Exploring an Object Essay Example | Topics and Well Written Essays - 1750 words

Exploring an Object - Essay Example Description: My grandfather’s weapon is a doubled barreled, semi-automatic CZ-USA Sporting Shotgun, which uses â€Å"ammunition of 12 or 20 gauges† and best suited for hunting, which is one of his most favorite hobbies (CZ-USA Shotguns 17). It is capable of firing both lead as well as steel pellets. With walnut wood gunstock and fore end, and â€Å"checkering† on its â€Å"gripping surfaces, it acquires a sleek outlook. The components of the â€Å"barreled action† are prepared in â€Å"construction steel† with the protection of â€Å"alkaline oxidation† on the surface (17). Its comfortable grip enables it to be balanced in both hands and it is easy to aim and shoot. Besides, the weapon facilitates best results even on the occasions of instinctive firing. Similarly, its trigger pull weight is low, and it possesses a high accuracy of fire, apart from having a â€Å"long service life and â€Å"high reliability† (17). The brown wood with a silver patch and the metallic steel barrels offer it an elegant look and render it a remarkable grace. (Image Source: CZ USA Shotguns 17) Formal Analysis: While normally people perceive a gun as merely a weapon, the fact remains that it connotes to concepts far beyond notions of an object of destruction. It represents class and power as well as emulates the emotion of pride in the person who possesses the equipment. Therefore, makers of gun pay meticulous attention in its design and visual appeal. The design of my grandfather’s shotgun illustrates these concepts and much beyond. Its whole structure and design inspires awe in the beholders’ eyes and the elongated barrel offers an impression of its muzzle power. The firearm’s heel is broader, which tapers down to its toe to a slightly pointed shape. Similarly, the stock is designed with a sharp slant upwards to the grip, while the grip is shaped to offer maximum comfort to the shooter when firing from the weapo n. In addition, the checkered design on the grip offers it great charm in close up besides providing extra firmness to the hold while gripping the weapon. The fore-end is also made in brown walnut wood, with the same checkered texture as in the case of the grip, to offer better hold on the weapon while firing from it. The magazine loading port is rendered in silver color, thus providing a contrast with the brown stock and base of the magazine tube. Similarly, the barrel done in metallic steel also compliments the color and appearance in full alignment with the stock and fore-end. The upper barrel is lined with steel grids, which give its design a three dimensional effect apart from providing it more sleekness. Further the elongated and rather narrow barrel best fits the athletic appeal of a sporting gun as well as renders it uniqueness from similar weapons. This object falls in the category of functional art, which envisages the concept that a piece of functional art is beautiful be cause of its â€Å"exquisite functionality† (Cairo xx). Thus, it can be construed that since the weapon serves a purpose and has functionality as a firearm, it needs to be categorized as functional art. Similarly, Cairo (2013) further clarifies that the ability to visualize is a tool and, therefore, functional art is a device, the aim of which is to â€Å"help an audience complete certain tasks† (23). Thus, it transpires that an object that serves a purpose falls in the cate

Leadership Essay Example | Topics and Well Written Essays - 750 words - 14

Leadership - Essay Example The proposed steps for this leadership plan are as follows: (a) Appoint an IT strategy team consisting of a Head of the group, a head of IT and at least three project development managers. This team should solicit ideas from team members and employees as well as focus groups on how the IT department’s performance can be improved. On the basis of these suggestions, revisions can be made to an existing plan on an annual basis. These revisions can also take into account the results derived from implementation of the Plan in the previous year and the loopholes or failures identified. (b) Incorporate measures in the Plan to prevent business failure. According to Pabrai (2004), a Disaster recovery Plan sets out the procedures to be followed in the event of errors caused by humans, environmental failures and natural disasters. Errors caused due to humans would also include failures and losses caused to the business due to terrorist attacks, while losses of data resulting from power outages and network failures could be classed as environmental failures. Losses to the business caused by natural events could include hurricanes, floods and similar natural calamities. Including a Disaster recovery element within the Plan would ensure that the Plan lays out specific procedures to tackle any of the above calamities. This would help the business to be prepared, so that employees are aware of procedures to be followed in tackling any emergencies and losses to the business can be minimized. Leadership has traditionally been associated with management, but this may not necessarily represent an accurate view because managers think incrementally while leaders think radically. Moreover, leadership involves a transformation in individuals, according to Spencer, â€Å"â€Å"transformational leadership is a process that changes and transforms individuals†. (Spencer 1).

Argumentative Essay Essay Example for Free

Argumentative Essay Essay Malcolm X expressed the pent up anger, frustration, and bitterness of African Americans during the major phase of the civil rights movement. According to Learning to Read, â€Å"I believe it took me a day. Then, aloud, I read back, to myself, everything I’d written on the tablet. Over and over, aloud, to myself, I read my own handwriting.† (Paragraph 8) This means that he basically read his own handwriting. In Malcolm X’s, Learning to Read, he enhanced his life with reading and comprehension by having to experience his black community being treated wrong and having to go to jail. According to Learning to Read, â€Å"Many who today hear me somewhere in person, or on television, or those who read something I’ve said, will think I went to school far beyond the eighth grade. This impression is due entirely to my prison studies.† (Paragraph 3) This means that he’s known for his famous speech. Either on television or someone who read something that he said. Malcolm X was imprisoned for a long time, and was studying while there. The qualities that he possessed while in prison were phenomenal and not worthy to the white people. But, he didn’t become intelligent in jail for them; he did it for his fellow black community. According to Learning to Read, â€Å"It had really begun back in the Charlestown Prison, when Bimbi first made me feel envy of his stock of knowledge.† (Paragraph 4) This really means that he really didn’t start to read and comprehend until he met Bimbi. However, Bimbi was the first person he met in prison that didn’t use slang language. It was a surprise to Malcolm, because he didn’t know there would ever be anyone learning to read and comprehend like him in jail. On the other hand, how did learning to read aid him to understand the struggle of African Americans in this country? From my understanding, I believe that it aided him by it freeing him physically in his mind. And, it aided him by leading black people in the civil rights movement. According to Learning to Read, â€Å"In my slow, painstaking, ragged handwriting, I copied into my tablet everything printed on that first page, down to the punctuation marks.† (Paragraph 7) This means that he basically was practicing his handwriting while, at the same time, reading the words and comprehending them. Also, how did it enable him to impress people of colors? In my opinion, I believe it enabled him by expanding his knowledge about blacks with the plight they were experiencing. To conclude, the central idea of the text was that reading and comprehension helped him understand the racism in the black community. Malcolm X was basically strong and opinionated. Also, he is ambitious and anxious to get the freedom for his people and for himself. The reason being was because to awaken black people or in other words, spark them.

Eal Observed In A Primary School

Eal Observed In A Primary School Learning a second language is one adaptation skill that proves to be necessary when diverse cultures come together.   For example, children from diverse linguistic backgrounds study English as a bridge to better education. The Rationale for Planning for Children Learning English as an additional language (2008) advocates that in planning for children who are learning English as an Additional Language (EAL), the following key principles must be observed: that bilingualism is an asset instead of a liability for children who know more than one other language other than their mother tongue or primary language.   This first language is essential not only in learning another language but also for ones identity formation. The EAL provider should keep the learner challenged cognitively with the continuous provision of linguistic and contextual support.   Lastly, the acquisition of another language should go hand in hand with the students cognitive and academic development within the same school environment and the student would not need outside support. It is already integrated in the inclusive curriculum given to the learner. Cummins (1984) came up with a matrix to explain the dynamics of second language learning development. One axis represents the BICS or the Basic Interpersonal Communicative Skills while the other axis represents the CALP or the Cognitive Academic Language Proficiency.   Baker (2006) explains that students engage in BICS when they communicate with contextual supports and props such as face-to face â€Å"context embedded† situations where they read the other persons non-verbal gestures, hand movements and sounds to support verbal communication. On the other hand, CALP happens in â€Å"context reduced† situations requiring higher order thinking skills such as analysis, synthesis or evaluation. This is usually encountered in more academic learning and communication where language is â€Å"disembedded† (Baker, 2006). This paper will report observations in a primary school that embraces multiculturalism and multilingualism and analyzed according to theories and to its compliance to standards and policies for implementing English as an Additional Language (EAL). Observations were done for key stage 2. The physical environment of the school and classroom Upon entering the school, a large map welcomes people with the sign that read: â€Å"Welcome to our school.   We come from all over the world and we speak 27 languages†.   For each language, it was connected to the country of origin as indicated in the map.   This sign gave a very warm welcome to anyone who visited the school no matter what culture he or she comes from. An IT room is available for any EAL learner to use whenever one needs to consult a computer for spelling or grammar or anything that pertains to the English language.   This additional resource to support their learning is another indication that the school anticipates learners needs and provides them when called for. The classroom observed had a big inflatable globe which represents a wide range of diversity is accepted there.   The children can freely explore the globe and search for their own countries and link it to their native language. A trained EAL teacher was employed by the school to help facilitate the cognitive, language and literacy development of foreign children.   Adults play a huge role in the language development of children, as they need someone who uses simple language in correct form and is flexible enough adjust his language to suit the childs (Clay, 1988).   Having a good second language teacher is essential to learning the language more fluently.   The researcher does not discount the fact that imitation of proper pronunciation and intonation is necessary. Hence, learners should have attentive ears and retentive minds, and of course, cooperative tongues to be able to speak fluently in such language.   Children also need opportunities to practice speaking and listening to the second language outside the language lessons, so that means they need a support system of learners to interact with. The school acknowledged and respected the childrens different cultures. As an example, the school held a Polish mass celebrated by a Polish priest on Tuesdays. Cummins (1986) contend that children are empowered when their cultural roots are celebrated.   Usually, when schools and teachers do not seriously consider foreign students their native culture, these children feel unaccepted and unworthy to belong to their classes, hence display inappropriate behavior.   They become lost in terms of academic achievement and develop insecurities about their skin color, ethnic characteristics or language accents.   Such embarrassment develops stress or anxiety during class. The students family may likewise seem withdrawn or non-participative in their childrens schooling and feel the same sense of not belonging to the new culture they have joined.   In view of this, culturally-relevant teaching must be learned by teachers.   Such teaching takes into consideration the cultural background of the students at all times.   It also keeps in mind cultural aspects in all interactions with students on both personal and educational levels. (Edwards Kuhlman, 2007).   Students cultures, languages and experiences need to be acknowledged, valued andused as important sources of their education because they deserve the best that society can give them.   This involves teachers learning about students backgrounds and personal experiences to use as tools to make connections with these students.   Some strategies that teachers can employ are the inclusion of the various histories, contributions, perspectives and concerns relevant to the diverse backgrounds of students (The IRIS Center for Training Enhancements, n.d.).   Incorporating these in the curriculum makes learning meaningful to these students.   Multicultural education using literature from various cultures engages such children in reading and writing and makes them eager to learn the social or cultural contributions made by various groups of people. Observations of the children It was learned that the children in the school were not allowed to speak their native language within the classroom but they are free to speak it outside with their peers.   This is part of their learning the English language in the classroom. This may be considered by the school as an effective way to immerse the children in the English language, however, the Rationale for planning for children learning English as an additional language (2008) recommends that children have free access to their primary language (L1) in order to fully understand their second or additional language (L2), so the classroom teacher should be more lenient in allowing children to use their L1 in class as a tool to learn their L2. There was quite a number of foreign students enrolled in the school.   The researcher approached some and asked them some questions regarding EAL.   Two Portuguese children were observed to be peer-teaching.   One was already fluent in the English language while the other was still struggling so the more adept one was helping him translate some words. Vygotsky (1962, as mentioned in Clay, 1998) emphasizes the value of childrens talk and their growing ability to articulate their understanding of their world orally and in writing.   Taking part in negotiating meanings is part of the educational process, and Vygotsky believes that just being with others helps children learn. In observing the two Portuguese children, some theories may explain why the more English language-adept child uses their native Portuguese to teach the less knowledgeable child. Swain Lapkin (2000) conclude in their study that the first language is by default, a tool used by students to learn their second language.   Collaborating with other students in tasks for learning a second language, students try to make sense of the requirements and content of the task, focusing their attention on language form vocabulary use and overall organization, then turn to their native language to process and discuss before finally getting back to completing the task.   Swain and Lapkin point out that without the use of their native language, they might not be able to accomplish the task effectively or it might not be accomplished at all.   They argue that the insistence of not being allowed to access their first language in a linguistically and cognitively complex task of decoding a second lan guage task would deprive them of an important cognitive tool.   They stress that bilingual programs that allow for the development and maintenance of the first language while learning the second language are successful in both goals. The researcher interviewed two students who both spoke Spanish.   When asked if they speak to each other in their native language, they admitted they only speak it at home with their parents.   They did not speak it in school and said they were more comfortable speaking in English because most of the time they were in school and with friends who all spoke the English language.   In this case, Lamberts (1977) subtractive bilingualism seems to be taking place as the childrens first language is being extinguished by the second language which is English.   Otto (2010) elaborates on Lamberts   theories on bilingualism. One issue in second language acquisition is its effect on the first language of the individual.   The immense concentration necessary to learn a second language may create a negative impact on the first language. This is known as Subtractive bilingualism.   When a child becomes fluent in a second language due to immersion in that language, there is a strong te ndency to forget the first language, causing disruptions in communication with family members who only know the first language.   Transmission of cultural beliefs and parenting interactions would need a shared language for it to be successful. If not, social relationships with families or other members of the community who are monolingual may break down. On the other hand, in learning a second language, a child need not forget the first language, but can be fluent in both.   This is called Additive Bilingualism which means that although a child actively learns a second language, concurrently, there is continued development in the home language (Lambert, 1977; Otto, 2010).   The goal is to enhance language skills in both languages.   In view of this, the case of the two Spanish boys interviewed by the researcher may also display additive bilingualism because they continue to speak L1 at home even if they are gaining competence in L2 in school and with peers. Two boys from Ethiopia do not speak the same language even if they come from the same country. In the different parts they come from, different languages were also used.   One of the boys speaks three languages French, English and Portuguese because his mother came from Portugal and his father from Ethiopia.   The other boy speaks Amharic which is similar to Arabic, but he is from Ethiopia.   Leon (1996) has outlined the need for migrant workers and their families to be supported in gaining English-speaking competencies to enable them to live more satisfying lives in English-speaking environments. He said lack of bilingual support for students impedes their motivation to learn, as they could not cope with other English-speaking peers, so they feel unwanted, and just skip school.   Gaining English language competency for these children will also raise their self-esteem so they get to be more confident to develop more personal and academic skills. Although the observations were limited to what has been reported, it already gave the researcher a good picture of how the school upholds the EAL program.   The foreign children seem to be comfortable in the school setting as they have settled in well in a welcoming environment.   The government consultation document ‘Aiming High: Raising the Achievement of Minority Ethnic Pupils (DfES 2003) states that â€Å"the particular needs of bilingual pupils are best met through a coordinated whole school approach led by headteachers and senior managers.† (DfES, 2005, p. 14).   The ethos of the primary school observed reflected a clear respect for the multicultural perspective. Otto (2010) contends that one of the main challenges posed by the English as a Second Language (ESL) approach is the development, selection and implementation of effective strategies and instructional techniques to suit the diverse learners since they come from various backgrounds.   The Rationale for planning for children learning English as an additional language (2008) takes upon Vygotskys (1978) concept of â€Å"scaffolding†.   As the term implies, scaffolds are temporary supports in the process of learning which are gradually taken away when the student is already capable of learning without them.   In EAL, scaffolding comes in three forms, One is scaffolding by adults by making their expectations clear by sharing learning objectives and criteria for success with the students by way of modeling and demonstrating the English language, ‘recasting of the childrens language from their L1 and providing them with opportunities to use their whole language repertoire to aid them in understanding their L2.   Another form of scaffolding is through collaborative work.   They engage in small group talks or work in pairs, usually with children who are more adept in the language are paired with children who are less adept, such as the two Portuguese boys observed peer-teaching in the school. The teacher may also use scaffolding thro ugh visual support, via pictures, props, models, frames and language prompts, graphic organizers, diagrams, maps, plans and essentially all the print and picture cues they put up in the environmental setting (Rationale, 2008).   Most of these scaffolds were observed in the school. The numerous issues on second language learning, especially English, only prove that it is creating much impact on the development of children from diverse cultures.   More and more people consider its advantages and possible disadvantages.   Such amount of attention is worth it because people think up of ways on how to maximize its benefits.   Learning another language apart from ones native language helps children be ready to be highly competent in an increasingly globalized world.   However, although they become bilingual, it should not be forgotten that they also become bicultural, and learning of one language and the culture that goes with it does not mean forgetting their original one. Teachers should take into consideration that their non-English speaking students should learn English in both its context and language elements so the students gain a better understanding and appreciation of the English language.

Othello :: essays research papers

(II, i, 176-178, p.71) IAGO (To himself) He takes her by the hand. Yes, very good, whisper to her! With This little web, I’ll catch a fly as big as Cassio. Yes, Smile at her, go ahead! I’ll catch you in your own flirtation. Character Intent: Iago is definitely speaking these lines for one clear reason. Iago wants to manipulate Cassio and get him close to Desdemona therefore Othello could see this occur and become angered. Iago knows that Cassio is a very flirtatious person and therefore, Iago’s evil deed might be a very easy task to accomplish. Iago uses the metaphor of the fly and the spider web to symbolize Cassio (fly) getting caught in the web (getting caught in Iago’s manipulation). Writer Intent: Shakespeare uses these lines in the dialogue to show Iago’s sarcasm about the situation occurring. Shakespeare also has Iago speak to himself in this part of the dialogue to show the insanity and sickness that Iago has built up inside, just aching to be released. Shakespeare also puts this dialogue into the story to show how courteous and respectful Cassio really is to Desdemona. And by seeing this, Shakespeare had the perfect opportunity to let Iago’s plans unfold. Behavior: The following lines should be said very dementedly by Iago. He should read the lines very slowly and creepy to show how passionate Iago is in wanting to achieve his goal of destroying Othello. (II, i, 197-201, p.73) OTHELLO If I were to die right now, I would die perfectly happy; for I’m afraid I am so splendidly content that I won’t have another joy like this one for the rest of my life. Character Intent: Othello spoke these lines in the dialogue to show the only thing he cares about. Othello shows that he cares about and loves Desdemona. He really puts his point across to everyone by saying that even if death struck him down at that very moment, he would die happy since he had the chance to see the love of his life, Desdemona. Othello makes it clear that even after his hellish fleet, the voyage would not be over until Othello saw his beautiful bride. Writer Intent: Shakespeare puts these lines in the story because they show a really strong meaning. This line reinforces everyone that Othello and Desdemona are in love with each other. Shakespeare shows the deep relationship between Othello and Desdemona to show how much they truly care and love each other.

Cuba :: essays research papers

The weeks that have elapsed since that fatal event of February 15th have been making history in a manner highly creditable to the American government and to our citizenship. Captain Sigsbee, the commander of the Maine, had promptly telegraphed his desire that judgment should be suspended until investigation had been made. The investigation was started at once, and 75 million Americans have accordingly suspended judgment in the face of a great provocation. For it must be remembered that to suppose the destruction of the Maine an ordinary accident and not due to any external agency or hostile intent was, under all the circumstances, to set completely at defiance the law of probabilities. It is not true that battleships are in the habit of blowing themselves up. When all the environing facts were taken into consideration, it was just about as probable that the Maine had been blown up by some accident where no hostile motive was involved, as that the reported assassination of President Barrios of Guatemala, a few days previously, had really been a suicide. . . . It has been known perfectly well that Spanish hatred might at any time manifest itself by attempts upon the life of the American representative at Havana, Consul General Fitzhugh Lee. This danger was felt especially at the time of the Havana riots in January, and it seems to have had something to do with the sending of the Maine to Havana Harbor. The Spaniards themselves, however, looked upon the sending of the Maine as a further aggravation of the long series of their just grievances against the United States. They regarded the presence of the Maine at Havana as a menace to Spanish sovereignty in the island and as an encouragement to the insurgents. A powerful American fleet lay at Key West and the Dry Tortugas, with steam up ready to follow the Maine to the harbor of Havana at a few hours' notice. All this was intensely hateful to the Spaniards, and particularly to the Army officers at Havana who had sympathized with General Weyler's policy and who justly regarded General Weyler's recall to Spain as due to the demand of President McKinley. The American pretense that the Maine was making a visit of courtesy seemed to these Spaniards a further example of Anglo-Saxon hypocrisy. That this intense bitterness against the presence of the Maine was felt among the military and official class in Havana was perfectly well known to Captain Sigsbee, his staff, and all his crew; and they were not unaware of the rumors and threats that means would be found to destroy the American ship. It was, furthermore, very generally supposed that the Spanish Cuba :: essays research papers The weeks that have elapsed since that fatal event of February 15th have been making history in a manner highly creditable to the American government and to our citizenship. Captain Sigsbee, the commander of the Maine, had promptly telegraphed his desire that judgment should be suspended until investigation had been made. The investigation was started at once, and 75 million Americans have accordingly suspended judgment in the face of a great provocation. For it must be remembered that to suppose the destruction of the Maine an ordinary accident and not due to any external agency or hostile intent was, under all the circumstances, to set completely at defiance the law of probabilities. It is not true that battleships are in the habit of blowing themselves up. When all the environing facts were taken into consideration, it was just about as probable that the Maine had been blown up by some accident where no hostile motive was involved, as that the reported assassination of President Barrios of Guatemala, a few days previously, had really been a suicide. . . . It has been known perfectly well that Spanish hatred might at any time manifest itself by attempts upon the life of the American representative at Havana, Consul General Fitzhugh Lee. This danger was felt especially at the time of the Havana riots in January, and it seems to have had something to do with the sending of the Maine to Havana Harbor. The Spaniards themselves, however, looked upon the sending of the Maine as a further aggravation of the long series of their just grievances against the United States. They regarded the presence of the Maine at Havana as a menace to Spanish sovereignty in the island and as an encouragement to the insurgents. A powerful American fleet lay at Key West and the Dry Tortugas, with steam up ready to follow the Maine to the harbor of Havana at a few hours' notice. All this was intensely hateful to the Spaniards, and particularly to the Army officers at Havana who had sympathized with General Weyler's policy and who justly regarded General Weyler's recall to Spain as due to the demand of President McKinley. The American pretense that the Maine was making a visit of courtesy seemed to these Spaniards a further example of Anglo-Saxon hypocrisy. That this intense bitterness against the presence of the Maine was felt among the military and official class in Havana was perfectly well known to Captain Sigsbee, his staff, and all his crew; and they were not unaware of the rumors and threats that means would be found to destroy the American ship. It was, furthermore, very generally supposed that the Spanish

Cost, Access, and Quality Essay

*Access to care may be defined as the timely use of needed, affordable, convenient, acceptable, and effective personal health services. Accessibility refers to the fit between the location of a provider and the location of patients. *Administrative costs are costs associated with the management of the financing, insurance, delivery, and payment functions. These costs include management of the enrollment process, setting up contracts with providers, claims processing, utilization monitoring, denials and appeals, and marketing and promotional expenses. *An all-payer system requires the participation of all major health care payers in a nationwide cost-containment program. APG stands for ambulatory patient groups, which are based on a patient classification and payment system designed to identify and explain the amount and type of resources used in an ambulatory visit. Patients in an APG have similar clinical characteristics, similar resource use, and similar cost. *Clinical practice guidelines (also called â€Å"medical practice guidelines†) are explicit descriptions representing preferred clinical processes. They are standardized guidelines in the form of scientifically established protocols designed to guide physicians’ clinical decisions. *Competition refers to rivalry among sellers for customers. In health care delivery, it means that providers of health care services would try to attract patients who have the ability to choose from several different providers. Although competition more commonly refers to price competition, it may also be based on technical quality, amenities, access, or other factors. *Cost-efficiency evaluates the relationship between increasing medical expenditures/risks and improvements in health levels. A service is cost-efficient when the benefit received is greater than the cost incurred in providing the service or the potential health risks from additional services. *Cost shifting refers to the ability of providers to make up for lost revenues in one area by increasing utilization or charging higher prices in other areas. *Critical pathways are case specific plans of medical care that identify along a time line w ho will provide what interventions and what the expected outcomes would be. *Demand-side incentives refer to the cost-sharing mechanisms that place a larger cost burden on consumers, thus encouraging consumers to be more cost conscious in selecting the insurance plan that best serves their needs and more judicious in their utilization. *Defensive medicine is the practice of medicine that involves prescribing tests and services that are not medically justified but are likely to protect physicians against possible malpractice lawsuits. *Fraud involves a knowing disregard for the truth. It generally occurs when billing claims or cost reports are intentionally falsified. It includes pro vision of ser vices that are not medically necessary and billing for ser vices that were not provided. *Outcome is the end result obtained from utilizing the structure and processes of health care delivery. Outcomes are often viewed as the bottom-line measure of the effectiveness of the health care delivery system. *Overutilization occurs when the costs or risks of treatment outweigh the benefits and yet additional care is delivered. *The term peer review refers to the general process of medical review of utilization and quality w hen it is carried out directly or under the supervision of physicians. *PRO stands for peer review organization. PROs are state-wide private organizations composed of practicing physicians and other health care professionals who are paid by the federal government to review the care provided to Medicare beneficiaries to determine whether care is reasonable, necessary, and provided in the most appropriate setting. *Quality has been defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. *Quality assessment refers to the measurement of quality against an established standard. *Quality assurance is a step beyond quality assessment and is synonymous with quality improvement. It is the process of institutionalizing quality through ongoing assessment and using the results of assessment for continuous quality improvement (CQI). *Reliability reflects the extent to which the same results occur from repeated applications of a measure. *Risk management consists of proactive efforts to prevent adverse events related to clinical care and facilities operations and is especially focused on avoiding medical malpractice. *Small area variations refer to the unexplained variations in the treatment patterns for similar patients and health conditions in different parts of the country. *Supply-side regulation typically refers to antitrust laws in the U.S., which  prohibit business practices that stifle competition among providers, such as price fixing, price discrimination, exclusive contracting arrangements, and mergers deemed anticompetitive by the Department of Justice. *A top-down control over total health expenditures establishes budgets for entire sectors of the health care delivery system. Funds are distributed to providers in accordance with these global budgets. Thus, total spending remains within pre-established budget limits. The downside to this approach is that, under fixed budgets, providers are not as responsive to patient needs, and the system provides little incentive to be efficient in the delivery of services. Once budgets are expended, providers are forced to cut back services, particularly for illnesses that are not life-threatening or do not represent an emergency. *TQM stands for total quality management and is synonymous with continuous quality improvement (CQI). It is an integrative management concept of continuously improving the quality of delivered goods and services through the participation of all levels and functions of the organization to meet the needs and expectations of the customer. *Underutilization occurs when the benefits of an intervention outweigh the risks or costs, yet the intervention is not used. *The validity of a scale is the extent to which it actually assesses what it purports to measure. REVIEW QUESTIONS 1. What are the two main objectives of this chapter? 2. What are the three major cornerstones of health care delivery? 3. What is meant by the term â€Å"health care costs†? Describe the three different meanings of the term ‘cost.’ 4. Why should the United States control the rising costs of health care? 5. Name and describe the 9 major factors contributing to the high costs of health care. 6. What is a third-party payment/reimbursement? 7. Explain how, under imperfect market conditions, both prices and quantity of health care are higher than they would be in a highly competitive market. 8. Discuss price controls and their effectiveness in controlling health care expenditures. 9. Discuss the role of PROs (peer review organizations) in cost containment. 10. What are the two competition-based cost-containment strategies? 11. What does access to care mean? 12. What are the implications of access for health and healthcare delivery? 13. What is the role of enabling and predisposing factors in access to care? 14. What are some of the implications of the definition of quality proposed by the Institute of Medicine? In what way is the definition incomplete? 15. Discuss the dimensions of quality from the micro- and macro-perspectives. 16. Discuss the main developments in process improvement that have occurred in recent years.