Explain in your own words Assignment Example | Topics and Well Written Essays - 500 words

Explain in your own words - Assignment Example Note that, the indefinite integrals of a function only differ by a constant (Dawkins 2014). Intuitively, this second part, opens the first part of the theorem to include the entire interval, not limited by (a,b).It holds that if F (x)and f(x) are functions such that , F(x) is an integral of f(x), then F’(x) = f(x) Assuming that a,is constant, then f (a) is zero, and if f(x) is x, then g’(x) =1, hence the whole term becomes f (g(x). Therefore, the definite integral is only influenced by the derivative, with the constant in the indefinite integral being a dummy. L’Hospital’s rule is a principle that helps to determine the limits of indeterminate forms. There are two most common indeterminate forms I.e. 0/0 and ∞/-∞ in which L’hospital rule majorly occurs. Note that these indeterminate forms create a controversy in the expected results. For instance, if we divide zero by zero, the answer may be 1(any number divided by itself is one), ∞ (any number divided by 0 = ∞) or 0 (zero divided by any number is zero) and so does the second case. therefore, there is need to manipulate indeterminate functions in order to obtain limits. Secondly, factoring out functions could be so tedious, and since derivatives reduce the highest power, then L’hospital rule can also be used (Ikenaga, 2005). L’hospital rule states that; Note that as x approaches infinity then the numerator also approaches infinity while the denominator approaches negative infinity, and thus (∞/-∞), moreover, if we x takes the value 2, then the function becomes (0/0), both of which are indeterminate forms. The Taylor series is an expression of a given function as the summation of infinite term obtained from its derivatives about a point. The effectiveness of Taylors function in approximating the function is based on the fact that, it sums up all the

Imperialist Policy Essay Example for Free

Imperialist Policy Essay To What Extent can it be argued that America Had an Imperialist Policy, Which Contradicted the Ideals Set down, By the Declaration of Independence? Annexation of the Philippines, the anti-imperialists protested over and over again, violated the very principles of independence and self determination on which the country (America) was founded. The above quotation summarises the key themes of this essay and the issues that will be explored. To examine the extent to which America had an imperialist policy, which contradicted the ideals, set down by the declaration of independence we must first analyse the terms used within the question and look at the ideals specified in the declaration of independence. Examples of when America showed this imperialist policy must then be examined to find to what extent they had one. Finally it must be investigated into reasons why America may have taken a turn towards imperialism which they were so strongly against when they broke from Britains rule in 1776. After thoroughly investigating and analysing the mentioned areas I will draw my conclusions as to the extent that America had an imperialist policy which contradicted the ideals set down by the declaration of independence. To begin with I shall explore the meaning of imperialism so that the question can be fully interpreted and answered fully. There are two meanings for the word imperialism below is the dictionary definition, which I will explain shortly. 1.The policy or principle of having and extending control over the territory of other nations, of creating or maintaining an empire, or extending ones countrys influence through trade and diplomacy. 2.An attempt by a developed country to interfere in the affairs of an underdeveloped country or countries. The first meaning is that imperialism is the expanding of one country into another countrys territory making them colonies and thus creating an empire, such as that of Britain in the 19th century controlling its colonies overseas. The second meaning of the word imperialism is that of a developed country influencing other countries by trade and diplomacy. It is this meaning that is often associated with Lenins view of imperialism as he felt that it was not necessarily about colonies but imposing control over another country through influence and tariffs. Using these interpretations it will be easier to analyse the actions taken by America and to find to what extent America had an imperialist policy. Now I have explored the meaning of imperialism I will go on to examine the ideals that were set down in the declaration of independence on 4th July 1776. For the purpose of this essay not all the issues raised in the declaration of independence are required so I will highlight the points that I feel are needed to answer the question best. Firstly the declaration refers to He meaning the King of Great Britain describing the injustices he has subjected the American colonies to. The first part I feel will highlight the issues within this essay talks about some of the injustices: He has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws, giving his assent to their pretended legislation: For cutting off our trade with all parts of the world; For imposing taxes on us without our consent; For depriving us, in many cases of the benefits of trial by jury; The above speaks of some of the things that the American people felt were wrong criticising British imperialism. The second piece continues to describe what they feel is wrong condemning British actions: For abolishing the free system of English laws in a neighbouring province, establishing therein an arbitrary government, and enlarging its boundaries, so as to render it at once an example and fit instrument for introduction the same absolute rule into these colonies; For taking away our charters abolishing our most valuable laws, and altering governments; For suspending our own legislatures, and declaring themselves invested with power to legislate for us all in cases whatsoever. He has abdicated government here by, declaring us out of protection and waging war against us. He has plundered our seas, ravaged our coasts, burned our towns, and destroyed the lives of our people. By declaring what they feel strongly against the American people are revealing their ideals of government and rule within a country. The final part of the declaration describes how America will continue once broken from British rule: We therefore the representatives of the United States of America, in general congress assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the name and by the authority of the good people of these colonies, solemnly publish and declare, that these united colonies are, and of right ought to be, FREE AND INDEPENDENT STATES; that they are absolved from all allegiance to the British crown, and that all political connection between them and the state of Great Britain is, and ought to be, totally dissolved; and that as free and independent states, they have full power to levy war, conclude peace, contract alliances, establish commerce, and do all other acts and things which independent states may of right do. This section of the declaration of independence concludes the intentions of the American people and how they will continue as a state. Looking at the excerpts I have taken I will refer back to these during the essay to point out contradictions in the American policy to prove the argument that America had an imperialist policy. Having looked at the question and analysing the terms used within it I shall now explore reasons as to why American policy took a turn towards imperialism. America had been expanding since after the first landings in Jamestown and Plymouth with settlers moving west and further south rapidly consuming the great expanse of the American continent. This early expansion within the continent was purely for the settlement of the American people however; the movements of the 1890s took a different path. Overseas expansion into already populated areas not so much for settlement but for the purpose of tactical naval bases, trading outposts or commercial centers on major trade routes. One view of this new policy was from Walter LaFeber: The United States did not set out on an expansionist path in the late 1890s in a sudden, spur-of-the-moment fashion. The overseas empire that Americans controlled in 1900 was not a break in their history, but a natural culmination. The above view expresses that imperialism and expanding is simply natural progression for any country and it was Americas time to expand. In America at the time few people liked the idea of imperialism, expanding had shown them benefits such as those of California and Oregon but imperialism meant control over other peoples by military conquest or economic domination which they did not want to be a part of. These attitudes however began to change as the end of the frontier was reached, as John A Kasson, a diplomat said in the North American Review: We are rapidly utilising the whole of our continental territory. We must turn our eyes abroad, or they will soon look inward upon discontent. Again this view explored that expanding was something that came naturally once all a nations land was occupied. Now that the question has been explained and reasons for imperialism explored I shall continue to discuss examples to show to what extent America had an imperialist policy. The first example of America advancing towards an imperialist policy can be seen as the introduction of the Monroe Doctrine, which was expressed during President James Monroes seventh annual message to congress in December 1823. Within this doctrine it was expressed that America felt that European powers no longer had the right to interfere in matters involving the Western Hemisphere and the American continent. as a principle in which the right and interests of the United States are involved, that the American continents, by the free and independent condition which they have assumed and maintain, are henceforth not to be considered as subjects for future colonisation by any European powers This speech showed that America had interests in lands outside their own territory and were declaring that they saw the Western Hemisphere as their sphere of influence. It had long been hoped that America would one-day annex Canada or Mexico for extensive trade and greater unity against the European powers, the Monroe Doctrine supported this idea. In 1867 Secretary of State William Henry Seward finished negotiations with Russia for the purchase of Alaska with the aim of sandwiching in Canada ready for its annexation. The discussion of the Monroe Doctrine and the purchase of Alaska have shown that America did have an imperialist policy and contradicts the ideals that they set down: For imposing taxes on us without our consent; For taking away our charters abolishing our most valuable laws, and altering governments; For suspending our own legislatures, and declaring themselves invested with power to legislate for us all in cases whatsoever. They themselves condemned the actions of the British for doing the above and now although they had purchased Alaska were subjecting its people to very similar events. The next example of Americas imperialist policy I shall explore will be Hawaii and Americas long hopes of annexing the islands. Hawaii was seen to be a key way-station in the middle of the Pacific Ocean and control of these islands would provide great military and commercial trade advantages. In 1875 a reciprocity treaty with Hawaii bound the Hawaiians to make no territorial or economic concessions to other nations as well as allowing sugar to enter the United States free of duty. This treaty increased Hawaiis economic dependence on America, this supports the Lenin view of imperialism discussed earlier as it shows America having domination over Hawaii via economic constraints. In 1891 King Kalakaua died and nationalist Queen Liliuokalani came to power. The new Queen disliked being ruled by a white minority and made way for a new constitution to give native Hawaiians more power. This caused trouble in Hawaii with the White Hawaiians revolting and America becoming involved militarily. The revolt was over in three days and the Queen surrendered. On 14th February 1893, the secretary of state John W Foster and officials from the new Hawaiian government signed a treaty annexing Hawaii to the United States. However only two weeks were left in president Harrisons term and the senate refused to approve the treaty. President Cleveland who came to power shortly later started an investigation into Americas involvement and found it to have been wrong. Cleveland decided to restore the queen to her throne but the provisional government established in Hawaii instead created the Republic of Hawaii. This backing down on America or Clevelands behalf shows that the pursuit of an empire was perhaps not so great or that Cleveland simply felt more strongly about the ideals of the declaration of independence. However in 1898 the issue of annexing Hawaii arose again this time with concerns over Japans interests in the islands. President McKinley sought an annexation treaty but this required a two-thirds majority vote in the senate. It was decided that a joint resolution be obtained rather than a treaty requiring a majority in both houses. With the new approach the annexation plans passed quickly through congress and McKinley signed it on 7th July 1898 annexing Hawaii which had been an American goal since the 1860s. Now despite the actions of President Cleveland the annexation of Hawaii was eventually achieved again showing Americas imperialist policy and how they contradicted their own ideals of not imposing power over another country or subjecting other peoples to laws or government foreign to their own. I will now go on to discuss part of Americas involvement in the Philippines during the war with Spain. On 1st May 1898 after the war had only been going on one week Commodore George Dewey crushed the Spanish fleet at Manila Bay. With this significant victory the Philippines were now within Americas grasp and by the 13th August after raising an expeditionary force they took Manila Bay and gained control of the Philippines. This expansion of America territory by military conquest shows Americas imperialist policy and as one of those against it at the time said: Dewey took Manila with the loss of one man and all our institutions. So it was obvious at the time to some people that Americas policy contradicted the ideals set down by the declaration of independence on which their country was founded. The Final example I shall explore focuses on the early 1900s and the events surrounding the Panama Canal. Great Britain had controlled the region in Central America, but while otherwise concerned had withdrawn troops from the area to allow for American plans of building an isthmian canal linking the Atlantic and Pacific Oceans. President Roosevelt began selecting a route which would run through the Panama region of Colombia being 6 miles wide, he offered Colombia $10million and $250,000 annual rental for the land and permission. Colombia rejected his offer and he considered seizing the area but instead hinted to the inhabitants of the Panama region to revolt. Within a short time they did so and the new Republic of Panama was created with American support. A new deal was struck and the canal commissioned with Panama relying on America and America now controlling an extremely important trade route. This example again shows America putting themselves in positions to be in an advantage over other nations highlighting another aspect of their imperialist policy. I have now looked at the reasons why America may follow an imperialist policy, how the term imperialism can be interpreted and, have shown a number of examples when America showed this imperialist policy. I shall now conclude my finding to answer to what extent America had an imperialist policy, which contradicted the ideals set down by the declaration of independence. I have not shown all the examples of when America showed signs of imperialism that I discovered my research but I have highlighted those that I felt were most important. All of the examples used have proved that America did have an imperialist policy to some extent or another they have also shown that at times some Americans felt that this policy did go against the ideals on which their nation was founded. So I conclude that America did have to a large extent an imperialist policy which contradicted the ideals set down by the declaration of independence whether they themselves recognised this policy or not as going against their own beliefs. Dewey took Manila with the loss of one man and all our institutions.

Clostridium Difficile Infection: Causes and Treatment

Clostridium Difficile Infection: Causes and Treatment Clostridium difficile   Introduction Clostridium difficile generally written as C. difficile is a bacterium (germ). It presents in a small quantity in the gut of many people without harming person. But, when the quantity of C. difficile bacteria increases in the gut, then it can cause infection. The C. difficile bacteria usually do not create infection in healthy people. Though, some  antibiotics can disturb the regular balance of usual bacteria in the gut that shield against C. difficile infection. This infection most commonly affects people whose treatment requires prolonged use of antibiotics. During use of antibiotics, if other harmless bacteria are killed, then this will allows C. difficile to grow in larger numbers than normal circumstances. The bacteria start to produce toxins that cause the symptoms given below. Therefore, if a person is taking antibiotics and He/she has C. difficile bacteria in gut, then bacteria may flourish and can cause an infection. This is a problem normally occur while taking many of the commonly used antibiotics. Spread of Clostridium difficile infection C. difficile bacteria are usually found in whole the environment — in air, soil, water, human and animal faeces. It is also found in food products, such as processed meats. C. difficile infection commonly associated with hospitals where a higher percentage of people carry the bacteria. C. difficile bacteria spread to food, surfaces when infectious people do not clearly wash their hands. The bacteria creates spores that can be persevered in a place for months. If you touch a surface polluted with C. difficile, then you may then unintentionally swallow the bacteria. Symptoms of the disease The symptoms of adisease can range from mild diarrhoea to a severe life-threatening inflammation of the bowel. The symptoms of a Clostridium difficileinfection generally grow when you are taking, or just finished taking an antibiotic. Seldom, symptoms mayappear up to 10 weeks after you finish taking antibiotics. List of symptoms include: Watery diarrhoea (sometimes can be blood-stained) three to four times a day; may be more. Colitis (inflammation of a larger bowel). Loss of appetite abdominal cramping and pain Nausea a high temperature (fever) of above 38 ºC (100.4 ºF) painful abdominal cramps No treatment may be required in mild cases only abandoning the antibiotics or drinking plenty of fluids is required to cure infection. However, cure with specific antibiotics is desirable in more severe cases. Identification of Clostridium difficile Infection Clostridium difficile Infection is identified in a patient in following cases; Anyone who develops diarrhoea who had used antibiotics within the previous two months, and/or When diarrhoea was developed due to stay at hospital, or after few weeks of releasing from hospital. Anyone has abdominal pain, or fever; Anyone has a diagnosis of colonoscopy, pseudo membranes on sigmoidoscopy or histological/pathological diagnosis of CDI; Anyone has a diagnosis of toxic mega colon. Laboratory testing of a sample of stool can be carried out to confirm the diagnosis. The test identifies the toxin material in the stool sample that is produced by C. difficile. An X-ray of abdomen, CT scan, or a Blood tests can be conducted if a patient more severe infection. Treatment of Clostridium difficile infection Clostridium difficile infection treatment depends upon severity of the illness. No treatment is necessary if one has no symptom. However, symptoms are shown various treatment are suggested for mild to severe infection. Mild infection treatment Patients having mild infection can be treated at home. If patient has mild symptoms of aC. difficile infection, infection can be controlled by just withdrawing antibiotics that have caused the problem. This will let the normal harmless bacteria to regrow in your gut. The excess growth of C. difficile should then decrease and symptoms often ease. Actually, many people will stopped the antibiotic anyway, after the completion of antibiotic course. In many cases where the signs are minor, stopping the antibiotics proved sufficient to clear the infection. Modest to severe infection If infection is of severe nature, patient will usually be admitted into hospital, so that patient can be treated and closely look after. If you have symptoms that are more bothersome, such as severediarrhoea or colitis, following treatment is prescribed to cure the infection: 1. Taking an antibiotic In case of severe symptoms such as severe diarrhoea or colitis, patients will be given antibiotics that can damage C. difficile bacteria. In the start, in moderate cases metronidazole is prescribed to cure the infection. But in severe cases vancomycinor fidaxomicin may be used to ease any colitis and stop perforation of colon. Symptoms then usually ease within two to three days, although it can take a week to make a significant recovery. Likely side effects of these antibiotics are stomach pain, feeling or being sick. 2. Fluid replacement In diarrhoea lot of fluid released from body and body becomes dehydrated. So, it is very important that fluid must be replaced in the body to maintain body’s water level. This reduction can easily be eliminated by drinking extra fluids. But, in case of severe, fluids should be given through a drip into veins or by nasogastric tube. 3. Surgery in rare cases Surgery cases are less than 1%. It is required only in life-threatening cases to remove a damaged section of bowel. Severe cases ofC. difficile infection can befatal,especially when they occur in those people who faces severe illness. Prevention C. difficile infection can be spread very easily. Normally, it can be prevented by maintaining good hygiene in healthcare surroundings, such as regularly washing hands and cleaning surfaces using bleach products. When someone is attending the patient having C. difficile infection, he/she can reduce the risk of spreading the infection by washing hands before and after entering the patient room. Soap and water should be preferred over Alcohol gel as in not effective against germs. Preventing the spread of infection into hospital I would implement strict guidelines about maintaining the hygienic environment in the hospital to avoid the spread of C. difficile infection. Possible guidelines would be; If possible, infectious patient should have their own room, washbasin and toilet facilities. Everyone should regularly wash their hands thoroughly with soap and water, particularly after using the toilet or anyone coming from outside to meet the patient. All the hospital staff must wear disposable gloves and aprons and they must wash their hands with water and soap before and after attending patient. Practice will be made of using soap and water should be used as a medium of washing instead of Hand gel because hand gel not kill the spores created by C. difficile. Visitors must also wear disposable gloves and aprons and must wash their hands before entering and leaving the room. Floors, Toilets, surfaces, bedpans, bedding, etc. should be clean washed regularly. Conclusion Clostridium difficile infection is caused by bacteria. It can range from severe to mild. Proper prevention and use of medicine can reduce the infection in very limited time. References Zar, Fred A., et al. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile–associated diarrhea, stratified by disease severity. Clinical Infectious Diseases 45.3 (2007): 302-307. Wilcox, Mark H. Treatment of Clostridium difficile infection. Journal of Antimicrobial Chemotherapy 41.suppl 3 (1998): 41-46. Bignardi, G. E. Risk factors for Clostridium difficile infection. Journal of Hospital Infection 40.1 (1998): 1-15. Gerding, Dale N., Carlene A. Muto, and Robert C. Owens. Treatment of Clostridium difficile infection. Clinical Infectious Diseases 46.Supplement 1 (2008): S32-S42. Wilcox, Mark H. Treatment of Clostridium difficile infection. Journal of Antimicrobial Chemotherapy 41.suppl 3 (1998): 41-46.

Essay --

The Partition of India in 1947 illustrated what the real situation for decades with conflicts of religion and dominance as India gained independence from the British Raj. The process of dividing the subcontinent along sectarian lines resulted to the establishment of Pakistan as the predominantly Muslim sections of India; and the establishment of the Republic of India composed of the southern and majority Hindu section of India. Religion played a major role in the conflicts that existed between Hindus and Muslims aggravated by British imperialism. The Hindus were unwilling to accommodate Islam and the conflicting religious views between Hindus and Muslims made it extremely difficult for their peaceful co-existence. Hinduism is a strict hierarchical structure that is separated into thousands of castes to isolated units. Hinduism as a closed society commands loyalty from the implemented system of each caste with the presence of outsiders considered as the barbarians. Any connection with such outsiders through intermarriage and any other kind of relationship or by simply sitting, eating or drinking with them are forbidden because such outsiders would only pollute the purity of Hindus. Hinduism principles are primarily directed against those who do not belong to them and all foreigners even if such individuals referred to as Maleccha are inclined to their religion. Hinduism in its strict intolerance of other faiths led to the rejection of Hindus to assimilate Indian Muslims and ensured of a barrier that always divided Hindus and Muslims. The religious differences were fundamental to the separation of Muslims and Hindus and the hostility that constrained the possibilities of cooperation between them. The Muslims shared a se... ...ions of right and wrong and has placed the British in a very ugly world impression of Britain’s evil capability of stirring up hatred and doing nothing to suppress the consequences of division the imperial power orchestrated; and thus left the Hindus and Muslims in conflict and an absolute despise of the British. The scheme of winning wars using the troops of India clearly benefitted the British Empire even with the result of the loss of millions of Indian soldiers. The British were the great benefactors of the conquered peoples who generously gave in to promises to address the natives’ sentiments for independence. The British Empire was fed a boost for its international power with the ordinary public playing the no role in international politics except its consent to continue the illusion of popular mandate in the conception of state power by modern democracy.

John Cena

John Felix Anthony Cena[1] (born April 23, 1977)[4] is an American professional wrestler and actor. He is currently signed to WWE. [8] In WWE, Cena has won 19 championships in total, including 12 world titles (having won the WWE Championship a record 10 times[9] and the World Heavyweight Championship twice). In addition, Cena has also won the WWE United States Championship three times,[10] and is a four-time Tag Team Champion, having held the World Tag Team Championship twice (once each with Shawn Michaels and Batista),[11] and the WWE Tag Team Championship twice (once each with David Otunga and The Miz).Cena also won the 2008 Royal Rumble match, the 2012 Money in the Bank contract for the WWE Title, and is a two-time Superstar of the Year Slammy Award winner (2009 and 2010). [12] He is the longest-reigning WWE Champion of the 2000s, having held the title for 380 days from 2006-2007, and also has the fourth highest number of combined days as WWE Champion behind Bob Backlund, Hulk Hog an and Bruno Sammartino. Cena is the only man to fail to capture a world title upon cashing in a Money in the Bank contract.Cena started his professional wrestling career in 2000, wrestling for Ultimate Pro Wrestling, where he held the UPW Heavyweight Championship. In 2001, Cena signed a contract with the World Wrestling Federation (WWF) and was sent to Ohio Valley Wrestling (OVW) where he held the OVW Heavyweight Championship and the OVW Southern Tag Team Championship (with Rico Constantino). Outside of wrestling, Cena has released the rap album You Can't See Me, which debuted at No. 5 on the US Billboard 200 chart, and starred in the feature films The Marine (2006), 12 Rounds (2009), and Legendary (2010). [13] Cena has also made appearances on television shows including Manhunt, Deal or No Deal, MADtv, Saturday Night Live, Punk'd, and Psych. Cena was also a contestant on Fast Cars and Superstars: The Gillette Young Guns Celebrity Race, where he made it to the final round before be ing eliminated, placing third in the overall competition.

Literary Analysis for John Updike’s A&P Essay

In John Updike’s A&P, a story of young man’s wasted effort on heroism is chronicled along with the fact that he has made a wrong decision on the situation. Sammy, a young teenager (assumed in the story), works as a cashier in A&P, a supermarket that caters to the different needs of consumers. One day, in an otherwise ordinary day, in walks three girls clad in skimpy bathing suits which capture the attention of everyone in the market, including the manager who reprimands them for such clothes. As the girls get embarrassed and leave the store, Sammy rushes to their defence and quits on the spot as he thinks that what the manager has done is unjustified. Sammy feels like a hero to the girls and leaves the store to rush after the girls, not knowing that the girls have long left without noticing Sammy’s â€Å"valiant† effort (Updike 596-601). In the story, there are many types of literary techniques which are evident. However, the three that stand out among the rest are the foreshadowing implemented by the author and narrator, the irony in the resolution, and symbolisms in the short story. Firstly, the foreshadowing can be seen in two ways. First, it can be perceived in terms of how the author uses a rather capturing opening of the story which gives a clue to the reader that something is bound to happen in the story and on that day in Sammy’s rather ordinary life. By using Sammy’s voice, there are allusions that something great is about to happen in the moment that the three girls walked in inside A&P and that Sammy’s life will never be the same again. The other aspect of foreshadowing can even be seen as an â€Å"en medias res† technique in the story. This is because in the middle of the story, the narrator reveals that what he is narrating has already happened and is not occurring. Hence, he is not narrating events but actually re-telling them. The other two literary techniques implemented in the short story is the use of irony which can be found in the conclusion of A&P and the symbolisms. Irony of circumstance is seen when Sammy quits his job for the girls when the girls do not even realize that he has done that. Hence, his attempt on being a â€Å"hero† is futile since the girls do not even think that they need one or that someone has rescued or stood up for them. The third and last literary technique is the usage of symbolisms. There are two symbolisms in the story: the supermarket itself and the three girls. The supermarket symbolizes the beginning chapter of Sammy’s life wherein he gets a taste of the different upsetting things that can happen in a person’s life; the three girls can represent the various forms of temptations any person encounters which can lead him to make wrong decisions. In conclusion, the use of literary techniques in any literature is very important since it adds more meaning, depth, and colour. Though any form of literature can do away with literary techniques, such aspects of literature make any written work more poignant, impacting, interesting, and meaningful. Works Cited Updike, John. â€Å"A&P.† The Early Stories: 1953-1975. New York: Ballantine Books, 2003.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   596-601. Print.

Ethics, Fraud, and Internal Audit at Ut Southwestern

There are many taxpayer supported medical schools in this country, most receiving their fees for services through Medicare and Medicaid. The Department of Health and Human Services requires that medical students who have graduated to the resident status have a teaching physician physically present when performing key portions of patient service to be able to bill those services to Medicare. In fact, the patient chart must be legibly signed by the attending physician that they were present and supervising the specific service in order to bill Medicare (â€Å"Guidenlines for teaching,† 2011).According to an article in the Dallas News, a former employee by the name of Jack Mooney was hired in 1991 by the University of Texas Southwestern Medical Center as a reimbursement manager to make sure that all medical billings submitted to Medicare and Medicaid were properly documented and billed (Dunklin & Moffeit, 2010). For example, that the teaching physicians were physically present wh en residents were performing services to meeting the required mandates for Medicare billing. He discovered that was not the case and took the information to his supervisors.Stricter policies were put into place for the departments to follow to make sure that all employees were following the necessary guidelines. In 1997, when Mr. Mooney was the director of UT Southwestern’s billing compliance office, he was still seeing and documenting the same problems. Mooney left the college in 1998 shortly after filing a federal whistle-blower lawsuit. The earliest documentation that can be found of UT Southwestern’s Internal Audit departments involvement comes in a 2003 when they approve of some of the college’s compliance policies, but noted that they do not have a policy in place to review reimbursement claim documents.Dallas News notes that six faculty meetings were held during 2007 and 2008 in which billing concerns were discussed. The Internal Audit Annual Reports for those years do not report any ongoing audits, but do report that they provide the billing compliance committee â€Å"independent consultation and guidance to help billing compliance activities address institution risks† (Rubel, 2008). In 2010 we finally see an internal audit performed of UT Southwestern’s billing compliance programs. The report stated that â€Å"the audit identified a significant finding in the Hospital Billing Compliance program†.As of 2010, the program had not yet implemented the 2005 Department of Health and Human Services, Office of the Inspector General (OIG) Supplemental Compliance Program Guidance for Hospitals. Although this guidance is voluntary, it is highly recommended by the OIG to help hospitals in â€Å"preventing the submission of erroneous claims and in combating fraud and abuse in the Federal health care programs (â€Å"OIG supplemental compliance†). The guidance specifically states that â€Å"hospitals should have in p lace procedures regarding resident rotation and monitoring†.The audit report recommends that the compliance program implement the OIG guidance, consolidation of the billing compliance groups (there are currently four), development of a single risk assessment plan with a corresponding audit plan, a monitoring system for both the risk assessment audit plan and the billing compliance audit report. Also of note in the audit report are repeated failures by the same department to meet billing practices. It is noted that these â€Å"recurring systematic failures increase the risk of exposure to potential civil damages and penalties, criminal sanctions, and administrative remedies, such as program exclusion†.The audit recommends that the failures be addressed at the department level and to develop a formal training plan to improve billing compliance. According to the report, all significant findings are tracked by the University of Texas System Audit Office to make sure that al l agreed upon recommendations have been implemented. These reports are unavailable for review and there has been no further comment on the billing compliance audit in the 2011 Internal Audit Annual Report. This issue was first brought to light 20 years ago by someone that was hired to review billing compliance.We know that 7 years ago the internal audit department was aware of the issue, but as far as we can tell, no significant audit of the hospitals billing department, in relation to Medicare billing requirements, was completed until 2010. Was the hospital fraudulently obtaining money from the government? Not in so far as anyone has determined. Was the audit department aware of the issue? Yes, as far as we can tell. Did the internal auditors follow the IIA’s mandatory guidance? Yes in the completion of the audit in 2010 but it is my personal opinion, given the facts provided, that the audit should have been ompleted years earlier. ?References Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2011). Guidenlines for teaching physicians, interns, and residents. Retrieved from website: http://www. cms. gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/gdelinesteachgresfctsht. pdf Department of Health and Human Services, Office of Inspector General. (n. d. ). OIG supplemental compliance program guidance for hospitals (Vol. 70, No. 19). Retrieved from website: http://oig. hhs. gov/fraud/docs/complianceguidance/012705HospSupplementalGuidance. df Dunklin, R. , & Moffeit, M. (2010, May 30). Feds probe alleged fraud at ut southwestern, parkland. Dallas News. Retrieved from http://www. dallasnews. com/news/community-news/dallas/headlines/20100530-feds-probe-alleged-fraud-at-ut-southwestern-parkland-. ece Rubel, R. (2008, November 03). Internal audit annual report fiscal year 2008. Retrieved from http://www. utsouthwestern. edu/media/footer_required_documents/audit-2008. pdf Rubel, R. (2010, February 24). Billing compliance audit report. Retrieved from http://res. dallasnews. com/localnews/responsivedocs_audit_2010. pdf