Reflective Essay on the US Healthcare System

Reflective Essay on the US Healthcare System What is right with the U.S. Health Care System Marina Bukhrashvili The national strategy presented in The Affordable Care Act (ACA) seeks to fund prevention and public health. This is an important goal in our nation’s health care system. Prevention services, which include wellness, research, health screening, educational campaigns for preventive benefits and immunization programs, may have a positive effect on decreasing health care costs. To me, this first mandatory fund, also known as the Prevention and Public Health Fund (PPHF), is very important since as I am planning a career path that involves public health and the health of the community. Seventy-six percent of the U.S. health care expenditure are spent on treating preventable chronic diseases (The Hasting Center, 2010). By law, the Prevention Public Health Fund must be used to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public health care costs. (American Public Health Association, 2010). I work in a skilled nursing facility which provides acute rehabilitation services to an elderly population following hospitalization. During an intake interview last winter, I asked an 82 year old female about her immunization history and she reported that â€Å"she never took a flu shot in her life.† And she doesn’t remember ever taking any type of vaccinations. She said that she was afraid that a vaccination would infect her and make her sick and that her sister â€Å"got sick from the flu vaccine.† It has been my experience that a great majority of our patients receive important immunizations for the first time during their stay at our facility. This finding is in line with research that shows that less than 50 percent of adults’ age 65 years or older were up-to-date with immunizations regardless of regular checkups (Department of Human Health Services, 2010). This is the case even though these services are paid for by almost all insurance plans, includ ing Medicare and Medicaid, according to the U.S. Preventive Services Task Force (USPSTF) (2011). Based on this experience, I feel that the PPHF maybe providing the necessary resources to promote the health of communities and contain health care costs that would arise from treating acute infections. Even though influenza and pneumonia are the fifth major causes of deaths in the country (Center for Disease Control and Prevention, 2013), the immunization rates are still moderate. Despite all efforts to control health care across, racial, gender and age, the differences in influenza coverage persist. As the focus of health care shifts from post-diagnostic treatment to preventive medicine, making immunizations a part of every person’s health care plan is an essential first step in achieving this goal. Doctors’ offices that treat adult population seem to be a good choice for promoting vaccination but this strategy is not effective in increasing immunization rates for adults since most physicians have busy practices which mainly focus on treating acute illness versus seeing healthy patients for preventive medicine. In addition, according to Agency for Healthcare Research and Quality (2009), the leading causes for low immunization rates in the last few years were the high cost of screening, insufficient funds to cover the co-payment or deductibles; lack of knowledge of what health insurance would cover; and lack of health insurance. In addition, many older adults may not have a regular doctor or do not go for a check up on a regular basis. The prohibitive cost was addressed for Medicare beneficiaries by the ACA (2010) to some extent, which broadens the Medicare coverage for preventive services suggested by the USPSTF and eliminates out-of-pocket costs. There is no payment for influenza, pneumococcal and hepatitis B vaccines (Cassidy 2010). Although compliance with influenza vaccination has increased dramatically after Medicare began paying for influenza vaccines for the nation’s older and disabled population and after health reform in 2010, the proportion of older persons receiving this vaccine is still considerably low in elderly populations (CDC, 2013). According to the research (Eurich et al., 2008) some patients benefited from receiving influenza vaccination before they were hospitalized for pneumonia. As a result of passage of Affordable Care Act, most health insurance now covers co-payments for recommended clinical preventive services, which reduces financial cost to beneficiaries, however, the challenge remains to make older adults aware of the value of preventive services and encourage them to get the services they need. All efforts should be made to expand awareness in the community about clinical preventive services and benefits. . Nurses could send reminders to the health care providers to notify patients when the vaccinations are due. Such reminders could be issued on seasonal basis to educate patients about importance about vaccinations during patient encounters such as the registration interview. Educational Seminars can be conducted across various community centers before immunization season begins. Interactions focusing on different ethnic groups may help to find and address their misconceptions about immunizations, if there are any. Nurses will play a key part in the f ulfillment of the mandate of ACA and their expending scope of practice is already shaping the future of healthcare. References Agency for Healthcare Research and Quality. National Healthcare Disparities Report 2008. Rockville, MD: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality; 2009. Available at: www.ahrq.gov/qual/nhdr08/nhdr08.pdf American Public Health Association (2010). Prevention of Public Health Fund. Available at: www.apha.org/advocacy/Health+Reform/PH+Fund/ Cassidy 2010: Cassidy A., Health Affairs and the Robert Wood Johnson Foundation. Health Policy Brief: Preventive Services Without Cost Sharing, Health Affairs, December 28, 2010. Available at: www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=37 Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. Department of Health and Human Services. Healthy People 2020, Older Adult Section, December 2010. Available at: www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=31 Eurich, D. C., Marrie, T. J., J, J., M, S. R. (2008). Mortality reduction with Influenza vaccine in patients with Pneumonia outside â€Å"flu† season. American Journal of Respiratory Critical Care Medicine, 178, 527-533 The Hasting Center. Health Care Cost Monitor. Projected Costs of Chronic Diseases, January 22, 2010. Available at: http://healthcarecostmonitor.thehastingscenter.org/kimberlyswartz/projected-costs-of- chronic-diseases/ The Patient Protection and Affordable Care Act. Section 4002: Prevention and Public Health Fund. 111th Congress. Enacted March 23, 2010. Available at: http://housedocs.house.gov/energycommerce/ppacacon.pdf U.S. Preventive Services Task Force. USPSTF A and B Recommendations. Available at: www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm

Report of Quantitative Research Essay -- Research Analysis

EL (English Learners) students are given an added challenge of succeeding in the education system do to their lack of strong English understanding and abilities. Authors Townsend, D. and Collins, P. published the findings of their research on EL students and the advantages of a specialized learning program. Over a period of several months, the researchers studied and worked with students from a middle school in southern California. At the end of the study, it was hoped that their efforts would lead to an improvement in the students who participated in the programs understanding of English vocabulary words. Research Questions/Hypotheses No specific hypothesis is noted, but the researchers do address the issues that drive the study. They state that the current study is concerned with, â€Å"applying evidence-based strategies in a new context: adolescent EL students learning general academic vocabulary words† (Townsend and Collins, 2009, p.997). The study also addresses, â€Å"the extent to which there is a threshold of English proficiency necessary for students to learn general academic vocabulary words† (Townsend and Collins, 2009, p. 997). These issues are addressed by the following research question: 1. Can an after-school, evidence-based academic vocabulary development intervention increase the academic vocabulary knowledge of middle school EL? 2. To what extent does English learners’ proficiency in English mediate their response to a vocabulary development intervention? It was hoped by studying a group of middle school students over a period that they would see growth in those student who participated in a program designed to add English vocabulary comprehension to their academic development would help them as EL students. T... ...s a great need to continue and accelerate the research and instructional efforts to support the academic literacy development of adolescent EL students† (p. 1015). A study that incorporates greater elements of vocabulary, reading comprehension, and time, is perceived to be needed in order to improve EL learner’s education. Townsend and Collins believe that there research can lead to much needed further research and that this can in turn help EL students achieve in a greater educational level. Works Cited Gay, L. R., Mills, G. E., & Airasian, P. (2009). Educational research: Competencies for analysis and application (9th ed.). Upper Saddle River, New Jersey: Merrill (Pearson). Townsend, D. & Collins, P. (2009). Academic vocabulary and middle school English learners: An intervention study. Reading and Writing: An Interdisciplinary Journal, 22, 993-1019.

Review of the Financial Statements of Merck and Novartis Companies

In module 2 case study I am to do the following understanding financial reports and continue to review the financial statements of Merck and Novartis to learn additional information. The emphasis of this Case is to review the income statement, balance sheet and computation of ratios. Review the financial statements for the companies and answer the following questions for the last reporting year: What components of stockholders' equity does each of the companies disclose?Merck & Company IncThe components of the stockholders equity common stock (authorized and issued), other paid-in capital, retained earnings, accumulated other comprehensive loss, and treasury stock. Novartis International Ag. The components of the stockholders equity are share capital, treasury shares, reserves, and non-controlling interest. Do the companies have preferred stock shares outstanding? If so, what special features do these shares contain? Merck & Company Inc. Merck has authorized 20,000,000 shares of pref erred stock in 2012.All preferred stock from the AMI a merger in 1998 is being converted to either cash or shares of Merck stock. Novartis International Ag. Novartis did not report any preferred stock. Do either of the companies report treasury shares? If so, do the companies disclose the reason for reacquiring the shares? Merck & Company Inc. Yes Merck reported treasury shares; they reported the purchase of treasury shares on the balance sheet in the equity section and also on the summary of common stock and treasury stock transactions.In this case no they didn’t disclose any reasons for reacquiring shares other than those from the merger. Novartis International Ag. Yes Novartis reported treasury share; No they did not disclose reasons for reacquiring shares Income Statement. What are the basic and diluted earnings per share for each company? Merck & Company Inc. Basic earnings per common stock $2. 03 Diluted earnings per common stock $2. 00 Novartis International Ag. Basic earnings per common stock $3. 93. Diluted earnings per common stock $3. 89Have the companies reported any discontinued operations? Merck & Company Inc Merck has not reported any discontinued operations Novartis International Ag. Novartis reported no discontinued operations for 2012. Do the companies disclose any stock compensation plans? If so, are they reporting such plans under the fair value or intrinsic value methods? What was the value of compensation expense measured for any outstanding stock option plans? Merck & Company Inc. Yes they are reporting under the fair value method.The value of the compensation expense measured was approximately $72 million to the holders and $4 million Merck common shares issued. Novartis International Ag. Novartis did not disclose any stock compensation plans Financial Ratios Compute the following ratios. Also, interpret and assess each group of ratios for the company. What type of story are the ratios telling the analyst? Profitability ratios: ? Gross profit margin = Gross income/sales. The gross profit margin is a financial ratio which is a measurement of a company's manufacturing and distribution efficiency during the production process.A company uses its gross income to fund such company activities as research and development and marketing, which are important for generating future sales. A prolonged decline in the gross profit margin is a red flag for possible impending negative pressure on sales and, ultimately, earnings. You need to know the trend of the company before you can make an analysis of whether or not the gross profit margin is good or not, in this case Novartis has a better gross profit than Merck. Merck & Company Inc. 8,739/47,267 = . 185 Novartis International Ag. 11,243/56,673 = . 198?Net profit margin = Net income/ sale Net profit is the profit that is generated from all phases of the business, including interest and taxes. This is the â€Å"bottom line† that garners most of the attention in dis cussions of a company’s profitability. The net profit margin (net margin) compares net income to sales. A consistently high net margin is often indicative of a company with one or more competitive advantages. Furthermore, a high net margin provides a company with a cushion during downturns in its business. In this case Novartis has a better net profit margin than Merck.Merck & Company Inc. 6,299/47,267 = . 133 Novartis International Ag. 9,618/56,673 = . 170 ? Return on stockholders' equity = net income/ shareholders equity Return on equity (ROE) is equal to a fiscal year's net income. It measures the rate of return on the ownership interest of the common stock owners and measures a company's efficiency at generating profits from every unit of shareholders' equity. Return on equity for most companies certainly should be in the double digits; investors often look for 15% or higher, while return of 20% or more is considered excellent.Neither of these companies is great for their ROE but they are close, Novartis being higher. Merck & Company Inc. 6,299/53,020 = . 119 (12%) Novartis International Ag. 9,618/69,219 = . 139 (14%) Liquidity ratios: ? Current ratio = current assets/current liabilities The current ratio is a financial ratio that measures whether or not a firm has enough resources to pay its debts over the next 12 months. While Merck is able to pay back its debt, Novartis can pay its debt more easily and have a lot left over. Merck & Company Inc 34,857/18,348 = 1. 900.Novartis International Ag:  124,216/30,946 = 4. 013 ? Quick ratio= current assets-inventory/current liabilities Generally, the quick ratio should be 1:1 or higher; however this varies widely by industry. In general, the higher the ratio is, the greater the company's liquidity (i. e. , the better able to meet current obligations using liquid assets). The quick ratio is also known as acid test ratio. Both companies have a quick ratio but Novartis has a better quick ratio than Merck. M erck & Company Inc. 34,857-7,305/18,348 = 1. 501 Novartis International Ag. 124,216-6,744/30,946 = 3. 796?Inventory turnover = COGS/Inventory The inventory turnover is a measure of the number of times inventory is sold or used in a time period such as a year. Merck & Company Inc Inventory not specified on the 10K. Novartis International Ag. 18,756/6,744 = 2. 781. Leverage ratios: ? Debt-to-assets= Total debt/total assets Debt to asset ratio is a financial ratio that indicates the percentage of a company's assets that are provided via debt. Novartis has a lower debt than Merck. Merck & Company Inc. 18,348 + 16,348 = 34,696 34,696/106,132 = . 327Novartis International Ag:  5,945/124,216 = . 048 ? Debt-to-equity= total debt/total shareholders’ equity The debt to equity ratio, usually abbreviated as D/E, is a financial ratio indicating the relative proportion of shareholders' equity and debt used to finance a company's assets. Novartis used fewer loans to finance the companyâ⠂¬â„¢s assets than Merck. Merck & Company Inc. 34,696/536,020 = . 065. Novartis International Ag. 5,945/69,219 = . 086 ? Times-covered ratio= earnings before interest and taxes/ interest Times interest earned (TIE) is a measure of a company's ability to honor its debt payments.The times interest earned ratio is also referred to as the interest coverage ratio. Merck & Company Inc. Only had a consolidated statements of income Novartis International Ag. Only had a consolidated statements of income What type of information do you find in footnotes to the financial statements? Additional information provided in a company's financial statements. Notes to the financial statements report the details and additional information that are left out of the main reporting documents, such as the balance sheet and income statement.This is done mainly for the sake of clarity because these notes can be quite long, and if they were included, they would cloud the data reported in the financial statement s. Do you find the balance sheet, income statement or other measures such as ratios the most informative? Comment on the advantages and disadvantages of using ratios for analysis. I find that the balance sheet and the income statement have the standings of how the company did per quarter but the ratios show comparison of how they did. The ratios are good because you breakdown all the big numbers and just use percentages and analysis what is important.The balance sheets show the breakdown of all the individual accounts consolidated so both are good. A disadvantage of depending on the statements are that they can mislead you indifferent ways, if you only look at the numbers and do not look at the foot notes you may make a bad decision. Bad information can also be given through the statements, although this is illegal people still do it and later on change it or say it was a mistake but you may not catch that. Ratios can also have disadvantages like if they are not computed correctly y ou may have the wrong percentages or you may have nothing to compare them to.

Savannah Cats Essays

Savannah Cats Essays Savannah Cats Paper Savannah Cats Paper A Savannah Cat is actually a hybrid between a Siamese cat and a Serval The Savannah cats name is given to the off spring of a domestic cat and several medium sized, large-eared Wild African cats. The unusual offspring became popular among breeders at the end of the 20th century, and in 2001 the I. C. A (International Cat Association) accepted it as a new registered breed. Savannahs are much more social than other breeds of cats they are often compared to dogs because of their loyalty and the fact that you can train them to walk on leashes and to do tricks. The Bengal breeder Judee Frank crossbred a male Serval belonging to Suzi Woods and a Siamese cat to produce the first Savannah cat named Savannah on April 7, 1986. Franks’ Savannah attracted the attention of Patrick Kelly who pushes one of Savannahs kittens in 1989 Kelly was the first enthusiast who worked toward establishing a new domestic breed . He approached many Serval breeders to help to develop this new breed and finally garnered the help of breeder Joyce Sroufe to work with him in taking the steps he needed to get the breed recognized. In 1996 Patrick Kelley and Joyce Sroufe wrote the original version of the Savannah breed standard and presented it to the I. C. A in 01 the board accepted the breed as a new type of Cat. 010 brought a significant event for the breed when the first female F1 Savannah was born and bred in the UK by Rosanne Boyle of Hotspotexotics name â€Å"Amazing Grace she was registered with the I. C. A from 06 the breed has seen significant growth throughout the UK as a result the breed of being so well received. As Savannahs are produced by crossbreeding Servals and domestic cats, each generation of Savannahs is marked with a filial number. For example, the cats produced directly from a Serval/domestic Cat cross are the, and they are 50% serval. F1 generation Savannahs are very difficult to produce, due to the significant difference in gestation periods between the Serval and a domestic cat and sex chromosomes. Servals can be very picky in choosing mates, and often will not mate with a domestic cat. Females of the F1-F3 generation are usually held back for breeding, with only the males being offered as pets. The reverse occurs when you reach F5-F7 generation, but to a lesser degree, with the males being held as breeding cats, and females primarily offered as pets Physical features Savannah Cats are one of the larger breeds of cats. The Savannahs tall and skinny appearance makes it look a great deal bigger than it actually weighs. Size varies on the gender and generation male Savannahs are usually bigger and weigh more than females. Because of random factors in Savannah hybrid genetics there can be different changes in size even in one litter. The coat of a Savannah depends a lot on what breed of domestic cars is used for the cross earlier generation have some form of dark spotting on a lighter coat early breeders used words like â€Å"Wild† to describe it. sing spotted breeds such as the Bengal and Egyptian Mau for the cross will preserve the very few Savannahs that look like they did in earlier Generations. Some of the colors include (cool to warm brown, tan or gold with black or dark brown spots), silver spotted tabby (silver coat with black or dark grey spots), black (black with black spots), and black smoke (black tipped silver wit h black spots) in additions the Savannah can come in unusual color variations such as the classic or marble patterns or snow coloration and blue or other thinner colors from domestic sources. Most breeders are trying to cull these unusual colors out of the gen pool by selling unusual colored cats as pets but some Savannah Breeders are interested in working with the colors to introduce them as new traits The overall look of the Savannah Cat depends greatly on generation the older generations often have a more wild look the domestic breed that is used influences the appearance as well the domestic out crosses for the Savannah breed that are permissible in the ICA are Egyptian Mau the Ociat the Oriental Shorthair and the Domestic Shorthair. In addition some Savannah breeders are non permit able breeds such as the Bengal for size or the Maine Coon cats for size for the domestic parentage but these non permit able outcrosses can bring many unwanted genes as well Outcrosses are rarely used these days at there are now many fertile males available and as well most breeders are exclusively doing Savannah to Savannah breeding. A Savannahs wild look depends mostly on the generation of the cat. The body of Savannahs are long and leggy when a Savannah is standing, their hind end is often higher than they’re neck the back of their ears have a central light band bordered by the black, dark gray or brown giving an eye like effect the short tail has black rings with a solid black tip the eyes are blue as a kitten and may be green brown gold or blended shad as an adult. The eyes have a boomerang shape with a hooded brow to protect from harsh sunlight. The Savannah cats behavior Savannahs are commonly compared to dogs in their loyalty, and they will follow their owners around the house like a canine. They can also be trained to walk on a leash, and even fetch. Some Savannahs are reported to be very social and friendly with new people and with other cats and dogs, while others may run and hide or revert to hissing and growling when seeing a stranger. Exposure to other people and pets is most likely the key factor in sociability as the Savannah kitten grows up. Owners of Savannahs say that they are very impressed with the animal intelligence of this breed of cat. An often-noted trait of the Savannah is its jumping ability. Savannahs are known to jump up on top of doors, refrigerators and high cabinets. Some Savannahs can leap about 8 feet (2. 5 m) high from a standing position. Savannahs are very inquisitive, and have been known to get into all sorts of things. They often learn how to open doors and cupboards, and owners of a Savannah will likely need to take special precautions to prevent the cat from getting into things. Many Savannah cats do not fear water, and will play or even immerse themselves in water. Some owners even shower with their Savannah cats. Presenting a water bowl to a Savannah may also prove a challenge, as some will promptly begin to bat all the water out of the bowl until it is empty, using their front paws. Another quirk Savannahs have is to fluff out the base of their tail in a greeting gesture. This is not to be confused with the fluffing of fur along the back and full length of the tail in fear. Savannahs will also often flick or wag their tails in excitement or pleasure. Vocally, Savannahs may either chirp like their Serval fathers, meow like their domestic mothers, or do both, sometimes producing sounds which are a mixture of the two. Chirping is observed more often in earlier generations. Savannahs may also hiss- a Serval-like hiss quite different from a domestic cats hiss, sounding more like a very loud snake. It can be alarming to humans not acquainted to such a sound coming from a cat. Health considerations Different individuals contain different amounts of Serval and of varied domestic cat breeds, and there are currently no established Savannah breed-specific health issues. Some veterinarians have noted that Servals have smaller livers relative to their body size than domestic cats, and some Savannahs inherit this. For this reason, care is advised in prescribing some medications. Lower doses per weight of the cat may be necessary. In addition, the blood values of Savannahs may vary from the typical domestic cat, due to the serval genes. There is anecdotal evidence, though no completed scientific studies, that Savannahs and other domestic hybrids (such as Bengals) do not respond well to anesthesia containing Ketamine Many Savannah breeders request in their contracts that Ketamine not be used for surgeries] Some (but not all) Savannah breeders believe strongly that modified live vaccines should not be used on Savannahs, that only killed virus vaccines should be used. Others are the complete opposite, having had poor reactions to killed vaccines, and no vaccine reaction (lethargy, illness, etc. ) to the modified live vaccines. This, also, has not been studied, and opinions vary widely from breeder to breeder Some breeders state that Savannah cats have no known special care or food requirements, while others recommend a very high quality diet with no grains or by-products. Some recommend a partial or complete raw feeding/raw food diet with at least 32% protein and no by-products. Some Savannah breeders recommend calcium and other supplements, especially for growing cats and earlier generations. Others consider it unnecessary, or even harmful. Most Savannah breeders agree that Savannahs have a need for more taurine than the average domestic cat, and therefore recommend taurine supplement which can be added to any food type. Laws and Regulations Laws governing ownership of Savannah cats in the United States vary according to state. The majority of states follow the code set by the United States Department of Agriculture, which defines wild or domesticated hybrid crosses as domesticated. Some states have set more restrictive laws on hybrid cat ownership, including Hawaii, Massachusetts, and Georgia. Some cities may have laws that differ from the state. For example, Savannahs more than five generations from the serval are allowed to be owned in New York state, but not in the city of New York. [9] The Australian Federal government has banned the importation into Australia of the Savannah cat, as the larger cats could potentially threaten species of the countrys native wildlife not threatened by smaller domestic cats.

Anti LGBT law Essays

Anti LGBT law Essays Anti LGBT law Essay Anti LGBT law Essay LGBT youth as well as young adults are predisposed to more health concerns than heterosexual youth and young adults. A study by Ayalon and Alvidrez (2007, p.1326) revealed that there are many cases of HIV diagnoses among gays below 25 years of age who come from racial and ethnic minority communities. This study concluded that risk factors for mental health challenges and involvement in drug and substance abuse are more evident among LGBT youth than their heterosexual counterparts. The National Institute of Health (NIH) (2013, p.5) posits that these risk factors include victimization, violence, harassment, and homelessness that make the youth and young adults in LGBT communities vulnerable. North CarolinaAnti LGBT Law In March 2016, the Governor of North Carolina, Pat McCrory, signed a law that requires citizens to use multi-stall bathrooms based on their birth certificates at various institutions such as schools, universities, and state agencies. This law is against the interests of the LGBT population because it compels transgender people to use rooms designated for women (Kopan Scott, 2016, p.1). According to the law, sexual orientation as well as gender identity can neither be used as the premise for the protection of people by local measures nor compel businesses to offer high minimum wages or paid sick leave. The law prohibits workers to file suit in the state courts against discrimination on the grounds of religion, color, age, handicap, race, national origin, and sex. Instead, it requires people to file their complaints to the State Commission. Elsewhere, in Harris County, Texas, a new inmate policy came to effect in 2013. The policy seeks to protect and guarantee LGBT inmates equal treat ment (Weaver, 2013). For example, the policy allows transgender people to choose their preferred gender and not biological sex as the basis for their provision of housing. References Ayalon, L., Alvidrez, J. (2007). The experience of black consumers in the mental health systemidentifying barriers to and facilitators of mental health treatment using the consumers perspective, Issues in mental health nursing, 28(12), 1323-1340 NIH (2013). Consideration of the Institute of Medicine (IOM) ;;report on the health of lesbian, gay, bisexual, and transgender (LGBT) individuals, Retrieved from https://report.nih.gov/UploadDocs/LGBT%20Health%20Report_FINAL_2013-01-03-508%20compliant.pdf Weaver, L. (2013). Harris County announces Trans-inclusive Housing Policy in Its Jails. Human Rights Campaign. Aguilar-Gaxiola, S., Loera, G., Mendez, L., Sala, M., ; Nakamoto, J. (2012). Community-defined solutions for Latino mental health care disparities: California reducing disparities project, Latino Strategic Planning Workgroup Population Report. Sacramento, CA: UC Davis. Alegr;a, M., Chatterji, P., Wells, K., Cao, Z., Chen, C. N., Takeuchi, D., ; Meng, X. L. (2015). Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatric services. American Psychological Association, Office of Ethnic Minority Affairs. (2008). A portrait of success and challenge-Progress report:1997-2005, Washington, DC: Author. Retrieved from apa.org/pi/oema/programs/recruitment/draft-report-2007 aspx. Ayalon, L., ; Alvidrez, J. (2007). THE EXPERIENCE OF BLACK CONSUMERS IN THE MENTAL HEALTH SYSTEM;IDENTIFYING BARRIERS TO AND FACILITATORS OF MENTAL HEALTH TREATMENT USING THE CONSUMERSPERSPECTIVE. Issues in mental health nursing, 28(12), 1323-1340. Bahrampour, T. (2013). Therapist say African Americans are increasingly seeking help for mental illness. The Washington Post. Bridges, A. J., Andrews III, A. R., Villalobos, B. T., Pastrana, F. A., Cavell, T. A., Gomez, D. (2014). Does integrated behavioral health care reduce mental health disparities for Latinos? Initial findings. Journal of Latina/o psychology, 2(1), 37. Burns J. (2013). Mental health and inequity: A human rights approach to inequity, discrimination, and mental disability. Health and Human Rights Journal.11(2). Cook, J., Leff, H., Blyler, C., Gold, P., Goldberg, R., Mueser, K., et al. (2005). Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness. Archives of General Psychiatry, 62(5), 505512. Davey G. (2013). Mental Health and Stigma. Psychology Today. Davis, K. (2012). Statistical Brief #358: Expenditures for Treatment of Mental Health Disorders among Young Adults, Ages 18-26, 2007-2009: Estimates for the U.S.Civilian Non-institutionalized Population. Rockville, MD: Medical Expenditures Panel Survey, Agency for Healthcare Research and Quality. Folsom, D., Hawthorne, W., Lindamer, L., et. al. (2005). Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. American Journal of Psychiatry, 162(2), 370-376. Frank R., Beronio, K., Glied, S. (2014). Behavioral Health Parity and the Affordable Care Act. Journal of Social Work in Disability and Rehabilitation. 2014; 13(1-2):31-43. Fund S.(2015) Challenging Views of Mental Health in Minority Communities. Diverse Harding, C., Brooks, G., Ashikaga, T., Strauss, J.S., Breier, A. (1987). The Vermont longitudinal study of persons with severe mental illness. American Journal of Psychiatry, 144 (6), 727735. Hoblan R., (2015). NCGA Senate Health and Human Services Budget: First Look. North Carolina Health News. Holden K., McGregor B., Thandi P., Fresh E., Sheats K., Belton A., Mattox G., Satcher D. (2014). Toward Culturally Centered Integrative Care for Addressing Mental Health Disparities Among Ethnic Minorities. Psychological Services.11(4):357-368. Jordan D. (2015) Going Mental: Minorities and Mental Health in Criminal Justice System. Decoded Science. Kessler, R., Heeringa, S., Lakoma, M., Petukhova, M., Rupp, A., Schoenbaum, M., et al. (2008). The individual-level and societal-level effects of mental disorders on earnings in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 165(6), 703-11. Kessler, R., McGonagle, K., Zhao, S., Nelson, C., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month Prevalence of DSM-III-R Psychiatric Disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51(1), 8-19. Kramer E., Francis G., (2009). I am not crazy. p 9. Lutterman T., Fiscal Year (2010). Revenues and Expenditure Study Results. SMHA Revenues and Expenditures Data Collection 2012, pdf. Macmadu A., Rich J. (2015). Correctional Health is Community Health. Issues in Science and Technology.32(1). Massetti G., (2016). Preventing Violence Among High-Risk Youth and Communities with Economic, Policy and Structural Strategies. Center for Disease Control and Prevention Report/Supplements. 65(1):57-60. McLaughlin, K. A., (2010). Hatzenbuehler ML, Keyes KM. Responses to discrimination and psychiatric disorders among black, Hispanic, female, and lesbian, gay, and bisexual individuals. Am J Public Health. 100(8):1477-84. Mental and Behavioral Health. (2015). Options and opportunities for Minnesota. Minnesota Hospital Association. Minnesota Telemedicine Act (SF 981/HF 1246. (2015). Minnesota Hospital Association. National Institutes of Health. (2013). Consideration of the Institute of Medicine (IOM) report on the health of lesbian, gay, bisexual, and transgender (LGBT) individuals. Retrieved from https://report.nih.gov/UploadDocs/LGBT%20Health%20Report_FINAL_2013-01-03-508%20compliant.pdf Rowings, K. (2015). Addressing mental Illness and Medical Conditions in County Jails: King County, WA. National Association of Counties . Ryan, C., Neil, K. (2015). The Integration for Mental Health, Substance Abuse, and Other Behavioral Health Conditions into Primary Care: Executive Summary of an American College of Physicians Position Paper. Annals of Internal Medicine.163(4):298-299. Sarteschi, C. M. (2013). Mentally ill offenders involved with the US criminal justice system. Sage open, 3(3), 2158244013497029. Poulin, S. R., Maguire, M., Metraux, S., Culhane, D. P. (2010). Service use and costs for persons experiencing chronic homelessness in Philadelphia: a population-based study. Psychiatric Services, 61(11), 1093-1098. Simon, C. (2015). There is a stunning gap between the number of black and white inmates in Americas prison. Business insider . State Legislation Report. (2015). National Alliance on Mental Illness. Swanson, J., Swartz, M., Gilbert, A., Frisman, L., Lin, H. J., Rodis, E., Domino, M. (2011). Costs of criminal justice involvement among persons with severe mental illness in Connecticut. Final Report Submitted to Eli Lilly Co. Swanson, J. W., McGinty, E. E., Fazel, S., Mays, V. M. (2015). Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Annals of epidemiology, 25(5), 366-376. Thompson, J. (2016). Mental Health Month Provides Opportunity to Break Down Mental Health Stigma for Latino Community. CalMHSA. Underwood, L. A., Washington, A. (2016). Mental illness and juvenile offenders. International journal of environmental research and public health, 13(2), 228. Weaver, L. (2013). Harris County announces Trans-inclusive Housing Policy in Its Jails. Human Rights Campaign . Joel E. Miller, et al., Nov. 2012. The Waterfall Effect: Transforming the Cascading Impact of Medicaid Expansion on States, National Association of State Mental Health Program Directors. White House. (Jan. 16, 2013). Now is the Time; the presidents plan to protect our children and our communities by reducing gun violence. White House. Grissom, B (May 18, 2013) With Consensus and Money, State Takes on Mental Health Care. Buchanan, W. (June, 27 2013) Governor Brown Proudly Signs Balanced Budget. 34. Gray, CD (Jul. 3, 2013) House Passes. Kopan, T., Scott, E. (2016, March 24). North Carolina governor signs controversial transgender bill. CNN. Retrieved from http://edition.cnn.com/2016/03/23/politics/north-carolina-gender-bathrooms-bill/

Final Exam Essay Questions Example | Topics and Well Written Essays - 1250 words

Final Exam Questions - Essay Example For example, a Dominican friar Montesinos criticized the Spanish authorities on the way they mistreated their subjects, especially the American Natives. This criticism provoked the authorities to amend parts of the Laws id Burgos. In general, more criticism of the way colonialists treated the natives caused the some sort of rebellion among the church leaders, who took interests in demanding to be included in the state administration. The establishment of the first Catholic Church in Philippines in 1521 saw the beginning of a church led governments. This was later followed by the arrival of Franciscan missionaries in Mexico, where they established their presence through direct association with Catholic Church by building missionary schools and hospitals. In England, the church played critical role in establishment of the marriage laws, particularly after Henry VIII annulled his marriage. This was after the mainstream Catholic Church was perceived too rigid to understand the people’s needs and desires. For example, the Catholic Church had tried to impose strict sexual mores on ordinary people (Sherman and Joyce 121). The Catholic Church grew unpopular, and Church of England started to offer a worthy alternative. Although they started off with very few followers, the Church of England grew faster than anticipated. Although there were increased lamentation about Catholic headed institutions’ continued traditional ways of doing things, they exerted a lot of authorities over these institutions that spread the education of the masses and establishment of the elite society with highly educated society. However, this influence has since waned as the Catholic Church strived to assert its own identity away from state. This journey started when Pope Pius XI started cutting links with the Government of Italy (Sherman and Joyce 173). Today, most of the states

Fabrication of a Reinforced Concrete Beam Lab Report

Fabrication of a Reinforced Concrete Beam - Lab Report Example Thirdly this gives sufficient space for the main reinforcement to develop full stressing and strength, which consequently prevents slipping of the bars. Lastly a sufficient cover gives a smooth surface which improves the aesthetics of the component as well. 3. 4. Bar codes are on the schedule so that the reader must understand that how the steel bar is is to be bended and what angles and shapes are to be made. In addition to this the reader can easily calculate the length of the bar, and consequently by using the diameter and the type of bar the total weight of the bar can be calculated and finally the total weight of the reinforcement. 5. The cover can be maintained by different methods. One method can be made by placing Metal plastic tipped bar chairs under the reinforcement so that a specified height can be maintained between the bottom surface and reinforcement. Then another method is to give spacer blocks, these can be small marble pieces or concrete plates. Another method used for very heavy reinforcement is the employment of Plastic strip bar chairs. 6. a) coarse aggregate = 122.4 Kg b) fine aggregate = 81.6 Kg c) cement = 40 Kg d) water = 22 Kg 7. Water cement ratio of the concrete is (weight of water / weight of cement ) is w/c = 22/40 = 0.55 SSD or saturated surface dry is a condition of the aggregate when all the surface pores of aggregate are fully filled and there is no excess water on its surface. In addition no more water will be absorbed by the aggregate when immersed in water. This aspect is important because if the aggregate is not saturated then it will start absorbing the water of the concrete which was supposed to be consumed in the hydration of the concrete. If there is less water in the concrete than required the concrete will not acquire the desired strength and the concrete will have microscopic cracks further weakening the concrete and this will also disturb the desired water cement ratio. Then this state helps in finding the absorptio n value of aggregates and also the specific gravity of aggregate. Lastly the aggregate must be saturated surface dry as the dry surface will help and ensure a good bond between the concrete and aggregate. 8. A clean beam form is important because presence of any loose material will attach on the surface of the beam and when the beam is subjected to bending the concrete around this loose material and the loose material it self will spall off. Hence the cover would be compromised and there is a chance that the steel reinforced will be naked and prone to environment resulting into its rusting and corrosion. 9. The indication of completion of the compaction is that the firstly there is no decrease/ decay in volume or height of the concrete and the movement of aggregates due to vibration in the concrete will very low. In addition the final indication is that the water will come on the surface of the concrete and it must be noted that as soon as the water film appears on the surface of th e concrete the vibrator must be pulled out of the concrete or else the concrete will segregate, resulting into separation of cement paste and aggregate. 10. The compaction of concrete is very important for its acquisition of desired strength, In essence compaction is the process in which the entrapped air is released from the