Sickle Cell Anemia Essays - RTT, Hematopathology, Hemoglobins

Sickle Cell Anemia The problem is that sickle cell anemia affects about 72,000 Americans in the United States. Sickle cell anemia is an inherited disease in which the body is unable to produce normal hemoglobin, an iron-containing protein. Abnormal hemoglobin can morph cells that can become lodged in narrow blood vessels, blocking oxygen from reaching organs and tissues. The effects of sickle cell anemia are bouts of extreme pain, infectious, fever, jaundice, stroke, slow growth, organ, and failure. Sickle cell anemia hurts many people today in fact it hurts about 72,000 Americans. But some doctors are finding cures for this inherited disease. This disease causes mainly strokes and fever. With this disease a stroke is not predictable, a stroke can happen as early as a one month old as a baby. It can hurt a person really bad because it causes them to not be able to do many things like can't play sports, and things that gets your heart pumping because if the red blood cells gets clogged up it can causes a stroke because oxygen can't flow. Most Americans who have sickle cell anemia are of African descent. The disease also affects Americans from the Caribbean, Central America, and parts of South America, Turkey, Greece, Italy, the Middle East and East India. Since sickle cell anemia is an inherited disease if both parents have the trait for sickle cell, their baby's chances of having sickle cell disease is one in four. Many doctors are trying to find cures for this disease by trying the solution on patients. Doctors at Emory University and University of Mississippi Medical Center in Jackson, Chicago. Doctors in Emory University in Atlanta credited an experimental stem cell transplant that for the first time is not from a related donor. This transplant cured the inherited disease from Keone Penn who is 13 years old from Georgia. He suffered a stroke at 5 years old and had a fever of 106 degrees, "I almost died" (Ferraro, Newspaper Article) What the doctors did was replaced the boy's bone marrow with stem cells taken from the umbilical cord blood of an infant not related to him. Dr. Ruby Bellevue of New York Methodist Hospital in Brooklyn has patient that he wants to do the transplant procedure on, but he is waiting for more studies to come out to see what the long-term effects are. Some effects could be rejection, complications, and/or death. For many years, doctors could only treat the sickle cell disease with blood transfusions and antibiotics. But until now, the only hope for a cure has been through bone marrow transplants, dangerous and rarely performed because they require a match between donor and the person receiving it. The good thing about stem cell transplants is does not require as precise a match. For Keone the 13 years old kid was worth it. "I am happy. This has been my wish my whole life, to not have sickle cell." (Ferraro, Newspaper Article) The doctors of University of Mississippi Medical Center use Doppler ultrasound to examine head and neck blood flow. The ultrasound measures the speed of the blood in the vessels. Early detection can help and decrease the risk of stroke. The program involved in this problem is the National Institutes of Health declared September as Sickle Cell Awareness Month. The educational and research organization have promoted awareness of sickle cell disease, a group of inherited disorders characterized by anemia which means a reduced number of red blood cell and the production of sickle hemoglobin is a molecule found in red blood cells that carries oxygen from the lungs to other parts of the body. My suggestion for dealing with this problem is to go to the doctor to get an examination if you play any sports or go for a jog or run and experiment any difficulty breathing. If you don't have trouble breathing, maybe if you feel dizzy or feel like you about to blackout when you do something I recommend going to the doctors for an examination. It is better to find out the problem first before you will experiment a stroke a high fever that can cause a death. I think early detection help a lot and could

What Contributions Did Florence Nightingale Make To The Deve essays

What Contributions Did Florence Nightingale Make To The Deve essays The majority of medical workers in the 19th century had very little training and skill; a surgeon would have learnt how to operate by becoming the apprentice of another surgeon. Nurses were seen to be quite low in society, what with being surrounded with poorly members of the public and having to work in filthy and very unpleasant conditions. The hospitals they had then were typically rat-infested, the wounded on the floor rather than on beds, with very low supply of bandages and no soap, towels or washing material. This quite clearly explains why Florence Nightingales family were utterly against her wishes to go into nursing. Florence Nightingale was born in 1820 to a wealthy family. She was given first class schooling and lived in a comfortable environment. The idea of someone in her position wanting to go into work, let alone nursing, was seen as preposterous. Nightingales family her mother especially - had no interest in her wishes. Then finally, Florences father gave h er 500 (a large sum of money in those days) to go and study nursing in Germany. During the Crimean War Florence Nightingale was working in the British barracks-hospital in Scutari (now part of Turkey), looking after the wounded soldiers who had been battling for Britain. The death rate of the wounded soldiers was exceedingly high. Florence Nightingale introduced very strict sanitation standards. The death rate within the hospital dropped by a substantial amount. After the war Nightingale returned home to a heros welcome. She promoted nursing as a professional medical career. She founded a training school at St Thomas Hospital and an army medical school. In 1869 she stayed in her home as a hermit, but still contributed administratively to the development of nursing in Britain and to the well being of patients in hospitals. In conclusion Florence Nightingale contributed a great deal to the development ...

The Cold War and U.S. Diplomacy Essay Example | Topics and Well Written Essays - 750 words

The Cold War and U.S. Diplomacy - Essay Example Reagan claimed that most people did not understand the functioning of Nicaragua, as they only knew it as a Marxist country but many were not for the idea of exchange of money and weapons and this made it difficult for the U.S to bring in funding (Bermann, Page 9, 1996). The Reagan Doctrine was out to offer both covert and overt support to resistance movements and anti-communists guerrillas so as to have the governments backed by the Soviet governments in Asia, Latin America and Asia. The doctrine was designed to cut down on the general Cold War strategy administration. After Reagan’s election in the year 1981, he decided to support the resistance revolutions in countries like Angola, Nicaragua, Afghanistan and Cambodia. In May 1982, Reagan approved a document which was referred to as, U.S National Strategy, which its main purpose was stop and overthrow the development of soviet management and the presence of armed forces worldwide, and also to increase the cost of support that was being provided by the soviet and increase the use of rebellious rule at the same time collaborating with the terrorist. Reagan started a campaign for the community to support his plans by using some of the strong statements to prove it. For example in 1985, he said that the U.S citizens were not to lose faith in those who were able to risk their lives for their country worldwide even in the dangerous continents like Afghanistan (Burns, page 89, 1999). One year down the line, he stated that America was going to support both morally and substantially those who were ready to fight for the freedom of their nation even if it included dying. Reagan’s destructive policies and measures caused much damage in many countries. The exploitation and management of the banks by the U.S for example that was practiced in Nicaragua led to the decimation of its economy. War on the Sandinista national liberation front was funded by the administration that the congress played a role in suppor ting it. This was a war that several terrorist from Nicaraguan, which was referred to as Contra, fought and its main aim was to conquer the Sandinistas who after the 1979 revolution, took over power (Flanagan, page 25, 2000). In 1981, was the year that establishment of Contra forces started and Reagan funded the Central Intelligence Agency by authorizing the release of large sums of money. There was also the generation of extra money from illegal sales of weapons to Iran which was channeled to the Contras. These illegal actions were later known in Iran Contra Affair in the month of November in 1986, which led to condemnation and conviction of his staff. The collapse of the FSLN (Frente Sandinista de Liberacion Nacional) in the 1980s was as a result of the U.S continuous hostility. The victory of the contra military was not the cause of the fall of the Sandinista, but it was because of the U.S economic blow, the restrictions on trade and the social and economic attack of the nation. President Daniel Ortega finally accepted that he was defeated in the 1990 elections due to the persistent economic failure and handed over the government to the conservative who emerged the winners (Oberdorfer, page 71, 1999).. The elections however were not held as a result of Reagan’s pleas but to others efforts especially President Oscar Arias. He was the one who held the negotiations of a peaceful handover

Develop an arguable, creative, and unique thesis about one theme in Essay

Develop an arguable, creative, and unique thesis about one theme in The complete Persepolis - Essay Example The author uses religion as a theme in the book on several occasions. For instance, Marjane introduces herself to the reader that she comes from a religious family yet her family is not religious. As observed at the beginning of the book, â€Å"I was born with religion† (Satrapi 6) according to Islam religion, God is viewed as a unique sustainer of the entire universe and accords favor upon those who call upon Him. God is the sovereign in the spiritual aspect of people’s lives and also the physical. Marjane at the tender age of ten believed in God and set out her imaginations of God for answers. Marjane mimic the historical revolutionaries in her dressing and pretends to be Cheguavera and Fidel Castro. This imaginative character in Marjane’s autobiography that offers a comic relief of macabre imaging of revolution and war in Iran at that time is seen. The religion of Marjane helps her to endure through hard times. She believes in religion as she even claims that she is a religious prophet. She emphasizes this by telling her teacher in the class that she want to be a prophet in future. When her belief in class is isolated, and her religion taken away from her, hope is lost for a while. Religion is forced on many women, through wearing a veil. The religion revolution of Iran had a significant role; they were two different parties who participated in the revolution religion. One party involved those who were trying to strengthen the religion in Iran while the other party involved people who were focused on modernizing Iran. This situation is seen and forecasted by Marjane as evident that she is a prophet, she claims â€Å"I want to be a prophet† (Satrapi 6). The Guardians of Revolution, who are focused to make Iran a religion country, detain anyone who breaks the rule of faith, just as they stopped the family of Marjane. Thos e who fail to

Oral immunotherapy for food allergy Research Paper - 1

Oral immunotherapy for food allergy - Research Paper Example In general, failure to avoid food allergen can trigger signs and symptoms related to allergic rhinitis, asthma, atopic dermatitis, and other types of food allergies (Steinman, 2010; CDC, 2008). As a type of immunological disease, having an allergy on food can significantly affect the socio-economic situation and quality of life of each person (Castellazzi et al., 2013). Aside from losing work productivity, the economic cost of food allergy can reach up to US$24.8 billion in which the direct cost of medication, hospitalization and healthcare visitations can be as high as US$4.3 billion each year (Gupta et al., 2013). Around the world, roughly 6% to 8% of all children have been affected by food allergy during their childhood life (Gupta et al., 2011; Steinman, 2010). In line with this, almost 15 million Americans have or had experience some sort of food allergies (news-journal, 2014). Among children, the Centers for Disease Control and Prevention (CDC) reported that the prevalence rate of food allergy at 5% is equal to young individuals between the age group of 0 to 4 years old, 5 to 9 years old, and 10 to 17 years old (CDC, 2013). Today, food allergy has been considered as one of the most common health problems among children (CDC, 2008). In general, the process of having severe food allergies can adversely affect or impair the quality-of-life of each person (Anagnostou et al., 2014; Clark et al., 2009). In one of the studies that were conducted by Gupta et al. (2011), the authors mentioned that 30.4% of these children had more than one type of food allergy and that almost 38.7% of children with food allergy had experienced some sort of a severe reaction. Even though Lyons and Forde (2004) pointed out that most people with food allergy does not consider this particular health situation to have a significant impact in

The Importance Of Core Communication Skills Social Work Essay

The Importance Of Core Communication Skills Social Work Essay According to Nelson (1980) social work was one of the first professions to recognise the importance of communications skills and the link to effective practice. Communication skills can be essential to the task of assessment, interviewing and later decision making for social workers. In practice, communication tends to be defined primarily as: The verbal and nonverbal exchange of information, including all the ways in which knowledge is transmitted and received (Barker, 2003: 83 in Trevithick, 2005, p 116). The latter elements of communication, which can often translate the emotional content of the communication, are also referred to as interpersonal skills. According to Thompson (2002) social workers use such skills to communicate ethically sensitive practice (p.307). The purpose of this essay is to highlight the role and importance of verbal and non verbal communication skills involved in social work practice. According to Koprowska (2008) communication is both interactive and context related. Therefore, careful consideration needs to be taken when communicating. There may be several barriers involved in communication, such as: authority; language; ability; personality; gender; age; and class (Thompson, 2009). True communication can only be achieved if the barriers are identified and removed. This can be attained by the practice of an anti oppressive and anti discriminatory approach to communication on the part of the social worker. Verbal Communication In practice good communication skills, practically listening and interview skills, are crucial for establishing efficient and respectful relationships with service users and lie at the heart of best practice in social work (Trevithick, 2005, p116). Social workers must demonstrate several skills while assessing or interviewing a client. Verbal communication is a key skill in social work practice and refers to face to face interactions and involves the impact of the actual words we use in speaking (Thompson, 2009, p100). It is importance for social workers to be aware of how and what they say in certain situations; for example, in regards to the issue of formality. If the social worker does not access the situation correctly they may be conceived as being too formal or informal and thus will inevitable create barriers. Further, many service users tend to come from vulnerable sections of society. It is possible that their involvement with social workers may invoke feelings of shame or f ear. It is likely that this will then leave them vulnerable to feeling misunderstood and not listened to. It is therefore fundamental that social workers treat each client as an individual and assess their situation as a unique case. In order to build a good relationship with each client the social worker must demolish any power or untrusting issues that may be present. This power may be either perceived or real in certain situations. For that reason, congruence plays an important role during the interview process. It may not be completely possible to eradicate the power imbalance but it is a key skill to be aware of the need to achieve congruence. This can be active by using the appropriate language so that the client can fully understand and be listened to. It is through such skills that social workers can convey genuine warmth, respect and non-judgement for the service user. Indeed, verbal communication skills also play a major role when working with other colleagues and professi ons, and are essential for decision making and assessments (Cournoyer, 1991). Non Verbal Communication Non verbal communication is a major component for interpersonal skill repertoire and includes posture, facial expression, proxemics, eye contact, and personal appearance (Kadushin and Kadushin, 1997, in Trevithick, 2005, p120), and it can support or contradict verbal communication. The importance of non-verbal communication is not a new concept in the social work field, in an article by DiMatteo, Hays, and Prince (1986) maintained that there are two dimensions of nonverbal communication, firstly decoding or sensitivity and secondly encoding or expressiveness. According to DiMatteo et al nonverbal decoding refers to the capacity to understand the emotions conveyed through others nonverbal cues such as facial expressions, body movements, and voice tone. Nonverbal encoding refers to the capacity to express emotion through nonverbal cues (p 582).For example, much of the understanding of non verbal communication can be gathered through using observation skills. Observation skills can be v ital for social workers interviewing a client. According to Kadushin and Kadushin (1997) there are five thousand distinctly different hand gestures and one thousand different steady body postures so precise observation of non-verbal behaviour is important(P 315). The client may tell the social worker they are coping fine and dont need any help but by observing their facial expression or lack of eye contact they may contradict this. Sheldon stresses that social workers must be aware of their own capacity for self-observation, although always somewhat limited, provides us with an opportunity to analyse our own role and impact. (Sheldon 1995: 132-3 in Trevithick, 2005, p123). Active listening Research has verified listening as the most utilized form of communication. If frequency is a measure of importance, then listening easily qualifies as the most prominent kind of communication (Adler Rodman, 1997, p. 283). Listening may appear to be straightforward but active listening skills need to be learned, practised in training, developed and refreshed for effective use in real situations. Active listening describes a special and demanding alertness on the part of the social worker involved in interviewing a client. For Egan, active listening is about being present psychologically, socially and emotionally, not just physically (Trevithick 2005,p.123). By using skills such as paraphrasing, reflective questioning and open and closed questioning the social worker can convey full interest and understanding to a vulnerable client. Self awareness The concept of self-awareness is important in social work interviewing. Burnard (1992) defines self awareness as the process of getting to know your feelings, attitudes and values (in Thompson, 2009, p.3). A key aspect of self awareness is being aware how we may be perceived by others. In regards to interviewing the social worker may believe they are being laid back, however for the client it may be conceived as being uncaring. Supervision is therefore an important tool to gain feedback and explored any issues. Further importance of self awareness included understanding how possible external factors may affect social workers. Social workers need to aware of concepts such as transference, triggers and blind spots during interviewing process. Thompson stressed that the worker can be affected by a situation without knowing. Therefore, the use of self is extremely important. Empathy Empathy is another important communication skills involved in social work interviewing. This skill involves understanding or appreciating the feelings of others, but without necessarily experiencing them (Thompson 2009, p111). Social workers must show sensitivity and respect to the feelings of the client. There is however a difference between sympathy and empathy. Therefore there is a fundamental skill to achieving empathy not merely expressing sympathy. It is clear from the above information that the failure to achieve efficient communication between the social worker and client can lead to serious consequences. Poor communication can contributed to the harm and inadequate care clients. For example, in recent times such failures of communication among a range of professionals have been highlighted in the public inquiries into the death of several children known to be in the care of social services.(rewrite) Personal Learning

Panama History and Culture Essays -- Panama Historical Cultural Essays

Panama History and Culture The culture and political structures of Panama as we know it today has evolved from an incredibly diverse and interesting history. Geographically, Panama lies on an isthmus, a strip of land that essentially connects the greater landmasses of North and South America. It is believed that volcanic activity in the late Pliocene era closed the former Central American Seaway that had separated the two continents. The climatic implications of this landform are incredible, allowing for the redistribution of oceanic currents and the formation of the Gulf Stream of the Atlantic of today. The native populations of Panama include the Chibchan, Chocoan, and Cueva communities, and like the fates of many indigenous populations in a period of European colonization, they were dealt a poor hand. In the early 1500s, Rodrigo de Bastidas from Spain became the first European to officially explore the Isthmus. Alonso de Ojeda and Diego de Nicuesa were granted permission to begin colonization shortly after, in 1509. Thus the first European colonies in Panama emerged, and the Spanish-influenced culture of Panama began to unfold. Many of the native populations chose to relocate to the surrounding islands, away from Spanish influence. Panama remained under Spanish control until the 1800s. In 1801, the Panamanian communities began the move toward independence. In November of 1821, General Josà © de Fà ¡brega met with the separatists in the Capitol, and the group called for a national assembly, in which representatives from every region in Panama came to convene on November 10th. At this assembly it was officially declared that Panama was severing its ties to the Spanish, and ... ... Health Perspectives, Vol. 109, Supplement 2. (May, 2001), pp. 191-198. Mà ©ndez, J. Ignacio. â€Å"Azul y Rojo: Panama's Independence in 1840.† The Hispanic American Historical Review, Vol. 60, No. 2. (May, 1980), pp. 269-293. Moreno, Stanley Heckadon. â€Å"Impact of Development on the Panama Canal Environment.† Journal of Interamerican Studies and World Affairs, Vol. 35, No. 3, Special Issue: The Future of Panama and the Canal. (Autumn, 1993), pp. 129-149. Russell, Graham. â€Å"Hurricane Mitch and Human Rights†. Development and Practice, Vol. 9, No. 3. (May, 1999), pp.322-325. Weeks, John; Zimbalist, Andrew. â€Å"The Failure of Intervention in Panama: Humiliation in the Backyard.† Third World Quarterly, Vol. 11, No. 1. (Jan., 1989), pp. 1-27. www.cnn.com (CNN Website) www.history.com (History Channel)

Thesis Titles

Nueva Ecija University of Science and Technology College of Architecture AR-443 Assignment In Research Method Submitted By: Neonimfa G. Angala Ar-4A Submitted to: Arch. Ofelia M. Bawan Title: VERTICAL HOUSING + SMALL SCALE FARM (hydroponics and aeroponics) Abstract: Agriculture is the main industry of the people because of its naturally rich soil. Lowland crops such as rice, corn, onions, vegetables and sugarcane are produced in great quantities and Nueva Ecija is widely referred to as the Rice Bowl of the country. Agriculture has played a vital role in molding the culture of the people.The typical Novo Ecijano family is tightly knit and is the basic working unit on the farm. Nueva Ecija is one of the top producers of agricultural products in the country. Its principal crops are mainly rice but corn and onion are also produced in quantity. The province is often referred to as the â€Å"Rice Granary of the Philippines. † Other major crops are onion, mango, calamansi (calamondin orange), banana, garlic, and vegetables. The town of Bongabon at the eastern part of the province at the foot of the Sierra Madre Mountains and its neighbouring Laur and Rizal are the major producers of onion and garlic.Bongabon is called the â€Å"onion capital of the country†. A sunflower farm is also housed inside the Central Luzon State University campus in Science City of Munoz. Nowadays in Nueva Ecija most of the farmlands were turn to subdivisions and sometimes commercial buildings and houses. To have a solution to these problems, the purpose of this project is to have a spacious place for dwelling and for farming without losing the farmland in the Nueva Ecija. It also aims to have a land for those people who want to farm exactly inside his property without buying any farmlands. Instead of horizontal widening, it is vertically. Title:How Architects Manage his Time Between God and his Profession. Abstract: Man was designed with a great capacity for God. But sin, which is man’s own individuality, pride and wrong thinking, keeps him from relating to God. Sin is a wrong relationship with God – it is not wrong doing, but wrong being – it is deliberate and stubborn independence from God, triggered by choice and personal insecurity masked as pride. He has the freedom to make choices, but he cannot choose the consequences of his choices. They will turn around and define his circumstances. Spending time for work and for God is hard specially if one choose work over God.The problem is can architects manage to equally spend their time praising God and doing work? How can it change his life if he choose God instead of work? Title: Edutainment: An Eco-Friendly Educational Amusement Park Abstract: Amusement parks  and  theme parks  are terms for a group of  entertainment  attractions,  rides, and other events in a location for the enjoyment of large numbers of people. An amusement park is more elaborate than a simple city park or  playground, usually providing attractions meant to cater specifically to certain age groups, as well as some that are aimed towards all ages.Theme parks, a specific type of amusement park, are usually much more intricately themed to a certain subject or group of subjects than normal amusement parks. Nowadays some schools hold field trips to amusement parks may be because amusement parks don’t have educational purposes for the students and other spectators. The usual amusement park is just filled with rides and for leisure only. The project aims to be educational at the same time having a great time inside the amusement park for the students and also for young children to learn faster. With great sustainable ways that can help the amusement park to be an eco-friendly.

A Beginners Look at the Subjunctive Mood in Spanish

A Beginners Look at the Subjunctive Mood in Spanish One of the most confusing aspects of Spanish for beginners is the subjunctive mood. In fact, it usually isnt taught, at least to those using English as a first language, until at least the intermediate level. But even as a beginning Spanish student, you should be aware of what role the subjunctive mood plays, if only so you can recognize it when you come across it in speech or reading. What is the Subjunctive Mood? The mood of a verb, sometimes known as its mode, indicates what type of role it plays in a sentence and/or the speakers attitude toward it. For the most part, in English as well as Spanish, the most common verb mood is the indicative mood. In general, it is the normal verb form, indicating both action and state of being. Both Spanish and English have two other verb moods. One of them is the imperative mood, used in making direct commands. For example. the Spanish Hazlo, and its direct English equivalent, Do it, use a verb in the imperative mood. A third mood, extremely common in Spanish and other Romance languages such as French and Italian, is the subjunctive mood. The subjunctive mood also exists in English, although we dont use it very much and its use is less common than it used to be. (The were in if I were you is an example of the subjunctive mood in English.) Without limiting yourself much, you can speak English for days and get by without using a subjunctive form. But that isnt true in Spanish. The subjunctive mood is essential to Spanish, and even many simple types of statements cant be made properly without it. In general, the subjunctive is a verb mood that is used to express an action or state of being in the context of the speakers reaction to it. Most commonly (although not always), the subjunctive verb is used in a clause that starts with the relative pronoun que (meaning which, that or who). Frequently, the sentences that contain a subjunctive verb are used to express doubt, uncertainty, denial, desire, commands, or reactions to the clause containing the subjunctive verb. Comparing the Indicative and Subjunctive Moods The most important differences between indicative and subjunctive moods can be seen by comparing two simple sentences: Indicative: Los hombres trabajan. (The men are working.)Subjunctive: Espero que los hombres trabajen. (I hope the men are working.) The first sentence is in the indicative mood, and the mens working is stated as a fact. In the second sentence, the mens working is placed in the context of what the speaker hopes for. It isnt particularly important to the sentence whether men work or not; what is important is the speakers reaction to it. Note also that while the Spanish distinguishes the subjunctive through the conjugation of trabajar, no such distinction is made in English. Although not common, sometimes a Spanish sentence using the subjunctive is translated to English using the subjunctive: Indicative: Insisto que Britney est sana. (I insist that Britney is healthy.)Subjunctive: Insisto en que Britney està © feliz. (I insist that Britney be happy.) Note how the first sentence in both languages asserts Britneys health as a fact. But in the second sentence, her health is stated as a strong desire. Insist is one of very few verbs in English that can trigger the subjunctive mood, but Spanish has thousands of such verbs. The following sentences show other reasons for using the subjunctive; note how a distinctive subjunctive form is used in English in only the final translation. Indicative (statement of fact): Britney est sana. (Britney is healthy.)Indicative (statement of fact): Sà © que Britney est sana. (I know that Britney is healthy.)Subjunctive (doubt): No es cierto que Britney està © sana. (It is uncertain that Britney is healthy.)Subjunctive (likelihood): Es probable que Britney està © sana. (It is likely that Britney is healthy.)Subjunctive (denial): No es verdad que Britney està © sana. (It is not true that Britney is healthy.)Subjunctive (reaction): Estoy feliz que Britney està © sana. (I am happy that Britney is healthy.)Subjunctive (permission): Es prohibido que Britney est sana. (It is prohibited for Britney to be healthy.)Subjunctive (desire): Espero que Britney està © sana. (I hope that Britney is healthy.)Subjunctive (preference): Preferimos que Britney està © sana. (We prefer that Britney be healthy.) Recognizing the Subjunctive Mood In everyday Spanish, the subjunctive is used in only two of the simple tenses, the present and the imperfect (a type of past tense). Although Spanish has a future subjunctive, it is nearly obsolete. While you may not need to memorize the subjunctive conjugations as a beginning Spanish student, becoming familiar with them can help you learn to recognize them.. Here are the subjunctive forms for regular -ar verbs, using hablar as an example: Present subjunctive: yo hable, tà º hables, usted/à ©l/ella hable, nosotros/nosotras hablemos, vosotros/vosotras hablà ©is, ellos/ellas hablen.Imperfect subjunctive: yo hablara, tà º hablara, usted/à ©l/ella hablara, nosotros/nosotras hablaramos, vosotros/vosotras hablareis, ellos/ellas hablaren. (There are two forms of the imperfect subjunctive. This one is the more common.) And the subjunctive forms for regular -er and -ir verbs using beber as an example: Present subjunctive: yo beba, tà º bebas, usted/à ©l/ella beba, nosotros/nosotras bebamos, vosotros/vosotras bebis, ellos/ellas beban.Imperfect subjunctive: yo bebiera, tà º bebieras, usted/à ©l/ella bebiera, nosotros/nosotras bebià ©ramos, vosotros/vosotras bebierais, ellos/ellas bebieran. The subjunctive perfect tenses and progressive tenses are formed by using the appropriate subjunctive form of haber or estar followed by the appropriate participle. Key Takeaways The subjunctive mood is a key aspect of Spanish grammar and is much more common in Spanish than it is in English.The subjunctive is used primarily for viewing a verbs action from the perspective of the speaker rather than stating it as a fact.The subjunctive mood is used in the present and imperfect tenses.

If you dont pee in your pants or throw up, youre not running fast enough.

If you dont pee in your pants or throw up, youre not running fast enough. On a call with my transformational growth group last week, one of the participants shared her high school running coachs words to the team: If you dont pee in your pants or throw up, youre not running fast enough. I immediately recalled a recent yoga class that I attended, where at the peak of the practice in a hot room I attempted- and came close to achieving- a difficult arm balance pose. I felt a wave of nausea come over me and knew I was venturing into new territory. Then I thought about last summer at the outdoor pool, when I watched a kid on the swim team barf by the fence and then hop right back into the pool. Other images, like early contestants on The Biggest Loser losing their cookies repeatedly, also came to mind. Similar physical reactions can result from experiencing strong emotional reactions. I have seen people vomit while doing emotional work; and I certainly know the feeling of queasiness that can come from touching deep emotional fear and pain, or from taking a risk in interpersonal communication. Sometimes simply the thought of doing something new or different for my business makes me want to throw up. What all these triggers have in common is that they arise when people are pushing past their comfort zone- which, by definition, is not comfortable! But this doesn’t mean that the activity or work is something to be avoided. If there’s anything new you want in your life, whether a physical result or an emotional transformation, you will experience discomfort on the way to achieving it. Is there somewhere in your life where you are jogging along, letting yourself get comfortable and staying there?  What would it look like to push past your comfort zone?  Are you willing to experience fear, nausea, or even peeing in your pants to get the result you want? Im choosing to take that feeling of nausea and/or fear as an indication that Im pushing my life in ways I want to push it. It means Im digging deeper. The payoff is stronger muscles, stronger relationships, and a stronger business. If you want to stretch more than you’re stretching in your life and work, and feel like you don’t have the tools or courage to do it, I recommend the training I’ve been taking part in for the past 2 years. See www.transformweekendtraining.com. The next weekend introductory workshop is March 13-15 in Chicago and you can register for free using code TTCOMP. I will be there and would love to meet you!

Interest rates and exchange rates (the details will be shown in Assignment

Interest rates and exchange rates (the details will be shown in instruction) - Assignment Example This is mainly because of the indifference of the investors. When the interest rate parity is covered, the interest rates and the forward exchange rate between two countries will be in equilibrium. This means that in such equilibrium, each unit return of home currency will be equal to the foreign currency. Thus, the covered interest rate parity states that the forward premium and the interest rate between two countries are equal and there will be no opportunity for arbitrage (Wang, 2009, pp.49-56). (Source: Dollery, University of Hull) The application of covered interest parity is that when it holds true, an investor will be indifferent of investment choice between two countries. For instance, if a French investor has the choice of either to invest or deposit in â‚ ¬ or $ then under CIRP, the investor will get same return irrespective of choice of currency. This is because in equilibrium the future value of investment or deposit will be same for both the currencies (Johann, 2008, p.10). Additionally, there will not be any scope for making profit due to the condition of no-arbitrage in CIRP (Gandolfo, 2002, pp.43-45). The covered interest rate parity is represented by the following equation: (1 + r$) = Ft/St x (1 + râ‚ ¬) Where, Ft = forward exchange rate during time‘t’; & the left hand side of the equation shows that dollar deposits return is equal to euro deposits the returns (Ullrich, 2009, pp.19-22). 2. Uncovered Interest Rate Parity (UIRP) – Investment in First Country The interest rate parity assumes that investors are willing to exchange foreign assets with domestic assets and vice-versa when there is opportunity of making profit from transactions. The theory also assumes that the assets are identical and hence perfect substitutes (Clark, 2002, pp.72-75). On the basis of this assumption it can be said that the investors will be willing to hold assets that yields superior returns irrespective of the origin country. This means that any random investor’s choice of investment decision will not be influenced by forward rates since the investor will earn equal returns on either option. This is because of the interest rate parity theory discussed earlier which assumes that there is no opportunity for arbitrage and the returns of domestic assets will be equal to that of foreign asset (Baillie and McMahon, 1990, pp.150-159). When the investor do not use the forward contract to hedge exchange rate fluctuations and the interest rate parity holds true (no opportunity for arbitrage), then the IRP is said to be uncovered (Harvey, 2008, p.90). The significance of uncovered interest rate parity is that it helps to determine the spot exchange rate by using the concept that expected changes in spot rate of two countries is equal to their interest rate differential (Melvin and Norrbin, 2012, p.115-119). a) Expected Exchange Rate Three Months from Birthday For the purpose of the study, the interest rates based on three month treasury bonds and changes in the interest rates were collected on daily basis. The exchange rates were extracted are the daily close price of exchange rates taken on the

Medicare Value Based Purchasing Program Research Paper

Medicare Value Based Purchasing Program - Research Paper Example The implementation of separate value based purchasing programs for each of the different Medicare providers requires more than just trumpeting the program. The program has different payment levels and efficiency measuring strategies for hospitals, physicians and other practitioners, home health agencies, ESRD providers and facilities, and skilled nursing facilities. (Reichard 2009). The Policy: The Medicare Value based purchasing programs have been formulated in an effort to facilitate the transformation of the Medicare system from a passive payer of claims to an active purchaser of care. The operational infrastructure of RHQDAPU as established by the CMS has been used as a base for the development of Medicare Value based purchasing programs which includes the following provisions: i. As specified by the President’s FY2006 and FY2007 budgets, the value based purchasing programs are budget neutral and are formulated in accordance with the policy recommendations of Institute of Medicine (IOM) and Medicare Payment Advisory Commission (MedPAC). ii. The existing Medicare performance measurements and reporting infrastructure together with RHQDAPU components have been used as a foundation for the structure of Value Based Purchasing Programs. iii. ... In accordance with the provisions of Patient Protection and Affordable Car Act of 2010, the data collected in the initial year would be utilized in informing the concerned medical individuals about their incentive payments. v. The implementation and coordination of VBP program would be undertaken by CMS, which will also monitor the effectiveness of the program through consensus processes such as Hospital Quality Alliance (HQA), National Quality Forum (NQF), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). vi. The reporting requirements specified in Division B, Title 1, Section 109 of Tax Relief and Healthcare Act will be utilized by VBP programs for the measurement of performance and the calculation of incentive payments. vii. The VBP programs will undertake the responsibility of eliminating existing disparities in the health care system. The enforcement of the Value based purchasing programs would not be undertaken without the consent of the concerned m edical personnel. viii. A withholding up to 2% of total payments pertaining to specific Medicare providers would be utilized in the evaluation of the incentive pool. All funds collected under the value based purchasing programs will be offered as incentive payments to the eligible participants will not be changed over time. (U.S. Department of Health and Human Services 2007). Models of VPB Programs: The value based purchasing programs are composed of three models which are listed as follows: Model 1: Single Large Purchaser: This involves a large active Medicare supplier which is working collaboratively with other suppliers. If reward incentives are targeted at these individuals then inevitably the overall performance of the health care system as a whole will