the process of continuing inquiries, making inferences as well as the process of discovery in the attempt for achieving the emic validity. Cultural?Systems?Paradigm? According to Street, (2014), the purpose of the Cultural?Systems?Paradigm?is for defining the concept of culture as well as the way through which the concept is utilized in the Cultural Ecology of Health and Change for better understanding the broad notions of well-being as well as human health. On the other hand, another purpose of the Cultural?Systems?Paradigm?is for informing the comprehensive approach to the CEHC program in the research of community assessment that is utilized for analyzing as well as collecting the community data that is utilized for informing the evaluation, implementation and the planning of CBIs. Demographics of Batam As per the ethnicity, Batam is heterogeneous in the Indonesian context as well as it is very diverse. Chinese, Minangkabau, Batak, Javanese as well as Malays are the predominant ethnicities. On the other hand, as per the religion, in Batam, Islam is the majority religion with the 74.25 % of the population, followed by the Buddhists, Christians and Hinduism. Malay origin are the native people of Batam (Spindler, 2014). It is still the Malayan Culture as well as Islam, even if Batam is multi-ethnic that forms the root of the local culture. Application of the Literature to the Trip Experience The Botam trip has helped in gathering huge experience in terms of Ethnography. In other words, this trip has helped in understanding the scientific description of culture and people with their habits, customs and the mutual differences in Batam, Indonesia (Pink, 2015) . While people go for a trip in a different place then they can get the scope to come in touch with the culture by interacting with the local people of that particular spot. From the point of view of the ethnography, such a trip is always significant to the travelers to be familiar with the culture, customs as well as systems of the visiting place. Hence, this particular fact can be established with the help of the proper analysis of Cultural?Systems?Paradigm model, which has been discussed in the literature review. Cultural? Systems? Paradigm? The Cultural?Systems?Paradigm?is the prime conceptual framework or the attribute of the ethnography that is significant for both of the cultural and the social systems. Cultural?System?Paradigm?provides the framework in order to initiate the study. On the other hand, it also provides an effective paradigm to store the ethnographic data. Therefore, the boundaries of this particular framework are not rigid. Hence, in case of this Batam, this framework can easily provide the ethnographic view of this trip. Figure 2: Cultural Systems Paradigm (Source: Miller, 2016) As per the Cultural?Systems?Paradigm, stories, values as well as the rituals are the major factor of this particular paradigm of Ethnography with the help of which, it would become very easier for the travelers to be attached with the people in the place where they are visiting. Hence, in case of the Batam trip, it is very important for the travelers to know the culture or to study the culture of that place. In order to do so, it is important to be very friendly with the people live in Batam. In batam, people are very religious (Nahman, 2013). Both of the ceremonies as well as the daily lives of the people in Batam have mythical as well as religious elements expressed in music, dance or other forms of art. Therefore, in this regard, it must be stated that the visitors must observe the local practices as well as customs while visiting Batam in Indonesia (Street, 2014). The use of Cultural Systems Paradigm in order to analyze several social units of Batam as the cultural systems have made possible while these system have the few significant factors. These are as follows: The preferred social structures as well as relationships off Batam The preferred systems of idea as well as the patterns of behavior Valued as well as the other objects those have been synthesized with the help of the group The existence within the social as well as physical environments The shared sense of needs that the group attempts for meeting and The shared historical processes as well as events that the group members in the trip either know explicitly or are influenced by tacitly. Conclusion This study has a complete analysis of a tourist experience by highlighting the culture, habits of the people and some essential difference in Batam, Indonesia. According to this study, it can be concluded that it covers all the details of a trip in Batam, Indonesia. The culture of the Indonesia is discovered in this paper, and it includes a brief study of their transport system. They are moving many places such as Galang Island, Sentosa, Waterfront City, Singapore. However, the overall experience of this trip is concluded that Indonesia is much better than discovered other places. References Evans, N., Stonehouse, G., Campbell, D. (2012).Strategic management for travel and tourism. Taylor Francis. Hammersley, M. (2013).What's wrong with ethnography?. Routledge. Miller, K. (2016). The accidental carjack: Ethnography, gameworld tourism, and grand theft auto.Game Studies,8(1), 147. Nahman, M. (2013).Extractions: An ethnography of reproductive tourism. Springer. Pink, S. (2013).Doing visual ethnography. Sage. Pink, S. (2015). Mediated sensory ethnography: doing and recording sensory ethnography in a digital world. Spindler, L. (2014).Interpretive ethnography of education at home and abroad. Psychology Press. Street, B. V. (2014).Social literacies: Critical approaches to literacy in development, ethnography and education. Routledge.