MAJOR DEPRESSIVE DISORDER RESEARCH THROUGH THE COGNITIVE PSYCHOLOGY APPROACH Essay Example

MAJOR DEPRESSIVE DISORDER RESEARCH THROUGH THE COGNITIVE PSYCHOLOGY APPROACH Essay Major Depressive Disorder Research through the Cognitive Psychology Approach Name: Course: Date: We will write a custom essay sample on MAJOR DEPRESSIVE DISORDER RESEARCH THROUGH THE COGNITIVE PSYCHOLOGY APPROACH specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on MAJOR DEPRESSIVE DISORDER RESEARCH THROUGH THE COGNITIVE PSYCHOLOGY APPROACH specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on MAJOR DEPRESSIVE DISORDER RESEARCH THROUGH THE COGNITIVE PSYCHOLOGY APPROACH specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Major Depressive Disorder Research through the Cognitive Psychology Approach Introduction Major depressive disorder affects millions of people worldwide every year and has become a common clinical condition. Normally, a person suffering from this disorder normally exhibits a sad mood and disinterest in things that would previously have fascinated him or her. Depression primarily has an effect over the â€Å"whole body†. In this case, the patients’ emotions and behavior undergo immense alteration. The exact causes of this condition are hard to pin point with some believing that it is hereditary or may be caused by an imbalance of chemicals in the brain. It has been established that major depressive disorder is a common condition among people suffering from Parkinson’s disease (PD) as well as a major contributor to disability and poor life quality (Nilsson, Kessing, Sorensen, Andersen, Bolwig, 2002). However, it is important to realize the difficulty of assessing this condition in patients with PD because of overlapping symptoms and assessing it in patients with cognitive impairment. In this regard, the Movement Disorder Society endeavored to carry out a research over the assessment of depression among patients with PD. A number of rating scales are used for the assessment of depression. The research was hence carried out to ascertain their credibility and consequently make recommendations. Literature Review Symptoms of depression have a tendency of occurring in people suffering from PD with studies suggesting that 40 percent are usually affected. Symptoms of depression have been recognized as being main determinants of how healthy PD patient lives and can as well affect cognitive function, and functional ability. This therefore makes it essential for the recognition and assessment of symptoms in patients suffering from PD. The research was able to identify a number of rating scales for the assessment and screening of depression disorder. Apparently, these scales are used to assess depression among patients suffering from PD or not (Hahlweg Goldstein, 2007). For purposes of selecting the scales, the research included all scales used for the assessment of depression disorder and those with the potential utility of assessing depressed patients suffering from PD. Scales specifically designed for the assessment of conditions similar to depression such as anxiety, apathy, and anhedonia were excluded. At present, the diagnosis of depressive disorder is done through the diagnostic and statistics strategy (DSM-IV) as recommended by the American Psychiatric Association. However, contrary to what the research found on the diagnosis of depressive disorder, I was able to establish otherwise. In this case, in research studies and clinical practice, particularly in treatment trials and surveys measuring the symptoms of depressive disorder, the use of DSM-IV is often not useful or feasible. The use of DSM-IV has shortfalls and has been recommended to undergo for revision. Even though discussions over how valid this criteria for depression assessment were not at the scope of the research, the problems involved and how they influence the assessment of severity and presence of depression in PD patients needs to be recognized and discussed. Methods The research team endeavored to form a committee for investigating the credibility of depression rating scales for patients with PD. The committee included seven members from North America, Europe, and Australia and included psychiatrists, psychologists, and neurologists who had good records of accomplishment in the field of depression for patients with PD. The members of the task force identified problems affecting the assessment of major depressive disorder. The team also identified eligible scales to be investigated. In this regard, I think that the committee members should have been subjected to a survey or interview to verify their credibility within the depressive disorder field. This would have been an efficient way of ensuring that the team selected was qualified to execute the research task. Nevertheless, the committee members organized a survey on the types of scales used to assess depressive disorder. The response rate amounted to four percent with 79 out of 2000 neurologists returning their questionnaires. A poor turn out of responses in this case possibly means that few neurologists make routine use of depression scales. In this regard, since the results of the research were drawn from a limited resource, then that ultimately renders the findings partly inconclusive. However, the research committee endeavored to formulate proforma for allowing a structured assessment of the depression scales. The proforma showed descriptions over scale availability, content, acceptability, and use. Judging by this data collection method, the committee worked well with the little information source they received and made clear and detailed tabulations. All statements made from the information were referenced and quantitative and qualitative results were summarized and tabulated. The rest of the task force assessed completed reviews and modified them in tune with unanimous suggestions. The chairperson was responsible for summarizing the identified problems, reviews, and conclusions. The final report was modified following group discussions with the entire task force. Results DSM-IV defines major depressive disorder as a loss in pleasure or interest or depressed mood for a period not less than two weeks, together with other symptoms that represent change from previous psychological state. These other features are changes in weight or appetite, retardation, insomnia, slowed speech, thought, worthlessness feelings, fatigue, guilt, death or ideas of suicide. Fundamentally, there should exclusion of symptoms that suggest a general condition. From this finding, I was able to establish that rating some of the depression symptoms is a daunting task because of considerable overlap of depression symptoms and PD symptoms. However, it is not clear whether there should have been an adoption of an inclusive approach for rating scales. The decision concerning how the symptoms should be rated is not trivial and influences the results of the study. In this regard, using diagnostic criteria and scales that have automatic inclusion of all somatic symptoms is capable of leading to incorrect depression results. In this situation, patients are more likely to be diagnosed with depression without the core depression symptoms. Alternatively, scales that do not include these symptoms may exhibit poor validity of criteria, particularly at as the depression spectrum ends. For example, apathy is a cardinal symptom of depressive disorder. However, apathy also occurs independently without depression (Nilsson, Kessing, Sorensen, Andersen, Bolwig, 2002). The research was also able to establish that major depression in some aspects differs from depression in PD. Furthermore, most of the patients suffering from PD exhibit depressive symptoms that do not fulfill the conditions of a major depressive episode. The research was also able to establish that scales for assessing depression have different uses. For example, one purpose serves to assess how severe depression is and check how the patient responds to antidepressant treatments. For this research or clinical task, a scale’s reliability, responsiveness, and responsiveness to good changes is relevant. The other reason of using rating scales is screening patients with PD for the possibility of depression. For purposes of screening, each use has use has an importance in clinical settings that require self-rating scales or untrained raters. Scales with good specificity and sensitivity may be used as screening tools. Rating scales used in depression do not offer assessment timing, something that is particularly crucial in patients suffering from PD. Furthermore, majority of rating scales are clinician rated, or patient reported. In this case, inputting collateral information may prove beneficial when assessing patients with PD. However, how or whether to use such information needs to be operationalized. The research found nine scales for assessing depression for patients with PD. These include the beck depression inventory, the Hamilton depression scale, the Zung depression scale, the Geriatric depression scale, the Montgomery depression scale, and the hospital anxiety and depression scale. Additionally, the corner scale was incorporated because it is the only universal scale used for patients with cognitive impairment, a common condition among depression patients with PD (American Psychiatric Association, 2000). Some scales were not included but were considered because they only assess moods wit h short life such as Profile Mood States. Whilst the results were in recognition of the limitations of the DSM-IV diagnostic criteria and recommendations for criteria improvement, these DSM-IV criteria should have been used for purposes of measuring the validity of the criteria in the literature. All scales were established as valid even though structure was subject to variance thus leading to chances of differentiation of the results. There was no available data to suggest the one responsible for administering observer rated scales. However, information regarding the training need on each scale should have been provided. Discussion All scales reviewed in this research have some relevance in their purpose of assessing depressive disorder. Available scales for depression have a number of functions. Different purposes mean that different properties of the scales have to be taken into account. Recommendations should be made regarding how appropriate each scale should be used. Diagnosing depression should not solely be made based on a rating scale score. A mere score of these instruments cannot capture a comprehensive range of depression disorder. In this case, high scores may arise when the endorsement of somatic symptoms occurs (Sudak, 2012). On the other hand, low scores may occur even though serious symptoms of depression are present. For this reason, the standard for diagnosing depression has to remain the DSM-IV criteria. Limited evidence is enough to warrant the best scales for rating depression for patients with PD. The statistics from the research suggest that other scales may be useful. However, further studies need to be conducted. Patients are sometimes capable of perceiving their condition in an off rather than an on period. Off periods can be linked with psychiatric symptoms such as delusions, anxiety, and depression. These often improve with time since they are short lived. Since the reviewed scales have been made to make correct assessments, the preceding one or two weeks the off periods may not be considered. The recommendation in this case requires that patients exhibiting motor fluctuations to be assessed while they are in the on period. More studies need to be undertaken on the specificity, sensitivity, and negative and positive predictive values for every scale. Assessing the concurrent credibility of the scales should be made in comparison to the criteria for DSM-IV of major depression. The criteria of assessment of depressive condition are going through changes (Guay, 2012). Incorporating somatic symptoms in depression scales leads to incorrect scores for patients suffering from PD. This may therefore influence the outcome of treatment trials. This calls for an investigation in a clinical format. In general, the observer should use an inclusive approach when scoring answers and patients have to be informed that they should not attribute their symptoms to depression or PD when scoring scales of self-rating. The instruments evaluated in this research are not used to or were not designed to identify subsyndromal or minor depression, and do not offer reflections over the diversity PD mood disorders have. Thus, there is a need to make further characterization of other depressive disorder types. Furthermore, cutoffs need to make adopted for the purpose of research and a specified period designed to include a larger variety of depressive disorders rather than dealing with major depression through cutoffs. Furthermore, there is a need for separate assessment when using scales to measure anhedonia, anxiety of apathy. In this research, the team did not make an assessment on multidimensional scales. However, these scales may prove useful in certain circumstances and have to be validated prior to their recommendation for usage. The caregiver’s role in reporting depression symptoms needs to be operationalized and in particular with scales that assess depressive disorder with comorbid symptoms. Whilst assessing depressive disorder with patients suffering from PD, the task force committee agreed that a majority of the same setbacks would be encountered when a new scale for PD is being developed. At present therefore, the task force does not offer any recommendation for a new scale development. Rather, it advises better studying existing scales. Developing a depression scale in PD is feasible and relevant only when there is an agreement over certain conceptual issues. Furthermore, the aspect of comparing symptoms of depression in PD with those from psychiatric disorders bears advantages. In conclusion, it is vital to recognize that major depressive disorder is a widespread mental complication in the modern world that may sometimes lead to disability or disease such as Parkinson’s disease (PD). The Movement Disorder Society in the United States endeavored to carry out a research in order to assess depressive disorder among patients with PD. The research was able to identify a number of rating scales for the assessment and screening of depression disorder. In this regard, these scales are used to assess depression among patients suffering from PD or not. The research was able to establish that the diagnosis of depressive disorder is at present being carried out through the diagnostic and statistics strategy (DSM-IV). This is as recommended by the American Psychiatric Association. However, upon reviewing the findings of this research, it is vital to recognize that certain considerations need to be appreciated. In this case, I was able to establish that the diagnosis of depressive disorder should not solely be made based on a rating scale score. A mere score of these instruments cannot capture a comprehensive range of depression disorder. This implies that further tests need to be made carried to facilitate informed and correct conclusions regarding the psychological status of the patient in question (Puig Encinas, 2012). Reference American Psychiatric Association. (2000). Practice guideline for the treatment of patients with major depressive disorder. Washington, D.C: American Psychiatric Association. Brown, M. R. (2004). Major Depressive Disorder Research. New York: Nova Biomedical Books. Guay, A. (2012). Major depressive disorder. Delhi: Research World. Hahlweg, K., Goldstein, M. J. (2007). Understanding major mental disorder: The contribution of family interaction research. New York: Family Process Press. Nilsson, F. M., Kessing, L. V., Sorensen, T. M., Andersen, P. K., Bolwig, T. G. (2002). Major depressive disorder in Parkinson’s disease: a register-based study. Acta Psychiatrica Scandinavica, 106, 3, 202-11. Puig, F. J. E., Encinas, F. J. L. (2012). Effectiveness of Cognitive-Behavioral Treatment for Major Depressive Disorder in a University Psychology Clinic. The Spanish Journal of Psychology, 15.( 3). 1388-1399. doi: http://dx.doi.org/10.5209/rev_SJOP.2012.v15.n3.39423 Simpson, H. B. (2010). Anxiety disorders: Theory, research, and clinical perspectives. Cambridge: Cambridge University Press. Sudak, D. M. (2011). Combining CBT and medication: An evidence-based approach. Hoboken: Wiley.

Alternative Sources of Energy as a Replacement of Oil

Alternative Sources of Energy as a Replacement of Oil Alternative Sources of Energy as a Replacement of Oil Modern society depends on electricity, which is the main type of available energy. Most of the electricity is generated using nonrenewable resources. Accessible oil and gas reserves are slightly higher than their current annual extraction. However, when comparing the figures related to the assessment of known reserves of most available fuels with the numbers of their current consumption, humanity can estimate the maximum time, for which these reserves may be sufficient. For oil, time is 65 years; for gas, it is 44 years; for coal, it is 320 years. In order to solve the energy problems by technical means, specialists offer two contrasting scenarios: the development of new techniques of energy production and the development of technology for energy efficiency. Thus, the development of new techniques of energy production using alternative sources of energy and the ability to replace oil and gas by them should be considered. Solar Energy Today, for the conversion of solar radiation into electrical energy, people have two possibilities: to use solar energy as a heat source to generate electricity by conventional means (for instance, using turbo) or directly convert solar energy into electricity in solar cells. The implementation of both options is still undeveloped. Solar energy is used for melting substances, heating, distillation of water, as well as heating after concentration by mirrors. As solar energy is distributed over a large area (in other words, has a low density), any system for the direct use of solar energy should have a collecting device (collector) with a sufficient surface. The simplest device of this kind is the flat-plate collector, a black stove, well insulated from the bottom. It is covered with glass or plastic that transmits light, but does not allow the infrared heat radiation. In the space, between the plate and black glass tube, through which water, oil, mercury, air, sulfur dioxide flow, are placed. Solar radiation penetrating through glass or plastic in the collector pipe is absorbed by the black stove and heat the working medium in the tubes. Thermal radiation cannot escape from the reservoir; therefore, the temperature in it is much higher (200-500 C pa) than the ambient air temperature. This reflects the so-called greenhouse effect. Ordinary garden greenhouses, in fact, are simple solar collectors. However, the farther away the equipment is from the tropics, the less effective the horizontal collector is, since turning it after the sun is too difficult and expensive. Therefore, these collectors are usually set at a certain optimum angle to the south. More difficult and expensive collector is a concave mirror, which focuses the incident radiation in a small volume around a certain geometric point - focus. The reflective surface of the mirror is made of metallized plastic or made up of many small plane mirrors attached to a large parabolic base. Due to the special mechanisms, this type of collector is constantly turned to the sun; thus, it can collect the largest possible amount of solar radiation. The temperature in the working space of mirror reaches 3000 C (Orloff, 2008). Arguments against the Use of Solar Energy Solar energy refers to the type of energy, which consumes a lot of material resources for production. Large-scale use of solar energy results in a substantial increase of demand of materials and, consequently, the labor force for the production of raw materials, enrichment, obtaining materials, manufacturing heliostats, collectors, other equipment, transportation. Calculations show that the production of 1 MWh of electricity per year would cost between 10 000 and 40 000 hours of human labor, comparing with the figure 200-500 000 hours in traditional energy sphere. Electricity produced by of the solar rays is much more expensive than the energy obtained by conventional methods. Biofuels Bioethanol is, in fact, a normal ethanol, which is produced by hydrolysis or fermentation of sugar-containing plants or straw and husks with subsequent distillation or purification. Biodiesel is a type of biofuel on the basis of vegetable or animal fats (oils), as well as the products of esterification, which are used in pure form or as various blends with diesel fuel. Any type of vegetable oil can be used for the production of biodiesel, but, as a rule, for these purposes specific oils are used such as canola (84%), sunflower (13%) and soybean (2%) oils. The main advantages of biodiesel are: Renewable energy sources; Preservation of natural resources; Can be used in conventional, unmodified diesel engines; Storage conditions are similar to conventional diesel fuel; The possibility of extending the life of diesel engines is higher than of fuel oil; The production and use of biodiesel have about 80% less carbon dioxide emissions, and almost 100% - sulfur dioxide (reducing pollution) (Brown, 2007). Moreover, the use of 5% bioethanol results in reduced carbon emissions by 3.5% and E85 (85% alcohol fuel) by 50%. In the biofuels, the presence of 15% ethanol reduces CO2 in the exhaust gas by 25%, hydrocarbons and nitrogen oxides - by 5-15%. In addition to the environmental benefits, the use of biofuels makes a considerable commercial value; General Motors, Ford and Daimler-Chrysler created hundreds of thousands vehicles, operating on a conventional gasoline, as well as on a gasoline mixed with ethanol. Oil companies are also looking for an alternative and increasingly conceive projects for the production of biofuels. Thus, this year known oil company Shell will produce ethanol with Brazil's Cosan, the largest exporter of sugar cane, and will invest in the project hundreds of millions of dollars (Brown, 2007). Wind Energy Resources of wind energy are more than a hundred times higher than the water energy of all the rivers of the world. Total wind energy potential of the Earth is 1200 TW. The average wind speed at a height of 20-30 m above the surface of the Earth should be large enough that the power of the air flow, passing through the properly oriented vertical section, reaches a value that is acceptable for conversion. Wind power stations are built mostly DC. Fantail drives the dynamo-electric generator, which also charges the parallel connected batteries. The battery pack is automatically connected to the generator at a time, when the voltage at its output terminals is greater than on the battery terminals and is also automatically turned off. Theoretically, coefficient of the efficiency of energy use of the air flow can be equal to 59.3%. In practice, the maximum coefficient of beneficial use of wind energy in the real wind turbine is about 50%. In addition, some of the energy of the air flow is lost in the conversion of mechanical energy into electrical energy, which is carried out with an efficiency of typically 75-95%. Taking into account all these factors, the specific electric power supplied by real wind power units, apparently, is 30-40% of the capacity of the air flow (Melis, 2001). The most crucial argument against this type of alternative energy is the high cost of a wind machine. Geothermal Energy Energy land or geothermal energy is based on the use of the natural heat of the earth. The upper part of the earth's crust is the thermal gradient, equal to 20-30 C per 1 km depth, and, according to White (1965), the amount of heat contained in the earth's crust to a depth of 10 km (excluding the surface temperature), is about 12,6*10 26 J. These resources are equivalent to the heat content of 4,6 1016 tons of coal, which is more than 70 thousand times greater than the heat content of technically and economically recoverable coal resources of the world. For electricity production in the fields of hot water, a method based on the use of the vapor formed by evaporation of hot liquid on the surface is used. This method uses the phenomenon that when the hot water under high pressure in wells goes from the pool to the surface, its pressure falls, and about 20% of the liquid boils and turns to steam. This vapor is separated from the water and sent to the turbine. Water coming out of the separator can be subjected to further processing, depending on its mineral composition. This water can be pumped back into the rocks at once, or if it is economically justified, with a preliminary extraction of its minerals (Orloff, 2008). Arguments against the Use of Geothermal Energy High prime cost, high cost of facilities for producing energy from geysers are the principal arguments against this type of alternative energy. Furthermore, obtaining geothermal energy directly from magma is not technically feasible. However, geothermal heat in the upper part of the crust (to a depth of 10 km) is too scattered to solve world's energy problems. Resources suitable for industrial use are separate fields of geothermal energy, focusing on accessible depth. They have a certain amount of heat, sufficient for their use for the production of electricity or heat. Technologies, needed to use energy of the hot dry rock, just begin to develop. Ocean Thermal Energy Last decade is characterized by certain success in the use of ocean thermal energy. Thus, stations for mini-OTEC (Ocean Thermal Energy Conversion) are created. For the first time in the history of technology, mini-OTEC system could give the external load utility power, at the same time covering its own needs. Experience gained in the operation of mini-OTEC, will faster enable to build a more powerful OTEC-1 and begin to design more powerful systems of this type. Arguments against are the technological complexity of implementing and high cost of the construction of such a facility (Horton, 2008). The Energy of the Tides For centuries, people have speculated on the cause of tides. Today, it is reliably known that this powerful natural phenomenon, a rhythmic movement of sea water, is caused by gravity of the Moon and the Sun. The maximum possible power from one tide to another can be expressed by the equation W=p*g*S*R2,where p is the density of water, g is the acceleration due to gravity, S is the area of the Tidal Basin, R is the difference in level at high tide. As it can be seen from the formula for tidal energy, some places are the most suitable on the coast, where the tides have large amplitude, while contour and coastal features can make a big closed "basins". Capacity of plants in some areas can reach 2-20 MW. First maritime tidal power station with capacity of 635 kW was built in 1913 in the Bay of Dee near Liverpool. In 1935, the building of a tidal power plant in the U.S. was begun. Americans dammed part of Passamakvodi Bay on the East Coast, spent $ 7 million, but the work was stopped. Argentine experts offered to use substantially high tidal waves in the Strait of Magellan, but the government did not approve the expensive project. Since 1967, at the mouth of the Rance River in France, at high tide of 13 meters, a tidal power station with the capacity of 240 thousand kW with an annual return 540 thousand kW has been working. Soviet engineer Bernstein developed a convenient way of blocks building on TPS, hauled afloat to the right places, and calculated the cost-effective procedure for the inclusion of TPS in the grid in the hours of their peak load by consumers (Horton, 2008). Arguments against this kind of alternative energy are inconvenience for the construction due to the lack of conditions (mismatch in seabed, etc.) and high cost of installation. The Energy of Sea Currents Inexhaustible supplies of the kinetic energy of ocean currents, accumulated in the oceans and seas, can be converted into the mechanical energy and electricity using turbines, immersed in water (like windmills, "immersed" in the atmosphere). One of the projects of waves using is based on the principle of an oscillating water column. In the gigantic "boxes" without a bottom and with holes at the top, water level rises and falls down under the influence of waves. The water column in the box acts like a piston: sucks air and forces it into the turbine blades. Currently, in some countries, and especially in England, an intensive work in terms of using of waves energy is being carried out. The British Isles have a very long coastline; in many places, the sea is stormy for a long time. Scientists estimate that 120 GW can be obtained up by the energy of the waves of the British territorial waters, which is twice more than the capacity of all power plants owned by the British Central Electri city Authority. Argument against this type of alternative energy is its low efficiency. One can expect to use only about 10% of the energy flow. There are also the technical difficulties of tools development: harmonization of inertia of turbine wheels with the amount of air in ducts in such a way that inertia keeps constant speed of turbine shafts in a wide range of conditions on the sea surface. Different types of alternative energy sources, their description "for" and arguments "against" their replacement of oil were considered. Nonetheless, it is also necessary to consider the reality (Zehner, 2012). The thing is that the current global financial system is totally dependent on the ever-increasing supply of oil and natural gas. Global financial and economic systems are built on the aspiration of the sustainable economic "growth". This growth of economic activity increases the amount of spent energy. At the moment, the global economy is able to perceive only fossil fuels (primarily oil and natural gas) as the form of energy, reserves of which are rapidly running out. A barrel of oil contains the energy equivalent of almost 25 thousand hours of human labor. Moreover, just one gallon of gasoline is the equivalent of 200-500 hours of human labor. Almost all of the work done in the world economy, such as all manufacturing, construction and transport, is done with energy, which is derived from fuel. In 2012, the production of one calorie of food, consumed in the United States, required ten calories of fossil fuel. 20% of the use of fuel resources in the U.S. is in the food chain, which means that their consumption of the food industry can compete with cars. Modern medicine, water and maintenance of the army are entirely based on oil and its chemical derivatives. In the U.S., the infrastructure of Internet supporting takes 10% of the produced energy. The dynamics of oil production is described by a Gaussian curve. An ever-increasing abundance of oil is on the upward slope of the curve; its increasing scarcity and high cost are on the downward. Conclusion Summarizing the above, alternative energy sources are a great option for development. However, the reality is that any source of alternative energy is able to cover the world's energy needs as it is 31 billion barrels a year, and it continues to grow. No source of alternative energy can produce energy without the cost of oil and gas for its production. None of them is cheap enough, clean (do not pollute the environment) and available in quantities of at least close to the immense volume of everyday consumption of oil and natural gas in the world. Discovering and extracting raw materials, such as silver, copper, platinum, uranium, which is necessary for the construction of solar panels and wind turbines, requires a huge amount of oil and other scarce resources. Oil is also needed for the development of alternative energy installations, distribution, support and their adaptation to the currently existing infrastructure. The reality is that it is preferred to invest world financial capi tal in military technology instead of investments in alternative energy sources, foreseeing future energy conflicts, namely the war for the remaining resources. The current system of market economy, the main purpose of which is to make more money and use more energy, will not allow the implementation of alternative energy sources, until reserves of oil and gas will end. As the exhaustion of oil and gas in the world's current economic model is inevitable, reserves of other forms of energy are not enough for a full-scale commercial operation, humanity is constrained to await for several depressive decades as long as the energy deficit will not be filled, and the world economic system will not be radically restructured.

4th Grade Math Lesson on Factor Trees

4th Grade Math Lesson on Factor Trees Students create a factor tree with numbers between 1 and 100. Grade Level Fourth Grade Duration   One class period, 45 minutes in length Materials blackboard or whiteboardpaper for students to write onIf you prefer a more artistic touch, copies with four evergreen tree shapes per page Key Vocabulary   factor, multiple, prime number, multiply, divide. Objectives In this lesson, students will create factor trees. Standards Met 4.OA.4: Find all factor pairs for a whole number in the range 1-100. Recognize that a whole number is a multiple of each of its factors. Determine whether a given whole number in the range 1-100 is a multiple of a given one-digit number. Determine whether a given whole number in the range 1-100 is prime or composite. Lesson Introduction   Decide ahead of time whether or not you wish to do this as part of a holiday assignment. If you prefer not to connect this to winter and/or the holiday season, skip Step #3 and references to the holiday season. Step-by Step Procedure Discuss learning target- to identify all of the factors of 24 and other numbers between 1 and 100.Review with students the definition of a factor. And why do we need to know the factors of a particular number? As they get older, and have to work more with fractions with like and unlike denominators, factors grow increasingly important.Draw a simple evergreen tree shape at the top of the board. Tell students that one of the best ways to learn about factors is by using a tree shape.Begin with the number 12 at the top of the tree. Ask students what two numbers can be multiplied together to get the number 12. For example, 3 and 4. Underneath the number 12, write 3 x 4. Reinforce with students that they have now found two factors of the number 12.Now let’s examine the number 3. What are the factors of 3? What two numbers can we multiply together to get 3? Students should come up with 3 and 1.Show them on the board that if we put down the factors 3 and 1, then we would be continuing this work forever. When we get to a number where the factors are the number itself and 1, we have a prime number and we are done factoring it. Circle the 3 so that you and your students know that they are done. Draw their attention back to the number 4. What two numbers are factors of 4? (If students volunteer 4 and 1, remind them that we aren’t using the number and itself. Are there any other factors?)Below the number 4, write down 2 x 2.Ask students if there are any other factors to consider with the number 2. Students should agree that these two numbers are â€Å"factored out†, and should be circled as prime numbers.Repeat this with the number 20. If your students seem confident about their factoring abilities, have them come to the board to mark the factors.If it is appropriate to refer to Christmas in your classroom, ask student which number they think has more factors–24 (for Christmas Eve) or 25 (for Christmas Day)? Conduct a factor tree contest with half of the class factoring 24 and the other half factoring 25. Homework/Assessment   Send students home with a tree worksheet or a blank sheet of paper and the following numbers to factor: 10099514036 Evaluation   At the end of math class, give your students a quick Exit Slip as an assessment. Have them pull a half sheet of paper out of a notebook or binder and factor the number 16. Collect those at the end of math class and use that to guide your instruction the next day. If most of your class is successful at factoring 16, make a note to yourself to meet with the small group that is struggling. If many students have trouble with this one, try to provide some alternate activities for the students who understand the concept and reteach the lesson to the larger group.

Abolitionist Pamphlet Campaign

Abolitionist Pamphlet Campaign In the summer of 1835 the growing abolitionist movement attempted to influence public opinion in the slave states by mailing thousands of anti-slavery pamphlets to addresses in the South. The material inflamed southerners, who broke into post offices, seized bags of mail containing the pamphlets, and made a spectacle of burning the pamphlets in the streets as mobs cheered. The interference with the postal system created a crisis at the federal level. And the battle over use of the mails  illuminated how the issue of slavery was splitting the nation decades before the Civil War. In the North, calls to censor the mails were naturally seen as a violation of Constitutional rights. In the slave states of the South, the literature produced by the American Anti-Slavery Society was viewed as a dire threat to southern society. On a practical level, the local postmaster in Charleston, South Carolina, requested guidance from the postmaster general in Washington, who essentially dodged the issue. After a spasm of demonstrations in the South, in which effigies representing abolitionist leaders were burned as anti-slavery pamphlets were thrown into bonfires, the battleground moved on to the halls of Congress. President Andrew Jackson  even mentioned the mailing of the pamphlets in his annual message to Congress (the forerunner of the State of the Union Address). Jackson advocated suppressing the literature by having federal authorities censor the mails. Yet his approach was challenged by an eternal rival, Senator John C. Calhoun of South Carolina, who advocated for local censorship of federal mail. In the end, the campaign of the abolitionists to mail pamphlets southward was essentially abandoned as being impractical. So the immediate issue of censoring the mails died out. And the abolitionists  changed tactics and began to concentrate on sending petitions to Congress to advocate for the end of slavery. Strategy of the Pamphlet Campaign The idea of mailing thousands of anti-slavery pamphlets into the slave states began to take hold in the early 1830s. The abolitionists couldnt send human agents to preach against slavery, as they would be risking their lives. And, thanks for the financial backing of the Tappan brothers, wealthy New York City merchants who had become devoted to the abolitionist cause, the most modern printing technology was made available to spread the message. The material produced, which included pamphlets and broadsides (large sheets designed to be passed around or hung as posters), tended to have woodcut illustrations depicting the horrors of slavery. The material may look crude to modern eyes, but in the 1830s it would have been considered fairly professional printed material. And the illustrations were particularly inflammatory to southerners. As slaves tended to be illiterate (as was generally mandated by law), the existence of printed material showing slaves being whipped and beaten was seen as particularly inflammatory. Southerners claimed the printed material from the American Anti-Slavery Society was intended to provoke slave uprisings. And knowing the abolitionists had the funding and personnel to turn out printed material of substantial quality was disturbing to pro-slavery Americans. End of the Campaign The controversy over censoring the mails essentially ended the pamphlet campaign. Legislation to open and search the mails failed in Congress, but local postmasters, with the tacit approval of their superiors in the federal government, still suppressed the pamphlets. Ultimately, the American Anti-Slavery Society came to realize that a point had been made. And the movement began to concentrate on other initiatives, most prominently the campaign to create strong anti-slavery action in the House of Representatives. The pamphlet campaign, within about a year, was essentially abandoned.

Encounter point Essay Example | Topics and Well Written Essays - 1250 words - 1

Encounter point - Essay Example The ownership claims over Jerusalem by Muslims and Jews seems to be the major issue involved in Israel-Palestine dispute. â€Å"Encounter point† is a 2006 award-winning film directed by Ronit Avni and Julia Bacha. It is about people, who have dedicated their lives to trying to resolve the Israeli Palestinian conflict through non-violence means. Non-violence was the ideology through which Mahatma Gandhi succeeded in removing British colonialism from Indian soil. The film â€Å"Encounter point† discusses the possibility of implementing that ideology in settling the issues between Israel and Palestine. This paper analyses various dimensions of the Israel-Palestine conflict as portrayed in the film encounter. In my opinion, the film is not portraying the conflict as between two equal or symmetrical parties. In fact the film describes Israel as the dominant party and the Palestinians as the receiving party. There are many scenes in the film in which wounded Palestinians express their bitterness against the Israelis. At the same time there are no scenes which describe any wounded Israeli blaming the Palestinians at the rehabilitation center. The above fact clearly suggests that the intention of the director of this film was never to portray the clashes between Israel and Palestine as a clash between two equal forces. The film is definitely unbalanced even though some perceive it as favoring the Palestinian side while others as favoring the Israeli side. â€Å"In one scene a Palestinian makes the claim the IDF put poison on their bullets. There is no Israeli to rebut that unlikely claim, nor to mention the fact that suicide bombers add metal bolts and screws to their explosives to maximize civilian casualties† (Gates). In other words, the film says many things about the massacres of Israeli soldiers. At the same time, it says nothing about the suicide bombers from the Palestinian side. The director seems to be taking the side of the

Role of Public Health Practitioners Essay Example | Topics and Well Written Essays - 1750 words

Role of Public Health Practitioners - Essay Example The main priorities of public Health policy in 2011 and 2012 includes controlling of death and dying, countering depression to promote emotional well being, achieving sexual and reproduction health and ensuring health at work. Through public health, the government in conjunction with the public health practitioners share the goals of giving every child the best start in life and enabling the children, the youth and the old people to utilise their potential and have control over their lives. It also plans to boost ill-health prevention and develop healthy and sustainable communities. The fair society healthy lives also seek to create fairness in accessing jobs and ensure healthy living standards for every citizen. Public health practitioners are the key implementers of any given health policy that is laid down. During their call to duty, they under go various challenges, rewards and experiences depending on a number of circumstances. This paper discusses the role of three public healt h practitioners Lucy Smith a public health manager in charge of mental well wellbeing, Sue Levi a consultant in public health medicine and Thara Raj a public health manager in sexuality and immunisation. ... s out time to time evaluation on the level of implementation of the public health policy on mental wellness and measure it outcomes after the implementation period. She organises, supervise and conduct trainings and meetings for local agencies, employers and school management teams to educate them on ways of improving and promoting the mental well being within their institutions. She continuously conducts research to find new ways of engaging the local authorities and agencies on ways that reduce health risks and promote the mental well being of the Lambeth residents. Some of the challenges that Lucy Smith faces as the one in charge of mental well being include failure to comply with the set down policies that promote a culture of participation, equality and fairness by employers and some learning institutions. This is because most employers are profit oriented and some of the policies designed do not work in support of making fast money. There is also limited number of psychological institutions that can offer counselling and mentorship advice to institutions and individuals in to promote mental wellbeing (Rowitz, 2009). Some of the approaches that are applied by Lucy Smith are through collaboration and the use of social media in promoting well being. One of such groups is â€Å"Mind Apples†. She clearly shows her support by saying that "We are thrilled to be working with Mindapples in our GP practices to get people talking about mental health in a positive way.† (Lucy Smith) Through this media, people are able to share positive thoughts on how they can stay positive in life and healthy too. Smith also promotes teamwork and collaboration among all the stakeholders in promoting mental well beings .For example, allocating specific topics of discussion to specific

The Fall of Rome Research Paper Example | Topics and Well Written Essays - 2000 words

The Fall of Rome - Research Paper Example This researcher paper "The Fall of Rome" analyzes the key causes that triggered the fall of Rome. The destructive effect of nomad tribes’ invasions has been discussed as one of the most significant reasons of Rome’s decay. This point of view is adopted by Ward-Perkins who claims a sort of military crisis caused by the invasion of people from Asia to have triggered the fall (Ward-Perkins). Having conquered the territory of the Black Sea region be the beginning of the 3rd century, the unions of Goths launched the military campaign against the Roman Empire. The first battle between Romans and Goths took place in 378 bringing overwhelming defeat to the Roman army and death to the emperor. After a pause lasting about 50 years, the tribes besieged Rome. Although the capital suffered raging hunger and diseases, Roman refused to surrender or accept Alaric’s proposals (Alaric was the head of the Goth army). Unfortunately, despite desperate attempts to hold the line, the e nemy had managed to gain control over Rome – it was for the first time in the history of this glorious empire that barbaric tribes had captured this city. Later, Vandals became the ones to deliver the final blow to the capital of the Western Roman Empire, killing an immense amount of citizens and enslaving the survivors. It is reasonable to add, that the name of this tribe has turned into a common noun for villains and destroyers as a result of the atrocities the conquerors committed in Rome. However, it was Guns who led the Western Roman Empire to the complete collapse.

Why death penalty should be abolished Essay Example | Topics and Well Written Essays - 750 words

Why death penalty should be abolished - Essay Example Being humane is a question we put on the limelight in discussing the death penalty. Those who are in favor of the punishment for heinous crimes cry for the safety of the majority, arguing that it is far better for men to extinguish a criminal’s life than put innocent lives in danger as they are exposed to possible criminal acts by the individual. It could be true that lives are endangered as we let criminals live however, the prison cells are created for them to recuperate lost trust and integrity. Death penalty kills not just the human body but the chance to become better as well. We do not just stand as judges before the convicted felon but as the killer of his hopes and dreams. Even criminals have the right for such. Pataki (52), as mentioned believes that the death penalty is not a source of crime deterrence so what is there to argue about? Are we not imposing the death penalty in the hope that people with inclinations to heinous crimes would think twice if not a hundred t imes and decide to do otherwise? Ending a criminal’s life is not the solution to ending heinous crimes because if that were the case, then we should have a crime-free world these days for the many lives the death penalty has claimed. Nor will it assure the safety of the innocent, otherwise we can now all go out in peace, free of the worries that nothing and no one can harm us and yet circumstances show us the naked truth that the system has never been successful in achieving its objectives. The argument that life begets life with the death penalty being an act of self-defense is totally erroneous not only because of the aforementioned point of view but that because history shows that not just a handful of convicted felons have been put to death so unjustly. I state my stand on the death penalty on the basis of my agreement with Lang’s (2011) philosophy that there is a chance, and may I add a humungous chance that a person may die because of being wrongly convicted. Let us not close our eyes to the fact that there are piles of evidences to such injustice. Michael Lang (2011) in his article mentioned the injustice suffered by Michael Blair and Charles Hood. Evidences presented in court showed that he did not commit the crime accused against him but that was after fourteen years of being in death row. Imagine the psychological and emotional torture the thought of dying for a crime he did not commit has caused him, not to mention the wasted fourteen years of his life, the records that could be used against him and the after-effects of the mental torture he survived in the jail. That part of his battle may to us seem over, but to Blair, his battle continues as he tries to live a normal life after more than a decade in prison which I reckon can never actually be normal again. The hope then for us is that, the system did not create a criminal out of him now that he is freely moving among us. Hood on the other hand is still on his journey that Blair trod and our cry for him is that he will be given the justice he deserves in the hands of the judge and prosecutor who admitted to having an illicit sexual affair (Lang). Things can never be said to have been better for the aforementioned examples but looking at the cases of mentally retarded people convicted of crimes they did not commit is far heart-breaking than any other case like that of Tony Chambers and Jerry Penry representing their fellow victims (Robinson). Chambers has at his age was expected to have an intelligence quotient of 100 but was found to be between 50-63, the IQ of a six-year old. Penry on the other hand was proven to have been mentally disadvantaged since he was a child triggered by the abuses of his mother; he was accused of murdering a twenty year old woman in 1979. Could such people still threaten us of an escape plan so that we claim to be protecting ourselves from the possible damage they can still cause? What about their right to live? Would it not be too mu ch for us to kill not just innocent but

Statement of Needs Essay Example | Topics and Well Written Essays - 750 words

Statement of Needs - Essay Example Stagman et al. (2011) argues that â€Å"the use of alcohol and illicit substances by youth often leads to adverse health outcomes. According to the Office of Adolescent Health, the case of substance abuse among adolescents has risen exponentially within the last decade. In the state of Illinois alone, the number of cases of cocaine use among high school students, from grades 9 to 12 is equal to the national percentage of 3%. Also, the rate of high school students in Illinois who are indulging in the use of inhalants is at 10%, just a per cent lower than the national average (Centers for Disease Control and Prevention, 2012). In Illinois, the support for substance abuse victims is often deficient and stationary as most are funded by private organizations and are also expensive, and that is on top of the fact that adolescents who are victims of substance abuse are not aware that they can get rid of drug and alcohol addiction. Furthermore, Stagman et al. observes that one factor that really challenges the reduction of substance abuse among adolescents is government fund because the delivery of care cannot be carried out without appropriate funding (Homer et al., 2008). In a mission to make a difference in the lives of many people suffering from the effects of substance abuse, the Gateway Foundation Alcohol and Drug Treatment is dedicated to the task of promoting awareness to adolescents about the adverse effects of substance abuse and restoring the physical, psychological, and cognitive health of the patients. The main concern of the organization is how to reduce substance abuse among adolescents in the State of Illinois by initiating public awareness campaigns that target adults and adolescents. Most of the substance abuse victims are those who have not gone in school or who are out-of-school youths. Due to lack of guidance and ultimate freedom to choose, they are often led to wrong directions. One

American and French Revolutions Essay Example | Topics and Well Written Essays - 750 words

American and French Revolutions - Essay Example Perhaps the major reason for this was that the American Revolution took place in an absolutely new country without almost any history, while the French Revolution occurred in one of the eldest European states. Consequently, the participants of the American Revolution did not have to overthrow the established aristocratic society and absolute monarchy in order to proclaim either equality of people (because they were equal) or sovereignty of their new state (the British monarch was geographically too far from them). In other words, the birth of the new society in the United States occurred without major tension. The French Revolution began in an absolutely different situation. It was a daring attempt to establish the principle of equality in the traditionally aristocratic society and cultivate political freedom in the most powerful European monarch (Doyle 2002).Economic factors played equally important role in the onset of both revolutions. The American Revolution was largely caused by the economic pressure of Britain, which was economically dependent on the colonies, but often failed to adequately justify the increasingly burden heavy burden of taxes. This problem – often termed ‘taxation without representation’ – is reported to be one of the most essential factors that eventually led to the revolutionary situation (Wood 1998).A similar situation was observed in the pre-revolutionary France where the absolute monarch kept increasing the burden of taxes for the poorest layers of population. (especially peasants) while the wealthiest and the least numerous layer of aristocracy often did not pay taxes at all. The growing unemployment, abnormal spending of the King and growth of prices added naturally to the picture (Hibbert 1981). Evidently, no acceptable explanation could be brought forth to justify such situation. Therefore, despite some disagreement within the scholarly community as for the causes and preconditions of the French and Am erican Revolutions (Kates 1997; Nash 2005), the assertion that the major causes were similar is likely to be correct. Secondly, the course of the American Revolution differed significantly from the developments of the French Revolution. During the revolutionary decade the army of colonists engaged in a number of clashes with the British troops until finally forcing them out of their territory: in other words, the emerging nation had an external enemy to deal with. By contrast, no major battles occurred on the territory of France during the French Revolution and no external threat was available. As a result, the major goal pursued by the inspirators of revolution was physical removal of the much hated representatives of aristocracy. The subsequent series of wars with other European states took place after the Revolution was over although there is not agreement between

Child Labor In Pakistan

Child Labor In Pakistan The factor of engaging a child below 15, to some work rather than sending them to school is called child labor. Child labor all over the world has increased speedily in the recent years. There is no exact information regarding child labor. In most developing countries of world, mostly children are working on the places that are auto mobile workshops, weaving industries, domestic servants, restaurants and in many industries in Pakistan. In other forms of work, it has seen that children are begging which they have to make for their masters. Lack of awareness and illiteracy are the main causes between parents who avoid sending their children to school. Mostly child labors are from alliterate families. Mainly three forms of child labor are Non-exploitative child labor mean any work done by a children which is hazardous, harmful for their health, or harmful for their mental, physical or social development and stop to get education. Some hazard conditions are working in mines, working with dangerous machinery and working with chemicals. Hired child labor mean children which are preferred by employers because they are cheaper as compare to adult. In many works child labor are more active like they have more speed to do work and their eyesight is sharper than any adult person. Bound child labor is performing in which owner give high interest loans to labors in exchange for long term work or when a person children or any family member takes a debt against any work. Labor may also be categorized according to the nature of job. Domestic servants, the child worker who are working in carpet industry, the children who work on shops, canteens, general store as salesman, the children who are working in the workshop using light machines like tools, tailoring or embroidery and children who are working in heavy workshops tough labor that is light labor. Children are working in different sectors of countries in different ways, types and in professions some of them are agriculture sector, cotton industry, flower industry , domestic labor, brick kilns, fireworks, cigarette rolling, construction, mining, forestry, manufacturing, retail and service industry, stone quarries, sugarcane, toys, slavery, child soldiers, jewelry making, news, sweatshops, restaurants, fishing, factories, carpets weavers, farm works, and trafficking. Child labor in Pakistan is the employment of children for work in Pakistan, leading to mental, physical, moral and social harm to children. The Human Rights Commission of Pakistan estimated in the 1990s that 11 million children were working in the country, half of those under the age of ten. In 1996, the median age for a child entering the work force was seven, down from eight years old 2 years prior. It was estimated that one quarter of the countrys work force was made up of child laborers (Wikipedia) Child Labor by Numbers are 218 million children worldwide are child laborers, 73 million working children are less than 10 years old, 126 million are estimated to work in the worst forms of child labor, one in every 12 of the worlds five to 17 years olds, 8.4 million children are trapped in slavery, trafficking, debt bondage and other forms of forced labor, forced recruitment for armed conflict, prostitution, pornography and other illicit activities, 2.5 million children work in the developed economies, 22,000 children die every year in work-related accidents, 127 million working children are in the Asia Pacific region. Nearly one third of children in Sub-Saharan Africa work (Child Labour Public Education Project) Child labor is a significant phenomenon, large in scope, and with very important social and economic implications. It takes a variety of forms, from children working on family farms or in family businesses to children engaged in sweatshop labor, prostitution, armed conflict, or other illicit activity. It also has serious implications on human capital accumulation and in perpetuating poverty and therefore is closely linked to progress against the MDGs, especially the goal of achieving universal primary education. Given the connections between child labor and schooling, the efforts of the Education for All partnership will not be fully successful without addressing child labor. (Gordon Betcherman, 2004) Child labor was employed to varying extents through most of history. Before 1940, numerous children aged 5-14 worked in Europe, the United States and various colonies of European powers. These children worked in agriculture, home-based assembly operations, factories, and mining and in services such as newsies. Some worked night shifts lasting 12 hours. With the rise of household income, availability of schools and passage of child labor laws, the incidence rates of child labor fell.(encyclopedia) One-third of the working children are literate, which shows that mere completion of primary education is not an effective deterrent to child labor. School enrolment indicates that economically active children who are not enrolled in school (34.2 per cent) are higher than economically active children combined with school (13.2 per cent). This shows that enrolment is negatively correlated with the involvement of children in economic activity. Education attainment is low because of limited opportunities resulting from inaccessibility of schools; inability of parents to afford schooling costs; irrelevance of school curriculum to real needs, and restrictions on girls mobility in certain parts of the country. (ILO, 2009) Child is not born for work rather to study, but wall of encumbrance either in financial term, economic term or in social term made him compelled for labor work. Understanding real economics of child labor can have better policy to tackle this issue. Asia has a large number of child domestic workers. These include children working as child minders, maids, cooks, cleaners, gardeners and general house-helps. The lack of information is major cause of not having thorough analysis of incidence and nature of child domestic workers in many Asian countries. However, there is not a significant reduction in child labor participation, especially in Asia. (htt12) Child labor has been acknowledged as a serious and challenging issue in the civilized societies around the globe. Its continued existence remains a source of concern for all segments of human society. Different socio-economic factors can be held responsible for the prevailing poverty, illiteracy, unemployment, lack of family planning, dissatisfaction about education system, absence of social security mechanism and many others. Now it is the responsibility of the government to provide children with their rights and to protect them from all sorts of exploitation, because the future of mankind and civilization lies in children. Their protection from physical and social hazards is a pre-requisite for proper development of children to ensure future progress and prosperity of mankind. (Khan) Objective of the Study The aim of this study is to determine the factors responsible for child labor in Pakistan and to find out the problems which affect the children to do work in early age in which all children are going to schools and play. Another aim if research is to know that what are the factors due to which a child in enforced to be a child labor in Pakistan. The objective of the study is to find out variables and factor due to which child labor occur or what are the causes behind child labor, why children do work in small age and the forms of the child labor in the country. The main three variables behind child labor are poverty, inflation and unemployment in the country which are somewhere cause of child labor. The primary object of this study is to estimate the effect of poverty, literacy, inflation and unemployment on the occurrence of child labor. So HYPOTHESIS The study would be based on following hypothesis; these hypothesis have been develop after reviewing the relevant literature To analyze the effect of poverty on child labor H1: Effect of poverty on child labor is significant H1o: Effect of poverty on child labor is in-significant To analyze the effect of Literacy on child labor H2: Effect of inflation on child labor is significant H2o: Effect of literacy on child labor is in-significant To analyze the effect of inflation on child labor H2: Effect of inflation on child labor is significant H2o: Effect of inflation on child labor is in-significant To analyze the effect of Unemployment on child labor H3: Effect of Unemployment on child labor is significant H3o: Effect of Unemployment on child labor is in-significant Chapter # 2 THEORETICAL FRAMEWORK Child is a person 14 years and below. Child labor is a permanent employment of children under the age of legal minimum. Worldwide total numbers of child labor (5-14 ages) are 250 million and almost half of them 120 million are working full-time. According to The ILO and the ETI Base Code state that a child is any person younger than 15 years of age, unless local minimum age law stipulates a higher age for work or mandatory schooling, in which case the higher age shall apply. If however, local minimum age law is set at 14 years. (Ethical Trade Insentive, 2012) According to the United Nations, a child is any person under the age of 18. Specific labor laws may consider people under the age of 16 children for legal purposes, and in some countries the cut off may be even lower, around 12 or 14. Statistics on this type of labor usually focus on children between the ages of five and 14, because many nations in which child labor are a problem have laws which allow people to work full time after the age of 14.(wise greek) Child labor was employed to varying extents through most of history. Before 1940, numerous children aged 5-14 worked in Europe, the United States and various colonies of European powers. These children worked in agriculture, home-based assembly operations, factories, and mining and in services such as newsier. Some worked night shifts lasting 12 hours. With the rise of household income, availability of schools and passage of child labour laws, the incidence rates of child labor fell.(encyclopedia) The worst forms of child labor. In all over the world there are an expected 218 million child laborers, which a in between the ages 5 to 17. A number of 126 million of these children work in hazardous conditions such as: Working in mines, working with chemicals and pesticides in agriculture, working with dangerous machinery, Forced and bonded labor, Armed conflict, Sexual exploitation and child pornography, illegal activities. Gender differences in child work activities: Activity Gender differences House cleaning Only girls Collecting  ¬Ã‚ re wood/ dry cow dung to sell Both boys and girls but more commonly girls Cleaning Both boys and girls Cooking food Only girls Child care Both boys and girls but mostly girls Mini-bus conductors, household maids, Mini-bus conductors are commonly boys, housemaids Loading goods on pack animals for market but commonly boys construction child labour commonly boys Waiters, kitchen hands in restaurants Both girls and boys engage in work in cuisine, cleaning dishes in restaurants Apprentices in garages/ workshops Only boys work as apprentices in garages Working as a porter Boys do more brokering, working as porters Causes of Child Labor: Poverty Children work for a variety of reasons. The major reason is poverty. Poverty is the lack of food, shelter, money and clothing that occurs when people cannot satisfy their basic needs. Poverty can be understood only lack of money or most of them in terms of barriers in everyday life. At certain levels of poverty in developing countries, child labor could play a useful role in the economic survival, which increases national economic development. The unequal attention of poverty between children compared to adults demands reason and attention. Child labor causes poverty because when a child is employed he takes a place of an adult job, so there is decrease in adult income in the industry. And when the child is without education and they do work so there is no possibility of escaping from poverty. Poverty in the country is the main cause of child labor which forces the parents to send their children to work. Poor Families which face the poverty force their children to work for extra income for their households. Poor families like to have more children and when the income of an individual one in not enough then they force their little children to go for work anywhere they have. A large number of members represent a financial need for families suffering from poverty; parents are forced to send their children to work to earn extra income. Lack of education Between the poorer parts of society is also most important cause for children to start working before time. Necessary education is not free in all countries and in many countries it is not available for all children, especially in rural areas. So if there are schools in some areas there is poor education or where education is expensive parents observe no value in education field then due to this situation parents send their children to work rather than schools. Children are mostly encouraged to work by their parents. Uneducated and unaware people never think about child labor and they are also unaware of the dangerous physical and mental pain of children. When parents agree to their children to go work, it affects their chances to go school. Schooling problems also contribute to child labor. Many times children search for employment just because there is no access to schools. Even as the parents cannot afford for their children to be educated nor do they understand the importance of primary education in children lives. Or Due to insufficient educational facilities many families think that school wont help their children survive. Gender inequity Means gender differences which refer to inequality between persons due to gender. The encouragement of gender equality means give equal opportunities to boys and girls, and men and women. Social thoughts towards girls and women are most important cause of child labor effect on child to do work because women are not allowed to go outside from home for any work. The encouragement of equality between girls, boys, men and women. Child labor is work which subjects children to use and abuse. Lack of unemployment Lack of unemployment of adults and when the adults are not in position to do work like disable adults or ill adults or death member of the family. Demand for child labor Demand for child labor is increasing day by day for cheap labor which is also a cause of child labor. Market demand of child labor cause strong demand by many companies because they want to win large market share. So children are considered as a cheap source of labor which provides an opportunity to increase earnings. And Demand for cheap labor by contractors means that children are often offered in the workplace of their parents. With limited margins of this type, such as contractors and farmers make game owners know that children can be exploited and forced to work for less than minimum wage. Escape from home This may also factor or cause of child labor. When a child escapes from home he may have many reasons like Bad temper of the parents, because generally the insufficient salary of fathers provides lack of basic human needs to their families which create a frustration and anger in the members of family after that it turn to the attitude of fathers or head of family in harsh or strict due to which a child prefer to leave from the home in search of his own comforts, it might be physical or mantel. And when a child leaves the home he faces different problems of necessities so that why he have to do any work to survive. Company of other children plays an important role in child grooming because the company of friend makes a child manner able and social. It is psychological fact that surroundings affect individuals behaviors and attitudes and the habits of child is also depend on the company of family and friends. Usually negative activities between the children create negative impact on child personality. Due to this sometime the passion of negative activities level become high and serious for a children future. In these situations the strictness from home and school enforce children to escape. Behaviors of the teachers at schools also plays very important role in child life. Because teachers are the builders of nation. But in our society the way of teaching is quite harsh and the methods of teaching are also useless. Mostly children are punished physically for their minor mistakes which create unfriendly atmosphere then due to these type of behavior of teachers impact bad impression on children and force child to runaway. And after those majority children get negative feedback from home as well so they escape. Attractions beyond the home also cause of child labor because it is the human nature that a person mostly tends toward those things which they dont have. And these types of want are found in children. In some cases due to some reasons parents are unable to provide the needs of their children so this also lead to child to escape for necessities. Political Crises Political crises and political issues Sometimes have caused violence, rallies, strikes, civil wars, terrorism and armed conflicts due to which there is a political and economic instability in the country so adults are unable to do work or jobs or in some other situations children have to do work for their needs. Overpopulation Large family sizes and over population are main factors which cause child labor. The basic cause of child labor is high population growth-rate, particularly in Third World countries. According to Wikipedia.org, Pakistan has increased its ranking from 7 to 6th in the list of most populous countries of the world. The figures are based on a July 1, 2007 estimate by the UN Department of Economics and Social Affairs, Population Division. Industrial revolution Revolution in industries plays role for child labor. Sometimes multinationals prefer to use child labor in developing countries due to industrial revolution and these which encourages multinationals to use child workers which cause a negative impact on children. Due to all these reasons child labor recruited for less pay, they take extra work from them and there is no problem of union in industry as well. This situation is also difficult for adults to find jobs and send their children for work. Impact on Child Labor: Immature and inexperienced child laborers might be totally unaware of the short and long term risks involved in their work. Children who work frequently face serious health problems due to continuous work in hazardous conditions. The employers also dont care at all about child labor that are unhealthy and carry on working for long time with a tiny or no break. Child laborers are mostly without a basic education, regular social interaction, and emotional support from their family. Lifetime physical and emotional hurt to the child. Their mental health also crushes. Mostly children face mental trauma when they reach to maturity. Children that cannot find work to feed big families choice to begging on the streets and in many cases child labor also killed or become victim of prostitution. And in many cases children turn in to thieves only because they need rapid money on which their families are depended. It also has a negative impact on the benefit of the country. Because these children do not get any education, and increasing literacy, and slow down the countrys economic growth in general, reflecting the weakness of human development. Girls who work as home servants away from their homes, sometimes in different Middle Eastern countries, are common victims of mental, physical and sexual abuses which cause shocking consequences on their physical condition. Some circumstances which are faced by the child are dangerous workplaces, full time work in early age, loss of education and future opportunities, too much working hours subjection to verbal, physical, psychological and sexual abuse, limited or no pay, no way to get education, powerless to run away from poverty cycle they do work in streets in bad conditions. Illegal Activities Now a days children have strong involvement in illegal activities like the production and trafficking of drugs. Trafficking is illegal activity of buying and selling of drugs in which a lot of children are involved. Mostly children may do these activities because they belief that this will give them money and status. Children who do this work take great risk of abuse and are addicted of drugs in early age. And then these children also doing other crimes like robbery, theft, mugging, hijacking, and the children may also do this for their gangs or for their family. These all activities by children are also done due to poverty. And also affect their mental and physical growth. Hypothetical Model and Variables under Consideration Literacy Inflation Unemployment Poverty Child Labor LITERATURE REVIEW (Dessy, 2003), Shows the Harmful forms of child labor have an economic role: by maintaining wages for child labor high enough, they allow human capital accumulation in poor countries. Unless appropriate mechanisms are designed to mitigate the decline in child labor wages caused by reduced employment options for children, a ban on harmful forms of child labor will likely prove undesirable. Poverty alleviation techniques would eliminate that segment of the worst forms of child labor. A food-for-education program, however, might help boost support for a ban on harmful forms of child labor. Because it relaxes the liquidity constraint of the poor, this food-for-education program may induce more time spent at school, which may be sufficient to offset the negative effects of the sudden increase in the supply of child laborers We perform our analysis within a simple model of parental investment in childrens education. (Ebudhia) Wrote Child labor is the worst from of child exploitation. It is widespread all over the world. About seventy-three million children belonging to the age group of ten to fourteen years are engaged in child labor all over the globe. Illiteracy of the parents, large families, need of additional income and poverty are the chief causes of the exploitation of child labor. Parents are indirectly responsible for this. Childhood is the foundation of ones career. At this stage, children should be sent to schools, not to work. Child labor lowers the wage rates of adult laborers. Employers exploit children due to their docile nature and their willingness to do monotonous jobs. They face health problems. Several programmed have been undertaken both at the national and international level to check and stop this practice. The people should also help the government in its efforts to tackle this problem. (Sanjeeta) Wrote that, Child labor is, no doubt, an evil that should be done away with at the earliest. The prevalence of child labor reflects very badly on society that is not able to stop this evil. But in a society where many households may have to suffer the pangs of hunger if the children are withdrawn from work, beggars cant be choosers. These families have to send their children to work, even if the future of these innocents is ruined, as that is the only choice open for them to survive in this world. Therefore, unless the socio-economic status of the poor families is improved, India has to live with child labor. (Sparc, 2012) Said that, Negligence on part of the government and parents, corporal punishment, poverty and poor law and order situation, especially in Fata, are the major factors behind child labor. After 18th constitutional amendment, child labor has become the legislative and administrative domain of the provincial governments, Children are being abused verbally, physical and sexually in factories, homes and streets, while many of them suffer from fatal ailments, he said, adding that 85 per cent of child labor in the country worked in automobile sector. Working children were being used by militants in suicide attacks across the country. He complained that Child Protection Units in district levels were ineffective, and urged the government to conduct proper surveys to know facts and figures about child labor for necessary action by NGOs. According to (ILO, 2002), Despite the increasing commitment by governments and their partners to tackle child labor worldwide, it remains a problem on a massive scale, said Juan Somavia, Director-General of the ILO. While there has been significant progress towards the effective abolition of child labor, the international community still faces a major uphill struggle against this stubbornly pervasive form of work that takes a tragic toll on millions of children around the world. It also says a lack of law enforcement, and the desire on the part of some employers for a cheap and flexible workforce worsens the situation. The effective abolition of child labor is one of the most urgent challenges of our time and should be a universal goal. (FASIH, 1998) The study has attempted to classify the supply side of determinants of child labor in Pakistan. The scholars have used the sample of 14,094 children from Punjab (Pakistan) in the age group of 5-14 years obtained from the child labor survey 1996. The study examines the supply side determinants of child labor by using the multinomial logit model. The study concluded that The possibility of going to school increases at a decreasing rate The children who join school with work remain in school for a longer period The possibility of becoming full time child worker increase with age The possibility of females children mostly in the labor force shows that females are 4.7 percent less likely to attend school Children who have taken some technical or professional training are more likely to become child laborers and start work at an early age Mothers literacy plays a positive role in schooling decision for female children. The girls who have literate mothers are 18 percent more likely to get to school moreover female children of literate mothers are 14 percent less likely to become child laborer The period in life cycle of the head of the family of expected to have a important effect in the case of schooling work choice. The older the head of family, the more likely it is that the child attend school Siblings of less than 4 years have negative effect on schooling and part time work and siblings in between the age group of 5-9 years has negative effect on part tome work. According to (Tesfay, 2003), Drawing upon the historical experience of advanced industrial countries, both legal restrictions and economic factors played a role in reducing child labour, although legislation appears to have been less significant. The process of industrialization may have initially increased the demand for and the scope of childrens work, however the long run economic impact of the industrial revolution resulted in its eventual elimination. Thus an increase in the aggregate number of child workers is expected to be transitory. The declining importance of children in industry combined with increasing female wage rates and the rising price of child rearing inputs, all contribute to the rising cost of child quantity and the decline in child demand. Moreover, a decline in the economic value of children in the home and in agriculture will increase the cost of children, in turn, reducing the demand for them. These factors also reduce the cost of quality and increase the dem and for these commodities relative to quantity. Thus, it is the long-run economic forces of technological change, rising income, the higher price of raising children and the corresponding declining relative cost of child quality that explain the changing economic role of children over time. According to (Rena, 2006), Education and child labor is the second Millennium Goal to achieve universal primary education before 2015. This is an objective based on the UNESCO Declaration on Education for All and is defined as ensuring that all boys and girls complete a full course of primary schooling. The duration of primary education will vary from country to country with an absolute minimum of 5 years from the age of 7 to the age of 12. The definition of child labor foresees however that the education or vocational training should continue to at least the age of 14 or 15. In countries where primary education only includes 5 years, one will see a high number of economically active children in the age group of 12 to 14, many of whom will be child laborers. As stated earlier, education is seen a right for all children and as a way for individuals and societies to develop. Given economic development, the return to education is proven to be very high for individuals. However, many dev eloping countries will not be able to meet this objective in the short time frame. Hence child labor will remain a serious challenge to the MDG. Child labor also affects school performance as children miss important lessons and fall behind academically. This creates a burden not only on the individual child but also on the entire education system. According to (Khan), That child is the demand of employers. Alongside factors which push children into earning money are others which pull children into the world of work. Cheap and well-trained with reasonably low wages paid to children are often a reason why employers prefer them to adult workers. Some children work unpaid, particularly as domestic workers, in conditions that would be denounced as slavery if they involved adults. Employers find children more obedient and easier to control. Unlike older workers, they are unlikely to initiate protests or form trade unions. Poor infrastructure is another factor that shows the practical difficulty of establishing a childs actual age in countries where the infrastructure may not be in place for e.g. systematic birth registration. This can disadvantage children in many ways. The role of education is also factor that children who receive little or no school education miss out on the knowledge that can create options for them later in life . Without it, they make less contribution as adults and are more exposed to exploitation and abuse. Not attending school is consequently both a cause and effect of child labor. According to (Udry, 2003), Lessons for policies that can move children from work to school is also a cause of child labor. He wrote that Child labor should be understood as the consequence of people coping with extreme circumstances. It is a result of current poverty and a cause of continued poverty for the children who sacrifice their education in order to work. It is a particularly insidious problem because its primary costs are long-delayed and realized by the child, while the benefits a

Analysis of the US Healthcare System

Analysis of the US Healthcare System Cost, Efficiency, Choice and Equity in the United States Health Care System While excellent medical care is available in the United States, health care economics and the service delivery system present many challenges for the consumer and practitioner alike. This paper addresses four dimensions that are pivotal to the successes and failures of the system: cost, efficiency, choice and equity. The interplay of these dimensions across the canvas of health care options defines a system in flux, policymakers seeking a fair balance, and a nation in need of quality, affordable, accessible care. How do Americans pay for health care? The cost of health care in the U.S. is the highest in the world today. A higher percentage of national income, and more per capita, is spent on medical care by the United States than by any of the twenty-eight other country members of the Organization for Economic Cooperation and Development (OECD). The United States spent $4,178 per capita on health care in 1998, more than twice the OECD median of $1,783, and far more than its closest competitor, Switzerland ($2,794). U.S. health care spending as a percentage of gross domestic product (GDP), 13.6 percent in 1998, also exceeded the next most expensive health care systems, in Germany (10.6 percent) and Switzerland (10.4 percent) However, the U.S. government finances a smaller portion of health-care spending than does any OECD country except Korea (Friedman, 2001; Hilsenrath et al., 2004). Being without medical insurance is synonymous with a lack of access to medical care. In the absence of a coherent, all-encompassing national health policy, such as universal coverage, Americans, under the age of 65 and above the low-income mark, face the necessity of obtaining some sort of private health insurance. However, more than forty-two million Americans (15.5 percent) were not insured in 1999 (Bureau of Labor Education at the University of Maine, 2001). Most of the uninsured have no employer-provided health care options and are unable or unwilling to bear the cost for the few types of plans available to them. If ineligible for government assistance, the uninsured have little choice but to wait until their health concerns justify emergency room treatment, an extremely costly option for hospitals. In fact, these emergency facilities may turn patients away unless their conditions are deemed to be medical emergencies. Of those who are insured, some can afford to pay, while others are covered by their employers for at least a portion of the cost. Employer-provided health care coverage, once an expected benefit, is becoming less common in the contemporary American workplace. Also, over the years, the array of services covered has become more limited, while the cost of insurance has risen. Rather like a black hole, the insurance industry, and the medical establishment in general, appear to suck in more resources while emitting less output. What are the private plan options? Cost, efficiency, freedom of choice and equity vary across the assortment of private health care insurance alternatives. The following includes a brief description of each type of plan (derived, in part, from Levchuk et al., 2000), and thoughts on the balance of these dimensions across alternatives. The traditional fee-for-service plan, while still a key part of the Medicaid and Medicare vocabulary, is a rarity in todays managed care world. Under this type of plan, freedom of choice is high for patients and for the medical establishment. Patients with a fee-for-service indemnity or reimbursement plan can choose any physician or facility. Out-of-pocket costs apply until a deductible is satisfied. Each service performed is the unit for payment and treatment decisions are not limited. Efficiency of service providers is not so precious a goal given these contingencies. While fee-for-service remains an option, the need for increased cost control and accountability drove reform that took the shape of managed care. Managed care organizations vary in cost, efficiency and freedom of choice across an alphabet soup of plan types. To the degree that equitable access to services can be seen as a function of cost for those services, equity also varies across plan types. However, some characteristics are shared among all these plans. In service of cost-effectiveness, these organizations manage the financing of care delivered to members. For example, buying in bulk achieves lower prices for services from hospitals and practitioners. Efficiency and cost control are enhanced by limiting choice; members are limited to a list of approved physicians, and doctors are restricted to formularies and sanctioned procedures. Another cost-saving measure is the prevalent requirement for referral from a primary physician in order to consult a specialist. This restriction may undermine efficient service delivery, as well as access to services. Choosing a pricier plan can mitigate the restrictions on freedom of choice; however, this poses the broader issues of equity and access. Of course, the member realizes efficiency benefits in that the plan manages the delivery system: the where, what and by whom of health care. Perhaps the best example of this is the one-stop shop of the HMO. Health Maintenance Organization (HMO) staff-model. Everything the member ordinarily needs is efficiently contained in a single location; caregivers and customer service, pharmacy and labs. The HMO premium is paid in advance by the plan member or the members employer. The size of the premium is independent of the individual plan members pattern of service utilization. Therefore, the actual cost to the plan for services delivered to members at the high end of the utilization distribution serves to raise the premium for all members. The premium covers all in-plan services, with the exception of deductibles and co-payments. This is an efficient fiscal arrangement in that it saves administrative costs for the billing process and the members time in responding to requests for payment. The inclusion of preventive care is a cost-saving strategy, as is the requirement for a referral process. Requiring referrals may benefit the patient by screening out unnecessary and, thus, inefficient procedures. If misused, however, this requirement becomes a barrier to obtaining necessary care. The potential for misuse is heightened by the practice of casting administrators, rather than caregivers, as architects of the guidelines for appropriate referrals. Health Maintenance Organization (HMO) independent practice association (IPA) model. With this type of HMO, the member sacrifices the efficiency of convenience for a greater freedom of choice; the plan sacrifices a modicum of control but gains facility-maintenance cost savings. IPAs are comprised of primary care doctors and specialists who see plan members in their own offices. Each doctor may be a participant in several IPAs, thus defraying the added facility-maintenance cost. Equity can be a greater issue with IPAs than staff-model HMOs; physical/geographic access to care is more variable with the IPA model. Preferred provider organizations (PPOs) are structured to offer members more freedom of choice in selecting a health care provider than do HMOs. In order to ensure coverage of cost, however, the member is constrained to choose from a defined network of physicians and treatment facilities. Typically, premiums are more costly for this type of plan. Providers within the network have contractual relationships with the PPO plan, agreeing to treat plan members at a discounted rate. The plan is responsible for recruiting/selecting an equitable mix of providers across locations, as well as for referral coordination and treatment plan review. Providers, who serve at the pleasure of the plan, must operate efficiently or operate at a loss to remain participants in a network. The final two types of private insurance plans to be discussed are hybrids of those previously described. Point of service (POS) plans offer greater freedom of choice than other managed care plans, and, therefore, command a higher price. Each point at which a health care service is desired presents an opportunity for the member to choose any service professional at any location to provide that service. Typically, resources characteristic of HMOs, PPOs and traditional fee-for-service plans are available to the POS plan member. The contingencies that condition this freedom are based on out-of-pocket cost to the member and are part of the agreement for membership in the plan. A different level of cost may be associated with each type of service; e.g., a visit with a physician outside the HMO and PPO entails higher out-of-pocket expense. In many POS plans, choice also is conditioned by the requirement for a primary care physician referral. Flexibility is high here. A member who prefers the efficient containment of an HMO for a routine physical and lab work may make this choice. The same member, experiencing headaches, may seek service from a clinic specializing in migraines, knowing that a portion of the cost will be absorbed by the plan. However, the cost for this degree of flexibility brings equity into question. Managed indemnity plans combine the freedom of choice and cost base characteristics of fee-for-service with certain cost-control measures inherent in managed care plans. Members may visit any physician they chose. Typically, members must seek prior approval from the plan administration before certain outpatient procedures and inpatient stays are warranted as covered by the plan. Often, preventive health care is not covered by managed indemnity plans, an arguably inefficient decision. Freedom of choice is quite pricey with this type of plan. Reimbursement for services is a relatively cumbersome process. The physician or member is required to submit fee-for-service claim forms to the plan. After the members deductible is satisfied, most plans pay a percentage of what they consider the Usual and Customary charge for covered services. The plan generally pays eighty percent of this amount, leaving twenty percent, known as coinsurance, for the member to pay out-of-pocket. If the chosen provider charges more than the Usual and Customary rates, the member is responsible for both the coinsurance and the difference. As with many of the plans discussed, the expense associated with a managed indemnity plan bars many Americans from taking advantage of the benefits offered. These are the privately-insured health care plans available, in varying degrees, to the American people. Each has strengths and weaknesses, evident in the relative balance of cost, choice, efficiency and equity across plan types. What publicly-funded options exist and who is eligible? Medicare is the federally funded health insurance program for Americans age sixty-five and older. Younger citizens with qualifying disabilities also are covered under this program. Medicare falls within the Social Security administration, the federal program charged with providing financial assistance to older Americans, the unemployed and the disabled. The program is funded by taxing employers and employees nationwide. Sounds like a good and straightforward idea; few would contest that the program has a great to offer and that these benefits are sorely needed. Medicare is really two health care plans: Medicare Part A insurance applies to hospital costs. Stays at other 24-facilities, including nursing facilities, psychiatric hospitals and hospice care, also are covered. Part A is free of cost to any Medicare recipient. Medicare Part B covers many outpatient procedures, doctor visits, lab test, some home health care and in-home use of medical equipment. Medicare-qualified individuals are enrolled automatically in Part B, and the monthly fee is deducted from the persons Social Security payments. However, a good deal of the medical care one is likely to require is not covered by this program. For example, Medicare does not cover nursing home care or long-term care in the home. Prescription drugs and routine physicals are not covered. Medicare also requires co-payments and deductibles. For seniors and others on a fixed and limited income, these charges add up over time and can serve as a real disincentive to appropriately seeking health care. Choice also is limited by the fact that many doctors do not accept Medicare and, of those that do, some do not accept the Medicare assigned amount as payment in full for all services. This means more out-of-pocket expense for health care services. Fewer doctors opening their doors to Medicare beneficiaries is an access problem, compounded by other barriers, such as the need for transportation and specialized services seniors may require to facilitate health care use. As a result, seniors able to afford the extra cost (an equity issue) are enrolling in private insurance plans structured to supplement Medicare benefits. Medigap offers one of the most widely available sets of plans for this purpose. Plans A-J, the ten plans available in most states, vary widely in coverage and in cost. Such plans help defray the expense of Medicare co-payments and prescription drugs, for example, but they do not apply to any service that is not covered by Medicare. Given that an acid-test for Medicare coverage is medical necessity, seniors and other Medicare beneficiaries still are in the cold with respect to such services as preventive care and regular check-ups. A fairly recent Medicare reform is the introduction of the HMO as a potential care provider. Traditionally, Medicare operates on a fee-for-service basis; patients are billed for each service received. Increasingly, states have begun to offer an HMO alternative to Medicare recipients. This type of public-private partnership for health care service delivery has many proponents and an equal number of critics. As discussed, HMO services can be more efficient, convenient and comprehensive than a fee-for-service plan. HMOs can compliment Medicare services by offering lower costs, much less paperwork, and a primary care doctor for coordination of care. However, without paying more, the patient is restricted to care providers within the organization. This can be especially troubling for seniors who may bring a long and complex relationship with a particular physician. Also, under HMO guidelines, the patient cannot seek service from a specialist without referral. The HMO model is particularly unsuitable for seniors who spend part of the year is a different location; services simply may be unavailable. The most terrifying health care issue in the Medicare arena is its potential bankruptcy. According to U.S. Census projections, the Medicare-eligible population will burgeon between the years 2010 and 2030 (when the baby boom generation reaches age 65). By 2030, there will be about 71.5 million older persons, more than twice the number in 2000. People age sixty-five and older made up12.4% of the population in 2000; that percentage is expected to increase to 20% by 2030. The number of people eighty-five and older is projected to increase from 4.6 million in 2002 to 9.6 million in 2030. To compound health care equity issues, minority populations are projected to represent 26.4% of the elderly population in 2030, up from 17.2% in 2002 (AoA, 2003). There are many proposals on the table with the aim of saving the Medicare program. This is one example of a political hot potato that deflects policymakers from the task of solving the overall health care dilemma in America. In President George Bushs proposal to strengthen and modernize Medicare, public-private partnership is at the forefront. He contends that, through private health plans competing for the business of Medicare beneficiaries, better coverage at lower prices can be achieved; also, government gets out of the medical price-setting business. He also foresees government leaving the field of crafting coverage guidelines because competition, again, will yield more flexible and innovative plans. What about a safety net for Americans who need health care but lack the resources to obtain it? Medicaid is that safety net for Americans. This is the joint state-federal program for financing health care delivered to people with sufficiently low incomes, or to the chronically ill and disabled. As with Medicare, services traditionally are reimbursed on a fee-for-service basis. Each state commits funding for the program and the Federal government provides a percentage match for these state funds. The rules by which states must run their Medicaid programs are dictated by the Federal government; however, many aspects of the program structure are at the discretion of each state. Therefore, the shape of the program varies from one state to another. Medicaid is subject to the same problems as Medicare, problems of access, cost, choice, equity and efficiency. Low-income recipients have difficulty locating providers, partly because low-income neighborhoods typically are underserved, but also because many doctors will not accept Medicaid patients. Often, the limited amount Medicaid pays for services is below market rates. Therefore, as previously mentioned, Medicaid recipients are forced to rely on emergency rooms for primary health care services. Another similarity to the Medicare program is the move by states to adopt a managed care model for Medicaid recipients. Managed care may correct some of the problems faced by Medicaid beneficiaries. If enrollment is achieved, then locating a provider is unnecessary. Access to preventive care may increase, and the range of coverage may improve. In the last part of the twentieth century, Medicaid expansions led some to see this as the path to universal coverage; yet it remains a means-tested program, subject to threats of political retrenchment (Grogan Patashnik, 2003). It should be noted that, without the Medicaid program, the majority of the current 51 million beneficiaries would be without coverage, because, according to the criteria that private insurers currently use to determine whom they will insure, most of these people need not apply (Iglehart, 2003, 2418). Conclusion Iglehart (1999) points to the painful conclusion that, for whatever reasons, the United States is alone among industrialized nations in its failure to develop a health care policy that offers basic benefits to all Americans, regardless of their ability to pay. The idea of a single-payer, publicly-funded plan has vocal and prestigious advocates (see Friedman, 2001); equally vocal and powerful advocates speak for the insurance industry and the medical establishment. The great American nationwide debate regarding how to make health care more widely available to all and still to control cost continues. Questions such as how best how best to measure efficiency in the provision of services, how to structure efficient care, and how efficiency compares with other health care values (e.g., equity and choice), continue as a focus of the debate. The World Health Organization (WHO) defined a fair health care system as one that provides a fair distribution of medical responsiveness across population groups and of financial support, so that everyone is protected equally from the financial risk of illness (Bureau of Labor Education at the University of Maine, 2001). For the United States, the overarching balance of cost, choice, efficiency and equity remains elusive. References Administration on Aging (AoA), U.S. Department of Health and Human Services (2003). A Profile of Older Americans: 2003. Washington, D.C Bureau of Labor Education at the University of Maine, (2001). The U.S. health care system: Best in the world, or just the most expensive? Issues Brief, Summer, pp. 1-8. Friedman, M. (2001). How to cure health care. The Public Interest, 142, pp. 3-30. Grogan, C. Patashnik, E. (2003). Between welfare medicine and mainstream entitlement: Medicaid at the political crossroads. Journal of Health Politics, Policy Law, 28(5), pp. 821-858. Hilsenrath, P., Hill, J., Levey, S. (2004). Private finance and sustainable growth of national health expenditures. Journal of Health Care Finance, 30(4), pp. 14-20. Iglehart, J.K. (1999). The American health care system: Medicaid. The New England Journal of Medicine, 340(5), pp. 403-408. Iglehart, J.K. (2003). The dilemma of Medicaid. The New England Journal of Medicine, 348(21), pp. 2140-2148. Levchuk, C.M., Kosek, J.K., Drohan, M. (2000). Health care systems, in Healthy Living, ed. A. McNeill, Farmington Hills, Mich.: UXL, Vol. 2.