Wednesday, October 30, 2019
Precision Pricing for Profit in the New World Order Essay
Precision Pricing for Profit in the New World Order - Essay Example This report discusses the concept of sprint selling by illustrating its basic elements and ways companies can implement this innovative sales approach. Sprint selling is a business technique that focuses on speeding up the time to close in order to increase efficiency and achieve better results for a company. To understand speed selling one must comprehend the consequences of going the opposite direction. All companies depend on having a cash flow in order to keep a business going. If it takes a company more than a year to close out its sales leads the firm is operating in a risky environment because overhead and operating expenses may eat up a company budget prior to achieving the sale. In the process of going for a home run customer that can bring high amounts of the revenue the company, basic necessities must be met, thus this is where sprint selling comes to the rescue. Sprint selling is a process that increases the chances of longevity because it ensures a quick sales turnover where a company obtains many closed sales in short periods of time. Spring selling works best a part of the integrated plan in which sprint selling is ut ilized as a combined strategy that involves the creation of a diversified customer portfolio. The responsibility of obtaining sales for a company is shared by the marketing and sales team. The marketing team concentrates on attracting new customers and sales leads, while the sales team has to follow up on those sales leads and are the ones that must close the sale. This means that the salespeople are the ones that have a greater influence on the total elapsed time of a sale cycle. The sales team has to incorporate a selection strategy of customer prospects that reduce risks associated with both extremes. Sprint selling works best for smaller accounts that require less hassle implying that a company can not solely survive with these accounts in the long term. Bigger accounts require more time and a sprint selling approach realizes the need of having a balance between smaller and larger customer. The approach does encourage to find ways to shorten the overall closing time for big accounts as part of the company overall strategy. Â
Monday, October 28, 2019
Organizational Conflict Essay Example for Free
Organizational Conflict Essay Often when we come across the word conflict, we usually think of more than a simple disagreement. We think of individuals or groups in sharp disagreement over issues, ideas, or interests. This results in an emotional disturbance between the involved parties, with stress developing undesirable behaviors being exhibited. [1] The present diverse workforce characterized by organizational change, competition, and complex communications are drawing attention to interpersonal conflicts among workers. 2] Organizational change for example, alters the status quo and requires members of an organization to work together in new ways and under new rules. Competition compounds issues of power and escalates conflicts of personalities and behavior. The complexities of communication make it more difficult for culturally, economically and socially diverse workers to resolve the issues and problems they encounter on the job. While conflict is inevitable in groups and organizations due to the complexity and interdependence of organizational life, theorists have differed about whether it is harmful or beneficial to organizations. Early organizational theorists suggested that conflict is detrimental to Organizational functioning (Pondy, 1967; Brow, 1983) and focused much of their attention on the causes and resolution of conflict (Schimidt Kochan, 1972; Brett, 1984). More recently, researchers have theorized that conflict is beneficial under some circumstances (Tjosvold, 1991; Van de Vliert De Dreu, 1994). [3] Thus, this paper attempts to present the losses and benefits from conflicts in organizations. I. CONFLICT IN GROUPS AND ORGANIZATIONS A. Definition Generally, conflict is defined as a contest of opposing forces or power. 4] it is a perceived difference between a two or more parties that results in mutual opposition. [5] Looking at conflict in the context of groups, there is what we call an Intergroup Conflict, which can be defined as the behavior that occurs among organizational groups when participants identify with one group and perceive that other groups may block their group’s goal achievement or expectations. [6] Intergroup conflict with in organizations can occur in both horizontal vertical directions. A. 1 Horizontal Conflict. This type of conflict occurs among groups or departments at the same level in the hierarchy, such as between line staff. 7] This is commonly observed between Production Quality Control Departments, Sales Finance Departments, or RD Marketing Departments. A. 2 Vertical Conflict. This arises over issues of control, power, goals, and wages and benefits. [8] A typical source of vertical conflict is between head quarters executives and regional plants or franchises. Status and power differences among groups are often greater for vertical conflict. Part of the reason vertical conflict occurs is to equalize power differences; for example, unions try to give workers more power over wages or working conditions. [9] B. The Nature of Conflict Conflict as related to competition is illustrated by the following figure: The illustration shows how conflict and competition are related. Competition occurs when groups strive for the same goal, have little or no antagonism toward one another, and behave according to rules and procedures. In conflict, on the other hand, one group’s goals jeopardize the others; there is open antagonism among the groups; and few rules and procedures regulate behavior. When this happens, the goals become extremely important, the antagonism increases, rules and procedures are violated, and conflict occurs. 10] C. Causes of Conflict A number of factors contribute to conflict. Several of the most important causes are discussed below. C. 1 Task Interdependence. Task interdependence refers to the dependence of one unit on another for materials, resources, or information. [11] Two types of task interdependence are particularly prone to conflict. One is sequential interdependenc e, in which one individual or work unit is heavily dependent on another. For example, waiters generally are more reliant on cooks than the reverse because waiters must depend on cooks to furnish good meals in timely manner. Line and staff conflicts often arise because staff members frequently are dependent upon the line to implement their ideas. The second form of task interdependence is reciprocal interdependence, in which individuals or work units are mutually interdependent. For instance, purchasing agents want engineers to provide detailed generic specifications so that they can negotiate lower costs from suppliers. At the same time, engineers need to obtain materials of the proper quality on a timely basis, so they may find it more convenient to specify a brand name. 12] Generally, as interdependence increases, the potential for conflict increases. [13] Sequential reciprocal interdependence require employees to spend time coordinating and sharing information. Employees must communicate frequently, and differences in goals or attitudes will surface. Conflict is especially likely to occur when agreement is not reached about the coordination of services to each other. Greater interderdependence means departments often exert pressure for a fast response because departmental work has to wait on other departments. C. 2 Scarce Resources. Another major source of conflict involves competition between groups for what members perceive as limited resources. [14] Possibilities for conflict expand when there are limited resources, such as office space, equipment, training, human resources, operating funds, and pay allocations. In their desire to achieve goals, groups want to increase their resources. This becomes another cause for conflict in groups. C. 3 Goal Incompatibility. Goal incompatibility is probably the greatest cause of intergroup conflict in organizations. The overall goals of an organization are broken down into operative goals that guide each department. The accomplishment of operative goals by one department may block goal accomplishment by other departments and hence, cause conflict. [15] Out of necessity, organization members frequently pursue goals that are somewhat different from one another, setting the stage for potential conflicts. [16] For example, sales personnel may find it easier to battle the competition by promising very quick deliveries, while people in manufacturing may find that small production runs on short notice interfere with their cost cutting efforts. C. 4 Communication Failures. Breakdown in communication due to distortions or lack of communication often lead to conflicts. [17] Conflict in an organization is an indication of the most basic communication failure. Failure to talk with someone. Failure to notify someone of something before it becomes public. Failure to involve someone in a problem-solving process. [18] C. 5 Individual Differences. Differences in personality, experience, and values make frequent conflicts likely. [19] Functional specialization requires people with specific education, skills, attitudes, and time horizons. When an individual who have ability and aptitude in marketing joins the marketing department. Eventually, that individual will be influenced by departmental norms and values, attitudes, and standards of behavior, differ across departments, which is often a source of horizontal conflicts. Cultural differences can be particularly acute in the case of mergers or acquisitions. Employees in the acquired company may have completely different work styles and attitudes, and a â€Å"we against them†attitude can develop. [20] C. 6 Poorly Designed Reward System.
Saturday, October 26, 2019
Introductory speech Change in Thinking :: essays research papers
Change in thinking This is very long ago I worked as a part time teacher for 3 months back home in India. When I was doing my undergrad .This was part of a project work in the course work. There were 20 odd students in the class. But they are not at all good at studies. They used to skip the classes, use fowl language, never showed any kind of interest in listening to teachers or respecting them and what not. The principal of the school is fed up with their behavior and decided he is going to fail all the students. Here I was appointed as a mathematics teacher. I went as extra mile and requested the principal to give me a month, to see if I can bring any change in the students. The principal did accept my request. To start with it was very tough and challenging assignment. I did plan well and here how I executed the plan †¦ It starts this way I went to the class and spoke to the students Here is the deal I will help you out in passing your exams but you have to do what I will tell you guys to do. First week: You have to attend all the classes I am going to give D grade if you just attend the classes. Students felt good about the deal and started attending the classes. Second week: Now you can copy in the exams and I am going to give C grade. Students liked the deal. They did that. Third week: I said now I am going to give B grade if you do not copy from others, just write what you know. This time students liked it better. It motivated the students to participate in the class and started involving and showed lot of interest. Slowly but steadily they started doing well. After a month the principle decided to come to the class and check the performance of the students. Now we had one more deal, whenever I ask you a question (tables) whoever knows the answer raises your right hand. Whoever don’t know raise your left hand. And I am going to ask the person who has raised his right hand. The day has come, the principle came.
Thursday, October 24, 2019
Long term objectives
Unfortunately in management, it is difficult to find standard definitions for many commonly used terms, yet a common vocabulary and a common understanding are vital to successful communication. The key terms for management are working with and through other people to accomplish the objectives of both the organization and its members. Management activities include planning, organizing, coordinating, motivating, leading and controlling; getting results effectively through other people by process of delegation. Management system refers to the organization's structure for managing its processes – or activities – that transform inputs of resources into a product or service which meet the organization's objectives, such as satisfying the customer's quality requirements, complying to regulations, or meeting environmental objectives. In strategic analysis for long term objectives, the framework can be used for examining the â€Å"fits†with managerial strategy. These fits fall into seven broad areas: (1) strategy; (2) structure; (3) shared values, attitudes, and philosophy; (4) approach to staffing the organization and its overall â€Å"people orientation†; (5) administrative systems, practices, and procedures used to run the organization on a day-to-day basis, including the reward structure, formal and informal policies, budgeting and programs, training and financial control; (6) the organization’s skills, capabilities, and core competencies; and (7) style of management (how they allocate their time and attention), symbolic actions, their leadership skills, the way the top management team comes across to the rest of organization. Managers should strive to develop and attain a variety of objectives in all areas where activity is critical to the operation and success of the management system. Now taking example of PetsMart case, and by going through the all available resources of market information, feedbacks and opinions of general public, if we analyze their management, their rating should be as follows. (1) Strategy                                                              Strong. (2) Structure                                                             Average. (3) Shared values                                                      Average. (4) Approach to staffing the organization                Strong. (5) Administrative system                                        Weak. (6) Core competences                                               Average. (7) Style of management                                          Average. Resource: â€Å"Management†By Patrick J. Montana, Bruce H. Charnov, Published 2000 Barron's Educational Series
Wednesday, October 23, 2019
Macbeth: Hero or Villain? Essay
The first time in the play we hear about Macbeth is in the very first scene. The witches are discussing when they shall next meet again, and one of the witches says ‘There to meet with Macbeth’. We are yet to read about Macbeth to discover his character but because of this scene we know somehow he is or will be associated with some kind of evil. Although when we read this nowadays we do not get frightened by this fact but in the sixteenth century when this play was written the audience would have been as they believed in witchcraft. The second time we hear about Macbeth is in scene two. In this scene he is described by a Captain, he describes him ‘brave Macbeth – well he deserves that name’. The captain says this as Macbeth has defended the rebellion of Highlanders and Islanders. We still haven’t heard Macbeth himself but we have two conflicting opinions of him. The first time we hear from Macbeth is in scene three. As the witches said, he met them on the heath. He is with Banquo, his best friend. He is greeted by the witches and they greeted him ‘All hail Macbeth, hail to thee, Thane of Glamis’ they also say Thane of Cawdor and then the third witch says ‘All hail Macbeth, that shalt be King hereafter’. They then tell Banquo his future and how his son will be King. I think that this is the very first stage of the change in Macbeth’s future. Their predictions make him fell more and more confident, then when he is made Thane of Glamis he feels superior as he has a strong feeling that he will one day be King. I think if Macbeth had not have been superstitious so he believed the witches he wouldn’t think he was so indestructible and then would not have been do evil. When Macbeth is made Thane of Cawdor after the Thane before was killed for treason, he writes a letter to his wife, he tells her about the witches’ predictions. I think this letter is the spark that starts Lady Macbeth’s own evil, as she is pleased with what the letter says, however she knows that although Macbeth has ambition he ‘is too full o’ the milk of human kindness’ to act upon the prediction. When Duncan stays with Macbeth and his wife, Lady Macbeth plans to kill him, she calls on evil spirits to ‘unsex’ her, so she is not feminine as women were seen as meek and feeble so she could carry out the murder of Duncan. She tells Macbeth to leave killing up to her. When Duncan arrives, Lady Macbeth greets him warmly; she doesn’t seem to show any emotions of remorse at this point. When the banquet is taking place Macbeth thinks over the decision to kill Duncan, finally he decides the murder will not go ahead – this decision shows that Macbeth is not truly evil. However when he tells his wife he doesn’t want to go ahead with the murder she talks him around by saying things such as if he were a real man he wouldn’t back out and how if she had promised something to him she wouldn’t break her promise. The way she says this is very powerful and underlines just how evil she could be, as she says ‘I have given suck, and know how tender ’tis to love the babe that milks me – I would while it was smiling in my face have plucked my nipple from his boneless gums, and dashed the brains out, had I so sworn as you have done to this’. I think the baby she describes is maybe a child that they lost, as we do not hear of this child apart from this in the play. I think she used the child as an example in her promise as it is something that they both feel strongly for and it brings them closely together. Before Lady Macbeth talks Macbeth into backing out of killing, in his soliloquy in Act one scene seven, Macbeth shows his conscience, he feels he doesn’t want to go ahead with the murder, although when he talks about killing Duncan he never mentions the word ‘murder’. At this point we still don’t really know if Macbeth is a villain or hero yet. Lady Macbeth was suppose to carry out the murder but she saw Duncan sleeping and said that she could not do it as he looked like his father, this shows that she in not totally evil either. Macbeth hallucinates a dagger pointing towards Duncan’s chamber before his murder showing he is unstable mentally and maybe nervous. These nerves make him kill the two guards that slept with Duncan and over react when the murder is revealed. After the murder Macbeth is made King as the Kings two sons had fled from Scotland. Now all of his predictions from the witches have come true, he feels threatened as the witches also predicted that Banquo’s son would be king. Now as he has already killed three people he sets out to kill Banquo and his son, Felance. Banquo is his best friend, so this really shows how Macbeth’s character is really changing for the worst. This time he doesn’t do it himself, he sends two murders that he persuades in such a way we’ve heard before. He tells them that if they were real men they would carry out the murders, this sounds like the type of persuasion that Lady Macbeth used on her husband so he would commit the murder of th e King. At the banquet he pretends he does not know when Banquo is and is upset that he isn’t there, but then he sees Banquo’s ghost. He is uneasy and he nearly says too much about all the murders when he gets upset and confused after he sees the ghost, but Lady Macbeth stops him in time and makes up a story of how he is ill so the guests do not suspect a thing. In Act four he goes back to see the witches. They tell him he is safe until Birnam wood comes to Dunsianane, and never by a man of woman born shall he be harmed. Macbeth can now relax, he thinks, as everyone is born of a woman and the wood will never move. They also tell him another prediction of Banquo’s children on the throne, this is still possible as the two murderers failed to kill Banquo’s son, Felance. Macbeth’s next actions, I think show just how much his mind is evil and he seems not to care or have any conscience left, and he sends an army to kill Macduff’s family! The first description we hear of Macbeth is ‘brave Macbeth’, but in Act four scene three Macduff describes him as a ‘tyrant’, his personality seems have to changed. In Act five scene four Lady Macbeth kills herself. At the start of the play Macbeth and his wife seem very close, but when she dies Macbeth is not moved in any way he shows no emotion at all, he is cold as if he has hardened to people dying. He says ‘she should have died hereafter’. His life seems meaningless; he doesn’t care for anything or anyone anymore, not even his wife. The army that are attacking his castle carry bits of trees from Birnam wood – Birnam wood seems to be moving. Now I thing this shows that his superstition has really ruined him. He seems to know he is going to die, he says ‘At least we will die with harness on our backs’, he wants to die a solider – but as the witches said no man of woman born can kill him. When the army attacks the castle he fights Macduff – it is then Macbeth finds out that Macduff was born of caesarean – I think now Macbeth is puzzled; should he carry on fighting or just give up? Macbeth’s last words are ‘Hold, enough!’ He almost seems childlike and in a last grasp for breath he shouts this. Ultimately Macbeth is a villain, but factors that helped to bring out these feelings are his wife, his own ambition and the fact that he was too quick to believe to witches and too trusting. Macbeth may have been a hero but he died a villain.
Tuesday, October 22, 2019
Integrated Pest Management essays
Integrated Pest Management essays As stated in Controlling Turfgrass Pests, Integrated pest management (IPM) is both a concept and a philosophy. It is a broad, multidisciplinary, systematic approach to controlling all pests. All types of control methods (biological, cultural, regulatory, physical, and chemical) are utilized. Use of IPM strategies should result in effective and economical suppression of pests with a minimum effect on nontarget organisms and the environment. IPM is based on understanding the biology and ecology of the turfgrass plant or community to be protected and the pests to be controlled (Shurtleff et al. 361). Now you have a definition for integrated pest management. How would you go about setting up this program? The truth is, you wouldnt be able to. If you didnt already know what IPM is, you would not have the knowledge in this field to succeed. Most people believe that all you do is put some grass down, add fertilizer, water, spray a little pesticide, and then mow once every other week. This is not the case. While all of these have their own role when used properly, the primary objective is to reduce pesticide use, states Robert Emmons in the second edition of Turfgrass Science and Management (339). Education is the key to a successful IPM program. Not only education about the program, but every facet of turfgrass management. For example, poor fertilization and water practices can lead to perfect conditions for a host of turfgrass pests. ...
Monday, October 21, 2019
Examples and Characteristics of Effective Analogies
Examples and Characteristics of Effective Analogies An analogy is a type of composition (or, more commonly, a part of an essay or speech) in which one idea, process, or thing is explained by comparing it to something else. Extended analogies are commonly used to make a complex process or idea easier to understand. One good analogy, said American attorney Dudley Field Malone, is worth three hours discussion. Analogies prove nothing, that is true, wrote Sigmund Freud, but they can make one feel more at home. In this article, we examine the characteristics of effective analogies and consider the value of using analogies in our writing. An analogy is reasoning or explaining from parallel cases. Put another way, an analogy is a comparison between two different things in order to highlight some point of similarity. As Freud suggested, an analogy wont settle an argument, but a good one may help to clarify the issues. In the following example of an effective analogy, science writer Claudia Kalb relies on the computer to explain how our brains process memories: Some basic facts about memory are clear. Your short-term memory is like the RAM on a computer: it records the information in front of you right now. Some of what you experience seems to evaporatelike words that go missing when you turn off your computer without hitting SAVE. But other short-term memories go through a molecular process called consolidation: theyre downloaded onto the hard drive. These long-term memories, filled with past loves and losses and fears, stay dormant until you call them up.(To Pluck a Rooted Sorrow, Newsweek, April 27, 2009) Does this mean that human memory functions exactly like a computer in all ways? Certainly not. By its nature, an analogy offers a simplified view of an idea or process- an illustration rather than a detailed examination. Analogy and Metaphor Despite certain similarities, an analogy is not the same as a metaphor. As Bradford Stull observes in The Elements of Figurative Language (Longman, 2002), the analogy is a figure of language that expresses a set of like relationships among two sets of terms. In essence, the analogy does not claim total identification, which is the property of the metaphor. It claims a similarity of relationships. Comparison Contrast An analogy is not quite the same as comparison and contrast either, although both are methods of explanation that set things side by side. Writing in The Bedford Reader (Bedford/St. Martins, 2008), X.J. and Dorothy Kennedy explain the difference: You might show, in writing a comparison and contrast, how San Francisco is quite unlike Boston in history, climate, and predominant lifestyles, but like it in being a seaport and a city proud of its own (and neighboring) colleges. That isnt the way an analogy works. In an analogy, you yoke together two unlike things (eye and camera, the task of navigating a spacecraft and the task of sinking a putt), and all you care about is their major similarities. The most effective analogies are usually brief and to the point- developed in just a few sentences. That said, in the hands of a talented writer, an extended analogy can be illuminating. See, for example, Robert Benchleys comic analogy involving writing and ice skating in Advice to Writers. Argument From Analogy Whether it takes a few sentences or an entire essay to develop an analogy, we should be careful not to push it too far. As weve seen, just because two subjects have one or two points in common doesnt mean that they are the same in other respects as well. When Homer Simpson says to Bart, Son, a woman is a lot like a refrigerator, we can be fairly certain that a breakdown in logic will follow. And sure enough: Theyre about six feet tall, 300 pounds. They make ice, and . . . um . . . Oh, wait a minute. Actually, a woman is more like a beer. This sort of logical fallacy is called the argument from analogy or false analogy. Examples of Analogies Judge for yourself the effectiveness of each of these three analogies. Pupils are more like oysters than sausages. The job of teaching is not to stuff them and then seal them up, but to help them open and reveal the riches within. There are pearls in each of us, if only we knew how to cultivate them with ardor and persistence.( Sydney J. Harris, What True Education Should Do, 1964) Think of Wikipedias community of volunteer editors as a family of bunnies left to roam freely over an abundant green prairie. In early, fat times, their numbers grow geometrically. More bunnies consume more resources, though, and at some point, the prairie becomes depleted, and the population crashes.Instead of prairie grasses, Wikipedias natural resource is an emotion. Theres the rush of joy that you get the first time you make an edit to Wikipedia, and you realize that 330 million people are seeing it live, says Sue Gardner, Wikimedia Foundations executive director. In Wikipedias early days, every new addition to the site had a roughly equal chance of surviving editors scrutiny. Over time, though, a class system emerged; now revisions made by infrequent contributors are much likelier to be undone by à ©lite Wikipedians. Chi also notes the rise of wiki-lawyering: for your edits to stick, youve got to learn to cite the complex laws of Wikipedia in arguments with other editors. Toget her, these changes have created a community not very hospitable to newcomers. Chi says, People begin to wonder, Why should I contribute anymore?and suddenly, like rabbits out of food, Wikipedias population stops growing.(Farhad Manjoo, Where Wikipedia Ends. Time, Sep. 28, 2009) The great Argentine footballer, Diego Maradona, is not usually associated with the theory of monetary policy, Mervyn King explained to an audience in the City of London two years ago. But the players performance for Argentina against England in the 1986 World Cup perfectly summarized modern central banking, the Bank of Englands sport-loving governor added. Maradonas infamous hand of God goal, which should have been disallowed, reflected old-fashioned central banking, Mr. King said. It was full of mystique and he was lucky to get away with it. But the second goal, where Maradona beat five players before scoring, even though he ran in a straight line, was an example of the modern practice. How can you beat five players by running in a straight line? The answer is that the English defenders reacted to what they expected Maradona to do. . . . Monetary policy works in a similar way. Market interest rates react to what the central bank is expected to do.(Chris Giles, Alone Among Governors. Financial Times. Sep. 8-9, 2007) Finally, keep in mind Mark Nichters analogical observation: A good analogy is like a plow which can prepare a populations field of associations for the planting of a new idea (Anthropology and International Health, 1989).
Sunday, October 20, 2019
The Tempest Analysis Discusses Morality and Fairness
'The Tempest' Analysis Discusses Morality and Fairness This analysis reveals that Shakespeare’s presentation of morality and fairness in the play is highly ambiguous and it is not clear where the audience’s sympathies should lay. The Tempest Analysis: Prospero Although Prospero has been treated badly at the hands of the Milan nobility, Shakespeare has made him a difficult character to sympathize with. For example: Prospero’s title in Milan was usurped, yet he did much the same thing to Caliban and Ariel by enslaving them and taking control of their island.Alonso and Antonio cruelly cast Prospero and Miranda out to sea, yet Prospero’s revenge is equally as cruel: he creates a horrific storm which destroys the boat and throws his noble counterparts into the sea. Prospero and Caliban In the story of The Tempest, Prospero’s enslavement and punishment of Caliban is difficult to reconcile with fairness and the extent of Prospero’s control is morally questionable. Caliban had once loved Prospero and showed him everything there was to know about the island, but Prospero’s considers his education of Caliban as more valuable. However, our sympathies firmly lay with Prospero when we learn that Caliban had tried to violate Miranda. Even when he forgives Caliban at the end of the play, he promises to â€Å"take responsibility†for him and continue to be his master. Prospero’s Forgiveness Prospero uses his magic as a form of power and control and gets his own way in every situation. Even though he does ultimately forgive his brother and the king, this could be considered to be a way to reinstate his Dukedom and ensure the marriage of his daughter to Ferdinand, soon to become King. Prospero has secured his safe passage back to Milan, the reinstatement of his title and a powerful connection to royalty through the marriage of his daughter – and managed to present it as an act of forgiveness! Although superficially encouraging us to sympathize with Prospero, Shakespeare questions the idea of fairness in The Tempest. The morality behind Prospero’s actions is highly subjective, despite the happy ending which is conventionally employed to â€Å"right the wrongs†of the play.
Saturday, October 19, 2019
The Indian Removal Act of 1830 Essay Example | Topics and Well Written Essays - 750 words
The Indian Removal Act of 1830 - Essay Example However, the Indian Removal Act 1830 evidently violated the US constitution as the Indians were removed from their land by force. Overview To illustrate, â€Å"the Indian Removal Act of 1830 was the culmination of a decades-long struggle between white and Native Americans over who would control vast tracts of territory that had been Native American lands for many centuries†(Tucker, 2011, p.381). As per the provisions of the Act, tens of thousands of the Native Americans were forcibly removed from the east of the Mississippi River. This Act made the prior treaties between the US government and the Native American groups void and the government tried to form new treaties that would better serve the interests of whites. The Act directly affected the Five Civilized Tribes including Choctaws, Cherokees, Chickasaws, Creeks, and Seminoles as they were the main inhabitants of the east Mississippi river. This agricultural land was extremely fruitful for crops like cotton, and many sou therners including some wealthy planters strongly desired the ownership of the land. Although the US Supreme Court had ruled that Native American tribes were sovereign nations and hence State law would not apply to them, President Jackson ignored the court decision and executed forceful removal of Native Americans from their land. Although the Indian Removal Act 1830 was an inhumane course of action that hurt the constitutional rights of people lived at the east Mississippi, it had also some positive effects on American Indian group. The Act and thereby forceful removal of Indians from their territory assisted them to escape from the depredations of whites to some extent. In addition, this change benefited the American Indians to resettle in a region where they could administer themselves without any external pressure. At the same time, the forceful removal adversely affected the economy as well as the social interest of the American Indian group. The American Indians had possessed fruitful agricultural fields until the time of the Act and therefore the forceful removal caused them to experience huge economic losses. In addition to the land loss, they were also forced to leave their homes and livestock behind and this situation caused them to lose what they had built over thousands of years. Historians reveal that this group was relocated to an area which no one needed that time. From an economic point of view, the nation lost several million dollars as part of this law enforcement. Furthermore, this arbitrary law amendment questioned the constitutional rights of American Indian group in the United States. Undoubtedly, the Indian Removal Act 1830 curtailed the fundamental human rights and constitutional rights of the American Indians. Out of the seven principles of the constitution, the seventh principle has specifically defined individual rights.
Assessment for Training Project Assignment Example | Topics and Well Written Essays - 2500 words
Assessment for Training Project - Assignment Example The training program can have a positive influence on teachers’ performance improvement. Teacher training program is a type of adult training which facilitates to develop personal knowledge. The teacher training program is designed to provide a context regarding the requirements of teachers and their desired learning activities (Wati 79-104). Nowadays, education is going through a serious transformation with the arrival of globalization, increase in social along with demographical diversity among students, the introduction of the knowledge-oriented economy and initiation of information and communication technology (ICT). Thus, traditional teaching activities are unable to generate skilled employees which are required for fulfilling the demand of present employment market. These changes have resulted in the development of the teacher-training program by Microsoft to enhance the effectiveness of teaching and learning procedure (Al-Hattami, Muammar and Elmahdi 39-45). In accordance with the opinions of Teachers Forum organized in 2005, it has been observed that most teachers believe that they are required to offer different learning experiences to the students. In the Teachers Forum of 2006, the teachers insisted on facilitating innovative learning activities by involving in authentic and meaningful tasks which can develop critical thinking and enhance their problem-solving ability within their respective environment (Microsoft Corporation 1-21). AREA OF TRAINING NEEDS TO BE ADDRESSED With respect to education, it is worth mentioning that the education system, designed for grandparents is not appropriate for present day’s students. Educational systems in various schools have not changed fundamentally in over a century. Thus, the key question arrives in this context is that if the traditional educational system is able to satisfy the requirements of the students of future generation? (Microsoft, â€Å"Teacher Training Programs†) Educa tional investigators have long proposed the schools to follow a new model of teaching and learning. One key priority with respect to teaching is to alter the core of schooling from teacher-centered to pedagogy-based understanding of students’ thought procedure, their abilities to learn and use theoretical concepts in order to derive the solution of practical problems. In order to understand the areas that must be addressed in Teachers Training Program a questionnaire has been designed for teachers (see appendix). About 50 teachers from various schools have been surveyed for recognizing their requirements. According to the outcome of questionnaire, it can be recognized that most of the teachers have not participated in any professional development training activities in last three years. Among the respondents who have stated that they participated in training programs in last three years depicted their participation in courses which are particularly related with their respecti ve subject areas, educational conferences and seminars and formal school arrangement training. The respondents also stated that the training programs
Friday, October 18, 2019
ECONOMICS Essay Example | Topics and Well Written Essays - 1500 words - 1
ECONOMICS - Essay Example So, for example, when Americans receive more income from their overseas investments than foreigners receive from their investments in the United States, American GNP will be somewhat larger than GDP in that year. If Americans receive less income from their overseas investments than foreigners receive from their US investments, on the other hand, American GNP will be somewhat smaller than GDP (http://www.context.org/PEOPLE/celeste/gnpp.htm). Equivalent estimates of GNP (or GDP) produced in a given year may theoretically be arrived at through at least three different accounting approaches, depending upon whether the transactions that determine the prices of final goods and services are looked at and tallied up by focussing on the buying or by focussing on the proceeds from selling or by focussing on the nature of the products themselves. Using the expenditure approach, you can estimate total GNP as the sum of estimates of the amounts of money that are spent on final goods and services by households (Consumption), by business firms (Investment), by government (Government Purchases), and by the world outside the country (Net Exports). Using the incomes approach, you can estimate total GNP by summing up estimates of the different kinds of earnings people receive from producing these same final goods and services: (Plus certain adjustments to account for wear and tear on productive assets like plant and machinery -- depreciation -- and what are called indirect business taxes). Using the product or output approach, you can estimate GNP by summing up the output of all the various organizations producing goods and services in the country, subtracting out the costs of their raw materials to avoid double counting and making suitable adjustments for depreciation and for the value of imports and exports. (Butt 2002, Kopecky 1995) (In theory, all three
Technical Abstrract-Article Summary Assignment Example | Topics and Well Written Essays - 250 words
Technical Abstrract-Article Summary - Assignment Example It is the slight curve of the Nexus display that makes people think that it has a flexible display. The manufacture of flexible smartphones is not without hurdles. For one, the durability of a bendable phone and its components remain questionable. Yet again, the cost of manufacturing the phone is higher than that for standard phones While OLED displays are better than LCD (Liquid Crystal Display) screens in that they can easily bend or fold without being destroyed, they may need to an additional glass layer to be more durable. A flexible display is beneficial compared to the rigid display in that it is more durable especially even when they fall. They also tend to be thinner and lighter than the standard screens since they are made of plastic. While plastic gives greater flexibility to displays, they are disadvantageous in that they are semi-permeable to air and water which can destroy the display. In conclusion, flexible OLED displays are more durable compared to their LCD counterparts given that they are more flexible. However, it remains to be seen how practical flexible displays are in the
Thursday, October 17, 2019
Three year strategic digital marketing plan Essay
Three year strategic digital marketing plan - Essay Example g the fact that Gap 360 is a relatively new company in this market, the success achieved by the company in its first and second year of trading is noteworthy. Having enjoyed a successful stint over the past two years, the company should aim to achieve a higher ground that provides robust foundation to become an undisputed leader in the market. In order to be able to reach the pinnacle in this market, Gap 360 must aim to attain a higher customer satisfaction index. This is precisely because a widening base of satisfied customers will serve as a sustainable source of profit for the independent travel service provider. However, the objective of higher customer satisfaction level can only be achieved if the company is able to increase its base of potential passengers which in actuality is the second objective that is specific to the requirement of the company. The objectives are very closely associated to each as one can only be attained if the other is accomplished. The fact can be evid enced with the third objective of the company which is to widen its products and service offerings (in terms of increasing number of destinations and types of trips) within five years of its launch. By doing so the company endeavours to attract greater number of passengers which in turn will provide them with the opportunity to offer superior quality services and hence, increase their customer base to a further level. Measureable: Gap 360 has to focus on increasing the amount of bookings done every year. In addition to that, they will also have to implement appropriate strategies in order to attain growth in the level of repeat sales per annum. As far as measurability of this objective is concerned, a target of 11,000 booking has been set which is to be achieved by 2016. On the other hand, a measurable target of 10% of the total bookings has been placed for repeat sales. Attainable: Given the size of the market in UK, the target that has been set in the section above is attainable.
Week 5 d1 Essay Example | Topics and Well Written Essays - 250 words - 1
Week 5 d1 - Essay Example Because of this, organizations can develop efficient and productive business process, which meets the expectations of the market. Management integration brings all operations under one roof or umbrella, which is the core in developing parameters for improvements as well as checking the progress (TechNet, 2014). Additionally, management integration helps in network management by event monitoring, security and reviewing performance (TechNet, 2014). It becomes easier to monitor the performances of an integrated management because all the departments are together. Similarly, it allows for automatic reporting that is vital to making the organization to progress (TechNet, 2014). Lastly, management integration assists in network management by offering support response as well as alert services that an organization may require at any given time (TechNet, 2014). It allows for timely delivery of information or critical data as may be needed at any given time to assist the organization is meeting the goals. For instance, Integration with IBM NetView network management system is essential in automatic reporting (TechNet, 2014). There are also other network management services, which offer different services required by the
Wednesday, October 16, 2019
Three year strategic digital marketing plan Essay
Three year strategic digital marketing plan - Essay Example g the fact that Gap 360 is a relatively new company in this market, the success achieved by the company in its first and second year of trading is noteworthy. Having enjoyed a successful stint over the past two years, the company should aim to achieve a higher ground that provides robust foundation to become an undisputed leader in the market. In order to be able to reach the pinnacle in this market, Gap 360 must aim to attain a higher customer satisfaction index. This is precisely because a widening base of satisfied customers will serve as a sustainable source of profit for the independent travel service provider. However, the objective of higher customer satisfaction level can only be achieved if the company is able to increase its base of potential passengers which in actuality is the second objective that is specific to the requirement of the company. The objectives are very closely associated to each as one can only be attained if the other is accomplished. The fact can be evid enced with the third objective of the company which is to widen its products and service offerings (in terms of increasing number of destinations and types of trips) within five years of its launch. By doing so the company endeavours to attract greater number of passengers which in turn will provide them with the opportunity to offer superior quality services and hence, increase their customer base to a further level. Measureable: Gap 360 has to focus on increasing the amount of bookings done every year. In addition to that, they will also have to implement appropriate strategies in order to attain growth in the level of repeat sales per annum. As far as measurability of this objective is concerned, a target of 11,000 booking has been set which is to be achieved by 2016. On the other hand, a measurable target of 10% of the total bookings has been placed for repeat sales. Attainable: Given the size of the market in UK, the target that has been set in the section above is attainable.
Tuesday, October 15, 2019
GBST300 Essay Example | Topics and Well Written Essays - 250 words - 3
GBST300 - Essay Example s relevant nuclear technology in manufacturing atomic energy and fundamental information to states that are not known as Nuclear Weapon countries by the conformity on the Reduction of Nuclear Weapons, is one of the major ways in which non-nuclear powers and terrorists build nuclear weapons. The upkeep of global stability and security is an essential part of the United Nations’ mission. Weapons of mass destruction (WMD) chemical, biological, nuclear, or radiological weapons that can bring harm to large figures of people and infrastructure have been at the forefront of worldwide security concerns since the advent of the UN. The production of viable nuclear weapons means of delivery, threatens incalculable consequences for global stability and prosperity especially from countries, which part of the NPT possess important unsafeguarded nuclear activities. Countries such as India, Israel and Pakistan are normally categorize as states that are not part of the NPT. The growth of international terrorism has added a new dimension to an old problem, as global and regional tensions rise, technology improves, and security falters in critical areas, giving rise to an international black market for WMD.Dr. Khan, a metallurgist and the architect of Pakistan bomb is considered the mastermind of the largest illicit nuclear proliferation network in history who had begun selling nuclear technology to Iran in the late 1980’s. This signaled the opening of business for an enterprise that eventually spread to North Korea, Libya and beyond to
Monday, October 14, 2019
What Are The Work Styles Essay Example for Free
What Are The Work Styles Essay Q.1 What are the work styles and personalities of Thomas Green and Frank Davis? Thomas Green could anticipate the market dynamics and device the ideas that should be implemented. This is evident by his focus of developing new up-selling software. Greens strong persuasion flair made him love meeting new people and charming them over. He also got compliments that he has a great rapport with his clients. Green likes to work independently. Greens self-assurance talent is expressed by his self-confidence and audacious behaviour. Green conveys his ideas to the clients and expects them to proceed by trusting his ideas. Greens leadership style is being ingenious. Greens leadership style is more productive when it comes to implement a task. He is industrious and self-motivated but has trouble in being directed. He prefers face to face communication and building rapport with other employees. He receives feedback from people and responds to them on the spot spontaneously. In a nutshell, he likes to under-promise and over-deliver. Unlike Frank, Green was interested only in the end result of the performance and not in the detailing structure of the job. As the Marketing Director, Frank is an excellent tactical leader. He has the vision to gauge the forthcoming possibilities and leverage the resources to effectively move forward. Having promoted from the position of a senior market specialist he was very proficient and experienced in his approach. He emphasised not only on accomplishing the work but also scrutinizing details. His stringent approach towards scheduling and documentation indicates how organized person he was, with his perfect managerial skills. He had the perfect blend of 15 year-long industry experience and other key skills. With this expertise he is able to chase the growth rate as mentioned. Overall, his leadership style is authoritarian, hence he is strict, and commands close control over followers by regulation of policies and procedures cascaded to then. However, his commands are explicit, easily comprehensible and precise and also well-adjusted to the prevalent management bureaucracy. His work style is scrupulous in details and improvises data with strategies. He is optimistic and diffuses positive energy to keep the moral of the followers maintained high. Davis keeps a check on the office dynamics and politics going on in the office. As a supervisor, it is Davis expectation that Green comply with provided recommendations for changes in demeanour and communication.
Sunday, October 13, 2019
Online Courses vs In-Classroom Courses Essays -- Online Education vs.
The Internet has revolutionized the way in which children, teenagers, and young adults are educated. The Internet greatly impacts not only the field of education but every aspect of society. Tamar Lewin comments, â€Å"those ages 8 to 18 spend more than seven and a half hours a day connected to the Internet†(Lewin, A1). To that end, the Internet is prevalent in many homes throughout the world and continues to impact the way in which people are educated both in the classroom and even at home where a student performs homework. The impact of the Internet becomes evident, when one begins to examine similarities and differences between the slew of contemporary online courses compared to the conventional in-class experience. While it is true that one will find that both the online course and conventional in-class experience provide teachers that instruct their students on the subject matter, one will still find a vast array of differences between the two methods of education. Argu ably one of the most glaring differences between the modern online distance educational learning method and the traditional classroom setting, is the lack of personal attention that the teacher can convey to the student. For instance, online instructors relay information solely through online exercises such as planned web posts and scheduled modules that one must perform over the Internet. In contrast, in the classroom experience a student is afforded the opportunity to interact one-on-one with the teacher. Furthermore, the traditional method of instruction typically empowers each person with the ability to sit in a classroom and yet excel at their own pace. Truth be told, a number of Internet classes offer an option to stay online and interact with the teacher af... ...mar. â€Å"If Your Kids Are Awake, They’re Probably Online.†The New York Times. The New York Times, 20 Jan. 2010: A1. Web. 15 Apr. 2014. . Bartha, Christina, MSW, et al. â€Å"Depressive Illness.†Depressive Illness (1999): 14. Web. 8 Apr. 2014. Grano, Vivian. â€Å"An Investigation of the Effectiveness of Personal Attention by Reading Teachers Upon Students Attendance an Academic Achievement.†(1976) Abstract. Web. 10 Apr. 2014. http://eric.ed.gov/?id=ED126482 Parsad, B., and Lewis, L. (2008). Distance Education at Degree-Granting Postsecondary Institutions. 3. Print. 2006-07 (NCES 2009-044). National Center for Education Statistics, Institute of Education Sciences, U.S. Education. Washington, D.C.
Saturday, October 12, 2019
Psychological Assessment 1 Midterm Multiple Choice :: essays research papers
Identify the letter of the choice that best completes the statement or answers the question. __D__ 1. Psychological tests a. pertain only to overt behavior. b. always have right or wrong answers. c. do not attempt to measure traits. d. measure characteristics of human behavior. __C__ 2. One's general potential, independent of prior learning, can best be described as a. achievement. b. aptitude. c. intelligence. d. ability. __D__ 3. Achievement, aptitude and intelligence can be encompassed by the term a. human potential. b. human traits. c. human personality. d. human ability. __B__ 4. The work of Weber and Fechner represent which foundation of psychological testing? a. individual differences b. psychophysical measurement c. survival of the fittest d. Darwinian evolution __B__ 5. A child's mental age a. cannot be determined independently of the child's chronological age. b. provides a measurement of a child's performance relative to other children of a particular age group. c. cannot be determined from a child's test score. d. can only be determined from large representative samples. __A__ 6. A major problem with the Woodworth Personal Data Sheet was that a. it assumed the answers were acceptable at face value. b. the normative sample was too small. c. it was difficult to administer. d. there were too few questions. __D__ 7. Factor analytic techniques were employed in the development of the a. MMPI. b. CPI. c. TAT. d. 16PF. __C__ 8. Which of the following scales would be used when the information is qualitative rather than quantitative? a. ordinal b. interval c. nominal d. ratio __C__ 9. In the Civil Rights Act of 1991, Section 106, a. within group norming was made legal. b. employers were prohibited from using test scores in hiring decisions. c. within group norming was made illegal. d. employers were prohibited from transforming test scores. __D__ 10. Each point on a scatter diagram represents a. the variance of a set of scores. b. the standard deviation of a set of scores. c. where an individual scored compared to the mean. d. where an individual scored on both x and y. __D__ 11. In a negative correlation, a. individuals tend to maintain the same or a similar relative performance. b. scores on one variable tell us nothing about scores on a second. c. individuals who score low on one variable tend to score low on a second. d. high scores on the x variable are associated with low scores on the y variable. __A?__ 12. Which of the following correlations represents the strongest relationship between two variables? a. .01 b. .85 c. .80 d. .50 __C__ 13. If the scores on X give us no information about the scores on Y, this indicates a. a positive correlation. b. a negative correlation. c. no correlation. d. a perfect correlation.
Friday, October 11, 2019
What Influences Free Clinic Usage by the Uninsured
What Influences Free Clinic Usage by the Uninsured? By Shelli Thomason A Paper Submitted to Dr. Dayna McDaniel Research Methods PA6601 Term 5, 2012 Troy University July 27, 2012 TABLE OF CONTENTS CHAPTER 1 Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 4 Statement of the Problem†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 2. 1 Purpose †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 2. 2 Problem Statement†¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 6 2. 3 Research Questions†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚ ¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 2. 4 Scope†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1. Literature Review†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 9 Dependent variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 9 1st Independent variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 11 2nd Independent variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 13 3rd Independent variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 14 4th Independent variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 16 4Hypothesis†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦18 4. 1 H1: hypothesis one†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 18 4. 2 H2: hypothesis two†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 18 4. 3 H3: hypothesis three†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦18 4. H4: hypothesis four†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 18 Chapter II: Methodology Design†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦ 18 Population/Sample†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 20 Variables†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦21 Dependent Variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 21 Independent Variables†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦22 Data Collection†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦22 Measuring Instrument†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦. 22 Materials†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 23 Delivery Method†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 24Data Analysis†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦ 24 Chapter III: Anticipated Findings†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 25 Chapter IV: Conclusion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦25 Implications†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦26 Recommendations†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦26 References†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦28 – 30 Appendices Appendix A Schematic Model†¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦.. 31 Appendix B Formula for Calculating Population Sample Size†¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 32 Appendix C Survey†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦ †¦ 33 – 35 Appendix D Demographics†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦36 Appendix E Example of Multiple Regression results†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦37 Chapter 1 Introduction Many United States residents delay or do without necessary healthcare because they lack the resources or knowledge to access it. There are 46 million people in the nation who have no health care coverage, and by not giving necessary attention to medical concerns and conditions, poor health risks increase, along with untimely mortality (Darnell, 2010).A Kaiser Commission study from 2006 identifies there are 18,000 deaths yearly in the United States resulting from lack of health care coverage (Trask, 2011). Recent Census Bureau shows a slightly highe r number of uninsured indicating there are 50 million uninsured, which would be the largest number on record, resulting from the national economic recession (Krisberg, 2010). According to Darnell (2010), there are 1007 free clinics in the nation, providing services during 3. 5 million clinic visits, by 1. 8 million uninsured patients, representing approximately 10% of uninsured adults of working age.The patients have no other health care alternatives to a free clinic due to a variety of factors including: no ability to pay, language barriers, lack of or inadequate medical insurance, homelessness, inaccessibility, and immigration or ethnicity issues. As private non-profit organizations, free-clinics are not recipients of federal funding, so many rely on state funding, local funding, and donations. Depaul (2010) notes that the National Association of Free Clinics estimated four million patients were seen in 2008, which doubled in 2009.It is also noted that free clinics have to turn aw ay patients because they cannot meet the demands. In a white paper for the American College of Physicians, Gorman (2004) notes, those who do not receive annual exams and preventative screenings run the risk of a delayed diagnosis and subsequent treatment, resulting in premature mortality. Additionally, untreated chronic symptoms result in worsened conditions and costly emergency care, placing a financial burden on hospitals, families and ultimately on the community. Furthermore, workers who experience poor health have lower productivity which is costly to the economy.Therefore, free clinics are a crucial component in the consortium of health care options in the United States. Isaacs and Jellinek (2007), state that 80 % of patients who receive primary care at a physician’s office are either uninsured or have Medicaid. Although physicians may see uninsured patients in their offices and take on a few of them as charitable cases, this practice is declining given lower insurance a nd Medicaid reimbursements and increased operational expenses. The nation has what is referred to as a safety net system to provide health care services for residents who are uninsured.This system is comprised of hospital emergency rooms, publicly funded health centers, and free clinics. With costs of health care escalating, it is crucial to identify methods to effectively optimize these providers. It has been suggested that accessibility to free clinics, which may keep the uninsured from accessing the ER for non-emergent care, is one such method. Studies show uninsured persons utilizing a free clinic have fewer emergency room visits than those who do frequent the ER for their primary care, which renders cost savings (Trask, 2011). Statement of the Problem PurposeThe purpose in this research is to make determinations as to what factors influence an uninsured person’s decision to access the services of a free clinic. In an effort to answer this question, factors will be recogn ized, through research, significant to a person making the decision to visit a free clinic for medical care. Uncovering these factors could assist in discouraging the misuse of other types of medical safety net provisions. One study shows if the group studied did not have use of a free clinic, 80% of the visits would have resulted in ER visits for non-emergency treatments (Corso & Fertig, 2011).This information could also assist in identifying strategies to effectively address the health care needs of constituents and provide funding sources with knowledge to make educated decisions on the most effective use of funds. Problem Statement This project will pinpoint the most acute variables influencing an uninsured person to seek treatment at a free health clinic, allowing local government leaders and medical providers to have access to research so they may further understand areas in which to place their focus and funding.Furthermore, an ancillary reason for study is to show that by pr oviding an uninsured person who is truly ill with a way to achieve wellness, they can become viable again, thus becoming a more productive worker, who may regain insurance and no longer need the free service, or any other type of medical care. If a person has a resource within which to address health concerns, that does not present them with barriers, they are likely to receive the necessary care needed, reducing further complications and costs, placing them in a position to become more sustainable.In one Healthcare Georgia study, evidence shows that free clinics can halt the escalation of health problems, reducing or eliminating the need for hospitalization (Corso & Fertig, 2011). Research questions This project will focus on four research questions that will aide in identifying specific factors that influence an uninsured person to use a free clinic (dependent variable). The primary question to be asked is â€Å"What factors influence an uninsured person to use a free clinic? Res earch questions inquiring about those influences (independent variables) are: 1) Does lack of alternative health care options influence an uninsured person to use a free clinic? 2) Does housing status influence an uninsured person to use a free clinic? 3) Does Hispanic ethnicity influence an uninsured person to use a free clinic? 4) Does age influence an uninsured person to use a free clinic? The independent variables thought to influence the dependent variable are defined so there is a clear understanding of their meaning.Lack of other alternatives: Many users of free clinics may have no other options for health care than a free clinic. They may be employed, but cannot afford the health care premiums offered by their employer or the employer does not offer health coverage. 83 percent of the patients seen at free clinics come from a working household and may hold two or three part time jobs (DePaul, 2010). Federally funded community health centers, different from free clinics, are t ypically located in rural or inner-city areas and help serve a large number of patients in high-needs communities.In 2009, the Government Accountability Office indicated that even with 8000 community health centers, there were still 43 percent of underserved areas without access (Whelan, 2010). Housing Status: The definition of â€Å"homeless†is a broader scope than merely the population living on the streets and includes individuals in a widespread range of unstable housing scenarios. Homeless individuals do not only live under bridges or in a car, but may also reside in emergency shelters; foster homes; HUD’s terminology of â€Å"doubling up†with relatives or friends; or tenants who have been served an eviction notice.Unstable housing status is a high risk factor for health disparities, much like genetics or eating habits. On average, a homeless person has eight to nine coexisting health problems (Batra et al. , 2009). A study of 6,308 homeless Philadelphian s determined the mortality rate among the homeless was 3. 5 times that of the city’s overall population. Earlier research has also noted the homeless have escalated rates of a vast array of health problems (Lewis, Andersen and Gelberg, 2003). Age: Different clinics have differing eligibility for the patients they serve.Many states have the option to offer an insurance plan covering children through the passage of the Children’s Health Insurance Program Reauthorization Act (Llano, 2011), then those over age 65 have Medicare. Therefore many clinics tend to turn their efforts toward those uninsured patients between the ages of 18-64. A 2004 study shows that overall general health significantly declines for those between age 50 and 60 if they are uninsured, underinsured or sporadically insured, compared to their counterparts who have adequate health coverage (Inguanzo and Kaplan, 2011).Hispanic Ethnicity: Llano (2011) states the greatest hindrance to health care for Hispan ics is the language barrier. Providers of service have difficulty communicating with Spanish speaking patients if there is no interpreter available, which may cause compromised diagnoses, treatment options and specialty referrals. Census Bureau data reveals that in 2010, 38. 7 percent of uninsured American residents were Hispanic (Inguanzo & Kaplan, 2011). Scope A survey will be completed, as part of this research. This project’s scope will investigate what influences an uninsured person’s visit to a free clinic.It will assist the free clinic administration in further developing strategic plans to make determinations on where their efforts should be focused. It may also contribute to local governments and other potential grantor’s decisions on making allocations. Free clinic usage is the primary focus, although the collective information may show related trends and concerns constructive to area healthcare providers and local governments. Each person surveyed wil l be treated equally. This study’s sample population will include patients of two free clinics: Community of Hope Health Clinic and Cahaba Valley Health Care Clinic in Shelby County, Alabama.The clinic only sees uninsured patients on Mondays from 8:30 am to 4:30 pm and Thursdays from 5:30 pm to 8:30 pm. They must show proof of residency in Shelby County. Literature Review Dependent variable: Free clinic usage by the uninsured As stated earlier, experts concur that there are over 1000 free clinics in the nation, providing services during 3. 5 million clinic visits, by approximately 10% of uninsured adults of working age (Darnell, 2010; Gertz, Frank and Blixen, 2010; George Washington University Report to Congress, 2012).This equates to approximately 90% of uninsured adults who are not utilizing a free clinic for their medical needs. Gertz, Frank and Blixen (2010) go further to say that since 1980, when there were 30 million uninsured people, there has been a 50% increase to 45 million. From a statewide perspective, Rhode Island remains consistent with national levels, as uninsured working age adults under age 64 doubled between 2000 and 2005, citing the waning of employer health care coverage (Gerber, et al. , 2008). The yearly cost associated with uncompensated medical treatment for the uninsured in the nation was $56 million in 2008.Determinations were made to suggest that use of emergency rooms for non-emergent care, along with rising hospitalization which could have been prevented are on the rise and creating costly problems. Communities are seeking other solutions to provide health care to the uninsured, which might include free clinics, mobile clinics, and church and school sites to administer treatment (Fertig, A. , Corso, P. & Balasubramaniam, D. , 2011). As stated earlier, free clinics are an important part of the United States health safety net, serving mainly the uninsured, working poor.Historically, given minimal resources and relying on volu nteer health care providers, free clinics have focused on gap filling, temporary solutions to the population's health problems. Implementing a new paradigm, free clinics are now making disease prevention and health promotion a top priority (Scariarti & Williams, 2007). A nationwide cross-sectional study using a survey was conducted by Gertz, Frank and Blixen (2010) which they compared to the only other known published study of its kind by Nadkarni, et. al from 2005 to determine free clinic characteristics.Both studies revealed a mean of between 4,000 and 6,000 uninsured visits to the free clinics annually, and a third study agrees that most (67%) are located in the Southern region of the United States (Gertz, Frank & Blixen, 2010; George Washington University Report to Congress, 2012). Additionally, 77% of the respondents of the Gertz, Frank and Blixen study (2010) indicated the level of care received at free clinics was superior to prior medical care received, and 24% indicated if there was no free clinic available, they would not seek care, mainly due to cost.A high number of free clinics seem to function as a fixed source of medical care for their patients. The majority of free clinics describe the service they provide to their patients as continuing, 20 percent indicate the care as recurrent, and 5 percent depicted the care as irregular, only seeing a patient once (George Washington University Report to Congress, 2012).In contrast, prior to the recent national economic recession, a study associated with the utilization of three Massachusetts free clinics was conducted to determine what factors influenced people to use the free clinics, when it appeared there were a variety of ample options for medical care irrespective of health care coverage or income level. Although the study unveiled the three free clinics saw patients who had insurance, 81% of the respondents were uninsured (Keis, DeGeus, Cashman & Savageau, 2004).Lack of health care coverage, is the s ixth-leading cause of death, equating to 18,000 deaths annually for adults between the ages of 25 and 64 (Groman, 2004). The uninsured person may encounter severe financial and wellness obstacles, limiting their ability to obtain medical care and many times become indebted and more ill, as a result. A study conducted by Becker (2001) found that not only did uninsured persons with chronic health conditions lack adequate health care; their illnesses were also inadequately managed.Other findings were that with deficiencies of education regarding their health, those persons who are uninsured lacked the information, understanding, and resources that would allow them to manage their illnesses more effectively. Many uninsured patients can pay more than double the cost if they are forced to use a hospital for their care, due to the inability for price leveraging that medical insurance providers can afford (Groman, 2004). 1st independent variable: Lack of other optionsThe National Associatio n of Free Clinics indicates they see patients they never thought would come to a free clinic, with 83% of free clinic patients come from working home, but cannot afford COBRA if they have lost a job and are now working several part time jobs. Patients have reported they would likely go the ER or not seek care if they did not have access to a free clinic (Depaul, 2010). Private practice doctors are the primary source of health care for the uninsured, mainly because, historically, they have been plentiful in numbers, with 720,000 providing care according to Isaacs & Jellinek (2007).A second expert (Groman, R. 2004), agrees that free care by physicians is decreasing, which will greatly impact the medical safety net with growing numbers of uninsured. As stated earlier, the decline is largely the result of higher operating costs and inadequate Medicare reimbursement rates, prohibiting the doctors from being able to treat those who cannot pay (Isaacs & Jellinek, 2007). Even though charity from practicing physicians plays a vital role in treating the uninsured, they are not stand-ins for health insurance. Because of revisions to financing and rganization of medical care systems, doctors indicate in a New York Academy of Medicine study, they are unable to provide the same class of care to the uninsured, as they provide to patients who have health care coverage (Groman, R. , 2004). A recent report to Congress indicates that free clinics overall see millions of uninsured persons who may not achieve any level of care elsewhere. One study highlighted in the report revealed four main reason listed in order of percentage, people use a free clinic are: no health insurance (82%), referrals by others (59%), medications (38%), and no knowledge of where else to go (34%).The report also states that three quarters of free clinic patients do not have a regular method of care except the free clinic or the ER, suggesting free clinics fill voids, offering services not available (or ea sily reached) somewhere else (George Washington University Report to Congress, 2012). The Keis, et al. (2004) study is in accord with the report to Congress in that one-third of survey respondent gave their reason for using a free clinic as not knowing where else to go to receive medical attention.Another one-third cited lack of transportation, long wait times, finding child care or inability to leave work as the primary reasons they could not use other types of medical providers and instead sought treatment at a free clinic. As already learned, access to local safety net providers has limits to readiness in other ways as well. For example, in Jeffrey Trask’s unpublished dissertation (2011), he cites and agrees with the Keis study stating that other than the emergency room, many safety net providers aren’t open in the evenings or are scarce, so due to the need to work, a patient’s only option may be a free clinic open in the evenings.Likewise, clients of free cl inics forego after care or specialty care only a hospital can offer due to costs. Trask (2011) gives the example, when an uninsured person using a free clinic needs additional services outside the free clinic’s scope of care, sometimes old or bad debt is a major obstacle to receiving necessary treatment. Finally, options are limited for people who are not legally residing in the country. A collective characteristic of a free clinic is capacity to treat any patient without documentation regarding immigration status (Keis 2004).In a 2010 national survey, a census, the first of its kind in 40 years, 764 clinics were deemed eligible out of 1188 surveys mailed. A finding from the study uncovered that free clinics are a more important aspect of the national safety net, especially in the area of ambulatory care that originally thought. However, only 188 of the clinics surveyed offered all-inclusive services, and the survey concluded that a free clinic is not a replacement for compre hensive primary care (Darnell, 2010). 2nd independent variable: Hispanic ethnicity Hispanic persons comprise approximately 16 percent of the population in the U.S. but make up 25 percent of free clinic patients. Experts agree that unbalanced degree of Hispanic patients in free clinics indicates higher rates of lack of health care coverage among this group (George Washington University Report to Congress, 2012; Isaacs & Jellinek, 2007), with the latter authors citing an example from a Racine, Wisconsin clinic who had a one percent Hispanic patient base in late 1980s and a 50 percent Hispanic patients in 2006. Results were compared from two student-run free clinic studies on clinic characteristics and concurred that most of the patients were minorities.One study of 59 clinics reported that 31% of the patients seen were Hispanic, while the other study of 39 clinics revealed 53% of patients were Hispanic. The student run clinics demographic is quite different from non-student run clinic who report a client base of mainly non-Hispanic people (Gertz, Frank & Blixen, 2010). Studies indicate that Hispanic persons are more likely than non-Hispanics to fail to complete the Medicaid application and miss important dates for submitting required documentation.Furthermore, 43 percent of Hispanics who speak Spanish had communication problems with physicians compared to 16 percent of Caucasians; and non-English speakers had more difficulty in comprehending doctor orders (Llano, 2011). Because of non-existent health insurance and consequently no immunizations, a considerable outbreak of rubella plagued a Hispanic community in New York in the late 90s. The outbreak spread to adjacent communities and those with insurance were just as affected. In communities with high numbers of uninsured residents, it becomes more ifficult to provide disease control, and medical personnel have fewer opportunities to identify early onset of outbreaks, hampering containment efforts (Groman, 2004). In a report examining the unmet medical needs of the nation’s Latino population conducted by the American College of Physicians and the American Society of Internal Medicine, it was discovered that uninsured women had twice the likelihood as their non-Latino peers to be diagnosed with breast cancer in the later stages and uninsured Latino men were four times as likely to receive a prostate cancer diagnosis compared to non-Latino men.It is suggested that Hispanic and Latino immigrants are very unlikely to have the ability to access health care services due to governmental restrictions of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, and fear that their citizenship opportunities will be compromised by attempting to secure public aid assistance (Inguanzo and Kaplan, 2011). 3rd independent variable: Homelessness According to Wilson (2009), there are close to 800,000 homeless people in the nation, many of which have multiple disorders to include ast hma, nutritional deficiencies, skin infections, wounds, and diabetes, to name a few.Wilson’s and O’Connell’s research goes on to say that the homeless person’s ailments which are largely left untreated and worsen, lead to devastating illness. The mortality rate is excessively high in the homeless populace. O’Connell (2005) agrees with Wilson’s conclusions with regard to high mortality rates, and that homeless people are three to four times more likely to die than the general population. The risk is greatly increased in those homeless persons between the ages of 18 and 54, and that younger homeless women are four to 31 times more likely to die than their housed counterparts.Life expectancy in the general population is 78 years of age, and falls to between 42 and 52 years of age for the homeless population (O’Connell, 2005). Approximately 9 to 15% of the US population becomes homeless during their lifetime. Those who are truly without a place to stay and are considered literally homeless may be included in this figure, although the homeless are transient and in and out of shelters. Additionally, this figure may include those who HUD calls â€Å"doubled up†or â€Å"couch-homeless†. Other developed countries have a lower rate of this ategory of homelessness than the United States (Hoback and Anderson, n. d. ). For the U. S. overall in 2000, the estimate is 1. 65% of the population is â€Å"couch-homeless†(Census Bureau, 2000). One study highlights the Columbia-Harlem Homeless Medical Partnership (CHHMP), a free clinic run by students, that targets Manhattan’s homeless, providing medical students with a service learning opportunity and simultaneously, providing a medical home for homeless patients. Free student-run clinics are an integral piece of the medical safety net.In these learning settings, the requirements of medical students and in-need patients transect with the outcome of qual ity medical care. The disordered lifestyle of the homeless patient requires outreach to this population and a need for relationship building. This type of need is not feasible in the medical school setting but can be met at a student-run free clinic. Students are able to deal with the human side of public health disparity and learn more about other services and make referrals that can assist the whole patient, such as housing, health screenings, mental health providers, etc. (Batra, et al. , 2009).In congruency with the independent variable of other options stated earlier, an interview study of 2578 homeless and sporadically housed persons indicated that housing instability, abuse, multiple arrests, physical and mental conditions, as well as substance abuse were contributing forces to causing heightened usage of emergency rooms with a trial study group revealing on average seven visits per year. Galwankar (2004) and Whitbeck (2009) both conducted studies which emphasized the need to decrease emergency room use among the homeless populations, by focusing on identified risk factors from a public health standpoint (Galwankar, 2004).A large percentage of the homeless use hospital emergency departments for their primary care, even though it is not the most effective method of medical care for them, as it cannot provide continuity. Additionally, for hospitals and governments it is not cost effective (Whitbeck, 2009). Independent variable: Age Eighty percent of free clinic patients are between the ages of 18-64; with 12% being children and elderly being eight percent (George Washington University Report to Congress, 2012). Two pieces of literature agree with he statistic that one in every six people ages 51 to 61 partaking in the National Academies Health and Retirement Survey who were at the start of the survey, uninsured, developed a new finding of stroke, cancer or heart disease, over the next six year period (Institute of Medicine, 2012; Inguanzo & Kaplan, 2011). In agreement with an IOM report cited, a national trend study from 2007, looking at 10,088 uninsured older working age adults, found that this group is less likely to receive regular preventative screenings for breast cancer, prostate cancer and cholesterol that those with insurance in the same age group.Additionally, women who are uninsured or are on Medicaid have a more advanced stage of breast cancer at first diagnosis and lower survival rate than their counterparts who have private health coverage (Gerber, et al. , 2008). In a 2009 Kaiser report, 30 percent of people between the ages of 19 and 29, are uninsured, the highest proportion of any age group. Though the majority of these young adults are working, they experience lower pay scales, and often find health coverage too expensive for their budget.Most people in this age group reported they were in good health, but 10 percent indicated they were in poor or fair health; twice as many as those with medical insurance (Weaver, 2 010). Now, in 2012, many of this age group, because of provisions under the Affordable Care Act, will now be able to remain a dependent on their parent’s insurance policy until age 26, thus likely reducing the high percentage of uninsured in this age group (The White House, 2010). The number of children nationwide with no healthcare coverage is on the rise, but the impact from being uninsured on a child’s health has not been heavily explored.According to a Journal of Public Health article, in 2006 over one million children became uninsured, raising the total to 9. 4 million, or 12. 1% of all children in the United States. The spike in numbers can be credited to decreases in employer health coverage without corresponding growths in support provided by Medicaid or the State Children's Health Insurance Program (SCHIP) (Abdullah, 2010). One study analyzed information from more than 23 million children, under age 18, in the United States, using two large patient databases, to evaluate the effect of health care coverage status on pediatric hospital stays.The study resulted in findings that the rate of death for children who were uninsured was over 37 percent of the deaths studied (Abdullah, 2010). Hypotheses H1: The fewer options for medical treatment will influence an uninsured person to use a free clinic for health care. The more alternative options for medical treatment will influence less free clinic usage by an uninsured person. Other options is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured.H2: Hispanic ethnicity will influence an uninsured person to use a free clinic for their medical care needs. Hispanic ethnicity will not influence an uninsured person to use a free clinic for their medical care needs. Hispanic ethnicity is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured. H3: Homelessness will influe nce a person to visit a free clinic. Homelessness will not influence a person to visit a free clinic. Homelessness is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured.H4: Age is a factor that influences free clinic usage by the uninsured. Age does not influence free clinic usage by the uninsured. Age is an independent variable that has an inverse relationship with the dependent variable of free clinic usage by the uninsured. Chapter II: Methodology Design This study will concentrate on one central research question: What impacts do availability of other medical care options, Hispanic ethnicity, homelessness and age have on the usage of a free clinic by people who are uninsured?These questions will pose the following hypotheses: H1: The fewer options for medical treatment will influence an uninsured person to use a free clinic for health care. The more alternative options for medical treatment will influence less free clinic usage by an uninsured person. Access to other options is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured. H2: Hispanic ethnicity will influence an uninsured person to use a free clinic for their medical care needs.Hispanic ethnicity will not influence an uninsured person to use a free clinic for their medical care needs. Hispanic ethnicity is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured. H3: Homelessness will influence a person to visit a free clinic. Homelessness will not influence a person to visit a free clinic. Homelessness is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured.H4: Age is a factor that influences free clinic usage by the uninsured. Age does not influence free clinic usage by the uninsured. Age is an independent variable that has an inv erse relationship with the dependent variable of free clinic usage by the uninsured. A schematic model illustrates the correlation between these variables. The model can be reviewed in Appendix A. The research question and problem will be answered by using a survey design study conducted by a convenience sample over a six week period.The reason behind using a cross-sectional design is that data on all variables of interest can be collected at the same time and is an efficient method for a large group (O’Sullivan, Rassel & Berner, 2008). The three page survey, written at a fifth grade level, in English and in Spanish, will make inquiries and gather information about the independent variables, and about the dependent variable. Attempts will be made to approach every patient signed in at the clinics during the study period. Internal and external validity, then, are important to maintain when surveying a sample population and asking questions on sensitive issues.The goal is to en sure that the independent variables of interest indeed caused changes to the dependent variable and not something else; along with certifying the outcomes are general of the population and can be reproduced in any location. The development and reliability of the research questions are integral to maintaining internal validity within the study. Cognitive pretesting of 10 patients will be performed before beginning the study to ensure the questions are commonly understood and to confirm that the survey questions are capturing the intended outcomes.Additionally, in order to ensure external validity, the results of the study can be implemented by other governments and non-profit agencies. Population/Sample The population for this study is patients visiting two free clinics in Shelby County, Alabama, ages 19-64. This limits the population to a specific age range of persons in the county, as it has been determined that those outside this age range are eligible for coverage through governm ent offered insurance programs, even if they have not applied for it.A Shelby County Development Services Department Profile indicates from 2010 Census data; the population for Shelby County, Alabama is 195,084 residents. Of those approximately 7% are uninsured, equating to around 10,000 uninsured residents. County demographics reveal an almost even division of males (49. 3%) to females (50. 7%). 83. 6% of the population is white, 10. 6% is Black/African American and 1. 5% is Asian (See Appendix D). An anomaly in demographics is observed in ethnicity, specifically Hispanic/Latino residents who are documented at 4. % (8,389) of the total population with an additional 4. 2% who ‘speak non-English language at home’ and 1. 6% who ‘speak English less than ‘very well. ’ If the results of a University of Alabama at Birmingham study are applied to undocumented Hispanics in Shelby County, the total would be more accurately reported at 37,314 (Patino, 2002). Gi ven the fact that both clinics have eligibility requirement for the patients they see, the sampling frame will include only people ages 19-64, who have no insurance and who reside in Shelby County or indicate they are homeless.The sample will consist of those who randomly visit the clinic, and are signed in on a first come, first served basis and are waiting to receive treatment at the clinics during the study period, representative of the near 2000 patients who actually received treatment in 2011. This total number of patients is captured from clinic data gathered and reported by the clinics. The sample will be chosen through convenience sampling methods. This method was chosen for its ease of execution and cost effectiveness, although it has a higher risk of bias.The sample size was chosen using a formula that calculated a 95 percent confidence level that the sample size will accurately represent the total population of patients. The sample size will be 563 patients. See Appendix B. Variables Dependent Variable For this study, a free clinic is operationally defined as being a privately run non-profit agency not receiving any federal funding, that offers general medical services, medication and dental care to individuals who have no health care coverage. Volunteer, licensed medical providers administer the care at minimal or no cost (Darnell, 2010).The dependent variable is measured using nominal scales, with letters of the alphabet used as labels instead of numerals. Questions in the survey that address the dependent variable specifically are Question 4 and Questions 9-13 (see Appendix C). Independent Variables The first independent variable: lack of other options, can be conceptually defined as locations where the uninsured might seek medical treatment, other than a free clinic. To measure this variable, use of other options will be measured using a series of questions asking questions related to medical care history.Since the survey will be given to uninsu red patients who may not have a high level of education, literacy, or understanding of terminology, the operational definition for the second independent variable of housing status in the survey will measure living arrangements. This will be accomplished by measuring the frequency of responses using nominal scales. The third independent variable, ethnicity, especially Hispanic ethnicity, has been defined as being of Hispanic origin. Per the US Census Bureau, persons of Hispanic origin are determined on the basis of question that asked for self-identification of the person's origin or descent.Persons of Hispanic origin, in particular, are those who indicated that their origin was Mexican-American, Chicano, Mexican, Mexicano, Puerto Rican, Cuban, Central or South American, or other Hispanic (U. S. Census Bureau). The fourth and final independent variable, used in this model is age, and is intended to measure which age groups of working age adults visit a free clinic most often; and if age is a factor for visiting the clinic. In the study, variable is operationally defined as working age adults between the ages of 19-64.Free clinics trends have shown most patients are non-elderly adults (Darnell, 2010). This will be accomplished by measuring the frequency of responses using nominal scales. Data Collection Measuring Instrument The use of free clinics by the uninsured between ages of 19-64 and the relationships of the factors that influence usage, will be gauged by using a survey comprised of 20 questions (Appendix C), consisting of issues related to accessibility, reasons for use, medical insurance status, health status, employment status, housing status, current diagnoses, and general demographic information.These questions include both ordinal and nominal scales. Two questions will provide an open-ended answer option where space will be provided to write in an answer. Some questions for the survey were extracted from previously tested and validated instruments, such as the National Health Interview Survey. The survey will be translated into Spanish, and for those who need assistance, an already on-site Spanish interpreter will assist in the introduction of the study as well as offer explanation for completion of the survey.The survey should take no longer than 10 minutes to complete. Materials The materials and expense necessary to execute the survey are marginal. Copies required for each respondent total 4 pages (one page is the introduction and confidentiality notice and three pages for the survey) each totaling 2252 multiplied by $. 05 equals approximately $112. 60. Office supplies including three dozen writing pens and a stapler and staples will also be purchased for around $25. 00. Additionally, incentives in the form of refreshments are an additional cost.Bottled water and healthy snacks such as granola bars, pretzels or crackers will be purchased in volume to reduce costs. 25 cases of water totals $180. 00 and snacks will be approxi mately $150. 00. Therefore the total cost to administer the survey with incentive is approximately $467. 60. The study will be given during clinic operating hours where clinic volunteers will be recruited to administer the introduction and surveys providing additional cost savings. Delivery Method In order to allow every patient in the convenience sample the same opportunity to participate in the survey, upon their arrival and egistration, a clinic caseworker will share with them a scripted introduction explaining the purpose for the survey and assure them it is voluntary and it will in no way cause them any risk and will in no way compromise their clinic visit nor treatment. The introduction will also discuss confidentiality. These measures will help to ensure internal validity since the orientation may provide a level of comfort for the respondent who in turn may be inclined to answer the questions more honestly.The survey will be administered to the patients during regular clinic hours on Mondays between 8:30 am and 4:30 pm and Thursdays between 5:30 pm and 8:30 pm, while they wait to be seen. To improve response rates, healthy refreshments will be provided to participants. Patients who have been waiting to register for hours, to be one of 30 patients seen during a given clinic, have likely not eaten and may welcome refreshment as incentive to participate in the study. Dr.Eleanor Singer, a population studies professor and researcher at Columbia University summarized the evidence on incentives from the standpoint of the survey literature in the use of incentives in her 2002 book. She uncovered that incentives improve response rates across all approaches. The effect has proven to be undeviating, larger incentives have superior effects on response rates. Those patients who are first in line to see a medical provider will have equal opportunity to participate in the incentive and the study upon completion of their visit. Data AnalysisOnce the surveys are collec ted the data will first be cleaned. It is very important that the data collected from the surveys be able to be interpreted properly in order to accurately measure the relationships between the dependent and independent variables. Each question on the survey will be coded with a value prior to being administered. Data will be entered into a SDSS program and a multiple aggression analysis will be performed. From this analysis it will be possible to find the correlating relationships between each individual independent variable and the dependent variable to show significance.Ultimately the computer program will show which factors strongly influence free clinic usage, which ones are less influential and which factors together may increase the relationship further. See the example in Appendix E. Chapter III: Anticipated Findings The literature that has been reviewed in relation to the variables in this study, along with the suggested approaches, in tandem offers backing to the outcomes that are expected of this study.It is anticipated that there will be a relationship between use of a free clinic by the uninsured and each of the four independent variables provided: lack of other options for health care, age, Hispanic ethnicity and homelessness. The expectation is that the computer software used in analyzing the findings will show relationships between the variables, contradicting the null hypotheses. A multiple aggression analysis would be used to show these relationships by entering the data into a computer program designed to perform the computations and ends up showing a prototype of realism (Simon, 2003).Each of the four independent variables, are believed to have direct relationships with the dependent variable. Ultimately, it is anticipated that each of the four corresponding hypotheses will be conclusive. Chapter IV: Conclusion Studies provide support for the need to address reasoning behind free clinic usage by the uninsured population. The literature revi ew has assisted in understanding each variable’s definition, emphasizing the ideas and findings of other scholarly studies, and establishing the integrity of the links between each independent variable and the dependent variable.As an example, the Kaiser report assists with understanding of the independent variable of age being a factor in why uninsured use a free clinic for their health care needs. It showed that younger working age adults in a certain age range were the group who are most often uninsured, and that this age group is forced to use free health care or have none at all, ultimately having medical conditions worsen, thus costing hospitals and tax payers more in the end. There is currently a staggering estimated $70 billion in uncompensated medical care from 2008 alone by uninsured patients (US Dept. f Health and Human Services, 2011). Therefore it is imperative that those with no medical insurance have access to some form of free or affordable health care in thei r community, with free clinics being an important piece of the equation. Implications The findings of this research are expected to be beneficial to the Shelby County local government, health and human service non-profit agencies and the medical system as the study will be proving assumed information, along with providing ancillary supportive data about the health care needs and gaps to serve uninsured residents of Shelby County, Alabama.In knowing information about what factors contribute to the free clinic usage among the uninsured, the community collaborative can propose modifications, improvements and additions for programming that may assist in lessening the burden, and ultimately solving the problem. While the outcomes from the study may not be exact to national trends, they should be very reflective and allow for reproduction of successful interventions. RecommendationsThe provided research will give evidence on four factors that contribute to the use of free clinics for medi cal treatment by the uninsured population of Shelby County, Alabama thus allowing for a community collaborative to be formed from local government, health care providers, faith based community, caseworkers, immigration and homelessness advocates, university department heads and others. Therefore, it is strongly suggested that this study be performed in order to gather this necessary information to determine if a more detailed needs assessment should be conducted.While there are additional independent variables that may contribute to the usage of a free clinic, only four have been highlighted for this study. Others additional factors should be investigated to identify other challenges that strain the health care system, ultimately contributing to the occurrence of free clinic use. REFERENCES Abdullah, F. et al. , (2009). Analysis of 23 million US hospitalizations: uninsured children have higher all-cause in-hospital mortality. Journal of Public Health, 32 (2), 236–244. doi:10. 093/pubmed/fdp099 Batra, P. , Chertok, J. , Fisher, C. , Manseau, M. , Manuelli, V. , & Spears, J. (2009). The Columbia-Harlem homeless medical partnership: A new model for learning in the service of those in medical need. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 86 (5). doi:10. 1007/s11524-009-9386-z Becker, G. , (2001). Effects of being uninsured on ethnic minorities' management of chronic illness. West Journal of Medicine, 175(1), 19–23. Corso, P. & Fertig, A. , (2011). ROI and free clinics in Georgia.HealthVoices, University of Georgia College of Public Health, Healthcare Georgia Foundation, Publication 51. Darnell, J. S. (2010). Free clinics in the United States: A nationwide survey. ARCH Intern Medicine, 170 (11), 946-956. Depaul, J. (2010). Free clinics: America’s best-kept secret. The Fiscal Times. Retrieved from: http://www. thefiscaltimes. com/Articles/2010/05/03/Free-Clinics-Lifeline-for-America. aspx#page1 Fertig, A. , Corso, P. , & Balasubramaniam, D. (2011). Benefits and costs of a free community-based primary care clinic.Retrieved from: http://hogwarts. spia. uga. edu/~afertig/policy1/FreeClinic_JHHSArevision_singlespace1. pdf Galwankar, S. , (2004). Role of homeless and uninsured patients in overcrowded emergency departments. Retrieved from: http://www. bmj. com/rapid-response/2011/10/30/role-homeless-and-uninsured-patients-overcrowded-emergency-departments George Washington University, Department of Health Policy, School of Public Health and Health Services (2012). Quality incentives for federally qualified health centers, rural health clinics and free clinics: A report to Congress.Washington, DC. Gerber, R. et al. , (2008). A place to be healthy: Blueprint for a new free clinic for the medically uninsured of Rhode Island. Medicine & Health/Rhode Island, 91(4), 105-108. Gertz, A. , Frank,S. & Blixen, C. (2011). A survey of patients and providers at free clinics across the United States. Journal of C ommunity Health, 36, 83-93. doi: 10. 1007/s 10900-010-9286-x Groman, R. , (2004). American College of Physicians white paper on the cost of lack of health insurance [White Paper]. Retrieved from: http://www. acponline. rg/advocacy/where_we_stand/access/cost. pdf Hoback, A. & Anderson, S. (n. d. ). Proposed method for estimating local population of precariously housed. Retrieved from: http://www. nationalhomeless. org/publications/precariouslyhoused/index. html Inguanzo, M. & Kaplan, M. , (2011). The social implications of health care reform: reducing access barriers to health care services for uninsured Hispanic and Latino Americans in the United States, Harvard Journal of Hispanic Policy, 23, 83. Institute of Medicine (2003). Hidden costs, values lost: Uninsurance in America.The National Academies Press. Washington, D. C. Retrieved from: http://www. nap. edu/catalog. php? record_id=10719 Isaacs, S. L. & Jellinek, P, (2007). Is there a (volunteer) doctor in the house? Free clinics a nd volunteer physician referral networks in the United States. Health Affairs, 26 (3), 871-876. doi: 10. 1377/hlthaff. 23. 3. 871 Keis, R. M. , DeGeus, L. G. , Cashman, S. , & Savageau, J. (2004). Characteristics of patients at three free clinics. Journal of Health Care for the Poor and Underserved, 15 (4), 603-617. Krisberg, K. , (2010).Jump in uninsured signals need to implement health reform: Economy takes a toll on health coverage. The Nation’s Health, 40 (9), Retrieved from: http://go. galegroup. com. libproxy. troy. edu/ps/i. do? id=GALE%7CA241780634&v= 2. 1&u=troy25957&it=r&p=AONE&sw=w Lewis, J. H. , Andersen, R. M. & Gelberg, L. , (November 2003). Health care for homeless women: Unmet needs and barriers to care. Journal of General Internal Medicine, 18, 921-928. Llano, R. , (2011). Immigrants and barriers to healthcare: Comparing policies in the United States and the United Kingdom.Stanford Journal of Public Health, Retrieved from: http://www. stanford. edu/group/sjph /cgi-bin/sjphsite/2011/06/immigrants-and-barriers-to-healthcare-comparing-policies-in-the-united-states-and-the-united-kingdom/ O’Connell, J. , (2005). Premature mortality in homeless populations: A review of the literature. National Health Care for the Homeless Council, Inc. , Nashville. Patino, F. , (2002). Material and child health services utilization by Hispanics in Alabama (doctoral dissertation). Birmingham, AL: The University of Alabama School of Public Health. Scariarti, P. & Williams, C. , (2007).The utility of a health risk assessment in providing care for a rural free clinic population. Osteopathic Medicine & Primary Care, 1(8). doi: 10. 1186/1750-4732-1-8 Simon, G. , (2003). Multiple regression basics. Retrieved from: http://people. stern. nyu. edu/wgreene/Statistics/MultipleRegressionBasicsCollection. pdf Singer, E. , (2002). The use of incentives to reduce nonresponse in household surveys. Survey Nonresponse, John Wiley & Sons, Inc. , New York, 163-177. Trask, J. , (2011). The relationship between primary care access to free clinics and emergency room usage (Unpublished doctoral dissertation).Graduate College of the University of Illinois at Urbana-Champaign. United States Census Bureau (2001). Households and families 2000, Census 2000 brief. US Department of Commerce. United States Census Bureau. Hispanic population of the United States. Retrieved from http://www. census. gov/population/www/socdemo/hispanic/ho00def. html U. S. Department of Health and Human Services (2011). ASPE Research Brief: The value of health insurance: Few of the uninsured have adequate resources to pay potential hospital bills. Weaver, C. , (2010).How health overhaul would affect the uninsured. Kaiser Health News. Retrieved from: http://www. kaiserhealthnews. org/stories/2009/september/21/uninsured-explainer-npr. aspx Whelan, E. M, (2010). The importance of community health centers: Engines of economic activity and job creation. Center for American Progress. Whitb eck, L. (2009). Mental health and emerging adulthood among homeless young people. Psychology Press, Taylor & Francis Group, New York. White House, (2010). Department of Health and Human Services. Retrieved from: http://www. whitehouse. ov/blog/2010/05/10/a-long-overdue-change-help-young-adults-get-coverage [pic] [pic] |Appendix B | | |Required Sample Size†| | | | | | | | | | | | | |0. 05 |0. 035 |0. 025 |0. 01 | |0. 05 |0. 035 |0. 25 | | | |10 | |10 |10 |10 |10 | |10 |10 |10 | | | |20 | |19 |20 |20 |20 | |19 |20 |20 | | | |30 | |28 |29 |29 |30 | |29 |29 |30 | | | |50 | |44 |47 |48 |50 | |47 |48 |49 | | | |75 | |63 |69 |72 |74 | |67 |71 |73 | | | |100 | |80 |89 |94 |99 | |87 |93 |96 | | | |150 | |108 |126 |137 |148 | |122 |135 |142 | | | |200 | |132 |160 |177 |196 | |154 |174 |186 | | | |250 | |152 |190 |215 |244 | |182 |211 |229 | | | |300 | |169 |217 |251 |291 | |207 |246 |270 | | | |400 | |196 |265 |318 |384 | |250 |309 |348 | | | |500 | |217 |306 |377 |475 | |285 |365 |421 | | | |600 | |234 |340 |432 |565 | |315 |416 |490 | | | |700 | |248 |370 |481 |653 | |341 |462 |554 | | | |800 | |260 |396 |526 |739 | |363 |503 |615 | | | |900 | |269 |419 |568 |823 | |382 |541 |672 | | | |1,000 | |278 |440 |606 |906 | |399 |575 |727 | | | |1,200 | |291 |474 |674 |1067 | |427 |636 |827 | | | |1,500 | |306 |515 |759 |1297 | |460 |712 |959 | | | |2,000 | |322 |563 |869 |1655 | |498 |808 |1141 | | | |2,500 | |333 |597 |952 |1984 | |524 |879 |1288 | | | |3,500 | |346 |641 |1068 |2565 | |558 |977 |1510 | | | |5,000 | |357 |678 |1176 |3288 | |586 |1066 |1734 | | | |7,500 | |365 |710 |1275 |4211 | |610 |1147 |1960 | | | |10,000 | |370 |727 |1332 |4899 | |622 |1193 |2098 | | | |25,000 | |378 |760 |1448 |6939 | |646 |1285 |2399 | | | |50,000 | |381 | 772 |1491 |8056 | |655 |1318 |2520 | | | |75,000 | |382 |776 |1506 |8514 | |658 |1330 |2563 | | | |100,000 | |383 |778 |1513 |8762 | |659 |1336 |2585 | | | |250,000 | |384 |782 |1527 |9248 | |662 |1347 |2626 | | | |500,000 | |384 |783 |1532 |9423 | |663 |1350 |2640 | | | | Appendix C Health Care Survey Questionnaire Circle your answer: 1. What is your age? a. 19-24 b. 25-34 c. 35-44 d. 45-54 e. 44-64 2. What would you classify your ethnicity? a. Caucasian or white b.African American or black c. Hispanic/Latino d. Asian e. Other________________ 3. What is your employment status? a. Full time employee b. Part time employee c. Self employed d. Unemployed – looking for work e. Unemployed f. Retired 4. Reason for no health care coverage/insurance? a. Employer does not offer b. Don’t work enough hours c. Became unemployed and lost coverage d. Cannot afford 5. What is your highest level of completed education? a. Did not complete High schoo l/did not obtain GED b. High School Diploma / GED c. Technical/Trade school d. Some college e. College degree f. Graduate degree g. Doctoral degree 6. What is your housing status? a.Own home b. Rent home/apartment c. Live with family/friends d. Reside at shelter/transitional housing e. Not housed 7. What language do you speak most often at home? a. English b. Spanish c. Other__________________ 8. Are there children living in your household ages 18 and younger? a. Yes b. No 9. When was the last time you received medical care before today’s visit? a. Within last week b. Within last month c. Within last three months d. Within last six months e. Within last year f. Longer than one year 10. Where did you last receive medical treatment before today’s visit? a. Doctor office b. Hospital ER c. Public health department d. Free Clinic 11.Which best describes the reason you chose the location for your last medical treatment? a. Location b. Hours of operation c. Recommended by fam ily/friend d. Did not know where to go 12. Did you have medical insurance the last time you received medical treatment? a. Yes b. No c. I don’t know 13. How would you rate your satisfaction level of your most recent medical treatment? a. Very satisfied b. Somewhat satisfied c. Somewhat dissatisfied d. Not satisfied 14. How would you describe your health? a. Excellent b. Good c. Fair d. Poor 15. Are you experiencing an ongoing health problem? a. Yes b. No c. I don’t know 16. Have you had a diagnosis for your health problem? a. Yes b. No c. I don’t know 17.Are you taking prescription medications? a. Yes b. No 18. If you are taking prescription medications, is a needed refill the reason for your visit today? a. Yes b. No c. Not applicable 19. How are you able to afford your medications? a. Medication assistance b. Lower cost generics c. Samples d. Self-pay full price e. I cannot afford them 20. Please discuss any other issues you are having where assistance may be needed, so referrals may be offered. 21. Please describe in detail what you hope to receive from your visit today. Appendix D [pic] Shelby County Development Services Profile Appendix E – Example of a Multiple Regression results chart [pic] [pic]
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