Reimbursement and Pay-for-Performance Essay

Introduction There is a growing trend in the United States called pay-for-performance. Pay-for-performance is a system that is used where providers are compensated by payers for meeting certain pre-established measures for quality and efficiency (What is Pay-for-Performance, n.a.). We are going to be discussing what pay-for-performance is. There are different aspects of pay-for-performance which include; the effects of reimbursement by this approach, the impact cost reductions has on quality and efficiency of health care, the affects to the providers and patients, and the effects on the future of health care. Pay-for-Performance Pay-for-performance (P4P) and value-based purchasing are terms that can be heard within the health care industry which, describes payment systems that reward physicians, hospitals, and other health care providers for their quality and efficiency. The objective of pay-for-performance (P4P) initiatives is to link reimbursement to quality of health care as well as reduce systemwide costs (Shi & Singh, 2012). Government agencies as well as private health plans are in the process of establishing programs in hopes to encourage hospitals, doctors, and other providers so that they will start to meet the quality of standards and achieve the ideal outcome for patients. The overall goal for pay-for-performance is to increase the quality of health care, while reducing the medical costs by implementing programs that will focus on things such as preventative care which would include services such as annual exams and vaccinations. Measurements and Incentives When it comes to quality of care measurements there are different categories one of which being structure. The structure measures patients access to health care, the use of electronic systems and the patients experience of the care that they received. Incentives can be either financial incentives or non-financial incentives. Pay-for-performance has quite a few pros  because it helps increase the motivation of the physician or health care facility which in return will how the company that the individual care for their job and wants to be rewarded based on their good behavior and quality of care that they provide the patient with. There can be a con when it comes to pay-for-performance which would be that if the physician or staff does not have the proper knowledge, training, and experience then they might not be able to reach or exceed the goals that have been set. When the proper knowledge, training, and experience is an issue than this can cause the company to have to invest money into getting that individual the training and resources that they need to obtain the set goals. How Reimbursement is Affected When it comes to the pay-for-performance programs they have been introduced to the health care system to offer incentives to physicians, hospitals, and other medical facilities however the underlying structure of the payment system already generates a lot of incentives on its own. Currently in the United States a majority of physicians are paid on a fee-for-service basis, which in returns encourages a high volume of services, without regard to the value of the service to the patient. In the health care industry there are services that after they are performed the reimbursement is more generous on the payout than others. The pay-for-performance can alter the current incentives that physicians, hospitals, and other medical providers already receive. Reimbursement has affected the pay-for-performance in a positive way because health care providers are able to financially gain from it for providing their patients with quality health care services. Reimbursements are reinventing the way that health care is going to be delivered because health care providers are going to be able to amplify their profit through improving their quality of care, instead of it being the fee-for-service quantity. Pros of Pay-for-Performance for Patients When patients see physicians who are part of the pay-for-performance program this can be beneficial for them. The reason that patients see benefits is because the physician will work with the patients individually to get better health care results for the patient. If a patient has high blood pressure then the physician will focus on that issue and will work with the patient  to get it back to normal which in return the physician will see an incentive for this and the patient wins as well because they are getting the treatment that they need and their overall health is going to increase as a result of the services provided. System Cost Reductions The system costs reductions will have a positive impact on the quality and efficiency of health care. A lot of analyst have worried that the Affordable Care Act will weaken the quality and efficiency in health care because there will be way more patients and not enough quality health care providers. According to Agency for Healthcare Research and Quality (n.d.): In 2000, health care spending rose to $1.3 trillion dollars, or an average of $4,637 per person. As a percentage of the Gross Domestic Product (GDP), it grew from 13.1 percent in 1999 to 13.2 percent in 2000. National health expenditures are expected to reach $2.8 trillion in 2011, with an average annual growth rate of 7.3 percent from 2001 to 2011. By growing 2.5 percent faster that then the GPD, expenditures will consume approximately 17 percent of the GDP in 2011(para. 6). Affects on providers and Customers Pay-for-performance affects health care providers and their customers in a positive aspect because it improves the quality of health care that they receive from their physician which in return increases value. The pay-for-performance program will take health care from basic health care delivery to high-quality health care delivery. The way that this is going to affect the patient â€Å"customer† is because they are going to have an overall better experience with more attention to their overall health. The patient will also see benefits because there are incentives for patients when they live a healthy lifestyle. One of the incentives that the patient will see is in cost savings in the immediate future. Pay-for-performance is positive for all stakeholders involved within the program because it delivers on the main goal which is to increase the quality of care to patients while reducing the costs. The pay-for-performance will also help health care providers to establish more rapport and generate a good feedback within the community because when their patient receives quality health care services then the patient is going to go back and tell their family and friends about their positive experience and recommend that health care provider to their loved  ones. Effects on Future Health Care Pay-for-performance programs are expected to expand across the United States health care in the near future, especially with the implementation of the Affordable Care Act. The pay-for-performance is going to continue to increase the quality of health care that the patient receives from their health care provider. Pay-for-performance is eventually going to be all across the United States and more medical professionals are going to be participating within this incentive program which is going to start making health care affordable for many Americans who cannot afford health care coverage and or services. In the future we are going to start seeing healthier Americans because they are going to get health care services that are tailored solely on their health care needs. Doctors are going to start working to provide quality care in order to get their patients healthier whether it be getting their weight under control, blood pressure, and various other illnesses. Conclusion Pay-for-performance and reimbursement is changing the health care delivery system into a more cost efficient health care system that before. This is going to improve the quality of care that one receives because it steers away from the fee-for-service and gives physicians motivation to provide their patients with a better quality of car because of the incentives that they will receive. There are going to be many baby boomers that are going to start requiring more health care services and with this pay-for-performance implementation it is going to give them a better quality of care than in previous years. With the pay-for-performance incentives this is going to motivate doctors to get their patients in overall better health which in the future we will probably start seeing a decrease in chronic illnesses as patients will be working towards a better and healthier lifestyle. References Agency for Healthcare Research and Quality (n.d.) http://www.ahrq.gov/research/findings/factsheets/costs/costria/index.html Rosenthal, M.B. (2006). How Will Paying for Performance Affect Patient Care?. Retrieved from http://virtualmentor.ama-assn.org/2006/03/pfor1-0603.html Shi, L., & Singh, D. A. (2012). Delivering health care in America: Health Policy (5th ed.). Boston, MA: Jones and Bartlett. Retrieved from The University of Phoenix eBook Collection database.

Redemption in The Kite Runner Essay

It is only natural for humans to make mistakes, just like Amir in the novel The Kite Runner, but it is how the mistakes are resolved that will dictate ones fate. The main character of The Kite Runner, Amir, knows a thing or two about making mistakes. What he struggles with throughout the novel is finding redemption for those mistakes. Throughout all stages of Amir’s life, he is striving for redemption. Whether Amir is saying the wrong thing or hiding from a hurtful truth, he always finds new things he will have to redeem himself for. That is why redemption is a huge underlining theme in The Kite Runner. When Amir is a child, he feels his father blames him for his mother’s death and cannot love him. He does everything he can think of to try and make up for the mistakes he made in the past. Since Amir feels his father does not love him, he thinks of ways to make things right with him. Amir sees Baba as a perfect higher presence that he could never amount to. When the kite running competition comes around he takes this opportunity to prove to his father that he can be more of an â€Å"ideal† son to Baba, ultimately getting redemption for everything his father has not approved of. Amir sees Baba as a perfect father figure because everyone looks up to him. Amir could never live up to Baba’s expectations of him and that is where the theme of redemption comes to play between these two characters. Although Amir impresses his father by winning the kite running competition, he ends the day by hurting his best friend in a terrible way and one day he will have to find a way to make up for it. Amir and Hassan are two inseparable children, but their relationship is unusual because Hassan is Amir’s servant. Amir is never very nice to Hassan, but Hassan would never turn his back on Amir. This is evident when he says, â€Å"For you a thousand times over†. Amir makes a huge mistake one day by hurting Hassan and it takes a ver y long time for him to find a way to redeem himself. The kit running competition was supposed to be the best day of Amir’s life. He would win, and earn his dad’s unconditional love once and for all, but things are not always as they seem. Although Amir did win the competition, something went very wrong. Hassan will always have Amir’s back, until the day he dies he would do anything for him. When Amir cut the last Kite down from the sky, Hassan decided to run it. Assef and his two friends didn’t exactly want Hassan to bring the kite back to Amir. Amir is a very evil young boy and since Hassan would do anything for Amir, he refuses to hand the kite over to Assef. Hassan’s final act of bravery results in his rape and Amir’s next big mistake. Amir watches Assef and his friends rape Hassan, but he does nothing to help his friend. Amir goes many years knowing this information but never tells anyone, but what goes around comes around. When everything finally catches up with Amir, he is a grown man. Things in Amir’s life have finally settled down, but now the past is brought b ack up; he must go find redemption once more. Amir survived his childhood, made a good life for himself and marries a beautiful Afghan woman named Soraya. One thing Amir is deprived of in his life is the ability to have children. Amir’s inability to have children could possibly be looked at as coincidental or symbolic to him making amends for his past mistakes and misgivings. Amir receives a phone call from his father’s old friend Rahim Khan. Although Rahim is dying, he asks Amir to come visit him in Afghanistan. Amir soon realizes that the main reason Rahim Khan asked him to visit was not to see him before he died, but because Rahim wants to help Amir succeed in reaching his final redemption. Rahim Khan has known about the kite running competition for Amir’s entire life, and he has a way for him to try and set things right. Hassan, who is dead now, has a son, but he is an orphan boy. The Taliban has taken over Afghanistan and they killed Hassan and his wife in cold blood. Sohrab, who is Hassan’s son, has been taken by the Taliban as payment for the orphanage. Rahim Khan puts Amir up to the challenge of going to find Sohrab and giving him a proper home. He states, â€Å"I have a way to make things right again†. In order for Amir to redeem his past with Hassan, he must go and find Sohrab, who is the ultimate symbol of redemption in Amir’s life. Finding Sohrab was Amir’s greatest accomplishment, it was the ultimate redemption for all the evil and unjust things that have haunted his past. Amir fails to stand up for himself and others, as a child. As an adult, he redeems his uncourageous past by setting it right with the help of some very close family members. Amir goes through many stages in his life, but he always seems to be redeeming himself for something. Sometimes life seems to work out in the end, and the search for redemption may not always be easy, as witnessed in Amir’s case. However, a strong will and determination can help guide the road to redemption and possible forgiveness.

Gauging The Patient Satisfaction Level Health And Social Care Essay

Fast alterations in the environment have put important force per unit areas on infirmaries to add patient satisfaction in their strategic stance and quest for market portion and long-run viability. Historically, the constitutions of quality criterions in wellness attention scenes were delegated to the medical professionals. Not surprisingly, quality was defined by clinicians in footings of proficient bringing of attention. The recent literature ( in the developed states ) , nevertheless, emphasizes the importance of the patient ‘s position. Hospital decision makers, insurance companies, community groups, and research workers have all need to acknowledge the value of the penetrations that patients can supply in order to custom-make their services harmonizing to the need/desire of the patients. It has been observed that there has been no such work done in the wellness sector of Pakistan. In order to accomplish client satisfaction, there is a strong demand to place some important factors that are responsible for fluctuation in client satisfaction degree and prove their significance in Pakistani environment.Scope/Justification:Estimating patient ‘s satisfaction degree through assorted factors is a widely ignored country in the wellness attention sector in Pakistan. Besides few private infirmaries no other public and private infirmaries are being focused on client centeredness. Unfortunately no important researches are taken topographic point in this country bespeaking deficiency of involvement. As internationally important research work had been done in this respect reflecting importance of patient ‘s satisfaction in order to run successful wellness attention organisation. As competition among the private infirmaries in urban countries of the Pakistan is on the rise hence there is demand of important research work to place the tools and factors responsible for fluctuation in client satisfaction degree in wellness attention industry in Pakistan. Su ch research work will supply an penetration to the infirmaries that how they can stay competitory. To get down with this research in which three major private infirmaries in Karachi will be evaluated on the footing of the feedback of the users of their service on different factors of satisfaction degree.Restriction:Due to fiscal and clip constrains it will non be possible to carry on the state broad research and hence the range of research will be confined to the Karachi metropolis merely.Boundary line:Karachi is a mega metropolis holding legion authorities and private infirmaries. Since this research will be conducted to prove the significance of five factor theoretical account on satisfaction degree of patients who attended private infirmary therefore all authorities infirmaries are excluded and merely private infirmaries are included in the research. In this respect three major private infirmaries including The Aga Khan University Hospital, Liaquat national Hospital and Ziauddin Hospital are selected.Methodology:This research will be qualitative in nature. Interviews will be conducted with a little but representative sample of selected infirmary users. Questionnaire will be developed in a mode which will let respondents to supply their feedback related to the factors selected and eventually their overall satisfaction with infirmary services. In following measure multiple arrested development will be applied after coding the information collected through questionnaire to look into the degree of significance of each factor on patient satisfaction degree. Patient satisfaction degree will be considered as dependent variable and factors including communicating with patients, competency of the staff, their behaviour, quality of the installations, and perceived costs will be used as an independent variable.Aim:The aim of this research is to prove the significance of five factor theoretical account including communicating with patients, competency of the physicians , attitude & amp ; behaviour of staff, quality of the installations, and perceived costs on fluctuation in client satisfaction degree.Research Question:Q. How significantly the factors including communicating with patients, competency of the physicians, attitude & amp ; behaviour of staff, quality of the installations, and perceived costs lending upon fluctuation in client satisfaction degree in private wellness attention scenes in Karachi?Introduction:Customer relationship direction is the most of import facet which these yearss every organisation has to work on to stay competitory. Hospitals has to concentrate on client centeredness in doing their policies and strategic plans.. In add-on to that fast alterations in the environment have put important force per unit areas on infirmaries to add patient satisfaction in their strategic stance and quest for market portion and long-run viability. This research survey proposes and trials five factors that explain considerable fluctuation in client satisfaction with infirmaries. These factors include communicating with patients, competency of the staff, their behaviour, quality of the installations, and perceived costs. The purpose of this instance survey is to place the most relevant factors that are responsible for fluctuation in client satisfaction degree. The result of this survey would supply an organisation an penetration to be more focussed on keeping or bettering these factors in order to increase satisfaction degree of the clients. The appraisal of service quality poses some interesting challenges that have engaged faculty members and practicians in the developed states for rather some clip now. Two major concerns continue to breed healthy argument on this issue: Who will measure quality and on what standards? Historically, the constitution of quality criterions was delegated to the medical profession. Not surprisingly, quality was defined by clinicians in footings of proficient bringing of attention. The recent literature ( in the developed states ) , nevertheless, emphasizes the importance of the patient ‘s position. Hospital decision makers, insurance companies, community groups, and research workers have all begun to acknowledge the value of the penetrations that patients can supply. Harmonizing to O'Connor, S.J. , Shewchuk, R.M. and Carney, L.W. , 1994. The great spread. Journal of Health Care Marketing 14 2, pp. 32-39.O'Connor, Shewchuk and Carney ( 1994 ) , â€Å" It ‘s the patient ‘s position that progressively is being viewed as a meaningful index of wellness services quality and may, in fact, represent the most of import position. † ( p. 32 ) .But some still feel that patients can non truly be considered good Judgess of quality, disregarding their positio ns as excessively subjective. Petersen ( 1988 ) challenges this position by proposing that it is non of import whether the patient is right or incorrect, what is of import is how the patient felt even though the health professional ‘s perceptual experience of world may be rather different. Remedy is a cardinal wellness service outlook. Specifically, patient satisfaction is defined as an rating of distinguishable health care dimensions. It may be considered as one of the coveted results of attention and so patient satisfaction information should be indispensable to quality appraisals for planing and pull offing health care. Patient satisfaction enhances hospital image, which in bend translates into increased service usage and market portion. Satisfied clients are likely to exhibit favourable behavioural purposes, which are good to the health care supplier ‘s long-run success. Customers tend to show purposes in positive ways such as praising and preferring the company over others, increasing their purchase volumes or paying a premium.Literature Reappraisal:Health attention industry is one of the fastest turning industries these yearss. Fast growing of this sector has been brought in dramatic alterations in the environment and hence wellness attention decision maker s have to happen out the ways to stay competitory. These force per unit areas include increasing options for clients for exchanging and better informed clients. Many infirmaries with the aid of researches have realized that client satisfaction is the nucleus component of scheme and the critical factor for long term sustainability and sustainable competitory advantage. 1.Donabedian A. ( 1988 ) , suggests in â€Å" Quality appraisal and confidence: integrity of intent, diverseness of agencies † , Inquiry, Vol. 25 pp.173-92. that â€Å" patient satisfaction may be considered to be one of the coveted results of attention information about patient satisfaction should be as indispensable to appraisals of quality as to the design and direction of wellness attention systems † . 2.Vaida and Osmo ( 2002 ) investigate in â€Å" Why are people dissatisfied with medical attention services in Lithuania? † chief beginnings of dissatisfaction with medical services among the population in Lithuania. They analyse written responses to an open-ended inquiry as a portion of a questionnaire study. Results revealed 12 classs of dissatisfaction that were related to three degrees: defects in the wellness attention system ( systemic degree ) , lacks in proviso and quality of services ( institutional degree ) and lacks in doctors ‘ attitudes, accomplishments and work ( single degree ) .3.Mario lino Raposo, Helena Maria Alves and Paulo Alexandre Duarte ( 2008 ) investigate in â€Å" Dimensions of service quality and satisfaction in health care: a patient ‘s satisfaction index † about importance of factors influence satisfaction are really of import for health care directors as it influences healthcare consequences and health care. Partial Least Square s way mold ( PLS ) was the technique chosen. The consequences show that patients ‘ satisfaction is 60.887 in a graduated table from 1 to 100, uncovering merely a medium degree of satisfaction. It is besides possible to reason that the most of import positive effects on satisfaction are the 1s linked to the patient/doctor relationship, the quality of installations and the interaction with administrative staff, by this order.4.J Hughes ( 1991 ) in his reappraisal â€Å" Satisfaction with Medical Care: A Review of the Field ( 1991 ) stated that Peoples dislike out-of-pocket costs, co-payments and deductibles, peculiarly if they have to pay at the site of attention ( Dolinsky and Caputo, 1990 ) . When they have inquiries, they like to hold person available to explicate processs to them until they understand. In factor analysis, satisfaction with insurance supplier tends to be a really independent dimension from satisfaction with suppliers, lending small to overall satisfaction ( Singh, 1990 ) . Satisfaction with ambulatory attention has mostly to make with satisfaction with one ‘s doctor, while satisfaction with the inmate experience has more to make with the quality of the staff ( Hall and Dornan, 1988 ) . With the doctor, satisfaction interruptions down into two facets, ( a ) satisfaction with sensed proficient competency and ( B ) satisfaction with interpersonal accomplishments. In measuring nurses and other staff, nevertheless, patients place much more accent of the interpersonal facets than on perceptual experiences of proficient competency. undermentioned tabular arraies are based on a sample of 1600 outpatients and 700 inmates of the University of Chicago, drawn from those who passed through the infirmary in January 1991. Harmonizing to the Picker Commonwealth sample of 1990, the University of Chicago has one of the highest rates of patient satisfaction in the state, so the findings are capable to the cautiousnesss about little discrepancy note d above. These two theoretical accounts of inmate and outpatient satisfaction are implicative of the variables that are by and large found to foretell overall satisfaction and the determination to return. The inquiries below were found to be the most prognostic of four or five times as many inquiries in the studies. 5.Ford, Robert C. ; Bach, Susan A. ; Fottler, Myron D. investigate in â€Å" Methods of Measuring Patient Satisfaction in Health Care Organizations, Health Care Management Review: Spring 1997 – Volume 22 – Issue 2 – pp 74-89 the advantages, disadvantages, and jobs associated with nine different methods of mensurating patient satisfaction with service quality. The rightness of each of these techniques under different organisational conditions is besides discussed. The article concludes with guidelines for measuring of patient satisfaction and execution of managerial follow-up including both qualitative and quantitative attacks. They vary in cost, truth, and the grade to which they inconvenience the patient. Choosing the best method or combination of methods should stand for an ideal balance between the organisation ‘s strategic ends and the cost of accomplishing these ends. Finding this balance depends upon the information the organisation is seeking, how t he ensuing information will be used, the fiscal resources available, the expertness available for roll uping the information, and the grade of statistical cogency and dependability required.6.Alessandra Mazzei, IULM, Vincenzo Russo, IULM, Alberto Crescentini, Alta Scuola Pedagogica di Locarno, investigates in â€Å" Patient satisfaction and communicating as competitory levers in dental medicine † the most relevant quality factors and communicating activities that are suited as competitory levers in dental medicine. This research is based on interviews with senior tooth doctors, focal point groups with patients and a study of dental medicine patients. They conclude that the repute of the tooth doctor, perceived service quality and patient satisfaction are progressively relevant in the current Italian medical services market. Indeed, to pull patients requires improved quality and communicating activities. Following theoretical accounts were suggested by the researches to be con sidered in order to set up effectual communicating7.M.A.A. Hasin, , Roongrat Seeluangsawat, M.A. Shareef, investigate in â€Å" Statistical steps of client satisfaction for wellness attention quality confidence: a instance study the elements of client satisfaction, by roll uping information through study, utilizing both written questionnaire and interview, and so statistically finding correlativity between factors and elements of dissatisfaction. The survey is performed at the Muang Petch Thonburi Private Hospital, located in Petchaburi state of Thailand. They conclude that though the infirmary has a good degree of overall service, there are many countries that need attending to further better the service. Continuous betterment of TQM is therefore really helpful to increase fight in infirmaries and many other wellness attention organisations. The followers are some factors which are found necessary at this specific infirmary, though the survey believes that they are necessary in an y other wellness attention organisation: Change attitude of employees about the nonconformist service, it does non intend lack in the section ; instead it means that things should better to run into client satisfaction. Training at all degrees ( non merely for physicians and nurses, but besides for others ) within the infirmary is required to better service quality. To increase the efficiency of inter-department cooperation and interrupt the departmental barrier, the operation consequences should be emphasized on an organization-wide footing alternatively of a department-wide footing. In add-on, use of job work outing meetings for operational struggles should be increased. Absence of policy is a job. ISO9000 QMS may assist in this respect. It may be mentioned that this infirmary decided to implement ISO9002 for this intent. This would intend internal audit besides. 8.The survey concluded and recommended solutions sing the sentiments of lone external clients. The survey suggests that for a better declaration in the field of TQM in any sort of organisation, employee behaviour and attitudes should be taken into history. Customer satisfaction represents a profitable competitory scheme variable because surveies have shown that the populace is inclined to pay more for attention from quality establishments which are better disposed to fulfill clients ‘ demands ( Boscarino, 1992 ; Hays, 1987 ) . Its value as a competitory tool besides derives from the fact that infirmaries with better images have been able to interpret these into increased use and market portion ( Boscarino, 1992 ; Gregory, 1986 ) . Delivering client satisfaction is besides imperative because today ‘s users of wellness attention services in urban countries are better educated and more cognizant than in the yesteryear. These users carefully study and monitor the options available to them ; they are, hence, more discerning users, cognizing precisely what they need. These alterations are being driven by the copiousness of information that is available to them from public and private beginnings. 9.Syed Saad Andaleeb ( 1998 ) tested in â€Å" Determinants of client satisfaction with infirmaries: a managerial theoretical account † five-factor theoretical account that explains considerable fluctuation in client satisfaction with infirmary. These factors include communicating with patients, competency of the staff, their behavior, quality of the installations, and perceived costs. A chance sample was selected and a multiple arrested development theoretical account used to prove the hypotheses. The consequences indicate that all five variables were important in the theoretical account and explained 62 per cent of the fluctuation in the dependant variable. Hospitals should device schemes to concentrate on these variables if competitory advantage is to be gained through presenting client satisfaction. 10.Syed Saad Andaleeb ( 2001 ) , investigates in â€Å" Service quality perceptual experiences and patient satisfaction: a survey of infirmaries in a underdeveloped state † quality factors that are of import to patients. He besides examines their links to patient satisfaction in the context of Bangladesh. A field study was conducted. Evaluations were obtained from patients on several dimensions of sensed service quality including reactivity, confidence, communicating, subject, and gratuity. Using factor analysis and multiple arrested development, important associations were found between the five dimensions and patient satisfaction. Deductions and future research issues are discussed. He concluded that all five dimensions of service quality were important in explicating patient satisfaction. The waies of the relationships were as hypothesized. Discipline, as an extension of the â€Å" tangibles † dimension, had the greatest impact on client satisfaction as indicated by the standardised I? values. While this determination is contrary to theoretical accounts in developed states, the developing state context, the by and large province of undiscipline in the service environment, and the hapless direction and disposal of service bringing seem to warrant this consequence. Assurance had the 2nd greatest impact on patient satisfaction. In an environment where the professional demeanour and public presentation of the hospital staff, particularly physicians, have frequently come under terrible unfavorable judgment, it is non surprising that patients were more satisfied when they felt more assured of their wellness results. There is besides grounds that for services with acceptance belongingss, confidence dramas an of import function in patient satisfaction ( Zeithaml, V.A. and Bitner, M.J. , 2000. Services selling, McGraw-Hill, New York.Zeithaml & A ; Bitner, 2000 ) . This determination is, therefore, corroborated, particularly in the fact that the writers besides suggest the similarity of demands between patients in developed and developing states. The impact of reactivity and communicating on patient satisfaction was besides important. While the magnitude of their effects was relatively lower than the effects of subject and confidence, this does non connote that reactivity and communicating are unimportant or should be ignored in infirmaries ‘ pursuit to better service quality. This lone suggests that greater additions in patient satisfaction can be realized by go toing to train and assurance in the infirmary environment. Baksheesh, while besides important, had the least impact on patient satisfaction. Although this determination may look surprising, a small contemplation suggests that it makes sense. Baksheesh does rarefy client satisfaction ; nevertheless, as a necessary immorality it possibly has merely nuisance value. The low impact of gratuity besides seems to back up the chief thesis of this paper – that quality ( via confidence and subject ) is more of import than cost and entree as reflected in gratuity. In other words, gratuity is marginally of import to patients for whom a disciplined scene, confidence of rapid recovery, and a antiphonal and communicative staff are of greater importance. If a little monetary value demands to be paid in the signifier of gratuity, its impact on patient satisfaction is important but fringy. 11.Jiunn-I Shieh, , Hsin-Hung Wub and Kuan-Kai Huang investigate in â€Å" A DEMATEL method in placing cardinal success factors of infirmary service quality † The critical factors to pull off a infirmary successfully, the of import ends are to pull and so retain as many patients as possible by run intoing possible demands of assorted sorts of the patients. This survey foremost conducted the study based on SERVQUAL theoretical account to place seven major standards from patients ‘ or their households ‘ point of views at Show Chwan Memorial Hospital in Changhua City, Taiwan. When the cardinal standards were found, the 2nd study developed for using decision-making test and rating research lab ( DEMATEL ) method was issued to the infirmary direction by measuring the importance of standards and building the causal dealingss among the standards. They concluded that The consequences show that trusted medical staff with professional competency of wellness attention is the most of import standard and reciprocally affects service forces with good communicating accomplishments, service forces with immediate problem-solving abilities, elaborate description of the patient ‘s status by the medical physician, and medical staff with professional abilities. Th erefore, preparations on communicating accomplishments and problem-solving abilities would ensue in positive interaction for patients to swear medical staff. When the sure medical staff provides professional competency of wellness attention to patients, satisfaction would be increased. 12.Sohail S.M. examines in â€Å" Service quality in Hospitals: More Favorable than you might believe † the quality of services provided by private infirmaries in Malaysia. Empirical research is used to find patients outlooks and perceptual experiences of the quality of service, and a comprehensive graduated table adapted from SERVQUAL is through empirical observation evaluated for its utility in the Malayan infirmary environment. Consequences based on proving the average testing between outlooks and perceptual experience indicate that patients perceived value of the services exceed outlooks and perceptual experience for the variable measured. These variables including tangibleness, dependability, confidence and empathy. 13.Pamela and J. Gregory attempted in â€Å" Verbal Communication Skills and Patient Satisfaction, A survey of physician patient interviews † to quantify specific behavior in the physcian ‘s initial interviewing manner with patients. The interviews were tape recorded and later on evaluated with the usage of the computerized Language Analysis System. It was found that three variables are significantly affection verbal communicating between patients and their doctors. The variables are usage of silence or reaction clip latency between talkers in an interviews, whether there was linguistic communication reciprocality as determined through the mutual usage of word lists and 3rd is the brooding usage of breaks within an interview. 14.Lekidou Ilia, Trivellas Panagiltis and Ipsilandis Pandelis investigate in â€Å" Patients Satisfaction and quality of attention An empirical survey in a Grecian Central Hospital † about the relationship of patients admittance, adjustment facets, external environment and the attention provided by physicians nurses and support helpers with service quality reflected on the patients, satisfaction. Their survey was patients centered and identifies the quality factor tha are of import to patients. They besides examine their links to patient satisfaction in the context of Greece. They conducted field study based on a sample of 164 patients of a cardinal public infirmary. The method used was multiple arrested developments. Consequences revealed important associations which shed visible radiation on the determiners of patients satisfaction particularly visiting hours, physicians consistence, the sort of insurance, yearss of hospitalization, the types of clinic and hygiene ‘s o bservation have a positive relationship with patients satisfaction. In add-on to that factors of dissatisfaction including if quiet is non observed, if its hard to turn up physicians, if jobs occur with parking, and admittance procedure, deficiency of communicating with nurses, physicians, impoliteness, orderly improper behavior and wellness detoriation after patients hospitalization were identified. 15.Sara N Bleich a, Emre A-zaltin B & A ; Christopher JL Murray investigates in â€Å" How does satisfaction with the health-care system relate to patient experience? † the factors underlying people ‘s grade of satisfaction with the health-care system and the extent to which the latter reflects their experience of attention. Datas from the faculty on wellness system reactivity in the World Health Survey for 2003 provided a alone chance to better understand the determiners of people ‘s satisfaction with the health-care system, besides their experience as patients, in 21 states of the European Union ( EU ) . Throughout the paper, research workers use WHO ‘s term â€Å" reactivity † to mention to satisfaction with the wellness system from the position of patient experience. They include in the analysis all 21 EU states for which informations were available in the World Health Survey for 2003. The study was conducted by face-to-face interviews in all states except Luxembourg, where it was conducted by telephone. Survey respondents were chosen through stratified, multistage bunch trying and interviewed in the national linguistic communication. Sample size varied by state. The cardinal consequences of the 7th and concluding OLS arrested development theoretical account, which was used to research the possible determiners of satisfaction with the health-care system showed positive consequence on client satisfaction degree. These factors including liberty, pick, communicating, confidentiality, self-respect, prompt attending and quality of basic comfortss. It is notable that all the covariates combined explained merely 17.5 % of the ascertained fluctuation in satisfaction with the health-care system, a determination that resembles that of a recent survey on the determiners of satisfaction in developing states. We do non believe that this consequence is due to high random measuring mistake. We attribute it, alternatively, to a ample spread in our apprehension of the factors finding people ‘s satisfaction with the health-care system. 16.Dr Sona Bedi, ** Dr Sanjay Arya, *** Prof RK Sarma ( 2004 ) proved in Patient Expectation Survey – A Relevant Selling Tool for Hospitals † . that a relevant tool for infirmary decision makers today is a patient outlook study, which reveals what patients really desire from infirmaries. They conducted patients expectation study among patients sing the Outpatient section of two authorities infirmaries in India. Entire 230 patients were surveyed. Consequences revealed that patient outlook study can be considered as a pro-active selling activity designed to hold a better opportunity at accomplishing patient satisfaction. It is seen that if any infirmary fulfils outlooks of patients, patients are more likely to remain with that peculiar service supplier for a longer clip. Patients in both infirmaries consider good physician with the ‘ability to bring around ‘ as the most of import property of medical attention in a infirmary. Different attributes which affair mo st to patients are about same, but comparative importance of these is a map of background ( socio-economic position ) and what is available in the infirmary. But the most of import thing is the physician, who should be non merely be competent i.e able to handle, but besides have good communicating accomplishments and is empathic. Good environment is needed to make a right feeling on the patient, and absence of the same can hold a negative impact. Marketing strategy- without technically or clinically competent physicians, a high degree of patient satisfaction is hard to accomplish. Physical installations and sanitation rate high in patient outlooks implicitly. 17.Shahbaz Shabbir1* , Hans Ruediger Kaufmann2 and Mudassar Shehzad3 ( 2010 ) investigated in â€Å" Service quality, word of oral cavity and trust: Drivers to accomplish patient satisfaction † the elements of the services provided in Pakistani infirmaries ( Public and Private ) and their part to patient satisfaction sing trust on the service suppliers. They conducted study of patient in public and private infirmaries in Islamabad. The informations were analyzed through a correspondence analysis which was applied to the consequences. of the 245 distributed questionnaires. Correlation and arrested development analysis were used to happen out the impact of Service quality, Word of oral cavity and Trust on patients satisfaction. Consequences revealed that Pakistani patients perceived public infirmaries to be superior in the quality of their service proviso, which is non, aligned with the bulk of recent survey findings. These consequences are recognized because Islamabad ‘s infirmaries are offering improved service so that they accomplish the demand of their patient. The information was gathered from infirmaries situated in Islamabad merely, therefore future research workers suggested that research could widen to other metropoliss in Pakistan to prove their generalizability as Islamabad is the capital metropolis and they are offering improved service so that they accomplish the demand of their patient. Besides consequences indicated that service quality is positively and significantly correlated with patients satisfaction in wellness attention industry. Trust and word of oral cavity is positive but non significantly correlated with patients satisfaction in wellness attention industry. 18.Aditi Naidu ( 2009 ) tried in â€Å" Factors impacting patient satisfaction and health care quality â€Å" to construct a comprehensive conceptual theoretical account to understand and step variables impacting patient satisfaction-based health care quality. A sum of 24 articles from international diaries were consistently reviewed for factors finding patient satisfaction and health care quality. The survey showed that outlooks were non equal for all three wellness service suppliers. For walk-in-clinic frequenters, the most of import influence on outlooks was staff friendliness and cost. For private physician patients, they were friendliness and clip spent with the client, intervention accounts and competency. Customers said exigency suites were the least attractive. The most of import influence were physician friendliness, competency, sum of clip spent with the client and the sum of information provided. Both private doctor and exigency room frequenters placed walk-in suites as the referent for their outlooks. Staff friendliness, cost and the sum of clip the physician spent with them were found to be the three most of import considerations/discriminators. With low outlooks, exigency suites generated higher than expected satisfaction degrees. The lone group where what was received was precisely as what was expected was walk-in frequenters. In the instance of private doctors, the public presentation fell abruptly of outlooks, therefore bring forthing dissatisfaction. Finally it was concluded that patient satisfaction is a multi-dimensional health care concept affected by many variables. Healthcare quality affects patient satisfaction, which in bend influences positive patient behaviors such as trueness. Patient satisfaction and health care service quality, though hard to mensurate, can be operationalized utilizing a multi-disciplinary attack that combines patient inputs every bit good as adept judgement. Restriction of this research is that it was a conceptual theoretical account that needs to be Confirmed through empirical observation. 19.Arpita Bhattacharya* , Prema Menon** , Vipin Koushal*** , K.L.N. Rao**** ( 2003 ) investigated in â€Å" Study of Patient Satisfaction in a Third Referral Hospital † the perceptual experience of patient attenders sing the services provided to in-patients by the Department of Pediatric Surgery at this Institute. PGIMER is a prime institute in India, which trains medical instructors, provides patient attention as a third referral centre and behaviors high quality medical research in India. The perceptual experiences and outlooks of attenders sing proficient quality, general satisfaction, communicating, interpersonal facets, handiness, convenience etc. The information was collected from two hundred 50s two inmates through an interview with the parents or a close relation at the clip of discharge of the patient.The collected information was analyzed as a whole and a comparative analysis besides done by spliting the patients into subcategories on the footing of admittance positi on ( ward vs. NSICU ) , position of unwellness every bit good as affordability and literacy of parents. Frequency distributions were obtained to look into the frequence of the self-asserting and negative responses. Chi-Square trial was applied to cipher the significance of differences between the sentiments of patient attenders belonging to different sub classs except admittance position. Consequences revealed that 61 per centum were paying patients. Fifty-nine per centum of the attenders were literate. Overall degree of satisfaction with physicians ranged from 89.3 % to 99.6 % . Very high degrees of satisfaction were expressed on proficient quality of physicians ‘ work and their accessibility. However 10.7 % felt that physicians had n't to the full explained the disease and the intervention. The per centum of satisfied attenders sing proficient facets of nursing attention was supra 90 % . Literate attenders were more satisfied sing accessibility of nurses to their personal jobs compared to illiterate/semiliterate attenders ( P & lt ; 0.01 ) . However, the latter were more satisfied than the literate attenders with the advice given at the clip of discharge ( P & lt ; 0.05 ) . The degree of satisfaction with behaviour and attitude of nurses towards the attenders was hapless. 24.2 % attenders thought that some of the nurses were ill-mannered whereas 21.4 % felt they were apathetic. In the NSICU, satisfaction degrees with attitude and manner of speaking of nurses was higher with paying, literate attenders. Moderate degree of satisfaction mark was noted sing quality of work of ward servants/sweepers. High rate of dissatisfaction was found sing their helpfulness. Many of the attenders ( 23 % ) did n't interact with them. Chronic and literate attenders were more satisfied with their quality of work, helpfulness, and communicating. 62.5 % of NSICU attenders answered that the figure of lavatories were equal. However in the ward, 85 % were dissatisfied on this facet. Harmonizing to 62.7 % attenders, the infirmary provided best installations for intervention. None of the respondents categorized intervention installations as bad but 37.3 % thought that it could be better. More than 94.5 % of the attenders besides responded positively to the general cleanliness and nutrient. Most of the attenders were satisfied sing OPD services provided.This survey provided an penetration to hospital disposal, staff, physicians and research workers who want to better the quality of service and patient satisfaction degrees. It appears that such little and good manageable forte centres may be an reply to the widespread unsatisfactory conditions predominating in general in public sector infirmaries in India.20.Al Johara A. Al-Hussyeena, ( 2010 ) investigated in â€Å" Factors impacting use of dental wellness services and satisfaction among adolescent females in Riyadh City † factors impacting use of dental wellness services among intermediate female school pupi ls in Riyadh in add-on to measuring their satisfaction with the alveolar consonant attention received during the last dental visit. The survey protocol was approved by moralss commission at the College of Dentistry Research Center, King Saud University and Ministry of Education, Saudi Arabia. Eight intermediate public and four private schools were selected indiscriminately from the four different administrative zones [ North, South, E and west ] in Riyadh City. The figure of selected pupils for each zone was based on the figure of schools and figure of the pupils enrolled in them. Datas for this survey was obtained through the usage of a self-administered Arabic questionnaire. Entire 531 pupils were included in this survey. Statistical Package for Social Science ( SPSS ver. 13 ) was utilized to cipher descriptive statistics and statistical trials. T-test was used.Results revealed that pupils who visited the tooth doctor for everyday intervention were more concerned about the quality of dental attention compared to those who made their visits due to trouble. Regular attenders visit the tooth doctor more often ; accordingly, they are more experient and demand high quality of dental attention. While those who visit merely in instance of hurting are pleased by holding the hurting relieved, these findings. Findingss of this survey besides indicated that stripling ‘s pick an use of dental service can be improved if dental clinics were located closer to their places and if they provided high quality of dental attention with sensible fees. High quality of dental attention, modern equipped alveolar consonant clinic which recommended by a comparative or a friend and have friendly staff, in add-on to acquiri ng convenient assignments were found to increase pupils ‘satisfaction significantly.21.B.Krishan Reddy, G.V.R.K. Acharyulu ( 2002 ) investigated in â€Å" Customer Relationship Management ( CRM ) in Health Care Sector – A Case Study on Master Health Check † some of the CRM constructs and elements – formulate CRM scheme to take proactive steps towards customer-centric concern in a corporate infirmary to better client satisfaction by constructing up better client relationships taking to increase in grosss. This survey focuses on the maestro Health Check bundles, profile of clients, their behavior and eventually finding the relationship factors to plan CRM scheme. An explorative research is undertaken to concentrate on making a client Relationship Management scheme for the Master Health Check in the infirmary. The research is chiefly based on secondary informations, and supplemented with primary informations. Secondary Data included MHC feedback signifiers, M HC patient records, repetition patient records and OP accession registry. Primary Data gathered through questionnaire, interviews and observations. Consequences revealed that maximal figure of people opted Master Health look into up due to comprehensive trials included in the bundle and besides its economical cost. Male clients availed more MHC bundle as compared to female clients due to miss of consciousness among females. It was further revealed that overall satisfaction has besides been increased by 12 % and dissatisfaction was increased by 1 % as compared to the twelvemonth 2000. Satisfaction with physicians and courtiousness of the staff has besides indicated positive consequence on client satisfaction.22.Fei Lung Lau investigated in â€Å" Can communicating accomplishments workshops for exigency section physicians improve patient satisfaction? That go toing of the communicating accomplishments workshops by the exigency section physicians improves patient satisfaction and redu ces the figure of ailments on physicians ‘ attitude. Patient satisfaction studies in four representative EDs conducted before and after the workshops, were collected and the satisfaction rates of physicians ‘ attitude, account and advice were later compared. Consequences revealed that after the series of workshops, there was a 42 % decrease ( from 26 to 15 instances ) in the figure of ailments against physicians ‘ attitude. This occurred despite the increased attending from 724 000 to 898 000 in the eight infirmaries. This survey supports writer ‘s belief that communicating accomplishments workshops can better the physicians ‘ communicating accomplishment with a corresponding addition in patients ‘ satisfaction and lessening in patients ‘ ailments towards ED physicians. 23.Kathryn Frazer Winsted ( 2000 ) examined in â€Å" Patient satisfaction with medical brushs – a cross-cultural position † about behaviours of physicians that influence patient rating of medical brushs in USA and Japan. Method used for analysis is that a list of behaviours relevant to patient rating of a medical brush is developed. Performance of these behaviours in specific medical minutess is so examined and the relationship between public presentation of each behaviour and brush satisfaction is analyzed. Behaviors are grouped, utilizing factor analysis from consumer studies. Consequences revealed that that many of the behaviours and constructs are of import to consumers in measuring service brushs are really similar across civilizations. These constructs are congenialness, communicating, civility concern and courtesy. 24.John e. Ware, Jr. PH.D. and Mary K. Snyder, PH.D. ( 1975 ) investigated in † Dimensions of Patient Attitudes Regarding Doctors and Medical Care Services † about patient attitudes sing features of physicians and medical attention. Four major dimensions of patient attitudes were identified and described, including attitudes toward physician behavior ( humanity and quality ) and such enabling constituents as handiness of services, continuity/convenience of attention and entree mechanisms ( cost, payment mechanisms, and easiness of exigency attention ) . Questionnaire were used to roll up informations with the patients. Factor analysis was applied to measure the findings of the information. Reliability and proof cheques were besides applied. Consequences revealed that these dimensions, which accounted for about 72 per cent of the dependable discrepancy in index tonss, include attitudes toward: a ) doctor behavior, B ) handiness of attention, degree Celsius ) continuity/con venience of attention, and vitamin D ) entree mechanisms such as fiscal considerations and entree to exigency attention, steps of patient attitudes toward the quality of attention received from physicians ( thoroughness, preventative steps, information giving, and the similar ) have fundamentally the same factor content as steps of physician humanity ( consideration and support ) suggests that consumers of medical attention services may hold one general attitude toward their physicians. Second dimension of measuring identified in the current survey involves attitudes toward constituents of wellness services including fiscal barriers, exigency attention services, handiness of wellness services resources as infirmaries, specializers, household physicians, and general medical installations which enable one to have attention. 25.Penelope Angelopoulou, Peter Kangis, George Babis, ( 1998 ) investigated in â€Å" Private and public medical specialty: a comparing of quality perceptual experiences † , that how do doctors and patients perceive the quality of medical services offered and besides is such perceptual experience is the same in the private and public sector? Method used to roll up the day of the month was through study conducted in Greece. Results revealed that patients in the populace sector property greater importance to resources of a medical and proficient nature and do non look peculiarly concerned about the contextual or environmental characteristics of a infirmary. Private patients are anticipating a more holistic attack to their intervention and anticipate some attending to be directed to their emotional demands. 26.Mosad Zineldin, ( 2006 ) investigated in â€Å" The quality of wellness attention and patient satisfaction: An explorative probe of the 5Qs theoretical account at some Egyptian and Jordanian medical clinics † , the major factors impacting patients ‘ perceptual experience of cumulative satisfaction to turn to the inquiry whether patients in Egypt and Jordan evaluate quality of wellness attention likewise or otherwise. Research questionnaire was used for study subsequently on through empirical observation analyzed for consequences. Results revealed that patients ‘ satisfaction with different service quality dimensions is correlated with their willingness to urge the infirmary to others. A remedy to better the quality for health-care services can be an application of entire relationship direction and the 5Qs theoretical account including Quality of object, Quality of procedures, Quality of substructure, Quality of interaction and Quality of atmosphere together with client orientation scheme. Practical deductions – The consequence can be used by the infirmaries to reengineer and redesign 27.Amira Elleuch, ( 2008 ) in â€Å" Patient satisfaction in Japan † , extended bing cognition about wellness attention quality and patient satisfaction by researching Nipponese context holding a different wellness attention system and a different civilization from the USA and Europe.A structural equation theoretical account is used to research links between quality perceptual experience and patient satisfaction every bit good as between patient satisfaction and knowing behaviour trusting on 159 Nipponese outpatient answers. Consequences revealed that procedure quality attributes including service velocity, quality of interaction with staff and the scene ‘s visual aspect were found to be patient satisfaction ancestor when measuring wellness attention service 28.Shou-Hsia Cheng, PhD Yu-Jung Wei, MS Hong-Jen Chang, MD, MPH, MS ( 2006 ) investigated in â€Å" Quality Competition Among Hospitals: The Effectss of Perceived Quality and Perceived Expensiveness on Health Care Consumers † that what quality and cost factors influence whether patients perceive wellness attention services as expensive and will urge a infirmary to other patients. The writers analyzed informations from a national study of patients in Taiwan in 2002 through questionnaires. Logistic arrested development theoretical accounts applied on the informations. Consequences revealed that a patient ‘s perceptual experience of expensiveness was determined at the same time with the sensed quality and the out-of pocket monetary value of attention, a patient ‘s perceptual experience of hospital quality appeared to be the most of import determiner for urging a infirmary, and while the out-of-pocket monetary value did non impact a patient ‘s recommendation, the sensed expensiveness of the services did. The sensed value instead than the monetary value itself is the kernel of quality competition in Taiwan ‘s wellness attention market. 29.Dilaver Tengilimoglu, Adnan Kisa and Sophia F. Dziegielewski ( 1999 ) investigated in â€Å" Consumer Opinions with Ancillary Hospital Services: Improving Service Delivery in Turkish Hospitals † through interviews about direct measuring of consumer-satisfaction and use of this information to better service bringing. The SPSS computing machine bundle plan analyzed all informations. One-way analysis of discrepancy ( ANOVA ) was used to find any statistically important differences in degree of consumer sentiment on accessory services between the seven infirmaries. Further, cross-tabulations were depicted between satisfaction degree and several of the independent variables. The t trial was utilized to mensurate the differences between male and female consumer penchants. Two critical countries were examined: accessory staff and consumer dealingss and overall feelings of the comfort of the installation. Relationships and per centums within and among these variables are reported. Consequences revealed that consumers were instead giving importance to direct intervention they focused on interactions with the infirmary ‘s staff and other services provided by the installation ( e.g. comfort, cleanliness, parking, etc. ) .

Assignment Week 4 Essay Example | Topics and Well Written Essays - 500 words

Assignment Week 4 - Essay Example The ordinary parking zone can be occupied by students who have opted for ordinary parking passes. A parking spot in this zone is not guaranteed but is rather filled up on a first-come first-served basis. The restriction imposed on ordinary parking zone would be that no special pass holder will be allowed to park their vehicles here. On the other hand if the peak hour parking slot is unoccupied after the designated time, it can be occupied by the ordinary pass holder if all ordinary parking zone is full to capacity. e.g.: If the peak hours are between 10:00 am - 12:00 noon and all parking spots are full except for a few peak hour parking spot, the same can be occupied by an ordinary pass holder after 1 hour from the end of peak time (i.e., 1:00 pm or later). In effect peak hour parking zone transforms into ordinary parking zone if spots are empty after end of peak hours to accommodate more vehicles. In this way students who regularly use the parking facility can be given a peak-time parking spot at higher rates to ensure maximum revenue, and additional revenue generated from ordinary parking zone where parking depends on first-come first-served. Parking slots for students, who require parking spots during peak hours, should be assigned only in the special parking zone. The ordinary parking zone can have students driving in and out of the parking lot and spots will not be reserved, thus ensuring that parking spots are not wasted. 3. The condition of the global market / the larger chain of consumers, clients, partners, competitors i.e. the linked organisations and entities that form the channel for revenue flow in and out of the industry and within the industry. If the target market is performing well and there is surplus demand than availability of resources then the pricing strategy should be adopted accordingly. Secondary factors that play a deciding role in the choice of a

Health Care Informatic Essay Example | Topics and Well Written Essays - 1000 words

Health Care Informatic - Essay Example For instance, an employee with the proper security clearance can look up medical information on the patients he is treating, but he can also look up ex-girlfriends, neighbors and anyone else his security clearance allows him to access. Because of such abuse, many information systems professionals run random system checks to see which employees are accessing records and for what reasons. However, it is not feasible to think that every employee can be monitored all of the time. Health care informatics make a patient's medical information accessible to anyone that might need it, but they also make it vulnerable to prying eyes that don't. Even worse, information that is on a computer system may be vulnerable to access by outside parties that were never intended to access the system, like "hackers" for instance. Such people could perform mass identity thefts, since social security numbers and even credit card numbers are often stored in health care information systems. This would result in unimaginable losses for patients, as well pose a huge liability for the health care provider. Some people worry that security precautions have not been able to keep up with the speedy evolution of health care informatics, and this may be a valid concern. If an entire information system was crippled or destroyed by such a hostile attack - or even by an act of nature, like a flood or tornado - and the back-up systems for the data were not preserved, an entire healthcare network could lose countless patients' medical records, possibly putting the lives of some patients at risk or even causing possible deaths due to treatment errors. Th e shift from filing paper charts on patients to digitally storing medical records has definite advantages, but such technology certainly comes with a serious set of security risks. As with many modern medical topics, the subject of the ethical use of medical records is under great scrutiny. Should private insurance companies be allowed to use medical records to deny coverage to people who are too old Should life insurance be denied to people with genetic disadvantages, like maternal cancers or paternal hypertension Medical research questions also come into the debate. Is it fair to collect data and research from medical records without the consent of the patients For instance, can you look at the rate of blindness of patients with diabetes at a certain hospital without informing the patients or their families New technological advances are even making it possible to enter a patient's symptoms and allow a computer program to suggest a diagnosis. Many health care providers think this is a wonderful new technology that will assist doctors in caring for their patients, but many others think it will become a crutch that will prevent physicians from properly practic ing the art of medicine. When should computers be used to compile information Who should access this information How vulnerable does technology make medicine All of these questions about health care informatics will need to be answered as the field evolves. 2. The Health Insurance Portability and Accountability Act of 1996, also known as HIPAA, is an act issued by the United States government that attempts to define the relationship between a patient's right to confidentiality and the need for medical

Expression Of Recombinant Tick Histamine-Binding Protein Lab Report

Expression Of Recombinant Tick Histamine-Binding Protein - Lab Report Example To facilitate further studies regarding the structure and function of HBP, there should be an efficient means by which HBP can be made available. For this, Pichia pastoris expression system was assessed for its competence in producing recombinant HBP. This was chosen for its effectiveness in glycosylating recombinant proteins. On the other hand, the HBP gene sequence used for this particular study was from cattle tick, Rhipicephalus microplus, which is considered to be an agricultural pest. If found to have therapeutic effect, the despised insect will be given a newly-discovered purpose. Culture and induction of transformed P. pastoris was able to produce c-myc epitope-containing proteins, potentially containing TC11485, as detected through dot blot and Western blot analysis. Future researches involve purification and characterization of the recombinant TC11485. Introduction Lipocalins 1. The structure-function relation in lipocalins Lipocalins are monomeric globular proteins compris ed of a single polypeptide with 150-200 amino acid residues, and ubiquitous in all life forms. In fact, these proteins are abundant in plasma, tissue and secretory fluids of humans. Despite its weak sequence homology, they are characterized by a tertiary structural level of a conserved ?-barrel configuration with an amino-and carboxy-terminal ?-helix attachment, contributing to their similarities in function, which will be discussed in the later sections. The barrel is shaped like a cone, in which the tip is a hydrophobic core that protects the parcel, and the base open to solvent acts as an entry point into the cavity. In fact, the term lipocalin is derived from ‘calyx’, which is the Greek and Latin word for drinking vessel (Cheng, 2010; Schlehuber and Skerra, 2005). Classification of lipocalins is based on variations in the length of the terminal segments. Aside from the highly conserved tertiary structure, lipocalins also exhibit similar arrangement of exons and intr ons in their genes’ coding sequences (Cheng, 2010). Understandably, each lipocalin has a distinct amino acid sequence. For human lipocalins, a single unpaired cysteine (Cys) residue allows intermolecular covalent binding of a lipocalin to another protein. Apolipoprotein D (ApoD) binds with apolipoprotein A-II, and NGAL associates with matrix metalloproteinase IX Other than being differentiated based on amino acid sequence, lipocalins vary in the shapes that their structures can assume. Logically, capability for such changes influences the function of the protein. For example, neutrophil gelatinase-associated lipocalin (NGAL) opens more widely to become more funnel-like, while the mouse major urinary protein (MUP) closes the opening of the barrel to totally encapsulate the ligand (Schlehuber and Skerra, 2005). 2. Physiologic role of lipocalins This family of proteins primarily functions to transport or store compounds that are insoluble or chemically sensitive. Among the compo unds transported by lipocalins are hydrophobic vitamins, pheromones, bilins, retinoids, lipids and steroid hormones, play significantly in transcription, enzymatic reactions and metabolism (Schlehuber and Skerra, 2005; Cheng, 2010). They deliver their ligands to the cell membrane receptor or to the targets (such as DNA) themselves. For example, the human plasma retinol-binding protein (RBP), the first lipocalin structurally characterized, transports the insoluble and highly oxidative vitamin A from the stores in the liver to the target tissues . ApoD transports progesterone and arachidonic acid, while NGAL has Fe(III)-enterobactin as its ligand (Schlehuber and Skerra, 2005). 3. Medical significance of lipocalins Because of their

Advertising Proposal for SONY Online Entertainment LLC Case Study

Advertising Proposal for SONY Online Entertainment LLC - Case Study Example Little of this consumer success radiates on SONY Online Entertainment (SOE) as yet, probably because it was established fairly recently as the online gaming firm of the SONY Corp. of America. Notwithstanding its distinguished corporate lineage, SOE is a fledgling company that needs to position its own brand, broaden its marketing base and overcome the heavy competition in online gaming through innovative thinking and ideas.FGH Associates, a full-service advertising agency, proposes to give SOE top-of-mind consumer recall and preference through a one-year advertising blitz that utilises every major medium - TV, radio, magazines, newspapers, cinema, video games, Internet, billboards - to deliver the message. The message: SOE is the online gaming firm for quality, innovation and delivery. This message will be delivered to the target market through meaningful advertising modules that exude warmth, energy and ingenuity. Advertising is meaningful if it is true-to-life and effective, warm i f gentle and sensitive, energetic if lively and appealing, ingenious if imaginative and silly but clever (McKay, 2005).In adopting an advertising strategy, positioning plays an important part. Positioning a product for a feasible market involves communication, which has become difficult in an "over-communicated" society (Goldman & Papson, 1994). There are just too many companies, too many products, and too much marketing noise such that in the US alone, per capita consumption in advertising is placed at $200 per year. In 2006, adspend worldwide was placed at $385 billion and is expected to reach $500 billion in 2010 (Chowdhury, 1994). Through all this noise, however, a firm can manage if it considers not only its own strengths and weaknesses but also those of its competitors. The easiest way to get into a person's mind is to relate to customers in a personal way (Desmond, 2003) and appeal to emotions in some ways (AllBusiness.com, 2008). This can only be done if the advertiser belie ves in his product. Even the most carefully thought out and highly creative ads would fail to connect if the product is not as good as advertised. The American Research Group (2007) sets 10 rules in making advertising more effective: 1. Tell a simple but good story instead of just purveying information. 2. Make the desired call to action an essential part of the story. 3. Use emotional appeal as basis. 4. Use easy and simple arguments. 5. Show instead of tell the message. 6. Use symbolic languages and images that relate to the senses, 7. Match what viewers see with what they hear. 8. Stay with a scene long enough for more impact. 9. Let a powerful video speak for itself. 10. Use identifiable music. When advertising takes these rules to heart and still fails to sway consumers, it may be worthwhile to follow

Literacy Programs for all Grade Levels Essay Example | Topics and Well Written Essays - 1000 words

Literacy Programs for all Grade Levels - Essay Example each individual learning has his or her own learning curve that is followed by the mind of each person. In this case, it should be recognized that each individual has his or her own pace of learning that must be carefully carried through in considering the different procedures that would help one get the grip of the most important lessons he need to know as he tries to be literate with his own language. 3 This is the reason why there is a continuous search for the best kind of literacy program that is general enough to serve all the needs of students from all grade levels. The generality of this program makes it much applicable both on the part of the teachers or the educators handling the students at school and also that of the parents handling the learning needs of their children at home. As noted earlier, children of different a... It could be noted how the mind of each child responds differently to the learning presentations provided by their instructors. For this reason, each child needs to reserve personal attention so as to assure that the subjects ought to be understood are to be given the right attention that they deserve. How could this be practically done The cooperation of the parents with regards the learning program set for their children is a very important factor to consider. This is perhaps the reason why many governments around the world settle for programs that directly involve the parents' participation that would likely increase the level of learning expertise of their children towards the understanding they need to have in connection with literacy and knowledgeable use of language.4 Presented below is a likely general program that could be used as a literacy enhancement procedure among different schools that handle different grade levels. DURATION ACTIVITIES SUGGESTED INSTRUCTIONAL DIRECTIONS REMARKS AND EXPECTATIONS 1 YEAR PROGRAM FOR ALL GRADES IN AN EDUCATIONAL INSTITUTION 1st Quarter Parent-Teacher Acquaintance Meeting Here, the teachers and parents would have either a group session meeting or an individual interview [whichever is much preferred by both parties]; this would provide both teachers and parents to have a better understanding on the level of learning that their children have. Likely, the connection they would be able to establish could help both parties in assessing the problems and possible issues that may occur during the one year learning schedule of the children. Through this particular step, it is expected that the teachers

Managerial Enterprise Theory Presented by Alfred Chandler Essay - 5

Managerial Enterprise Theory Presented by Alfred Chandler - Essay Example The report starts with a short description of the theories proposed by Chandler followed by a discussion of how the theories proposed by Chandler are applicable in the modern corporate setting. The relationship between the strategies proposed according to the theory and the structure of modern economies are identified and explained. Also, a section of the report includes drawing references from the national patterns of management enterprises so that a parallel can be drawn between the theory proposed by Chandler and the importance of these theories in the 20th century corporate and managerial enterprises. The advantages, as well as the shortcomings of the theories proposed by Chandler, are identified and analyzed in detail. The report is concluded by drawing suitable inferences from the analysis and by proposing suitable arguments in favor of the views as per the analysis. The theory postulated by Chandler deals with the functioning of managerial enterprises. As per the view of Chand ler, the managerial enterprises refer to the big scale industrial companies in which the crucial investment and operating decisions are taken in a hierarchical manner in which a number of salaried executives and managers propose the basic decision propositions and the final decisions are taken by a governing body which is the board of directors of the company. The key logic behind Chandler’s theory of managerial enterprise is that the necessary investments in the production, management, and distribution of the enterprise are made with the aim of achieving economies of scale and benefitting from the learning curve for organizations. The main strategic intent of investment decisions is based on creating a dominating presence of the enterprise within the industry in which it operates. In this context, the economies of scale refer to the benefit of a company that the cost of production per unit decreases as the production output volume of the enterprise increases.

Collaboration Photography Assignment Example | Topics and Well Written Essays - 250 words

Collaboration Photography - Assignment Example The scene is mechanical, and captivating at the same time, and through right angle shoots outs the object confronts the subject directly and the use of light and shadow brings more focus on the object. Though people consider black and white photography is often treated as the poor relation of color, it can make a photo look captivating. A distraction brought out by color in the photo is eliminated by the use of the black and white photography; a studio brings out the best of the colors. In fact, the black and white boils to major concepts: removal of distraction, contrast, pattern, texture and lighting. Color photography unlike the black and white one does not effectively provide patterns, in fact, slight ones go unnoticed. On the other hand, a black and white Photoshop provides more vivid capturing patterns, as the viewer’s attention is more focused on the shapes formed by the elements in the

Ethical theories Essay Example for Free

Ethical theories Essay There are five types of ethical theories: 1. Teleological theory of ethics 2. Deontological theory 3. Virtue ethics 4. Justice as fairness 5. Feminism The teleological theory examines the consequences in terms of pleasure and pain, which is termed as â€Å"Utilitarianism†. According to this theory, our obligation in any situation is to perform that action which will produce the greatest amount of good over evil. Under this theory, the ethical virtues such as being honest or not lying are not obligatory. Utilitarian morality compels you to do only those particular acts which bring out good results only. For instance, consider a situation where telling the truth can break someone’s heart or hurt his/her feelings then in the light of this theory, lying is better than honesty. One of the fundamental characteristics of utilitarianism is universalism which talks about the pleasure of everyone, rather than benefitting your own self only. The two versions of utilitarianism have evolved from these conditions, act-utilitarianism and rule-utilitarianism. The two great philosophers, Jeremy Bentham and Stuart Mill presented their views in the light of this theory. Bentham proposed the act-utilitarianism theory and said: â€Å"An action is right if it produces greatest amount of pleasure over pain for everyone† However, this statement was greatly opposed by many critics since they termed it as a â€Å"pig philosophy†. Critics complained that pleasure alone can not constitute the good for human beings because even pigs are capable of attaining pleasure from their own bodies so it would be better to live the life of a satisfied pig rather than being a dissatisfied human being such as Socrates. Seeing these objections, Stuart Mill supported the utilitarianism gave the idea of act-utilitarianism by giving his view that an action is right if it produces greatest amount of pleasure over pain by following certain moral rules. Mill said that a person should go for qualitative pleasure rather than quantitative pleasure. Mill also defended the accusation of pig philosophy on Bentham by giving his views that human beings are able to enjoy the higher levels of pleasure than swine. Human beings can pursuit pleasure in the form of intellectual arts and other such activities. Hence, Mill categorized pleasure in higher and lower forms of pleasure. Rule-utilitarianism emphasized tremendously on morality and social obligations, which in fact, are the problems of all teleological theories. Concluding the discussion now, the best theory is the rule-utilitarianism as compared to act-utilitarianism theory because one does not need to calculate the amount of pleasure and pain before performing any deed. Instead, it provides the basic grounds of morality and goodness for doing any action.

Power and Inequality in a Cultural and Linguistic Anthropolistic View Essay Example for Free

Power and Inequality in a Cultural and Linguistic Anthropolistic View Essay Centuries have passed and the different relationships of power and inequality are still present. Power and inequality have always been an issue and a topic of discussion among many different people in different cultures. Although much has changed throughout history, the struggle between power and inequality is still inevitable. There are many different types of power and inequalities ranging from gender to race and culture. Anthropologists can investigate issues surrounding power and inequality by submerging into different cultures and studying how power and inequality play a role in their society. Power and inequality still play a role in modern human cultures as seen by different struggles of cultures as well as the differentiation of linguistics. Cultural anthropologists can investigate issues surrounding power and inequality in modern human populations as they immerse themselves into understanding the different circumstances of different cultures of today and of the past as well. Throughout the years, there has been a struggle of power and inequality between many, including gender and race. Gender has been an issue in many different cultures, and continues to be a struggle even today. In the past, gender issues have resulted in many problems. For example, after China passed the one child law, many parents wanted to have sons rather than daughters because of the thought that sons were more worthy. This however, has resulted in an imbalance of the male and female ratio as it has reached 144:100, in the rural areas of China (Peters-Golden, 2012). In modern society, it is evident that in most cultures, the male is still the dominant gender. In some cultures, including some in the Middle East, women are looked down upon, mistreated and are not treated as equals. Even in the modern Western culture, there is still evidence that the women are at a disadvantage compared to the men (Feminist Economics, 2003). Along with gender, race has also been a reoccurring issue of as well. Previously, the Western worlds perceived themselves as having more power and were more superior to any other culture. Culture today, according to cultural anthropologists, is learned and is subject to modification meaning that the modern population can adapt to new races and cultures as well as their own. Different societies should be subject to his or her own culture rather than perceiving that one race or culture as superior to any other. Cultural anthropologists believe that â€Å"how people have been accepted and treated of a given society of culture has a direct impact on how they perform in that society† (American Anthropology Association, 1998). Thus concluding that not everybody can see themselves as superior, as it affects the society as a whole as well. The United States is an example of many different cultural prejudices, and its affects are apparent in their everyday lives including the media. Cultural anthropologists have been studying different cultures of the world, and many of them have different opinions of power and inequality as can be seen by the ways the cultures interact. In the modern world, there are many pieces of evidence that power and inequality are still present and is still an issue in modern human populations. Power and inequality have much to do with cultural studies, but can also be interpreted in a linguistic anthropological view as well. Linguistic anthropology studies how language influences social society in cultures. Although not necessarily seen as inequality, many different languages have different words categorising between gender, age, and status among others. Linguistics is also an important part of cultural anthropology as well. In many different languages, the use of words reflects the cultures status on both power and inequality (University of Washington, 2004). For example, in many languages, including French, Spanish, and Persian, noun classification is sorted by gender. In Thai, there are around 13 ways to say the pronoun â€Å"I† each one used in different circumstances, depending on who and what is being said. In both cases, the use of language is separated by power and could be thought of as a social inequality because different people are referred to by their gender or social status. As well as words that play a role in cultures, the different languages does as well. According to Mary Bucholtz and Kira Hall (1995), linguistic anthropologists, they say that power is linked with markedness. Markedness is a process where â€Å"some social categories gain a special, default status that contrasts with the identities of other groups, which are usually highly recognisable† and is evident in some countries (Bucholtz Hall, 1995, p. 372). An example of this is in Zambia, a country that speaks a total of 73 languages, however, only around 7 are considered the ‘dominant’ language as they are positioned above the others, while English is the official language that is unmarked, and considered to be the most important (Spitulnik, 1998). Linguistic anthropology is an important part when studying the different power and inequalities of cultures. Linguistics can show how cultures can interact by languages and determine who is ‘dominant’ or can differentiate people by status or gender. In modern human populations, the existence of power and inequality is still present. Anthropologists, both linguistic and cultural, investigate the presence in struggle of balancing power and inequality. Different times represent different mindsets, however, both power and inequality have been present for basically all of human existence. Prejudice is inevitable in both the past and current human population, ranging from race, gender, different individuals, and cultures, among others. Anthropologists can investigate issues surrounding power and inequality by submerging into different cultures and studying how power and inequality play a role in their society. Studying the language of other cultures by linguistic anthropologists can also determine many aspects of power and inequality in not only the different cultures of today, but also of the past as well.

Why did jammu and kashmir conflict start

Why did jammu and kashmir conflict start Since 1989 Jammu and Kashmir has been the most important issue in the Indias internal security scenario. Jammu and Kashmir was a major site of the extremely bloody 1947 war. The first few years saw a relative domination by terrorist group when the casualties were mainly civilians. Jammu and Kashmir which lies in the northwest of the subcontinent bordering china. At the time of partition -the British provinces divide two countries India and Pakistan the Hindu majority on the side of India and the Muslim majority on the side of Pakistan and j s k one such a rich pricey and nature rich state had a vesicular problem. Because its the state is in India at the time of partition means under Hindu majority but having Muslim population. In 1947 the population of Kashmir is 77% of Muslims and 20 % of Hindu. After the partition both the country claims that J and k is theirs country state but the result they had wars with each others many times over this region. In 1987 the alliance won and Faroo q Abdullah was the chief minister of the Kashmir. The relation between India and Pakistan is soured. They fought three times in 1947 to 1948, in 1965 and in 1971.so in this quarrel then United Nations invited. From the Indian side it instead that the no referendum could occur until all of the state had been cleared of irregulars. The Jammu and Kashmir are has been administrated by both India and Pakistan .The insurgency was first predominant in Srinagar when militants were largely Kashmirs youth. Muslims are majority in poonch, rajouri, kisth, and doda. And the Shia Muslims make for majority in kargil region. The definition of insurgency means is an armed rebellion against a authority (for ex- which recognised by the United Nations) those who taking part in this rebellion are not recognised by any nation. Insurgency in Jammu and Kashmir existed in various forms. It includes, civilians, Kashmir are, Indian armed forced and foreign militants etc. Kashmir has been the target by all the sides in the conflict. After the elections of 1987 some of the state legislative assembly formed groups or militant wings and further more that has started a catalyst for the insurgency. And it was the starting point of the insurgency in j and k .According the press release there were 3,400 cases of disappearances. U.S intelligences also believes that the al-Qaeda and Taliban are helping to organizing terror camps in Kashmir to foment conflicts it has left more than 4.7000 people dead till 2009.and in the year of 2000 because of insurgencies 31,000 Indian civilians lost their lives .terror camps play a central role in this Insurgencies. The Pakistans inter services intelligence has been accused by India many times to supporting and training terrorists. Like between India and Pakistan. The government believes that the terrorists groups from Afghanistan entered in to this region with the help of isi (Pakistans intelligence).since then the violence has increased significantly in stre ngth. Some parties which are present in the j and k are demanding for an independent Kashmir these parties names are hurriyat conference and Jammu and Kashmir liberation front. Other militant groups favour as a Pakistani Kashmir. It is hard to determine the total numbers of casualties. Because in Jammu and Kashmir it is very common after the partition. Kashmir continuous to remain at the highest volatile region in the world with a highest average of 2,500 every year. Every individual has his or her own ideology so some fight in the name of the religion and some are for independent Kashmir. Several new groups and organisation have also emerged. India claims that the there are also other afghan, Egyptian and Bangladeshi terror active in Jammu and Kashmir. And Is I is the main suppliers of funds and support these groups. But the Pakistani government always denied these type of statements to India. Richer Bennett, a British intelligence analyst that the isi helped these militant groups and has many of their attacks both within the Kashmir and the other major big cities of India. There are between 2,600 to 3,600 militant camps across Pakistan and Pakistan administrated Kashmir. The FBI has also produced images of camps which are located in pok. India claims that the every year thousand of armed and terrorists cross the loc and enter into the Indias administrated Kashmir and spread the terror. During a piece summit between Pakistans former president pervej Mushrraf and Indias former president Atal Bihari Vajpayee in Jan 2004.pakistan assured that they would do everything possible to curb the activities any training camps on its territory. But the violence has continued despite three year long peace process between India and Pakistan. In 2005 there were 166 incidents in the result 201 people are died. So all the problem faced by both the country people. Islamabad has done little to stop the training camps on its soil it was the statement by p. mussaraf the former pri me minister of Pakistan the statement was a truly fake or false statement. Covered by the media. However India claims that the Islamabad supports these terror groups. Thousand of pandits move from Kashmir because of terror. Not much about these groups some says that they collaborate and they are the members of an alliance known as united jihad council. the two groups which India says they were behind the attack in parliament in New Delhi .they are known as jaish -e-Mohammed and lashkar -e- toiba. They are in the favour of Pakistans Kashmir. They are believed to be the members of u g c. In a letter to American people written by Osama bin laden he stated the reasons that why he was fighting against America is because of her support to India on the Kashmir issue. The u .s secretary of defence on a trip to New Delhi in 2002 suggested that al-Qaeda was active in Kashmir. India says that the it was jaish e Mohammed who hijacked the Indian airline flight I c 814 to Kandahar and to force th e Indian government to release the commander of Jaish e Mohammed named Maulana Masood azhar and also attacked the assembly of Kashmir in 2001. All the support or you can say the arms given to them by Pakistan military or i s i. Between august 1988 and at the end of 1989 JKLF was the only terrorist group present in insurgency in Jammu and Kashmir. Later the I s I promot them. The main work of I s I is to give arms to the militants and help them to shifted them to Indians administrated Kashmir. Because of terrorism the state, tourism has been badly affected. Insurgency is the most threatening attempt by Pakistan. It has used to seize the state. Pakistan knows that it this phase of insurgency does not flair up into an open war. The situation came closer in june1999 in the Kargil region when Pakistans army regulars were detected holding positions in peaks of loc. India frequently warned many a times to Pakistan that finish that terrorists camps but Pakistan government always indulged th e statements that their country is peaceful and no terror activities involved by their country. Some of Pakistans Organistaions report that Indian armed forces have been responsible for the death of 4,500 Kashmiri. So Pakistan have also point out India many time In the year of 1990 to 1999 there are 4,242 cases of rape of womens in Kashmir. Another reason of dispute over Kashmir is water. Jehlum and Chenab which flows in Pakistan and the three river ravi , Sutlej and beas irrigate in northern India. In 1960 the Indus water treaty signed to resolved the most of dispute over the sharing of water. But the Pakistan raised the issue when India constructed the dams on its side and which limit water to Pakistans side. How to control the insurgency in Jammu and Kashmir? There is a possibility of changing everything for the good. Religious terrorism is a major part of today. Both the countries should take steps for remove the terrorists parties from their country specially for Pakistan. Pakistan needs to destroys all the camps of terrorists. Because it is the time to finish the issue not to make the issue. So, it is our responsibility to stop the terrorist attacks and to fight with terrorists. .We had already soft on the terror. There are only four or five countries which fight like a child war for states. We have done nothing except kill our men and people of the other countries. Both the countries India and Pakistan have same religions , currency and etc so we are the two faces of one coin. Respect the other religions. I DREAM THAT THE INDIA WE LEAVE BEHIND WILL BE MUCH MORE WONDERFUL THAN THE INDIA WE INHERITED. I SINCERELY HOPE YOU SHARE MY DREAM.THANK YOU