Client uploads

Discussion: Online Pharmaceutical Ordering System ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Online Pharmaceutical Ordering System I’m working on a engineering exercise and need a reference to help me study. Grantham University ET 410 Week 8 Online Pharmaceutical Ordering System Project Course Name – Week 8 Assignment Tunnel Cost Comparisons Question 1: Write a 1-2 page paper. In your paper, discussion the following: Discussion: Online Pharmaceutical Ordering System Search the internet for the link to the Boston tunnel, “the Big Dig” or the “Channel Tunnel,” and London’s Millennium Dome. In spite of their poor cost performance, why do you think these projects were supported to their conclusion? What would it take to kill a high visibility project such as these? Provide a comparison of the projects, what extent were the cost overruns and how were the overruns handled by the authorities? Include a title page and adhere to the Publication Manual of the American Psychological Association (APA), (7 th edition) when writing and submitting assignments and papers. Make sure to provide references. Make sure you use in-text citations in the body of the assignment. Here is a website to aid with citations: https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/in_text_citations_the_basics.html Question 2: Submit a document with the following documents compiled into one. Save it as “ET410 Final Report_GID.docx” and remember that you will be submitting this in ET450. Project Proposal Requirements Document and Systems Design Review Document Final Schedule Final Budget Lessons Learned Document attachment_1 attachment_2 attachment_3 PROJECT LESSONS-LEARNED DOCUMENT Project Name: Prepared by: Date (MM/DD/YYYY): The purpose of this template is to help the project team share knowledge gained from experience so that the entire organization may benefit. A successful Lessons-Learned program will help project teams: Repeat desirable outcomes Avoid undesirable outcomes. Your project team should begin to use this document at its first project meeting. Continually recording Lessons-Learned throughout the project is the best way to ensure that they are accurately recorded. Topics to consider include all of the following (feel free to change the list). The Lessons Learned Checklist is also available as a guide to discussion. Project Management Technical Management Human Factors Overall Project Planning Requirements Communication Customer Satisfaction Resource Management Specification Team Experience Technical Success Risk Management Test Plan Interaction with Sponsor Quality product Change Control Construction Interaction with Customer Product Accepted Procurement Testing Interaction with Management On Time Budget Management Rollout Management support Within Budget Quality Control Training Quality of meetings Met Project Objectives Status Reports Documentation Vendor interaction Met Business Objectives Vendor Selection Vendor Management At the end of your project, use this document to summarize your experience. During your discussions: Be positive Do not place blame! Focus on successes as well as failures Indicate which strategies contributed to success Indicate which improvement strategies would have the greatest impact Discussion: Online Pharmaceutical Ordering System 1. Project Journal During each project team meeting discuss what strategies contributed to success as well as areas of potential improvement. For the Strategies and Processes that led to Success section, give a detailed description of the factors you applied that led to a positive outcome that not only affected the current project but would aid you in future projects. For the areas of potential improvement, indicate factors or processes you have learned that will not only help you with this project but will provide success for other projects in the future of your career). Enter your conclusions in the table below (insert rows as needed): Strategies and Processes that led to Success Date Description Areas of Potential Improvement Date Description 2. Project Close-Out Discussion At the end of your project, gather all stakeholders for a Lessons-Learned meeting: Step 1: As a group exercise, fill out the Lessons Learned Checklist (create hyperlink if needed) Step 2: Use the questions below to summarize your Lessons-Learned discussion. Enter comments in the areas provided. Focus on Lessons Learned that will help in future projects. (Insert rows as needed) A. List this project’s three biggest successes. B. List other successes that the team would like highlighted: C. Areas of potential improvement. Give a detailed description to indicate factors or processes you have learned that will not only help you with this project but will provide success for other projects in the future of your career. D. Enter other comments: 3. Project Lessons-Learned Document / Signatures Project Manager: Discussion: Online Pharmaceutical Ordering System I have reviewed the information contained in this Project Lessons-Learned Document and agree: Name Title Signature Date (MM/DD/YYYY) The signatures above indicate an understanding of the purpose and content of this document by those signing it. By signing this document, they agree to this as the formal Project Lessons-Learned Document. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Describe five instruments used to measure psychopathy Describe five instruments used to measure psychopathy ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS 1-Name and describe five instruments used to measure psychopathy . 2-Does playing violent video games increase the probability that children and adolescents will behave in a violent manner? 3-Compare and contrast a) overt and covert acts of aggression ; b) reactive and proactive aggression. 4- How has the media affected public perception of mental disorder and violence? 5-What are status offenses? Give examples as well. 6-Describe guilty but mentally ill statutes. Why do many legal scholars oppose them? 7-Identify and include symptoms of the four diagnostic categories most relevant to criminal behavior. Requirements: Answer each questions Answer preview to name and describe five instruments used to measure psychopathy. You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Potential barriers that may prevent your EBP change proposal Efficiency Potential barriers that may prevent your EBP change proposal Efficiency from continuing to obtain the same desired results 6 months Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of EBP is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time. Name two potential barriers that may prevent your EBP change proposal from continuing to obtain the same desired results 6 months to a year from now, and your strategies for overcoming these barriers. ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Payment Structures In Health Care Industry Payment Structures In Health Care Industry Identify a significant problem with one of the three payment structures used in the health care industry across the care continuum (from DQ 1) and propose a solution from one of the other two payment structures MY FIRST PATIENT AS A MEDICAL STUDENT was a victim of the United States health care system. A fifty-year-old man who died of a heart attack shortly upon arriving at the hospital, this particular gentleman had been experiencing chest pain for over a year. But he had forgone a doctor’s visit because he had let his health insurance lapse due to its high cost. He is by no means alone. Sadly, the United States manages to leave 47 million Americans—about 17.7 per- cent of the country’s nonelderly population—uninsured.1 Of these uninsured Americans, 61 percent stated they either could not afford the cost of insurance or lost coverage after being laid off.2 Payment Structures In Health Care Industry ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Yet, remarkably, 55 percent of Americans do not approve of the Affordable Care Act (ACA).3 In 2010, the Demo- cratic Congress passed the ACA—better known as Obamacare—in an effort to increase coverage for those individuals without health insurance. The Republican House of Representatives has voted numerous times to repeal the law, and the GOP has made the legislation the central target of its partisan attacks. At first glance, this concerted opposition would appear to be the result of a lack of understanding on the part of the public, or merely political theatrics. Indeed, a Pew Research poll has indicated that, despite the displeasure with the ACA, 75 percent of Americans do not know how the law would impact them personally.4 However, is there, in fact, any real cause—beyond blind partisanship—to be dissatisfied with the ACA? Such an essential policy cannot be analyzed within the proverbial political echo chamber; policy makers and ordinary Ameri- HARVARDKENNEDYSCHOOLREVIEW.COM64 cans alike must objectively examine the merits and shortcomings of the law, several years after its passage. Without this more nuanced analy- sis, Americans resign themselves to blindly take sides in a partisan war that threatens the future of our health care system, our economy, and the well-being of American citizens. To adequately understand the suc- cesses and failures of the law, we need to return to the bill’s origins: Massachusetts, circa 2006. This journey back in time reveals a truth that conforms to neither of the carefully cultivated liberal or conservative talking points: the ACA, modeled on Massachusetts health reform and facing similar political and practical constraints, largely addresses access to health care and quality improvements but does not sufficiently confront the out-of-con- trol growth of health care costs. Under then-Governor Mitt Romney, Massachusetts discovered a successful recipe for universal cover- age that would also satisfy important industry stakeholders.5 It is not sur- prising, then, that these same policy ingredients would reappear years later in the ACA. However, these policy choices do not necessarily rep- resent the best, most affordable solu- tion to providing increased health coverage; instead, they represent the policies that could both achieve expanded health coverage and also survive the Massachusetts political process. The ACA has many complex parts, including Medicaid expansion, Medicare reform, and incentives for changing the current fee-for-service reimbursement method, but the legis- lation contains no direct measure to decrease the per-unit cost of medical services—unjustifiably higher in the United States than anywhere in the world.6 The ACA, like Massachusetts reform, accomplishes its primary objective: expand health care access in a politically constrained environ- ment. At the time, cost control was, by necessity, an ancillary concern. Yet the inability of the ACA to sufficient- ly address cost control will ultimately erode our health care system un- less future reforms are made. What, therefore, should be our focus? We must shift the conversation away from repealing the ACA and toward tackling the equally massive problem of excessive costs. MASSACHUSETTS HEALTH CARE REFORM During the 2006 health care fight, Governor Romney had one primary goal: to ensure the passage of health care legislation that would effectively expand health coverage, even if that meant not addressing every aspect of the health care conundrum, particu- larly cost control. He and his allies in the legislature capitalized on a win- dow of opportunity to pass reform, utilizing valuable lessons from their predecessors who failed at the same task. Massachusetts’s health reform would ultimately prove a success because the politicos behind the bill provided a policy framework that managed to both expand coverage and also garner the support of key stakeholders, such as businesses and health care industries that had previ- ously opposed reform. But it was precisely this push to satisfy key stakeholders that, while pivotal to the legislation’s passage, would also leave skyrocketing costs unsolved. Romney’s interest in health care reform was driven by necessity. In TO ADEQUATELY UNDERSTAND . . . THE LAW WE NEED TO RETURN TO THE BILL’S ORIGINS: MASSACHUSETTS, CIRCA 2006. VOLUME XIV 65 2004, a federal waiver for a Mas- sachusetts Medicaid program was up for renewal. This waiver provided $385 million annually to fund safety net hospitals and was to be renewed every five years by the U.S. Depart- ment of Health and Human Services (DHHS). Contrary to expectations, in the wake of President George W. Bush’s reelection, the DHHS denied renewal. The result was disastrous; the state would lose $1 billion in federal funding over the next three years. Governor Romney and mem- bers of the Massachusetts legislature scrambled to find a solution. They eventually proposed to the DHHS that rather than use the waiver to support safety net hospitals, they cover 600,000 uninsured with the available funds. Essentially, they would create universal health care in Massachusetts with the aid of government subsidies. The DHHS, excited at the prospect, accepted their proposal.7 In the words of Dr. John Mc- Donough, former cochair of the Massachusetts Joint Committee on Health Care and former Senior Advisor on National Health Reform to the U.S. Senate Committee on Health, Education, Labor and Pen- sions: “Massachusetts put a financial gun to its head that made passage of universal coverage legislation a policy, political, and financial neces- sity and the Bush administration provided the bullets.”8 Romney, who had shown little interest in universal coverage pre- viously, needed to find a path for covering Massachusetts’s uninsured, and he needed to do it quickly. The majority of the uninsured were between the ages of eighteen and sixty-four, comprising healthy young adults, individuals who could not afford coverage, and the poor, who were Medicaid-eligible but had not enrolled.9 Romney needed to target these uninsured groups through a com- bination of private marketplace re- forms and government assistance. He was not the first to attempt this bal- ancing act. In 1988, Massachusetts Governor Michael Dukakis tried but failed to pass a bill that would have dramatically expanded health coverage in the state. He attempted this partly through a policy called pay-to-play, in which employers with six or more employees would be mandated to provide health insur- ance, and infuriated business owners in the process. Payment Structures In Health Care Industry Many of the individuals who had worked on the Dukakis health care reform still carried scars from the 1988 defeat. They did not want to face a repeat experience. Nancy Turnbull, a professor at the Harvard School of Public Health, recounts the key lesson from the Dukakis health care push: without the support of business and other health care industries, reform efforts were bound to fail.10 Consequently, Romney’s health bill would need to cover Mas- sachusetts’ uninsured, be financially feasible, and also manage to gain the support of businesses. Additionally, he needed to achieve all of this with- out upsetting the national Republi- can Party and his future presidential aspirations.11 The lessons of previous attempts, and the incentives facing the health care industry, led the legislature to craft a bill standing on three main policy legs (see Figure 1). Each proved essential to the success of the plan—and would later appear in the ACA as well.12 The first leg involved systemic reform of health insurance in Mas- sachusetts. This had two major elements. One was guaranteed issue, which eliminated insurers’ ability to deny coverage based on preexisting conditions. The other element was the development of a marketplace— the Commonwealth Connector— where employers and individuals could buy coverage. The idea of an exchange was particularly popular among Republicans, who favored private competition in the health market.13 The second policy leg was an in- dividual mandate to purchase health coverage or pay a fine. Originally, the Heritage Foundation (a conservative think tank) and other Republicans had proposed the mandate as an alternative to President Bill Clinton’s failed health care bill in 1993.14 Romney worried that the mandate would be too radically conservative. However, the Urban Institute (a non- partisan economic and social policy research group) and other groups emphasized to him the perceived fi- nancial importance of the mandate.15 Payment Structures In Health Care Industry ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Universal Coverage Subsidies for Low-Income Residents Sys- temic Health Insurance Reform Individual Mandate Figure 1 — John McDonough’s three- legged policy to achieve universal health care coverage. HARVARDKENNEDYSCHOOLREVIEW.COM66 essential stakeholders. Overall, stakeholders believed this reform bill would benefit them.18 This story would largely repeat itself during the passage of the national health care bill, and the result would look remarkably similar. Importantly, Massachusetts’s health reform can teach us a valu- able lesson relevant to the ACA as well: improving access, while politi- cally challenging, has proved easier than fixing cost. Today, 98 percent of Massachusetts residents have health coverage, but this increase in the in- sured population did not reduce the state’s health care costs—the highest health expenditures in the nation, at $9,728 per capita, compared to a median of $6,795.19 This high cost is not a result of the 2006 reform, but was not corrected by the legislation either (see Figure 2). BIRTH OF THE AFFORDABLE CARE ACT IN 2010 Like Romney, Obama faced the challenge of expanding access while countering reluctant stakehold- ers. Consequently, it should be no surprise that the ACA shares similar characteristics and unaddressed is- sues with the Massachusetts legisla- tion. This includes the lack of truly effective cost control. Despite the public’s uncertainty regarding health care, many politi- cians in Washington understood the impact it was having on the economy and the well-being of many Ameri- cans. In illustration of this point, during the 2008 presidential election, even while the economy was head- ing into a recession, candidates from both parties discussed their plan to reform the health care system. With the election of Obama, and with Democratic control of both the House and Senate, the passage of national health care reform suddenly seemed possible. Yet like Romney before him, Obama needed the support of key stakeholders. A wide array of com- peting interests had ensured that national health care reform had been discussed, attempted, and abandoned numerous times during the past cen- tury by presidents from both political parties, including Franklin Roosevelt, Richard Nixon, and, most recently, Bill Clinton.20 Since 1998, major health care stakeholders have spent over $5.36 billion lobbying Washing- ton, more than was spent in the same Figure 2 — Massachusetts versus United States per capita health care expenditures. Source: Graph based on data from Health Care Expenditures per Capita by State of Residence, Kaiser Family Foundation. Finally, the third policy element involved the passage of subsidies for individuals at 100 percent to 300 percent of the poverty level. This was partly made possible by an agreement between Romney and the DHHS. The annual $385 million previously dedicated to safety net hospitals would now support these subsidies and enable universal cover- age.16 Each of these legs would prove essential to the success of universal health coverage. Guaranteed issue without individual mandate would permit individuals to avoid purchas- ing insurance until they are sick, known as adverse selection. Several states, including Kentucky, New Hampshire, and Washington, saw health care premiums soar when they implemented guaranteed issue with- out a mandate as well.17 However, in theory, the combination of the man- date and guaranteed issue reduces adverse selection and stabilizes costs. To avoid punishing those individuals who cannot afford the coverage of- fered to them in the marketplace, the state must also provide subsidies for low-income individuals. Payment Structures In Health Care Industry Crucially, this three-legged approach also had the support of VOLUME XIV 67 time period by the oil and defense industries combined.21 The pharma- ceutical industry was prepared to spend $200 million either fighting or supporting the national health care reform bill.22 For their part, the Clintons discovered the importance of these industries the hard way: the American public was in favor of health care reform when Clinton began his fight, but after months of negative advertisements supported by the health industry, opinions evolved, and health care passage failed. Obama, eager to avoid Clinton’s mistakes, presented stakeholders with the opportunity to shape policy. In a meeting called by the Senate Task Force, a room of gathered stakehold- ers was provided with three options for health care reform, which had been given the names Constitution Avenue, Independence Avenue, and Massachusetts Avenue: respectively, undergoing a major overhaul (single payer, etc.) of the current system; implementing more limited reforms (possibly tax credits and smaller mar- ket reforms to incentivize purchasing insurance); and adopting the Mas- sachusetts reform as a template. After hours of discussion, the stakeholders voiced unanimous support for the Massachusetts Avenue approach. Faced with similar incentives on a national scale as in Massachusetts, public and private stakeholders sup- ported a bill that, not surprisingly, would achieve near-universal cover- age in a similar manner to Massachu- setts’s reform.23 After two years of work, the ACA would be voted into law in 2010. In total, the ACA has nine titles and one amendment. Title I of the two thousand–page legislation reflects the bill’s Massachusetts ori- gins, employing the same three policy legs to expand health coverage to the uninsured.24 Thus, the ACA came to be defined by the same characteristics that allowed Massachusetts’s health reform to successfully increase ac- cess to health insurance. Foolishly, many Republicans tend to ignore the conservative bona fides of the ACA’s essential characteristics and ignore their role in allowing the legislation to grow insurance coverage. Repub- lican Senators Orrin Hatch (Utah), Tom Coburn (Oklahoma), and Rich- ard Burr (North Carolina) put the most recent repeal effort, in January 2014, forward. This proposal would repeal the individual mandate, the subsidies for the poor, and remove many of the protections against dropping care based on preexisting conditions.25 Such a proposal would, in effect, undermine precisely the pil- lars necessary for expanding health coverage. To make matters worse, their plan also cancels Medicaid for the working poor. People like my first patient would once again be faced with health coverage they could not afford. Despite all its shortcomings, repealing the current iteration of the ACA is no solution to America’s health care needs. Rather, we need policy that builds on the successes of the ACA, while addressing the remaining problems unanswered by the current law. THE FAILURE TO ADDRESS COST Massachusetts’s reform and the ACA—not to mention the various Republican suggestions—ultimately do too little to address the root cause of increasing health care cost: the unit price for health care services. Nor were they intended to achieve such a formable goal. Massachu- setts’s experience suggests that while an individual mandate is essential to maintaining basic financial feasibility, the policies that allow for expanded coverage are not going to fix the price tag of health care. The ACA—and its Massachu- setts prototype—achieves only small victories in controlling costs. In the case of the ACA, these include THE ACA . . . ACHIEVES ONLY SMALL VICTORIES IN CONTROLLING COSTS. PHOTO: FLICKR/CARBONNYC HARVARDKENNEDYSCHOOLREVIEW.COM68 Endnotes 1 Garfield, Rachel, Rachel Li- cata, and Katherine Young. The Uninsured at the Starting Line: Find- ings from the 2013 Kaiser Survey of Low-Income Americans and the ACA. Henry J. Kaiser Family Foun- dation, 6 February 2014. 2 Henry J. Kaiser Family Founda- tion. Key Facts About the Uninsured Population. Henry J. Kaiser Family Foundation, 26 September 2013. 3 Jones, Jeffrey M. “Americans’ Ap- proval of Healthcare Law Declines.” Gallup, 14 November 2013. 4 Pew Research Center for the People and the Press. As Health Care Law Proceeds, Opposition and Uncertainty Persist. Pew Research Center, 16 September 2013. 5 McDonough, John E. Inside Na- tional Health Reform. University of California Press, 2012. 6 Anderson, Gerard F. et al. “It’s the Prices, Stupid: Why the United States Is So Different from Other Coun- tries.” Health Affairs 22(3): 89-105, May 2003. 7 McDonough, Inside National Health Reform. 8 Ibid. 9 Garfield, Licata, and Young, The Uninsured at the Starting Line. 10 Turnbull, Nancy. Lecture on Massachusetts Health Care Reform, John F. Kennedy School of Govern- ment at Harvard University, 5 Febru- ary 2014. 11 McDonough, Inside National Health Reform. 12 McDonough, John. Interview with the author on Massachusetts and the ACA, 15 January 2014. 13 McDonough, Inside National Health Reform. port politicians through campaign donations and aggressive political adverting. Who suffers from this boundless profiteering? The Ameri- can public. One in three Americans report struggling to pay medical expenses. Those households strug- gling to pay for health insurance are the true fatality of this health care industrial complex. If we are going to figure out how to address the cost of health care, however, Congress will not only need to relearn how to pass legislation, but also must do so without stake- holders blocking cost control efforts. At first blush such a task seems near impossible, foretelling a bleak future for the American health care system and economy. Yet Massachusetts, enjoying the success of universal coverage and some of the best quality care in the country, is now beginning to study methods of aggressively address- ing rising health care costs and has passed three bills directly targeting this issue. Notably, in 2012 Mas- sachusetts set annual spending limits on health care costs. Vermont is also discussing ways to address cost by moving to a single payer system. Once more, the country may need to turn to a progressive state for inspiration.31 We have expanded health care access; the legislation is a success in achieving this main goal. But without addressing the projected growth in health care costs, our health system threatens to engulf our economy, cause premiums to rise to levels unaf- fordable to even the middle class, and add millions to the already substan- tial group of uninsured in America. It is time for Congress to place the needs of ordinary citizens above those of powerful businesses, build on the progress already made under the ACA, and pass truly transforma- tive legislation that will decrease the unit price of health care. incentives for alternative payment methods, Medicare reforms, and penalties to hospitals for readmis- sion, but none of these will nearly be sufficient. Ultimately, we need to address why health care is so much more expensive in the United States than anywhere else in the world. The growth rate for health care costs in the United States is twice that of the general economic growth rate, and health care spending constitutes 18 percent of total gross domestic product (GDP). It is predicted that if this growth continues, by 2037 one in four American dollars will go to pay for health care, a proportion, the Congressional Budget Office argues, that is unsustainable.26 In contrast, Japanese citizens uti- lize their health care system twice as much as Americans, including almost three times the MRI usage, and are among the healthiest individuals on the planet. Japan also has universal coverage for its citizens.27 Simultane- ously, the nation spends a fraction of what we do for medications, medi- cal procedures, and diagnostic tests. Perhaps we get better-quality care for this high cost? In fact we do not; the deaths due to medical error dur- ing surgery is more than three times higher in the United States than in Japan.28 Stakeholders such as pharmaceu- tical companies, the health insurance industry, physicians, and hospitals have been making fortunes in the past three decades while Americans have watched their premiums con- tinue to rise as they struggle to afford health coverage. Unfortunately, filling the pockets of these wealthy indus- tries has made them powerful. The top five health insurance companies have been doing pretty well also, and in 2011 made $3.3 billion in prof- its.29 And lastly let us not forget the physicians, who make up the largest portion—27.2 percent—of all the top 1 percent of earners in the United States.30 This wealth translates into power when these profits help sup- Thomas C. Kingsley is a joint 2014 MD/MPH Candidate at the Universi- ty of Massachusetts and the Harvard School of Public Health. Payment Structures In Health Care Industry VOLUME XIV 69 14 McDonough, Interview on Massachusetts and the ACA; Mc- Donough, Inside National Health Reform. 15 Turnbull, Lecture on Massachu- setts Health Care Reform. 16 Garfield, Licata, and Young, The Uninsured at the Starting Line; McDonough, Inside National Health Reform. 17 McDonough, Inside National Health Reform. 18 Turnbull, Lecture on Massachu- setts Health Care Reform. 19 Henry J. Kaiser Family Founda- tion. Health Care Expenditures per Capita by State of Residence. Henry J. Kaiser Family Foundation, 2009. 20 Altman, Stuart, and David Shactman. Power, Politics, and Universal Health Care: The Inside Story of a Century-Long Battle. Pro- metheus Books, 2011; McDonough, Inside National Health Reform. 21 Brill, Steven. “Bitter Pill: Why Medical Bills Are Killing Us.” Time, 4 April 2013, 16-55. 22 Cummings, Jeanne. “Wield- ing Influence in Health Care Fight.” Politico, 28 December 2009. 23 McDonough, Inside National Health Reform; McDonough, Inter- view on Massachusetts and the ACA. 24 McDonough, Interview on Mas- sachusetts and the ACA. 25 Jost, Timothy Stoltzfus. “Be- yond Repeal—A Republican Pro- posal for Health Care Reform.” New England Journal of Medicine 370(10): 894-896, 6 March 2014. 26 Congressional Budget Office. The 2013 Long-Term Budget Out- look. Congressional Budget Office, 17 September 2013; Congressio- nal Budget Office. The Budget and Economic Outlook: 2014 to 2024. Congressional Budget Office, 4 Feb- ruary 2014; Emanuel, Ezekiel et al. “A Systemic Approach to Containing Health Care Spending.” New Eng- land Journal of Medicine 367(10): 949–954, 2012. 27 Kondo, James. “The Iron Triangle of Japan’s Health Care.” BMJ 330(7482): 55–56, January 2005; Babazono, Akira et al. “Does Income Influence Demand for Medi- cal Services Despite Japan’s ‘Health Care for All’ Policy?” International Journal of Technology Assessment in Health Care 24(1): 125-130, Winter 2008; Hashimoto, Hideki et al. “Cost Containment and Quality of Care in Japan: Is There a Trade-Off?” Lancet 378(9797): 1174–1182, 24 Septem- ber 2011. 28 Organization for Economic Co- operation and Development. Health Policies and Data. 29 Ubel, Peter. “Is the Profit Mo- tive Ruining American Healthcare?” Forbes, 12 February 2014. 30 White, Jeremy et al. “The Top 1 Percent: What Jobs Do They Have?” New York Times, 15 January 2012. 31 Mechanic, Robert E., Stuart H. Altman, and John E. McDonough. “The New Era Of Payment Reform, Spending Targets, and Cost Contain- ment in Massachusetts: Early Les- sons for the Nation.” Health Affairs 31(10): 2334–2342, October 2012. Copyright of Kennedy School Review is the property of President & Fellows of Harvard College and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. Payment Structures In Health Care Industry Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Discern cultural values of an organization by analyzing symbols Discern cultural values of an organization by analyzing symbols The student must then post 2 replies of at least 400 words. For each thread, students must support their assertions with scholarly citations in APA format. Each reply must incorporate scholarly citations in APA format. Any sources cited must have been published within the last five years. • At least 1 scholarly article or biblical integration; Discussion Board Forum 4 ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Managing Dynamic Organizational Processes Teresa L. Bell Masters of Business Administration Liberty University OnlineBUSI 610-B11: Organizational Design and Structure Dr. Clifton Howell March 2, 2021 Organizational Culture and Ethical Values The possibility of an outsider to accurately discern cultural values of an organization by analyzing symbols, ceremonies, dress and other observable aspects is approximately 33.3% in my opinion. To calculate this percent, I considered how the culture of an organization can be interpreted. As mentioned by Daft (2016), “identifying and interpreting culture requires that people make inferences based on observable artifacts” (p. 389). In order to review the observable aspects of an organization, I would need to look at rites and ceremonies, stories and sayings, symbols, organization structures, power relationships and control systems (Daft, 2016). In the detail that follows, I justify my percentage as I found only two out of the six observable aspects would be easy for an outsider to analyze an organization’s culture. The possibility of an outsider to discern an organizations culture by analyzing rites and ceremonies would be difficult as the outsider would not have a full understanding of what the rites and ceremonies mean in context to the culture of the organization. What a ceremony may mean in one organization may not be the same for another. Stories and sayings would be possible for an outsider to analyze the culture of an organization. Stories relayed although possibly embellished would set the standard for characteristics the organization embrace as normal and to be encouraged (Daft, 2016). Moving on to symbols, outsiders would be able to distinguish culture when looking at symbols organizations utilizes in certain circumstances. “Reward systems are part of a fundamental strategy to modelize organizational culture through the installation of symbols that has a direct impact on the employee value proposition” (Hepner, 2019, p. 13). An example of a symbol an outsider would recognize is the “Daisy Award”. HCA Healthcare utilizes the “Daisy Award” to recognize outstanding nurses who exhibit qualities such as clinical excellence, compassion and teamwork. The structure of an organization would be possible for an outsider to see as a whole, but the intricate details of the order in which an organization is designed structurally would not be. An outsider would not be able to determine the “degree of flexibility and autonomy” employees have in their duties (Daft, 2016, p. 391). Power relationships would not be easy for an outsider to use to analyze the culture of an organization. An outsider would not be able to tell who “influences or manipulates” others in relationships (Daft, 2016, p. 392). Finally, an outsider would not easily be able to determine an organizations culture by observing control systems. An outsider would not be afforded the “methods of financial control, rewards systems or how decisions are made” in an organization (Daft, 2016, p. 392). Innovation and Change Managers prefer stability, however, because of the demands of a changing environment, change is inevitable, therefore, I would tend to agree with the statement that change is a product of the environment and stability is a product of the organization (Daft, 2016). While it may be the desire of an organization to remain stable in its operations, this would prove detrimental to the viability of an organization. Changes in environment are inevitable. Organizations can respond in a few ways. Episodic change, continuous change, and disruptive change and innovation are responses an organization can respond to environmental pressure to change (Daft, 2016). Of these three, managers seeking stability would prefer the episodic change as this type of change allows for “periods of relative stability” (Daft, 2016, p. 422). Decision-Making Processes While I do believe managers are able to make decisions based on experience and intuition, I do not believe this is without some form of evidence-based management. “Increasing competition in the present dynamic business environment pressurizes companies to innovate perpetually” (Szutowski, 2020, p.182). As a result, decision making almost becomes second nature to mangers. Being able to successfully manage in an ever changing environment depends on the “quality of decisions made at…consecutive stages” (Szutowski, 2020, p.182). This is only possible if managers are provided the information from organizational control systems to utilize as a basis for the decisions being made, hence they are relying on evidence-based information when making these decisions (Szutowski, 2020, p.182). Conflict, Power and Politics In his description of rational verses political models of decision making, Daft (2016) explains that “typically, both rational and political processes are used in organizations” (p. 519). “The rational process perspective investigates how issues can be divided into structured decision problems” (Kolbe et al., 2020, p. 998). The assumption with the rational model is that issues are handled through a process involving analysis of alternative choices and what their outcomes may be prior to finalizing the decision (Kolbe et al., 2020). The assumption with the political model is that decisions are made in relation to “power, negotiation and mutual influence” (Kolbe et al., 2020, p. 998). Studies have indicated that the primary method of decision-making is make utilizing the rational model while at the same time exploring the political model by creating an environment where decision are supported by coworkers and peers (Kolbe et al., 2020). Biblical Integration In this forum there were several topics discussed: culture and values, innovation and change, decision-making process and conflict, power and politics. The bible is full of verses that can touch on any of these topics. Luke 6:31 discusses culture and values when indicating we should do unto others as we would have them do unto us (New Standard American Bible, 2002). Next, we discussed innovation and change. While we find in live the one constant is change, we have the promise that our Lord and Savior Jesus Christ is the same always; He never changes (Hebrews 13:8, New American Standard Bible, 2002). As we move to the topic of decision-making, we find in James we are reminded that if we lack wisdom, we can go to God with our request guidance in decision-making and He will provide (1:5, New American Standard Bible, 2002). Finally, we can see conflict, power and politics in many verses of the bible. One that comes to mind is also located in the book of James. James 1:2-4 states that we should be full of joy when we face trials; knowing that testing will produce unwavering resolve; lacking nothing (New American Standard Bible, 2002). References Daft, R. L. (2016). Organization Theory and Design (12th ed.) Mason: Cengage Learning.Hepner, L. (2019). Innovative reward as a strategical culture designer. Strategic HR Review, 18(1), 13-16. http://dx.doi.org.ezproxy.liberty.edu/10.1108/SHR-10-2018-0086 Kolbe, Linn Marie, Bossink, Bart & De Man, Ard-Pieter. (2020). Contingent use of rational, intuitive and political decision-making in R&D. Management decision, 58(6), 997–1020. Print.New American Standard Bible (2002). The Zondervan Corporation (original work published 1960) Szutowski, D. (2020). The Impact of Management Control Systems on Decision-Making Quality throughout the Innovation Process. An Empirical Analysis. Research Papers of the Wroclaw University of Economics / Prace Naukowe Uniwersytetu Ekonomicznego We Wroclawiu, 64(6), 182–195. https://doi-org.ezproxy.liberty.edu/10.15611/pn.2020.6.14 Answer preview to the possibility of an outsider to accurately discern cultural values of an organization by analyzing symbols Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Assignment: Design Project ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Design Project I need you to write introduction and background. write about design number (3) in the green book. All the information that you need are in files. Assignment: Design Project attachment_1 attachment_2 WIDENER UNIVERSITY Department of Civil Engineering CE 250 Dr. Mersky Spring, 2018 20 Points Design Project A four-lane highway of design speed 55 MPH currently ends at sta.12 in the village of Northern Babaganoosh. An extension is planned to connect Northern Babaganoosh with the central business district of South Pita. Your first assignment, as an employee of the firm of Salad Engineering (we’re so environmentally aware that even our name is organic), is to design a curve connecting the existing highway with the new South Pita Extension. Your design will include the horizontal and vertical alignment of the connector. Your design must contain the following: 1. A report clearly showing: ? ? ? ? ? ? ? ? ? ? ? ? Starting and ending stations of the horizontal curve Horizontal curve center line offsets every 20 feet Horizontal curve center line external distance Normal crown on tangents Lane and shoulder widths Superelevation rate Locations of all superelevation transition points (A-E) Starting and ending stations of the vertical curve Vertical elevations of the center line every 20 feet Station and elevation of maximum vertical elevation At least 2 CAD drawings. Justification of all selected design values including: o o o o o Side friction factor Superelevation Length of horizontal curve Length of vertical curve Use or nonuse of transition spirals 2. An appendix with your calculations clearly organized and labeled. Your design must consider: ? ? ? ? AASHTO requirements, specifications and recommendations Cultural and environmental impacts Current events Economic costs The following information is available: The existing highway approaches sta. 12 from the southwest at 210o counterclockwise from 0o. The South Pita extension direction will be southeast at 30o clockwise from 0o. The existing highway is horizontally tangent approaching sta.12. PI for the curve will be at sta. 12. Vertical grade of the existing highway is +2o. The South Pita extension will have a grade of -3%. The VPI of the grades occurs at the mid-station of the horizontal curve. The Eggplant Rock Historic Site (marking the location of the first commercial farm in Northern Babaganoosh) is centered 30 feet directly south of the inner edge of the current highway terminus and 11 feet east of the existing highway edge. It is round with a diameter of 6 feet. Rainfall infiltration within a distance of 2 feet from Eggplant Rock is an important aquifer recharge. Any infiltration reduction of more than 30% would cause irrigation deficits. The residential area of Northern Babaganoosh begins 60 feet directly north of sta. 12. In the Spring, endangered Atlantic Condors migrate over Northern Babaganoosh as low as 160? above mean sea level. While Atlantic Condors can avoid slow moving objects, they often cannot avoid vehicles traveling above 50 MPH (which largely explains why they are endangered). Surveying and construction costs for vertical curves are assumed to be $100.00/ft more than construction costs of grade tangents. Surveying and construction costs for horizontal curves are assumed to be $80.00/ft greater than construction costs for horizontal tangents. Excavation and removal of soil for crest curves costs $2.00 per cubic foot. Elevation at sta. 12 is 150’ above mean sea level. Your design must be consistent with the 2001 Green Book. … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Why EBP is an essential component of the practice of a BSN-prepared RN Why EBP is an essential component of the practice of a BSN-prepared RN Discuss why EBP is an essential component of the practice of a BSN-prepared RN. Identify two ways in which you will continue to integrate evidence into your practice and encourage it within your work environment . What obstacles could challenge this plan, and what steps will you take to minimize their impact? ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Answer preview to discuss why EBP is an essential component of the practice of a BSN-prepared RN. You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Describe the assessment of a patient detailing the signs and symptoms Describe the assessment of a patient detailing the signs and symptoms , assessment, plan of care, and possible differential diagnosis. Describe your clinical experience for this week. Did you face any challenges, any success? If so, what were they? Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and possible differential diagnosis. What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse ? Support your plan of care with the current peer-reviewed research guideline Submission Instructions: ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources Answer preview to describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and possible differential diagnosis. You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Perform a physical assessment of a community given Perform a physical assessment of a community given Assessment/Interview Select a community of interest in your region. Perform a physical assessment of the community. Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide. “Interview a community health and public health provider regarding that person’s role and experiences within the community. Interview Guidelines Interviews can take place in-person, by phone, or by Skype. Develop interview questions to gather information about the role of the provider in the community and the health issues faced by the chosen community. Complete the “Provider Interview Acknowledgement Form” prior to conducting the interview. Submit this document separately in its respective drop box. Compile key findings from the interview, including the interview questions used, and submit these with the presentation. PowerPoint Presentation Create a PowerPoint presentation of 15-20 slides (slide count does not include title and references slide) describing the chosen community interest. Include the following in your presentation: ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Description of community and community boundaries: the people and the geographic, geopolitical, financial, educational level; ethnic and phenomenological features of the community, as well as types of social interactions; common goals and interests; and barriers, and challenges, including any identified social determinates of health. Summary of community assessment: (a) funding sources and (b) partnerships. Summary of interview with community health/public health provider.Identification of an issue that is lacking or an opportunity for health promotion. A conclusion summarizing your key findings and a discussion of your impressions of the general health of the community. While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Answer preview to select a community of interest in your region. Perform a physical assessment of the community. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Major organizational subsystem Paper Major organizational subsystem Paper What one major organizational subsystem needs to be changed in the organization? Justify your choice. How does it compare to a similar successful organization? How will the subsystem change affect the two other subsystems within the organization that you have identified and how will you realign the total system? HRM-Assignment-1 MGT420-Human-Resources-and-Change-.-Assignment-Template-1 ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Answer preview to what one major organizational subsystem needs to be changed in the organization You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10