The Trailer For Kill Bill - 1552 Words

The trailer for Kill Bill: Vol. 1 (2003), the fourth film directed by Quentin Tarantino, is a fast paced, violent, and action packed trailer that pays homage to Japanese sword fighting, martial arts, and gunplay. The main character known as The Bride (Uma Thurman), is a former assassin whose former lover, Bill (David Carradine) attempted to kill her on her wedding day. After waking up from a coma, The Bride begins to tell her story about how she was attacked by the Deadly Viper Assassination Squad, which she was once a part of, while pregnant. The trailer begins with the click sound of a revolver s hammer being pulled back, and then firing. The camera is then positioned behind The Bride s butt, as she begins to narrate her story. Frames of the bullet are shown as she talks, until it hits its victim - The Bride. She hits the floor in her wedding gown, after being shot in the head. A montage of violent sequences that start in an average suburban neighborhood, where she fights Vernita Green (Vivica A. Fox) in her own home, and leads to a Tokyo nightclub bloodbath, where she fights yakuza boss O-Ren Ishii (Lucy Liu). Contrary to your average movie trailer involving action and violence, the perpetrators of these violent acts are the female characters, instead of the male characters. The protagonist is on a path of retribution against the assassins who crashed her wedding and attempted to kill her, but despite the fact that there is a male member of the Deadly ViperShow MoreRelatedCreative Writing : A Short Story1162 Words   |  5 Pagesstore, climbed into the rig’s trailer, and started pulling pallets off of it. After pulling out multiple heavy crates, he finally reached the front of the rig. At the front, there was a pallet full of fruits that had been smashed as if an anvil fell upon them. With a look of dismay, Joe stared at the scattered fruit fibers covering the front of his trailer. He then noticed something peeking out of the edge of the crate; ther e were three crisp one-hundred-dollar bills under the pallet. Now utterlyRead MoreSupreme Court Cases and the Eighth Ammendment865 Words   |  3 PagesJefferson was commenting that the Bill of Rights from governmental. Both the Bill of Rights and the U.S. Constitution had more purpose; The Bill of Rights was meant to give citizens of the U.S. promising freedom to rely on. The Constitution set terms for the U.S. to abide by. The Constitution was established for the people and was a social contract; it was an agreement between the government and society to protect the nation’s deserved rights and liberties. The Bill of Rights was included in the Constitution;Read MoreA Day At A Mile1390 Words   |  6 PagesAll-Volunteer Armed Force has been so successful that contemporary America continues this practice. For this reason, there has been a rise of military propaganda. In addition to that, many Americans are attracted to joining the forces because of the GI Bill (Bailey). In 1970, Joseph began basic training for the army in Fort Dix, New Jersey. The soldiers underwent rigorous physical training and were taught the ins and outs of safety. For instance, they had to crawl through a tightly enclosed space underRead MoreBrief Notes On Eating Breakfast1655 Words   |  7 Pagesdrafted† (â€Å"Statistics about the Vietnam War†). Within the decade in between the end of World War II (1939-1945) and the beginning of the Vietnam War (1955-1975), there was a dramatic shift in men’s willingness to go to war, presumably due to the GI Bill that was implemented towards the end of World War II. However, regardless of how his friends ended up in the army, they all shared similar positive experiences with Joseph. Some of them had fought in Vietnam; others had traveled to U.S. military basesRead MoreHorse Slaughter - Argumentative Paper1527 Words   |  7 Pagesraised the cost of traditional meats; Time Magazine reported from Carlson’s, a bu tcher shop in Westbrook, CT, that they were selling over 6,000 pounds of horse meat a day. (Weil) In 2006, the House of Representatives voted to end horse slaughter; the bill passed to make the killing and selling American horses for human consumption an illegal practice in the United States. Today in the US, people do not consume horse meat on a whole sale basis. But because many other counties do, the exporting of horseRead MoreEssay on Benefits of Horse Slaughter Industry1918 Words   |  8 Pagesbe rendered into animal feed. nbsp;Little or no monetary compensation is gained by the owner unless the horse was insured. The second way horses are turned into food is the typical slaughterhouse procedure. nbsp;Many animals are herded into the kill chute, they are stunned with a blast of carbon dioxide into their brain, and then their throats are slit. nbsp;The horses are bought at auction or privately from the owner for as much as $1000. nbsp;All horsemeat that is edible for humans is theRead MoreGmos, Good Or Bad For You?2238 Words   |  9 Pagescountry. In recently there has also been a bill in Washington about GMO’s. The bill wanted all food that contained GMO’s to be labeled so that consumers would be aware of what they are about to purchase. Ninety one percent of the population wanted the foods to be labeled read a recent poll done by Emilee Jacobsin of the Washington Post (GMO Bill). Most people wanted the food labeled so that they would be able to steer clear of the product. When the bill was voted on in Washington it was denied. Read More The Doggie in the Window Essay1277 Words   |  6 Pagesthat pet stores keep puppy mills in business. The vast majority of dogs sold in pet stores, up to half a million a year, are raised in puppy mills. Puppy mill kennels usually consist of small wood and wire-mesh cages, or even empty crates or trailer cabs. â€Å"All dogs are kept outdoors, and the females dogs are bred continuously, with no rest between heat cycles. The mothers and their litters often suffer from malnutrition, exposure, and lack of adequate veterinary care. The continuous breedingRead MoreThe Old Man And The Sea By Ernest Hemingway1599 Words   |  7 Pagesdescriptions continue by giving the reader a front-row truthful look into the life of a 1950’s Cuban fisherman, â€Å"...his tail was sharp as a scythe and almost of that size and shape. When the old man had gaffed her and clubbed her, holding the rapier bill with its sandpaper edge and clubbing her across the top of her head until her colour turned to a colour almost like the backing of mirrors†¦Ã¢â‚¬  (49). These descriptions effortlessly use similes and personification as well, â€Å"â€Å"...his tail was sharp as aRead MoreSummary Of The Pig Farmer Killer Essay1404 Words   |  6 PagesEagle Ridge Hospital and Eistetter healed in the closest emergency room. This charge was dismissed in January of 1998. From 1998 to 2002, Pickton was recruiting many more women to visit his farm, which was noticed by a worker of his by the name of Bill Hiscox. Hiscox noticed that these same women were then later reported missing. Police found personal items of some of the missing women inside of Pickton’s farm, after a search warrant was executed to search for illegal firearms inside the property

Increasing Incidence Of Hypertension And Related...

Increasing incidence of hypertension and related cardiovascular disease, prompted the National Institute of health (NIH) to propose funding to determine the impact dietary patterns have on blood pressure in the (US National Heart, Lung, and Blood Institute, 2015). Working with five established medical research centers in different US cities, the Dietary Approach to Stop Hypertension (DASH) feeding trial was developed to investigate the effects of dietary patterns on blood pressure (Appel et al., 1997). The original study began in 1993, and completed in 1997. The study was novel in that it included a team comprised of nutritionists, nurses, doctors, and the research coordinators. The DASH diet was created to provide high levels of nutrients previously identified to help reduce blood pressure that had proven ineffective at reducing blood pressure in supplement form or individually (Appel et al., 1997). The DASH trial, was unique in that it was constructed to test dietary patterns and their effect on blood pressure, rather than looking at individual nutrients (Appel et al., 1997). The study compared a control diet to two experimental diets: †¢ Control diet – A diet based on the typical American diet, high in meats and processed foods, limited fruits and vegetables, providing low levels of fiber, potassium, magnesium and calcium, and high levels of fat and protein. †¢ Fruits and vegetables diet – A diet higher in fruit and vegetables, otherwise similar to the typicalShow MoreRelatedDiabetes And Coronary Heart Disease1228 Words   |  5 PagesDiabetes is a disease from which numerous other health complications can arise. In their article, â€Å"Diabetes and Coronary Heart Disease: A Risk Factor for the Global Epidemic,† Chilha, Njeim, Chedrawy (2012) state that diabetes can lead to a plethora of various other illnesses. These diseases not only affect the United States as a whole, but developing countries as well (Chilha et al., 2012, pp. 697,240). Developing countries have had increasing cases of diabetes that have led to a number of otherRead MoreInfluence Of Bmi On Cardiac Output And Peripheral Blood Flow1118 Words   |  5 PagesIN YOUNG ADULT MALES INTRODUCTION: According to WHO, obesity is increasing alarmingly worldwide including India. Obesity is rising as an epidemic globally and according to WHO, one in six people on Earth (approximately one billion) are overweight and, alarmingly, more than 300 million of them are obese. This might be due to more sedentary life style excessive intake of energy rich diet is associated with various chronic diseases thus posing a major public problem. [1][2] High and middle incomeRead MoreStroke Education : A Preventable Death909 Words   |  4 Pagesbreast cancer in American women? Stroke is one of the most serious diseases, leading to deaths and severe morbidities around the world. The causes of stroke are closely related to lifestyle and are keys to reduce the incidence of this disease that causes abrupt deaths or worsens the quality of life. Jahan (2012) reminds the risk factors that increase the chances to have a stroke, the signs and symptoms, the treatment for this disease and how to prevent stroke. Certainly, the major risk factors mentionedRead MoreCardiovascular Disease Essay example1806 Words   |  8 PagesCardiovascular Disease in the African American Community Causes, Preventions, and Treatments Cardiovascular disease (CVD) refers to the dysfunctional conditions of the heart, arteries, and veins that supply oxygen to vital life- sustaining areas of the body like the brain, the heart itself and other vital organs. Since the term cardiovascular disease refers to any dysfunction of the cardiovascular system there are many different diseases in the cardiovascular category, and many of these diseasesRead MoreCardiovascular Disease And The Heart Disease Essay1727 Words   |  7 PagesCardiovascular diseases are diseases which involve the heart or blood vessels, they are in fact the leading causes of death and disability in the world. Cardiovascular diseases include coronary artery disease, or ischaemic heart disease (heart attack), cerebrovascular disease (stroke) and diseases of the aorta and arteries including hypertension and peripheral vascular disease (Mendis, Puska, Norrving, 2011). They are all due to a disease known as atherosclerosis which affects arteries (GeorgeRead MoreThe Proband s Maternal Aunts Essay1501 Words   |  7 Pagesalso shown that patients with type 2 diabetes that have the HLA-DR4 allele associated with type 1 diabetes have a lower rate of cardiovascular mortality than those with DR4− allele (Tuomi, 2005). To date, none of the proband’s maternal family members with T2D, that are the offspring of her grandmother with T1D, have been diagnosed with any renal or cardiovascular disease. Patients with a family history with a mixture of T1D and T2D have some common genetic predispositions of both diabetic types (TuomiRead MoreInfertility : Polycystic Ovary Syndrome1113 Words   |  5 Pagescommon cause of anovulatory infertility (11), associated with an increased risk of miscarriage after either spontaneous or assisted conception (1) and the development of ovarian hyperstimulation syndrome (OHSS) in assisted conception (12). A higher incidence of first trimester spontaneous abortions (25–73%) has been reported in women with polycystic ovaries or PCOS (13). Abnormalities in LH secretion were found in 81% of women with recurrent fetal loss, and higher androgen levels were observed in womenRead MoreThe Role Of Leptin And Its Effects On The Reproductive System Essay1409 Words   |  6 Pagesfrom the adipose tissue, serum levels of which are influenced by obesity, insulin resistance and the levels of sex steroids (androgens and estrogens) and insulin. It is mainl y involved in the regulation of body weight by decreasing appetite and increasing energy expenditure. Besides regulating the energy metabolism of the body, leptin has important actions on the reproductive system, which makes it an important link between the adipose tissue and hypothalamus– pituitary–gonadal (HPG) axis (2). Long-termRead MoreSymptoms And Treatment Of Hypertension1599 Words   |  7 Pages Psychosomatic disease affects both mind and body; hypertension certainly applies to this due to its effect on both the mind and the body alike. Hypertension occurs when an individual has abnormally and excessively high blood pressure, in which stress is highly related to. High blood pressure can be perilous because it makes the heart work even harder in order to pump blood into your body, which ultimately leads to heart failure or other illnesses such as kidney disease and strokes. ApproximatelyRead MoreNutrition Case Study1159 Words   |  5 Pages Parenteral a dministration of the Mg supplement is contraindicated in patients with heart block or myocardial damage (66). Role in cardiovascular disease Mg is associated with a number of conditions and chronic diseases. It can prevent inflammatory and oxidative stress, endothelial dysfunction, increased vascular reactivity, increased vascular tone, hypertension, CVD, stroke, insulin resistance, type 2 diabetes mellitus and obesity (63) (Figure 2). Thus the consumption of magnesium-rich foods is

The, Dog And Cat And Coffee And Tea Great Gatsby And...

Introvert â€Å"Dog and Cat. Coffee and Tea. Great Gatsby and Catcher in the Rye. Everyone knows there are two types of people in the world. What are they?†. This question is quite easy to answer and refers to human behavioural quirks and nature, Introverts and Extroverts. Surrounding the two vague types are many stereotypes, but this will be addressing and explaining what it truly means to be an Introvert. Introverts are typically more complex characters as a whole compared to Extroverts, the dynamics between the two already a major difference. When a person hears ‘Introvert’ they think ‘Alone’, ‘Hates People’, ‘Pessimist’ and ‘Boring’, whilst thinking Extroverts, on the other hand, as ‘Happy’, ‘Friendly’, ‘Optimists’, and ‘Fun’ - two†¦show more content†¦But when Introverts give themselves permission to seek the solitude they crave, life becomes light er and better. Social situations are more bearable. Even small talk is easier to endure when they’ve fortified themselves with solitude. Introverts are known for being quiet, another universal quirk. Introverts are written economists suffering in a world of verbal hodgepodge. Unfortunately, this has lead to awkward confrontations like â€Å"Are you shy?† or â€Å"Why are you so quiet?†. Now it’s time to debunk the typical Introvert myths. The most common one is that being Introverted means you’re shy, and often use the two words interchangeably. Both introverts and shy people tend to avoid socializing at times, but they do so for different reasons. Introverts often stay on the sidelines at social events because socializing drains their energy, whilst shy people tend to avoid going to unnecessary social events at all because of their fear of the unknown. Instead of worrying about being drained, they’re concerned about making a mess of themsel ves or being rejected / judged. The next most common is that Introverts are socially awkward. People assume that because you are Introverted, you don’t know how to behave or act socially. Many introverts have superior social skills. They are confident, assertive, and interesting to talk to. People don’t realize this because they assume everyone with good social skills is an extrovert.

The World s Second Highest Number Of International...

Host Country Details : (Morella, 2014) (New Zealand education) India stands one among the top ten economies of the world. It is a trillion-plus economy. People are exited with this fact that the nation is booming in both perspectives of human development as well economically. India is a heterogeneous country that could still hold a stable democracy and set a high economy level and grab a lot of people out of poverty level at the same time, this established a favourable context for opportunity with rapid growth in middle class, an ever increasing youth population and an enormous unmet demand for education. International students rates have been growing rapidly as Indian students continues to demand quality education. When it comes to NZ and India there was a remarkable growth in the number of students which was 8010 in 2013 which raised to 19,622 in 2014 , approximately 69% growth . India provides the world s second highest number of international students next to china. There definitely is a strong difference in the quality of education provided by India s premier educational firms to International institutions of repute. With wide range of scholarships and funding opportunities , Indian students would always prefer to migrate abroad for higher education. INITIATIVE 1 : FAIR EXHIBITION (Dambok) Fair is nothing but gathering a large crowd of people to barter or sell goods/services at regular intervals. It often takes place with shows or entertainment at a fixedShow MoreRelatedUse of Tobacco Products at the University798 Words   |  4 PagesEvery year around half million people die from smoking tobacco or exposure to secondhand smoke (CDC). Tobacco use is an epidemic that cannot be stopped right away; however, many countries in the world are aware of this problem and have created new regulations that will prevent and reduce the number of smokers, hopefully in time. New polices have been implemented in schools, universities, indoor and outdoor places. Now, smoke-free or tobacco- free laws are posted in almost all colleges around theRead More Bilingual Education Essay1695 Words   |  7 Pagespressing issue. The organizations should be composed of public officials, Marquez3 students, educators, administrators, and business people and should try to determine the biggest problems facing Latino students in their community. These groups need to work together to develop a statewide agenda. Hispanic students, according to some studies, lag behind other students in classroom performance; have the highest dropout rate of any ethnic group in the country; and, according to federal data, areRead MoreNotes On Depleting Fish Stock1419 Words   |  6 Pages, 3Bharathi, S. and 4Vinoth, S 1Department of Fish Pathology and Health Management, School of Aquaculture, Fisheries College and Research Institute, Tamil Nadu Fisheries University, Thoothukudi, Tamil Nadu, 628008, India. 2Department of Fisheries Biology and Resource Management, School of Fisheries Resource and Environment Management, Fisheries College and Research Institute, Tamil Nadu Fisheries University, Thoothukudi, Tamil Nadu, 628008, India. 3Third year, Undergraduate Student, Fisheries CollegeRead MoreThe Theory Of Hegemonic Stability1692 Words   |  7 PagesHegemony demands power. The theory of hegemonic stability in our international system requires a single, predominant state to enforce the rules of the system. A hegemonic state is indeed that; the most powerful state. In order to achieve this authority as a hegemon in the international system there are key attributes a state must possess in order to secure a stable position through competitive capability. The presence of a hegemon is a necessary condition for regime formation. Liberal regime theoryRead MoreShould Iceland Adopt Canadian Dollar?1387 Words   |  6 Pages Econ 345 Assignment 2 Topic: Should Iceland adopt Canadian Dollar? Student number: 301238117 Student Name: Shuk Man Chan The Abstract Iceland is now having financial crisis because of its unhealthy banking system and monetary policies. Its currency becomes an unwanted dollar due to its fluctuating exchange rate. To regain the confident and rebuild its financial system, a sound currency is crucial. Canada, one of the strongest economies in OECD, has a healthy banking system and conservativeRead MoreIs It Neglected Suicide? A Major Issue Regarding College Students? Essay1283 Words   |  6 Pagescommonly neglected suicide has become a major issue regarding college students. The website Suicide.org, report on a couple international suicide statistics saying that, each year over one million people die by suicide worldwide. They also report that on average, one person dies by suicide every 40 seconds somewhere in the world and in the past forty-five years, it has led to a sixty percent increase globally (Suicide.org). The World Health Organization (WHO) ranked 170 countries by suicides per 100Read MoreInteresting Facts About South Korea1338 Words   |  6 PagesInteresting facts about South Korea. Interested to learn some fun facts about South Korea? 1.The number â€Å"4†³ is considered extremely unlucky, to the point where most buildings in Korea do not have a 4th floor. This is actually true in many parts of Asia because the number four is a homonym with the word death in Chinese. For this reason, many countries in Asia consider the number to be extremely unlucky. So much so that many hotels skip the fourth floor. 2. In Seoul, Taxi’s are color coded.Read MoreIndi The Largest Exporter Of The Most Popular Games780 Words   |  4 PagesMangoes India is the largest producer of mangoes in the world. Every year, over 15 million tons of mangoes are produced in India. India alone produces around 40% of world s total mangoes. Despite being the largest producer, India is not the largest exporter of mangoes due to the fact that much of the mangoes are consumed in India itself. Chess The earliest form of chess originated from India in the 6th century and was played using four members of army which were cavalry, elephantry, chariotry andRead MoreUniforms are One Less Distraction696 Words   |  3 Pagesclothes makes the student†Ã¢â‚¬â€ school uniform policies seemed to have made the difference in many schools throughout the world. Over the last decade, the implementation of such policy has been on the rise, bringing about waves of debate among students, parents and teachers. Today, more than ever before, the role of a teacher has become much more complex. Most assume responsibilities that extend outside of the more traditional instructional role, and include expectations to provide student with emotionalRead MoreCauses and Effects of Immigration1521 Words   |  7 Pagesvoluntarily emigrate. II_ Effects of immigration A_ the immigrants will offer various benefits for the recipient country like immigrants will often do jobs that people in the host country will not or can`t do. B_ for the host country`s economy, immigrants offer an increased talent pool, if they have been well education in their original country. C_ high crime rates were common among previous immigrant groups when they were still new comers, particularly the Irish, Italian and

Utilization of Quality Management in Health Care in Support of Quality Provided Services free essay sample

Utilization of Quality Management in Health Care in Support of Quality Provided Services The Patient Protection and Affordable Care Act of 2010 established regulations that require the quality improvement in â€Å"the delivery of health care services, patient health outcomes, and population health† (The Henry J. Kaiser Family Foundation, 2011, p. 10). The national quality strategy section of this law further required the Secretary of the Department of Health and Human Services to develop a National Strategy for Quality Improvement in Health Care (the National Quality Strategy) which will stimulate the establishment of quality health care serving the needs of patients, families, and communities by setting priorities in a strategic plan to guide both the providers and payers (U. S. Dept of Health, 2011, Exec. Sum). The requirements further established an Interagency Working Group to help develop the National Quality Strategy. This group, composed of representatives from 23 Federal Health Care responsible agencies, is to ensure cooperation between both the Federal and private sector. This group developed a draft plan which was then provided to over 300 health care industry entities and the general public for comment on the draft principles and priorities. The combined effort came up with a strategic plan that is composed of three aims, six priorities, and ten principles (Working for Quality, 2011, About the National Quality Strategy). Section III of the National Strategy for Quality Improvement in Health Care will have the greatest impact on a health care organization’s quality management efforts since it addresses ten areas that establish the foundation for several quality improvement measures including payment, public reporting, quality improvement, certification, measurement of care processes and evaluation and feedback (U. S. Dept of Health, 2011, Polices and Infrastructure Needed to Support Priorities). Additionally, the quality management organization that is established by the health care provider will have to annually review the list of proposed new measures that will be imposed the following year by the Centers for Medicare and Medicaid Services (CMS) to ensure their quality program has effective measures established and in place to comply with new statutory requirements (Working for Quality, 2011, Multi-Stakeholder Group Input on Quality Measures). Understanding and implementing the quality measures that are imposed by the Patient Protection and Affordable Care Act of 2010 (ACA) will be the foundation for an effective quality management unit within the health care organization. The quality requirements of the Patient Protection and Affordable Care Act will require many health care organizations to examine their existing quality programs in order to adjust them to accommodate the new requirements, or in some cases, will cause the health care organization to implement a new department or unit to ensure that a quality management system is in place in order to comply with the law. The use of Deming’s fourteen points for management to make improvements in industrial environments is well known and it is only natural that health care providers would turn towards this proven technique to improve health care quality. Total Quality Management techniques have already been implemented in various health care organizations, where over time, they have moved from Quality Assurance (QA), to Quality Improvement (QI), to Quality Management (QM) (which incorporates parts of both QA and QI (Carefoote, n.d. n. p. ). There are ten characteristics of a successful Quality program: Clear Mission Goals, Active Leadership, Defined Structure and Accountability, Coordinated Activities, Effective Planning, Comprehensive Scope of Services, Focus on Improvement, Data Driven Decision Making, Sound Policies and Procedures and Adequate Resources. The QM organization must have a clear mission and goals which are derived from the requirements of the ACA as well as its own objectives and strategies to serve its population. One of the most important aspects is active leadership, which must flow from the top down to ensure that the quality program meets all of its objectives. This particular characteristic has important implications if the program is to succeed. Leadership, both medical and administrative, must â€Å"walk the walk and talk the talk† of a quality program. The surest means to ensure failure of the QM program is for the health care providers (employees) to sense that the health care organization leadership is only giving â€Å"lip service† to the program. This can also be seen with regard to the program’s defined structure and accountability. There must be direct communication between the Leadership (overall responsible) and the day to day workers (who are required to provide the quality care). Coordination must be organization wide such that all departments have buy-in to the quality function to ensure that quality is not just a program but a way of life. Effective quality planning must articulate all regulatory and accreditation requirements and all objectives of the program. It should include three processes: an annual program description; an annual action plan that delineates the activities critical to achieving the objectives established by the mission and goals, and a method to assess the organization’s performance of the plan. The scope of quality services must be all-inclusive comprised of clinical care and services. Each must have standards that included monitoring, evaluation, and improvement. Additionally, it must ensure that metrics for health problems of the population, the organization serves, are reviewed on a regular basis. An important element of the QM program is to emphasize continuous process improvement; however, it should be applied throughout the organization and should not solely focus on areas that are below standards. This can be achieved through the use of the Joint Commission Accreditation of Healthcare Organizations’ ten step monitoring and evaluation process: assignment of responsibility; delineate the scope of care service; identify the important aspects of care and services; identify indicators; establish means to trigger evaluation; collect and organize data; initiate evaluation; take action to improve care and services; assess effectiveness of actions and maintain improvements; communicate results to affected individuals. Additionally, Health Employer Data and Information Set (HEDIS) performance measures as well as National Quality Forum (NQF) endorsed measures and ACA requirements should be folded into the continuous improvement process. QM decisions must be based on data collected with regard to both service and quality. Quality performance can be determined by comparing results to standards set by the QM program. For example: Did care meet timeliness standards; or did the cost of care exceed the norm for the care given. This necessitates a close working relationship between the QM organization and the various other departments in the health care organization to ensure that the correct data is being collected to support the ability to make sound data driven decisions. The simplest way to ensure this occurs is to promulgate an organizational Quality Management guidebook (which is annually updated) that meticulously sets out the various procedures and policies of the QM department/unit. The final cog in this organization is to ensure that it is provided with the staffing, funds and resources to accomplish its objectives (Carefoote, n. d. n. p. , NCQA, 2011, HEDIS and Quality Measurement, Stelmark, n. d. slides 43 and 48). While there are several different programs that require empirical quality measures as evidence of quality care, pay for performance is one of the most common. According to Susan Hart-Hester et al. , (2008): Pay for performance (P4P) programs provide financial incentives to healthcare providers based on quality of care and cost efficiency of services. P4P measures may include clinical outcomes, cost efficiency, processes related to best practices, use of health information technology (HIT) (e. g. , electronic health records and registries), patient satisfaction, and patient safety (Impact of P4P). Research in 2008 showed that when P4P measures were well defined and looked at a narrow scope of clinical measures, healthcare outcomes improved (Hart-Hester et al. 2008, n. p. ). Here the QM team must work closely with the healthcare provider to ensure that the proper treatment data is being collected to support P4P requirements thus ensuring a quality score. An interesting point with regard to P4P as discussed by Conrad and Perry (2009) is that outcome based incentives are overshadowed by process based incentives since the provider has more control over the processes; therefore, the incentive is frequently strengthened by adding in a measure of outcome that is expansive enough to cover patient risk factors such that the blended quality measure will overcome the healthcare provider’s inclination to â€Å"treat to the test. † They also state that there is little evidence that supports whether incentives are a more effective measure in improving quality over the use of penalties (p.360). In one study of a Massachusetts healthcare provider, Conrad and Perry stated that process improvement was shown for diabetic care where there was a combination of rewards and withholds (penalties), but there was no way to establish which caused the improvement (p. 362). As an example of how the QM program would work, the following will discuss how empirical quality measures would impact reimbursements for the health care organization by utilizing data standards from the Blue Cross and Blue Shield of Texas Bridges (BCBSTX) to Excellence Diabetes Care Program. As can be seen in the chart below, specific empirical data must be gathered either by the healthcare provider or a metrics collector from the QM team and then forwarded to BCBSTX to qualify for financial rewards. The data must also be submitted to any one of four Performance Assessment Organizations (Health Care Incentives Improvement Group, IPRO, National Committee on Quality Assurance, and American Board of Internal Medicine) in order to become a Recognized Physician or Organization (Blue Cross Blue Shield of Texas, n.d. n. p. ). It should be noted that BCBSTX uses a combination of outcome based incentives as well as process based incentives to establish quality care. Clinical Measures Threshold Minimum Criteria Maximum Points Poor Control Measures HbA1c Control 9. 0 27. 5% of pts in sample 15 Blood Pressure Control 140/90 40% of pts in sample 15 LDL Control 130mg/dl 40% of pts in sample 10 Superior Control Measures HbA1c Superior Control 1 7. 0 40% of pts in sample 5 HbA1c Superior Control 2 8. 0 40% of pts in sample 5 Blood Pressure Superior Control 130/80 30% of pts in sample 10 LDL Superior Control 100mg/dl 35% of pts in sample 10 Process Measures Ophthalmologic Exam N/A N/A 10 Nephropathy Exam N/A N/A 5 Podiatry Exam N/A N/A 5 Smoking Status and Cessation Advice and Treatment N/A N/A 10 Total Points 100 Percentage of Total Points Needed to Achieve Recognition 60 As long as the health care provider maintains patients within the applicablesample percentage and has an overall percent of 60 or higher, financial rewards and recognition will be obtained for the quality care. Quality Management is not the only instrument that should be in a health care organization’s tool box to improve quality care and support continuous improvement. Lean, Six Sigma, Key Performance Indicators, Return on Investment and Benefit-Cost Analysis are all additional tools that need to be utilized to improve healthcare. All of these can assist a healthcare organization in finding the specific data needed to support not only the requirements of ACA but help with internal issues of quality improvement. Quality Management, however, should be the governing approach in using these tools. Success in this endeavor requires the commitment of all employees to see quality as a way of life. In a healthcare organization this commitment should be easier than in most other organizations since the personnel already have a commitment to make people’s lives better through medical treatment. An important fact here is that information flow must be two-way, with information flowing down on big picture issues and the day to day workforce providing input up the chain of organization on how to do things better, for they are the ones that are in the trenches and already know what works and what does not. Yes, there are always better and more efficient ways to provide medical treatment, but what works in New York City might not work in Austin for a variety of reasons. More and more healthcare organizations are moving to P4P and not just because of ACA. The California P4P program, was established in 2003 and â€Å"remains the largest in terms of dollars distributed and while clinical quality metrics have improved by an average of 3 percent annually patient satisfaction surveys have stagnated† (Altarum Institute, 2011, p. 13). It is therefore incumbent on healthcare organizations to be proactive and incorporate a distinct QM organization that crosses all department lines and works closely with each sub unit to ensure that both quality care and quality improvement are addressed and measured accurately relying heavily on sound empirical data.

Compare and Contrast the Shall I compare thee to a summers day and Sonnet 130 Essay Example For Students

Compare and Contrast the Shall I compare thee to a summers day and Sonnet 130 Essay This essay is based on two sonnets, Shall I compare thee to a summers day and Sonnet 130, both of which are written by William Shakespeare. Although the poems are different to each other, they both come across as having the same meaning. Shall I compare thee to a summers day is a traditional, romantic love poem of the seventeenth century. The purpose behind the poem is to flatter women. In the poem, Shakespeare compares his love to a summers day. The way he does this is by highlighting all the negative points about summer and saying that she is much better. He beguiles her into thinking that in comparison to a day of summer she is much more extravagant. On the other hand Sonnet 130 contradicts this poem. In Sonnet 130 Shakespeare mentions all the bad points about his mistress in comparison with the small beauties in the world. This may sound as though he is unromantic towards his mistress, but he says that despite his mistress not being perfect, he still loves her as she is rare. In this poem he is very critical towards other sonnets, for being over exaggerated and unrealistic to flatter women, as he feels it doesnt do women any justice. The irony about this is that, Shall I compare thee is written by Shakespeare in a traditional form as well as Sonnet 130but this is written to exploit poets, who misguide women into believing they are love goddesses, but Shall I compare thee does exactly this, so in a way Shakespeare contradicts himself. The poem Shall I compare thee poses with the question, Shall I compare thee to a summers day? , this opening line gives the impression that the author is going to compare his love to all the beauties of summers day, but instead it follows on to say that she is more lovely and more temperate than a summery day, as a summery day has so many faults. He goes onto explain how at the start of summer the winds are rough and that they shake The darling buds of May and he complains about the short, allocated time for summer. He also argues about how at times, the eye of heaven shines with too much heat, and how often its gold complexion is dimmd. This metaphor and personification about the sun being the eye of heaven and having a gold complexion tries to represent, that although it is beautiful and has a big status, it is still not perfect. It may be fair, but sooner or later beauty fades and dies because of natures changing course. He says that his eternal summer will never fade by giving her an immortal life through making sure that she is remembered through this poem as the perfect beautiful summers day. She cannot lose possession of her beauty and that death cannot even bring, his wanderst in his shade, as she is immortal. He completes the sonnet by coming to a conclusion that so long lives this it gives life to thee. He says that so long as men can breath, or eyes can see which is forever, his love will be loving in this poem as the most beautiful and eternal lady. He can come to terms with all the things in life to end but he will not let his love be forgotten. As this poem was written in pre sixteenth century it would have been very romantic and flattering for a woman, at that time as traditional poetry like this was very common. Whereas now many women would find this poem to be rather dramatic and unreal, as he over exaggerates the negative sides to nature compared to his love. Throughout the poem it seems as though his love may be dead as he speaks about her a though she is a memory. On the other hand, Sonnet 130 criticises poems such as Shall I .. as it mentions right at the start that his, mistresss eyes are nothing like the sun, implying the fact that the sun is beautiful but the eyes of his love are not. The sun is usually used to represent beauty, light and radiance by most poets like in Shall I it is described as the eye of heaven, but in this poem Shakespeare says that his mistress eyes have none of these qualities. The sun can be used to be symbolic as all the world revolves around the sun but the world does not revolve around his mistress as she is an average normal person. He highlights the fairytale image of women that most people have such as red lips , black hair, a white complexion and uses them to describe his mistress to be the opposite of all these and look unattractive. He describes coral to be redder than her lips, her breasts to be dun (a muddy, grey colour) in comparison to white snow. Many other poets would use flowers like coral to describe their women to be precious or talk about their breast with great admiration, but Shakespeare criticises them. This shows that Shakespeare is not like most men who try to flatter women, or describe them to be beautiful. He talks about having seen Roses damasked red and white, this may have a connotation to it: as damasked is a type of rose but it could also mean that he has seen red and white roses be unveiled. In What Ways Does Philip Larkin EssayOne of the most significant comparisons between the two poems is the mentioning of the sun. Shall I compare thee highlights the bad points of the sun, such as; how it lets out intense heat. The poem does not refer to the Sun by its name; instead it is metaphorically described as the eye of heaven. It gives the sun an important position by giving this particular description. In Sonnet 130 it gives importance to the sun my mistress eyes are nothing like the sun indirectly implying that the sun is beautiful, radiant and full of life whereas his mistress eyes have none of these qualities. Both of the poems give a reference to the sun, showing its importance. The two poems use the significance of the sun in different ways, to compare or contrast it with the ladies they love. The poem Sonnet 130 gives a direct opinion that not all women are goddesses and that the mistress that the poem talks about is no goddess as when she walks, she treads on the ground. He is trying to be humorous about how other poets describe the ladies that they love to be goddesses, when in actual fact no one knows what goddesses look like or even if they exist. However, Shall I compare thee indirectly mentions all the qualities of a goddess to be in the lady he loves, assuming that he knows what a goddess is like. The lady appears to be a goddess as she appears to have supernatural qualities. This is perceived through the poets description of the lady being better, in equivalence to things like nature and also through the belief of the poet that his love is immortal and eternally living that even death cant affect her. The two poems can be compared in terms of their structure, concepts and the way they convey their message to the reader. The sonnets do differ quite a bit, through the approaches that are used by Shakespeare. The poems can be contrasted through the techniques that Shakespeare has used in each poem, for example, in Shall I compare thee Shakespeare uses literacy techniques, like personification and metaphorical speech when he describes the Sun, eye of heaven gold complexion. Whereas in Sonnet 130 Shakespeare prefers to use similes to compare his love to other luxuries and not once does he use metaphorical speech or personification. Shall I compare thee uses literacy techniques to beguile his love into believing his false promises. However, Sonnet 130 uses literacy devices, to destroy these false promises that other poets make. Shakespeare uses the technique of being pedantic and humorous to a great effect in Sonnet 130. The purposes of both poems are the same; to convince the ladies mentioned, that they are very special. The way they do this is very different though, Shakespeare has written Shall I compare thee to be seriously convincing and romantic. Whereas, he has written Sonnet 130 to be more humorous and critical rather than serious and romantic. Shall I compare thee is over exaggerated and quite unrealistic, due to the supernatural element of the women that is used. However, Sonnet 130 is much more realistic and convincing than Shall I compare thee as it eliminates all these false images of women from peoples mind and introduces the idea that you do not need to be beautiful to be loved. The two poems contain sentences that play on our senses. Shall I compare thee concentrates on the senses of seeing and touching, inds shake darling buds of May. However Sonnet 130 uses a wider range as it uses the senses; seeing, smelling and hearing, music hath a far more pleasing sound. Out of the two poems I most enjoyed Sonnet 130. This is because I found Shall I to be typically romantic and quite old fashioned, as I thought it was over exaggerated and too serious. However, I found Sonnet 130 to be extremely enjoyable. This is because it was very humorous and sarcastic and I though it was quite a unique love poem compared to others that I have studied. I think that it would really appeal to a young, modern female audience due to its criticism of poets stereotyped image of women. Along with being humorous it is also very romantic as it basically sends the message that no matter how a person looks on the outside it is what they are like on the inside that makes them special. It also shows that being unique does not mean that you have to be beautiful its just your inner qualities that make you beautiful; these sorts of messages that are sent through the poem are very romantic. Shall I is a poem that sort of indoctrinates women, into thinking that they are better than natural beauties, but it is well known that this is being quite untrue. It is being unfaithful to women by making all these false promises. Both of the poems are very effective in different ways due to the literal devices that are used by Shakespeare. These two sonnets are a perfect example of Shakespeares versatility in writing love poems but with totally different approaches.