Conflict between Free

Conflict between Freewill and Fate Essay Sophocles lived in the 5th Century BC, arguably the age at which the Greeks started questioning the validity of their Gods and Religious beliefs. As a playwright and as a keen social observer (he is credited with winning the maximum number of awards for his plays during his lifetime among his contemporaries), Sophocles might have felt an obligation to emphasize that Fate and Gods were what guided the human life. A healthy respect for Fate was required to accept Life in its entirety. The underlying concept of the story of Oedipus Rex is the all encompassing power of coincidences. One might choose to call it Fate or a deterministic Universe. For Sophocles and all his readers, it is the amazing possibility of symmetry in events. What is Free Will? Freewill is the ability to take independent decisions, and it also includes a deep rooted desire to counter any attempt to predetermine future. Freewill always tends to adopt measures to break loose from any prediction. This tendency to try and break away from any foregone conclusion has been the chief motivation for progress. But, in the limited context of Oedipus Rex, predictions, instigate the freewill to try and rebel. Prominent evidence of this struggle from Oedipus Rex â€Å"An oracle Once came to Laius (I will not say Twas from the Delphic god himself, but from His ministers) declaring he was doomed To perish by the hand of his own son, A child that should be born to him by me. †(lines 713-715) Jocasta and Laius were forewarned through a Prophecy that a son born through their union shall slay Laius. But this only led them to banish the child to be killed in the hope that the prophecy is belied. At the same time, the prophecy to Laius and Jocasta was not complete – it did not talk about the incestuous relationship their son would have with his mother. â€Å"†¦Apollo sent me back Baulked of the knowledge that I came to seek. But other grievous things he prophesied, Woes, lamentations, mourning, portents dire; To wit I should defile my mothers bed And raise up seed too loathsome to behold, And slay the father from whose loins I sprang. †(lines 816-821) Thus was Oedipus forewarned. He had gone to the Oracle to find out if there was any truth in the scandal that was spreading in Corinth that he was not the son of the king Polybus of Corinth. Instead of giving him any clarity on his confusion, the oracle set him on the course of his life that would fulfill the prophecy. When he learnt that he shall commit murder of his father and incest on is mother, Oedipus was still under the impression that Polybus and Dorian were his parents. To avoid any such possibility in his life, Oedipus decided to leave Corinth and that journey (prompted wholly by the prophecy) actually set him on the path to his destiny – A self fulfilling prophecy. These two are the most important manifestations of freewill trying to rebel against a rarely revealed future events of fate. When it is prophesied that certain events of great magnitude or villainous impact are about to happen in the future, it is the absolute nature of the freewill to try and avoid it. Arguments suggesting that Sophocles does not support the supremacy of Fate over Free will Eminent scholar E. R. Dodds in his â€Å"misunderstanding of Oedipus Rex† criticizes the most significant ways of understanding Oedipus Rex. His most important grouse is that the scholars and students alike fall prey to viewing Sophocles’ work through the prisms of philosophical thought processes which were non-existent during Sophocles’ time. Besides, the student community that studies Oedipus Rex tries to ascribe motive where none might have been intended. Point wise rebuttal to Dodds’s arguments Dodds. In his scholarly analysis of the popular misunderstanding of Oedipus Rex puts forth the following points in defense of his arguments. †¢ Sophocles does not intend Oedipus to be a villainous person being punished by Gods for his evil thoughts and actions. †¢ Sophocles does not intend Oedipus to be the prototype Greek tragic hero, whose one tragic flaw creates all the tragic consequences in the drama. †¢ Sophocles does not intend to state that there is no scope for free will and that the Fate reigns supreme. The first point of the argument is valid as Sophocles designs the character of Oedipus as heroic and it is prominently mentioned in most conversations of the stand alone characters and the chorus. His valor, his compassion and his ability to seek truth even if it be detrimental to his own self are heroic characteristics designed to evoke a mixture of admiration for his strength of character and sympathy for the travails he undergoes. The chorus sing the virtues of the king in unequivocal terms and all the incidents that lead to the story of Oedipus Rex establish his character as admirable, if not entirely beyond reproach. (his suspicion of his brother-in-law might be a lapse, but not a flaw of character) â€Å"Upraise, O chief of men, upraise our State! Look to thy laurels! for thy zeal of yore Our countrys savior thou art justly hailed:†(lines 53-55) Tragic Flaw While trying to relieve Oedipus of the tragic flaw, Dodds tries to reason that the concept of hamartia led by hubris is not evident in the Sophoclean hero. It can be argued that â€Å"Poetics† of Aristotle was a guiding light to playwrights and was a great contributor in shaping Greek literature. But it was within the capacity of the playwrights, creative geniuses all, to reinterpret the laws or rules of Poetics to further their own literary achievements. Even while adding his own interpretation to the concept of tragic flaw, Sophocles remains loyal to the concept per se. The tragic flaw of Oedipus might have been the fact that even when he was forewarned of a future in which his life shall harbor aberrations that the natural universe abhors, he had the courage to try and avoid it. A lesser man would have hid behind the inevitability of Fate or made such drastic changes to his won character as to avoid any such possibility. As Dodds suggests, some of the readers of Oedipus wonder why Oedipus did not give up fighting (even in self defense) against people older than him or in engaging in physical relationship with women older than him. Dodds answers saying that we are not to question what is not in the play. In fact, this might be the tragic flaw of the protagonist. Even after he is warned of the possibility of patricide and incest, Oedipus does not leave behind his virtuous qualities of valor (which leads him to kill Laius) and compassion (which leads him to free Crete from the songstress and take Jocasta as his wife). His sense of righteousness makes him leave Corinth to avoid patricide and incest as he believes Polybus and Dorian to be his parents. This flight is in the strongly held belief that he detests the unnatural acts of patricide and incest and it is within his capacity to avoid them by charting his own course and at the same time retaining his primary character traits of compassion and courage in the face of adversity. Dodds stresses his argument that Sophocles does not intend to make any statement on the finality of Fate and he bases it on two points. †¢ Sophocles is not the victim of any knowledge of determinism which was a later stage philosophical development largely credited to the Kantian determinism. †¢ Sophocles does not intend to preach the supremacy of fate because most incidents of the Play are a result of the exercise of Free will. Sophocles might not have been privy to the philosophical leanings of the determinism of the late 18th and early 19th century. But that does not exclude the gamut of his knowledge from knowing anything of that. In fact philosophical treatises have been, for the most part, clarified pronunciations of the existing thought derived through scientific observation. Determinism as a clear treatise might not have been available to the Greek playwrights but the concepts of a superior design to life which has the power to supersede human interventions has always caught the fascination of creative contributors as evidenced from the earliest forms of literature. The French concept of Poetic justice or the Christian concepts of adequate justice have been used in works earlier than these periods but they have been recognized and grouped only in the last four to five centuries. It is not that the critics are viewing the older works through newer prisms but the scholars are able to identify the evidence of such concepts even in earlier works. This is intellectually honest analysis and it is hard to understand why Dodd argues them to be invalid. For instance, if Pasteur discovered germ theory of disease in the early part of the 19th century, why is it not valid to find that similar germs or micro-organisms were cited in the out break of any contagious disease in the previous centuries. The scientists and philosophers in both cases have only discovered what was either already existent or known in some different form. Therefore, it seems invalid to argue that Sophocles might not have had the supremacy of Fate or determinism in mind when he crafted the symmetrical cycle of events in Oedipus Rex. Dodds says that Oedipus Rex is a manifestation of Free will. In his own words, â€Å"Oedipus might have left the plague to take its course; but pity for the sufferings of his people compelled him to consult Delphi. When Apollos word came back, he might still have left the murder of Laius uninvestigated; but piety and justice required him to act. He need not have forced the truth from the reluctant Theban herdsman; but because he cannot rest content with a lie, he must tear away the last veil from the illusion in which he has lived so long. Teiresias, Jocasta, the herdsman, each in turn tries to stop him, but in vain: he must read the last riddle, the riddle of his own life. The immediate cause of Oedipuss ruin is not Fate or the gods—no oracle said that he must discover the truth—and still less does it lie in his own weakness; what causes his ruin is his own strength and courage, his loyalty to Thebes, and his loyalty to the truth. In all this we are to see him as a free agent: hence the suppression of the hereditary curse. And his self-mutilation and self ¬-banishment are equally free acts of choice. †(Dodds 1985, p71) But these are not manifestations of free will but the struggle of free will against an all powerful fate. All the attempts made by the wise and virtuous Oedipus to avoid the aberrations of nature at his won hand are defeated partly by design and partly by curious coincidences. Conclusion Aristotle’s Poetics suggests that Greek drama is not pure entertainment. It had a communal function to contribute to the development of the community. It is easy to believe that Sophocles was a strict adherent to this principle because he won the most competitions during his lifetime compared to any of his contemporaries. His dramas were popular with both the entertainment-seeking public and the critics. Therefore it is safe to assume that Sophocles tries to establish the depravity of the acts of Patricide and incest through Oedipus. The message that resonates is that if a man of great wisdom, courage and all admirable qualities like Oedipus can fall prey to the hands of fate and commit the most heinous of acts, it is but the duty of the wider public to guard against any temptations that might make them break the natural or communal law. Besides, if Oedipus could not over come his guilt even after trying his entire life to avoid such acts and if the guilt is so all consuming that he blinds himself and seeks exile, it is better for the normal man to watch out for any of these sins. The all-consuming guilt is so over powering that no man can remain nonchalant after committing any of these crimes knowingly or unwittingly. A good moral for a drama that retains its mystique and appeal due to its craftiness and perfect symmetry in the cycle of events References Dodds. E. R. (1985). The Ancient Concept of Progress and Other Essays on Greek Literature and Belief: And Other Essays on Greek Literature and Belief. New York : Oxford University Press (Translated by Malcolm Heath). Aristotle. 1996. Poetics. London: Penguin Classics

Case Study Of Psychosomatic Pain Nasrin Nursing Essay

Case Study Of Psychosomatic Pain Nasrin Nursing Essay It is a case of psychosomatic pain disorder in which a twenty seven year old lady named Nasrin is suffering from lower abdomen pain. Recently she had hysterectomy due to heavy periods and regular severe uterine pain. But after six months of her surgery she still feeling pain in her lower abdomen and she have no improvement in pain after six months of her surgery. Her gynecologist confident her that everything was normal but she was not satisfied with this statement. She visits many specialists but found no relief. She felt sharp pain everyday from few minutes to hours. In recent times she felt chest pain and thought she is having heart attack. But after her checkup in emergency the physician recommended that it might be anxiety. She felt insulted .Her GP influenced her to go to psychologist. GP clarified her that at times even emotions causes difficulties in medical problems Clients problems and Diagnosis: Nasrin went to consultant and told her problems. She explained that she has severe low backache and her pain is presently radiating both legs. Pain is very sharp and brought herself to tears. Pain occurs every day at different time intervals. She has lack of motivation and interest. She didnt sleep properly in night. She felt insulted when GP told her that these are only the signs of anxiety and tell her to see a psychologist. She avoids to meet anyone and seen herself failure and weak. By studying the whole case the case is diagnosed with the help of DSM IV checklist and it is diagnosed as a case of pain disorder associated with psychological factors. The client has following features: Her main problem was significant pain from long time. There are many psychological factors which play main role in the beginning, severity, exacerbation or preservation of pain. As pain felt everyday at different times and intervals. Pain is very sharp that brings Nasrin to tears. The symptoms are not purposely produced by the patient. Background: Patient Nasrin is the youngest one in her family. Since puberty she has not good health. She was having severe recurrent headaches but those headaches were not diagnosed as the attacks of migraine. When she was twelve years old her grandmother died. She was suffered with the symptoms of after stroke for four years before her death. After the death of her grandmother her mom showed sympathy towards her and whenever she felt those headaches she told her lie down. Her mother gave cold compression to her head. Mostly she felt chest pain during the stress period of exams. She got married at the age of twenty one and she left her study because of her severe headaches. She always tried to become an ideal companion. Her husband Alfred was also caring but due to her continuous appointments with doctors and their expenses he started criticizing her. Her husband left her after two years of her marriage. She was heartbroken at that time then she started work for supporting herself but soon she l ost her job due to her health problems. Because of her continuous visits to doctors she was absent from work many times and this was the reason for her job lost. After that she joined her parents and moved to their house. Case formulation: For formulating the case, first of all the consultant assesses and socializes into cognitive therapy. CBT is the therapy of choice in various mental health problems. CBT promote patient to talk about himself in a way that how the patient think about himself, the surrounding world and the other persons surrounding him. What are the things affects patients thoughts and feelings. By knowing all these things CBT helps in patients thinking (Cognitive) and what he do (behaviour) and this can help patient to feel better regarding his life. After that assessed the detailed description of the problem of client and in this case it is recurrent lower abdominal pain. Assess the predisposing factors and in Nasrin case these are recurrent headache and chest pain during stress like in exams etc. The precipitating factors were her grandmothers death and separation from her husband soon after her marriage and the maintaining factor is long term complaint of lower abdomen pain. Then ABC analysis of pr oblem was done by the consultant. Diagnose historical context of the problem, its assumptions and core beliefs. After that constructed a treatment and management plan .Afterwards socializing the client towards the self task. When client came to consultant initially in first session he/she should tell the client about the confidentially of their conversation for gaining faith of client, tells the cognitive therapy and regarding the estimated time of the therapy. CBT sessions are depends upon the patients problems and objectives. Generally with CBT results are better realized when sessions are between 6-20 and varies from 40 minutes to one hour each session. Every session is generally has a gap of one week or fifteen days. CBT cannot remove the patients problems but it can help to handle them in an optimistic way. Therapist helps patient to find ways by changing your thoughts and behaviour so that the patient cope with the problems in better way. (Sheldon, 2011). Consultant assesses the details of the problem as in this case Nasrin has a problem of severe lower abdomen pain. She suffers from this pain from a long time. She has heavy menstrual bleeding and severe lower abdominal pain. Her gynecologist was n ot agreeing to do surgery for this pain but Nasrins frequent visits and continuous pain problem agreed her to do surgery. Because of this continuous and sharp pain she influenced her surgeon and had hysterectomy in her young age. After six months of her surgery she felt no improvement in her pain. She visited to many specialists for finding the cause of her pain problem. But nothing was found by any specialist. Recently she felt chest pain and thought that she was having heart attack. But physician told her she is normal and this all was because of anxiety. She felt insulted with this comment. At last her GP influenced her to consult a clinical psychologist and clarify her that at times emotions made worse to medical problems. GP explained her that psychological assessments will better treat her condition. ABC analysis of Nasrin case: In this case A- activating events are the hysterectomy of client which was done at young age. Nasrin is separated from her husband and stay with her parents. B-Her rational thoughts and beliefs are that she is having severe pain in her lower abdomen. She also felt chest pain. She thoughts that she is pathetic for being like this .C- Consequences regarding the emotions she is nervous, irritated, shame and hurt also. In her behaviour she is always sad, there were crying episodes as sometimes the pain bring her to tears and she feels isolated also. After assessing Nasrin problem consultant gave her a questionnaire to do at her home .It is a questionnaire based on Hamilton anxiety rating scale (HAM-A). The main reason for giving this questionnaire to know the severity of symptoms of anxiety in patient. This scale contains 14 items and each of these items distinct by a number of symptoms. This scale calculates both psychic and somatic anxiety. Each item is scaled on 0-4 in which 0 means not present and 4 means severe. Total score range is 0-56 and if a person scores less than 17 it shows less severity and 18-24 means mild to moderate severity 25-30 means moderate to severe symptoms of anxiety ( Guy,1976,Hamilton, 1959). In her next visit Nasrin has to bring that filled questionnaire and consultant assessed those answers. In the next session consultant go through that filled questionnaire and identifies and clarified Nasrin problems by DSM IV checklist. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is the usual classification regarding mental disorders and is used by mental health professionals in America. This has five axis in which Axis I covers clinical disorders, Axis II includes personality disorders and mental retardation. Axis III includes general medical conditions, Axis IV psychosocial and environmental conditions and Axis IV global assessment of functioning scale (American psychiatric association, 2000). Consultant assesses and found that she has a problem of pain disorder associated with psychological factors. Consultant took a detailed historical background in this visit. When consultant asked Nasrin about her background she told him that she was the youngest in her brother sisters. She has poor health since teenage. She has recurrent headaches from puberty but those head aches were not fit into migraine attacks and her grandmother died when she was 12 and her mother shows sympathy towards her after her grandmothers death. She has chest pain during stress. She was married when she was only 21 years old and left her university study because of her severe headache problem. Her husband left her after two years of her marriage. The reason for her separation was the high expenses due to frequent visits to doctors for her complaint of lower abdomen pain. After her separation she started work as personal assistant for supporting her. She lost her job soon because of continuous absent from her job due to her health problems. After that she shifted to her parents place and stay with them. Consultant listen all the background and gave Nasrin a homework task to maintain a daily pain dairy. In which she has to write at what time she has the pain as the pain starts in morning, afternoon or evening. Where is the pain in the scale of 0-10, in which 0 means no pain, 5 means moderate pain and 10 means worst possible pain. She has to write in dairy that what she was doing when the pain started. Did she take any medicine and what was the dose of that medicine? What were the other treatments she used? After one hour what the pain rate was in the rating scale like is it relived or gone worse. What are the other problems she faces? She has to maintain this daily pain dairy (AGS Foundation for Health in Aging, 2006) for one week till her next visit and bring it with her in her next visit. In her next visit the consultant gone through her daily pain dairy and identify her problem. Consultant done a counseling session about her hobbies and her likes and dislikes with her and in that conversation she told that she was previously used to write a personal dairy daily. But due to her health problems she didnt do this now. By knowing this entire, consultant asked her that why not she again start writing a book on her life and choose this as a smart goal for her. But she said that she is not able to do all this because of her health problems then consultant told her to just give this a try. In smart goal it is specific for Nasrin to write a book on her life story. This is measureable as the book will have 150 pages and her progress would be measured monthly. It will be an attainable goal as if she complete twelve and half pages in a month then she would have 150 pages by the deadline. This smart goal is realistic also as at times it will be difficult for Nasrin to get her tho ughts on paper, so she give herself enough time to complete her book. For time she has to finish this book in twelve months that means twelve and half pages in a month and150 pages in a year. So consultant advised her to work on this smart goal and she agreed on that. Generating Solution: For Nasrin consultant planned cognitive behaviour therapy for 6-12 weeks in which she has to continue her pharmacotherapy that means she has to continue her drugs prescribed by physician. She is advised for relaxation therapy and supportive psychotherapy for her anxiety problem. For relaxation therapy she has to do some relaxation techniques which helps in reducing tension of muscles and improving patients in general feeling of wellness and minimizes anxiety. Deep relaxation for 20-30 minutes reduces general anxiety, reduces the incidence and harshness of panic attacks. These techniques also good for sleeplessness and fatigue. It also increases self confidence and reduces the symptom of self blame (Bourne, 1995). In supportive psychotherapy, patient has to be supported for coping with stressors by many actions like carefully paying attention and cheering expressions regarding thoughts and feelings. Supporting the patient to understand the situation and its alternatives and trying to give a hope to patient (Douglas, 2008). Â   She has advised for some physiotherapy to support and tone up her lower abdominal muscles and keeps her body fit. Consultant advised Nasrin some preferred solutions for her problem. She has advised to do early morning yoga for half an hour. Then after her breakfast she is advised to visit local library for reading books on biographies. And coming back to home relax for some time and do some household works and after lunch go out for shopping and start socialising with friends and neighbours. In the evening watch tele with her parents. After dinner chat for some time with parents. Before going to bed while listening music try to write her biography. She has to follow the same till her next visit. After all these visits Nasrin is quiet satisfied and relaxed. Her episodes of pain are reducing day by day.

Analysis of the Healthcare Reform Act

Analysis of the Healthcare Reform Act According to the U.S. Department of Health and Human Services the Health policy broadly describes actions taken by governments national, state, and local to advance the publics health. It is not a single action but requires a range of legislative and regulatory efforts ranging from ensuring air and water quality to supporting cancer research. Health care policy deals with the organization, financing and delivery of health care services. This includes training of health professionals, overseeing the safety of drugs and medical devices, administering public programs like Medicare and regulating private health insurance (U.S. Department of Health and Human Services 2010). This analysis covers the federal statute enacted in 2010: the Patient Protection and Affordable Care Act (PPACA), which was designed to help families across the states gain access to quality, affordable health care. Many countries integrate a human rights viewpoint when creating their health care policies. The World Health Organization reports that every country in the world is party to at least one human rights treaty that addresses health-related rights, including the right to health as well as other rights that relate to conditions necessary for good health (World Health Organization, 2012). The United Nations Universal Declaration of Human Rights (UDHR) asserts that medical care is a right of all people (The United Nations, 2012). UDHR Article 25: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, and housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. Health care reform in the United States has a long history. In 1900 the American Medical Association (AMA) became a powerful national force. By 1910 the American Association for Labor Legislation (AALL) organized the first national conference on social insurance. Liberal activists argued for health insurance. In the 1930s the Depression changed priorities, placing more importance on unemployment insurance and old age benefits. The Social Security Act was passed, omitting health insurance. By the 1940s prepaid group healthcare began and was seen as radical. During the 2nd World War, wage and price controls were placed on American employers. To compete for workers, companies began to offer health care benefits, this employer-based system in place today. President Roosevelt asked Congress for economic bill of rights, including the right to adequate medical care. President Truman offered national health program plan, recommending a single system that would include all of American society . Trumans plan was criticized by the American Medical Association (AMA), and is called a Communist plot by a House subcommittee. In the 1950s, hospital care cost doubled. In the early 1960s, President Lyndon Johnson signed Medicare and Medicaid into law. President Richard Nixon renamed health care plans to health maintenance organizations (HMOs), with regulations that provided federal endorsement, certification, and assistance. American medicine was viewed as being in a state of emergency. President Nixons plan for national health insurance was rejected by liberals labor unions. In the 80s Corporations began to integrate the hospital system (previously a decentralized structure), consolidating control. Healthcare shifted toward privatization and corporatizations. In 1986 Congress passed and President Ronald Reagan signed into law COBRA, an option that former workers could stay on the company health care plan for 18 months after leaving a job, although the former employee would pay for the coverage. In 1988 prescription drug benefit and catastrophic care coverage was added to Medicare; Congress repealed the law the next year. Under President Reagan, Medicare moved to payments for diagnosiss (DRG) rather than for treatment received. Health care costs increased at double the rate of inflation. Federal health care reform legislation failed passage for a second time in the U.S. Congress. By the end of the decade there were 44 million Americans, which was 16 % of the nation, with no health insurance at all. With a fresh era and Health care costs are on the upsurge again. Medicare is viewed by some as unmentionable under the current organization and must be rescued (Associated press, 2012). After years of unsuccessful attempts by a series of Democratic presidents and a year of bitter partisan struggle, President Obama signed legislation on March 23, 2010, to overhaul the nations health care system and guarantee access to medical insurance for tens of millions of Americans. The Affordable Care Act seeks to extend insurance to more than 30 million people, primarily by expanding Medicaid and providing federal subsidies to help lower- and middle-income Americans buy private coverage. It will create insurance exchanges for those buying individual policies and prohibit insurers from denying coverage on the basis of pre-existing conditions. To reduce the soaring cost of Medicare, it creates a panel of experts to limit government reimbursement to only those treatments shown to be effective, and creates incentives for providers to bundle services rather than charge by individual procedure. (Henry J. Kaiser Foundation, 2010) According to research done by the New York Times the law will cost the government about $938 billion over 10 years, according to the nonpartisan Congressional Budget Office, which has also estimated that it will reduce the federal deficit by $138 billion over a decade (Andrews, 2012). One feature of the Affordable Health Care Act is that insurance companies including all exchange plans will provide adequate benefits to their enrollees. The essential health benefits package will define the minimum set of benefits that new health plans must offer for private market individual and small group plans as well as for Medicaid enrollees in benchmark coverage and those covered by state Basic Health Programs. Many expected the Department of Health and Human Services to outline the services to be included in essential health benefits package; instead it specified that each state would select the package that best meets the needs of children and families (Merles, M. 2005). Essential health benefits (Ebbs) are the least amount benefits that the Affordable Care Act (ACA) requires to be offered by non-grandfathered health plans in the individual and small group markets. Section 1302 of the ACA identifies the requirements for the essential health benefits. This approach allows states have the discretion to choose a benchmark set of benefits from among the existing health plans. Section 1302 also establishes some specific guidelines in defining the Ebbs. Benefits may not be designed in ways that discriminate against individuals because of their age, disability, or expected length of life and are required to take into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups.(Touschner, 2011) EHB packages must include benefit protections established in other parts of the ACA, including parity for mental health services and preventive services offered at no cost to enrollees. For infants, children, and adolescents, the preventive services requirement incorporates the services recommended in the American Academy of Pediatrics Bright Futures initiative (Touschner, 2011). The need for adequate Childrens benefits is critical due to their constant development and growth. Children have need of health services that are different than adults, which includes preventive screenings depending on their age and development stage. Childrens growing bodies may also require long-lasting medical equipment (like wheelchairs) on a more frequent schedule than adults. In its Scope of Health Care Benefits for Children policy statement, the American Academy of Pediatrics (AAP) outlines the services that are essential for children. (Scope of health, 2012) For many years, Americans have paid the price for policies that have allowed insurance companies to place barriers between them and their doctors, dropping their coverage for sickness, and discriminating against anyone for pre-existing conditions. Mississippi has one of the nations highest percentages (63.2 percent) of uninsured people who would qualify for Medicaid under the expansion in the United States (Kaiser 2010). The Affordable Care Act gives middle-class and low income families in Mississippi the health insurance coverage they deserve. The new health care law dictates that insurance companies are to play by the rules, they can no longer drop coverage if you get sick, sending you into bankruptcy because you have met your annual or lifetime limit, but most importantly they cannot discriminate against anyone with a pre-existing condition (U.S. Department of Health and Human Service, 2010). It is now mandated that health plans allow parents to maintain coverage of their children who are under the age of 26 and without insurance on their jobs. Resulting from this provision, As of December 2011, 37,000 young adults in Mississippi now have insurance which is included in 3.1 million young people nationwide. The health care law includes Medicare prescription drug coverage benefits which have made prescriptions more affordable. In 2010, a $250 rebate was given to 34,604 people with Medicare in Mississippi who had hit the prescription drug donut hole. In 2011, they began receiving a 50 percent discount on covered brand-name drugs and a discount on generic drugs (U.S. Department of Health Human Services, 2012). Since the law was enacted, residents with Medicare in Mississippi have saved a total of $41,809,338 on their prescription drugs. As a result of the discounts people are saving $591 per year and a total savings of $11,732,360 in Mississippi in 2012. It is projected by 2020; the law will close the donut hole. Last year (2011) 330,017 people with Medicare in Mississippi received free preventive services or a free annual wellness visit with their doctor (U.S. Department of Health Human Services, 2012). Approximately 47 million women, including 381,704 in Mississippi now have guaranteed access to additional preventive services without cost-sharing. Under the new health care law, insurance companies must provide consumers greater value by spending generally at least 80 percent of premium dollars on health care and quality improvements or they must provide consumers a rebate or reduce premiums. This means that 51,744 Mississippi residents with private insurance coverage will benefit from $10,122,532 in rebates from insurance companies this year which will average to $329 for the 30,800 families in Mississippi covered by a policy. Under the new law Mississippi has received $4,783,208 to help fight arbitrary premium increases. As of August 2012, 317 previously uninsured residents of Mississippi who were locked out of the coverage system because of a pre-existing condition are now insured through a new Pre-Existing Condition Insurance Plan that was created under the new health reform law (U.S. Department of Health Human Services, 2012). Mississippi has received $21,143,618 in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges. Since 2010, Mississippi has received $5,200,000 in grants from the Prevention and Public Health Fund created by the Affordable Care Act. This new fund was created to support effective policies in Mississippi, its communities, and nationwide so that all Americans can lead longer, more productive lives (U.S. Department of Health Human Services, 2012). In Mississippi, there are 21 health centers providing preventive and primary health care services to 324,046 people from183 different sites. These health centers have received $49,784,983 under the Affordable Care Act to support the operations and establishments of new health center sites. Mississippi was granted $4,100,000 for school-based health centers, to help clinics expand and provide more health care services such as screenings to students and $3,100,000 for Maternal, Infa nt, and Early Childhood Home Visiting Programs. These programs bring health professionals to meet with at-risk families in their homes and connect families to the kinds of help that can make a real difference in a childs health, development, and ability to learn such as health care, early education, parenting skills, child abuse prevention, and nutrition (U.S. Department of Health Human Services, 2012). The Patient Protection and affordable care Act (PPACA) will be implemented in a span of the next four years. The law includes an increase of the number of persons who are eligible to Medicaid; the government will reward discount of insurance premiums, for businesses providing health insurance. Insurance companies will no longer be able to deny coverage or claims because of the health history of any person. With the Patient Protection and affordable care Act all Americans will have the security of knowing that they dont have to worry about losing coverage if theyre laid off or change jobs. Insurance companies now have to cover preventive care like mammograms and other cancer screenings. The new law also makes a momentous investment in State and community-based efforts that promote public health prevent disease and protect against public health emergencies. Although this healthcare plan comes with its own costs, they will be covered by the taxes that will be imposed on the wealthy. Individuals who choose not to have insurance will be penalized with a tax fee as a way of encouraging every member in society to have insurance and this will be as a source of income to offset the plans cost. This was a great step towards ensuring a good healthcare for all the people of the US regardless of whether they are insured or not. There are several classes of people living in the US, who do not have access to insurance. These people range from illegal immigrants to others who see insurance as very expensive and cant afford to pay for insurance. The number of uninsured Americans is estimated to be 32 million today but after the PPACA was signed in to law the number is expected to decline considerably to about 23 million. Most of the uninsured people are drawn from illegal immigrants because they are not eligible to obtain insurance while they are resi ding in the US. Poor and middle class persons and their families also tend to go without insurance. (Institute of Medicine of the National Academies 2010 available online) The Affordable Care Act was specifically designed to give States the resources and flexibility they need to tailor their approach to their distinctive needs and to help families across the country gain access to quality, affordable health care. The Affordable Care Act ensures hard-working, middle class families will get the health care they deserve by keeping health care costs low, encouraging prevention, and making insurance companies accountable.

Violence on College Campuses Essay -- essays research papers

On college campuses today, there is a lot of violence. Violence occurs for many reasons, its unfortunate but true. One of the main reasons that violence accurs is because 90 percent of violence on college campuses is alcohol related. That is one of the many reasons why violence occurs. There have been reports of increased violence on U.S. college campuses since the early 1980s. Alcohol-related problems have included vandalism, fighting, injuries, and rape. However, as in the past, crime on campuses frequently was not reported to authorities or not divulged by institutions. Therefore, it is difficult to know if there has been an increase in incidences or just increased reporting. Roark (1987: 367) has suggested that "although comparative data from previous years are difficult to obtain, it seems to many student affairs professionals that there is an increase in violence on campuses." One study reported that residence hall advisors mediated more physical confrontations between students in the mid-1980s compared to previous years. College campuses are communities populated with individuals at high risk for unintentional and violent injury, the vast majority of whom are single and experiencing freedom from home and parental supervision for the first time. Des pite broad-based concern about violence on campus, accurate information about the scope and nature of this problem is hard to come by. Nevertheless, there is general agreement that since the 1960s crime and vio...

A Memorable Game of Cricket :: Art

A Memorable Game of Cricket Statement of Intention: My intended audiences for this piece of writing are teens who are interested in sports. I aim to show them that in times of need how people from all different interests come together as one to help those in need. I plan to do this with a very soft, friendly yet excited tone of writing, which I am writing a journal entry. Dear Diary, Cricket, one of the best sports any can play, where eleven fielders and two batsmen stand on a field trying to show how they are better than the other. This was definitely not the case at one of the best cricket matches I have ever been to. The Asian XI VS The Rest of the World XI match which was played at the Melbourne Cricket Ground in January 2005. This match was played for the reasons of Charity for the Boxing Day Tsunami disaster in 2004. The match was very different to a normal cricket match where racial slurs would be thrown around and people would only be supporting their own team and putting down the other. There were many factors that made this match very special and very memorable. Well excluding the first factor that made this match special that millions of dollars were being raised to go to the countries that were hit by the terrible Tsunami disaster, there were so many others. One of the things that made this match very special, which would be near the top of my list was that you got to see all your favorite superstars in the one go. You had some of cricket’s greats including Sachin Tendulkur, Brian Lara, Steve Waugh, Daniel Vettori and last but not least muttiah muralitharan. To see all these players, playing together in the same teams was just excellent. Talking about teams I don’t think there were any. Even though the players were in two different teams playing against each other the crowds didn’t seem to think so. For the first time at a cricket match that I have seen people from all countries supporting not just their own country but all the others no matter which side they were on. Everyone was joining into the chants no matter which country they were from or were supporting. I being Indian was sitting in a huge group of Indians and what really got my attention was that the Indians were joining the Go Aussie Go chants and the Australians were joining into the Indian chants though I doubt they new what they meant but yet still chanting along.

Management and Business Plan Outline Essay

Writing a business plan may sound simple enough, but it actually takes several dire and crucial steps. According to entrepreneur Darrell Zahorsky, the following steps are all essential in comprising a plan for one’s business: 1. â€Å"Audience & Funding Type: When writing a business plan, you must determine who will be reading it. This decision will shape the business plan. Do you plan to go for debt or equity financing? Each form of funding for your business has pros and cons. For instance, the venture capital market can be very time consuming and competitive. Do you have the time to write the business plan for investor funding and to network within the community? Writing a business plan for investors is 15-30 pages with in-depth analysis and full details of facts and figures to support assumptions of the market. Writing a business plan for the bank is 10-15 pages and focused with the bank’s concern with risk. A venture plan presents the upside and potential return on investments, whereas a bank plan reduces the risks and sells the ability to repay the loan. † You must also â€Å"Determine the purpose of your business. Identify it on paper and go into as much detail as you can at this point. For instance, are you providing a service to the community? Perhaps you are selling a product. Write down what you want the focus to be†, says Jennifer Metz. 2. Business Plan Outline: Zahorsky identifies the next step as follows: â€Å"A business plan outline is the second most important starting point once you’ve pre-determined your audience. The business plan outline should be prepared before the actual research and writing of the business plan. † During this step, it is also pertinent for one to decide: â€Å"Who is your target consumer? Will it be men or women? Old or young? Individuals or businesses and corporations? Local consumers or long distance consumers? † 3. Research & Information Collection: In this step, Zahorsky says â€Å"Once you have made the decision of the type of funding your business requires, it is time for the research. Business plan research covers several areas: -Insight from your experience working and observing the industry you will enter. This data will have to be backed but by the next two sources. -Published information from library, Internet, and paid database services will provide information on the market growth, overall industry perspective, and customer profiles. -Field research covers interviews with customers, suppliers, competitors, and industry experts. This provides the real insight behind all the published facts. † â€Å"Decide how to market to your target consumer. Will you use the Internet? Newspapers? Maybe you will make packets to deliver to local businesses and corporations in an effort to gain their business. You will need a clear understanding at this step of the purpose of your business and your target consumer. For instance, you will most likely not need to place a newspaper ad if you are providing corporate services, and you will probably not need a business packet if you are advertising to the general public. † 4. Collection Files: Mertz identifies this step as the point when one should decide the following: â€Å"Where will your business be based out of? Will you work from home, or do you need a location? Obviously if you are running a store, you will need a store front. Location is key so start researching now how much rents are in your desired location. You would want a high traffic, or easily accessible area for a store. Perhaps you are just selling stuff online, in which case you don’t need a store, but either enough space in your home if you have inventory or a storage unit. If you are a service provider, you may or may not need a location outside of your home. These are all questions you need to answer to define your business structure. † Zahorsky adds: â€Å"The easiest way to go about collecting all your experiences, interviews, and research is to create files for each section of the business plan. These files can be: paper-based, computer files or set-up using business planning software. As you start the research and collection phase of planning, fill your files with notes and printouts. † 5. General Industry Overview: At the fifth step, one should: â€Å"Begin the research process with an overview of the industry; uncovering industry and association reports. By having a general understanding of the industry, you will avoid embarrassment in contacting experts with basic questions. Begin the field research once you have a good grasp of the industry fundamentals and need answers to the hard-to-find information. † This step is also the time where one would answer the following questions: â€Å"What kind of tangible items will you need to get your business started? Do you need inventory? You will most likely need an assortment of office supplies no matter what your business. Items such as a computer, printer, and fax machine are all typical office needs in today’s society. Do you need equipment? This is a good time to research what you may need in the way of equipment for your business. Make a detailed list so you can easily research costs for each. † 6. Analysis: â€Å"Once the bulk of the data has been collected, the process of analysis begins. Look at building a competitive profile, contingency plan, risk assessment, etc. † This is the point in the business plan where one should: â€Å"Create a chart to calculate costs. This is the step you perform all the research and write down the costs of everything in the above steps. Don’t just guess, but do some actual research. This will include making telephone calls and doing internet searches as well. Creating a list will give you a good idea of what finances you will require in order to get started. Once you have that number calculated, add an additional 10% for incidentals. † 7. Financials: â€Å"Start the financials when you have found some average industry ratios for your business. Work closely with your accountant to develop realistic projections. Being overly optimistic will raise eyebrows with your investors or banker. † says Zahorsky. Mertz adds: â€Å"Draft your â€Å"Action Step† list. At this step, while looking over the first 6 steps, create your â€Å"Action Step† list, or your â€Å"To Do† list. This will and should be extensive. There are many things to do when starting a business. Once you have completed all seven steps, you are ready to move on. You may want to consider hiring a professional business plan writer, or at the very least, you may want to take a class in business plan writing. Other things to consider are consulting an attorney to answer your legal questions. Do you need a license? Should you incorporate? You should also visit an accountant who specializes in small businesses. He or she can give you great financial advice before you get started so you are aware of all the financial aspects and repercussions of starting a business. † 8. Executive Summary: The following tips from Zahorsky should be utilized in this step: â€Å"Save the first section for last. When you have thoroughly, completed all sections of the business plan, write the summary. Highlight the key points and include the return on investment or loan payback requirements†. 9. Review & Editing: â€Å"Remember, you only have one shot at making a good impression. A well-written business plan that opens doors and wins the money is a plan that has been revised and reviewed. Do not forget this important step. Ask others for feedback. Make certain to edit, proofread, proofread, and proofread. Business planning is not easy but by following these critical steps to writing a business plan, you will ensure your business has a chance at funding and success in the future. †

Sally Jameson: Valuing Stock Options in a Compensation Package (Abridged)

Sally Jameson: Valuing Stock Options in a Compensation Package (Abridged) Sally Jameson, a second-year MBA student at Harvard Business School, was thrilled but confused. It was late May 1992, graduation was approaching, and she had finally landed the job of her choice. She had just finished an early morning telephone conversation with Bob Marks, the MBA recruiting coordinator at Telstar Communications, a large, publicly held multinational company. Mr. Mark had offered Ms.Jameson a unique position in operations at Telstar, and from the description, it sounded exactly like the job that she wanted Since her first interview with Telstar, she had been very impressed with the company and its people while Ms. Jameson was certain that she would accept the job, there was still one unsettled, yes crucial, matter—her compensation. During the conversation with Marks, Jameson had asked what her compensation package would be Marks: â€Å"Well, Sally, we are all very impressed with you and would like to offer you a starting salary of 50,000.In addition, you will also, receive a signing bonus† Jameson: â€Å"that has salary is a little below what I had expected. Is that negotiable? † Marks: â€Å"I’m afraid not. That’s the same starting package all MBAs get However, you will receive a bonus upon accepting our offer. You can receive $5,000 in cash, or choose stock option instead. Jameson: †I’m not too familiar with stock options. Could you explain to me what they are? † Marks: â€Å"Sure. Executives at Telstar have been eligible to receive stock options for years. The goal was to tie management’s compensation more closely to increases in shareholder value.Although our stock has performed erratically over the last ten years, the board continues to believe that stock options are the best form of incentive compensation. Because the options represent the right to buy Telstar stock at a set price, after a set period of t ime, management has an incentive to take actions to move the stock price upward. Several months ago, we had a consulting firm examine our compensation structure. They recommended that we extend eligibility for stock options to all employees as part of our new inventive-based compensation plans.Thus, the two MBAs that we hope to hire this year will be the first employees who will be offered stock options. Given that this is an experiment, we decided to give MBAs a choice between cash or options. Jameson: â€Å"How much are these options worth? † Marks: â€Å"To tell you the truth, I’m not really sure. All I know are the details: each of the 3,000 options you’ll be granted allows you to buy one share of Telstar stock at $3500 per share at the time of your fifth anniversary with the furn. Yesterday, our stock, which pays no dividend and is not expected to pay one in the foreseeable future, closed at $1875. hould you leave any point before you fifth year, you lose the options. You can’t take them with you. Casewriter’s note: stock options of this sort would more typically have been written with a strike price equal to or just slightly above the current price. Professor peter Tufano and Research Associate Michael Lewittes prepared this case. HBS cased are developed solely as the basis for class discussion. Certain details have been disguised Cased are not intended to serve as endorsements, sources of primary data, or illustrations of effective or ineffective management.Copyright 1993 President and Fellows of Harvard College To order copies or request permission to produce material, call 1-800-545-7685, write Harvard Business School Publishing, Boston, MA 02163, or go th http://www hbsp Harvard edu. No part of this publication may be reproduced, stored in a retrieval system, used in spreadsheet, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the permis sion of Harvard Business School I have been told by our legal staff that these incentive stock options meet the IRS code for special treatment—that means you won’t pay any taxes on the options until you actually exercise them and then sell the shares. At that point, you gains on the shares(equal to the difference between their fair market value at that time and $3500) will be taxed at either ordinary tax rates or at capital gains rates, depending on whether you’ve held the stock for less than or more than one year after exercising the option.If you choose the cash signing bonus, it is taxed at ordinary tax rate? It’s your choice, Sally, but just between you and me, I’d take the case bonus. Telstar stock is only at $1875; it doesn’t seem to me that these options are worthe the paper thatr they’re printed on I think it’s just another example of consultants trying to justify their fees. You do what you think it best; either way, t hough, I need to know by tomorrow if you accept the offer and, if you do, which compensation package you’d prefer â€Å"While Bob Marks seemed to prefer the cash bonus, Sally Jameson was less sure. Taking out her Wall Street Journal, she noticed that both short-term and long-term. Telstar options were traded (seed Exhibit 1). Form an online financial database, she got a graph of Telstar’s common stock price and a plot of the historical volatility of the stock price as measured by the annualized standard deviation of the stock’s returns (see Exhibits 2 and 3). She also found data on government bill, note, and bond yields that would be useful in her analysis (see Exhibit 4).As she thought about the problem, she decided to approach it in two steps: first, she would attempt to determine what the options were worth, assuming she stayed at Telstar for at least five years. Then, she would consider other issues, including the likelihood that she might not stay at Telst ar that long.