The Meteor as a Symbol in the Scarlet Letter

The Meteor that Dimmesdale sees in Chapter 12 of Nathaniel Hawthorne's The Scarlet Letter is an important symbol. As the minister watches the night sky, together with Hester and Pearl, a meteor appears that traces out an „Aâ€Å". While most of the people think that the „Aâ€Å" stands for „Angelâ€Å" and is showing that Governor Winthrop is gone and it marks his the entry to heaven, which will be proofed later on, but Dimmesdale, on the other hand, interprets it differently. Him hiding his sins and „cover his heart with his handâ€Å", the „Aâ€Å" reminds him of Hester‘s Scarlet Letter. He thinks, it is a sign for him to wear the mark of shame too, so as Hester does. Seeing that God is trying to show his sins to the public, what he does not want, even through he is dying of that. The minister only will find peace by telling and confessing his sin and accepting it finally, to what he is not able to do until the end of the book. This symbol shows us that there is more than one way to interpret things, like the Puritan way, who think of messages from God, typical warnings and bad things that will happen to them affecting their community. Dimmesdale only thinks about himself and the issue he has, he only interprets the meteor his way and no other, the symbol helped pushing him forward to finally built up the courage, he so badly needs to confess in front of the townspeople.

Why I Learn English

Why I learn English Learning English is necessary for my future career. Nowadays, practically every prestigious and well-plaid job, not only working as an English teacher, requires proficiency in this language. Those who know English, have a big advantage on the labour-market over those who don’t. But it certainly isn’t the only reason why I learn English. I have been interested in studying foreign languages since I went to school, and I always knew that my future profession would be connected with linguistics. I believe that the mentality of every nation is closely connected with its language.It’s impossible to translate any text from one language into another without slight changing of its meaning. Every language has some set-phrases and sayings that can’t be translated word for word. So, when you learn to think in a foreign language, you begin to think in a different way. You can see the world from a different viewpoint. To my mind, it compensates the t ime spent on studying the language. One another reason why I study English is connected with general intellectual development. Scientists have proved that learning languages serves as an excellent training for our brain.When a person learns one foreign language, other languages become easier for him or her to learn. On the whole, he or she begins to understand better all subjects, even if they are not connected with linguistics. Moreover, learning English provides me with extra opportunities. For example, I can understand, what my favorite musical bands sing: it’s extremely important for me, as I’m a music lover. Of course, one can like a song just because it sounds tuneful, but I prefer to understand the message that the author wanted to pass to the listeners. In addition, I can read books and watch movies in the original.It’s very useful, as the interpretation not always can transmit the richness of the author’s language, the subtlety of his thoughts. A nother opportunity, provided by the knowledge of the English language, is the ability to communicate with foreigners. I can get acquainted with new people while I travel abroad or just walk in Moscow, and then continue communicating with them in social networks. After all, I just like English: I like the way it sounds, and I find the culture and the history of England very interesting, as they have little resemblance to those of our country.

Technology Is the Solution to Overpopulation

Technology is the Solution to Overpopulation About ten years ago while in a science museum, I saw a counter that estimated what the world population was at that given moment. Innocuous at first glance, since a number in excess of five billion is difficult to comprehend, what became alarming after watching the counter for a minute was the continual increase in the population. Thinking about the circumstances related to the population rise logically made the problem seem apparent. The earth is finite both in terms of physical size and in resources but the population is growing towards an infinite value.At some point the steadily rising population will move from being a problem that is geographically distant to one that is immediate and more salient than just an increasing value on a faceless counter. This problem of population growth leads to a number of solutions that could have significant implications on the quality of life. Taking no action and allowing population to grow unchecked could possibly risk the entire human species if food or clean water were to become unavailable worldwide.Aiming for zero population growth would in theory maintain the existing quality of life since a stable population would not increase their use of resources. However not all resources are renewable, so scarcities could still occur with a fixed population size. In an extreme case permanent resource depletion under zero population growth could have the same extinction effect that unchecked growth can lead to. Despite the escalating risk of unchecked population growth, technological advances necessitated by the increase in population will at least maintain the quality of life and could possibly improve conditions.Southwick in â€Å"Global Ecology in Human Perspective† says that human population has increased geometrically over the past two millennia. With a high number of people in their reproductive age the potential for continued growth is likely. Southwick says that scient ists think the world population has increased far beyond an optimal size of one to two billion. The optimal population comes from a standard of middle class quality of life. A more critical analysis of population growth relates it to a cancer in an organism.Despite the level of pessimism on population growth, future research needs to be conducted with a more objective viewpoint to counteract cultural and emotional origins (Southwick, 1996). With the likelihood that population will continue to increase when considering Southwick’s observation that many people able to reproduce, the population will continue to move further from its â€Å"optimal† size. This deviation implies that the quality of life must be decreasing for many. In reality this decline has not happened. As discussed in class, increased agricultural yields have allowed for a larger population to be adequately supported.Even with the increased amount of food, Southwick says that 20 percent of the world popu lation is malnourished (1996). More food may be available but it still is not being distributed to all of those who need it. The lack of rapid worldwide transport of all goods including food may appear to be a hindrance to well-being but this disconnection between locations may provide an important health safeguard. Diseases are another negative factor to human population growth and some highly contagious fatal diseases can risk human extinction.A virus can only spread if it can find someone else to infect before it kills the carrier. A fatal disease that leads to death after a long period of time increases the chance that the carrier can infect other people, in turn bringing population closer to extinction. In terms of transportation, if people and goods in the world are too well connected, then a fatal disease that has the potential to lead to extinction would be able to infect many people over large area since the disease can spread quickly over trade routes.The World Health Orga nization has found that the current spread of Severe Acute Respiratory Syndrome or SARS is facilitated by international travel and can quickly infect many people around the world. Originating in Southeast Asia, speedy transportation has turned SARS from a regional problem into an international issue (World Health Organization, 2003). To avoid the risk of mass deaths due to rapidly spreading diseases, international policymakers need to avoid the creation of a level of world interconnectedness that is too quick. A slightly disconnected world may mean oods may not reach all places where in demand, but the risk of fatal diseases affecting large regions of population would be less. The ideal model of resource distribution is to have necessities be located near areas of population. Localized resources would reduce the need for goods to travel long distances over a lengthened period of time to avoid the spread of disease. Increased levels of population could live well off of added amounts of food that are nearby. This best case of locating populations near resources would be difficult to obtain in practice as resources and populations are already in fixed locations.If people were unwilling to move near where food is available it would be difficult, except in times of war and famine, to force them to relocate. A compromise solution would accept the fact that not all people of the world will be able to have a high standard of living but the potential for improved quality exists. This potential cannot be reached immediately since resources and population remain geographically separate and faster transportation would increase the spread of fatal diseases.Improvements in resource production such as increased crop yields makes it possible to support higher populations and improve the quality of life at least at a local level. References Southwick, C. H. Global Ecology in Human Perspective, Chapter 15. Oxford Univ. Press. (1996). World Health Organization â€Å"Frequently Asked Questions on Severe Acute Respiratory Syndrome (SARS),† Communicable Disease Surveillance & Response (CSR), March 24. (2003). World Health Organization . Retrieved March 29, 2004.

Corporate Governance and Accountability Essay Example | Topics and Well Written Essays - 3000 words

Corporate Governance and Accountability - Essay Example Hence, good governance is called for and indeed, demanded from the corporates. This part of the paper looks at the dimensions on which corporate governance can be analyzed by undertaking a literature review of the readings that have been assigned in different weeks of the course. The emphasis in this part is on a multidimensional and multi perspective look at some of the determinants of corporate governance. The aspect of executive or senior management compensation and its effect on corporate governance is one of the frequently cited determinants (Forbes & Watson, 1993, 335). In view of the ongoing global economic crisis that was caused partly due to the excessive risk taking of bankers and the role played by incentives (flawed, in hindsight) in causing such amoral behaviour. Given the gap between executive compensation and the compensation of the lowest paid worker in many corporations (to take an extreme case, the ratio is said to be 300:1), it is indeed the case that the system of incentives and executive compensation needs to be relooked at (Main et al, 1996, 1638). To take the examples of banks that failed like Lehmann Brothers and the very recent case of MF Global, where the structure of executive compensation and the misaligned incentives directly led to their downfall, it is apparent that the role played by executive compensation needs to be addressed as quickly as possible. In fact, even auto majors and other companies in sectors that were traditionally more egalitarian have fallen prey to the disease of excessive compensation for the top management (Conyon & Leech, 1994, 238). Added to this is the fact of additional benefits in terms of bonuses, privileges and other perks that have resulted in the compensation system being skewed further to the advantage of the senior management and leading to severe issues of governance and behaviour (Conyon & Peck, 1998, 153). Board directors in firms are

Comparing Essay Example | Topics and Well Written Essays - 500 words

Comparing - Essay Example During those years, Donald performed well both in academe and social relations. In 1964 he graduated and pursued his college education in Fordham University. He then transferred to Wharton School of Finance at the University of Pennsylvania where he learned accounting and finance. Trump graduated with a degree in economics. While working with his father during the summer time, he also learned the principle of money making, mortgages and construction works. He then joined his father's company and became the president of it in 1975. He changed the company's name to Trump Organization. He built a billion-dollar empire with his name branded on it. These were the Trump Tower, Trump Plaza, Trump Plaza Hotel, and Casino, Trump's Castle, Trump Parc and Trump Place. Thus, his name Trump was synonymous with wealth, luxury and prestige. He loved to utilize attractive architectural designs that would earn high profit and win public recognition. He was well known as the entrepreneur who found, bought and turned around losing properties. Just like Trump himself I also would like to have an empire of my own, and I do try to work on my thoughts to bring them to realization. Aside from his great achievements during his early career life, he also experienced downfall times when the real state market went down.

PepsiCo Strategic analysis Term Paper Example | Topics and Well Written Essays - 3500 words

PepsiCo Strategic analysis - Term Paper Example In this paper, the researcher will analyze PepsiCo’s strengths and weaknesses and whether the marketing environment within and outside the organization is favoring it or not. This paper fundamentally is a strategic analysis of PepsiCo, by keeping in consideration the internal and external forces and resources that can help the company to become a market leader. In the light of the research conducted on markets, in which PepsiCo is incorporated, the author of this report suggests business and corporate level strategies that can be utilized for succeeding in market place. Undoubtedly, Pepsi is the largest manufacturer of carbonated drinks around the world. Initially, the company was started by a North Carolina based chemist and pharmacist, Caleb Bradham in 1898. He named his cola drink â€Å"Brad’s Drink†. PepsiCo’s presence in UK dates back to 1950s when the company sold its first cola drink in London. Now PepsiCo is present in United Kingdom with a diversi fied work force of 5,000 individuals. PepsiCo operations can be divided into four regions in the world. These four strategic business units are PepsiCo Americas Beverages (PAB), PepsiCo Europe, PepsiCo Asia, Middle East and Africa (AMEA) and PepsiCo Americas Foods. It is evident from the marketing analysis of the company that it offers world’s largest range of brands in food and beverages industry. In UK, beside general stakeholders, which includes the employees, customers and the public, PepsiCo is working side by side with public service organizations and corporations. For example, PepsiCo

Introduction to Criminal Justice Coursework Example | Topics and Well Written Essays - 750 words

Introduction to Criminal Justice - Coursework Example Another problem with UCR is that it only reports the most serious offense and does not collect all important pieces of information. To improve the reliability and validity of UCR data efforts are being done to improve how crime statistics will be reported and collected. Apart from UCR, there is now the National Incident-Based Reporting System (NIBRS) which aims to provide a more detailed crime statistics and collect information in a more categorized and defines ways. 2. Victimization surveys refer to the method of questioning the victims of a crime about their experiences. These surveys collect a more detailed information about the crime incident, for instance when and where it occurred, how was the crime executed, and whether the victim was related to the offender. The advantages of Victimization surveys are: (1) provides more accurate estimates on the dark figure crime; (2) collected data help in understanding why some people choose to not report crime events to the law enforcement ; (3) the information gathered provides criminologists further explanation about the association of crime and social interaction that exists between the victim and offender. On the other hand, Victimization Surveys are also perceived to be limited in scope, unreliable due to memory errors, deception, sampling error, and telescoping. 3. Children are deemed to be one special population of crime victims. Since they are young and helpless, it is very easy for them to be abused by older family members. Different forms of abuse (physical, sexual and emotional) and neglect are the usual types of victimization that they confront, and the rate of victimization is on its highest among the youngest children. Another special population of crime victims is the senior citizens group. The usual types of victimization they face are nonfatal violent crime which is at 5%, and property crimes which is at 25%. The third special population of crime victims is the intimate partner. Intimate partners norm ally experience violent acts like murder, rape, robbery, and assault. Approximately, there are 570,000 women offended by their partners. 4. Often, the victims interact with the police in an uncomfortable and apprehensive manner because, first, the victims find the police’s process of questioning intimidating and, second, the victims are virtually always anxious about the result of the investigation which poses conflict to the â€Å"slowly but surely† process of the police. Similarly, the victims also feel uncomfortable and intimated whenever they interact with the prosecutors because of direct confrontation and vandalizing their property. In terms of the victims’ interaction with the parole boards, the conflict between the victims and parole boards usually arises when their offender receives an early release order, not to mention that majority of the parole boards give less credit to the statemenst of the victims. 5. The four main goals of punishment are general deterrence, specific deterrence, incapacitation, and retribution. 6. A punishment is deemed effective when, as much as possible, the offender is being punished immediately after the offense, the offenders are well-informed as to why they are being punished, there is consistency in the implementation of punishment, and there exist a strong and healthy relationship between the criminal and the punisher. Generally, punishment in the United

Landmark Decisions Essay Example | Topics and Well Written Essays - 2000 words

Landmark Decisions - Essay Example In this regards, Plessy has also filed the petition against John H. Ferguson, the director of the rail company of United States (Street Law, Inc., 2000). By reviewing the case scenario, it has been observed that the Plessy v. Ferguson case was concentrated on the violation of law related to racial discrimination. The case was in favor of John Howard Ferguson, who was the legal authority of the case for Louisianan Railroad Companies, as a defendant of the case. In accordance, the decision was announced by the supreme court of Louisiana stating that Plessey was legitimized as per the Unites State laws, which was established for creating segregation as per racial basis. In this case, the legislation was recognized as major influence behind the decision making process of Supreme Court of Unites States (Street Law, Inc., 2000). Besides, Supreme Court’s decision in the year of 1875 has restricted the federal government’s ability towards making any kind of intervention in the state government affair. In order to make any kind of involvement in the racial segregation as well as discrimination related act, the federal government needs to take the permission from the Congress in power (Street Law, Inc., 2000). Contradictorily, in favor of the plaintiff, Plessy’s lawyer provided evidence, which suggested that the violation of rules under thirteenth and fourteenth amendments had taken place by the railway company. According to the plaintiff, the state railway company was accused of making differences between the boarding of rail car for whites as well as for colored race during providing services. As per the fourteenth amendment rules, Plessy was provided with the ticket of accessing common compartments, which indeed makes him liable for equal treatment in the rail besides the fact that the rule to ensure separate facilities on the basis of consumers’ race was in itself ethically

The economic growth in the countries of Asia-Pacific region Essay

The economic growth in the countries of Asia-Pacific region - Essay Example The paper attempts to establish a quantitative relationship between the economic development and the factors affecting it in a cross-national context with particular reference to East Asian countries. Economic growth in the East Asian region over the last half-century has not been the same in all the countries. The growth in economic performance of a country and the differences underlying the economic conditions of various countries in the region is owing to the factors affecting growth. McKinnon and Shaw emphasize on the critical importance of the development of a country’s financial sector towards the enhancement of its economic growth. They are of the view that economic growth is closely linked with the financial market liberty in a country. Government interference and subjection over the financial sector through different means result in economic deterioration. The past (pre-crisis) and recent (post-crisis) economic boost as noticeable in Malaysia is not a matter of coincidence, rather it has been due to the fact that the factors responsible for economic growth prevail and flourish rapidly in the country as discussed throughout the essay. Malaysia has been one of those few countries in the region to be able to recover quickly from the East Asian crisis and thus has rapidly taken a tremendous development track. On the contrary, the countries having a slower economic growth rate such as Philippines reveal the lagging of factors that undermine a country’s economic growth.

Kearlsey Case Study Essay Example for Free

Kearlsey Case Study Essay Tony Kearsley applies for a position as a firefighter with the City of St. Catharines and was accepted on condition that he were to pass a medical examination by a doctor specified by the city. However, during the medical exam the doctor discovered that Kearsley had an atrial fibrillation (an irregular heartbeat) and refused to pass him. Kearsley took it upon himself to consult a medical specialist who advised him that his condition would indeed not affect his ability to perform his job as a firefighter. Kearsley then filed a complaint against the city with the Ontario Human Rights Commission. At the Commissions Bored of Inquiry hearing, the doctor who had originally examined Kearsley testified that atrial fibrillation led to increased risk for stroke meaning his heart could fail to pump sufficient blood to his organs during the extreme conditions that come with firefighting. The Board of Inquiry called a medical expert in atrial fibrillation. The expert testified that the increased risk for stroke in someone of Kearsley’s age was inconsequential. The expert further testified that there was no increased risk for heart failure in someone like Kearsley because he was otherwise in good health. Meanwhile, after Kearsley got turned down by the St. Catharines fire department, Kearsley had become a firefighter in the City of Hamilton, achieving the rank of first-class firefighter in October 2001. 2. Why did the Board of Inquiry rule in Kearsley’s favour? The Board of Inquiry ruled in Kearsley’s favour because they came to the conclusion that Mr. Tony Kearsley had in fact suffered discrimination. The Board noted that it would have been the City of St. Catharines responsibility to seek an expert opinion when confronted with a medical condition such as that found in Kearsley. The Board also indicated that this was the procedure used in other municipalities. The City did not follow their responsibilities which led to Mr. Kearsley’s unfair treatment and discrimination based on disability. For these reasons, this is why I think the Board of Inquiry most definitely ruled in Kearsley’s favour. 3. Do you agree with the decision in this case? Why or why not? I strongly agree with the decision of the case. Tony Kearsley was without a doubt, discriminated based on disability which is illegal in Canada. I feel like the city of St. Catharines defiantly should have handled this matter in a more ordered and professional way, as it seems that none of the facts in favour of the city of St. Catharines truly added up. I feel like the city jumped to conclusions too quickly not taking into account that Tony Kearsley was still fully capable to fulfill all duties of a firefighter. They did not treat Mr. Kearsley as an equal after finding out he had a disability; this is an act of discrimination and this is illegal. The city of St. Catharines owes at the least these things to Mr. Tony Kearsley in return for their lack of knowledge towards him while doing their job. 4. In what ways in this case a question of human rights? This case is a question of human rights because it is strongly discriminating against disability in the workplace. The Ontario Human Rights Code provides in part: 5(1) Every person has a right to equal treatment with respect to employment without discrimination because of †¦ handicap. 10(1) â€Å"because of handicap† means for the reason that person has or had, or is believed to have or have had a) any degree of physical disability that is caused by illness. 17(1) a right of a person under this Act is not infringed for the reason only that the person is incapable of performing of fulfilling essential duties or requirements attending the exercise of the right because of handicap. It is obvious at once that a person with very bad eyesight is not discriminated against when refused a job as a truck driver nor a person with inadequate strength when refused a job as a police officer or firefighter. There is no doubt that St. Catharines considered that Mr. Kearsley had a physical disability, atrial fibrillation. The issue is whether St. Catharines was justified in concluding that because of this perceived disability; Mr. Kearsley was incapable of performing or fulfilling essential duties as a firefighter. It was later found out that Mr. Kearsley could indeed perform all duties as a firefighter, as he got hired by the City of Hamilton later that year. Therefore, Mr. Kearsley was discriminated against based on disability and this is without a doubt, a question of human rights.

Psychosocial Concepts in Radiography

Psychosocial Concepts in Radiography â€Å"Promising too much can be as cruel as caring too little† (Kelley, 2005, p. 69). The aim of this assignment is to describe and discuss the psychosocial aspects of patient/client care as applied to radiography, and the skills required the deal with a range of issues in work environment and explore medico legal aspects of radiographer’s scope of practice while relating to the given scenario. Oxford English Dictionary(2013) defines psychosocial as â€Å"relating to the interrelation of social factors and individual thought and behaviour† and medico legal â€Å"refers to that which is related to medicine and the law. It refers to that which pertains to the legal aspects involved in the practice of medicine. It covers the prerogatives and responsibilities that a medical professional is bound by as well as the rights of the patient† (AJ, 2013). Upon arriving to the department it is paramount the radiographer justifies the x-ray request form on clinical grounds, and must adhere to the minimum requirements set by IR(ME)R which requires 3 forms of ID, the request form to be signed, information to identify the patient and clinical information to justify exposure. (DoH, 2000). once patient has been located, the radiographer is greeted by angry relatives who are complaining their mother had nothing to drink for 24 hours and has soiled herself, with this in consideration it is vital the radiographer introduces themselves and confirms the patients details for example, patients name, DOB and Address and hospital number if checking wristband as patient has limited ability to communicate. Infection control will be required as the patient has defecated herself, a quick check for infections such as clostridium difficile; if infections are present it should be present on the x-ray request or patient notes. The first impression a patient forms from the way practitioner portray themselves by greeting the patient and explaining the procedure in the first few minutes. If a negative impression is formed during this encounter, it will be difficult to erase and the subsequent practitioner and patient interaction will be affected (Ramlaul and Vosper, 2013). When dealing with the patient/relatives the radiographer must be assertive, confident compassionate, and empathetic to the patient’s situation (Scriven and Orme, 2001), and must use clinical reasoning which refers to thinking and processes associated with the clinical practice of health care providers (Higgs, Jones, Loftus and Christensen, 2008) Reassure the family that you have just arrived and here to resolve the matter, explain there could be a valid reason regarding the water, but you will look into it. Give reasons why there might be a shortage of nurses due to â€Å"fast interaction period of emergency departments which may be similar times to medical imaging† (Ramlaul and Vosper, 2013, p.13). This might be why the radiographer was not able to locate the nurses. Communication between healthcare professionals and patients is paramount to improve quality of care for patients, and eliminate any possibility for mistakes (O’Daniel and Rosenstein 2008). This scenario has clearly demonstrated the lack of Inter-professional communication and collaboration and how detrimental it is to patient care. The psychosocial aspects of any individual can be affected by a small initial stimulus which can start a chain of events that have enormous outcomes; this is known as the butterfly effect (Burton, 2013). Little do we realise a smile can be enough to put someone at ease, and that can be the difference between a positive experience and a negative one. We have to understand the social/environmental aspect of an individual also plays a huge role in the way they think, talk, and behave (Niven, 2000). The radiographer must take into consideration the psychological state of the patient, which may help understand the different feelings the patient might be experiencing such as, anxiety, shame, angry, distressed, shocked, and unwell. It is important the radiographer focus on their thoughts and feelings to better treat them. Compassionate care must be 1st priority for all health professionals; this constitutes the six C’s, Care, compassion, competence, communication, courage, commitment. This guide helps health professionals to make sure their care meets the standards patients rightly expect and deserve (Cummings and Bennett, 2012). This should apply to all health professionals. With regards to Francis report UK The Mid Staffordshire NHS Foundation Trust Public Inquiry, (2010) which was carried out from January 2005 to March 2009 for the hundreds of appalling failings of compassionate care were left in excrement in soiled bed clothes for lengthy periods and many other failings. Referring back to the scenario it is seen the patient is in a similar situation and as a witness; the radiographer must report this, failure to do so is against the law. Radiographers should uphold National Health Service constitution and values which are based on comprehensive service available to all race, gender, disability, age, sexual orientation, religion or belief and adhere the core value of NHS, respect and dignity, commitment to quality of care, compassion, communication, improving lives, and working together for patients (DoH, 2013). Communication comes in many forms, verbal, non-verbal (sign language, facial expression and other forms of body language) it can be difficult at times to assess patients, this may be due to may barriers such as gender, age, language and disability, each barrier differ from patient to patient, with regards to the scenario the frail old lady is in a venerable state and unable to communicate regardless the radiographer must communicate with her as she may understand other means of communication which may include simple muscle movements such as blinking or squeezing a hand. Due to the lack of time usually available to radiographers, the task of identifying and treating symptoms may become the only goal for the practitioner, who then denies the patient the opportunity to explain their illness (Edelmann, 2000). Radiographers must provide holistic care for the patient, while assessing patients and their clinical requirements to determine appropriate radiographic technique, and to perform a wide range of radiographic examinations on patients to produce high quality images while observing and maintaining contact with patients during their waiting, examination and post-examination stay in the hospital, And complying with Data Protection Act, IRMER, IRR, ALARP, Health and Safety at work, and many more (Agcas, 2012). Radiographers must keep within their scope of practice based on competency, education, extent of experience and knowledge while practising in a safe and competent manner (SoR, 2008). And adhere to legislations set for radiographers, scope of practice, local rules, policies and procedures and HCPC standards of proficiency, is responsible and accountable for the patient undergoing x-ray (and other imaging modalities). What is scope of practice for a radiographer? HCPC (2012) defines the scope of practice is the area/areas in which the radiographer has knowledge, skills and experience to practice lawfully, safely and effectively in a way that meets the HCPC standards and does not pose a danger to the public or to yourself. However if a practitioner wanted to move outside their scope of practice can do so providing they are capable of working lawfully, safely and effectively. Relating back to the scenario it may need to be considered whether taking a portable abdominal x-ray is in the local rules, policies, and procedures, must weigh the risks/benefit, consider their personal experience and is it enough to carry out the x-ray in a safe, effective and lawful manor. As health professionals one must understand their own capacity and limitations and act accordingly. Taking consent from the patient can be verbal, written or implied. Every adult has the right to determine what is done to their body (UIC, 2004). Taking an x-ray without obtaining valid consent can be detrimental which leaves the practitioner open to lawsuits and questions their fitness to practice. As we know the patient is not able to communicate, hence the radiographer might adopt different means on consent for example implied. Patient might be asked to blink twice if it’s okay to go ahead and blink once if not vice versa. Pertaining to moving and handling patient the radiographer should make use of the mandatory manual handling training provided by the trust/university. The radiographer must not in under any circumstance cannot pat-slide by themselves and must have a minimum of 3 trained personals. This scenario is a classic example of negligence, where no nurses are present to attend to the patient, torts law comes into play in this scenario, where unintentional negligence of the patient where the duty of care is at breech. If the radiographer carried out the x-ray after the patient had been cleaned by the radiographer and/or nurse, the radiographer must inform patient about the x-ray being taken and once consented markers must be used in the primary beams instead of post processing to avoid confusions, and most importantly, the x-ray can be used in court if required, furthermore upon taking the x-ray a holders form need to be filled in if holder was required and must wear lead coats. A risk assessment must be carried out to determine if it is possible to carry out the x-ray and apply ALARA (as low as reasonably achievable) as mobile x-rays tend to used higher exposures this is achieved by many ways such as increasing the FDD. This scenario can most certainly make everyone feel agitated, stressed, scared and terrified, and nervous. However as professionals one must show confidence in the face of adversity and demonstrate good communication skills and follow the HCPC standards of conduct, the scope of practice, upholding the NHS constitution along with compassionate care guide, will ultimately enable the health practitioner to be more confident and well equipped in practice. In conclusion one can argue it requires inter-professional team effort to give the best experience to any patient, which is be true, but it requires the efforts of each individual put together collectively to formulate productivity and efficiency for the best interests of the patients. Reference List Agcas. (2012). Role of a diagnostic radiographer. Prospects. Retrieved December, 13, 2013, from http://www.prospects.ac.uk/diagnostic_radiographer_job_ description.htm. Burton, J. (2013). Radiography and the butterfly effect. SoR. Retrieved December, 16, 2013, from http://www.sor.org/ezines/scortalk/issue-13/blog-radiography-and-butterfly-effect. Cummings, J Bennett, V. (2012). Compassion in practice. Retrieved December, 22, 2013, from http://www.england.nhs.uk/nursingvision/. Department of health. (2000). Ionising Radiations Medical Exposure Regulations: Good Practice. Retrieved November, 25, 2013, from https://www.gov.uk/government/uploads /system /uploads/attachment_data/file/227075/IRMER_regulations_2000.pdf. Department of Health. (2013).  The NHS Constitution: TheNHS belongs to us all. Retrieved December, 10, 2013, from  http://www.nhs.uk/choiceintheNHS /Rightsandpledges/NHSConstitution/Pages/Overview.aspx. Donald R. Kelley. (2005). Divided Power: The Presidency, Congress, and the Formation of American Foreign Policy, Intraparty factionalism on key foreign policy issues. (p.69). University of Arkansas Press Edelmann, R. J., (2000). Psychosocial Aspects of the Health Care Process.  Harlow Prentice Hall Higgs, J. Jones, M. Loftus, S. Christensen, N. (2008).  Clinical Reasoning:  in the Health Professions.  (3rded.). London: Elsevier Jeevs, A. (2013). What is medico legal? AskJeeves. Retrieved December, 20, 2013, from http://uk.ask.com/question/what-is-medico-legal. Niven, N. (2000).  Health psychology: For health care professionals. (3rded.). Edinburgh: Livingstone. O’Daniel, M. Rosenstein, A. H. (2008). Patient Safety and Quality: Professional Communication and Team Collaboration. PubMed, 8(43), 33. Ramlaul, A. Vosper, M. (2013). Patient centred care in medical imaging and radiotherapy: In medical imaging and radiotherapy.London: Churchill-Livingstone. Scriven, A. Orme, J. (2001). Health Promotion, professional perspectives. (2nded.). London: Macmillan. The Health Professions Council. (2012). Standards of proficiency, your scope of practice.  London: HCPC. The Society of Radiographers. (2013). Code of Conduct and Ethics.  London: SoR. University of Illinois at Chicago College of medicine UIC. (2004), Informed consent, Retrieved November, 30, 2013, from http://www.uic.edu/depts/mcam/ethics/ic.htm. United Kingdom. The Mid Staffordshire NHS Foundation Trust Public Inquiry. (2010). Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust. London: TSO. (Chairman R. Francis).

Equity and PFI Strategies in the NHS

Equity and PFI Strategies in the NHS A) Equity NHS hospitals acquire some finance from the private sector and many patients use private health insurance to gain access to treatment; a two tier health care system is emerging (Browne, 2002). From the time the NHS began there has been concern about inequalities in health care. The Black report (1980) looked further at this and the Department of health report â€Å"Saving lives† (1999) rates the importance of equity highly. Equity can conflict with efficiency (Wagstaff, 1991). Sassi (2001) explains that mechanisms of achieving equity are unclear especially when there is the conflict with efficiency. Sassi (2001a) found that for cervical cancer screening, renal transplantation, and neonatal screening for sickle cell disease there was no consistency between NHS policies and equitable principles. Social class has an influence on the incidence and the survivability of many malignancies (Brown, 1997) but despite this fact in the cervical screening program the women most at risk were the least likely to get screened (National Audit Office, 1998). The monetary incentives to achieve screening targets by general practitioners did not address this problem. There are also morally related benefits such as respect for the individual and respect for autonomy that need to be considered. Although â€Å"there should be equal access to health care within the NHS based on equal need† (Davey, 1993) the advent of prescription charges and the extent of the exclusions of dental treatment and of optician services from the NHS (New, 1996) and particularly the exclusion of the bulk of infertility treatment negates this principle. Whilst the prescription charges and optical and dental charges do not, in general, mean that the patient’s need is not met (since the inherent means testing excludes those who are likely to be able to pay themselves) the fertility treatment issue is quite different. Whilst allocation by index of social deprivation or by ethnicity may be a requirement this may conflict with allocation by clinical need. The important question is whether there is equal treatment for equal need. Since those who are poorer in financial terms have the greatest health care needs in addressing the question it becomes apparent that those individuals who are poorer should have an appropriate resource allocation for health care. The system of resource allocation is slightly â€Å"pro poor† (Propper, 2001). The lowest 25% of the population economically do get 25% of the funding (the financial groups were standardised for equality of health care need). Equity in resource allocation does not however mean equity in terms of health actually achieved. The question is whether there is effectiveness of this allocation. Inequalities in health persist across social boundaries (Acheson report, 1988). Propper (2001) analysed â€Å"equal treatment for equal need† accordin g to whether those of equal clinical need but of differing financial means actually had equal treatment. The issue to address is whether there is equal access to healthcare, so this goes a step forward from just equal funding. Interestingly Propper (2001) finds little effect by age. The higher health care expenditure with increased age was generally in the last few months of life regardless of age. There is not currently a fair distribution of health care provision across multi ethnic groups (Erens, 2001). Whether affirmative action policies would assist in a more equitable distribution awaits further evaluation (Sassi, 2004). The Department of Health’s â€Å"Tackling health inequalities† (2003) places much emphasis on targeting racial groups for enhanced care. Health care targeting of ethnic minority groups with greater health care needs has begun to show some evidence of improved outcome (Arblaster, 1996). Health authority funding has tended to be overly weighted according to age distribution (Judge, 1994). Judge (1994) calls for a â€Å"unified weighted capitation system†. Coordination is a problem. Budgetary allocation may be partly determined on the previous year’s spending. Mechanisms of altering care according to need have often not assessed how this might be achieved (Majeed, 1994). Those individuals with the greatest health care needs include young children, the elderly, people living in areas of social deprivation and people from ethnic minority groups (Majeed, 1994). However it is these groups of the greatest need who have general practitioners with the greatest primary care work load (Balarajan, 1992). People from ethnic minorities and those living in areas of social deprivation have the lowest uptakes of immunisation (Baker, 11991). There is a fundamental need still for the equal need – equal access equation and despite the difficulties of trying to achieve a balance (which may be viewed over pessimistically, Doyal, 1997) it remains a worthwhile objective. References Acheson Report. Independent inquiry into inequalities in health report. 1998 Department of Health London: The stationary office. Arblaster L Lambert M Entwistle V et al 1996 A systematic review of the effectiveness of health service interventions aimed at reducing inequalities in health. J Health Serv Res Policy 1: 93-103. Baker D Klein R 1991 Explaining outputs of primary health care: population and practice factors. BMJ303:225-9. Balarajan R Yuen P Machin D 1992 Deprivation and general practitioner workload. BMJ 304:529-34. The Black report 1980 Department of Health and Social Services. Inequalities in health: the Black report. London: DHSS Brown J Harding S Bethune A et al 1997 Incidence of Health of the Nation cancers by social class. Population Trends 90: 40-47 Browne A and Young M 2002 A sick NHS: the diagnosis. The observer Special Reports Sunday April 7, 2002 Davey B, Popay, J. Dilemmas in health care. Buckingham: Open University Press, 1993:27-42. Doyle L 1997 Rationing within the NHS should be explicit: the care for BMJ 314:1114-1118 Erens B Primatesta P Prior G 2001 Health survey for England 1999: the health of minority ethnic groups. London: Stationery Office. Judge K Mays N1994 Equity in the NHS Allocating resources for health and social care in England BMJ 308:1363-6 Majeed FA N Chaturvedi N R Reading R 1994 Equity in the NHS Monitoring and promoting equity in primary and secondary care BMJ 308:1426-29 National Audit Office 1998 The performance of the NHS cervical screening programme in England. London: Stationery Office. New B 1996 The rationing agenda in the NHS BMJ 312:1593-1601 Propper C 2001 Expenditure on Health Care in the UK: A review of the issues. CMPO Working Paper Series No. 01/030 Available on http://www.bris.ac.uk/cmpo/workingpapers/wp30.pdf Accessed 1 May 2006. Sassi F Archard L Le Grand J 2001aEquity and the economic evaluation of health care. Health Technol Assess 5(3). Sassi F Carrier J Weinberg J 2004 Affirmative action: the lessons for health care BMJ328:1213-1214 Saving lives: our healthier nation 1999 Department of Health. London: Stationery Office Tackling health inequalities. A programme for action. 2003 Department of Health. London: DoH, 2003. Wagstaff A 1991 QALYs and the equity-efficiency trade-off. J Health Econ 10: 21-41 B) Private Finance Initiative (PFI) PFI is a partnership between the NHS and a private company. It is increasingly used to purchase a new hospital building. Instead of a capital payment being made revenue payments are made over a number of years. Advantages of PFI Many hospital buildings are extremely old and are clearly no longer suitable for their purpose. The buildings hamper the introduction of new technologies and new ways of working. Costs of new buildings are prohibitively high. The PFI arrangement enables a new building to go ahead where otherwise the opportunity to rebuild would not have arisen at all. PFI certainly overcomes the difficulties that would ensue from a rise in taxes to achieve new hospital builds which would be very unpopular with the public and would be difficult to provide equitably. The PFI does achieve a building with the minimal of public spending at least in the short term. The view of Government is that PFI allows money to be spent on equipment rather than buildings (Ferriman, 1999). There is an argument that PFI is only a procurement issue and other procurement processes are not without problems (McGinty, 2000). The blame laid on PFI may have occurred with alternative means of funding the building of a new hospital. Under the PFI scheme there is a clear incentive, once agreement has been reached, to commence and complete the building work. The private company has a financial interest to see completion to a satisfactory standard. The advantage here for the healthcare provider is that the scheme will complete quickly. There is an ongoing interest in the building by the building and finance companies and this may work to the benefit of the health care provider. Disadvantages of PFI The cost may increase once the building work has begun and this may lead to cost containment negotiations resulting in a decreased number of beds or result in other cutting of health care services. Smith (1999) finds where there is PFI there is an increase in the number of private beds to help to finance the project. This may arise as a choice to increase the revenue from private work as opposed to cutting the number of beds in the new build. The PFI scheme does not really take into consideration the fact that an increasing amount of health care previously provided in hospitals is now done in the community and investment is now in â€Å"services not beds† (McCloskey, 2000). A view, though not universal, (Smith, 1999) is that with PFI the planning is done in the private sector and is therefore not so readily visible. There is increasing evidence that PFI is costing more than the costs of using public money (Pollock, 1997). â€Å"Private capital is always more expensive than public capital† (Smith, 1999). The cost through PFI of construction plus financing costs is 18-60% higher than the building costs (Gaffney, 1999). This is a worrying aspect. It is likely the deficit will be met by cutting costs in the service (Gaffney, 1999). Gaffney (1999) argues comparisons prior to approval of PFI schemes use comparisons with public sector building that involve â€Å"discounting† of costs and adjustments to reflect â€Å"risk transfer† in its appraisal methodology which biases towards approval of PFI. The discounted cash flow analysis makes the PFI look better value than it actually is. Such discounting is appropriate for the private sector where it is useful to maximise profits. Its value in health care where there is not the aim to profit is therefore suspect. The level of concern about PFI has reached the level where the British Medical Association opposes the scheme and wishes the public to be informed of the anticipated long term repercussions and that there be an audit of present such schemes (Beecham, 2002). There is some evidence that PFI is now becoming less popular with private companies (O’Dowd, 2005). There is a concern that some feel that purely because the private sector is involved the procedure must be wrong. It is not the partnership with the private sector that is wrong but the lack of a credible system of achieving an appropriate balance between the financial rewards to the investor and the value for money of the health care provider. If the scales tip the way many fear they will there will be a very serious financial drain on the health service. The Government has now become concerned about the cost implications of PFI and is presently delaying further PFI plans whilst investigating the issue further (O’Dowd, 2006). References Beecham L 2002 PFI schemes should be vigorously opposed BMJ 325:66 Ferriman A 1999 Dobson defends use of the PFI for hospital building BMJ 319:275 Gaffney D, Pollock AM, Price D et al 1999PFI in the NHSis there an economic case? BMJ 319:116-9 McCloskey B Deakin M 2000 Series did not address real planning issues BMJ 320:250 McGinty F 2000 Partnership between private and NHS is not necessarily wrong BMJ 320:250 O’Dowd A 2005 Private sector is losing interest in PFI projects BMJ331:1042 O’Dowd A 2006 Three hospital PFI schemes are delayed while government looks at their cost BMJ332:196 Pollock AM Dunnigan M Gaffney D et al 1997 on behalf of the NHS Consultants Association, Radical Statistics Health Group, and the NHS Support Federation. What happens when the private sector plans hospital services for the NHS: three case studies under the private finance initiative. BMJ 1997; 314: 1266-1271 Smith R 1999 PFI: perfidious financial idiocy BMJ ;319:2-3 C) Managing Scarce Resources Clear mismatch been healthcare resources and needs leads to rationing but the actual mechanism of this is unclear. There are important differences between rationing and priority setting/resource allocation (New, 1996). The former denies a service to individuals whereas the latter concerns value judgments in providing services to groups. Rationing only concerns those treatments which are of proven benefit and is not concerned with evaluation of treatment effectiveness (Nice, 1996). There is healthcare rationing within the NHS today and this is not clear or widely acknowledged and therefore is implicit (Coast, 1997). As a result where treatment is denied to individuals the public do not realize this is due to rationing but on the occasions it finds out there is generally public dissatisfaction, sometimes culminating in litigation as with child B (Price, 1996). Arguments against rationing being explicit include the difficultly of creating such a scheme since there are no ethical rules by which to do it Klein, 1993). â€Å"There is no such thing as a correct set of priorities, or even a correct way of setting priorities (House of Commons Health Committee, 1995). Even if it could be done some consider it is unlikely to work not least because those disadvantaged may bring about dispute and disruption leading to a return to an implicit system (Mechanic, 1995). Coast (1997) sees the disutility (dissatisfaction with the poorer clinical outcome where treatment is denied) of explicit rationing as a distinct problem. With explicit rationing the public would be colluding with decision making and would feel responsibility and disutility where treatment is denied. Coast (1997) argues that in an implicit system the doctors will tend to medicalise the decisions not to treat. When there has been explicit rationing there is no evidence of improved decisio n making but reluctance to determine which treatments should be denied (Cohen, 1994; Donaldson, 1994). Arguments in favour of explicit (openly acknowledged) rationing, a view favoured by healthcare policy makers, include; openness and honesty, possibly leading to a more equitable, efficient service, in which the public can influence the rationing process democratically. Doyal (1979) favours explicit rationing and promotes â€Å"evaluat[ion of] the justice or the efficiency of the rationing process,† and considers the inability to face this is in contrast with the moral foundation of the NHS. Doyal (1979) favours rationing according to need (degree of disability) not by disease popularity, or social worth. Incorporation of uniform clinical guidelines might facilitate the process. Points to consider in a rationing process include (New, 1996); Which services are to be rationed What are the objectives of the rationing process What are the ethically acceptable criteria for rationing Who should do the rationing The Rationing Agenda Group’s function is to increase debate on rationing. This body believes rationing and public involvement in the process are essential (New, 1996). There are various methods of rationing, one includes a cost effective analysis, another involves capacity to benefit (New, 1996). Different approaches are used for different needs for instance infertility treatment may be denied entirely. In any explicit rationing process objectives need clarification and here the objectives might include (New,1996) maximising quality adjusted life years or minimising health inequalities by group or area of residence, The decision making process at national level will include formulae for allocation by geographical area and also work in response to national agendas such as Health of the Nation. At local level there will be health care commissioning incorporating decisions about which health care services to purchase for a community. The processes will be subject to pressure from groups such as; pressure groups, complaint mechanisms and statutory bodies such as community health councils and review by the national Audit Office (New, 1996). Even when a rationing criteria is agreed upon the situation remains complex. Rationing by age may be morally wrong and some would advocate its illegality (Rivin, 1999). Age is a major factor in the rationing of renal transplantation (Lewis, 1989) despite the fact that age does not have a good relationship with prognosis (Wolfe, 1999). Sassi (2001) explains the lack of equity principles in the way such decisions are made in the NHS. O’Boyle (2001) auditing rationing secondary care for excision of skin lesions and found poor patient and general practitioner satisfaction with the process and a high rate of re-referrals. The debate as to the degree of openness of the rationing process continues. The problems of rationing are inherent in the process and openness of the process exposes yet more difficult decision making. References Coast J 1997 Rationing within the NHS should be explicit; the case against BMJ 314:1118-1122 Cohen D 1994 Marginal analysis in practice: an alternative to needs assessment for contracting health care. BMJ 309:781-4. Donaldson C 1994 Commentary: possible road to efficiency in the health service. BMJ 309:784-5. Doyal L 1997 Rationing within the NHS should be explicit: the case for BMJ 1114-1118 House of Commons Health Committee 1995 Priority setting in the NHS: purchasing. London: HMSO 57. Klein R 1993 Dimensions of rationing: who should do what? BMJ 307:309-11. Lewis PA Charny M 1989 Which of two individuals do you treat when only their ages are different and you cant treat both? J Med Ethics 1989; 15: 29-32. Mechanic D 1995 Dilemmas in rationing health care services: the case for implicit rationing. BMJ 310:1655-9. New B 1996 The rationing agenda in the NHS BMJ 312:1593-1601 OBoyle Cole R P C 2001 Rationing in the NHS : An audit of outcome and acceptance of restriction criteria for minor operations BMJ323:428-429 Price D 1996 Lessons for health care rationing from the case of child B BMJ 312:167-9. Rivlin M 1999 Should age based rationing of health care be illegal? BMJ319:1379 Sassi F Le Grand J Archard L 2001 Equity versus efficiency: a dilemma for the NHS BMJ323:762-763 Wolfe R Ashby V Milford E et al 1999 Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341: 1725-1730

The Usurper in Macbeth :: Macbeth essays

The Usurper in Macbeth      Ã‚  Ã‚   In William Shakespeare's tragedy Macbeth there is an ambitious captain who takes the throne of Scotland by force. Let's examine his character in this paper.    Lily B. Campbell in her volume of criticism, Shakespeare's Tragic Heroes: Slaves of Passion, explores the workings of Macbeth's mind as he plots the destruction of Banquo and son :    If the witches have spoken as truly to Banquo as to him, Macbeth sees that he wears a "fruitless crown" and carries a "barren sceptre" in his hand; he has indeed given peace and immortality to make the race of Banquo kings. And he proceeds to his interview with the murderers, plotting what he dare not do openly, for the fear that comes when we are rivals for a thing and cannot both have it makes it seem to Macbeth:    That every minute of his being thrusts Against my near'st of life;    and he will kill his fear by having Banquo and Fleance both put to death.(224)    In Everybody's Shakespeare: Reflections Chiefly on the Tragedies, Maynard Mack shows how Macbeth complements his wife:    Her fall is instantaneous, even eager, like Eve's in Paradise Lost; his is gradual and reluctant, like Adam's. She needs only her husband's letter about the weyard sisters' prophecy to precipitate her resolve to kill Duncan. Within an instant she is inviting murderous spirits to unsex her, fill her with cruelty, thicken her blood, convert her mother's milk to gall, and darken the world "That my keen knife see not the wound it makes" (1.5.50). Macbeth, in contrast, vacillates. The images of the deed that possess him simultaneously repel him (1.3.130, 1.7.1) When she proposes Duncan's murder, he temporizes: "We will speak further" (1.5.69). (189)    In his book, On the Design of Shakespearean Tragedy, H. S. Wilson tells how the audience is inclined to identify with such a rogue as Macbeth:    That such a man should sacrifice all the wealth of his human spirit - his kindness, his love, his very soul - to become a victim to continual fears, a tyrant ruthlessly murdering in the vain attempt to feel safe, finally to be killed like a foul beast of prey - this is terrible, and pitiful, too. Shakespeare has here achieved for us most poignantly the ambivalence of the tragic effect Aristotle described. We The Usurper in Macbeth :: Macbeth essays The Usurper in Macbeth      Ã‚  Ã‚   In William Shakespeare's tragedy Macbeth there is an ambitious captain who takes the throne of Scotland by force. Let's examine his character in this paper.    Lily B. Campbell in her volume of criticism, Shakespeare's Tragic Heroes: Slaves of Passion, explores the workings of Macbeth's mind as he plots the destruction of Banquo and son :    If the witches have spoken as truly to Banquo as to him, Macbeth sees that he wears a "fruitless crown" and carries a "barren sceptre" in his hand; he has indeed given peace and immortality to make the race of Banquo kings. And he proceeds to his interview with the murderers, plotting what he dare not do openly, for the fear that comes when we are rivals for a thing and cannot both have it makes it seem to Macbeth:    That every minute of his being thrusts Against my near'st of life;    and he will kill his fear by having Banquo and Fleance both put to death.(224)    In Everybody's Shakespeare: Reflections Chiefly on the Tragedies, Maynard Mack shows how Macbeth complements his wife:    Her fall is instantaneous, even eager, like Eve's in Paradise Lost; his is gradual and reluctant, like Adam's. She needs only her husband's letter about the weyard sisters' prophecy to precipitate her resolve to kill Duncan. Within an instant she is inviting murderous spirits to unsex her, fill her with cruelty, thicken her blood, convert her mother's milk to gall, and darken the world "That my keen knife see not the wound it makes" (1.5.50). Macbeth, in contrast, vacillates. The images of the deed that possess him simultaneously repel him (1.3.130, 1.7.1) When she proposes Duncan's murder, he temporizes: "We will speak further" (1.5.69). (189)    In his book, On the Design of Shakespearean Tragedy, H. S. Wilson tells how the audience is inclined to identify with such a rogue as Macbeth:    That such a man should sacrifice all the wealth of his human spirit - his kindness, his love, his very soul - to become a victim to continual fears, a tyrant ruthlessly murdering in the vain attempt to feel safe, finally to be killed like a foul beast of prey - this is terrible, and pitiful, too. Shakespeare has here achieved for us most poignantly the ambivalence of the tragic effect Aristotle described. We

Holden Essay -- essays research papers

Holden Caulfield, the narrator and the main character of The Catcher in the Rye by J.D. Salinger, is a young adult, who, at first seems to simply describes his four day adventure in New York City after bring expelled from his forth school. However, at the same time he narrates more; through his many experiences, which he describes in the book, we can see the themes of the work. The theme that definitely stands out is the loss of innocence. Holden portrays himself as an individual, who does not want to grow up and change. From the beginning, it is obvious that Holden does not like anyone, except children. To Holden, the world around him, the adult world and all of its members, is phony. In other words, the innocent world of children is the only world that appeals to Holden. However, in the end the reader also gets to see Holden's change and eventual surrender to the adult world. The Catcher in the Rye is simply about Holden's futile resistance to growing up and his surrender. Holden's attempts to refuse maturing are seen through his failures in education, his attitude towards the adult world, and his caring for only children, but his sudden fall into maturity shows there is no escape from growing up. Holden's actions and the way he describes his experiences clearly show his refusal to grow up. The first sign of Holden's refusal to leave the childhood world behind is his constant failures in school. Holden has been kicked out of several schools already, from each one within a...

Democracy Best Form of Government?

Democracy is best defined as the government of the people, by the people. The classical example of democracy is that of ancient Athens, where the whole populace would meet in the marketplace to vote on decisions. It has been said that democracy is the worst form of government, except all the others have been tried. In my opinion, democracy is not a perfect system, but it is the best form of government when compared to others and is the most effective among all different types of government. In a democratic government, power is given to the people. This allows the people to have a direct say in who governs them, via the votes cast by every adult member of the population. As such it ensures that a government is made up of those who are truly representative of the people, satisfying the population of electing a government that will think about them, care about them and provide for them. Furthermore, when power is given to the people, the people will be more careful when using their power as they will have to bear the consequences if the leader elected is corrupted or not a wise leader. By giving power to the people allows decisions to be made according to the will of the people and also prevents the abuse of power. Citizens are kept informed by the media and are thus fully capable of making an informed decision. Furthermore, the will of the people is far more representative of different groups in society than the condescending rule by elites, who have no understanding of different ways of life. Only the citizens of a country understand what kind of leader they truly needs and in a democratic country they will have the ability to vote for them. Democracy empowers the people and allows them to participate in decision-making, which is why it is the best form of government. Besides power, democracy also allows the freedom of speech and that allows a nation to improve and progress. Democratic nations allow citizens to criticize leaders, their policies and laws. Being open to criticism allows leaders to listen to opinions of the citizens and understand what the citizens truly needs. This allows policies to be improved and the nation to progress better. By silencing the people and censoring any constructive criticisms, citizens will gradually stop thinking critically and start to follow laws blindly. This will be detrimental to the innovation and creation of ideas in a nation. Allowing criticisms can ensure that citizens think critically of how policies and laws will affect them, constantly sharpening their thoughts. Having a population that thinks critically is vital to the progress of a nation, and a democratic government that allows the freedom of speech can allow the nation to improve and progress, thus being the best form of government. As mentioned earlier, democracy is a not perfect form of government. Citizens of a country have never received any training and do not possess any skills needed to face and solve the problems that a state faces. Also, the masses are easily manipulated and tend to act according to their feelings. For example, after the 911 terror attacks in New York, many citizens of America pushed for the use of nuclear technology against Middle East. If America were a full democratic country, it would have already been engulfed into another nuclear war, and the consequences are heavy. As such, expecting the people to elect the â€Å"best tools for the job† is unrealistic. Government from above can see, by virtue of its position and advantages, what is a better solution for problems. Therefore, democracy may not be as effective in certain situations as other forms of government. Furthermore, real, effective leadership must come from above and not from below. The government should give orders, make laws and not take orders from the people. Democracy functions on the unrealistic assumption that all citizens are as capable as the leaders and is able to make the best decision. This is what makes democracy imperfect and ineffective. In conclusion, democracy is, to a large extent, the best form of government. The best form of government is that which teaches us to govern ourselves. However, if man were angels, no government would be necessary. Hence, a balance should be striked between governing the people and allowing them to make decisions themselves, and democracy is the only form of government where such a balance can be found.

Managed Health Care

Within the past thirty to forty years, the scope and cost of health care coverage and services has drastically changed, altering the manner in which health care was previously managed. There are several factors that have affected the cost of health care coverage over the course of the past two to three decades. One of these factors is the introduction and rapidly increasing enrollment in managed health care insurance plans. Managed care health insurance plans can, in most cases, help to alleviate the rising costs of effective medical coverage. Another important factor that has affected health care costs is the invention and implementation of new medical technologies. As prominent researchers and economic analysts have discovered, there is a distinct and direct correlation between advancing medical technologies and rising health care costs. Medical innovation has been proven time and again to be an important determinant of health care cost growth. It would appear that managed care health insurance plans, which attempt to lower health care costs, and highly expensive new medical innovations and procedures are at cross purposes, pulling against one another in very different directions. Market-level comparisons have found the cost growth of health care in markets with greater managed care penetration to be generally slower than that of non-managed care health insurance markets. However, managed care is unlikely to prevent the share of gross domestic product spent on health care from rising unless the cost-increasing nature of new medical technologies changes. Managed care health insurance plans differ greatly from indemnity fee-for-service, or FFS, insurance plans. Since the early 1970's, rapidly growing enrollment in managed care health insurance plans has transformed the health insurance market in the United States. Virtually nonexistent in most markets three decades ago, managed care health plans covered 63 percent of the nation's employees by 1994. Managed care incorporates a range of features that allow the insurer greater influence in the process of care delivery. Managed care plans aggressively contract for lower prices from physicians and hospitals and attempt to constrain the use of health care services by monitoring providers and changing provider incentives. Health insurance providers that operate under the fee-for-service concept grant the consumer much more freedom of choice concerning doctors and treatment programs, thus freeing the consumer of any feelings of discontent with â€Å"interfering† insurance companies. Consumers of indemnity plans, however, pay a price for that freedom by way of drastically higher rates and little knowledgeable input on doctors, specialists and nearby hospitals that will fit their particular needs. Many of today's health insurance consumers choose to place their trust in a managed care insurance company, relying on the expertise of the provider to support and facilitate their various medical treatments and needs. Health maintenance organizations, commonly known as HMOs, have emerged as the clear leader of managed care providers. Other types of managed care plans include preferred provider organizations, point of service plans and managed indemnity plans. Most studies focus on HMOs and so do not describe variation in the type of HMO or in the extent of the level of management in non-HMO plans. HMOs have effectively reduced health care expenditures (Scheid, 2003) A natural assumption would be that the quality of care would be lowered as insurance rates go down and remain reasonable and affordable. However, these cost savings have been achieved, according to most evidence, without significant reductions in the quality of care (Bransford, 2006). This suggests that managed care health insurance plans -HMOs in particular- tend to reduce inefficiencies in the health care system. In fact, a study that examined changes in hospital expenses in California found as much as a forty-four percent slower rate of hospital care cost growth in markets with high HMO penetration relative to markets with low HMO penetration (Cooper, & Gottlieb, 2000) There are two main types of services that managed care health insurance companies use to categorize and label their treatments and procedures. These categories are known as complementary services and substitutive services. These two terms apply to new innovations in medical technology and the amount of money spent to provide the technology to the consumer. Complementary services are those whose use increases with the use of the new technology. Complementary services are attractive to the consumer, who, understandably, desires the latest, most effective medical technology to treat themselves and their loved ones. For example, suppose an improvement were to be made in the field of diagnostic imaging. This improvement could provide clearer, higher quality images, thus leading to more favorable surgery outcomes. The likelihood of a better surgical outcome may result in more individuals electing to receive surgical treatment. The development of this new technology in diagnostic imaging would, no doubt, have been highly expensive. Also, the costs associated with an illness in which there is an increased need for surgery are usually quite high. If an innovation leads to greater use of complementary services, expenditures raise more than would be predicted by simply examining the direct expenditures on the innovation. In this case, imaging and surgery are complementary technologies. This example suggests that the use of complementary services may increase the costs associated with use of new innovations by as much as fifty percent. Substitutive services, on the other hand, differ in that they are not provided because of the use of new technologies. The savings associated with the avoidance of these services offset the costs of the technological innovations and complementary services. If the innovation results in improved health outcomes, substitution away from services that would have been consumed later may also occur. It is also hoped that this type of substitution would accompany most preventive services and many other innovations that yield a reduction in morbidity in the long-run. Evidence suggests that medical innovation has led to higher expenditures on health care services. It appears that if the rising cost of health care that results from technological advances remain unchecked by managed care, the effect of technological progress will tend to offset any cost savings achieved by managed care through lower prices or lower use of established services. Factors such as population increases, extended life expectancies and overall inflation have contributed to rising health care costs. However, studies have proven that important advances in specific areas of medical technology have had the most intense effect on health care costs. This finding still applies when it is considered in terms of managed care health insurance plans to a certain undeniable extent (Scheid, 2003). Studies have been conducted during many periods over the course of the past several decades, focusing on substantial increases in health care costs in direct correlation to particular medical procedures and fields. Among these procedures and fields are child birth, radiation therapy, coronary bypass surgery, and nuclear medicine and cancer treatments. For example, the innovation of cesarean sections used during problematic child deliveries has increased health care costs. The various medical personnel must all be compensated for their time and labor: the anesthesiologists, the surgeon, the nurses, etc. Also raising health care costs are fetal monitoring and ultrasound techniques. In the case of breast and other cancers, radiation therapy, as well as combination therapies that include chemotherapy has contributed to rising health care costs. One field of medical practice which has become notorious for being costs-increasing is the study and treatment of heart attacks. In the treatment of heart attacks, the prime cost-increasing technologies were the introduction of intra-coronary streptokinase infusion and coronary bypass surgery. A study performed by Glenn P. Mays, Gary Claxton, and Justin White; (2004), using Medicare claims from 1994 to 2001, report a four percent annual increase in the average reimbursement for treating elderly heart attack patients. They attribute the majority of this increase to the diffusion of new technologies for performing invasive revascularization procedures. Over the period of the study, cardiac catheterization rates rose from eleven percent to forty-one percent of heart attack patients. Bypass rates rose from five percent to thirteen percent, and angioplasty rates rose from one percent to twelve percent. The population studied by Glenn P. Mays, Gary Claxton, and Justin White; (2004) was overwhelmingly enrolled in traditional FFS Medicare; therefore, any finding must represent a spillover. Furthermore, they do not address the likelihood of receiving a related service, coronary bypass surgery, so we have an incomplete picture of how practice patterns change over the period of time studied. Different approaches are used to determine the impact of new technologies and innovations on health care costs. One approach, called the affirmative approach, focuses on individual technologies or diseases. This approach suffers from an inability to access the aggregate impact of technology on cost growth. The body of evidence suggests that the impact of technology varies by disease. One study notes that in certain areas, technology clearly lowers costs, particularly when that technology facilitates complete cure or prevention of a disease (Scheid, 2003). One example of this type of innovation is the Salk-Sabin polio vaccine, which is inexpensive to develop and manufacture and almost completely eliminates the high costs of polio treatment. Another approach that is used to examine the effect of technology on health care costs is known as the residual approach. This approach views technological advances as being the sole reason for rising health care costs simply because the innovations are so expensive that there must be a method of which to pay for the invention and further development of the technology. The differences between health care givers and the companies that provide the health care insurance have blurred substantially. A decade ago managed health care organizations was referred to as an alternative delivery systems. However, today in the United States, managed health care organizations are now the leading form of health insurance coverage. Every individuals currently living in the United States of America has a need for affordable and accessible health care coverage. Over the last thirty to forty years, the extent and cost of health care coverage have significantly changed; therefore, altering the method in which health care is managed. The demand for health care has expanded because of changes in the age population, increasing incomes, and improvement in medical technology. Elderly people demand more health care and health care systems must supply the expected quality if health care. The improvement of medical technology has largely increased treatments to enable people to have a good quality of life. The resource factors such as land, labor, income, capital, goods and services cause shifts in the managed care. The increase in the health care price reduces people's income and this means that the health care price is more expensive in comparing to other goods and services. An increase in income leads to an increase in demand and vice versa. However, a decrease in income will reduce the amount of health care treatments. The relationship between price and quality of health care demanded indicates the quantity of health care services that can be obtained at conceivable price. A change in price leads to a movement along the demand curve. For example if the price of eye surgery rose significantly, then people would seek another alternative of treatment. This would lead to a fall in the demand, but when income or prices of health care services change, the demand curve will shift. If the level of cost changes then the supply curve will shift. For example if the doctors or nurses income increases, this process will increase health care cost. Managed care plans substituted the traditional fee for service system. The plans provide a number of economic incentives for health care providers, patients, and payers to cut health care cost. The increased enrollment will reduce the health care expenditures through reduction of price and quantity. Currently, the new plans are popular among public sector of health care programs such as Medicaid and Medicare. Medicaid and Medicare is a joint federal and state-run program that provides health coverage to selected low-income individuals who cannot provide their own health insurance and senior citizens over 65 years of age. Government intervention contributes to an increase of health care cost and creates inefficiencies, while big employers are cutting benefits, demanding higher contributions from their employees and saying there is more of the same to come, smaller and medium-sized employers offering health care plans dropped in 2002. People might demand a better Medicare of Medicaid program, but they will be affected by escalating health care costs. The private insurers will be under even more pressure, as they will have to provide policies tailored to the needs and budgets of their clients. They will increasingly have to keep costs down by using their bargaining power. People in this country demand health care because they want to be healthy. This trend has been fueling managed health care systems for the last forty years. Changes in health care structure are influenced in this country by macroeconomic conditions and the standard of living. Government agencies have a tremendous impact on regulating and controlling of health care spending. Changes in age structure, increasing real incomes, and improvements in medical technology have all fueled this desire for better health care. References Bransford, C.L. (2006). The Exercise of Authority by Social Workers in a Managed Mental Health Care Organization: A Critical Ethnography. Journal of Progressive Human Services, 17 (2), 63-85. Cooper, C. C., & Gottlieb, M. C. (2000) Ethical issues with managed care: Challenges facing counseling psychology. The Counseling Psychologist, 28, 179-236. Glenn P. Mays, Gary Claxton, and Justin White; 2004; Managed Care Rebound?   Recent Changes in Health Plans' Cost Containment Strategies: (Health Affairs, August 11, 2004) Scheid, T.L. (2003). Managed care and the rationalization of mental health services: Journal of Health and Social Behavior, 44 (2), 146-161.   

The Lost Duke of Wyndham Chapter Two

Several hours later Grace was sitting in a chair in the corridor outside the dowager's bedchamber. She was beyond weary and wanted nothing more than to crawl into her own bed, where she was quite certain she would toss and turn and fail to find slumber, despite her exhaustion. But the dowager was so overset, and indeed had rung so many times that Grace had finally given up and dragged the chair to its present location. In the last hour she had brought the dowager (who would not leave her bed) a collection of letters, tucked at the bottom of a locked drawer; a glass of warm milk; a glass of brandy; another miniature of her long-dead son John; a handkerchief that clearly possessed some sort of sentimental value; and another glass of brandy, to replace the one the dowager had knocked over while anxiously directing Grace to fetch the handkerchief. It had been about ten minutes since the last summons. Ten minutes to do nothing but sit and wait in the chair, thinking, thinking†¦ Of the highwayman. Of his kiss. Of Thomas, the current Duke of Wyndham. Whom she considered a friend. Of the dowager's long-dead middle son, and the man who apparently bore his likeness. And his name. His name. Grace took a long, uneasy breath. His name. Good God. She had not told the dowager this. She had stood motionless in the middle of the road, watching the highwayman ride off in the light of the partial moon. And then, finally, when she thought her legs might actually function, she set about getting them home. There was the footman to untie, and the coachman to tend to, and as for the dowager – she was so clearly upset that she did not even whisper a complaint when Grace put the injured coachman inside the carriage with her. And then she joined the footman atop the driver's seat and drove them home. She wasn't a particularly experienced hand with the reins, but she could manage. And she'd had to manage. There was no one else to do it. But that was something she was good at. Managing. Making do. She'd got them home, found someone to tend to the coachman, and then tended to the dowager, and all the while she'd thought – Who was he? The highwayman. He'd said his name had once been Cavendish. Could he be the dowager's grandson? She had been told that John Cavendish died without issue, but he wouldn't have been the first young nobleman to litter the countryside with illegitimate children. Except he'd said his name was Cavendish. Or rather, had been Cavendish. Which meant – Grace shook her head blearily. She was so tired she could barely think, and yet it seemed all she could do was think. What did it mean that the highwayman's name was Cavendish? Could an illegitimate son bear his father's name? She had no idea. She'd never met a bastard before, at least not one of noble origins. But she'd known others who had changed their names. The vicar's son had gone to live with relatives when he was small, and the last time he'd been back to visit, he'd introduced himself with a different surname. So surely an illegitimate son could call himself whatever he wanted. And even if it was not legal to do so, a highwayman would not trouble himself with such technicalities, would he? Grace touched her mouth, trying to pretend she did not love the shivers of excitement that rushed through her at the memory. He had kissed her. It had been her first kiss, and she did not know who he was. She knew his scent, she knew the warmth of his skin, and the velvet softness of his lips, but she did not know his name. Not all of it, at least. â€Å"Grace! Grace!† Grace stumbled to her feet. She'd left the door ajar so she could better hear the dowager, and sure enough, her name was once again being called. The dowager must still be overset – she rarely used Grace's Christian name. It was harder to snap out in a demanding manner than Miss Eversleigh. Grace rushed back into the room, trying not to sound weary and resentful as she asked, â€Å"May I be of assistance?† The dowager was sitting up in bed – well, not quite sitting up. She was mostly lying down, with just her head propped up on the pillows. Grace thought she looked terribly uncomfortable, but the last time she had tried to adjust her position she'd nearly got her head bit off. â€Å"Where have you been?† Grace did not think the question required an answer, but she said, nonetheless, â€Å"Just outside your door, ma'am.† â€Å"I need you to get me something,† the dowager said, and she didn't sound as imperious as she did agitated. â€Å"What is it you would like, your grace?† â€Å"I want the portrait of John.† Grace stared at her, uncomprehending. â€Å"Don't just stand there!† the dowager practically screamed. â€Å"But ma'am,† Grace protested, jumping back, â€Å"I've brought you all three of the miniatures, and – â€Å" â€Å"No, no, no,† the dowager cried, her head swinging back and forth on the pillows. â€Å"I want the portrait. From the gallery.† â€Å"The portrait,† Grace echoed, because it was half three in the morning, and perhaps she was addled by exhaustion, but she thought she'd just been asked to remove a life-sized portrait from a wall and carry it up two flights of stairs to the dowager's bedchamber. â€Å"You know the one,† the dowager said. â€Å"He's standing next to the tree, and he has a sparkle in his eye.† Grace blinked, trying to absorb this. â€Å"There is only the one, I think.† â€Å"Yes,† the dowager said, her voice almost unbalanced in its urgency. â€Å"There is a sparkle in his eye.† â€Å"You want me to bring it here.† â€Å"I have no other bedchamber,† the dowager snapped. â€Å"Very well.† Grace swallowed. Good Lord, how was she going to accomplish this? â€Å"It will take a bit of time.† â€Å"Just drag a chair over and yank the bloody thing down. You don't need – â€Å" Grace rushed forward as the dowager's body convulsed in a spasm of coughing. â€Å"Ma'am! Ma'am!† she said, bringing her arm around her to set her upright. â€Å"Please, ma'am. You must try to be more settled. You are going to hurt yourself.† The dowager coughed a few last times, took a long swallow of her warm milk, then cursed and took her brandy instead. That, she finished entirely. â€Å"I'm going to hurt you,† she gasped, thunking the glass back down on her bedside table, â€Å"if you don't get me that portrait.† Grace swallowed and nodded. â€Å"As you wish, ma'am.† She hurried out, sagging against the corridor wall once she was out of the dowager's sight. It had begun as such a lovely evening. And now look at her. She'd had a gun pointed at her heart, been kissed by a man whose next appointment was surely with the gallows, and now the dowager wanted her to wrestle a life-sized portrait off the gallery wall. At half three in the morning. â€Å"She can't possibly be paying me enough,† Grace mumbled under her breath as she made her way down the stairs. â€Å"There couldn't possibly exist enough money – â€Å" â€Å"Grace?† She stopped short, stumbling off the bottom step. Large hands immediately found her upper arms to steady her. She looked up, even though she knew who it had to be. Thomas Cavendish was the grandson of the dowager. He was also the Duke of Wyndham and thus without question the most powerful man in the district. He was in London nearly as often as he was here, but Grace had got to know him quite well during the five years she'd acted as companion to the dowager. They were friends. It was an odd and completely unexpected situation, given the difference in their rank, but they were friends. â€Å"Your grace,† she said, even though he had long since instructed her to use his given name when they were at Belgrave. She gave him a tired nod as he stepped back and returned his hands to his sides. It was far too late for her to ponder matters of titles and address. â€Å"What the devil are you doing awake?† he asked. â€Å"It's got to be after two.† â€Å"After three, actually,† she corrected absently, and then – good heavens, Thomas. She snapped fully awake. What should she tell him? Should she say anything at all? There would be no hiding the fact that she and the dowager had been accosted by highwaymen, but she wasn't quite certain if she should reveal that he might have a first cousin racing about the countryside, relieving the local gentry of their valuables. Because, all things considered, he might not. And surely it did not make sense to concern him needlessly. â€Å"Grace?† She gave her head a shake. â€Å"I'm sorry, what did you say?† â€Å"Why are you wandering the halls?† â€Å"Your grandmother is not feeling well,† she said. And then, because she desperately wanted to change the subject: â€Å"You're home late.† â€Å"I had business in Stamford,† he said brusquely. His mistress. If it had been anything else, he would not have been so oblique. It was odd, though, that he was here now. He usually spent the night. Grace, despite her respectable birth, was a servant at Belgrave, and as such privy to almost all of the gossip. If the duke stayed out all night, she generally knew about it. â€Å"We had an†¦exciting evening,† Grace said. He looked at her expectantly. She felt herself hesitate, and then – well, there was really nothing to do but say it. â€Å"We were accosted by highwaymen.† His reaction was swift. â€Å"Good God,† he exclaimed. â€Å"Are you all right? Is my grandmother well?† â€Å"We are both unharmed,† Grace assured him, â€Å"although our driver has a nasty bump on his head. I took the liberty of giving him three days to convalesce.† â€Å"Of course.† He closed his eyes for a moment, looking pained. â€Å"I must offer my apologies,† he said. â€Å"I should have insisted that you take more than one outrider.† â€Å"Don't be silly. It's not your fault. Who would have thought – † She cut herself off, because really, there was no sense in assigning blame. â€Å"We are unhurt,† she repeated. â€Å"That is all that matters.† He sighed. â€Å"What did they take?† Grace swallowed. She couldn't very well tell him they'd stolen nothing but a ring. Thomas was no idiot; he'd wonder why. She smiled tightly, deciding that vagueness was the order of the day. â€Å"Not very much,† she said. â€Å"Nothing at all from me. I imagine it was obvious I am not a woman of means.† â€Å"Grandmother must be spitting mad.† â€Å"She is a bit overset,† Grace hedged. â€Å"She was wearing her emeralds, wasn't she?† He shook his head. â€Å"The old bat is ridiculously fond of those stones.† Grace declined to scold him for his characterization of his grandmother. â€Å"She kept the emeralds, actually. She hid them under the seat cushion.† He looked impressed. â€Å"She did?† â€Å"I did,† Grace corrected, unwilling to share the glory. â€Å"She thrust them at me before they breached the vehicle.† He smiled slightly, and then, after a moment of somewhat awkward silence, said, â€Å"You did not mention why you're up and about so late. Surely you deserve a rest as well.† â€Å"I†¦er†¦Ã¢â‚¬  There seemed to be no way to avoid telling him. If nothing else, he'd notice the massive empty spot on the gallery wall the next day. â€Å"Your grandmother has a strange request.† â€Å"All of her requests are strange,† he replied immediately. â€Å"No, this one†¦well†¦Ã¢â‚¬  Grace's eyes flicked up in exasperation. How was it her life had come to this? â€Å"I don't suppose you'd like to help me remove a painting from the gallery.† â€Å"A painting.† She nodded. â€Å"From the gallery.† She nodded again. â€Å"I don't suppose she's asking for one of those modestly sized square ones.† â€Å"With the bowls of fruit?† He nodded. â€Å"No.† When he did not comment, she added, â€Å"She wants the portrait of your uncle.† â€Å"Which one?† â€Å"John.† He nodded, smiling slightly, but without any humor. â€Å"He was always her favorite.† â€Å"But you never knew him,† Grace said, because the way he'd said it – it almost sounded as if he'd witnessed her favoritism. â€Å"No, of course not. He died before I was born. But my father spoke of him.† It was clear from his expression that he did not wish to discuss the matter further. Grace could not think of anything more to say, however, so she just stood there, waiting for him to collect his thoughts. Which apparently he did, because he turned to her and asked, â€Å"Isn't that portrait life-sized?† Grace pictured herself wrestling it from the wall. â€Å"I'm afraid so.† For a moment it looked as if he might turn toward the gallery, but then his jaw squared and he was once again every inch the forbidding duke. â€Å"No,† he said firmly. â€Å"You will not get that for her this evening. If she wants the bloody painting in her room, she can ask a footman for it in the morning.† Grace wanted to smile at his protectiveness, but by this point she was far too weary. And besides that, when it came to the dowager, she had long since learned to follow the road of least resistance. â€Å"I assure you, I want nothing more than to retire this very minute, but it is easier just to accommodate her.† â€Å"Absolutely not,† he said imperiously, and without waiting, he turned and marched up the stairs. Grace watched him for a moment, and then, with a shrug, headed off to the gallery. It couldn't be that difficult to take a painting off a wall, could it? But she made it only ten paces before she heard Thomas bark her name. She sighed, stopping in her tracks. She should have known better. The man was as stubborn as his grandmother, not that he would appreciate the comparison. She turned and retraced her steps, hurrying along when she heard him call out for her again. â€Å"I'm right here,† she said irritably. â€Å"Good gracious, you'll wake the entire house.† He rolled his eyes. â€Å"Don't tell me you were going to get the painting by yourself.† â€Å"If I don't, she will ring for me all night, and then I will never get any sleep.† He narrowed his eyes. â€Å"Watch me.† â€Å"Watch you what?† she asked, baffled. â€Å"Dismantle her bell cord,† he said, heading upstairs with renewed determination. â€Å"Dismantle her†¦Thomas!† She ran up behind him, but of course could not keep up. â€Å"Thomas, you can't!† He turned. Grinned even, which she found somewhat alarming. â€Å"It's my house,† he said. â€Å"I can do anything I want.† And while Grace digested that on an exhausted brain, he strode down the hall and into his grandmother's room. â€Å"What,† she heard him bite off, â€Å"do you think you're doing?† Grace let out a breath and hurried after him, entering the room just as he was saying, â€Å"Good heavens, are you all right?† â€Å"Where is Miss Eversleigh?† the dowager asked, her eyes darting frantically about the room. â€Å"I'm right here,† Grace assured her, rushing forward. â€Å"Did you get it? Where is the painting? I want to see my son.† â€Å"Ma'am, it's late,† Grace tried to explain. She inched forward, although she wasn't sure why. If the dowager started spouting off about the highwayman and his resemblance to her favorite son, it wasn't as if she would be able to stop her. But still, the proximity at least gave the illusion that she might be able to prevent disaster. â€Å"Ma'am,† Grace said again, gently, softly. She gave the dowager a careful look. â€Å"You may instruct a footman to procure it for you in the morning,† Thomas said, sounding slightly less imperious than before, â€Å"but I will not have Miss Eversleigh undertaking such manual labor, and certainly not in the middle of the night.† â€Å"I need the painting, Thomas,† the dowager said, and Grace almost reached out to take her hand. She sounded pained. She sounded old. And she certainly did not sound like herself when she said, â€Å"Please.† Grace glanced at Thomas. He looked uneasy. â€Å"Tomorrow,† he said. â€Å"First thing, if you wish it.† â€Å"But – â€Å" â€Å"No,† he interrupted. â€Å"I am sorry you were accosted this evening, and I shall certainly do whatever is necessary – within reason – to facilitate your comfort and health, but this does not include whimsical and ill-timed demands. Do you understand me?† They stared at each other for so long that Grace wanted to flinch. Then Thomas said sharply, â€Å"Grace, go to bed.† He didn't turn around. Grace held still for a moment, waiting for what, she didn't know – disagreement from the dowager? A thunderbolt outside the window? When neither was forthcoming, she decided she could do nothing more that evening and left the room. As she walked slowly down the hall, she could hear them arguing – nothing violent, nothing impassioned. But then, she'd not have expected that. Cavendish tempers ran cold, and they were far more likely to attack with a frozen barb than a heated cry. Grace let out a long, uneven breath. She would never get used to this. Five years she had been at Belgrave, and still the resentment that ran back and forth between Thomas and his grandmother shocked her. And the worst part was – there wasn't even a reason! Once, she had dared to ask Thomas why they held each other in such contempt. He just shrugged, saying that it had always been that way. She'd disliked his father, Thomas said, his father had hated him, and he himself could have done quite well without either of them. Grace had been stunned. She'd thought families were meant to love each other. Hers had. Her mother, her father†¦She closed her eyes, fighting back tears. She was being maudlin. Or maybe it was because she was tired. She didn't cry about them any longer. She missed them – she would always miss them. But the great big gaping hole their deaths had rent in her had healed. And now†¦well, she'd found a new place in this world. It wasn't the one she'd anticipated, and it wasn't the one her parents had planned for her, but it came with food and clothing, and the opportunity to see her friends from time to time. But sometimes, late at night as she lay in her bed, it was just so hard. She knew she should not be ungrateful – she was living in a castle, for heaven's sake. But she had not been brought up for this. Not the servitude, and not the sour dispositions. Her father had been a country gentleman, her mother a well-liked member of the local community. They had raised her with love and laughter, and sometimes, as they sat before the fire in the evening, her father would sigh and say that she was going to have to remain a spinster, because surely there was no man in the county good enough for his daughter. And Grace would laugh and say, â€Å"What about the rest of England?† â€Å"Not there, either!† â€Å"France?† â€Å"Good heavens, not.† â€Å"The Americas?† â€Å"Are you trying to kill your mother, gel? You know she gets seasick if she so much as sees the beach.† And they all somehow knew that Grace would marry someone right there in Lincolnshire, and she'd live down the road, or at least just a short ride away, and she would be happy. She would find what her parents had found, because no one expected her to marry for any reason other than love. She'd have babies, and her house would be full of laughter, and she would be happy. She'd thought herself the luckiest girl in the world. But the fever that had struck the Eversleigh house was cruel, and when it broke, Grace was an orphan. At seventeen, she could hardly remain on her own, and indeed, no one had been sure what to do with her until her father's affairs were settled and the will was read. Grace let out a bitter laugh as she pulled off her wrinkled clothing and readied herself for bed. Her father's directives had only made matters worse. They were in debt; not deeply so, but enough to render her a burden. Her parents, it seemed, had always lived slightly above their means, presumably hoping that love and happiness would carry them through. And indeed they had. Love and happiness had stood up nicely to every obstacle the Eversleighs had faced. Except death. Sillsby – the only home Grace had ever known – was entailed. She'd known that, but not how eager her cousin Miles would be to assume residence. Or that he was still unmarried. Or that when he pushed her against a wall and jammed his lips against hers, she was supposed to let him, indeed thank the toad for his gracious and benevolent interest in her. Instead she had shoved her elbow into his ribs and her knee up against his – Well, he hadn't been too fond of her after that. It was the only part of the whole debacle that still made her smile. Furious at the rebuff, Miles had tossed her out on her ear. Grace had been left with nothing. No home, no money, and no relations (she refused to count him among the last). Enter the dowager. News of Grace's predicament must have traveled fast through the district. The dowager had swooped in like an icy goddess and whisked her away. Not that there had been any illusion that she was to be a pampered guest. The dowager had arrived with full retinue, stared down Miles until he squirmed (literally; it had been a most enjoyable moment for Grace), and then declared to her, â€Å"You shall be my companion.† Before Grace had a chance to accept or decline, the dowager had turned and left the room. Which just confirmed what they all knew – that Grace had never had a choice in the matter to begin with. That had been five years ago. Grace now lived in a castle, ate fine food, and her clothing was, if not the latest stare of fashion, well-made and really quite pretty. (The dowager was, if nothing else, at least not cheap.) She lived mere miles from where she had grown up, and as most of her friends still resided in the district, she saw them with some regularity – in the village, at church, on afternoon calls. And if she didn't have a family of her own, at least she had not been forced to have one with Miles. But much as she appreciated all the dowager had done for her, she wanted something more. Or maybe not even more. Maybe just something else. Unlikely, she thought, falling into bed. The only options for a woman of her birth were employment and marriage. Which, for her, meant employment. The men of Lincolnshire were far too cowed by the dowager to ever make an overture in Grace's direction. It was well-known that Augusta Cavendish had no desire to train a new companion. It was even more well-known that Grace hadn't a farthing. She closed her eyes, trying to remind herself that the sheets she'd slid between were of the highest quality, and the candle she'd just snuffed was pure beeswax. She had every physical comfort, truly. But what she wanted was†¦ It didn't really matter what she wanted. That was her last thought before she finally fell asleep. And dreamed of a highwayman.