Friday, March 20, 2020

Diversity Quotes

Diversity Quotes When the news reports cover ethnic wars and cultural domination on a regular basis, it is easy to miss out on one important lesson: diversity is a positive thing, in the world, in business, and in education. In the U.S., diverse cultures will soon be in the majority. Public conversations on the challenges of a diverse nation make the nation stronger. In business, diversity in an organization increases its responsiveness to its diverse clients and customers. As businesses become  ever more globalized, diversity becomes more important. In education, diversity provides a range of experiences in a class that would otherwise not exist and prepares students for life in a diverse world. Read what leaders, activists, and writers have said about the importance of diversity. Diversity Quotes Maya AngelouIt is time for parents to teach young people early on that in diversity there is beauty and there is strength.Cesar ChavezWe need to help students and parents cherish and preserve the ethnic and cultural diversity that nourishes and strengthens this community and this nation.James T. EllisonThe real death of America will come when everyone is alike.Catherine PulsiferWe are all different, which is great because we are all unique. Without diversity, life would be very boring.Mikhail GorbachevPeace is not unity in similarity but unity in diversity, in the comparison and conciliation of differences.Mahatma GandhiI do not want my house to be walled in on all sides and my windows to be stifled. I want all the cultures of all lands to be blown about my house as freely as possible. But I refuse to be blown off my feet by any.Hillary ClintonWhat we have to do... is to find a way to celebrate our diversity and debate our differences without fracturing our communities.Anne FrankWe a ll live with the objective of being happy; our lives are all different and yet the same. John F. KennedyIf we cannot end now our differences, at least we can help make the world safe for diversity.Mark TwainIt were not best that we should all think alike; it is difference of opinion that makes horse races.William Sloane Coffin Jr.Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without.John HumeDifference is of the essence of humanity. Difference is an accident of birth, and it should therefore never be the source of hatred or conflict. The answer to difference is to respect it. Therein lies a most fundamental principle of peace: respect for diversity.Rene DubosHuman diversity makes tolerance more than a virtue; it makes it a requirement for survival.Jimmy CarterWe have become not a melting pot but a beautiful mosaic. Different people, different beliefs, different yearnings, different hopes, different dreams.Jerome NathansonThe price of the democratic way of life is a growing appreciation of peoples d ifferences, not merely as tolerable, but as the essence of a rich and rewarding human experience.

Wednesday, March 4, 2020

How to Make a Volcano Using Pop Rocks

How to Make a Volcano Using Pop Rocks The classic homemade chemical volcano relies on a reaction between baking soda and vinegar to produce an eruption of foamy lava, but you can make a volcano even if you dont have these ingredients. One easy way is to use Pop Rocks candy and carbonated soda. The reaction between these two ingredients gave rise to the false notion that drinking cola and eating Pop Rocks would cause your stomach to explode. Its true the two ingredients combine to produce a lot of gas, but if you eat them, you burp out the bubbles. In a homemade volcano, you can make a cool eruption. Heres what you do: Pop Rocks Volcano Materials 20-oz bottle of any soda or other carbonate beveragepacket of Pop Rocks candy (red or orange colored flavors look most like lava)model volcano If you dont have a model volcano, you can use homemade dough to form the shape of a volcano around the unopened soda bottle. If you like, paint or decorate the dough so it looks like a volcano. How To Make the Volcano Erupt The eruption can be messy, much like the Mentos and soda reaction, so its a good idea to set up your volcano outdoors, on a kitchen counter, or in a bathtub. Otherwise, place a plastic tablecloth around the volcano to make clean-up easier.Dont open the soda until you are ready for the eruption. When its time, carefully uncap the bottle. Disturb it as little as possible, to help prevent gas from escaping.Pour in the Pop Rocks candies. One way to get all the candy into the volcano at once is to roll up a sheet of paper into a tube. Put your finger on the end of the tube to close it off and pour in the Pop Rocks. Release the candies over the mouth of the bottle. Move away quickly or youll get sprayed with lava! How the Volcano Works Pop Rocks contain pressurized carbon dioxide gas that is trapped inside a candy coating. When you eat them, your saliva dissolves the sugar, releasing the gas. The sudden release of pressure makes the popping and cracking sound  since ​the  pressure of the gas breaks out of the candy once it gets thin enough. The volcano works much the same way, except its the soda that dissolves the candy shell to release the gas. The eruption is made more forceful by the sudden release of carbon dioxide in the soda. The bits of candy provide surface area for the dissolve carbon dioxide in the soda to collect and form bubbles, which push their way out of the narrow mouth of the bottle. Things To Try If you want lava that overflows the volcano, try adding a squirt of dishwashing soda to the soda before you add the Pop Rocks. For more colorful lava, add a few drops of red or orange food coloring to the soda or else use a red-colored soda, like Big Red, or a brown soda, like Dr. Pepper or any brand of root beer. Some energy drinks are also lava-colored. At that matters is that the drink is carbonated.

Sunday, February 16, 2020

Apple case study Essay Example | Topics and Well Written Essays - 1750 words

Apple case study - Essay Example The company in its approach, designed strategies based on the market player’s weaknesses and customer generational needs to ensure faster growth. In particular, it integrated superior infrastructural set up than market players, which provided modern recording and sales techniques. This is to ensure that customers receive modern musical services based on broadband and iPod technological enabled systems. Ideally, most customers in the music industry including recorders consider modern technological enabled production system, which ensures good quality hence superior returns. This element enabled Apple to develop its .market rapidly due to its advancement in various aspects, which was a weakness to renowned market players. Variably, the company also integrated its management techniques to ensure effective administration of its resources to ensure quality proceeds, a concept the dominant firms poorly executed. It also provided favorable recording terms with initiation of subsidy f und system to poor artist who would could not sustain recording expenses. This aspect attracted most artist to its services coupled with it modern techniques of production. Further, its technological capacity through adoption of Apple computers, which offered a breakthrough towards effective management, and coordination of web music highly, attracted most individuals including Michael Jackson (Lynch 2009). It is imperative to note that its launching strategy also propelled its performance since it communicated basic information where it provided potential services, which were unique to its rivals. 2. SWOT analysis on Apple business model Apple designed its operations based on superior strategies with a strong focus to gaining competitive benefits and provision of quality services to customers globally (Lynch 2009). In particular, its infrastructural capacity provided its greatest strength, which has significantly contributed to its competitiveness and general performance. Modern gen erational musical production and publishing techniques is critical towards production of superior music with high demand. Variably, its sound management practices have also enhanced its operations compared to its rivals since the administration of its affairs is based on clear ideals and principles. The company has a substantial market share with strong strategic alliance network portfolios, which facilitates its sales and financial prospects for example Nokia and Samsung service providers. Quality production and delivery of service to consumers also forms its major strength in this industry where quality greatly affects performance potentials. Imperatively, the strengths contributed greatly to its sound performance compared to its rivals, which operated on inferior management practices, adopted low quality generational musical infrastructure and poor strategic coordination. Similarly, the company’s opportunities include increased demand of its services, market expansion, new ventures and diversification capacities, and favorable legislation to regulate the industry effectively. Observation of these opportunities is vital since they hold the organizations continuous competitiveness and performance capacity. The organization also faces various threats and weaknesses, which should be addressed to ensure sustainable growth without providing unwarranted leeway to new entrants (Lynch 2009). The strengths and weaknesses include possible new

Sunday, February 2, 2020

London School Business & Finance Essay Example | Topics and Well Written Essays - 500 words

London School Business & Finance - Essay Example As the report discusses  internet marketing is an effort that helps to facilitate overall marketing concept by using different internet portals as well as various electronic medium. Global context that are associated with digital improvement is an identical objective that is evident within every marketing practices and assist in enlarging the value that is associated with the overall advertising technique that is provided using electronic media.This essay stresses that in the current complex social domain, it is identifiable that the organisations that are trying to develop its competitive advantage need to maintain a string digital presence. In order to maintain the competitive advantage within the current complex business internet marketing has emerged to be a concept that helps in engaging overall business artillery using large web mediums.  Internet marketing is identified to be a process of marketing as well promoting events that are conducted using the Web, email along with other mediums that helps in fulfilling the needs of internet marketing. Various elements including social media, website, blog, networking, and attractive public interfaces enhances the ability of the internet .Social media is identified to be having certain involvement to increase the overall business campaign virtually.  Now a day’s people highly prefer to conduct online activities and sharing information with the use of digital media.

Saturday, January 25, 2020

Caring for Child and Family with terminal Illness

Caring for Child and Family with terminal Illness The aim of this assignment is to critically explore the concept of paediatric palliative care and the relevance of a childrens hospice in Ireland. A critical analysis of literature surrounding this topic will be undertaken in order to gain an in-depth understanding. Key elements relating to paediatric palliative care will be highlighted. Finally, the author will conclude on appropriateness of a hospice for sick children. An initial need for palliative care for children was acknowledged in the 1980s; having identified the need for this service, a nun opened and successfully ran a hospice for sick children (Rowse 2008). Interestingly, thirty years on, there is much debate surrounding the advantages and disadvantages of a national childrens hospice in Ireland. However, contrary to beliefs and the success of many hospices, it is recognised by the Department of Health and Children (DOHC) (2001); Rowse (2008); Watson et al (2009); Bishop et al (2008); that children with a life-limiting illness are best cared for at home. In addition, Watson et al (2009) outlined that when the premature death of a child was evident, the option of home, hospice or hospital as a place of death was presented to a child and their family, the majority of children and their families chose home. Caring for a child with a life-limiting illness can be a stressful and exhausting experience; it can put enormous pressures on the family unit (Wolff 2008). From personal experience, a familys dynamics can be seen to change over a period of time when a child is born or diagnosed with a life-limiting illness. Individual family members appear to take up a specific role when faced with a diagnosis of a life-limiting illness. A life limited-illness can be viewed as a condition that has no cure at present and will inevitably lead to the premature death a child (International Childrens Palliative Care Network (ICPCN) 2008; DOHC 2005). However, in many cases of paediatric palliative care it is very difficult to place a time frame on the length of the illness and its trajectory. Watson et al (2009) illustrated that these factors depend greatly on the individual childs diagnosis and the rarity of the illnesses being experienced. The DOHC (2010) identified conditions and diseases that children most commonly suffer with and divided them into 4 individual groups according to their types. However, experience and further reading has demonstrate that, in reality these illnesses dont always stand alone and can be combined with another illness or condition; as a result they may not always fit into a specific group type. Therefore, needs change and vary depending on the individual. While et al (1996) identified that an alarming 60% of children suffering with a life-limiting illness were dying from non cancer related conditions. It would appear difficult to clearly ascertain how long individual paediatric palliative care provisions would needed for, as many of the paediatric cases are unique in there diagnoses and have vast amounts of unknown variables. Similarly, these problems can be mirrored within the adult population of individuals with an intellectual disability, many individuals within this group are living with complex mental/physical illnesses throughout their lives, a further diagnosis of a life-limiting illness and its illness trajectory is surrounded by even more uncertainty (Gary and Stein 2008). Unfortunately, individuals with an intellectual disability are viewed as being one of the most disadvantage groups in society (Ryan McQuillan 2005). It would appear that a comparison could be drawn to a childs position regarding their needs, Watson et al (2009) highlighted that when a child is at an advanced stage within the illness trajectory many problems can occur, however, children unlike adults tend to live many years longer; many parents find this extremely difficult. From the authors experience many individuals with a primary diagnosis of severe intellectual disabilities and a life-limiting illness, appear to live longe r than that envisaged by the doctor. Although it has been acknowledged by the DOHC (2005), that within the trajectory of a child illness, children can cross over in their requirements for care needs throughout their illness due to the individuality of cases. The same has not been recognised within individuals with an intellectual disability. It can be argued that there are similarities between the philosophies of adult and paediatric palliative care. Gaining recognition of these differences has proven difficult to achieve (Richie 2008). In addition to this, Malcom et al (2008) acknowledged that children and adult palliative care principles were comparable, although, the uniqueness and specialist field of paediatric palliative care continues to emerge on its merits. McCulloch et al (2008) identified that paediatric palliative care principles are largely based on adaptation of the adult principles. However, Watson et al (2009) recognised some variations of these were developmental factors, approaches to consultation, physiology/pharmacokinetics, family structure and function, school and finally illness trajectory. Unfortunately, Dangel (2002) acknowledged that in the past some groups of children within Europe, where paediatric palliative care was not recognised or offered as part of multidisciplinary team involvement, a pr edisposing factor for the more recent tapered number of children receiving the provisions and benefits of a palliative care input. Furthermore, The European Association of Palliative Care (2009) advocated that a child should not be compared to that of a small adult, it was reiterated that their individual needs differed to that of an adult, although adult palliative care knowledge and experience can be a valuable and enriched source of expertise. The World Health Organisation (WHO) (2002a) illustrated that adult palliative care aims to improve quality of life for patients and their families with problems associated with life-threatening illness, this can be achieved through the prevention, relief, early identification, holistic assessment and treatment of pain, encompassing all factors associated with physical, psychosocial and spiritual needs. Moreover, the paediatric definition applied by the WHO (1998a) bears a very close resemblance to that of the adult definition, however, central to the paediatric definition is active total care of the childs body, mind and spirit, giving support to the family from the start of diagnose and will continue regardless of whether or not a child receives treatment directed at the disease, this should be a broad multidisciplinary approach availing of community resources provided tertiary care including that of the home. Furthermore, a Report of the National Advisory Committee on Palliative Ca re (2001) stated that, if a child requires a palliative care service due to their life-limiting illness, their individual needs must be addresses and differ from that of adults. As a direct result of the recommendations published within this report, the DOHC (2005) devised a document on the assessment needs of a child needing palliative care. Murphy (2009) cited by Hawley (2010) outlined that the collaboration and interagency workings of professionals and families is key to unlocking the puzzle and viewing the holistic needs of a child and family. Interestingly, Hawley (2010); Gary and Stein (2008); McKechnie (2006) reported that as professionals we only see the needs of individuals based on the experiences and components that our own disciplines allow us to see. The needs of a child are identified by the DoHC (2010), where they foresee the future provision of paediatric palliative care in Ireland. Within this insight there is much change and some encouraging prospects for the field of paediatric palliative care. The main areas within both medical and nursing care that are being addressed are specialist paediatric positions, education and training, co-operation and collaboration between paediatric and palliative care services (DOHC 2005). Furthermore, in light of the primary care strategy DOHC (2001) the focus of health c are is being developed within the community setting, lead by General Practitioners, Public Health Nurses (PHNs) and other members of the multidisciplinary team. The question on many people minds is, is there adequate funding, recourses and trained staff in place to deal with the number of complex palliative care cases? It would appear that the Department of Health and Children and the Irish Hospice Foundation have worked collaboratively in response to the needs of those within the community and paediatric palliative care, concurring with recent advances in publication of paediatric palliative care. However, it would appear that the greatest financial input has come from the voluntary sector. The Irish Hospice Foundation (2010) has vowed to provide somewhere in the region of à ¢Ã¢â‚¬Å¡Ã‚ ¬2.25 million over the next three to five years to fund the cost of providing eight outreach nurses with specific training to work and care for children with life-limiting illnesses. Furthermore, the Jack and Jill Foundation a registered charity, also provide à ¢Ã¢â‚¬Å¡Ã‚ ¬3m annually to families whose children suffer with a form of brain damage, providing them with financial and emotion support in their homes. Hynson et al (2003) identified that as home care is central to paediatric palliative care it would appea r the most appropriate place to begin supporting in the task of improving the quality of life, reducing fears and allowing families to continue with as much normality as possible within their lives. However, in the case where home care is not appropriate or possible due to the complexity of illnesses, lack of trained nurses or that of geographical problems, a hospice may be more appropriate from that of an acute hospital setting. It was been well documented that children with a life-limiting illness and their families needing palliative care support, require a holistic approach to their individual case (Wolfe et al 2000). This can be an extremely challenging experience for the health care professional. To provide adequate care it is important to assess the needs of health care professional as well as the service users needs. Papafadatou (1997) identified that as health care professionals deal with a death of a child, they too can become disheartened by their failed attempts to save a childs life, this can happen on different three levels, firstly, the feeling of not being able to save the childs life, secondly, as a practitioner they could not protect the child from harm and thirdly the feeling of betrayal to the parents who trusted them with their child. The importance of supervision is reiterated by Butterworth and Faugier (1992), where it allows professionals to care for their emotional, social, physical a nd physiological needs. It would appear easier to be achieved within a hospice due to the central locality of staff. Having identified concerns related to paediatric palliative care, is it not more commendable to have a paediatric hospice that encompasses all needs supported by highly skilled staff, adapted and equipment within this specific area of medicine. An advantage of a hospice could be that of continuity of care and expertise management of rare and complex conditions. However, a disadvantage could be taking a child out of its familiar environment, causing fear and anxiety. The DOHC (2005) illustrate that only in exceptional and rare circumstances is taking a child out of its home is in the best interest of the child and their family. It only seems natural that grief associated with life-limiting illnesses will have long lasting effects on a childs siblings and a family as a unit. Wells (2001) outlined that coping with the death of a sibling was an impossible task; a surviving childs self esteem was directly related to the length and trajectory of the illness experience. Many problems can oc cur and personality changes in a surviving child can be seen following the death of a child with a life-limiting illness. However, Groot et al (2005) outlined, that these problems were less apparent when a child was cared for throughout the illness within the home environment. Again, this leads one to believe that the most appropriate place for a child to be cared for is that of the home with extensive provision of palliative care in place. However, Stelle et al (2008) identified little is known about a childs or families rational for attending a hospice. Benini et al (2008) outlines that in the Veneto region of Italy there is a paediatric palliative care network team supported by a regional paediatric hospice, there is a multi-disciplinary team approach with specialist supervision, training and care integrated within acute hospital services. It would appear that when a child is diagnosed with a life-limiting illness, there is a cascade of expert professionals contacted from the hospice, the child and their family then meet with the skilled professionals affiliated to the case to discuss options and resources available to them; as a result they coordinate care accordingly. The ultimate aim is to try getting the child home, pending influencing factors such as locality, staffing and cost, once a home a continuous reassessment of needs is carried out by the family paediatrician who coordinates care and liaises closely with the members of the multi disciplinary team involved. From this model it would appear that the hospice has multi functions. It appears to provide professional expertise, training, skills, knowledge and is a base for experts within the profession. The above concerns are similar to that within Ireland; the optimum locality for a hospice that is accessible to all within Ireland is of great concern. Furthermore, the American Academy of Paediatricians (AAP) (2000) cited by Jennings (2005) illustrated that hospice care is different to that of palliative care, as hospice care offers a package of care incorporating multi-disciplinary team workings. However, within the DOHC (2010) it is envisaged that there will be integration and co-ordination of services in a bid to provide an effective and efficient seamless palliative care service for children with life-limiting illnesses and their families within the home. In order for this to be implemented and carried out there will be an amalgamation of services from all organisations within the healthcare system. The DOHC (2005) reiterates the importance of a key worker to act as a link connecting services. The implementation of a childrens outreach nurse will undertake this role in an attempt to co-ordinate services and facilitate the needs of health and social care professionals, (Department of Health and Children 2010). From the literature, it would appear that nurses have a greater knowledge and experience in dealing with adult palliative care cases (While et al 1996). This is primary due to the limited number of paediatric palliative care cases in Ireland. In 2002 it was believed that there was a population of 1,013,301 children in Ireland (The Government of Ireland 2007). Moreover, the Irish Hospice Foundation (2008) estimated that there are 1,369 children living in Ireland with a life-limiting illness. As there are limited cases of paediatric life-limiting illnesses many cases appeared to be spread over a wide geographical area and this is bound to pose problems for organisations, influencing the levels of available expertise, training and costs European Association of Palliative Care (EAPC) Taskforce (2007). However, under the directions of the DOHC (2010) policy it has recognised that if effective palliative care is required, it can be successfully delivered even if resources are limited. Bear ing this is mind, the DOHC (2001), illustrated that there were three levels of palliative care, a minimum of level 1 should be practiced by all staff indifferent of their area of expertise. The role of outreach nurses incorporates the training needs of staff at a local level (DoHC 2010). Furthermore, within the DoHC (2010) document it states there is a requirement for a consultant paediatrician with an interest in palliative care. However, some criticism with lack of limited research within this field and the majority of guidelines are based on opinions and a need for evidence based medicine Straatman et al (2008). The All Ireland Institute for Hospices and Palliative care (2007) identified that educational programmes were being made available for staff caring for children with a life-limiting illness. This was done in order to raise standards and provide up-to-date evidenced based care for children with a life-limiting illness. However, these programmes are located in Northern Ireland; recent economic difficulties do not promote attendance of staff to courses due to the financial burden and reduced staffing levels within organisations. However, within the current policy the DOHC (2010) have acknowledged that staff should ideally have knowledge, skills and confidence in both childrens and palliative care practices when providing paediatric palliative care. Many of the nurses who are experience within this field appear to work within the acute setting. While et al (1996) identifies that families have expressed a wish that when the time comes their child could die at home, however, there was some unease that without adequate nursing support this would not be possible. The Health Service Executive plan to implement a hospice home care programme, combined with a group of skilled and knowledgeable nurses providing advice and support to parents and other professionals alike who are caring for children at home (DoHC 2010). Benini et al (2008) advocates that a paediatric hospice is an important link within the paediatric palliative care chain, it can aid the transition from hospital to home, with the aim to achieve some normalisation within the childs life and prepare them for the home environment. The Cancer Strategy (2007) sets out principles outlining the ways in which palliative care service for the adult population should be developed and met. This is reiterated globally within the World Health Organisation (2007) document. Moreover, The Department of Aging and Disability Home Care (2004) produced a report more specific to the needs of an individual with intellectual disabilities identifying how policies and procedures can be implemented to achieve standardised practice. On a paediatric level, the publication of a national policy is a starting point for things to come. The DoHC (2010) aims to provide training in paediatric palliative care, thus improving standards for those afflict with a life limi ting illness. Literature informs the author that both the hospice and the home have equal credibility when implementing palliative care principles. However, firsthand experience speaks for itself, Time is precious and whatever time a child has left should be used to ensure they are as happy as possible in a home environment ODwyer-Quinn (2010), this is a profound and very heartfelt message sent out by a mother who suffered the loss of her little girl, 5 years later, she remains heavily involved and at the forefront of paediatric palliative care, contributing and present at the unveiling of the national policy on paediatric palliative care in March this year.

Friday, January 17, 2020

Reaction Paper: the Exorcism of Emily Rose

THE EXORCISM OF EMILY ROSE REACTION PAPER Many years ago, there was part of history in Heaven, where angels fought against God. The war broke out after one angel, named Lucifer the light bearer, became envious about God’s power. Lucifer gathered his own army of angels. The battle led into an extermination of distrustful angels in heaven. Lucifer was defeated by Michael, God’s Archangel. The fallen angels of Lucifer fell on earth and Lucifer was banished by God into a place where he could never do anything evil in Heaven. Lucifer roams on earth in another name, called Satan, the prince of darkness.In the movie, The Exorcism of Emily Rose, there was a big misunderstanding about the death of a certain girl, named Emily Rose. The movie started when Emily was found dead. More stories about the life of Emily were just flashed back in the trial court. In the scene, Fr. Richard Moore was charged of negligent homicide after doing the rite of exorcism. Experts in the field of psy chology, neurology and medicine were called to explain the causes of Emily’s death. Most of the experts said and agreed that Emily was suffering from epilepsy and psychosis. Some experts stated that Fr.Moore’s advice led to the death of Emily Rose. As a justification about the movie, I believe that Emily’s death was caused by demonic possession. Her actions were not the results, caused by epilepsy and psychosis. With her actions narrated by some citizen who knew her, I believe that she was truly possessed by demons. Some said that her actions were inhumane and scary. As what was Fr. Richard Moore was telling, he witnessed that Emily’s actions and movements were manipulated by some evil forces surrounding her. One who is being possessed shows the symptoms of uncontrollable strength raging from the victim’s body.Some people who were possessed had more than one demon possessing them. That is why the possessed are strong and scary. Only the power of Go d through the use of his servants can extract demonic possession. As what I believe of being a Christian, I believe that those people who have less faith will easily fall in Satan’s hands. To avoid such incident, we must know how to pray to God. We must not rely on our own human nature, for it has no match against Satan’s dark powers. We must try to live in accordance to God’s will for he alone knows what is right and wrong.

Thursday, January 9, 2020

Essay on External and External Influences in Health Care

Abstract External and internal influences are relevant in health care. These influences continue to affect the total operations of a health care facility. I will summarize the insights I have gained into the external influences of the new health care reform policy and quality initiatives. The recent health care reform legislation was passed in the house and senate this year. The senior vice president, that I have interviewed, states that health care reform is an â€Å"unknown† for organizations. In addition, I will research the quality improvement initiatives and how these external influences include implications for organizations and health care administrators. Introduction The Health Care Reform legislation passed on†¦show more content†¦Mr. Lease states, that the hospital will not increase full-time equivalents (FTEs) or begin any major construction projects in the next fiscal year because of the â€Å"unknown† of health care reform. Mr. Lease indicates that illegal immigrants will not be permitted to participate in health insurance. He states if private payers and providers lower costs to make up for public payers, the reimbursement will be much less than the hospitals costs. Mr. Lease indicates that quality in health care is another external influence in the delivery of health care services. The integration of medical services into larger payment groups, when using value-based purchasing and improving coordination of care would increase productivity in health care; making medical services much more affordable and increasing the quality of care (W. Lease, personal communication, July 23, 2010. Pay-for Performance Initiatives The three significant pay-for-performance (PFP) initiatives in the United States are the Leap Frog Group’s Hospital Rewards Program, Bridges to Excellence and the Medicare PFP initiatives. 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