Media and Plastic Surgery Essay -- Females Self Image Cause Effect Ess

Media and Plastic Surgery Images produced by the media will make people do almost anything to fit American standards of the unadulterated body. Plastic operating theatre offers a quick fix to help achieve this goal but no matter how much surgery nothing is perfect. Images produced by media, quick fixes and the offspring of the fixes are problems that women of all ages deal with. From the time of birth, images of physical perfection bombard young minds. When children are young their minds are fragile and mold to what they are taught. atomic number 53 of the first toys a young girl is given is a Barbie doll Girls are shown Barbie and parents tell the children that Barbie dolls are beautiful. So young girls are taught that Barbie is what a perfect female is. Eventually when the girls reach middle school they find Barbie what they still want to physically achieve but find talking about Barbie childish. So they turn to more life size Barbie dolls like Britney Spears and Destinys Child . jejune girls, who consider themselves individuals, all strive for the same goal to become what the opposite sex is attracted to. Teenage girls want to dress and look like young celebrities so they suffer tons of makeup and dress in clothing that would have their great grandparents play in their graves. Schools all over the country are taking the parents job by changing the dress code so that girls do not wear clothing that show their mid drifts and bare shoulders. Even when girls enter college they are still effected b...

The Dark Romantics :: essays research papers

The dark Romantics describe life as evil, sinful, insane, and deceptive, which is more like life today. For example, the towns people in the fatal Veil can be seen as evil and sinful. The reason they are thought as evil and sinful is because they say things ab disclose him because he is draining the black veil. This can be seen in Hawthorns the minister and the Black veil when Mr. Hooper says, why do you tremble at me? Cried he wrestleing his veiled formulation around the circle of pale specters. Tremble also at each other Have men avoided me and women shown no pity, and children screamed and fled only for my Black veil? In addition Ahab in "Moby Dick" is considered not only as an evil and sinful person but is selfish and greedy. The reason why he is sinful, evil, selfish, greedy, in the first place is because he didnt care what the other people on the ship wanted or that what he was going to do would or could bring dangers, and what he was doing was a waste of time, be cause instead of getting vengeance on "Moby Dick". He could be hunting whales for food and selling whats left of them and carry money. Furthermore evil and sinful people today, like Charles Manson. The reason why he is considered an evil and sinful person is because he killed a lot of people. another(prenominal) reason he is evil is because he said he was God. This is one of the many reasons why I agree with the Dark Romantics. The second reason out of the many reasons of why I agree with the Dark Romantics is because a lot of people are insane. For example, mad or insane people caused the Columbine tragedy. one(a) of the doddering things they did was running around the school shooting and blowing things up. While trying to take as many lifes as they could. Another crazy or insane thing is the fact that they took pride in what they did. The reason I say they took pride in it . Is because they made a video that showed them express joy and saying that they were going to do all the stuff they did, and how they were going to do it. In addition, the mother who shot her kids is more proof that people can turn insane at any minute.

Philosophical Foundation of Ecological Ethics :: Ecology Ecological Philosophy Papers

Philosophical Foundation of ecologic EthicsABSTRACT Principles of Buddhistic philosophy central to the formation of an ecologic paradigm of mentality include a dynamic vision of the beingness, a governance of relative truth asunder from dogmas, a moral foundation for scientific knowledge, an emphasis on nonviolence and the absence of repressive scientific methods, and the progressive drive of the intellect to Universal intellect which postulates the unity of microcosm and macrocosm. The comparative analysis of laws and principles of modern ecological science and basic Buddhist thought points to their common intentional stress. Buddhist philosophy declares the creative engagement of humankind in the united world synergistic process and forms to be the foundation of an altruistically marked ecological ethics. entireness and interdependence of onthological reality international scales of crisis which destroyed our planet requires the united measures and efforts of East and We st in formation of ecological ethics. East and West two separate of mankinds consciousness. If a man realizes it he can become a perfect human being. And only after that he can lap those global problems of surviving, which mankind is lining now. (A. Govinda)The fundamental idea of all Buddhist philosophy is the inseparable unity of subject and object, man and nature, substance and mind. The Buddhists consider world and man as a dynamic psychophysical entirety. Its character and direction which is called stream (santana) that set outs a principle of absolute change (anytyata).Anityata is of a deep ecological importance. It raises a problem of uneternity of psychocosms spheres and admage of its being destroyed. According to Buddhist religious doctrine the category anitya must occupy a certain position in each analysis. Speaking of a statement it is important to take into consideration its change and movable character. Only stable and permanent efforts of all living beings make this world better and without this direction for making kindness our world can become worse and suffering permanent characteristics of sansara can acquire rude and double-dyed(a) forms. Besides simple basic assumption of change anityata says about non-reversibility of former conditions. Its impossible to reverse ones life. Its impossible to return of the memorial of a country backward as well as impossible to make the planet evolution come to beginning.The principle of emptyness ( shunyata ). Buddhism denyes the inherent existence of things and phenomena. If you take away the reasons and conditions of existense of something then it forget disappear itself because it doesnt have inherent existence.Philosophical Foundation of Ecological Ethics Ecology Ecological Philosophy PapersPhilosophical Foundation of Ecological EthicsABSTRACT Principles of Buddhist philosophy central to the formation of an ecological paradigm of mentality include a dynamic vision of the world, a system of relative truth apart from dogmas, a moral foundation for scientific knowledge, an emphasis on nonviolence and the absence of repressive scientific methods, and the progressive movement of the intellect to Universal Consciousness which postulates the unity of microcosm and macrocosm. The comparative analysis of laws and principles of modern ecological science and basic Buddhist thought points to their common intentional direction. Buddhist philosophy declares the creative participation of humankind in the united world synergistic process and forms to be the foundation of an altruistically marked ecological ethics. Entirety and interdependence of onthological realityGlobal scales of crisis which destroyed our planet requires the united measures and efforts of East and West in formation of ecological ethics. East and West two parts of mankinds consciousness. If a man realizes it he can become a perfect human being. And only after that he can solve those global problems of survivin g, which mankind is facing now. (A. Govinda)The fundamental idea of all Buddhist philosophy is the inseparable unity of subject and object, man and nature, substance and mind. The Buddhists consider world and man as a dynamic psychophysical entirety. Its character and direction which is called stream (santana) that makes a principle of absolute change (anytyata).Anityata is of a deep ecological importance. It raises a problem of uneternity of psychocosms spheres and admage of its being destroyed. According to Buddhist religious doctrine the category anitya must occupy a certain position in each analysis. Speaking of a statement it is important to take into consideration its change and movable character. Only stable and permanent efforts of all living beings make this world better and without this direction for making kindness our world can become worse and suffering permanent characteristics of sansara can acquire rude and vulgar forms. Besides simple constatation of change anitya ta says about non-reversibility of former conditions. Its impossible to reverse ones life. Its impossible to return of the history of a country back as well as impossible to make the planet evolution come to beginning.The principle of emptyness ( shunyata ). Buddhism denyes the inherent existence of things and phenomena. If you take away the reasons and conditions of existense of something then it will disappear itself because it doesnt have inherent existence.

Free College Essays - The Forest as a Symbol of Freedom in Hawthornes The Scarlet Letter :: free essay writer

The Scarlet Letter - The Forest as a Symbol of Freedom Wilt thou let me be at peace, if I once verbalise thee? asked Hester. In Nathaniel Hawthornes The Scarlet Letter, life is centered around a stiff prude confederacy in which unmatchableness can not scotch in their deepest sentiments. Puritan society does not let human beings show how they really feel. accordingly Hester had to seek refuge to explore her inner thoughts, such as the forest. In the forest Hester brings out mevery hidden emotions, Hester shows her love for Dimmsdale, and the forest is a place where the both of them may keep up an open conversation without the constraints of Puritan society. The forest is a symbol of freedom. Nobody ever watched over the forest as a place of misbehavior, that is why mountain went there to do what they wanted. jumble off the shackles of law and religion. What good have they done you anyway? Look at you, a young and vibrant women, with child(p) old before your time. And n o wonder, hemmed in, as you are, on every side of prohibitions. Why, you can hardly walk without tripping over the commandment or another. know to me, and be masterless. Of coarse Hester takes returns of this when she meets with Dimmsdale in the forest. She talks to him about things they could never imagine to discuss in any other place except the forest. What we did had a concecration of its own, we felt it so, we said to eachother. Dimmsdale is ball over and tries to hush Hester but realizes he is in the safety of the forest and no one else may hear them. Just the thought of Hester speaking to Dimmsdale in their society is un mentionable. Yet in the forest they may feel free to do as they wish and not have to misgiving about any one else knowing. In Puritan society every one is assumed to be selfrelient. The puritans believe that you should have yourself to depend on emotionally, spiritually, and physically. Therefore Hester could never show her veritable emotions to Dimmsdal e or for them to comfort each other. In the forest all of these cares are thrown away. Be though strong for me, counsel me what to do. This is Dimmsdales cry for function to Hester, which they could never discuss in their Puritan village. When he asks her for help he shows that he thinks of Hester as an equal and he is not above her in any way.Free College Essays - The Forest as a Symbol of Freedom in Hawthornes The Scarlet Letter free essay generatorThe Scarlet Letter - The Forest as a Symbol of Freedom Wilt thou let me be at peace, if I once tell thee? asked Hester. In Nathaniel Hawthornes The Scarlet Letter, life is centered around a stiff Puritan society in which one can not indulge in their deepest thoughts. Puritan society does not let human beings show how they really feel. Therefore Hester had to seek refuge to explore her inner thoughts, such as the forest. In the forest Hester brings out many hidden emotions, Hester shows her love for Dimmsdale, and the forest is a place where the both of them may have an open conversation without the constraints of Puritan society. The forest is a symbol of freedom. Nobody ever watched over the forest as a place of misbehavior, that is why people went there to do what they wanted. Throw off the shackles of law and religion. What good have they done you anyway? Look at you, a young and vibrant women, grown old before your time. And no wonder, hemmed in, as you are, on every side of prohibitions. Why, you can hardly walk without tripping over the commandment or another. Come to me, and be masterless. Of coarse Hester takes advantage of this when she meets with Dimmsdale in the forest. She talks to him about things they could never imagine to discuss in any other place except the forest. What we did had a concecration of its own, we felt it so, we said to eachother. Dimmsdale is shocked and tries to hush Hester but realizes he is in the safety of the forest and no one else may hear them. Just the thought of He ster speaking to Dimmsdale in their society is un mentionable. Yet in the forest they may feel free to do as they wish and not have to worry about any one else knowing. In Puritan society every one is assumed to be selfrelient. The puritans believe that you should have yourself to depend on emotionally, spiritually, and physically. Therefore Hester could never show her true emotions to Dimmsdale or for them to comfort each other. In the forest all of these cares are thrown away. Be though strong for me, advise me what to do. This is Dimmsdales cry for help to Hester, which they could never discuss in their Puritan village. When he asks her for help he shows that he thinks of Hester as an equal and he is not above her in any way.

Interaction of Human Culture and the Environment :: Environment Environmental Pollution Preservation

Interaction of Human Culture and the EnvironmentIn the mid 1970s and early 1980s, the field of clinical psychology underwent a revolution with the emergence of family therapy. Therapists initially understood disorders as being the result of a linear chain of causality. For instance, one theory of schizophrenia held that the disorder resulted from vulnerability to a certain pattern of behavior on the part of the patients m some other. Mothers of schizophrenics were often found to be particularly cold, unresponsive, dominant, and conflict-inducing towards their children. Researchers argued that such schizophrenogenic behavior was the direct cause of the disorder. palmy treatment, then, required the patient and mother to examine their relationship and seek out better, more than positive methods of interaction. Family therapists, however, then began to realize that the etiology of the disorder was far more complex than simply the mother inducing the disorder within the child. The schi zophrenic and the mother were enmeshed within a complex system of interactions both within, as well as outside, the family. Thus, the schizophrenic was affected by both his mother and father, the schizophrenic himself had an impact on his parents, the father and mother affected each other through their marital relationship, and social and cultural norms had an overall impact on all members of the family. Family systems researchers realized that these various relationships were constantly changing, and that each one had a authoritative effect on the others. Problems within the family were now understood in terms of circular causality rather than linear. For instance, it might very well be trustworthy that the schizophrenics mother is cold, conflict-inducing, and unresponsive towards him. It is also true, however, that the schizophrenic manifests very bizarre behavior, such as hearing voices, acting on paranoid impulses, hallucinating, and displaying inappropriate (or flat) emotiona l responses. These behaviors would surely affect the mother, as she would be stressed and deeply concerned for her childs well being. The mother might also be affected by a combative marital relationship with her husband, which itself might be negatively impacted by the childs schizophrenic behavior. Finally, the family might be negatively affected by the society in which they live, as their neighbors or colleagues might view them as outcasts and purposely isolate them because of their childs inappropriate behavior. Ultimately, this series of negative interactions may result in a feedback loop, in which maladaptive behavior is amplified and the childs schizophrenic behavior worsens.

Essay on Facing the Consequences in King Lear -- King Lear essays

King Lear Facing the Consequences Shakespeares tragedy King Lear is a detailed description of the consequences of unrivalled mans decisions. This fictitious man is Lear, King of England, whose decisions considerablely alter his breeding and the lives of those around him. As Lear bears the status of King, he is, as one expects, a man of great power. But, sinfully, he surrenders all of this power to two of his daughters, as a reward for their demonstration of love towards him. This untimely abdication of his throne results in a bowed stringed instrument reaction of events that sends him on a journey toward Hell, in order to expiate his sin. As the play opens one displace almost immediately see that Lear begins to commit mistakes that will eventually result in his d birthfall. The very first words that Lear speaks in the play are Give me the map there. Know that we have shared out/ In three our kingdom, and tis our fast intent/ To shake all cares and business from our age, / Conferring them on younger strengths while we/ Unburdened crawl to death. (I.i.38-41) This gives the reader the first denotation of Lears intent to abdicate his throne. He goes on further to offer parcels of his kingdom to his daughters as a form of reward for passing his test of their love spacious rivals in our youngest daughters love, / Long in our court have made their amorous sojourn, / And here are to be answered. Tell me, my daughters/ (Since now we will divest us both of rule, / Interest of territory, cares of state), / Which of you shall we say doth love us most? / That we our largest bounty may extend/ where nature doth with merit challenge. (I.i.47-53) The most signif... ... All of this suffering that Lear endures can be traced back to the case-by-case most important error that he made, the decision to give up his throne. This sin has proven to have massive repercussions upon the life of Lear and the lives of those around him, eventually leading to the death s of almost all who were directly involved with his abdication. After following Lears demise which was brought on by a single wrong turn, one cannot help but wonder what difficult corners lie ahead that may cause similar alterations in ones own life. Works Cited Bloom, Harold. Shakespeare The Invention of the Human. New York Penguin Putnam, 1998. Boyce, Charles. Shakespeare A to Z. New York Roundtable Press, 1990. Shakespeare, William. King Lear. Eric A. McCann, ed. Harcourt Brace Jovanovick.

Essay on Facing the Consequences in King Lear -- King Lear essays

King Lear Facing the Consequences Shakespeares tragedy King Lear is a detailed description of the consequences of one mans decisions. This fictitious man is Lear, King of England, whose decisions greatly spay his life and the lives of those around him. As Lear bears the status of King, he is, as one expects, a man of great power. But, sinfully, he surrenders all(prenominal) of this power to two of his daughters, as a reward for their demonstration of love towards him. This untimely abdication of his throne results in a chain reaction of events that sends him on a journey toward Hell, in order to expiate his sin. As the play opens one can almost immediately see that Lear begins to make mistakes that will eventually result in his downfall. The very first words that Lear speaks in the play are Give me the map there. Know that we draw divided/ In three our kingdom, and tis our fast intent/ To escape from all cares and business from our age, / Conferring them on younger strengt hs while we/ Unburdened crawl to death. (I.i.38-41) This gives the reader the first indication of Lears intent to abdicate his throne. He goes on nevertheless to offer parcels of his kingdom to his daughters as a form of reward for passing his test of their love Great rivals in our youngest daughters love, / Long in our court have made their amorous sojourn, / And here are to be answered. Tell me, my daughters/ (Since now we will divest us both of rule, / Interest of territory, cares of state), / Which of you shall we say doth love us most? / That we our largest bounty may extend/ where nature doth with merit challenge. (I.i.47-53) The most signif... ... All of this suffering that Lear endures can be traced back to the single most all important(predicate) error that he made, the decision to give up his throne. This sin has proven to have massive repercussions upon the life of Lear and the lives of those around him, eventually leading to the deaths of almost all who were d irectly involved with his abdication. After following Lears demise which was brought on by a single wrong turn, one cannot help but interrogate what difficult corners lie ahead that may cause similar alterations in ones own life. Works Cited Bloom, Harold. Shakespeare The Invention of the Human. fresh York Penguin Putnam, 1998. Boyce, Charles. Shakespeare A to Z. New York Roundtable Press, 1990. Shakespeare, William. King Lear. Eric A. McCann, ed. Harcourt Brace Jovanovick.

Attitude and Behavior Essay

If someone has a negative spatial relation toward a special unmarried or group, for example, what are the potential implications of their behavior toward that individual or group? How do implicit and explicit attitudes differ? Go to the Project connotative website and take a crap the Implicit Association Test (implicit.harvard.edu/implicit). Choose any test within the demonstration category. After retrieving the results of your test, share them with your classmates and realise their accuracy. Were you surprised by your results? Do they accurately portray your attitude toward the group? Do you think these types of tests are reliable in measuring prejudice? please explain your answer. smooth on the kinship between personal attitudes and resulting behaviors, using the Theory of Planned Behavior, Cognitive Dissonance Theory, and Self-Perception Theory as your references. If someone has a negative attitude toward a particular individual or group, for example, what are the potentia l implications of their behavior toward that individual or group? How do implicit and explicit attitudes differ?Go to the Project Implicit website and take the Implicit Association Test (https//implicit.harvard.edu/implicit/). Choose any test within the demonstration category. After retrieving the results of your test, share them with your classmates and consider their accuracy. Were you surprised by your results? Do they accurately portray your attitude toward the group? Do you think these types of tests are reliable in measurTo download this material Click this link https//bitly.com/1wyTIGqCollege could be a great experience, no matter how challenging it may seem. The advice below is sure to help you with some of the tough stuff so you have more(prenominal) time for fun. Use the tips you have learned here, and from other places as well, with care after all, your college choices play a major role on how your life turns out.Reflect on the relationship between personal attitudes an d resulting behaviors, using the Theory of Planned Behavior, Cognitive Dissonance Theory, and Self-Perception Theory as your references. If someone has a negative attitude toward a particular individual or group, for example, what are the potential implications of their behavior toward that individual or group? How do implicit and explicit attitudes differ?Go to the Project Implicit website and take the Implicit Association Test (https//implicit.harvard.edu/implicit/). Choose any test within the demonstration category. After retrieving the results of your test, share them with your classmates and consider their accuracy. Were you surprised by your results? Do they accurately portray your attitude toward the group? Do you think these types of tests are reliable in measuring prejudice? Please explain your answer.Respond substantively to at least two of your classmates posts.

Morality in Ethan Frome Essay

In The Morality of Inertia, Li peerlessl Trilling argues that Ethan Fromes inability to make his own ethical determinations ultimately makes his strike a tragic event caused by the inactivity of morality. The nonexistence of this moral inertia is the explanation, for Trilling, for the outcome of Frome the lack of moral responsibility in any of the main characters from the beginning of their lives paralyzes their decision making process they simply exist and do what is their duty.Trillings aspect that Frome was a morally inadequate man is a valid situation affirmed by Edith Whartons provided bottomground of him the idea that he was unable to make choices and is only confident of enduring can be proven outside with his Fromes actions throughout the story. The notion that Ethan Frome is incapable of making ethical decisions based on his background can also be countered with his background and actions.Trilling uses Fromes duties as a husband and son as support for his claim that ch oice is incompatible with Ethans existence (from Morality of Inertia). However, the reader is exposed to Ethans ability to sleep together choices, and decisions not to act on them, throughout the story. Frome acknowledges his dilemma of running away with Mattie or staying with Zeena, but is inefficient in seeing past the initial consequences of all(prenominal) choice and exploring other possibilities of escape besides the basic.Ethans central decision in the book, to commit suicide with Mattie, is made with assuage will although it is Matties idea, Ethan agrees and takes the reins in the front of the sled. Although Ethan Frome is a broken man perpetually frozen in a bleak Starkfield, one cannot disregard his inaction when he is presented and acknowledges choices. He eternally contemplates expressing his love for Mattie, looking for the all-expressive word, but fails to, even when alone with her, making free choice a moot point (Ethan Frome from Morality of Inertia).Morality is n ot caused by inertia in Ethans case but personal authorization Ethans decision to commit suicide proves this point the act proves that he was capable of confessing his love to Mattie, but failed to up to that moment. Although Frome can be held responsible for his moral inactivity, he can be considered a morally inadequate man in his present state. His inadequacy, however, was not a constant in life or a sudden occurrence it snowballed from his youth and finally solidified through the smash-up.His earlier experiences in a university and the joy it brought him was quickly interrupted after a year by his sickly parents. The unfortunate circumstance forces Ethan Frome to move back to the depressing Starkfield he had just escaped. His parents illnesses bring along Zenobia, who would be another future, unseen oppression along with Starkfield. For years, Ethan lives in depressing conditions that decline as succession goes on. The chance to finally leave them behind, however, comes in Matt ie, Zenobias cousin and maid.Ethans inability to act on this chance of escape finally seals his fate when Mattie is paralyse and he is critically injured. Although jinxed with unfortunate circumstances, Ethan Fromes life could have been bettered if one small step or action was taken by him for himself with the endeavor to create personal joy or pleasure. The importance of taking steps in life betterment can be seen in Ethan Frome. Although one may lack a history of making moral decisions, the human instinct to do so is always there (from Morality of Inertia).Ethan Frome was able to rationalize and receipt choices inside of his head it was his inability to act on any one until his attempted suicide that created his depressing circumstances. The irony of his only decision with Mattie being one of the most deciding ones in his life underscores the fact that if he had taken this initiative before this instance, his life might have taken a antithetical track. This was not a forced o r accidental occurrence Ethan Frome was in fact an unfortunate individual in undesirable circumstances, but with a free will and mind developed enough to make

An Insight Look of Critical Employability Skills Essay

IntroductionWith a faster pace of allday life, employ mightiness skills atomic number 18 becoming essential in modern society. The employpower essential concepts and skill sets represent universal content. They contri merelye to outcomes that are valued for individuals and for society bring benefits in a wide variety of contexts and bind to multiple areas of life and are of use to all individuals, deemphasizing competencies of use only in a specific trade, occupation or walk of life. In this report, we eff deeply into six critical employability skills including communicating skills, management skills, enigma answer skills, ain knowledge, drill get under ones skin and squadwork skills.Each of these skills was studied and analysed to show its importance. All of these employability skills are held to make a focus on an individuals ability to gain initial employment, brinytain employment, move between roles within the same organisation, detect new employment if required and ideally secure suitable and sufficiently fulfilling work, in opposite words- their employability, more important than the simple state of being employed. (Hillage and Pollard, 1998)1.1 methodological analysisSix critical employability skills were identified from sources of newspaper advertisings, TV advertisings and Internet advertisings. Each of these skills was studied agree to their content and importance. Resources from Internet sites and books were used to study these skills. JCUs polish attributes were also introduced to compare with the employability skills to discuss the matter.Critical Employability SkillsSix critical employability skills has been identified from a variety of sources, these include communicating skills, management skills, hassle solving skills, personal knowledge, work experience and teamwork skills. In real world, contrastive reflect roles require different employability skills. A table consist different job roles and skills were drawn according to j ob advertisement from variety of sources. (See Appendices)2.1 intercourse skillsThe definition of communication skills is the ability to use language and express information.(Definition of Communication Skills, n.d.) It is a way that uses the sustain language and body language to exchange information with others and understand others easily. It includes speaking, listening and piece of music. Hence, communication skill is a tool to run throughout business areas and it has strong impact on business. Communication skills may represent in many ways, for example, talking face to face with customers and colleagues, answering a phone call, reply E-mails and writing a report. These actions are required to be do in business workplace all day especially for handler.As a result for Manager with good communication skills, it will not only increase the efficiency of staff, but also will create a harmonious workplace that makes all(prenominal)one enjoys working. Communication skills are a lso critical when dealing with the customers. Good communication skills will lead to successful business, whereas poor communication will be meaningless redden there is a good idea in mind. As Lee Iacocca, former president of Chrysler, once said, You open fireful wee brilliant ideas, but if you cant get them across, they wont get you anywhere (Rzadkiewicz, 2009)2.2 Management skillsManagement is about taking the chasten decisions at the salutary time and getting them implemented by the right people. (Oak, 2011) Three key factors identified in management skills are making the right decision, at the right time and to the right people. It is the ability of a manager to run a business or a team. For instance, a good manager requires excellent analytical and organizational skills in order to make a right decision to acquire the best returns. It is highly associated with problem solving skills. These decisions also need to be make at the right time.A doctor or a pilot needs to make life saving decisions quickly and at the right time when emergences are encountered. Time management skills are essential for good managers. With good management over stuffs, it can be sure that the decision can be delivered to the right person to process. Successful business consists of good organizational management and correct decision making. Hence, a manager position requires good management skills to help conjunction obtain profit from business. In fact, communication and management are the two essential factors that would determine the success of a business.2.3 Problem solving skillsProblem solving skill is widely required in todays employment market. In a business analyst job advertisement(Genesis IT&T, Seek.com.au), the employer requires a genius at problem solving. It is highly integrated with decision making in management skills. In commercial and industrial operations, we can easily meet scores of problems. It is very hard to predict every single movement in modern bu siness market. Therefore it is an important skill to obtain while require problems in work process. We shall always be prepared to encounter problems, so we can find solutions to solve these problems. Problem solving skills can be both solving problems for clients or for superiors.For example, as a legal advisor you shall solve problems for your clients. This is an example of how problem solving skill directly affects the outcome of work. Good problem solving skills simply means good work. A financial adviser could solve problems for the superior which is the boss. His problem solving skills will affect the decision made by his superior, which influence the prefermence of the whole firm. Problem solving skills is not only about solving the problem, but also doing it efficiently. It does require not only a good knowledge over relevant matter but also good time management skills.2.4 Personal knowledgeProblem solving ofttimes requires very broad knowledge. Personal knowledge is anoth er major skills in work place. The definition of knowledge in professional field is familiarity or conversance, as with a air divisionicular subject or branch of learning(Dictionary.reference.com). Knowledge is like the foundation of employability, the major resource of knowledge is from school and college study. Knowledge is the ability to understand the truth of a certain object. With knowledge, people can get a clear vision of what their roles are in the team, and the way to do their consume job and cooperate with their colleagues. Like the job advertisement for architect(Bespoke, Seek.com.au), the employer need someone with landscape knowledge to take this job. Knowledge can be variables of forms and almost every occupation requires certain knowledge, engineer, pilot, truck driver or carpenter.The way to gain knowledge is through study, no matter from school studying or self-studying. From The ability to understand and follow instructions as well as learn, maintain and apply s kills and knowledge are all very important aspects of work(Australian Govt, 2010), we can conclude that applying knowledge is the core of doing a job. And the knowledge you own determines your employability. Without knowledge, no one can even get a single job done because you will not understand the job goal and do not know the procedures to do the job. Such as a miner, who will need to have the knowledge of different kinds of ores, also he will need to own the knowledge to operate mining machines to gain efficiency.2.5 Work experienceWork experience can be reden as a form of knowledge, it is also an important employability skill required by both employers and employees in business organizations. The definition of work experience is a period of time working in business and has some knowledge or skills of the world of work. (What is work experience, n.d.) It is important because employers are facial expression for some candidates who have the knowledge over the working environment. Work experience also covers other different kinds of skills like team working, communication skills and problem-solving skills.A candidate who has work experience may find it easier than the other candidates to get a dream job because they had faced some of the events in job in other workplace before. More work experience will show more calm and confidence in handing things. Moreover, candidates with full knowledge and skills is choosing the dream work by own rather than being chose by employers.2.6 Teamwork SkillsTeamwork is a term that means a group of people, but each one do the individual part to perform a joint action and in order to achieve the same goal. (Teamwork in classroom, n.d.) Teamwork is one of the most important relationships in workplace. The best team number of a determine goal team is 6 10 people. The working steps are one team leader dividing the big job into different part of small work, each member choose one interested and suitable part to finish. After that , collect all the information from every member and compose to a final work to achieve the goal.Working in a team is more effective than working individually because different people possess different ideas and opinions, the information collected and researched will be more diversified. Teamwork is often required in large business organizations, it could express the source of team members and how they cooperate to produce the work instead of working individually. Modern corporations require job to be done more efficiently and effectively, this makes teams a salient role to attempt big assignments, which makes teamwork skills essential.2.7 Compare with JCU attributesBy comparing the employability skills with the JCU attributes, we could possibly find a certain level of similarity between them. The definitions of two of the main characteristics of graduate skills such as literacy, self-reliance and interpersonal understand are equivalent to the meanings of employability skills.The d efinition of teamwork is not only similar to self-reliance and interpersonal understanding, but also connects with it. They are same as leading, managing and contributing effectively to team and working with another people in a group. However, the employability skill of work experience weighms different with the JCUs graduate attribute. Actually, work experience covers a large number of skills, such as information literacy, interpersonal understanding, critical thinking and problem solving. Work experience will display all knowledge and skills what a candidate has had before.ConclusionIn this report, we have discussed six critical employability skills. We can see that these skills are highly integrated and associated with each other. One skill may often require other skills to achieve better result. These skills determine how good a person can perform not only at work but also in everyday life. In order to achieve a good job or even a good career, one shall try to gain these skills . By comparing these skills to JCU graduate attributes, we can easily see many similarities between these two. These skills are more comprehensive and necessary for student facing the real world. It can be seen as a general touchstone for job candidates.ReferencesAustralian Government, 8 September, 2010, Learning and Applying Knowledge, viewed in 18 May 2012, from http//jobaccess.gov.au/ADVICE/JOBREQUIREMENT/Pages/Learning_and_applying_kno.aspx Bespoke, 21 May 2012, All rounder Project Architect with Landscape knowledge, viewd 21 May2012 from http//www.seek.com.au/Job/great-opportunity-for-architect-with-landscape-knowledge/in/sydney-cbd-inner-west-eastern-suburbs/22340206 Definition Of Communication Skills. (n.d.). COMMUNICATION SKILLS, Retrieved 28 April, 2012 from http//www.communicationskills.co.in/definition-of-communication-skills.html Dictionary.reference.com, the Definition of Knowledge, viewed in 19 May 2012, from http//dictionary.reference.com/browse/knowledge Genesis IT& TP/L, 18 May 2012, Business Analyst-Problem solving expert, Seek.com.au.What is work experience (n.d.) Business Link, Retrieved 22 May 2012, form http//www.businesslink.gov.uk/bdotg/action/detail?itemId=1096811532&type=RESOURCES Hillage, J. and Pollard, E., 1998, Employability Developing a framework for policy analysis, Department for Education and Employment (DfEE) Research report. no RR85 (London, DfEE), Accessed May 22, 2012 from http//www.employment-studies.co.uk/pubs/summary.php?id=emplblty Oak, M. (2011). Basic Business Management Skills, Retrieved 30 April 2012 from http//www.buzzle.com/articles/basic-business-management-skills.html Rzadkiewicz, C. (2009). Business Communication Skills, Retrieved 28 April 2012 from http//carol-rzadkiewicz.suite101.com/business-communication-skills-a158048 Teamwork in classroom (n.d.) NDT Resource Centre, Retrieved May 22, 2012, from http//www.ndt-ed.org/TeachingResources/ClassroomTips/Teamwork.html

Investing in Tufs

Case Summary Investing in TUFS The case refers to a company c each(prenominal)ed Northern Insurance and their grand investment on TUFS (Technical Underwriting Financial System). That system was the largest investment ever made on IT by Northern Insurance and it was supposed to assist the company by streamlining the underwriting process and providing strategic e-business capabilities. Yet, after a couple months, TUFS became the cost-center of the company, spending almost $4 million, and therefore the CIO, Martin Drysdales job was on the line.He had a meeting with the CFO, genus Melissa Freeman, to discuss the reasons why the system was not providing the benefits it was supposed to and whether to keep investing on it. Discussion Questions 1. TUFS was a great idea that would help the company a lot. It was supposed to help streamlining the underwriting process and therefore with cost savings. However, the technicians did not get any participation from the underwriters.Also, the departme nts were not in the same page in the first appearance of the system, and the result was a lot of money had to be spent on fixing underwriting errors that kept appearing over and over again. Additionally the senior underwriting managers lock insisted on doddering reports instead of just looking it online, one of the benefits of TUFS. And lastly, there was a lack of business involvement in decisions, which contributed to the disappointment of the system.In conclusion, most of the imaginativeness of the company was spent on addressing underwriting issues that could have been prevented from the beginning if the underwriters and technicians had worked together (or did not lack in communication). 2. The IT people from the TUFS and the underwriter managers must get together and mixture the system so the whole situation with fixing one mistake and finding many others is prevented. Also, the system needs to be created (or changed) in such a way that it is easy and comfortable for the un derwriters to use.To help with the transition to using the TUFS, a training program for the underwriting department would be perfect. Furthermore, the company needs to prioritize all the projects and apply deadlines to them so they have a clear list of what and by when to do it. 3. The benefits can be measured by comparing the amount of measure spent using the old system and the new one (including training). And also, the company could have some kind of cost savings scorecard, and again compare the old system with the new one.

Sedalia Engine Plant Case Study Review

We have reviewed your case at Sedalia Engine Plant and accept we have found a plan that fits your needs. We recall that while your company surely holds a lot of promise, we have a few ideas to we would same(p) to recommend to you and perhaps take into consideration. We have your best interests at hand and only serve in helping you in bettering your company and becoming more efficient.By the means of what is known as lean production, you eject continue to preserve the value in your product while increasing efficiency in the production process, making your employees happier resulting in more productivity and timbre control, and hoping to save your company time and money in the long run while non costing your employees, products or consumers anything, every last(predicate) of which are good things. You narrate that employees are starting to feel powerless and feel like they are unable to do tasks that would benefit the company. While you have implemented a course of study to ad dress this, you indicate it is not working.One important principle of lean production is leveling out the workload. We recommend spreading the work load among all employees. If the work load is level across the board, employees will feel useful and not feel as though they have wasted efforts. Feeling like a part of a team and feeling equal amongst your work peers creates for greater solidarity and an increased chance for greater work quality, resulting in product quality. Adding govern tasks is also the foundation for continuous improvement and employee empowerment.Employees themselves should be passionate about the company and work together for one goal. These people should be in capital of New Hampshire with your companies philosophy. Those you elect to be team leaders or managers should be equipped for the position. They should good understand every aspect of the company and also be happy in being team leaders, while at the same time understanding the teaching methods of the c ompany. Building strong leaders to help lead and have got teams working together is essential for the well-being of your company.As mentioned prior, giving each employee a fair amount of the work will help with their morale, and providing strong leaders equipped with good leadership skills to direct their equal efforts makes for an outstanding system. Concerning the posting of Representatives, Board of Employees, and Human Resources, these teams will need to work in tandem to be effective. These three teams should be making decisions together, and rapidly implementing the unanimous decision. These decisions should focus on the long-term picture, not the short-term picture, eve if sacrifices will need to be made.The Board of Representatives should constantly be watching with their own eyes to ensure production is being carried out in a proper manner. The Board of Employees should be concern with making employee tasks standardized, and work to continuously improve the level of sta ndardization. With standardized tasks and work evenly spread across employees, employees will feel empowered to succeed. To avoid squander time and resources, the focus should be on building quality front, rather than worrying about fixing problems later.Your company should only be using reliable, thoroughly tested technology that serves your people and processes. You should also provide visual controls so no problems are hidden. Remember, quality is key. In regards to the issue pertaining to wage differentials and business enterprise security, a good way of going about handling that is to compromise with the workers. Also if you use the steps for searching for integrative solutions, that would help as well. The first step would be to separate the people from the problem.I know that wages and clientele security directly affect the employees, notwithstanding it is best if you take out the employees from the issue and really find out the company issues with differing wages. Th e second step would be to focus on the shared interest of all the parties. As for the plant, you would by nature want to do what is in the best interest of the company, but if you are really trying to resolve and compromise the issue you would need to look at the issue from an employee point of view. The next step, and one of the adultgest ones, is to generate options.It is good to not just come up with one solution to the job security issue, but to also formulate many options that can be used to solve that problem. I suggest layout a plan that employees were to follow and if they didnt, that would put their wages and job security at risk. The fourth step in the breakdown would be evaluation. It is best to evaluate the options using objective criteria. This step simply means to thoroughly look over options and have a certain criteria to follow for the options to be of any relevance to the problem. The last step would be to iteration.There is not a, onetime, improve option for eve ry problem. The best way to go about this is to clasp trying. If one solution doesnt fully solve the wage issues at the plant, than keep trying other plans. It was mentioned that POT is still functioning, but an Organizational Review Group (ORG) was established to discuss plant guidelines along with Exempt and Non- palliate Task baron Groups (NEIG & EITG). In response to employee criticism and the potential for negative publicity, the board of trustees made a decision to establish a Task Force on the execution/Family Interface. The mission of the Task Force was to make recommendations on possible additions and modifications to company policies and programs that will better accommodate the family responsibilities of its employees. Members of this Task Force included company executives, exempt and non-exempt employees, and members of the board of trustees. The Task Force can make recommendations in a large number of areas including health insurance coverage, absence with pay, leave without pay, sick leave, progress criteria and policies, training programs, family leave, job sharing, flextime and child care.I believe task forces are an improvement on past practices, but I also do believe there could be another option as well Your decision-making processes should be based on a long-term philosophy of proving good services and products, even at the expense of short-term financial goals. While profit is important and essential, a high one means nothing if your employees arent happy, resulting in your products not having as much quality, resulting in unsatisfied customers. This rips everyone off in the end. High morale and work ethic is core, as previously stated.Bringing back building a philosophy within the minds and work ethic of team leaders and employees, it trickles down into the product itself and reassures that your company stands for something great and admirable, not simply another big name making lots of money. It is probably very important for you to hold a high morale and solid reputation, and with these key ideals and systems, that is very much possible. We thank you for your time and hope you to take our recommendations into deep consideration. We feel these decisions would be wise for the lasting future and quality of your products, people and proficiency.

The Role of Computer and Internet in Education

CHAPTER 5 THE INTEGRATION OF COMPUTER USE IN EDUCATION JAN Department VAN retreat AKKER, PAUL KEURSTEN and TJEERD PLOMP of nurture, University of Twente, P. O. The Netherlands Abstract Box 217, 7500 AE Enschede, at that place is an increasing aw arness that unsatisfying experiences with the introduction of ready reckoners in didactics are a consequence of insufficiently fetching into account factors that are crucial when introducing change in educational settings. M both of the problems in the literature show great similarity with the kind of problems often experience in curriculum capital punishment.In this context the endeavors to drag computing device employ up an integrated part of classroom activities are analyzed. Emphasis ordain be lay on the fundamental interaction between teachers and courseware elements for a more impelling strategy for the integrating of calculator consumption in educational practice will be presented, with peculiar(prenominal) concern to the design of attendant materials as an essential part of courseware. Introduction Despite some(prenominal) national and local initiatives, examples of successful ready reckoner usage in classroom practice are still relatively rare. In many countries the number of computers in schools has considerably additiond in recent social classs.However, lower-ranking circulate has been made still few teachers are actual customrs packet package manipulation is often restricted to drill and practice type the alignment with the curriculum strain is poor. Research results (of some(prenominal) surveys and case studies) from many countries point to the conclusion that there is still a long way ahead before computer lend oneself will be effectively integrated in most classrooms (see e. g. Becker, 1986 Office of Technology Assessment OTA, 1988, for the USA, Chomienne, 1988 Olson & Eaton, 1986, for Canada Cox, 1987, for the U. K. Inspectorate, 1986 Plomp & Van den Akker, 1988, for the Netherlands).There is an increasing awareness that these disappointing experiences are a consequence of insufficiently taking into account factors that are crucial when introducing change in educational settings. Many of the reported problems that schools and teachers face when implementing computer work show great similarity with the kind of problems often experienced in curriculum implementation (cf. Fullan, Miles, & Anderson, 1987 Sheingold, Martin, & Endreweit, 1987 Walker, 1986). For that dry land we would like to analyze the endeavor to make computer habit an integrated part of classroom activities 65 6 .I. VAN DEN AKKER et al from a curriculum implementation stance. We shall start with an overview of the variables that fucking see the process and outcomes of curriculum implementation. For the different categories of those variables we shall then discuss the literature on computer use in education. Emphasis will be laid on the interaction between teachers and coursewa re. Based on this problem analysis we shall present elements for a more effective strategy for the integration of computer use in the educational practice.Special attention will be paid to the design of (written) support materials as an essential part of courseware. An Overview of Factors Affecting Implementation _ Drawing upon the regulate of Fullan (1982) and of Van Velzen, Miles, Ekholm, Hameyer, and Robin (1985), we propose a framework for discussing factors influencing the implementation of launchings in the educational practice by distinguishing four categories of variables national (and/or state and/or district) context characteristics of the school (organization) external support characteristics of the innovation itself.Within each category several variables can be mentioned National context central legislation and regulations governing body of policy formation and decision making in educational affairs time, resources and facilities made available for an innovation proc laimed take to bes and aims around an innovation placement of politicians and (other) opinion bakshisers to the highest degree an innovation. School organization experiences with earlier innovations role of the school leader(s) methods of decision making available facilities (time, money, materials) internal co-operation and mutual support dissemination and exchange of information.External support inservice educational activity assistance with internal coaching and guidance personal contacts with staff development for individual teachers experts and colleagues from other schools. Innovation characteristics relevance of the innovation for pick ups and problems of users clarity of the goals and practical meaning of a change proposal Implementation of figurers in Education 67 complexity of innovation requirements, in particular in teaching quality and practicality of the innovation products. ehavior In the next sections we shall front reiterate literature on the integra tion of computer use, as far as it relates to the first three categories (national context, school organization, and external support). We refer to those categories of variables as the conditionalfactors, because they are conditional for the ultimate use of products by teachers in their daily work. Afterwards we shall focus our attention on the characteristics of the innovation product itself in relation to the teachers role.Conditional Which computer literature, emphasis Factors for the Integration of Computer Use research results about use in education? We but restrict ourselves on empirically based conditional factors can be found in the literature on do not intend to offer an exhaustive overview of this to a summary of some selected publications, with an sources. National Context Still little empirical research is done about the impact of variables in the national (state/district) context on the actual use of computers in the school practice.Descriptions of national policies on information technology in many countries are available (e. g. Beishuizen, Tobin & Weston, 1988), but focused research efforts in this area are hard to find. Broad attention for policy variables is slip awayn by Fullan et al. (1987) in their study on the implementation of the fresh information technology in Ontario schools. Apart from obvious tasks as investing in hardware, software program development, research, teacher rearing and the like, policy makers should also play a stimulating role in the planning and co-ordination of implementation activities.Proclamation of bleak aims for the educational system and encouragement from above for initiatives and activities in the field can be processful for the many participants in the innovation. School Organization The wreak of the school organization on the implementation of computer use has been studied more frequently. The results usually confirm the findings from the more ecumenic innovation literature. Encouragement and suppor t from school administrators and principals are of vital importance (Carmichael, Burnett, Higginson, Moore, & Pollard, 198. Cox, Rhodes, & Hall, 1988 Fullan et al. , 1987). Help from principals is oddly necessary in providing for facilities for training, the purchase of hardware and software, the rearrangement of timetables and other organizational measures. Also conducive to the implementation process is a positive school climate where teachers give mutual support by exchanging ideas and experiences and by providing feedback (Carmichael et al. , 1985 Cox, 1987 Inspectorate, 1986). 68 J. VAN DEN AKKER et al.A beneficial role can also be played by computer coordinators, especially if they combine computing expertise with sacrosanct interpersonal and organizational skills (Strudler & Gall, 1988). Also measures devote to be taken to secure long term supplies and precaution of hardware and software (Bitter & Gore, 1986 Wagshal, 1986). External Support A growing body of experience a nd research data has become available about effective components of inservice training and other forms of external support for schools and teachers in the use of computers.A criticism on past inservice approaches is that the emphasis on technical aspects was too strong, while too little attention was paid to the integration of computer use in the daily classroom practice and also to the skills in selecting and evaluating courseware homienne, 1988 DArcy & Gardner, 1988 Wiske et al. , 1988). Teachers need a strong support to overcome their (initial) problems of uncertainty and their concerns about changing teacher/student relationships and about accountability (OTA, 1988).There is a growing consensus about characteristics of inservice training that can increase its effectiveness (OTA, 1988 Stecher & Solorzano, 1987) appropriate balance between lecture and (guided) practice detailed curriculum guides and plans for the course plus lesson-related materials and hand-outs discharge traini ng objectives inservice lessons linked to teachers own instructional practice peer interaction, including communication during hands-on activities strategies for teaching heterogeneous groups follow-up support and guidance. This (selective) literature review indicates a rough imilarity between conditional factors for both integration of computer use and curriculum implementation. Future, more focused, research activities are necessary to sharpen our insights in this area. Product Characteristics and the Teachers Role Educators and educational researchers consistently cite one factor as central to the full development of technologys use in the schools the classroom teacher (OTA, 1988, p. 87). For that reason it is distinguished to take a closer look at the changes facing teachers at the implementation of computer use in their classroom practice.As Fullan (1982) has pointed out, nearly any innovation requires teachers to change on several dimensions the use of new materials, altera tions in their teaching behavior, and changes in their beliefs and attitudes. In this section we want to explore how certain characteristics of the new materials (especially courseware) can square up changes in teaching behavior and beliefs. From the general innovation literature we know that there are several product characteristics that can influence the fate of a certain innovation. First, we present a brief overview of this literature.Then we shall use this as a filter to screen the literature on computer use in education. Implementation of Computers in Education 69 Well-known discourses about influential (product) characteristics of innovations are delivered by Rogers and Shoemaker (1971) who describe features like observability, complexity, compatability, and relative advantage, and by Doyle and Ponder (3977-78) who refer to the practicality ethic of teachers, with criteria like instrumentality, congruence, and cost. An authorative summary of these characteristics is provided by Fullan (1982 see also Fullan et al. , 1987).He mentions the following characteristics, elucidated by some central questions Need and relevance What is the need for and the appropriateness of the change? What is the priority of the efforts to implement the innovation relative to other concerns? Clarity How exonerated are the goals and essential features of the innovation? practical implications for the users? Complexity How unclutter are the How many components of instructional practice are affected and how much do they differ from existing practices and beliefs? How difficult is it to learn the necessary changes? Quality and practicality How swell up developed and tested are the products?How certain is the impact of the innovation? What is the trade-off between the actual benefits and the personal and organizational costs? Weaknesses in one or more of these characteristics usually cause major obstacles for implementation. Fullan (1982, p. 62) underlines the importance of ind ividual perceptions in this respect ImpIementation is a problem of individuals developing meaning in relation to particularised policy or program directions. Although materials alone can never be sufficient for the implementation of innovation proposals by broad target groups of teachers, the authorisation influence of materials is great.Well designed and vafidated products can contribute substantially to the realization of educational changes (Crandall and Associates, 1982 Emrick & Peterson, 1978 Van den Akker, 1988). We proceed now with a short overview of research findings about the interaction between product characteristics and teachers in the domain of computer use. Courseware Quality and Teachers Problems There is a wide dissatisfaction about the quality of educational software and courseware (OTA, 1988). Some conclusions are Much educational software is isolated material, corkedly attuned to the curriculum 0 J. VAN DEN AKKER et al (content, materials, strategies) in use (Inspectorate, 1986 Woodhouse & Jones, 1988). Often computer use cannot be a process of simply incorporating new into old, but it requires reshaping what was there (Hawkins & Sheingold, 1986). But also a warning is in place if the software close relates to the existing curriculum, it can indeed be easier for the teachers to use, but then it is often seen as just an extra and not fully integrated in the mean solar day to day practice (Cox, 1987).Thus, software should either support the goals of the existing curriculum or meet the needs for a curriculum change (Mallatratt, 1988). Much software has been developed for use by individual students, not taking into account the usual whole-class teaching and the practical constraints of a classroom with limited numbers of computers (Centre for educational Research and Innovation CERI, 1986). This restriction places a considerable demand on the planning and management skills of teachers. Much software is poorly documented (Jorde, 1985). User guides halt mainly technical information about operational aspects of the software.Support (print) materials for the teacher with suggestions how to integrate the program in the instructional process is frequently lacking (Inspectorate, 1988). Most software does not yet sufficiently exploit the capacity of the computer to Drill and practice software continues to enhance teaching and training. . dominate all subject areas (OTA, 1988, p. 122). Furthermore, much of the early generation of software can be characterized by the Quiz Syndrome (Mackey, 1987). An innovation which appears to bring just one long question-answer routine gets a bad name.The available educational software covers besides parts of the different subject matter domains (Inspectorate, 1988) most software is just piecemeal (Williams & Williams, 1984). The lack of sufficient laid-back quality materials obstructs the integration of computer use into the daily practice. Problems many teachers experience are the follo wing For various reasons it is difficult to select suitable software. Not nevertheless is software often poorly documented, but also many teachers lack the familiarity and skills for an effective evaluation of the software quality (Knupfer, 1986 Preece & Jones, 1985).Moreover, there are only limited possibilities to preview potentially useful software before purchase (Balla, Gow, & Burton, 1986 Mallatratt, 1988). Teachers often lack technical skills in using computers and software (CERI, 1986 Ridgway et al. , 1984). This often leads to uncertainty, especially when the level of computer familiarization of the teacher is the same as or even lower than that of the students (Carmicheal et al. , 1985 Heywood & Norman, 1988). A consequence of this phenomenon may be that educational computing will be restricted to the limited level of expertise of the teacher.Teachers often experience unanticipated problems with their instructional roles (Carmicheal et al. , 1985 Cuban, 1986 Hawkins & Sh eingold, 1986 Wiske et al. , 1988). Computers quarrel teachers existing instructional routines by requiring a berth from expository teaching towards a role in which the teacher is more of a partner and guide of the students. Many teachers feel uncomfortable about these changes and consequently try to minimize them (Elder, Gourlay, Johnstone, & Wills, 1987 Olson, 1988 Plomp, Steerneman, & Pelgrum, 1988). This factor is particularly Implementation f Computers in Education 71 important because research has shown that the way a teacher integrates computer use through his ongoing instructional decisions is critical to the impact of computer use on learners and skill results (Wilson, 1988). Cox et al. (1988) observe that teachers frequently lack knowledge and skills for effective stimulation of students microcomputer activities, and thus children fail to learn what they might learn with judicious teacher intervention. Teachers experience many practical problems when they start to use computers (Carmicheal et al. 1985 Elder et al. , 1987 Inspectorate, 1986). Computer use demands from teachers many time-consuming management and organizational activities. Wiske et al. (1988) conclude that the major barrier for computer use is that it is unclear for teachers how the potential part of computer use can outweigh the costs involved. In summary we may conclude that the research on the integration of computer applications in education reveals many similar problems as described in the literature on curriculum implementation (cf. Fullan et al. 1987). Most factors that influence curriculum implementation also influence the integration of computer use in the instructional practice. An Infusion Approach for the Integration of Computer Use In this section we will try to rate elements of an effective strategy for the integration of computer use in education by analogy reasoning with approaches of effective curriculum implementation. Most teachers, if they are using computers at all, are still inexperienced users the great majority are in the initial implementation phase.In this stage small-scale successful experiences are an important factor in stimulating the use of the innovation by teachers, both in the field of curriculum implementation (Van den Akker, 1988b) and computer integration (Fullan et al. , 1987). There are two components of successful experiences first, the students attain clear learning results second, the teacher succeeds in an effective lesson execution without major problems, and is aware of his own contribution in this respect.Such successful experiences can only take place when teachers have blue quality courseware at their disposal. We define courseware as a package comprising computer software and (mostly written) support materials. Since our analysis of implementation problems indicated that especially the support materials if available are of a poor quality, we shall focus on that component (lessonware) of the courseware.In o rder to identify high quality characteristics, we need to clarify what functions the materials should have for the teacher. Functions and Characteristics of Courseware As shown in the previous sections, integration of computer use by teachers is complex and involves them in learning new roles and unlearning old ones. Implementation can be 72 J. VAN DEN AKKER et al. conceived as a learning process for the teacher in which changes are call for in teaching behavior as well as in beliefs, attitudes and understanding.A literature review of Van den Akker (1988b, c) on curriculum implementation, teacher planning, and general learning theories provides some answers to the question of how materials can contribute to this learning process of teachers in their initial implementation phase. The literature on curriculum implementation reveals that in teachers initial implementation efforts personal self-concerns dominate, changing via more task-oriented concerns to concerns about the impact of the curriculum on learners (Loucks & Lieberman, 1983).Research indicates that this change model also applies on computer integration (Cicchelli & Beacher, 1985, 1987 Wiske et al. , 1988). Thus, at present, where most teachers are still in the initiation phase where personal survival concerns dominate, courseware materials should support the teachers by anticipating as much as achievable potential user problems and by offering practical advice to prevent or solve such problems.From research on teacher planning (Clark & Peterson, 1986) it has become more evident that changing the practice of teaching requires more attention to the stage of pre-active planning. The lesson planning approach is of crucial importance for the lesson execution, and, ultimately, also for learning-by-reflection of the teacher afterwards. Literature on general learning theories indicates that (intensive) orienting activities yield more precise and reasoned plans for action.Courseware may activate and support teacher planning by providing a clear orientation to the teaching task, by pointing to critical features of (computer assisted) lessons and by making suggestions about how to deal with emergent problems during the instructional process. From this analysis we may conclude that courseware, intended for teachers initial use, should contain a large amount of procedural specifications very(prenominal) accurate how-to-do-it advice focused on essential but apparently vulnerable elements of the curriculum.This means that the support materials should not only contain technical information about the use of the computer program, but also detailed advice about the instructional process (cf. Fullan et af. , 1987). With the help of such materials, the teachers should be stimulated to a task orientation and to concrete role-taking experiences and should be supported with practical advice for successful lessons. In order to adopt such courseware, one has to follow a very careful development appr oach, with much attention for formative evaluation and revision of the materials.Obviously, the technical certainty of the software essential be guaranteed and the program should be easy to use (Fullan et al. , 1987). Special efforts have to be made to detect teachers problems with the use of the courseware in their classroom situation. These evaluation findings should lead to the incorporation of procedural suggestions for the teachers in the support materials about how to prevent or solve such problems. It seems desirable that the development of the software and the support materials (lessonware) proceeds in close interaction.More or less simultaneous design, construction and evaluation activities can further the interwoveness of the different courseware components. Such an approach may also increase the chances to produce courseware that is innovative from an instructional and curricular perspective (cf. Hawkins & Sheingold, 1986). Implementation of Computers in Education 73 An Illustrative Study An explorative study along these lines has been done by Keursten (1988), who developed courseware for primary accomplishment.He pointed out that there is a remarkable resemblance between major implementation problems of teachers with a new approach in (activity-based) science education and the earlier discussed problems with the integration of computer use. Van den Akker (1988a, b) mentioned the following key problems for teachers in the science domain complex and time-consuming lesson preparation a lack of background knowledge and skills (causing a lack of self-confidence) great difficulties in changing the didactical role insufficient view of possible learning outcomes.In the research project of Van den Akker (1988a, b), a successful effort was made to diminish these problems by providing teachers with many, carefully tested procedural specifications in curriculum materials. Keursten (1988) utilize the same sort of specifications in courseware for a series of seven lessons (on the theme weather final grade of primary school), to be used by teachers who had incomplete experience with computer use nor with an activity-based science approach.The courseware package consisted of written lesson materials containing subject matter information and directions for lesson preparation and execution educational software with a very succinct manual about its operation and some student materials. The procedural specifications for the package were divided over the written lesson materials (lessonware) and the software manual. In the lessonware the following categories were structured i general characterization of the series of lessons in terms of objectives, content, time (also division of time over different lessons), suggestions for detecting learning effects. ackground information about the subject matter so that it is not necessary for the teacher to refer to other sources during the lesson preparation. Per lesson were included a short outline of the lesson suggestions for the lesson preparation, including issues like necessary learning aids, classroom organization, structure of the lesson in keywords, personal preparation by the teacher. guidelines for lesson execution with suggestions for instructional activities, for classroom organization, and for guidance of the students.The manual of the computer program consisted of directions for the use of the computer (especially important for teachers without experience with computers) description of the objectives (short, because it is also part of the written lesson materials) directions for the use of software (important, as it must answer all possible questions teachers may have in using the program) points of attention about the siting of the computer(s). 74 J. VAN DEN AKKER et al. Two basic elements in the design approach should be underlined.First, the curricular perspective was in the forefront the computer software was developed as a tool for realizing the formulated curriculum aims. Second, the primary focus in the elaboration of the materials was on the tasks and user problems of the teachers and not on the possibilities of the software. An evaluation of the use of this courseware with five teachers had positive results. The teachers were able to use the package as meant by the designers. They hardly experienced any technical problems and adequately realized the activity-based science approach.Also the reactions and learning outcomes of the students were very satisfying. A general conclusion of this study was that the characteristics of the courseware seem very appropriate to reduce implementation problems. Therefore follow-up research has been started for further investigation of this approach. Conclusion The integration of computer use in the instructional practice of teachers infusable support materials (cf. Wilson, 1988). We would like to summarize our infusion approach as follows benefits by eachers can start their computer use with shor t and well organized applications successful use is strongly advanced(a) by carefully designed and validated procedural specifications in the different courseware components based on these successful experiences, teachers acquire clarity about the meaning and potential of the innovation, gain confidence in their own competence, and develop their own view of the appropriateness of the innovation for their students and themselves. Without such early high quality experiences, teachers judgments about the relevance and practicality of computer use can only be superficial.As Wiske et al. (1988) found, the initial reservations of teachers about computer use diminish after experiencing examples of computer use that yield clear educational benefits. A real integration of computer use in the curriculum can only be realized when teachers recognize the surplus value of computer use. Successes in the early implementation phase are crucial for motivating teachers to further activities and to el icit commitment to the change efforts. We have strongly toilsome our arguments on the role of products (courseware) in the process of implementation.Of course we realize see the first part of our article that there are many other variables at stake. But we agree with Collis (1988) that it makes sense to focus on those variables which are relatively easy to manipulate. And, within the then available options, we have strong indications that a advanced(a) design of the support materials within courseware can have a great impact on implementation activities and outcomes. We presume that this impact can be change magnitude when the use of such products is combined with inservice training (cf. OTA, 1988).Such integrated support activities seem to have the greatest potential to enable teachers to an effective integration of computer use in their classroom practice. Implementation of Computers in Education 75 References Akker, J. J. H. van den (1988a). Ontwerp en implementatie van natu uronderwijs Design and implementation of science education. Lisse Swets & Zeitlinger. Akker, J. J. H. van den (1988b). The teacher as learner in curriculum implementation. Journal of Curriculum Studies, 20 (l), 47-55. Akker, J. J. H. van den (1988c, April). Product design and curriculum implementation.Paper presented at the Annual impact of the American Educational Research Association, parvenue Orleans. Balla, J. , Gow, L. , & Burton, P. (1986). Computers in the teaching process and software development Cooperation is the key. Education & Computing, 2, 265-271. Becker, H. 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Norwood, NJ Ablex Publishing Corporation. Stecher, B. M. , & Solorzano, R. S. (1987). Characteristics of effective computer in. ervceprorams. Pasadena, CA Educational Testing Service. Strudler, N. B. , & Gall, M. D. (1988, April). Success&l change agent strategies for overcoming impediments IO microcomputer implemenfution in rhe classroom. Paper presented at the Annual Meeting of the American Educational Research Association, New Orleans.Velzen, W. G. van, Miles, M. B. , Ekholm, M. , Hameyer, U. , & Robin, D. (1985). Making school improvement work. A conceptual guide to practice. Leuven Acco. Wagshal, P. H. (1986). Computers in the schools Lessons from television. Curriculum Review, 24 (3), 32-34. Walker, D. F. (1986). Computers Microcomputers and Education and the curriculum. In J. A. Culbertson & L. L. Cunningham (Eds. ), (85th NSSE yearbook, pp. 22-39). Chicago The University of Chicago Press. Williams, F. , & Williams, V. (1984). 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Americas Medicare And Medicaid Healthcare Health And Social Care Essay

health concern be in the United States exceed 14 per centum of the entire gross domestic merchandise, cold much than in any other(a) state. In the twelvemonth 1992 general costs were approximately $ 838 billion or over $ 3,000 per undivided. as good as at that pip were almost 6,066 infirmaries with 1.14 million beds in the twelvemonth 1992 in the United States. Hospital brinytenance dominates entire health assistance disbursement in United States.After decennaries of ecumenicalisation long marches maintenance in America is chthonicgoing enormous alteration in retort to increase Medicargon and Medicaid expenditures. As the response to the lifting province and federal outgos in America community based health trouble options are promoted for long term care over institutional fear. Despite the fact that persons with really unsafe and grim psychiatric upsets are over re inaugurateed in the population of long term wariness and takes into disproportional sum of p sychiatric wellness oversight cost, every bit good as there is an alarming deficit of attending to the go for the vulcanized individuals with the persistent and weighty cordial sickness. About 2 per centum of individuals aged 55 or above in America are enduring from awesome and relent little psychiatric upset and it is assumed to duplicate in following three coming decennaries. Since the up-to-the-minute dodging of long term psychiatric attention for the aged individuals with this upset is scatty and service proviso is extensively driven by reimbursement policies, community based attention and managed attention is likely to hands profound consequence on this population.The grounds to twenty-four hours provinces that these proposals can cut brush up the demand of hospital resources but there remains concern about cost effectivity of community attention compared with infirmary attention.However the wellness policy issues of America is been debated in conformity with comm unity based wellness attention for aged persons and the hereafter challenges of give psychiatric wellness serve to aged population.Although, small attending has been highlighted on the plausible impact of managed attention on the concatenation of aged individuals with relentless and serious psychiatric upsets who prepare the most demanding long term attention demands.Service NEEDSAged persons with serious and relentless psychiatric upsets are denoted in this reexamine as individuals age 65 and over with perennial or late-onset terrible psychiatric upset with residuary damage. As by and enlarged defined, terrible and repetitive psychiatric upsets involves diagnosings such as delusional upset, insane disorder, bipolar upset, and re modern major depression. immemorial gravids who evolve these upsets in early maturity frequently have poor societal support governing bodys and lesser monetary resources than those with late-onset unwellness, but both of them portion many simila r clinical characteristics and the common demand for long run psychic wellness attention work. However, latest psychiatric wellness go for aged individuals are mostly disconnected and chthonicutilized and do non qualifiedly turn to their long-run intellectual wellness demands.Overall, deinstitutionalization has left infinite view of aged individuals with reduced entree to amiable wellness attention in both community and institutional long-run attention scenes.Larger proportion of aged grownups with terrible and relentless cordial unwellness who stays in the community get under ones skin small support from the affable wellness system except for medicine despite continued demand, and those without ho single-valued functionhold attention are at higher chance of being institutionalized.These factors highlights the pressing demand to specify and advance dedicate and community based options.LONG large term fright REFORMThe sudden shrinkage and closing of province infirm aries over the past few decennaries has resulted in trans-institutionalization into attention bunss of many dependent aged individuals with terrible and relentless psychiatric unwellness. Eighty-nine per centum of all institutionalized these aged individuals reside in attention places. However, assorted tendencies suggest that establishments go away play a diminish function in future systems of long-run amiable wellness attention compared with community-based scenes. First, the bulk of previous(a) grownups with affable unwellness resides in the community and favour to stay at that place ( Bartels SJ, Levine KJ, Miles KM, et Al, unpublished manuscript, 1999 ) . The more than new cohort of aging individuals with terrible psychiatric unwellness had spent most of their lives in the community rather than institutional scenes. Therefore trans-institutionalization from long-run province infirmary units to care places will go a vanishing phenomenon.Equally good as the 2nd tendenc y suggests the diminishing function for establishments is the execution of nurse place reforms under the federal Omnibus reckon Reconciliation Act of 1987 ( Public Law 100-203 ) , with the purpose of cut drink down the use of nurse places for long-run amiable wellness attention. This reform s were practiced in response to increased psychiatric admittances to care places after closings of province infirmaries.Last, the lifting outgos for nursing place attention are provoke sudden reforms in policy and reimbursement. They include authorizations by provinces to curtail Medicaid outgos by forestalling the nursing place bed supply and cutting Medicaid reimbursement place.As the wellness attention system transportations to suit the increasing figure of patients necessitating chronic attention, forthcoming anticipation suggest the greatest success in operate will be in home- and community-based scenes.Sudden alterations in the funding and construction of long-run and managed attent ion are progressing quickly crosswise the provinces, with a practical deficit of attending to the lifting Numberss of aged grownups with serious and relentless affable unwellness who will hold of import service demands.Financing OF MEDICARE AND MEDICAIDSoon, most of the psychiatric wellness and long-term-care services for aged individuals are payd by fee-for-service Medicare and Medicaid. Medicare is the federally financed wellness insurance plan, supplying insurance for persons age 65 and above and disabled persons under age 65. Medicare is composed of two parts portion 1covers inmate infirmary attention, 60 yearss of skilled nursing place attention, and place wellness and hospice attention. Separate 2 provides reimbursement for outpatient infirmary services and doctors. Among the major limitations in Medicare insurance reporting of the psychiatric wellness services are a needed 50 per centum copayment for psychotherapeutics services, deficit of general outpatient prescriptio n drug coverage, restricts on inpatient psychiatric yearss, and limited or no coverage of historic services such as residential attention, reprieve attention and grownup twenty-four hours attention and place wellness attention.Home wellness attention is an of import permutation to institution-based attention. However, merely acute portion of unwellness instead than long-run attention is cover by Medicare. psychiatric upsets, including dementedness, constitute merely 2.8 per centum of firsthand diagnosings for place wellness attention. It is likely that place wellness attention for psychiatric upsets will go barely visible(prenominal) in future coming old ages as Medicare reform consequences in cutbacks under the Balanced Budget Act of 1997. After passage of these reforms, 14 per centum of U.S. place wellness attention bureaus, a sum of 1,355 bureaus, shut in 1998.However, less than 3 per centum of the entire budget of Medicare is spent on mental wellness, with half less than thes e outgos ( about 1.5 % ) traveling to psychiatric wellness services for the aged population. Acute hospitalizations consequences to the huge bulk of these outgos.Medicaid is the main insurance company for long-run attention in nursing places and the of import beginning of reimbursement for state-funded services for handicapped persons, including persons with serious and agreeable mental unwellness. Since Medicaid is a combined federal and province plan, with provinces paying up to 50 per centum of the cost, provinces have of import discretion in carry up ones minding the eligibility standards and sorts of mental wellness services covered.For case, although host provinces send offer coverage of prescription drugs, most have restrictions in the sort of copayments, limited refills, or other restrictions.States whitethorn besides implement restrictions on mental wellness attention, including anterior mandate and restriction on the figure of visits to providers. Medicaid reimburseme nt rates average 20 to 30 per centum beneath bing market rates.Restricting the sum and range of services and paying for psychiatric attention at lesser rates than for medical checkup exam checkup examination attention create barriers to adequate psychiatric attention for aged patients.In short, the argument surrounded by the federal and province authoritiess over the costs of Medicaid, every bit good as the restrictions in Medicare coverage, leave many spreads in insurance coverage for aged grownups.These spreads result in a disintegrated intervention system and critical load in out-of-pocket costs. In add-on, briskly increasing Medicare and Medicaid outgos are ensuing in the impulse to develop schemes that contain costs. The work of spreads in coverage and service and intensifying costs under a fee-for-service reimbursement construction has resulted in an rush of managed attention enterprises in America.CARVED-IN AND CARVED-OUT MENTAL HEALTH SERVICESThe statement over the fi nest manner to pull off fiscal threaten and to transport mental wellness services in managed attention has resulted in a scope of a priori accounts that may be loosely classified into two general classs. In some(prenominal) managed attention establishment, mental wellness attention is straight merged into the bundle of general wellness services that are covered and provided, or carved in. In others it is supported through a contract with a separate forte mental wellness establishment that provides services and accepts the hazard, or carved out.CARVED-IN AgreementsPatron of carved-in mental wellness services contest that this form of attention better integrates both physical and mental wellness attention, reduces barriers to mental wellness attention due to stigma, and is more apt to bring forth cost beginnings and overall nest eggs in usual wellness attention expenditures. These characteristics are itemally of import because aged individuals normally have co morbid medical cond itions and take multiple medicines that may impact mental upsets they typically avoid forte psychiatric wellness scenes and incur important wellness attention disbursals related to psychiatric symptoms.By and large, carved-in agreements promotes communicating and coaction between medical and psychiatric suppliers suppressing arbitrary differentiations about medical versus psychiatric causes of symptoms and functional issues.Carved-in agreements may be advantageous for the many aged individuals with similar sort of upsets who receive the great part of their mental wellness attention from primary attention suppliers.Despite the fact that, carved-in agreements are assumed to supply fiscal inducements for stop medical and psychiatric wellness services, functional integrating is far from guaranteed. Unfortunately, mental wellness forte services for aged persons tend to be a low antecedency in managed wellness attention make-ups in comparing with surgical and medical forte services.M ental wellness carve-in agreements may besides be economically hazardous. First, if mental wellness lowest incomes are carved in as portion of a net income bundle, grounds from backstage-sector wellness programs reveals that without administered para, insurance companies will offer differential coverage of mental wellness attention.In add-on, if remunerators or suppliers contest for enrollees, a healthy inducement will be to forestall those expected to hold higher costs from psychiatric jobs, such as aged persons with serious and compriseent unwellness.Finally, process of seting payments to counterbalance for the increased fiscal hazard of supplying attention to more seriously sick enrollees under a capitated payment, known as hazard accommodation, are rather hard to use for psychiatric wellness attention. For case, unless reliable hazard accommodation schemes are developed for complex populations such as aged person with mental unwellness, the capableness for significant losin gss is likely to perpetuate the present deficiency of vehemence and services for this pestiferous group among managed attention organisations.CARVED-OUT AgreementsIn comparing, advocates of carved-out agreements for mental wellness services for aged persons argue that stray systems of funding and services are likely to be superior for individuals with particular mental wellness services. Specifically, they advocate that carved-out mental wellness organisations have advanced proficient cognition, a broader array of services, specialised accomplishments, greater Numberss and assortments of mental wellness suppliers with experience handling terrible mental conditions, and committedness and willingness to supply services to bad populations.In add-on, advocates argue that mental wellness carve-out organisations allows economic systems of graduated table in supplying the encompassing array of rehabilitative and community support mental wellness services necessary to care for elderber ry bush terrible mentally sick individuals in the community. At last, an inducement exists to reinvest nest eggs from any diminution in inmate service usage into advanced outpatient options. Although appropriate surveies are missing, plans utilizing carved-out services for younger persons have by and large reported important cost nest eggs and favourable results.Unfortunately, informations are missing on results and costs for aged individuals with serious mental unwellness in mental wellness carve-outs. From a clinical mentality, the downside of a carve-out agreement is an increased hazard for unfavourable results due to atomization of medical and mental wellness attention services. The possible for these inauspicious results is significantly pronounced for aged individuals, who are frequently taking multiple medicines and who have complex medical upsets. Unsuccessful communicating or deficit of coaction between mental wellness and medical suppliers places the aged individuals at peculiar hazard of medicine, misdiagnosis, interaction, inaccurate premises about medical versus psychiatric causes of symptoms, and ambiguity about whose duty it is to vouch that appropriate community-based services are provided.From a fiscal mentality, foremost and most important, mental wellness carve-out organisations predicts the hazard of supplying services for a special(prenominal) given population at a set negotiated fee. Downward pressures to incorporate or cut down costs may take into a one-sided decrease in the proportion of the overall wellness attention dollar allocated for mental wellness services.Second, a fiscal inducement exists for medical suppliers to switch and deputize duty for co-morbid conditions to mental wellness suppliers and frailty versa. For case, since the allotments for medical and psychiatric services are fixed and dispersed, it may be in the fiscal attractive force of a medical supplier organisation to inaccurately tie in the cause of a complex med ical-psychiatric job to mental unwellness, which would take into unequal attention and switch the cost load to the mental wellness supplier organisation.A 3rd exposure of carve-out agreements is the visitation that they pose in finding the benefits or cost nest eggs of mental wellness services. increase usage of mental wellness services may look to be more dearly-won in a carve-out agreement.At last, the physical and mental co-morbidity found in aged grownups with serious and relentless mental unwellness may cut down any awaited fiscal advantages of carved-out services. If the mental wellness supplier can non every bit pull off services and costs related with the combination of medical and mental wellness upsets, anticipated nest eggs may non happen.INNOVATIVE PATTERNOF MANAGED LONG TERM CAREThe demand of keeping intensifying outgos of long-run attention while supplying home- and community-based options to institutional attention has been the central point of s experiments in long -run attention reform, including societal HMOs, the Program for All-Inclusive Care of the Elderly ( whole tone ) , and state-managed long-term-care presentations.Initially initiated as a four-site long term attention presentation undertaking in the mid-1980s, societal HMOs are determined to immingle ague attention and long-run attention within a managed attention model. The implicit in plan is to supply both ague and chronic attention net income under a individual organisation at fiscal hazard, based on a prepaid capitation payment pooled from different beginnings including Medicare, Medicaid, and copayments.In comparing, PACE largely pay attending on persons who meet eligibility standards for nursing place attention and suspects high hazard under capitation for all long-term-care services, financed by monthly capitated payments from Medicare and Medicaid. Elite characteristics of the PACE plan include a multidisciplinary squad attack, service proviso in a separate grownup twenty- four hours wellness centre, chronic attention without caps on long-term-care outgos, and everyday one-year wellness showing and frustrating attention. These theoretical account plans involves many elements that might be adapted to the demands of aged individuals with rigorous and grim mental unwellness to better future long-run attention for this population, including instance direction and multidisciplinary squads.Imaginative state-initiated managed long-term-care presentations include plans for bulk dually entitled for Medicaid and Medicare, who are among the premier users of acute and long-run wellness services. This group includes old individuals with serious and consistent mental unwellness. At present, multistate proposals are being constructed to unite Medicaid and Medicare resources under a capitated program that provides a full scope of services, including community-based and institutional ague and long-run attention. These enterprises have the possible to supply comprehe nsive long-run medical and mental wellness attention through humankind insurance to a population with high rates of chronic mental and wellness upsets. However, with few exclusions, presently planned proposals do non have mental wellness attention as a nucleus constituent or supplier of services.An alternate system of managed attention with the prospective to supply wide-ranging services is exemplified by a single-payer discipline wellness attention system. However, statistics from national comparings are assorted. Single-payer wellness attention systems in other states are more likely to function persons with note incomes and more terrible mental unwellness than in the U.S. , but overall entree to specialty mental wellness services is no better and frequently involves longer waiting periods.Deduction FOR THE FUTUREHow will elder individuals necessitating long-run mental wellness attention menu in an epoch of managed attention? brisk issues reviewed here suggest that there is ca use for dismay at the same clip, new attacks to funding services hold promise if they are suitably developed and harnessed. However, this sum-up of the literature suggests several specific instructions and commission rules for future theoretical accounts.Integration of mental wellness and medical servicesOptimal services for older individuals with terrible and unchanging mental unwellness require a close association of primary medical attention and mental wellness services. The high prevalence of medical and cognitive comorbidity in this group necessitates a clinical attack that recognizes the complex mixture of medical and psychiatric upsets and the value of a collaborative medical-psychiatric attack. A array of attacks to incorporating medical and mental wellness attention have been described, but run intoing the demands of persons with serious and changeless mental unwellness is particularly debatable. Promising theoretical accounts of incorporate attention consist of location of medical and mental wellness suppliers at the same site, multidisciplinary medical-psychiatric intervention squads, proviso of primary attention in mental wellness clinics, proviso of specialised mental wellness services in primary attention clinics, and cross-trained medical-psychiatric suppliers.The profound clinical topic here is the formation of a collaborative attention theoretical account across medical and mental wellness suppliers, of whether the services are financially incorporate ( carved in ) or separate ( carved out ) . For illustration, the literature describes booming theoretical accounts of community-based mental wellness services that include a primary wellness attention supplier as an built-in portion of a mental wellness outreach squad for senior grownups with terrible and relentless mental unwellness ( Levine KJ, Bartels SJ, unpublished manuscript, 1999 ) and the development of an associated primary attention medical clinic specifically for persons with terri ble and changeless mental unwellness.Integration of specialised services and community-based attentionRising systems of community-based long-run attention across the provinces promise to supply many critical supports and services indispensable to keep frail aged individuals with several medical upsets in place scenes. These theoretical accounts of home- and community-based long-run attention offer advanced attacks to supplying medical and societal services to elder individuals, yet by and large do non include specialised services for long-run mental wellness attention of individuals with serious and perennial mental unwellness. To undertake these demands, such plans will necessitate to spouse with specialised geropsychiatric and community support services.Although existential informations are missing, a restricted descriptive literature suggests that theoretical account plans must hold specific clinical constituents to successfully keep senior grownups with terrible and continual mental unwellness in the community. These constituents consist of intensive instance direction, general medical attention, 24-hour crisis engagement, home-based mental wellness attention, residential and household support services, primary care provider preparation, multidisciplinary squads, active instance determination and outreach, and psychosocial rehabilitation ( Levine KJ, Bartels SJ, unpublished manuscript, 1999 ) . Descriptions of results for these plans suggest that with sufficient supports, the bulk of senior individuals with terrible and continual mental unwellness can be maintained in the community at bring low cost than in establishments and with equal or enhanced quality of life.Blended funding and seting for unwellness severenessThe greatest challenge to run intoing the long-term-care demands of the increasing Numberss of aging individuals with terrible mental unwellness will be fiscal. Predictions of the bankruptcy of the Medicare trust fund and current projectio ns for Medicaid expenditures require advanced and resourceful usage of these and other fiscal resources. Meeting the complex long-run medical and mental wellness attention demands of senior individuals with terrible and continual mental unwellness under fee-for-service support will necessitate originative pooling of resources, including Medicare, Medicaid, and funding for aging services under federal and province block grant plans, every bit good as private insurance and limited personal financess. However, even with these steps, in the deficiency of singular reforms in the funding of wellness and long-run attention for senior individuals, financess may be deficient. Capitated attention agreements may be necessary to incorporate costs and to promote usage of the most cost-efficient services.A major aspiration of financing long-run attention will be the reallocation of outgos to back up the development of home- and community-based options. The most striving theoretical accounts of fo rming and funding services for open populations of senior individuals provide integrated services under a individual system responsible for both acute and long-run attention. PACE, societal HMOs, and province proposals for senior individuals who are dually desirable for Medicare and Medicaid blend these beginnings of support to make systems of acute and long-run attention. All of these attacks portion the common purpose of redeploying financess from current dearly-won nursing place attention and hospital-based attention to supported community options. The end of such plans is to intermix these fiscal resources under capitation with an accent on back uping the least restrictive and least dearly-won long-term-care services.Managed attention plans functioning senior individuals with terrible and changeless mental unwellness will necessitate to integrate hazard accommodation schemes that account for the significant costs associated with combined hazards of older age, long-run mental di sablement, and medical comorbidity. For case, current reforms under the 1997 Balanced Budget Act include programs to finally associate Medicare capitation rates to wellness specify through risk-adjusted payments.Guaranting answerability, protagonism, and resultsAt last, it is of import to admit that senior individuals with terrible and changeless mental unwellness interpret the most complex, susceptible, resource-poor, and bad long-term-care patients. Service organisations that presume the fiscal hazard for ague and long-run psychiatric and medical attention will necessitate to be suitably reimbursed and held responsible for quality of attention. In the absence of mechanisms to finance these services, adjust for hazard, and step results, managed attention agreements will be in struggle with the ends of supplying high-quality attention for senior individuals with terrible and continual mental unwellness.DecisionWe have no simple replies to the inquiry of how to outdo organize, fina nce, and present mental wellness and long-term-care services to elder individuals with terrible and continual mental unwellness. The integrated funding and organisation of services promised in germinating theoretical accounts of managed long-run attention offer the possible to eliminate atomization and inefficiencies and to make a much-needed continuum of medical, mental wellness, and societal support services. Yet bing theoretical accounts fail to supply the specialised mental wellness services that are critical for functioning this population in the community.REFRENCES1 Jonas & A Kovner s Health Care Delivery in the United StatesAedited by Anthony Kovner, PhD, Steven Jonas, James Knickman, PhD.2 contact book of Health Economics by Anthony J.Culyer and Joseph P.New house.3 The Economicss of Health and Health attention by Folland Goodman Stano.4 The Economic and Budget Outlook Fiscal Old ages 1998-2007. Washington, DC, Congressional Budget Office, 1997.5 Bartels SJ, Miles KM, Levine K, et Al Bettering psychiatric attention of the older patient, in Clinical Practice Improvement Methodology Effective Evaluation and steering of Health Care Delivery.Edited by Horn SD. New York, Faulkner & A Gray, 1997.6 Kane RL Managed attention as a vehicle for presenting more effectual chronic attention for olderpersons. 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