Modernism

Free Essays on Overcoat By Gogol

A Revolution through Literature Nikolai Vasilievich Gogol’s The Overcoat is a humanitarian and mystical short story about the dreary life of a low class man. Akaky Akakievich is a forlorn copying clerk in a stuffy government office. He is wholly devoted to his routine and monotonous copying, so much so that the continuous mocking and ridicule in the office do not keep him away from his work. Akaky orders a new overcoat after saving and making other privations. He lavishes attention on it, selects the color and the fabric out of love and longing, and waits desperately for its completion, only to have it stolen off his back the first day he wears it. This literal level of the story is full of images and symbols which have a latent meaning that Gogol is trying to communicate. In The Overcoat he contrasts meekness and humility of the normal man with rudeness of the so called ‘important personage’. He gives a satirical narration of the Russian bureaucracy, and criticizes and protests against the cat egorization of each person by rank and the behaviors set for each rank. Akaky himself is really an excuse for the writer to describe in some detail the bureaucracy itself, which means that the background and setting are not implied but may be as important to the significance of the story as Akaky is himself. He is the little man crushed by the economic and political injustice. The focus of this story, apart from Akaky, is his new overcoat. The overcoats in this story signify rank. The rich have marten and silks on their coats to show their rank while the poor make do with other materials. Akaky’s old coat is referred to as the dressing gown by the other clerks who make fun of him. He is looked down upon, ignored and mistreated. But when he gets his new coat the same staff congratulates him and accepts him. They act as if he has been promoted and the new overcoat signifies this rise in stature. New doors open up for him and he is invit... Free Essays on Overcoat By Gogol Free Essays on Overcoat By Gogol A Revolution through Literature Nikolai Vasilievich Gogol’s The Overcoat is a humanitarian and mystical short story about the dreary life of a low class man. Akaky Akakievich is a forlorn copying clerk in a stuffy government office. He is wholly devoted to his routine and monotonous copying, so much so that the continuous mocking and ridicule in the office do not keep him away from his work. Akaky orders a new overcoat after saving and making other privations. He lavishes attention on it, selects the color and the fabric out of love and longing, and waits desperately for its completion, only to have it stolen off his back the first day he wears it. This literal level of the story is full of images and symbols which have a latent meaning that Gogol is trying to communicate. In The Overcoat he contrasts meekness and humility of the normal man with rudeness of the so called ‘important personage’. He gives a satirical narration of the Russian bureaucracy, and criticizes and protests against the cat egorization of each person by rank and the behaviors set for each rank. Akaky himself is really an excuse for the writer to describe in some detail the bureaucracy itself, which means that the background and setting are not implied but may be as important to the significance of the story as Akaky is himself. He is the little man crushed by the economic and political injustice. The focus of this story, apart from Akaky, is his new overcoat. The overcoats in this story signify rank. The rich have marten and silks on their coats to show their rank while the poor make do with other materials. Akaky’s old coat is referred to as the dressing gown by the other clerks who make fun of him. He is looked down upon, ignored and mistreated. But when he gets his new coat the same staff congratulates him and accepts him. They act as if he has been promoted and the new overcoat signifies this rise in stature. New doors open up for him and he is invit...

Fence discrimination defence(not sure which one) Essay

Fence discrimination defence(not sure which one) - Essay Example The fences we put up are getting bigger, more inhuman and harder to overcome. It is the argument of this paper that these fences should not be allowed to exist, that we should not fence people in, whether the context is moral, social or cultural. Dr. Christina Kochemidova , in her article The Culture of the Fence: Artifacts and Meanings, brings up the various contexts a fence can be looked at. A fence can be used in many ways; as a bar, or barrier, to prevent ingress or to prevent escape. Alternatively it can be used as simply a marker, to demarcate a boundary. More often, fences are used as a division and increasingly as a means of control. These sorts of fences are invisible; they exist as rules, laws, and attitudes. This is also noted by Naomi Klein in her article Don' Fence Us In. There are numerous examples of this; racism, privatization and property rights are the most prevalent. These create barriers that are incredibly difficult to overcome. Man may have originally have used the fence to demarcate, but over the centuries it has evolved into more; a protective barrier, in one way, to keep the "other" out. The other can be anyone we perceive as a threat, or conversely anyone we wish to control. The fence as a control measure is frightening. This avatar is especially clear in the case of racism Racism is universal. Whether it manifests itself as the oppression and slavery of blacks in the United States, or as hatred of Pakistanis and Muslims in Norway, or the conflict between Hindus and Muslims in India and Pakistan, the common factor is the segregation and separation of two peoples based on the belief of the inherent superiority of one over the other. In fact, the word "apartheid" was created from the Afrikaans word for "separate"; the whole concept of a fence lies in that word. Racism has been responsible for some of the most horrible atrocities ever committed; the Holocaust, the slavery of blacks. In the United States, prior to the Civil War, Blacks were not even allowed the right to be citizens of the country; they were not even given the right to be considered human. Segregation in the south of the country took the form of separate facilities for everything including transport and housing. Even when they were finally recognized under the Constitution, they were still e ducated separately under the guise of "separate but equal" schools under the law. This sort of segregation is a fence. It separates and empowers one group, and suppresses another as is evidenced by the example given above. Denying an ethnic group the status of "human" is one of the most horrific fences that can be put up. This status was used to control the blacks and keep them "in their place". Denied education, proper housing, denied their very independence, the blacks were successfully controlled by these fences that kept them exactly where they were wanted. Education became an extremely important way to break out of these barriers. However, as noted by Hansman et al, education itself is prone to racist overtones. They remark that in many multicultural institutions, the structure of the work is planned around the majority culture, thereby leading to the ineffectual training of minority groups. Institutional factors therefore have a role in maintaining racial prejudice. Another

Summarization for 7 chapter of the weather makers Essay

Summarization for 7 chapter of the weather makers - Essay Example By going on to detail the level of environmental destruction, the footprint of human development, and the means whereby otherwise pristine regions have been reduced to little more than a wasteland, the author fully grips the reader’s imagination and attention with regards to the poignancy of the issues at hand. Likewise, Chapter 10, entitled â€Å"Peril at the Poles† focuses upon the key importance that the earth’s polar climates have with relation to nearly every other known and observable weather pattern that climatologists track. Moreover, rather than merely relating the direct effect that a warming arctic region portends for other world weather patterns and the overall sea rise that such temperature increase necessitates, the author spends a great deal of time discussing how the delicate balance of life within the ecosystems are being intimately affected by the temperature changes. Examples of the close interconnected nature of krill, seal, polar bear, pengui ns, and caribou are all discussed as the author lays out the case for how temperature change bears the threat of acting as a veritable wrecking beam for an otherwise complex and interdependent ecosystem. Chapter 11, entitled â€Å"The Great Stumpy Reef?†, details the means by which human action has and continues to have a profound effect on the development, loss, and evolution of the coral reefs that dot the globe. As the author points out, the destruction of the coral reefs cannot be understood within the same context as the destruction of the ice shelves that have been discussed earlier; rather, human activity, pollutants, and other factors mean that the nature and extant species represented within the coral reef are necessarily changed. In this way, human actions and pollutants can encourage one species to shift the balance and develop a primacy for food and resources that necessarily puts another species at the brink of destruction within the region or worse yet, extincti on. Chapter 12, entitled, â€Å"A Warning from the Golden Toad† takes the level of analysis down even further into the realm of the individual species that is affected by the changing nature of the planet’s weather conditions. Such is very much the case of the Golden Toad which became extinct due to the fact that its eggs were no longer suitable for survival within the changing climate. This is a powerful example as extinction due to climate change is a topic that had not been of particular notice within the field of science or evolutionarily biology before this occurrence. However, due to the existence and subsequent disappearance of the Golden Toad, meteorologists and biologists alike have reason to be alarmed. If definitive proof therefore exists that as a direct result of climate change it can be determined that a species has now left earth’s ecosystem, it is likely that such is an example of merely the tip of the iceberg. Due to the rapidly decreasing numbe r of species left on earth, this issue is cause for alarm. Chapter 13, entitled â€Å"Liquid Gold: Changes in Rainfall†, discusses the fact that there is a direct relationship to the increase in global temperature and the overall increase in rainfall. Although it may seem that rainfall increase is a good thing in a planet that more and more frequently suffers from desertification, the fact of the matter that the author seeks to acquaint the reader with is that this

Effective Team and Management Essay Example | Topics and Well Written Essays - 2250 words

Effective Team and Management - Essay Example Many people have different perceptions about the value that teams bring to an organization. Some people think that teams are a waste of time and other resources and thus organizations need to focus on individual output as is opposed to group performance. They point out certain weaknesses of teams such as laxity by some members and lack of individual responsibility when mistakes do arise. Teams also overshadow talent and other stand to gain where they did not sow. However, there is strong evidence that teams and teamwork is the best way to go for organizations that are seeking success. For teams to realize productivity there needs to be certain principles in place which have to be observed by all team members. Building a team spirit is a huge task and requires that managers acquire better skills of interpersonal management as well as interpersonal communication. Various theories have been fronted to help understand teams or groups and group dynamics. This paper takes a reflective appr oach to the modules we studied and tries to link it with the learning outcomes that were expected at the end of the session. Theories and other concepts learnt will be utilized in this critical reflection and discussion (Senior & Swailes, 2007, pp.138-153). Reflection from group exercises in weeks one to three Reflection is important in the course of my study (Illes, 2003, pp.209-215). Groups at work places are very important additives to any organization’s success story. I realized that there must be clear objectives as to why teams are formed in work places in the first place. This is because previously I had a notion that teams are simply about numbers. But I realized that teams should not be formed on the basis of filling up positions and coming up with large groups of people who have no objective of being together in such workplace settings. Many organizations end up promoting teams in workplaces for the purpose of boasting and propagate a total quality environment at wo rk. This is a very wrong idea. Teams within a workplace have been a very powerful tool in many successful organizations. The benefits of having teams at work are many and include the provision of motivation to employees who are members; they enhance job coordination (Sonnentag, 1999); they give an improved problem solving environment; and assist in better decision-making process, among others. However, I realized that there is a price to pay for having this good performance (Stajkovic & Luthans, 1997, pp.1122–1149). As noticed, making decisions within a team takes a longer period than if one was to do it as an individual. This could be attributed to the fact that all members need to be consulted and consensus reached before a final decision could be acted upon. The process taken for teams to mature is also very long and slower. Teams have been known to evolve and mature into formidable groups that could carry out work effectively and this could not happen as fast as I thought . The other idea that I realized was the fact that teams needed long periods of training and comprehensive training for that matter in order for them to mature. Despite these shortcomings, I noticed that teams have major benefits mentioned above, which do outweigh these problems and frustrations faced by managers in many situations (Senior & Swailes, 2007, pp.138-153). Belbin Team Roles Theory has posed a good model for many managers struggling with teams in their organizations. The model has various fundamental concepts that are based on roles. I realized that

Cost Effectiveness of Dialysis for ESRD Patients

Cost Effectiveness of Dialysis for ESRD Patients From 2002-2009 diabetic nephropathies represented 41% of all end-stage renal (ESRD) patients in St. Lucia, which is significantly higher when compared with global distribution. Renal replacement therapy for ESRD is resource intensive, consuming a significant part of the health budget. Financial pressures on the health system continue to increase in the face of the global financial crisis, yet cost-effectiveness studies of ESRD treatment options are not only scarce but nonexistent in the Eastern Caribbean. A retrospective approach to data collection was used and a Markov model of cost, quality of life and survival will be developed to compare hemodialysis and pharmaceutical management of ESRD among diabetics. Micro-costing was used to assess the cost of hemodialysis for ESRD over the 8 year period. While preliminary findings have not identified whether or not hemodialysis for diabetic nephropathy is cost-effective the economic burden of hemodialysis for diabetic nephropathy was signif icant: EC$6.9 million, in St. Lucia for the 8 year period. Pre-emptive procedures need to be considered for the treatment of diabetes to delay onset or progression of ESRD. From a medical as well as fiscal perspective, prevention is the most cost-effective intervention. The health system in St. Lucia needs to focus attention on effective prevention strategies as the mean age among diabetic ESRD patients is 56 years (2.3SD). This age group is representative of a significant part of the countrys labour force and, if left unchecked, could have serious implications for economic development. Introduction End-stage renal disease (ESRD) and its precursor, chronic kidney disease (CKD), are globally emerging as a significant public health problem, with increasing morbidity and mortality as well as economic implications for healthcare (Szucsa et al., 2004). The World Health Organizations 2002 estimate indicated that globally CKD contributes to over 850,000 deaths and over 15 million disability-adjusted life years, with epidemic rise of ESRD in multiple regions in the world (WHO, 2003). The report also predicted that by 2010 more than 2 million people would require maintenance dialysis worldwide, and global estimates indicate that approximately 30% of patients with ESRD suffer as a consequence of diabetic nephropathy (Zelmer, 2007). The economic pressures of ESRD treatment on the collective health system are well documented. Haller, et al. (2011) identifies it as resource intensive, requiring substantial amounts of finite healthcare funds to treat a small percentage of the population. In 2005 alone, care for ESRD patients in Canada represented 1.2% of all healthcare expenditure, despite a 0.092% incidence of the disease (Zelmer, 2007). In St. Lucia, chronic renal insufficiency as a result of diabetes, hypertension, autosomal dominant polycystic kidney disease, and sickle cell disease are the main reasons for starting dialysis treatment in patients with kidney function failure. This is similar to the findings of Perovià ¡ and Jankovià ¡ (2009). In addition to being a chronic disease with significant morbidity impact, ESRD also involves high-cost treatment options (Zelmer, 2007), which are often limited in developing countries such as St. Lucia. Yet cost-effectiveness studies of the modalities of treatment are few and limited, especially in developing countries (Haller, 2011). Previous research has been conducted to identify the economic impact of the estimated health-care costs for ESRD, as well as the cost-effectiveness of various alternatives for renal replacement therapies; however, similar studies have not been replicated in the Eastern Caribbean. The findings are especially relevant to the health system in St. Lucia, as the incidence of diabetes continues to increase in the Caribbean Region (Henry, 2004). Additionally, the recent decision to expand the dialysis service to two new facilities without understanding the scope and magnitude of the total economic burden of ESRD could prove to be challenging. Cost-effectiveness is the fastest growing field in health research and it embodies a form of full economic evaluation that looks at cost and consequence of health programmes or treatment (Muennig, 2008). Cost-effectiveness analysis (CEA) of intervention programmes as a valuable tool employed by decision-makers can be used to appraise as well as possibly improve how the health system operates. Its application allows policy makers to identify which interventions provide the highest value for money and assist in helping to select interventions and programmes that maximize health for the available resources. Health economists are able to purchase the most health under a fixed budget, prioritizing services within the health sector. CEA therefore requires information to indicate the extent to which current and potential interventions are effective for improving population health, and which resources are required to implement the interventions, i.e., costs (Muennig, 2008). Referring to Palmers 2005 definition that states cost-effectiveness studies compare costs with clinical outcomes measured in natural units, like life expectancy or years of diseases avoided, Glassock (2010) noted that the totality of costs may not necessarily be captured. The inclusion of cost means that the design of the study will incorporate cost-unit analysis as a tool to examine the economic impact of dialysis for ESRD patients with diabetes and cost effectiveness to determine the quality adjusted life year (QALYs) or health related quality of life (HRQoL) for that population. The main outcome measure will focus on costs per quality-adjusted life years ($/QALYs), similar to a study conducted in Austria (Haller et al., 2011). Glassock (2010) notes that community willingness-to-pay is the threshold value used to determine cost effectiveness. He goes on to note that these values vary globally, and are estimated at  £30,000/QALY in the United Kingdom, 40,000/QALY in Europe, Aus $5 0,000/QALY in Australia, and US $90,000/QALY in the United States (Glassock, 2010). In the absence of a national threshold value, one can be established using GDP as an objective economic benchmark, (Eichler, et al., 2004). Cost will be viewed from the perspective of direct spending on health care for dialysis, coupled with the indirect costs of productivity losses due to premature death and short- and long-term disability. The impact of mortality costs as the sum of the discounted present value of current and future productivity losses from premature deaths will be measured from an incident-based human capital approach, drawing from a similar study conducted in Canada in 2000 (Zelmer, 2007). Muennig (2008) posits that because it is often difficult to account for all cost, and the time and resource constraints associated with micro-costing, certain assumptions related to costs are often made during cost-effectiveness analysis. This paper serves to examine the cost-effectiveness of hemodialysis among type 2 diabetics in St. Lucia over an 8 year period (2002-2008). Employing the use of CEA, it aims at comparing the cost and effects or outcomes (cost-effectiveness) of hemodialysis for diabetic nephropathy using the comparator of doing nothing, which in this case is the pharmaceutical management of patients with diabetic nephropathy to delay progression of ESRD. The findings will also help to inform those making policy decisions, and may be useful in establishing a set of priorities for further research, prevention programs, and in the planning of alternative treatments to help alleviate that burden. Perspective of the Study Cost effectiveness of dialysis for ESRD patients with diabetes in St. Lucia will be analyzed from a government perspective. This requires conducting cost analysis that measures the recurring direct and indirect cost of providing the service. In the region, specifically in the country under study, health care organizations rarely know the cost of the service provided and rarely employ the tools needed to assess that cost on a regular basis. In a globally operating economic society, economic trends have made it imperative for both profit and non-profit organizations that provide services, including government agencies, to assess the cost of clinical services provided. Finance for health is not infinite and with substantial budget cuts in the health service industry, there is increasing pressure for health care facilities to become more accountable and efficient with the funds allocated to health care (Basch, 1999). Health economics recognises the need for health services to be provided in a manner that is not only efficient but sustainable. Measuring, understanding and documenting the cost of services makes it easier to improve cost-efficiency of these services; it also highlights the funding needs of the sector and by extension, the government. It also provides an opportunity to establish fees for clients that are based on realistic site costs. Previous studies on cost-effectiveness of treatment options for ESRD have compared different modalities of dialysis or transplantation (Haller et al.; Gonzalez-Perez et al., 2005, Yang et al., 2001). Treatment modalities for ESRD patients in St. Lucia are either hemodialysis or pharmaceutical management. The analysis of hemodialysis versus pharmaceutical management to delay ESRD progression hinges on the fact that the current capacity of the Renal Unit in St. Lucia cannot provide dialysis for all ESRD patients. In an interview dated December 14, 2010 with the head of the Nephrology Unit, Victoria Hospital, Saint Lucia, it was indicated that while dialysis is offered, the increasing ESRD population means that patients are placed on a waiting list if they are not able to commence treatment due to unavailability of space (Olivert Dupree, 2010). If a patients prognosis requires immediate dialysis, he is treated at the private facility and the government absorbs that cost. But it is quit e clear that hemodialysis, like pharmaceutical management, is not the optimal treatment option for ESRD; rather, the optimal protocol is transplantation. The health system in St. Lucia is mandated by its objectives to improve the health of the population and consequently needs to ensure that its limited resources are not devoted to expensive interventions with small effects on population health, while at the same time low cost interventions with potentially greater benefits are not fully implemented (Ministry of Health, Human Services, Family Affairs and Gender Relations, 2000). Methods Data Sources The study population comprises of ESRD patients with diabetic nephropathy. Patients were considered depending on whether they received hemodialysis or whether their diabetes was being pharmaceutically managed to delay ESRD progression. Data was collected retrospectively and the study population was selected from the only public Renal Unit which forms part of the general hospital, Victoria Hospital. While there is another Renal Unit in St. Lucia that offers dialysis, it is a part of the private hospital, which did not wish to participate in this study. Of the 111 patients on dialysis, 45 were due to diabetic nephropathy and 19 were actively receiving dialysis at the time the study was being conducted. The nephrologists identified 12 ESRD patients who were not receiving dialysis but were being managed pharmaceutically. All diabetics who are or have been on dialysis with end-stage renal disease for the period 2002-2009 and were receiving dialysis due to diabetic nephropathy were included in the study. Persons were excluded from this study if they were on dialysis prior to being diagnosed with diabetes. The comparator group differed from the hemodialysis group only in the form of treatment that they are receiving, and consisted of all patients with ESRD due to diabetic nephropathy who are not receiving dialysis but whose diabetes is aggressively managed with medication to delay ESRD progression. Other variables were considered in the study and a standard questionnaire was administered to the study population to obtain data on the socio-economic status of individuals. A pool of eight persons from those who were on dialysis for reasons other than diabetic nephropathy served as a pilot test group for the socio-demographic questionnaire. This group was similar to the study population in terms of gender, education, socio-economic status and geographic location (Table 1). Content analysis was used to evaluate the information obtained from the socio-demographic questionnaire. All study participants received a letter concerning anonymity and confidentiality and informed consent was obtained prior to participation. Ethical approval was obtained from the IRB at St. Georges University and the ethics committee of the Ministry of Health in St. Lucia. A literature review conducted relied upon peer-reviewed economic evaluations of dialysis treatment modalities among diabetic patients. Ebscohost and PubMed were searched using the keywords cost-effectiveness, dialysis, end-stage renal disease, and diabetic nephropathy and was limited to articles published in the last 12 years (2000-2011). Some articles, if they were published outside of the selected timeframe, were accepted based on the strength and relevance of their findings. Articles were included if they had the keywords in the subject headings as well as focusing on Renal Replacement Therapy/economics, Renal Dialysis/economics, Hemodialysis Units, or Kidney Failure. If they included the term peritoneal dialysis or hemodialysis they were also selected. Exclusion criteria comprised of non-English articles and those that did not compare treatment options. A total of 379 articles were identified but 31 were selected as being relevant. Models Used Chronic conditions such as ESRD require continuous treatment and as a consequence, the cost-effectiveness of treatment options over a period of time for a cohort of patients employs the use of the Markov model to investigate long term costs and outcomes. The Markov model developed for this study describes the process of care noting that patients began their progression through the model in either of two states, hospital hemodialysis or pharmaceutical management of type 2 diabetes to delay ESRD progression, with death signifying the end of the cycle. Data on health care costs, transition to other health states and quality of life were inputted into the Markov model. Data was obtained from the Renal Unit at the Victoria Hospital, the public health facility. Data on quality of life was obtained using the 15D, a multidimensional, standardised generic instrument to measure quality or health-related quality of life (Sintonen, 2001). The 15D was used since it combines the advantages of a profile and single index score measure that describes the health status by assessing 15 dimensions. The mean score value for each dimension was used to determine the health related quality of life in the study population. The use of the 15D to measure quality of life outcome was reported in terms of QALYs, a measure of the burden of disease that included the quality and quantity of life lived against a monetary value, medical treatment or intervention. The mean score value for each dimension measured by the 15D was used to determine the health-related quality of life of the study population using the scale provided by Sintonen (2001). The findings were standardized against the burden of disease markers identified by the WHO. Costs and Analysis Cost-effectiveness, examined from a governmental perspective, used the clinical records of the Division of Nephrology patient registration and billing systems at the Victoria Hospital coupled with information from published studies on survival and quality of life among diabetic nephropathy patients. The model used included the direct health service costs associated with the treatment options, and an annual cost per patient was calculated for each health state in the model. Direct healthcare costs associated with dialysis use included costing regular dialysis sessions, complications of the dialysis, such as clotting of the fistula or hypotension episodes, laboratory tests and services required as a consequence of dialysis and medication use as a result of treatment. Assumptions were made on the regularity of direct healthcare cost associated with dialysis, such as that involving laboratory testing and blood transfusions. Micro-costing, collecting data on staffing, consumables, capital , and overheads were used to determine the cost of one session of hemodialysis (Table 2). Structured interviews were used to obtain details regarding staff time allocated to dialysis activities, as well as the regularity of other services used as a result of the treatment options. Capital items were identified as the building space allotted to the Unit for treatment, and equipment such as the dialysis machines and air conditioner unit. Costs have been reported in Eastern Caribbean Dollars (EC) presented at the 2008 level and an equivalent annual cost calculated using a 3 percent discount rate over the predicted life span. Muennig (2008) argues that a governmental perspective can include some aspects of transportantion costs. Evidence from the Minstry of Communication and Works and the Transport Board implies that there is no nationally agreed-upon policy for transport costs. There are variations across St. Lucia in terms of mileage costing; therefore for the purposes of our analysis, transport costs are excluded. The study reviewed costs over an 8 year period (2002-2009). This time frame was partly determined by the availability of the data two years after the programme was initiated and the assumptions made with reference to the analysis were tabulated (Table 3). Incremental costs per QALY gained will be calculated by using the estimates of costs and QALYs for each of the two modalities obtained from the model, and the findings were presented as incremental costs per QALY ($/QALY). The threshold value used to determine cost effectiveness of the intervention was established based on the recommendations of the Commission on Macroeconomics and Health, and CHOICE, which uses gross domestic product (GDP) as an indicator to determine cost-effectiveness. They established that an intervention was highly cost-effective if cost per QALY was less than GDP per capita, it was cost-effective if it was between 1 and 3 times the GDP per capita but was not cost-effective if it was more than 3 times GDP per c apita (WHO, 2011). A one-way sensitivity analysis will be used to investigate variability in the data, varying the discount rate from 3% to 5%, then age weights and finally, the disability weights. A final sensitivity analysis of mortality rates will be conducted since the assumption was that the mortality rates for hemodialysis were the same as those of pharmaceutical management of ESRD diabetics. Based on that assumption it becomes important to identify whether any one of these factors, discounted rates, age weights, and disability weights independently affected the data. Multiple linear regressions will be used to identify how the variables and assumptions affected dialysis lifetime. Preliminary Findings Demographic Characteristics The socio-demographic characteristics of the study population are presented in Table 4. According to the modalities compared the mean ages were 52 years (SD 10.06) for hemodialysis patients and 42 years (10.34SD) for patients who were being pharmaceutically managed. Briefly 62% of the patients were male (Figure 1), 40% had completed only primary level education and 20% had received no formal education. Married patients made up 46.7% of the study group and 26.7% were currently employed; but of these patients 80% of them received some form of family support or National Insurance Corporation (NIC) compensation. There was little variation between the groups (hemodialysis and pharmaceutically managed) in terms of employment and education. ESRD, as a consequence of diabetic nephropathy, represents 41% of all patients who have received hemodialysis for the period 2002-2009 (Figure 2). The end of that 8 year period mortality rate among that population is 53% with the average age of death at 57 years and average dialysis lifetime of 3 years. Costs A list of the parameters used to determine cost is presented in Table 2 and total yearly cost for the period is presented in Table 3. The total cost of dialysis for diabetic nephropathy was EC$6.9 million. From a governmental perspective, in 2009 the total cost of dialysis for diabetic nephropathy patients with ESRD totalled EC $1,002,597.23, accounting for approximately 2.27% of all healthcare expenditure for 0.01% of the population. Secondary and tertiary care services accounted for 59% of the total health budget for 2001-2002, 60% for 2002 -2003 and 64% for 2003-2004. Primary care services accounted for 22% in 2001-2002, 22% 2002-2003 and 18% for 2003-2004 (Figure 3). Discussion This is the first study of its kind in the region. It is able to serve as a precursor to further research and therefore is poised to help guide policies on how cost-effectiveness studies are done in the region. Additionally, there will be future application to decision-making in healthcare. While the absence of other studies that compared the treatment modalities used in this study serves as a limitation to this paper, it remains the only viable comparator that was available to the researcher, and being the first of its kind allows it to inform the existing research. The preliminary findings of this paper have significant implications for health and the operations of the dialysis unit. The literature from other studies (Haller et al, 2011; Zelmer, 2007) indicates that the average lifetime on dialysis is 7-10 years, with survial rates lower among senior adults, aged older than 65 years. The inverse seems to be suggested by the preliminary findings, with an average lifetime of 3 years in patients less than 57 years. The deviation may be attributable to younger persons being less compliant with regular dialysis sessions and the strict dietary and lifestlye adjustments that dialysis requires. Further research would need to be conducted to validate these findings. The economic burden of ESRD for diabetic nephropathy is significant: EC$6.9 million, in St. Lucia for the 8 year period (Table 2). While the focus of this study is on the cost-effectiveness of dialysis, the data identified that health services accounted for most of the observed costs. The governmental perspective of the research restricts the papers ability to adequately address the diabetic nephropathy related morbidity and premature mortality among the study population and the substantial burden that it places on society. The early indicators suggest a need for the effectiveness of the programme to be examined against its objectives and how its outcomes compare with other units within the region or the privately operated unit in St. Lucia. In 2006 Government health expenditure per person per year was EC$499.50 (Ministry of Health, Human Services, Family Affairs and Gender Relations, St. Lucia). Yet for that corresponding period, government spending for dialysis per person per year was EC$48,597.81 (Figure 5), for 0.0014% of the population. St. Lucias GDP for that period is estimated as $6,037.00 PPP (EC$16,299.90) and total expenditure on health is estimated as 6.3% of GPD (Table 5). While cost-effectiveness has not been conclusively established, using the threshold value of GDP as an economic estimate to determine cost-effectiveness, a cost-effective programme is one that is between 1 and 3 times the GDP per capita (WHO, 2011). The National Strategic Health Plan 2006-2011 (2006) posits that the Ministry of Healths actions have not been consistent with its declaration of a commitment to Primary Health Care (PHC) as part of its strategy for National Health development. Health spending continues to increase in the areas of secondary and tertiary care and less of the health budget is spent on primary care. The expansion of hemodialysis to meet the growing ESRD population, and an increased incidence of diabetic nephropathy in St. Lucia has implications for the findings of this study. It is important that focus is directed at primary and secondary interventions aimed at reducing cost of diabetic care and consequently complications from diabetes, such as diabetic nephropathy. Primary interventions are the most cost-effective and as such health promotions to reduce risk of developing diabetes, a risk factor for ESRD, needs to become part of the mandate of the Ministry of Health. A policy on chronic diseases develop ed within the primary healthcare plan that currently exists would help guide that focus. The study was limited by the accuracy and quality of the data, which Basch (1999) argues is a recurring problem in developing countries. There are limitations and difficulties in any attempt to calculate the mean cost of a dialysis session, especially in public facilities where cost is subsidized, as every facet of care and cost associated with the session must be taken into consideration. Consequently, assumptions were made on cost for direct and indirect services related to treatment options compared in this study. Assumptions are justified as this is a non-funded research with time constraints and a need to reduce cost drivers. The study was also limited in its perspective as it could not present on national costs from a societal perspective such as the patients ability to work or opportunity costs. Costs from the private facility could not be used as they did not wish to participate in this study. The inability to capture their costs is relevant as they are used by the government to provide dialysis for ESRD patients whose prognosis prevents them from being placed on a waiting list; this cost is incurred by the government. A patient who commenced dialysis at the private facility and transferred to the Renal Unit at the government facility is not distinguished in the patient register. The strength of the research lies in the use of triangulation to gather and analyse data to ascertain their common conclusion, effectiveness based on costs, and QALYs. Decrop (1999) concurs that one of the main ways to avoid the contentious issue of validity and reliability is the use of triangulation. Triangulation involves the use of multiple data sources in the investigation of a research question for justification or clarification, which in this case involved utilizing primary and secondary data, as well as information from the attending physician. Denzin (1978) also claims that triangulation limits personal and methodological bias as well as enhances the studys generalizability. The use of the Markov model is an inherent strength of the study. Gonzalez-Perez, et al. (2005) argue that the models ability to prognosticate relative effectiveness and cost overtime makes it appropriate for modelling chronic treatment options such as Renal Replacement Therapy (RRT). Cost-effectiveness to determine QALYs as well as the use of a standardized instrument to measure QALY also strengthens the findings of the research. The 15D is recognised as generally being a small measurement burden to both respondents and researchers. As an evaluation tool it is highly reliable due to its repeatability of measurements with minimized random error. The results generated are valid because of the degree of confidence that researchers can place in the inferences that are drawn from the scores. Sintonen (2001) posits that as an instrument to measure cost-effectiveness, it is particularly suitable for calculating quality-adjusted life years (QALYs). While the majority of cost-effectiveness analysis of treatment modalities for diabetic nephropathy focuses on the disease at its latent or progressed stage, Glassock (2010) noted that a study by Gearde et al. (2008) identified that early detection of diabetic nephropathy and intensive pharmaceutical interventions are not only cost effective but significantly reduces the risk of ESRD among type 2 diabetics. These findings are replicated in two studies by Keane and Lyle (2003) and Szucs, et al. (2004) who found that Losartan reduced the incidence of ESRD among diabetics. They went on to argue that proteinuria, which is the single most powerful predictor of CKD in type 2 diabetes, is a simple and inexpensive screening test, and early detection can lead to the early administration of drugs that have been proven to reduce ESRD incidence. Mann, et al. (2010) argue caution against population based screening for CKD, and advocate that screening, as a secondary intervention, should focus on at-risk populations. Their study concluded that targeted screening of people with diabetes is associated with an acceptable cost per QALY in publicly funded healthcare systems. Such an approach can be adopted in the health system in St. Lucia. Cost-effectiveness analysis is able to provide valuable insight to prioritizing within healthcare and so the findings of this research will be able to provide evidence to support efficiency in the use of limited resources. Policy-makers would be able to use these findings to review the decision to expand the number of hemodialysis centres in St. Lucia. Further research to identify more cost-effective treatment options would be the first step to improving efficiency of resource allocation. The preliminary findings have not identified whether or not hemodialysis for diabetic nephropathy is cost-effective. The domination of hemodialysis as a treatment modality for ESRD, despite the plethora of studies that have identified it as the least cost-effective of RRTs (Haller, et al., 2011; Just, et al., 2008, Kontodimopoulos Niakas, 2008), provides the health sector with the evidence needed to revise treatment protocols and an opportunity to improve cost-effectiveness of ESRD treatment. This can be achieved by reducing the use of hemodialysis and introducing as an alternative peritoneal dialysis, which has been cited as being the most effective of dialysis options. Just, et al. (2008) caution that the economics of dialysis in the developing world, where labour may be cheaper than the importation of equipment and solutions, may lead to the perception that peritoneal dialysis is more expensive than hemodialysis. They go on to note that this is not conclusive as there is a dearth in economic evaluations in developing countries to substantiate that view. As an alternative, a well developed CKD Care Program is able to significantly reduce the probability of developing ESRD among at risk populations, as well as significantly lower healthcare costs among ESRD patients (Wei et al., 2010). There is a need to expand the services offered by the Renal Unit as well as its coverage to help achieve that end. Conclusion of Preliminary Findings Despite a declared commitment to Primary Health Care (PHC) as a strategy for National Health development, the Ministry of Healths actions have not been consistent with its declaration. Secondary and tertiary care service is posing a great financial burden on the health system, as purported by the preliminary findings of this paper. Evident in the resource allocations for health in St. Lucia, Primary Care Services are allocated a decreasing or stagnant proportion of the health budget, considered against a decreasing allocation of total public expenditure to health. A sustainable health system needs to maximize the use of health resources, creating a more efficient health system that is capable of providing quality health services in a cost-effective manner in order to maximize population coverage. Primary health care needs to become the thrust used to promote efficiency in health as it is recognized as the most cost-effective of interventions. References Basch, P. (1999). Textbook of International Health

The Role of Technology in Automobile Safety :: exploratoty essay research paper

Safety in automobiles always seems to be a large concern for both car manufacturers and buyers alike. While airbags and anti-lock breaks have become a common, yet useful commodity, the increasing role that technology is playing in the development of cars truly shows its potential with these in-the-works safety features. Night Vision Night Vision is a system that uses infrared cameras to help drivers see much farther distances at night while driving. Many different companies are each working on different designs of night vision, but they all have similar ideas. There are several mirrors with little cameras in them placed throughout the car. There is a lightsensing element inside the mirror which is also heat sensitive. Warmer objects, such as people or animals, appear white, while cooler objects, like buildings or trees, appear as various shades of gray or black. The mirrors are also programmed to automatically darken to reduce the glare of oncoming cars. On a clear night, some systems have been able to detect objects more than 1500 feet away which is almost four times as far as a driver can normally see. The only problem with the program is that it isn't as reliable during precipitation. The images aren't as detailed as they normally are. Collision Radar Researchers from Intelligent Vehicle Initiative, a partnershipd between the U.S. Department of Transportation and automobile industries are making advances on systems which, if successful, can tell you if you're about to run off the road or hit another car. The system is a pretty complicated construction of lasers which are set all over the vehicle. Since there are always blindspots, the idea is that the lasers compare the path of your car to the paths and speeds of the vehicles around you. If something is your car's path, collision radar systems can warn you and calculate the distance you have to stop. A camera is even programmed to look for painted lines on the road to determind if you are off center or drifting into another lane. Some advanced systems will even be able to detect lines when snow is covering the ground.

Sqc – Statistical Quality Control

Statistical quality control (SQC) The application of statistical techniques to measure and evaluate the quality of a product, service, or process. Two basic categories: I. Statistical process control (SPC): – the application of statistical techniques to determine whether a process is functioning as desired II. Acceptance Sampling: – the application of statistical techniques to determine whether a population of items should be accepted or rejected based on inspection of a sample of those items. Quality Measurement: Attributes vs Variables Attributes:Characteristics that are measured as either â€Å"acceptable† or â€Å"not acceptable†, thus have only discrete, binary, or integer values. Variables: Characteristics that are measured on a continuous scale. Statistical Process Control (SPC) Methods Statistical process control (SPC) monitors specified quality characteristics of a product or service so as: To detect whether the process has changed in a way that w ill affect product quality and To measure the current quality of products or services. Control is maintained through the use of control charts. The charts have upper and lower ontrol limits and the process is in control if sample measurements are between the limits. Control Charts for Attributes P Charts – measures proportion defective. C Charts – measures the number of defects/unit. Control Charts for Variables X bar and R charts are used together – control a process by ensuring that the sample average and range remain within limits for both. Basic Procedure 1. An upper control limit (UCL) and a lower control limit (LCL) are set for the process. 2. A random sample of the product or service is taken, and the specified quality characteristic is measured. . If the average of the sample of the quality characteristic is higher than the upper control limit or lower than the lower control limit, the process is considered to be â€Å"out of control†. CONTROL CHA RTS FOR ATTRIBUTES p-Charts for Proportion Defective p-chart: a statistical control chart that plots movement in the sample proportion defective (p) over time Procedure: 1. take a random sample and inspect each item 2. determine the sample proportion defective by dividing the number of defective items by the sample size 3. lot the sample proportion defective on the control chart and compare with UCL and LCL to determine if process is out of control The underlying statistical sampling distribution is the binomial distribution, but can be approximated by the normal distribution with: mean = u = np (Note – add the bars above the means used in all the equations in this section) standard deviation of p: sigmap = square root of (p(1 -p ) / n) where p = historical population proportion defective and n = sample size Control Limits: UCL = u + z sigmap LCL = u – z sigma p is the number of standard deviations from the mean. It is set based how certain you wish to be that when a l imit is exceeded it is due to a change in the process proportion defective rather than due to sample variability. For example: If z = 1 if p has not changed you will still exceed the limits in 32% of the samples (68% confident that mean has changed if the limits are exceeded. z = 2 – limits will be exceeded in 4. 5 (95. 5 % confidence that mean has changed) z = 3 – limits will be exceeded in . 03 (99. % confidence) c-Charts for Number of Defects Per Unit c-chart: a statistical control chart that plots movement in the number of defects per unit. Procedure: 1. randomly select one item and count the number of defects in that item 2. plot the number of defects on a control chart 3. compare with UCL and LCL to determine if process is out of control The underlying sampling distribution is the Poisson distribution, but can be approximated by the normal distribution with: mean = c standard deviation = square root of c here c is the historical average number of defects/unit Con trol Limits: UCL = c + z c LCL = c – z c Control Charts for Variables Two charts are used together: R-chart (â€Å"range chart†) and X barchart (â€Å"average chart†) Both the process variability (measured by the R-chart) and the process average (measured by the X bar chart) must be in control before the process can be said to be in control. Process variability must be in control before the X bar chart can be developed because a measure of process variability is required to determine the -chart control limits.R-Chart for Process Variability: UCLR = D4(R) LCLR = D3(R) where is the average of past R values, and D3 and D4 are constants based on the sample size -Chart for Process Average: UCLR = X bar + A2(R) LCL = X bar – A2(R) where X bar is the average of several past values, and A2 is a constant based on the sample size Other Types of Attribute-Sampling Plans Double-Sampling Plan: Specifies two sample sizes (n1 and n2) and two acceptance levels (c1 and c2 ) 1. f the first sample passes (actual defects c1), the lot is accepted 2. if the first sample fails and actual defects > c2, the lot is rejected 3. if first sample fails but c1 < actual defects c2, the second sample is taken and judged on the combined number of defectives found. Sequential-Sampling Plan: Each time an item is inspected, a decision is made whether to accept the lot, reject it, or continue sampling. Acceptance Sampling Goal: To accept or reject a batch of items.Frequently used to test incoming materials from suppliers or other parts of the organization prior to entry into the production process. Used to determine whether to accept or reject a batch of products. Measures number of defects in a sample. Based on the number of defects in the sample the batch is either accepted or rejected. An acceptance level c is specified. If the number of defects in the sample is c the atch is accepted, otherwise it is rejected and subjected to 100% inspection. Sqc – Statistical Quality Control Statistical quality control (SQC) The application of statistical techniques to measure and evaluate the quality of a product, service, or process. Two basic categories: I. Statistical process control (SPC): – the application of statistical techniques to determine whether a process is functioning as desired II. Acceptance Sampling: – the application of statistical techniques to determine whether a population of items should be accepted or rejected based on inspection of a sample of those items. Quality Measurement: Attributes vs Variables Attributes:Characteristics that are measured as either â€Å"acceptable† or â€Å"not acceptable†, thus have only discrete, binary, or integer values. Variables: Characteristics that are measured on a continuous scale. Statistical Process Control (SPC) Methods Statistical process control (SPC) monitors specified quality characteristics of a product or service so as: To detect whether the process has changed in a way that w ill affect product quality and To measure the current quality of products or services. Control is maintained through the use of control charts. The charts have upper and lower ontrol limits and the process is in control if sample measurements are between the limits. Control Charts for Attributes P Charts – measures proportion defective. C Charts – measures the number of defects/unit. Control Charts for Variables X bar and R charts are used together – control a process by ensuring that the sample average and range remain within limits for both. Basic Procedure 1. An upper control limit (UCL) and a lower control limit (LCL) are set for the process. 2. A random sample of the product or service is taken, and the specified quality characteristic is measured. . If the average of the sample of the quality characteristic is higher than the upper control limit or lower than the lower control limit, the process is considered to be â€Å"out of control†. CONTROL CHA RTS FOR ATTRIBUTES p-Charts for Proportion Defective p-chart: a statistical control chart that plots movement in the sample proportion defective (p) over time Procedure: 1. take a random sample and inspect each item 2. determine the sample proportion defective by dividing the number of defective items by the sample size 3. lot the sample proportion defective on the control chart and compare with UCL and LCL to determine if process is out of control The underlying statistical sampling distribution is the binomial distribution, but can be approximated by the normal distribution with: mean = u = np (Note – add the bars above the means used in all the equations in this section) standard deviation of p: sigmap = square root of (p(1 -p ) / n) where p = historical population proportion defective and n = sample size Control Limits: UCL = u + z sigmap LCL = u – z sigma p is the number of standard deviations from the mean. It is set based how certain you wish to be that when a l imit is exceeded it is due to a change in the process proportion defective rather than due to sample variability. For example: If z = 1 if p has not changed you will still exceed the limits in 32% of the samples (68% confident that mean has changed if the limits are exceeded. z = 2 – limits will be exceeded in 4. 5 (95. 5 % confidence that mean has changed) z = 3 – limits will be exceeded in . 03 (99. % confidence) c-Charts for Number of Defects Per Unit c-chart: a statistical control chart that plots movement in the number of defects per unit. Procedure: 1. randomly select one item and count the number of defects in that item 2. plot the number of defects on a control chart 3. compare with UCL and LCL to determine if process is out of control The underlying sampling distribution is the Poisson distribution, but can be approximated by the normal distribution with: mean = c standard deviation = square root of c here c is the historical average number of defects/unit Con trol Limits: UCL = c + z c LCL = c – z c Control Charts for Variables Two charts are used together: R-chart (â€Å"range chart†) and X barchart (â€Å"average chart†) Both the process variability (measured by the R-chart) and the process average (measured by the X bar chart) must be in control before the process can be said to be in control. Process variability must be in control before the X bar chart can be developed because a measure of process variability is required to determine the -chart control limits.R-Chart for Process Variability: UCLR = D4(R) LCLR = D3(R) where is the average of past R values, and D3 and D4 are constants based on the sample size -Chart for Process Average: UCLR = X bar + A2(R) LCL = X bar – A2(R) where X bar is the average of several past values, and A2 is a constant based on the sample size Other Types of Attribute-Sampling Plans Double-Sampling Plan: Specifies two sample sizes (n1 and n2) and two acceptance levels (c1 and c2 ) 1. f the first sample passes (actual defects c1), the lot is accepted 2. if the first sample fails and actual defects > c2, the lot is rejected 3. if first sample fails but c1 < actual defects c2, the second sample is taken and judged on the combined number of defectives found. Sequential-Sampling Plan: Each time an item is inspected, a decision is made whether to accept the lot, reject it, or continue sampling. Acceptance Sampling Goal: To accept or reject a batch of items.Frequently used to test incoming materials from suppliers or other parts of the organization prior to entry into the production process. Used to determine whether to accept or reject a batch of products. Measures number of defects in a sample. Based on the number of defects in the sample the batch is either accepted or rejected. An acceptance level c is specified. If the number of defects in the sample is c the atch is accepted, otherwise it is rejected and subjected to 100% inspection.

Essay on Belief and Trans Verb

Essay on Belief and Trans Verb Essay on Belief and Trans Verb bolster: TRANS VERB to encourage or lend support to. Syn: block, undermine Her words bolstered me in those dark times. bountiful: ADJ liberal in giving; generous. Ant: niggardly, stingy Matt's bountiful compliments to his teachers on a daily basis made him a favorite on the team disclose: TRANS VERB to make known; reveal Ant: conceal, hide, suppress The reporter was unwilling to disclose the name of her source. dogmatic: ADJ asserting beliefs and opinions as though they were proven facts. Matt's dogmatic speech, although opinion-based, was very convincing enterprising: ADJ bold, energetic, and full of initiative. Ant: lazy, unenterprising, unimaginative As a result of her enterprising attitude, Mary was chosen by her teachers as Student of the Month. illuminate: TRANS VERB to make clear or understandable; clarify; explain. Ant: confuse, darken, obscure The footnotes help to illuminate the text. to give knowledge to; enlighten Will you illuminate us as to your intentions? integrity: NOUN a strong sense of honesty and morality; firmness of moral and ethical character. Ant: dishonesty He showed great integrity when he refused to lie for his employer. muster: TRANS VERB to gather up or call forth (often followed by up). He mustered up all his strength and pushed the truck over. pivotal: ADJ critically important or crucial; on which something is contingent It is pivotal to your academic success to stay on top of your homework assignments.

The eNotes Blog Eight Million Stories Humans of New YorkProject

Eight Million Stories Humans of New YorkProject â€Å"There are eight million stories in the Naked City. This has been one of them.†    From The Naked City In 2010, Brandon Stanton lost his job as a trader in Chicago.   Despite his mothers objections, Stanton moved to New York City to pursue the latest thing with which he had become borderline-obsessed:   photography. At first, Stanton was only snapping pictures of the citys residents. His original goal was simply to photograph 10,000 New Yorkers and plot their photos on a map.   But after a few months, Stanton began adding captions and commentary to the photographs.  Ã‚   Taken together, the photographer explains,   these portraits and captions became the subject of a vibrant blog, which over the past two years has gained a large daily following. With nearly one million collective followers on Facebook and Tumblr, HONY now provides a worldwide audience with glimpses into the lives of strangers in New York City. In The Great Gatsby, F. Scott Fitzgerald called New York City the wild promise of all the mystery and beauty in the world.   Some eighty-eight years later, it still holds all that mystery and beauty, and through his lens and careful attention, Stanton helps develop those stories in colorful resolution. The following are just a few of my favorite images and stories. Follow Humans of New York here. I found these two in Central Park. After I took their photo, I began to ask Dad some questions, but ended up getting some perfectly valid, yet generic responses: What was your happiest moment? When my daughters were born. What’s the  proudest you’ve been of your daughter? I’m always proud. What was the saddest moment of your life? I’d rather not say. After a few more attempts, I resigned myself to the fact that the man wasn’t going to reveal any details about his life. His reserve was perfectly understandable, but I left a bit downtrodden. Because I loved the photo and was hoping to pair it with a great caption. When I got home, there was an email in my inbox: Dear Brandon, I saw you in Central Park this evening with my daughter (red head). You asked me about my happiest day I told you when my daughters were born (I meant it). You asked me what the saddest day in my life was i told you I’d rather not answer. Well, it was Aug 12, 2006 on that day, my wife and I lost our first baby she was 36 weeks pregnant (his name was Peter). It was horrible. But now we have 2 beautiful little girls, so Im grateful. The reason I was unable to provide a specific answer to questions about my happiest day or what makes me proud about my girls because everything does. Thank you. I’m an artist. I paint murals. What would you say to a young artist? Fuck the rules. This man was cruising through Central Park, while his dog jogged out in front of him. â€Å"They keep trying to give us tickets, said the man, â€Å"So I taught him a trick. Watch this. He shouted: â€Å"Police! And the dog jumped up on the scooter. She does her thing, I do my thing. We interact in between. We’ve been married 30 years, and that’s how we like it. The girl on the right told me she wanted to be a veterinarian. Then, almost as an afterthought, she threw in- â€Å"Also, the President of America. Charmed by her extremely ambitious postscript, I chuckled a bit.What are you laughing at? said Dad. What are you reading? Rimbaud. He’s a 19th Century French poet that turned romanticism on its head. Before him, poets tended to associate nature with order and harmony, and extended that to man. He was the first to really describe nature and man as chaotic and unpredictable. He was especially good at expressing teenage angst. OK, I’ll give you 60 seconds to find a passage that demonstrates what you just said. Here’s what he chose: The wolf howled under the leaves / And spit out the prettiest feathers / Of his meal of fowl: / Like him I consume myself. (Hey, is it just me or does this girl remind you of a Robert Crumb drawing too) She agreed to a photograph, but seemed a bit uneasy about the whole â€Å"being interviewed by a stranger thing. I really liked the photo, so I kept trying questions, hoping to strike on one she felt comfortable answering- but no luck. Eventually she said: â€Å"This feels like a really bad date. If you could give one piece of advice to a large group of people, what would it be? Stay away from large groups of people. What’s your favorite thing about your dad? He works really hard outside. But after that, he still rides bikes with me. You know the scariest drug I ever did? What’s that? Sobriety. I tried that shit, and suddenly I realized that my girlfriend was insane and all my friends were assholes.

Rewarding team performance Essay Example | Topics and Well Written Essays - 1250 words

Rewarding team performance - Essay Example There is a perception that rewards are often more costly for the employer but to have a motivated and enthusiastic team gives much more returns to the business and even contributes towards the growth which are much more profitable for the firm in comparison to the cost that the employer incorporates reward system. Rewarding team performance can be defined as a mechanism through which the employees are motivated to create more high standards of performance so as to contribute towards the growth and success of the organization (Armstrong, 2012). It can also be termed as acknowledging the hard work of the team to achieve the common goal by the management. According to Bob Nelson in his book, â€Å"1001 ways to reward employees† states that there are many different forms of schemes for rewards that are used by many organizations to reward and motivate their staff. The rewards that are given to the employees can be very costly or less costly but all that should be taken into consideration by the employer is that the rewards that are given should be of value to the employees and the entire system of rewarding should be unbiased where the same team member should not be given rewards. An organization that has lower budget for their reward system can use methods such as a voucher, thank you note, cake, etc., to appreciate performance of the team. The organization with a bigger budget for the team reward system can incorporate measures such as team events, lunch, a holiday package, etc. The most formal way of rewarding team performance is through bonuses, increase in salaries, promotions, etc. The bonuses or salaries that are linked to the performance require an organization to set goals or KPIs so as to measure the overall performance or that of an individual. The incentives then can be classified as performance related bonus as team or individual basis on achieving the goals, performance

World Trade Organization and tariffs Assignment Example | Topics and Well Written Essays - 500 words

World Trade Organization and tariffs - Assignment Example Tariffs also have been used in providing additional revenue for the government and to domestic producers at the expenses of foreign producers and customers (Alexander and Andenà ¦s, 38). This is used as one of the tools to shape policies of trade. Types of barriers imposed by Saudi Arabia for exports and importsThere are different trade barriers that are used in Saudi Arabia. The first strategy that has been used is tariffs. Saudi Arabia implies the GCC common external tariffs of five percent of most of the products used in the nation with limited number of expectation. Saudi Arabia implies twelve percent on the local products in some cases to protect the industries of the nations. Textile products are among the products that implies the 12 per cent import tariffs. Higher rates of the tariffs implies to smaller group. There is also implication of 15 per cent for other products such as aluminum and furniture. Majority of food products are subjected to five percent import duty. The le vel of imports duties ties to the level of local production of similar goods. Import prohibitions and licensing either is used in Saudi Arabia where the importation of certain articles is the prohibition of some goods or require approval from other appropriate authority. In the country, there is prohibition of goods such as pork products, used clothing, firearms, and automobiles (Alexander and Andenà ¦s, 33). Importation of some products requires special approval such as agricultural feeds, books, visual or audio media and religious materials.