U.S. history between the end of the World War II (1945) and the Assignment

U.S. history between the end of the World War II (1945) and the present - Assignment Example McCann contends that the terrorist attack of September 11, 2001 showed that American citizens were no longer secure and safe1. According to McCann, assaults on the US amounted to thirty-seven between the end of the Cold War and 2006. Critics have argued that Clinton and Bush’s administrations failed blatantly to confront the attacks from terrorists2. It has been perceived that the intelligence agents in the United States expressed a lot of laxity in preventing US from terrorism since 19453. Nations have an international obligation to prevent terrorism within and outside their boundaries4. The international community has established crime law to endeavor to deal with the conduct of the non-state terrorist actors5. In this respect, states should not breach their primary obligation to punish, as well as, prevent acts of terrorism. Evidently, the video shows that the impact of the terrorist attacks was tremendous and resulted in death of many people. In essence, terrorism is an issue that has tormented the United States since 1945 to the

Graduation Speech -- Graduation Speech, Commencement Address

Well, here we are. Sitting in this stuffy gym wearing these unflattering robes, while the band is poised and ready to play â€Å"Pomp and Circumstance.† We’ve always known this day would come and, whether our teachers, our parents or ourselves are prepared for it, here it is. We’re about to take that giant leap in just a few minutes and after that, it’s time to make our own choices. No longer will our biggest decisions entail which person to ask to prom or which period would be the best to TA during. Now our choices will begin to revolve around which bills we need to pay and what job we want to be doing 20 years from now. And whether you choose to earn a degree, get a job certification or immediately start working, there are some universal choices that everyone should make to ensure a fulfilling life for ourselves and our families. First is the choice of love. The time is almost upon us to stop being children and start being parents. Unfortunately, there seems to be an alarming trend in the breakdown of families nationwide. Parents are becoming too busy to involve themselves in children’s lives. Not enough of them are talking to their children about important issues, such as tolerance, suicide and drug abuse. Divorce rates are high and not enough children receive the proper attention or counseling during those rough times. All of these factors combine to make an unsteady environment for children of today and the future. Teen drug abuse is high. Teen suicide rates are high. And for some awful reason, kids even as young as first grade are killing each other. Starting today, we have the power to change this. Growing up is an intimidating thing: a large, never ending cycle that we cannot slow nor stop but can only dig in deep with ... ...o be on this earth, so if you don’t live your life to the absolute fullest, you may have more regrets than you can count. You only have one shot at living your life so don’t make it a dull one with little meaning. Finally, in the end, after we’ve lived our lives and it’s all said and done, not all of us are going to be as wealthy as Bill Gates or have more than 15 minutes of fame. Our autobiographies won’t be best sellers and most of us won’t compete in pro sports or make it on television. This is not to say, however, that our lives will have little impact on the world around us. It is the families we raise, the friendships we honor and the beliefs we cling to that will determine in the end whether or not we were successful. I wish all of you, my friends, the very best the adult world has to offer — our time starts now. Live it fully with no regrets. Thank you.

Family Medicines: a Strategic Weakness Essay

Recently the trends of urbanization and fast population increase expose several problems to healthcare system in Vietnam like shortage of healthcare manpower, low quality of care, unreasonable distribution of healthcare manpower in different geographic areas, particularly the serious shortage of physicians in Mekong Delta and North-west highland areas as specialists tend to locate their practices in urban medical centers where they could have access to advanced technology, supportive services and consultations from other specialists while rural areas are underserved and patient care becomes highly technocratic, fragmented and episodic. Furthermore, the shortage of physicians in major cities results in a seriously permanent overload at Central level and some specialty hospitals like Oncology, Pediatrics, Obstetrics and Gynecology .. etc.. In sustainable issues, deficit of Family medicine – a basic foundation of modern healthcare in the world, is identified as one of main causes of such problems in Vietnam healthcare system. The purpose of this Essay is to provide a theoretical discussion and analysis about the Family medicine weakness in Healthcare system and Family physician insufficiency in Vietnam to better understand about their impacts to the healthcare system at present and some proposed solutions and recommendations to improve these deficits. 2. Family Medicine and its roles in global healthcare system. In contemporary medicine, Family medicine remains the foundation stone of healthcare service in the community. As the most interesting and challenging of medical disciplines it is based on six fundamental principles: * primary care * family care * domiciliary care * continuing care All above principles are all designed to achieve: * preventive care * personal care (Pereira Gray, 1980). In the contemporary climate where medical services are fragmented and there are competing interests there is a greater need than ever for generalists. In those principles, primary care is the backbone of the health care system and encompasses the following functions: * It is first – contact care, serving as a point of entry for the patient into the healthcare system * It includes continuity by virtue of caring for patients in sickness and health over some period * It is comprehensive care, drawing from all the traditional major disciplines for its functional content. It serves a coordinative function for all the healthcare needs of the patient * It assumes continuing responsibility for individual patient follow-up and community health problems * It is a high personalized type of care (Rakel 2011) In the 2008 report, the World Health Organization (WHO) reaffirmed the importance of primary health care with its report â€Å"Primary health care now more than ever† and its emphasizes that primary care is the best way of coping with the illnesses of the 21st century, and that better use of existing preventive measures could reduce the global burden of disease by as much as 70%. The commentary emphasizes that ‘primary care brings promotion and prevention, cure and care together in a safe, effective and socially productive way at the interface between the population and the health system’. The key challenge is to â€Å"put people first since good care is about people† (WHO, 2008). Rather than drifting from one short-term priority to another, countries should make prevention equally important as cure and focus on the rise in chronic diseases that require long-term care and strong community support. Furthermore, at the 62nd World Health Assembly in 2009, WHO strongly reaffirmed the values and principles of primary health care as the basis for strengthening health care system worldwide. The essence of Family medicine is continuity of care and the evidence for its contribution to quality of care and better outcomes as follows: * Lower all cause morbidity * Better access to care * Less re-hospitalization * Fewer consultations with specialists * Less use of emergency service Better detective of adverse effects of medication interventions. Role definition of Family physician varies considerably both among family physicians and among people with whom they interact. Some individuals, particularly other medical specialists, see family medicine as merely another name of general practice. For others, family medicine is synonymous with primary care. A large proportion of family physicians further elaborate their role to include emphasis on personalized and humanized care. A smaller group adds a third component to their role: caring for families. The largest proportion who subscribes to this last notion refer to family physicians’ treating all members of a family (Cogswell, Sussman, 1982). In view of Family medicine, Family physicians are generalists who primarily draw their scientific medicine and technical expertise from five older specialties – internal medicines, pediatrics, surgery, obstetrics-gynecology and psychiatry-neurology. Compared to these specialties, family medicine is still a young field marked both by rapid expansion and by change, variety, ambiguity and conflict in the images and definition of the role of family physician. As the largest caring scope in healthcare services, the quality and quantity strengths of Family physician force play key roles to improve the health quality of national population. Globally the scope of Family medicine is extended with the recent view of global health care which is a field at the intersection of several disciplines: epidemiology, economics, demography and sociology. The term global health, as opposed to international health, implies consideration of the health needs of the people of the whole planet above the concerns of particular nations. That means global health has wide scope and reach to equity that the term of international health. The â€Å"global health† concept in Family medicine raises the changes in primary care nature as follows: * All population has to deal with the same risk of health due to the phenomena of traveling and immigration. Increase the gap between the poor & the rich globally. * The process of the urbanization/globalization. * Increase of the population in the world. * Decrease of the resources for health care. * Global warming phenomena. * Vaccination Era. * Evidence Based Medicine in daily practice. * Increase the bad behavior such as fast food, tobacco, stress, use alcohol†¦ * Primary health care change to Primary care concept  (Pham Le An, 2009). Such comprehensive changes upgrade the scale of Fami ly medicine in healthcare. In order to promote the global health support as well as strengthen the co-operation of national members, the World Organization of National colleges and Academies (WONCA), World Organization of Family physicians in WHO, was officially established and based in Singapore after the Fifth World Conference on General Practice in Melbourne in 1972. 3. Family medicine situation in Vietnam Although Family medicine basis had been established in the world for over 40 years, Family physicians, the most recently recognized specialists in Vietnam, are in the enigmatic situation of developing the occupational role which they simultaneously occupy. Family medicine had been only approved for establishment by Vietnam Ministry of Health since 2000. Until 2003, Family medicine specialty was established at 3 Medical Universities of Hanoi, HCMC City and Thai Nguyen province to train Family physicians and its specialists. However, its development was spontaneous with 7 Family medicine clinics (in both public and private sectors) nationwide and not strategically organized at all levels so far. There are only 59 post-graduated specialists and around 1,1 General practitioners who partly handle the roles of family physicians per 10,000 people averagely. The imbalance between Family medicine and other specialists can be seen by the ratio of 7,2 Medical doctors per 10,000 people in overall (Vietnam General Statistics Office – GSO – 2011) and the healthcare system only satisfies about 60- 70% of the demands and are lower than neighbor countries like Thailand, Singapore, Malaysia, Philippines.. tc. In 2011 report, Vietnam Ministry of Health forecasted the demand of 34,000 General practitioners more to obtain 10 Medical doctors/10,000 people in 2020 and this is a significant challenge to all 19 Medical educational Universities/Colleges to educate Medical doctors and post-graduate levels in medicine which capacities supply 4,800 graduated Medical doctors every year to add around 3,500 physicians more a year. Not only the quantity of family physicians is seriously insufficient, but also their quality to fulfill the roles of a family physician does not meet the needs of the patients and social development. The General practitioner training programs don’t orient student to the WHO’s critical requirements of â€Å"good doctors† in Family medicine, even though the criteria are more and more demanding by time, for example, the newer criteria of John Murtagh in 2001 â€Å"What makes a good General Practitioner? : * Develop rapport and good communication skills * Ask the right questions * Be astute and observant * Develop optimal ethical and professional standards * Have a fail-safe diagnostic strategy * Develop supportive networks * Know essential therapeutics * Develop basic procedural skills * Be well prepared for emergencies * Know yourself and your limitations including own general practitioners. The importance of certain specific competences and soft-skills in family physician force are emphasized in many studies. An interesting survey on patient care by representative health consumers conducted at St Vincent’s Hospital Melbourne revealed that the most important attributes of good doctors were (in some order of importance) caring, responsibility, empathy, interest, concern, competence, knowledge, confidence, sensitivity, perceptiveness, diligence, availability and manual skills. Additionally, there are neither comprehensive residency programs for Family physicians at Medical Universities/ Colleges in Vietnam nor supporting policy to them and general practitioners practicing at remote or rural areas so far. With effort to resolve the overload situation of Central hospitals in major cities, Project 1816 of Vietnam Ministry of Health deployed in 2008 with the purpose of â€Å"Fielding rotated professionals from upper level hospitals to lower levels to improve the quality of medical care† achieved some initial results such as transferring some technologies and conducting on-site training to improve skills and qualifications for lower level health care professionals; initially improving the quality of medical care at lower levels, especially in the mountainous, remote areas with staff shortage†¦etc, but its couldn’t obtain one of basic goals to reduce overcrowding for upper level hospitals, especially central level hospitals because it made the shortage of central level and specialty hospital more serious by the rotation. 4. Impacts of Family Medicine weakness in Healthcare system & Family physician insufficiency in Vietnam. Due to low reliability and poorly structured family physician network, patients tend to bypass to specialists/ central level hospitals (Vietnam Ministry of Health – 2011 Report), opposite with the trend in the world in which healthcare activities for chronic diseases such as diabetes, hypertension, asthma†¦are moved from in-patient to out-patient services with comprehensive treatment protocol at each level (Dang Van Phuoc, 2012) The irregular bypass causes the overload at Central level and specialty hospitals and the overloading condition becomes more serious, i. e, bed using capacity at Central hospitals increase from 116% (2009) to 120% (2010) and 118% (2011). It’s extremely high in some specialty hospitals such as K (Cancer) Hospital: 249%, Bach Mai Hospital: 168%; Cho Ray hospital: 154%; Central Obstetric and Gynaecological hospital: 124% .. etc. High capacity occurs in some specialties such as Oncology, Cardio-vascular, Orthopaedics (at 100% of hospitals), Obstetrics and Gynaecology, Paediatrics (at 70% of hospitals) while 36,8% of General hospitals are overloaded. The similar situation also happens in Consulting Departments with 80 exams/day/doctor while 60% – 80% of patients at Central level hospitals could be examined at local level and 40% of surgery cases at Central level hospital could be performed at local levels (Ministry of Health – Plan to decrease workload of Central level hospitals 2012- 2020) With the cost in health care, the deficit of Family medicine in Vietnam is one of reason making the medical expenses of patient higher. Total Expenditure on health as % of GDP (5. 1) is fairly high while General Government expenditure on health as % of total expenditure on health (28. 5) is so low to neighbor countries (Susan, 2005). The most cost-effective healthcare systems depend on a strong primary care base. This has been confirmed by a variety of studies comparing the care given by physicians in different specialties because primary care provided by physicians specifically trained to care for the problems presenting to personal physicians, who know their patients over time, is of higher quality than care provided by other physicians. When hospitalized patients with pneumonia are cared for by family physicians or full-time specialist hospitalists, the quality of care is comparable, but the hospitalist incur higher hospital charges, longer lengths of stay, and use more resources (Smith et al. , 2002). Similarly, the greater quantity of primary care physicians practicing in a nation, the lower is the cost of health care. The cost of healthcare is inversely proportional to the percentages of generalists practicing in that nation. According to OECD Health (Organization for Economic Cooperation and Development – OECD Health Data, June 2005), United Kingdom has twice the percentage of family physicians but half the cost to U. S.. Administrative overhead accounts for a major part of the high overhead cost (31%) of U. S. health care (Woolhandler et al. 2003). Countries with strong primary care have lower overall health care costs, improved health care outcomes, and healthier populations (Starfield, 2001; Phillips and Starfield, 2004). The shortage of Family physicians and Family medicine deficits also cause other problems in health care as follows: * Incomplete or unsuccessful Primary health care performance. * The gap between urban care and rural care in the health care network. * The competition among specialties: lack of cooperation in chronic disease care, increase the cost of management. * Barrier in teaching ambulatory care and doing out-patient’s research in academies (Pham Le An, 2009). In society, Family medicine meets some resistances of patients such as family hysicians are unfairly treated as â€Å"general consultants†, â€Å"home caring doctors† and even in medical community, they are considered as â€Å"incompetent doctor†, â€Å"poor specialist†, â€Å"unfair competitive doctor†.. e tc. Many other specialists and hospitals’ managements list Family physicians as one of financial losing causes to their hospitals. Such unfair treatments make many Family physicians feel uncomfortable with the specialty and their roles of Family physician. The reliability of patients and society to them is fairly low and this specialty does not attract the general practitioners to study. 5. Some proposed solutions & recommendations to improve Family medicine. In order to improve the Family medicine in Vietnam, it requires a comprehensive strategy with strong supports of government, educational institutes and society. Within the limit of this essay, I would like to propose some solutions and recommendations as follows: a. Increasing the quantity of Family physicians with additionally trained General practitioners and using the retired medical doctors: The greater the number of primary care physicians in a country, the lower is the mortality rate and the lower cost (Rakel, 2011). In the United States, a 20% increase in the number of primary care physicians is associated with a 5% decrease in mortality (40 fewer death per 100,000 population), but the benefit is even greater if the primary care physician is a family physician. Adding one more family physician per 10,000 people is associated with 70 fewer death per 100,000 population, which is a 9 reduction in mortality (Rakel 2011). A study of the major determinants of health outcomes in all 50 U. S. states found that when the number of specialty physicians increases, outcomes are worse, whereas mortality rates are lower where there are more primary care physicians (Starfield et al. , 2005). Starfield (2000) states, â€Å"the higher the primary care physician-to-population ratio, the better most health outcomes are† (p. 485). Researches in England reveal that with each Family doctor more in 10,000 people (about 20%), adjusted mortality will reduced about 5% in chronic diseases (Gulliford 2002). The increase of Family physicians obviously reduces the workload at Central level and specialty hospitals (49. 3% of out-patient and 59% of in-patient totally) because with many researches in the world, over 90% of patients are taken care with better service by Family physicians in developed medical or developed countries (Didier, 2011). They can help patients and their relatives in 80% health problems: acute or chronic diseases without complications or no need to transfer to Specialty hospitals (Dang Van Phuoc, 2012). To compensate the continuing decline of the number of students entering primary care as a common trend in the world (Bodenheimer et al. 2009) and insufficiency of graduated general practitioners, a policy to support general practitioners and retired medical doctors to practice as Family physicians such as additional training about Family medicine, financial supports, incentive†¦should be prepared and implemented. Rather than other countries where Family physicians usually work at home or their private clinics, Vietnam has a wide network of local level medical centers at wards/hamlets and popularly private clinics/medical units. This advantage allows Family physicians to practice and deploy the primary care programs easily and popularly. b. Family physician residency training programs: Quality of care and the inadequacy of medical training are two major concerns of Family physicians. Eventually, medical schools and residency programs graduated more specialists and fewer physicians trained for primary care. To improve their quality of care in accordance with global health principles, proposed solution is to build emerging curricula of family practice residency programs to envisioning family physicians as â€Å"horizontal specialists† who can deal with the large majority of patients’ needs on a continuing basis (Rakel, 2011) and envisioning this role as integrating humanized care with a high level of competence in scientific medicine. In contrast to the training of the general practitioner, the additional training that family physicians receive is intended to make them more proficient generalists in scientific medicine through formal training in appropriate interpersonal skills and in the behavioral and social sciences. Implementation of this role, however, requires reorganization within the medical system (Folsom, 1966) for continuing, comprehensive care by primary physician is difficult if not impossible within the normative organizational structures of highly specialized medical centers. As Family physicians play the important role in primary care, the Global health awareness program should be combined into General practitioner and Family physician’s training curriculum for being sure about the quality of â€Å"primary care† as follows: (i) Clerkship: adding knowledge of burden global disease in the world such as: tuberculosis, malaria, Preventive care: vaccination; improving skills such as clinical making decision, communication. ii) Orientation: Adding knowledge of new   emerging infectious disease like SARS, non communicable diseases, traumatism care, HIV/AIDS; (iii) Residents: adding knowledge of prenatal care,   neonatal care,   chronic care, mental health care, adolescen t care;   Emergency care in disaster; improving skills such as: doing research and practice Emergency care in disaster, Behavioral care after disaster, Kangoroo’s program, Obs-Gyn care program; building up the relationship center care with WIN- WIN theory for both developed and developing countries to increase of cooperation and Team work. In addition, the cooperation among experts in different medical fields should be strengthened for teaching, managing, doing research to promote the concept â€Å"relationship center care† through many activities: * Establish Continue Medical Education, Patient’s clubs. * Build the bridge or integrate the teaching contents   in Family medicine   with the other specialties like Pediatrics, Traditional Medicine ( Oriental nutrition, Shiatsu), Cancerology (Palliative care), Multidiscipline (Disaster care, EBM, chronic care). Communication through Internet/ Video conference and Electronic medical: The WHO 2008 report emphasiz es the appropriate ‘use of information and communication technologies to improve access, quality and efficiency in primary care. The writer has made a small contribution to basic patient education (also known as doctor education) by the production of common patient handouts which are available for print out from General practitioners’ computers or for one page photocopying from the book ‘Patient Education’ (Murtagh J; 2008). Besides the residency training programs, on-going training courses to improve the competences and skills of Family physicians should be set for attributes considered most important for patient satisfaction (Stock Keister et al. , 2004a). Overall, people want their primary care doctor to meet five basic criteria: â€Å"to be their insurance plan, to be in a location that is convenient, to be able to schedule an appointment within a reasonable period of time, to have good communication skills, and to have a reasonable amount of experience in practice†. They especially want â€Å"a physician who listens to them, who takes the time to explain things to them, and who is able to effectively integrate their care† (Stock Keister et al. , 2004b, p. 2312). c. Others solutions and recommendations (i) Building an incentive scheme and financial supporting policy to Family physicians, especially whom working in remote and rural areas: The effectiveness of this model had been proved in many countries, particularly in Thailand and Malaysia where healthcare conditions are fairly similar to Vietnam. Contrarily, the recent P4P (Pay for Performance) policy of Thailand’s of Ministry of Health to replace the incentive scheme to Family physicians creates several problems to healthcare force and patients and is considered as a main cause leading the Family physicians moving to major cities. With relation between income and satisfaction, in an analysis of 33 specialties in U. S. , Leigh and associates (2002) found that physicians in high-income â€Å"procedural† specialties, such as Obs – Gyn, ENT, ophthalmology and orthopedics, were the most dissatisfied. Physicians in these specialties and those in internal medicine were more likely than family physicians to be dissatisfied with their careers. Among the specialty areas most satisfying was geriatrics. Because the population older than 65 years old in U. S. has doubled since 1960 and will double again by 2030, it is important to have sufficient primary care physician to care for them. The need for and the rewards of this type of practice must be communicated to students before they decide how to spend the rest of their professional lives. Patient satisfaction correlates strongly with physician satisfaction, and physicians satisfied with their careers are more likely to provide better health care than dissatisfied ones. Physician satisfaction is associated with quality of care, particularly as measured by patient satisfaction. The strongest factors associated with physician satisfaction are not personal income, but rather the ability to provide high-quality care to patients. Physicians are most satisfied with their practice when they can have an ongoing relationship with their patients, the freedom to make clinical decisions without financial conflicts of interest adequate time with patient and sufficient communication with specialist (DeVoe et al. , 2002). Landon& colleagues (2003) found that rather than declining income, the strongest predictor of decreasing satisfaction in practice is the loss of clinical autonomy. This includes the inability to obtain services for their patients, control their time with patients, and the freedom to provide high-quality care. ii) Compulsorily assigning General practitioners/ Family physicians to practice at local level hospitals, the servicing term at local level hospitals must be reasonable and acceptable. (iii) Improving facilitates of local level hospitals/clinic s, enforcing the lower level hospitals to implement modern technologies and quality control. This allows Family physicians to better serve patients as some achievements of Project 1816 of Vietnam Ministry of Health. (iv) Involving patients for private and family health care and prevention, structured information supporting treatment. (v) Improving the reputation of Family medicine and physicians in society through public media channels like television, newspaper.. etc, medical education programs and medical community. Even after the specialty is formally acknowledged by institutionalized medicine, family physicians have experienced a variety of negative responses from medical colleagues in other specialties. Carmichael (1978) perceived 3 stages in the reactions of those in medicine to Family medicine: first, the field was ignored; second, it was actively opposed; and then, family medicine is entering a third stage of possible co-optation by medicine. 6. Conclusion The weakness of Family medicine and insufficiency of family physicians cause many strategic consequences to the healthcare system in Vietnam. Their correction requires a long-term strategy to increase the quantity of Family physicians, quality of care, revise the residency training programs, improve its reputation in the society .. etc. In conclusion it seems appropriate to paraphrase Dr Robert Rakel in his keynote presentation to the 14th WONCA World Conference to reaffirm the Family medicine era in the contemporary medicine: â€Å"Regardless of how computer literate we are or how high our technology or whether the setting is urban or rural, good medical care in the future will continue to depend on patient care provided by a concerned and compassionate family physician. The physician will be governed by ethics, not economics, by a partnership with the patient, not politics; and by compassion and communication, and not by capitation. Good medical care in the future will depend, as it does now and always has, on the quality of our interaction with the patient† Dr Robert Rakel – 14th WONCA World Conference) REFERENCES 1. Alain J. Montegut, The Power of Primary Care for the Future of health care: Is Family Medicine the Answer? 1st International PHC Conference Doha, Qatar 1 – 4 November 2008 2. Bod enheimer et al. , 2009. Bodenheimer  T. ,  Grumbach  K. ,  Berenson  R. A. :  A lifeline for primary care. N Engl J Med  Ã‚  2009;  360:2693-2696. 3. Cogswell BE, Sussman MB, Family Medicine: A new Approach to Healthcare (Marriage & Family review, ISSN 0149-4929; v. 4, no. 1/2), The Haworth Press Inc. 1982. 4. Dang Van Phuoc : Plan to decrease workload of Central level hospitals 2012- 2020 – Vietnam Ministry of Health, 2012. 5. Didier L. Roles of Family medicine, Texbook of Family medicine for the co-operation between Liege University – Brussel and Vietnam, Medicine Publisher, 2009. 6. DeVoe et al. , 2002. DeVoe  J. ,  Fryer  G. E. ,  Hargraves  L. ,  et al:  Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care?. J  Fam Pract  Ã‚  2002;  51:223-228. 7. Gulliford, J Public Health Med 2002; 24:252-4, and personal communication 9/04. 8. Landon et al. , 2003. Landon  B. E. ,  Re schovsky  J. ,  Blumenthal  D. :  Changes in career satisfaction among primary care and specialist physicians, 1997–2001. JAMA  Ã‚  2003;  289:442-449. 9. Leigh et al. , 2002. Leigh  J. P. ,  Kravitz  R. L. ,  Schembri  M. ,  et al:  Physician career satisfaction across specialties. Arch Intern Med  Ã‚  2002;  162:1577-1584. 10. Murtagh J: The road to excellence. Australian doctor 3 2008, 46-8. 11. Murtagh J: Paradigms of Family medicine: bringing traditions with new concepts; meeting the challenge of being the good doctor from 2011, Asia Pacific Family Medicine, 2011, 10:9 12. Murtagh J: Patient education. 5 edition. Sydney: McGraw-Hill; 2008. 13. Pereira Gray DJ: Just a GP. J R Coll Gen Pract 1980, 30:231-239 14. Pham Le An, Integrate the issue of global health in FM curriculum: promising solution for improving the quality f Primary care in Hochiminh city, Vietnam  , Introducion FM concept: global healh, texbook of Family medicine, Vietnamese version, Medicine Publisher, 2009. 15. Pham Le An, Global health perspective in Vietnam, A â€Å"Train the Trainer’s Workshop†   WONCA   ASIAN PACIFIC Vietnam Ho Chi Minh city, 2008 16. Phillips and Starfield, 2004. Phillips  R. L. ,  Starfield  B. :  Why does a U. S. primary care physician workforce crisis matter?. Am Fam Physician  Ã‚  2004;  70:440-446. 17. Rakel RE: Family medicine-meeting new challenges. Australian Family Physician 1996, 25(9 Suppl 2):S91-6. 18. Rakel RE: The Family Physician, Textbook of Family Medicine, Eight Edition, Elsevier Saunders, 2011, pp4-15 19. Rivo et al. , 1994. Rivo  M. L. ,  Saultz  J. W. ,  Wartman  S. A.   et al:  Defining the generalist physician’s training. JAMA  Ã‚  1994;  271:1499-1504. 20. Smith et al. , 2002. Smith  P. C. ,  Westfall  J. M. ,  Nicholas  R. A. :  Primary care family physicians and 2 hospitalist models: comparison of outcomes, processes, and costs. J Fam Pract  Ã‚  2002;  51:1021-1027. 21. Starfield, 1994. Starfield  B. :  Is primary care essential?. Lancet  Ã‚  1994;  344:1129-1133. 22. Starfield, 2000. Starfield  B. :  Is U. S. hea lth really the best in the world?. JAMA  Ã‚  2000;  284:483-485. 23. Starfield, 2001. Starfield  B. :  New paradigms for quality in primary care. Br J Gen Pract  Ã‚  2001;  51:303-309. 24. Starfield et al. , 2002. Starfield  B. ,  Forrest  C. B. ,  Nutting  P. A.   et al:  Variability in physician referral decisions. J Am Board Fam Pract  Ã‚  2002;  15:473-480. 25. Starfield et al. , 2005. Starfield  B. ,  Shi  L. ,  Grover  A. ,  et al:  The effects of specialist supply on populations’ health: assessing the evidence. Health Aff (Millwood)  Ã‚  2005;  24:W5-97-W5-107 26. Stock Keister et al. , 2004a. Stock Keister  M. C. ,  Green  L. A. ,  Kahn  N. B. ,  et al:  What people want from their family physician. Am Fam Physician  Ã‚  2004;  69:2310. 27. Stock Keister et al. , 2004b. Stock Keister  M. C. ,  Green  L. A. ,  Kahn  N. B. ,  et al:  Few people in the United States can identify primary care physicians. Am Fam Physician  Ã‚  2004;  69:2312. 28. Susan JA, Vietnam’s Healthcare system: A Macroeconomic Perspective, Paper Prepared for the International Symposium on Health Care Systems in Asia Hitotsubashi University, Tokyo, 2005. 29. Vietnam Ministry of Health: Plan to decrease workload of Central level hospitals 2012- 2020, 2012. 30. Woolhandler et al. , 2003. Woolhandler  S. ,  Campbell  T. ,  Himmelstein  D. U. :  Costs of health care administration in the United States and Canada. N Engl J Med  Ã‚  2003;  349:768-775. 31. World Health Organisation: The World Health Report 2008: Primary Health Care now more than ever Geneva; 2008. 32. World Health Organisation: World Health Report 2009: Promoting health and development-closing the implement gap Geneva; 2009. -oOo-

The Between Loveless, Dysfunctional Family Lives And...

The National primarily provides legitimate facts about the Charlie Hebdo event. Although the article repeatedly emphasizes that it does not condone the brothers’ acts, it does speak about how the brothers cannot be blamed for 100% of their actions. The article does seem to present slight bias favouring the brothers. This can be attributed to the fact that the Emirates freed themselves of the British in 1968 meaning that they know a recent history of violence. Stated in the article â€Å"People the world over survive the most unpromising of origins without becoming ruthless killers†¦ but it is difficult to dismiss a possible link between loveless, grossly dysfunctional family lives and dehumanized conduct in adulthood† (Conroy Randall). The article consistently defends the brothers’ actions with their upbringings stating â€Å"They knew no love. In religious fanaticism, he found the family he never had†¦ they [his mentors] were able to get into his hea d. It’s easy to pick on such isolated and vulnerable kids. No one was there to guide him on the straight and narrow†¦ but if he’d had a happy childhood, would he have become a terrorist† (Conroy Randall). The majority of these quotes come from individuals who knew the brothers growing up, thus displaying slight bias by only communicating the voices of those with a deep connection to the brothers. By only including the voices of those who support the brothers rather than including some voices of those who disapprove of their acts, the

Analysis Of Horkheimer And Adorno s Dialectic Of...

Published in 1944, Horkheimer and Adorno’s Dialectic of Enlightenment raises certain themes curated by different institute members of the Frankfurt School. A Psycho-analytical theory is applied to ‘anti-Semitism’, authoritarianism and fascism; it initially however, discusses the mass culture industry, the power of instrumental reason and of course the philosophy of enlightenment. Adorno argued, in regard to both cultural production and mass culture that Capitalism has: ‘hi-jacked’ art and its requirements of the market, this notion can also be applied to the ‘relationship’ between media/power and the elite, today. Thus, reliance needs (dependency) are fashioned in the minds of consumers of said culture by fresh forms of culture curating a set of conditions of dependency by the powerful. The aim of commercial ‘art, it goes on to argue, is to be presented without any critique, thus making its produce essentially ideological; the extra dominated interpretations of reality are reproduced, reinforced and strengthened through this. The authors’ state that the Enlightenment and science, developing from the thoughts and concepts of Francis Bacon, has focused primarily on dominating nature and therefore other humans and thus formulating a critique of both positivism and the philosophy of history. The domination of nature is integral to the philosophy of the Enlightenment. However, it could even be said that a basis that was once linked to liberation has been modified into aShow MoreRelatedCulture is a Mean of Social Control: Theodor Adorno998 Words   |  4 PagesTheodor Adorno is a representative of the Frankfurt School of Sociology, where the main theories and ideas were influenced by Karl Marx’s work. His main idea that the society is simply divided by a base-superstructure model and that the economy influences everything from religion to politics, referred to as economic determinism, is challenged by Adorno’s thought. Therefore, the Frankfurt school is part of the neo-Marxist approach as they interpret and add new things in Marx’s ideas. The fundamentalRead More Transcending Herbert Marcuse on Alienation, Art and the Humanities4411 Words   |  18 Pagesnecessary to theorize our society critically if we are to have a vehicle for correctly informed transformative practice. The problem is that much of what is called critical theory today is rooted in ideas developed by Herbert Marcuse, Max Horkheimer, Theodor W. Adorno, and Georg Lukacs. What I want to argue here is that their work has tended to formulate a particular approach to aesthetic educationand a unique version of a philosophical humanismwhich is then presented as critical theoryagainst the debilitatingRead MoreOrganisational Theory230255 Words   |  922 Pagesmanaging, organizing and reflecting on both formal and informal structures, and in this respect you will find this book timely, interesting and valuable. Peter Holdt Christensen, Associate Professor, Copenhagen Business School, Denmark McAuley et al.’s book is thought-provoking, witty and highly relevant for understanding contemporary organizational dilemmas. The book engages in an imaginative way with a wealth of organizational concepts and theories as well as provides insightful examples from the

Child Abuse Prevention And Treatment Act - 2352 Words

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Prison Overcrowding Free Essays

â€Å"Overcrowding in Americas Prison System† ABSTRACT In the early years of this country flogging, exile, branding, and the â€Å"stocks† were some of the ways used to punish a guilty offender. Today, though, these types of punishments would quickly be labeled as cruel and unusual forms of retribution. Since we can no longer utilize such forms of punishment, the criminal justice system has turned to; imprisonment, probation, fines, and even the death penalty to help and deter offenders from a life of crime. We will write a custom essay sample on Prison Overcrowding or any similar topic only for you Order Now As the prison population continues to rise in this country health and safety questions rise as well. Not only for the prisoner but for also for the guards that are there to watch over and protect the inmates. It is time to ask some very important questions regarding sentencing alternatives including; â€Å"Do we rely too much on the prison system†, â€Å"Are there better ways to punish some crimes? † and probably most importantly, â€Å"Does prison truly act as a deterrent to crime? † The Bureau of Justice’s statistics in the recent years have shown a dramatic increase in the prison population which has led to a large amount of United States prisons being overcrowded. State prisons, on the average, are 16 percent over their capacity with Federal prisons holding an average of 38 percent more inmates than their original construction capacity. (Bureau of Justice) Overcrowding, though, is just part of the problem. Many of the prisons in America today are rundown and substandard. Inadequate security is also an issue, often times lacking the personnel to keep the inmates safe from assaults and other violations. For years, it has been the belief of the American public, politicians, and criminal justice authorities that crime rates in this country were just too large. It has also been the general consensus that in order to stop the rising crime rates, there had to be a great push in the severity of sentencing in the courtroom. Mostly this was done by way of utilizing the maximum sentence for a crime in hopes of deterring others and decreasing the amount of recidivism. One other method was to impose a minimum sentence for certain nonviolent crimes including; driving while intoxicated, drug offenses, child molestation, spousal abuse, and sexual assault. â€Å"Over the past three decades, the United States has built the world’s largest prison system. This system is ten times larger today than it was in the mid-1970s. † (Lynch, 2007)As America’s prison population has grown there has been a lot of debate on whether or not prison is working. Arguably, all intents and purposes of a prison system are to deter crime. The hopes of our criminal justice system, all of its judges, lawyers, and even the American people is that either someone will not commit an offense with fear of going to prison or that if they do, they will not do it again once they have stepped foot inside a correctional institution. Is this the case? Do prisons in fact act as deterrents and reduce crime rates? Lynch goes on his book after a review of several studies on the effects of prison as a deterrent to say, â€Å"While sentencing reforms seemed to reduce crime, they did so only by substantially increasing the size of the incarcerated population. In light of this observation, and in an effort to avoid the problem of extensive prison growth, the use of selective incapacitation strategies that carefully target specific kinds of offenders may be of the more benefit. (Lynch, 2007) Michael Jacobson is a former Commissioner of Probation for the City of New York, appointed by Mayor Rudolph Giuliani, supports the fact that the use of prisons may not be the deterrent we have been hoping for and is best suited for the most violent of offender. In his book, â€Å"Downsizing Prisons: How to Reduce Crime and End Mass Incarceration† Jacobson explains; After all is said and done, the number of people in the U. S. jails and prisons-almost 2. 2 million at the time of this writing-reflects a public policy gone mad. Prisons and especially long prison sentences should be reserved for the most violent among us. There is no need to lock away for years hundreds of thousands of nonviolent drug offenders or to keep people in prison well past their crime-committing years, effectively turning some prisons into the equivalent of secure nursing homes. (Jacobson, 2005) It is easy to see that the use of harsh sentencing guidelines does not necessarily have the effect that it once was thought to have. Not only that ut now we are using and already overcrowded prison system to punish minor crimes and to house parole violators. What is the cost of such action? The answer simply put? Way to high. Over the years, the costs of running a prison have increased dramatically. Today, it can cost well over $75,000 to build a single cell and over $25,000 to house a prisoner for a year. Let’s put this in an even better prospective by saying that, in today’s society, it could cost well over $330 million to bu ild and run a 500 cell prison over a period of 30 years. If a state struggling to run a prison has to obtain money, where does it come from? More and more states are starting to shift funds from their higher education departments. If states are taking money away from schools to fund prisons, it may be time for a change. There has to be to reduce the American criminal justice system’s use of prison. Community corrections legislators believe that there are several alternatives to prison from which the court can choose from. One of the most popular types of intermediate sanctions is, of course, probation. Probation is used in lieu of incarceration and affords the offender the ability to be supervised in their community by a probation officer who works as an agent of the court. Other types come in the form of; house arrest, electronic monitoring, shock probation (boot camps), intensive supervision, day-reporting centers, community service, fines, restitution, and forfeiture. To make intermediate sanctions work and to decrease the reliability on the prison system, there has to be a change in the sentencing guidelines for some crimes. We can no longer look to prison to punish every crime that an offender may commit. Drug offenses, theft related crimes, driving while intoxicated, parole violations, and other nonviolent crimes need to be handled in the community with a combination of the intermediate sanctions mentioned earlier. Michael Tonry, in his book, â€Å"Intermediate Sanctions in Sentencing Guidelines† supports this conclusion, â€Å"For offenders who do not present unacceptable risks of violence, well-managed intermediate sanctions offer a cost-effective way to keep them in the community at less cost than imprisonment and with no worse later prospect for criminality. † (Tonry, 1998) While prison has been leaned on for many years as a way to deter crime and to punish offenders of the American criminal justice system, the increase reliability has led to a very dangerous and expensive prison system. Overcrowding has led to violence, health concerns, and substandard prison conditions. It is now time that we look to other means to punish offenders who are not a great threat to society. Through the use of intermediate sanctions, I believe that America can lower its prison population while at the same time punish offenders of state and federal laws. Bibliography Anderson, D. 1998). Sensible Justice: Alternaives to Prison. New Press. Bureau of Justice. (n. d. ). Bureau of Justice. Retrieved 03 09, 2011, from www. ojp. usdoj. gov/bjs Jacobson, M. (2005). Downsizing Prisons: How to Reduce Crime and End Mass Incarceration. NYU Press. Jusitce, B. o. (2010). Bureau of Justice. Lynch, M. (2007). Big, Prisons, Big Dreams: Crime and the Failure of America’s Penal System. Rutgers University Press. Paulus, P. (1988). Prison Overcrowding: A Psychological Perspective. Springer-Verlag. Tonry, M. (1998). Intermediate Sanctions in Sentencing Guidelines. Oxford University Press. . How to cite Prison Overcrowding, Essay examples Prison Overcrowding Free Essays Nowadays, overcrowding in prisons has become a serious concern in the United States, especially in California where there is not enough space for the increasing inmate population. And according to the most recent statistics from Californians Department of Corrections and Rehabilitation, the state gives a bigger budget to prisons than any other state. With annual spending of about nine billion dollars and forty-five thousand dollars per inmate, California obviously pumps more money on prisons than higher education. We will write a custom essay sample on Prison Overcrowding or any similar topic only for you Order Now On average, murderers and violent criminals are jailed from four years up to twenty-five years. The more time they serve in Jail, the more money the state has to spend. Hence, in order to solve the prison overcrowding problem and save a lot of money, some solutions have been executed such as increasing prison capacity, restitution, or house arrest, but they have not worked so far. There is a better way that may work. That is setting up battle arenas in prisons and authorizing inmates to beat each other to death. The prize for the survivor is the immediate freedom and a certain sum of money. Thereby, we not only avoid prison overcrowding, but also cut prison budgets. It seems like an outrageous idea, but at least it would work because inmates have nothing to lose; thus, they are highly motivated to fight for their freedom. After all, there are three reasons why this cruel solution should be implemented. Firstly, by allowing prisoners to kill each other, every prisoner dies, it immediately decreases forty-five thousand dollars of the prison annual budget. If we had lessened the number of prisoners, we could have stopped deeding them and building new Jails. Through a simple computation, we will get almost five million dollars if one thousand criminals die per year. We could use the saved money to build more supportive housing for people in need, support returning veterans, open more public transportation, and spend more money on subsidies for higher education. Secondly, according to Bureau of Justice Statistics of the US Department of Justice, there is seventy percent of felony defendants repeating their prior crimes. For this reason, inmates, who can’t survive in their fight, have no more Hansen to do their crimes again. Innocent people would be safer. The losses of family members caused by crimes would be reduced. Thirdly, prisons now look like a battlefield, and inmates fight to die, the entertainment organizations could take advantage of this to make the reality TV shows about life in prisons. This would attract not only Americans, but also other foreign countries. Because most people, especially those are under fifty, want to see violent scenes. Indeed, ninety percent of movies and sixty percent of TV shows today show depictions of violence (Nor, 1). For example, WE, a fighting show, has twenty million viewers in a single week. Nevertheless, WE is still staged by actors who are called superstars. On the other hand, we have real fighters in prisons, and they will try their best to fight for their life. Everything happening in prisons are real, and people would even love watching it more than WE for its reality and brutality. As many people watch these prison shows, it would increase the nation’s economy because people will spend money to see them. With all mentioned above, this is one of the best solutions for the prison overcrowding problem at the moment. How to cite Prison Overcrowding, Papers Prison Overcrowding Free Essays This paper will discuss prison overcrowding and what type of numbers have come about over the years when it comes to inmates being imprisoned. It will discuss the cost of a prisoner annually as well as the decision to add verses build when it comes to new facilities. The overcrowding in one particular prison will be touched on as well as whose responsibility it is for upkeep. We will write a custom essay sample on Prison Overcrowding or any similar topic only for you Order Now It will discuss how funding plays a role in overcrowding as well as the â€Å"three strikes† rule in California and how big of an impact it has made on the prison system.Lastly, society’s choice to vote will be touched on as how large of a determining factor it is in overcrowding prisons. State and Federal Prisons housed approximately 1. 3 million inmates in the year 2000, not to mention the jails had an estimate of 600,000 as well. Ten years previous the prisons housed 700,000 inmates and jails were at about 400,000. At that rate, the population of people being incarcerated almost doubled from 1. 1 million to 1. 9 million inmates. The last count in 2008 jumped again to an astonishing 2. million imprisoned within the country (Diiulio, Jr. , J. , 2010, March). Factors that contribute to prison and jail overcrowding is that so many people are incarcerated each year, funding, upkeep of a facility, the three strikes rule and tax payers are unwilling to pass levees. One of the largest reasons prisons are overcrowded today is that it is reported that one out of every 99. 1 adults are currently in prison or jail. This is the largest number in nation’s history and seven times the inmate rate from 1973.Amazingly ninety-five percent of prisoners are released back into communities to continue living their lives. They are not thrown to the wolves; they are released â€Å"with a basic education, job training and preparation, improved pro-social pattern of thinking, adequate life/social skills, and a lowered risk for substance abuse, anger and self esteem issues† (Boehm, D. P. , Lampert, R. O. , 2008, October). If an inmate needs continued treatment once released, they are provided the assistance and resources to make the transition as successful as possible.Even when a prisoner was on a psychotic medication when released they are hooked up with a regional mental health and substance abuse center to make their reentry as flourishing (Boehm, D. P. , Lampert, R. O. , 2008, October). At 157 percent capacity, San Quintin State Prison, a maximum security prison is no doubt overcrowded and it costs about $49,000 each year for an adult inmate to be housed in the San Quintin State Prison (Sterngold, J. , 2008, July/August). Taxpayers are unwilling to pass levees to build facilities to house prisoners which lead to an overcrowding prison. The criminal justice system needs to have stronger sentences for crimes to deter people from offending to begin with and not release inmates early due to overcrowding. Inmates are being released early because there are not enough beds to hold all of the criminals. In the end it leads to a higher crime rate because the inmate’s count of being released early and they are not being reformed. A way to reduce funding problems is to have inmates take care of their own facilities like they would their homes.Cleaning supplies can be handed to the inmates and it can be their job to clean the showers. It should not be the responsibility of the prison staff to keep the facility clean, the inmates should be given duties and be held accountable or forced to live in the conditions they allow for themselves. Funds should not be taken from the taxpayers to pay someone to clean up after the inmates, the taxpayers’ funds could be used for security and building to prevent additional overc rowding. The problem with many jails and prisons today is the upkeep.Most facilities today do not have the funding to build a brand new facility but what needs to happen is to make the additions and upgrades more efficient. Replacing a furnace or air conditioning system for a place a huge as a prison could be extremely time consuming and expensive especially if the newer model is not the most efficient and then has to be replaced again and again prematurely. The best way to spend the taxpayers’ money is to buy the most energy efficient and best model and not replace it as often. As the age old saying, â€Å"you get what you pay for. The same goes for other materials when doing an addition or fixing an existing structure, the administrators need to take the time to research and see what the best materials are for longevity and spend money wisely (Lucas, R. , 2009, November/December). As Robert Lucas (2009) said, â€Å"Money spent well at the beginning of a project may save the facility from spending more in the future. † Like California, many other states have the â€Å"three strikes† rule and one of every nine of the inmates who are on their third strike get 25 to life sentence (Haerens, M. , 2010, May 15). This rule contributes to the vercrowding issue which an individual is taking up more space in jails and prisons. For example, if a person is charged three times with felony drug trafficking and is convicted that would be the third offence and would serve twenty-five year to life in jail. A violent offender, like a murderer, could that the place of that individual and rot in jail and make the community safer, it is the lesser of two evils. There are many factors that contribute to prison and jail overcrowding, funding, upkeep, three strikes rule, taxpayers not wanting to pass levees and the fact that so many people each year are incarcerated. Funding can be redirected if the upgrades were made more efficiently around the prisons. To help save money, inmates can do daily duties and have responsibilities around the prison and jail grounds. The three strikes rule needs to be revised to focus on violent crimes. Tax payers need to stop complaining about criminals in the community unless they are willing to pass the levees to build jails and prisons to lessen the likelihood of overcrowding.References Boehm, D. P. , Lampert, R. O. (2008, October). Thinking Outside the Cell: Expanding Safety and Security Beyond the Perimeter. Corrections Today, 70 (5). p. 4-61, Retrieved from Academic Search Premier Resource Center. Diiulio, Jr. , J. (2010, March). Prison Breakout. America,202 (6). p. 11, Retrieved from Academic Search Premier Resource Center. Haerens, M. (2010, May 15). California’s â€Å"Three Strikes† Law Is Fair. † Opposing Viewpoints: Mandatory Minimum Sentencing. Detroit: Greenhaven Press, Retrieved from Opposing Viewpoints Resource Center. Lucas, R. (2009, November/December). To Build or Not To Build? American Jails,23 (5). p. 493, Retrieved from Criminal Justice Periodicals Index Resource Center. Sterngold, J. (2008, July/August). Worst of the Worst. Mother Jones, 33 (4). How to cite Prison Overcrowding, Papers