Family Medicines: a Strategic Weakness Essay

Recently the trends of urbanization and fast population increase expose several problems to healthcare system in Vietnam like shortage of healthcare manpower, low quality of care, unreasonable distribution of healthcare manpower in different geographic areas, particularly the serious shortage of physicians in Mekong Delta and North-west highland areas as specialists tend to locate their practices in urban medical centers where they could have access to advanced technology, supportive services and consultations from other specialists while rural areas are underserved and patient care becomes highly technocratic, fragmented and episodic. Furthermore, the shortage of physicians in major cities results in a seriously permanent overload at Central level and some specialty hospitals like Oncology, Pediatrics, Obstetrics and Gynecology .. etc.. In sustainable issues, deficit of Family medicine – a basic foundation of modern healthcare in the world, is identified as one of main causes of such problems in Vietnam healthcare system. The purpose of this Essay is to provide a theoretical discussion and analysis about the Family medicine weakness in Healthcare system and Family physician insufficiency in Vietnam to better understand about their impacts to the healthcare system at present and some proposed solutions and recommendations to improve these deficits. 2. Family Medicine and its roles in global healthcare system. In contemporary medicine, Family medicine remains the foundation stone of healthcare service in the community. As the most interesting and challenging of medical disciplines it is based on six fundamental principles: * primary care * family care * domiciliary care * continuing care All above principles are all designed to achieve: * preventive care * personal care (Pereira Gray, 1980). In the contemporary climate where medical services are fragmented and there are competing interests there is a greater need than ever for generalists. In those principles, primary care is the backbone of the health care system and encompasses the following functions: * It is first – contact care, serving as a point of entry for the patient into the healthcare system * It includes continuity by virtue of caring for patients in sickness and health over some period * It is comprehensive care, drawing from all the traditional major disciplines for its functional content. It serves a coordinative function for all the healthcare needs of the patient * It assumes continuing responsibility for individual patient follow-up and community health problems * It is a high personalized type of care (Rakel 2011) In the 2008 report, the World Health Organization (WHO) reaffirmed the importance of primary health care with its report â€Å"Primary health care now more than ever† and its emphasizes that primary care is the best way of coping with the illnesses of the 21st century, and that better use of existing preventive measures could reduce the global burden of disease by as much as 70%. The commentary emphasizes that ‘primary care brings promotion and prevention, cure and care together in a safe, effective and socially productive way at the interface between the population and the health system’. The key challenge is to â€Å"put people first since good care is about people† (WHO, 2008). Rather than drifting from one short-term priority to another, countries should make prevention equally important as cure and focus on the rise in chronic diseases that require long-term care and strong community support. Furthermore, at the 62nd World Health Assembly in 2009, WHO strongly reaffirmed the values and principles of primary health care as the basis for strengthening health care system worldwide. The essence of Family medicine is continuity of care and the evidence for its contribution to quality of care and better outcomes as follows: * Lower all cause morbidity * Better access to care * Less re-hospitalization * Fewer consultations with specialists * Less use of emergency service Better detective of adverse effects of medication interventions. Role definition of Family physician varies considerably both among family physicians and among people with whom they interact. Some individuals, particularly other medical specialists, see family medicine as merely another name of general practice. For others, family medicine is synonymous with primary care. A large proportion of family physicians further elaborate their role to include emphasis on personalized and humanized care. A smaller group adds a third component to their role: caring for families. The largest proportion who subscribes to this last notion refer to family physicians’ treating all members of a family (Cogswell, Sussman, 1982). In view of Family medicine, Family physicians are generalists who primarily draw their scientific medicine and technical expertise from five older specialties – internal medicines, pediatrics, surgery, obstetrics-gynecology and psychiatry-neurology. Compared to these specialties, family medicine is still a young field marked both by rapid expansion and by change, variety, ambiguity and conflict in the images and definition of the role of family physician. As the largest caring scope in healthcare services, the quality and quantity strengths of Family physician force play key roles to improve the health quality of national population. Globally the scope of Family medicine is extended with the recent view of global health care which is a field at the intersection of several disciplines: epidemiology, economics, demography and sociology. The term global health, as opposed to international health, implies consideration of the health needs of the people of the whole planet above the concerns of particular nations. That means global health has wide scope and reach to equity that the term of international health. The â€Å"global health† concept in Family medicine raises the changes in primary care nature as follows: * All population has to deal with the same risk of health due to the phenomena of traveling and immigration. Increase the gap between the poor & the rich globally. * The process of the urbanization/globalization. * Increase of the population in the world. * Decrease of the resources for health care. * Global warming phenomena. * Vaccination Era. * Evidence Based Medicine in daily practice. * Increase the bad behavior such as fast food, tobacco, stress, use alcohol†¦ * Primary health care change to Primary care concept  (Pham Le An, 2009). Such comprehensive changes upgrade the scale of Fami ly medicine in healthcare. In order to promote the global health support as well as strengthen the co-operation of national members, the World Organization of National colleges and Academies (WONCA), World Organization of Family physicians in WHO, was officially established and based in Singapore after the Fifth World Conference on General Practice in Melbourne in 1972. 3. Family medicine situation in Vietnam Although Family medicine basis had been established in the world for over 40 years, Family physicians, the most recently recognized specialists in Vietnam, are in the enigmatic situation of developing the occupational role which they simultaneously occupy. Family medicine had been only approved for establishment by Vietnam Ministry of Health since 2000. Until 2003, Family medicine specialty was established at 3 Medical Universities of Hanoi, HCMC City and Thai Nguyen province to train Family physicians and its specialists. However, its development was spontaneous with 7 Family medicine clinics (in both public and private sectors) nationwide and not strategically organized at all levels so far. There are only 59 post-graduated specialists and around 1,1 General practitioners who partly handle the roles of family physicians per 10,000 people averagely. The imbalance between Family medicine and other specialists can be seen by the ratio of 7,2 Medical doctors per 10,000 people in overall (Vietnam General Statistics Office – GSO – 2011) and the healthcare system only satisfies about 60- 70% of the demands and are lower than neighbor countries like Thailand, Singapore, Malaysia, Philippines.. tc. In 2011 report, Vietnam Ministry of Health forecasted the demand of 34,000 General practitioners more to obtain 10 Medical doctors/10,000 people in 2020 and this is a significant challenge to all 19 Medical educational Universities/Colleges to educate Medical doctors and post-graduate levels in medicine which capacities supply 4,800 graduated Medical doctors every year to add around 3,500 physicians more a year. Not only the quantity of family physicians is seriously insufficient, but also their quality to fulfill the roles of a family physician does not meet the needs of the patients and social development. The General practitioner training programs don’t orient student to the WHO’s critical requirements of â€Å"good doctors† in Family medicine, even though the criteria are more and more demanding by time, for example, the newer criteria of John Murtagh in 2001 â€Å"What makes a good General Practitioner? : * Develop rapport and good communication skills * Ask the right questions * Be astute and observant * Develop optimal ethical and professional standards * Have a fail-safe diagnostic strategy * Develop supportive networks * Know essential therapeutics * Develop basic procedural skills * Be well prepared for emergencies * Know yourself and your limitations including own general practitioners. The importance of certain specific competences and soft-skills in family physician force are emphasized in many studies. An interesting survey on patient care by representative health consumers conducted at St Vincent’s Hospital Melbourne revealed that the most important attributes of good doctors were (in some order of importance) caring, responsibility, empathy, interest, concern, competence, knowledge, confidence, sensitivity, perceptiveness, diligence, availability and manual skills. Additionally, there are neither comprehensive residency programs for Family physicians at Medical Universities/ Colleges in Vietnam nor supporting policy to them and general practitioners practicing at remote or rural areas so far. With effort to resolve the overload situation of Central hospitals in major cities, Project 1816 of Vietnam Ministry of Health deployed in 2008 with the purpose of â€Å"Fielding rotated professionals from upper level hospitals to lower levels to improve the quality of medical care† achieved some initial results such as transferring some technologies and conducting on-site training to improve skills and qualifications for lower level health care professionals; initially improving the quality of medical care at lower levels, especially in the mountainous, remote areas with staff shortage†¦etc, but its couldn’t obtain one of basic goals to reduce overcrowding for upper level hospitals, especially central level hospitals because it made the shortage of central level and specialty hospital more serious by the rotation. 4. Impacts of Family Medicine weakness in Healthcare system & Family physician insufficiency in Vietnam. Due to low reliability and poorly structured family physician network, patients tend to bypass to specialists/ central level hospitals (Vietnam Ministry of Health – 2011 Report), opposite with the trend in the world in which healthcare activities for chronic diseases such as diabetes, hypertension, asthma†¦are moved from in-patient to out-patient services with comprehensive treatment protocol at each level (Dang Van Phuoc, 2012) The irregular bypass causes the overload at Central level and specialty hospitals and the overloading condition becomes more serious, i. e, bed using capacity at Central hospitals increase from 116% (2009) to 120% (2010) and 118% (2011). It’s extremely high in some specialty hospitals such as K (Cancer) Hospital: 249%, Bach Mai Hospital: 168%; Cho Ray hospital: 154%; Central Obstetric and Gynaecological hospital: 124% .. etc. High capacity occurs in some specialties such as Oncology, Cardio-vascular, Orthopaedics (at 100% of hospitals), Obstetrics and Gynaecology, Paediatrics (at 70% of hospitals) while 36,8% of General hospitals are overloaded. The similar situation also happens in Consulting Departments with 80 exams/day/doctor while 60% – 80% of patients at Central level hospitals could be examined at local level and 40% of surgery cases at Central level hospital could be performed at local levels (Ministry of Health – Plan to decrease workload of Central level hospitals 2012- 2020) With the cost in health care, the deficit of Family medicine in Vietnam is one of reason making the medical expenses of patient higher. Total Expenditure on health as % of GDP (5. 1) is fairly high while General Government expenditure on health as % of total expenditure on health (28. 5) is so low to neighbor countries (Susan, 2005). The most cost-effective healthcare systems depend on a strong primary care base. This has been confirmed by a variety of studies comparing the care given by physicians in different specialties because primary care provided by physicians specifically trained to care for the problems presenting to personal physicians, who know their patients over time, is of higher quality than care provided by other physicians. When hospitalized patients with pneumonia are cared for by family physicians or full-time specialist hospitalists, the quality of care is comparable, but the hospitalist incur higher hospital charges, longer lengths of stay, and use more resources (Smith et al. , 2002). Similarly, the greater quantity of primary care physicians practicing in a nation, the lower is the cost of health care. The cost of healthcare is inversely proportional to the percentages of generalists practicing in that nation. According to OECD Health (Organization for Economic Cooperation and Development – OECD Health Data, June 2005), United Kingdom has twice the percentage of family physicians but half the cost to U. S.. Administrative overhead accounts for a major part of the high overhead cost (31%) of U. S. health care (Woolhandler et al. 2003). Countries with strong primary care have lower overall health care costs, improved health care outcomes, and healthier populations (Starfield, 2001; Phillips and Starfield, 2004). The shortage of Family physicians and Family medicine deficits also cause other problems in health care as follows: * Incomplete or unsuccessful Primary health care performance. * The gap between urban care and rural care in the health care network. * The competition among specialties: lack of cooperation in chronic disease care, increase the cost of management. * Barrier in teaching ambulatory care and doing out-patient’s research in academies (Pham Le An, 2009). In society, Family medicine meets some resistances of patients such as family hysicians are unfairly treated as â€Å"general consultants†, â€Å"home caring doctors† and even in medical community, they are considered as â€Å"incompetent doctor†, â€Å"poor specialist†, â€Å"unfair competitive doctor†.. e tc. Many other specialists and hospitals’ managements list Family physicians as one of financial losing causes to their hospitals. Such unfair treatments make many Family physicians feel uncomfortable with the specialty and their roles of Family physician. The reliability of patients and society to them is fairly low and this specialty does not attract the general practitioners to study. 5. Some proposed solutions & recommendations to improve Family medicine. In order to improve the Family medicine in Vietnam, it requires a comprehensive strategy with strong supports of government, educational institutes and society. Within the limit of this essay, I would like to propose some solutions and recommendations as follows: a. Increasing the quantity of Family physicians with additionally trained General practitioners and using the retired medical doctors: The greater the number of primary care physicians in a country, the lower is the mortality rate and the lower cost (Rakel, 2011). In the United States, a 20% increase in the number of primary care physicians is associated with a 5% decrease in mortality (40 fewer death per 100,000 population), but the benefit is even greater if the primary care physician is a family physician. Adding one more family physician per 10,000 people is associated with 70 fewer death per 100,000 population, which is a 9 reduction in mortality (Rakel 2011). A study of the major determinants of health outcomes in all 50 U. S. states found that when the number of specialty physicians increases, outcomes are worse, whereas mortality rates are lower where there are more primary care physicians (Starfield et al. , 2005). Starfield (2000) states, â€Å"the higher the primary care physician-to-population ratio, the better most health outcomes are† (p. 485). Researches in England reveal that with each Family doctor more in 10,000 people (about 20%), adjusted mortality will reduced about 5% in chronic diseases (Gulliford 2002). The increase of Family physicians obviously reduces the workload at Central level and specialty hospitals (49. 3% of out-patient and 59% of in-patient totally) because with many researches in the world, over 90% of patients are taken care with better service by Family physicians in developed medical or developed countries (Didier, 2011). They can help patients and their relatives in 80% health problems: acute or chronic diseases without complications or no need to transfer to Specialty hospitals (Dang Van Phuoc, 2012). To compensate the continuing decline of the number of students entering primary care as a common trend in the world (Bodenheimer et al. 2009) and insufficiency of graduated general practitioners, a policy to support general practitioners and retired medical doctors to practice as Family physicians such as additional training about Family medicine, financial supports, incentive†¦should be prepared and implemented. Rather than other countries where Family physicians usually work at home or their private clinics, Vietnam has a wide network of local level medical centers at wards/hamlets and popularly private clinics/medical units. This advantage allows Family physicians to practice and deploy the primary care programs easily and popularly. b. Family physician residency training programs: Quality of care and the inadequacy of medical training are two major concerns of Family physicians. Eventually, medical schools and residency programs graduated more specialists and fewer physicians trained for primary care. To improve their quality of care in accordance with global health principles, proposed solution is to build emerging curricula of family practice residency programs to envisioning family physicians as â€Å"horizontal specialists† who can deal with the large majority of patients’ needs on a continuing basis (Rakel, 2011) and envisioning this role as integrating humanized care with a high level of competence in scientific medicine. In contrast to the training of the general practitioner, the additional training that family physicians receive is intended to make them more proficient generalists in scientific medicine through formal training in appropriate interpersonal skills and in the behavioral and social sciences. Implementation of this role, however, requires reorganization within the medical system (Folsom, 1966) for continuing, comprehensive care by primary physician is difficult if not impossible within the normative organizational structures of highly specialized medical centers. As Family physicians play the important role in primary care, the Global health awareness program should be combined into General practitioner and Family physician’s training curriculum for being sure about the quality of â€Å"primary care† as follows: (i) Clerkship: adding knowledge of burden global disease in the world such as: tuberculosis, malaria, Preventive care: vaccination; improving skills such as clinical making decision, communication. ii) Orientation: Adding knowledge of new   emerging infectious disease like SARS, non communicable diseases, traumatism care, HIV/AIDS; (iii) Residents: adding knowledge of prenatal care,   neonatal care,   chronic care, mental health care, adolescen t care;   Emergency care in disaster; improving skills such as: doing research and practice Emergency care in disaster, Behavioral care after disaster, Kangoroo’s program, Obs-Gyn care program; building up the relationship center care with WIN- WIN theory for both developed and developing countries to increase of cooperation and Team work. In addition, the cooperation among experts in different medical fields should be strengthened for teaching, managing, doing research to promote the concept â€Å"relationship center care† through many activities: * Establish Continue Medical Education, Patient’s clubs. * Build the bridge or integrate the teaching contents   in Family medicine   with the other specialties like Pediatrics, Traditional Medicine ( Oriental nutrition, Shiatsu), Cancerology (Palliative care), Multidiscipline (Disaster care, EBM, chronic care). Communication through Internet/ Video conference and Electronic medical: The WHO 2008 report emphasiz es the appropriate ‘use of information and communication technologies to improve access, quality and efficiency in primary care. The writer has made a small contribution to basic patient education (also known as doctor education) by the production of common patient handouts which are available for print out from General practitioners’ computers or for one page photocopying from the book ‘Patient Education’ (Murtagh J; 2008). Besides the residency training programs, on-going training courses to improve the competences and skills of Family physicians should be set for attributes considered most important for patient satisfaction (Stock Keister et al. , 2004a). Overall, people want their primary care doctor to meet five basic criteria: â€Å"to be their insurance plan, to be in a location that is convenient, to be able to schedule an appointment within a reasonable period of time, to have good communication skills, and to have a reasonable amount of experience in practice†. They especially want â€Å"a physician who listens to them, who takes the time to explain things to them, and who is able to effectively integrate their care† (Stock Keister et al. , 2004b, p. 2312). c. Others solutions and recommendations (i) Building an incentive scheme and financial supporting policy to Family physicians, especially whom working in remote and rural areas: The effectiveness of this model had been proved in many countries, particularly in Thailand and Malaysia where healthcare conditions are fairly similar to Vietnam. Contrarily, the recent P4P (Pay for Performance) policy of Thailand’s of Ministry of Health to replace the incentive scheme to Family physicians creates several problems to healthcare force and patients and is considered as a main cause leading the Family physicians moving to major cities. With relation between income and satisfaction, in an analysis of 33 specialties in U. S. , Leigh and associates (2002) found that physicians in high-income â€Å"procedural† specialties, such as Obs – Gyn, ENT, ophthalmology and orthopedics, were the most dissatisfied. Physicians in these specialties and those in internal medicine were more likely than family physicians to be dissatisfied with their careers. Among the specialty areas most satisfying was geriatrics. Because the population older than 65 years old in U. S. has doubled since 1960 and will double again by 2030, it is important to have sufficient primary care physician to care for them. The need for and the rewards of this type of practice must be communicated to students before they decide how to spend the rest of their professional lives. Patient satisfaction correlates strongly with physician satisfaction, and physicians satisfied with their careers are more likely to provide better health care than dissatisfied ones. Physician satisfaction is associated with quality of care, particularly as measured by patient satisfaction. The strongest factors associated with physician satisfaction are not personal income, but rather the ability to provide high-quality care to patients. Physicians are most satisfied with their practice when they can have an ongoing relationship with their patients, the freedom to make clinical decisions without financial conflicts of interest adequate time with patient and sufficient communication with specialist (DeVoe et al. , 2002). Landon& colleagues (2003) found that rather than declining income, the strongest predictor of decreasing satisfaction in practice is the loss of clinical autonomy. This includes the inability to obtain services for their patients, control their time with patients, and the freedom to provide high-quality care. ii) Compulsorily assigning General practitioners/ Family physicians to practice at local level hospitals, the servicing term at local level hospitals must be reasonable and acceptable. (iii) Improving facilitates of local level hospitals/clinic s, enforcing the lower level hospitals to implement modern technologies and quality control. This allows Family physicians to better serve patients as some achievements of Project 1816 of Vietnam Ministry of Health. (iv) Involving patients for private and family health care and prevention, structured information supporting treatment. (v) Improving the reputation of Family medicine and physicians in society through public media channels like television, newspaper.. etc, medical education programs and medical community. Even after the specialty is formally acknowledged by institutionalized medicine, family physicians have experienced a variety of negative responses from medical colleagues in other specialties. Carmichael (1978) perceived 3 stages in the reactions of those in medicine to Family medicine: first, the field was ignored; second, it was actively opposed; and then, family medicine is entering a third stage of possible co-optation by medicine. 6. Conclusion The weakness of Family medicine and insufficiency of family physicians cause many strategic consequences to the healthcare system in Vietnam. Their correction requires a long-term strategy to increase the quantity of Family physicians, quality of care, revise the residency training programs, improve its reputation in the society .. etc. In conclusion it seems appropriate to paraphrase Dr Robert Rakel in his keynote presentation to the 14th WONCA World Conference to reaffirm the Family medicine era in the contemporary medicine: â€Å"Regardless of how computer literate we are or how high our technology or whether the setting is urban or rural, good medical care in the future will continue to depend on patient care provided by a concerned and compassionate family physician. The physician will be governed by ethics, not economics, by a partnership with the patient, not politics; and by compassion and communication, and not by capitation. Good medical care in the future will depend, as it does now and always has, on the quality of our interaction with the patient† Dr Robert Rakel – 14th WONCA World Conference) REFERENCES 1. Alain J. Montegut, The Power of Primary Care for the Future of health care: Is Family Medicine the Answer? 1st International PHC Conference Doha, Qatar 1 – 4 November 2008 2. Bod enheimer et al. , 2009. Bodenheimer  T. ,  Grumbach  K. ,  Berenson  R. A. :  A lifeline for primary care. N Engl J Med  Ã‚  2009;  360:2693-2696. 3. Cogswell BE, Sussman MB, Family Medicine: A new Approach to Healthcare (Marriage & Family review, ISSN 0149-4929; v. 4, no. 1/2), The Haworth Press Inc. 1982. 4. Dang Van Phuoc : Plan to decrease workload of Central level hospitals 2012- 2020 – Vietnam Ministry of Health, 2012. 5. Didier L. Roles of Family medicine, Texbook of Family medicine for the co-operation between Liege University – Brussel and Vietnam, Medicine Publisher, 2009. 6. DeVoe et al. , 2002. DeVoe  J. ,  Fryer  G. E. ,  Hargraves  L. ,  et al:  Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care?. J  Fam Pract  Ã‚  2002;  51:223-228. 7. Gulliford, J Public Health Med 2002; 24:252-4, and personal communication 9/04. 8. Landon et al. , 2003. Landon  B. E. ,  Re schovsky  J. ,  Blumenthal  D. :  Changes in career satisfaction among primary care and specialist physicians, 1997–2001. JAMA  Ã‚  2003;  289:442-449. 9. Leigh et al. , 2002. Leigh  J. P. ,  Kravitz  R. L. ,  Schembri  M. ,  et al:  Physician career satisfaction across specialties. Arch Intern Med  Ã‚  2002;  162:1577-1584. 10. Murtagh J: The road to excellence. Australian doctor 3 2008, 46-8. 11. Murtagh J: Paradigms of Family medicine: bringing traditions with new concepts; meeting the challenge of being the good doctor from 2011, Asia Pacific Family Medicine, 2011, 10:9 12. Murtagh J: Patient education. 5 edition. Sydney: McGraw-Hill; 2008. 13. Pereira Gray DJ: Just a GP. J R Coll Gen Pract 1980, 30:231-239 14. Pham Le An, Integrate the issue of global health in FM curriculum: promising solution for improving the quality f Primary care in Hochiminh city, Vietnam  , Introducion FM concept: global healh, texbook of Family medicine, Vietnamese version, Medicine Publisher, 2009. 15. Pham Le An, Global health perspective in Vietnam, A â€Å"Train the Trainer’s Workshop†   WONCA   ASIAN PACIFIC Vietnam Ho Chi Minh city, 2008 16. Phillips and Starfield, 2004. Phillips  R. L. ,  Starfield  B. :  Why does a U. S. primary care physician workforce crisis matter?. Am Fam Physician  Ã‚  2004;  70:440-446. 17. Rakel RE: Family medicine-meeting new challenges. Australian Family Physician 1996, 25(9 Suppl 2):S91-6. 18. Rakel RE: The Family Physician, Textbook of Family Medicine, Eight Edition, Elsevier Saunders, 2011, pp4-15 19. Rivo et al. , 1994. Rivo  M. L. ,  Saultz  J. W. ,  Wartman  S. A.   et al:  Defining the generalist physician’s training. JAMA  Ã‚  1994;  271:1499-1504. 20. Smith et al. , 2002. Smith  P. C. ,  Westfall  J. M. ,  Nicholas  R. A. :  Primary care family physicians and 2 hospitalist models: comparison of outcomes, processes, and costs. J Fam Pract  Ã‚  2002;  51:1021-1027. 21. Starfield, 1994. Starfield  B. :  Is primary care essential?. Lancet  Ã‚  1994;  344:1129-1133. 22. Starfield, 2000. Starfield  B. :  Is U. S. hea lth really the best in the world?. JAMA  Ã‚  2000;  284:483-485. 23. Starfield, 2001. Starfield  B. :  New paradigms for quality in primary care. Br J Gen Pract  Ã‚  2001;  51:303-309. 24. Starfield et al. , 2002. Starfield  B. ,  Forrest  C. B. ,  Nutting  P. A.   et al:  Variability in physician referral decisions. J Am Board Fam Pract  Ã‚  2002;  15:473-480. 25. Starfield et al. , 2005. Starfield  B. ,  Shi  L. ,  Grover  A. ,  et al:  The effects of specialist supply on populations’ health: assessing the evidence. Health Aff (Millwood)  Ã‚  2005;  24:W5-97-W5-107 26. Stock Keister et al. , 2004a. Stock Keister  M. C. ,  Green  L. A. ,  Kahn  N. B. ,  et al:  What people want from their family physician. Am Fam Physician  Ã‚  2004;  69:2310. 27. Stock Keister et al. , 2004b. Stock Keister  M. C. ,  Green  L. A. ,  Kahn  N. B. ,  et al:  Few people in the United States can identify primary care physicians. Am Fam Physician  Ã‚  2004;  69:2312. 28. Susan JA, Vietnam’s Healthcare system: A Macroeconomic Perspective, Paper Prepared for the International Symposium on Health Care Systems in Asia Hitotsubashi University, Tokyo, 2005. 29. Vietnam Ministry of Health: Plan to decrease workload of Central level hospitals 2012- 2020, 2012. 30. Woolhandler et al. , 2003. Woolhandler  S. ,  Campbell  T. ,  Himmelstein  D. U. :  Costs of health care administration in the United States and Canada. N Engl J Med  Ã‚  2003;  349:768-775. 31. World Health Organisation: The World Health Report 2008: Primary Health Care now more than ever Geneva; 2008. 32. World Health Organisation: World Health Report 2009: Promoting health and development-closing the implement gap Geneva; 2009. -oOo-

Pinnacle Manufacturing Case

Original Work please INTEGRATED CASE APPLICATION –PINNACLE MANUFACTURING: PART II 9-37 (Objectives 9-7, 9-8) In Part I of the case, you performed preliminary analytical procedures for Pinnacle (pp. 245–247). The purpose of Part II is to identify factors influencing risks and the relationship of risks to audit evidence. During the planning phase of the audit, you met with Pinnacle’s management team and performed other planning activities. You encounter the following situations that you believe may be relevant to the audit: 1.Your firm has an employee who reads and saves articles about issues that may affect key clients. You read an article in the file titled, â€Å"EPA Regulations Encouraging Solar-Powered Engines Postponed? † After reading the article, you realize that the regulations management is relying upon to increase sales of this division might not go into effect for at least ten years. A second article is titled, â€Å"Stick to Diesel Pinnacle! â €  The article claims that although Pinnacle has proven itself within the diesel engine industry, they lack the knowledge and people necessary to perform well in the solar-powered engine industry. . You ask management for a tour of the Solar-Electro facilities. While touring the warehouse, you notice a section of solar-powered engines that do not look like the ones advertised on Pinnacle’s Web site. You ask the warehouse manager when those items were first manufactured. He responds by telling you, â€Å"I’m not sure. I’ve been here a year and they were here when I first arrived† 3. You also observe that new computerized manufacturing equipment has been installed at Solar-Electro. The machines have been stamped with the words, â€Å"Product of Welburn Manufacturing, Detroit, Michigan. 4. During a meeting with the facilities director, you learn that the board of directors has decided to raise a significant amount of debt to finance the construction of a new manufacturing plant for the Solar-Electro division. The company also plans to make a considerable investment in modifications to the property on which the plant will be built. 5. While standing in line at a vending machine, you see a Pinnacle vice president wearing a golf shirt with the words â€Å"Todd-Machinery† You are familiar with the company and noticed some of its repairmen working in the plant earlier.You tell the man you like the shirt and he responds by saying, â€Å"Thank you. My wife and I own the company, but we hire people to manage it. † 6. After inquiry of the internal audit team, you realize there is significant turnover in the internal audit department. You conclude the turnover is only present at the higher-level positions. 7. While reviewing Pinnacle’s long-term debt agreements, you identify several restrictive covenants. Two requirements are to keep the current ratio above 2. 0 and debt-to-equity below 1. 0 at all times. 8.While reading the footnotes of the previous year’s financial statements, you note that one customer, Auto-Electro, accounts for nearly 15% of the company’s accounts receivable balance. You investigate this receivable and learn it has been outstanding for several months. 9. The engagement partner from your CPA firm called today notifying you that Brian Sioux, an industry specialist and senior tax manager from the firm’s Ontario office, will be coming on-site to Pinnacle’s facilities to investigate an ongoing dispute between the Internal Revenue Service and Pinnacle. 0. A member of your CPA firm, who is currently on-site in Detroit at the Welburn division, calls you to see how everything is going while you are visiting Solar-Electro in Texas. During your conversation, he asks if you know anything about the recent intercompany loan from Welburn to Solar-Electro. 11. During discussions with the Pinnacle controller, you learn that Pinnacle employees did a significant amoun t of the construction work for a building addition.The controller stated that the work was carefully coordinated with the construction company responsible for the addition. Required a. Identify specific considerations from Parts I and II of the case that affect your assessments of engagement risk and acceptable audit risk. Use each of the three factors in the text to categorize your conclusions: External users’ reliance on financial statements Likelihood of financial difficulties Management integrity As the Independent Auditor I would require from Pinnacle, the client a Management Representation Letter.This is a letter an auditor is required to obtain from management at the conclusion of fieldwork, confirming representations explicitly or implicitly given to the auditor, indicating and documenting the continuing appropriateness of such representations, and reducing the possibility of misunderstanding regarding the representations. b. Assess acceptable audit risk as high, medi um, or low considering the items you identified in requirement a. (A risky client will be assessed as a low acceptable audit risk. I will identify the audit risk as high. c. Identify inherent risks for the audit of Pinnacle using the information from Parts I and II. For each inherent risk, identify the account or accounts that may be affected. (1)Related Parties – A reporting entity’s affiliates, principal owners, and management also, any members of their immediate families. Points of consideration is a Pinnacle VP owning Todd-Machinery, its repair men working at Pinnacle at the time the auditor was at field work, while standing in front of vending machine. 2) While reviewing Pinnacle’s long-term debt agreements, there were several restrictive covenants. Two requirements are to keep the current ratio above 2. 0 and debt-to-equity below 1. 0 at all times. This is an item of consideration of possibilities for Pinnacle to â€Å"cook the books† so as to keep in compliance with covenant. (3) There is a high turnover of employees. After inquiry of the internal audit team, you realize there is significant turnover in the internal audit department. You conclude the turnover is only present at the higher-level positions. 4) While reading the footnotes of the previous year’s financial statements, you note that one customer, Auto-Electro, accounts for nearly 15% of the company’s accounts receivable balance. This receivable and learn it has been outstanding for several months. This is an inherent risk of being a related party transaction wherein goods could be sold to Auto-Electro, a related party, but Pinnacle has not received collection of receivables because this is just to make the financial statements look good as having the sale.Revenue and Inventory accounts are affected. (5)There is an ongoing dispute between Pinnacle and Internal Revenue Service. 10-43 (Objective 10-5) In Parts I and II of this case, you performed prelimi nary analytical procedures and assessed acceptable audit risk and inherent risk for Pinnacle Manufacturing. Your team has been assigned the responsibility of auditing the acquisition and payment cycle and one related balance sheet account, accounts payable.The general approach to be taken will be to reduce assessed control risk to a low level, if possible, for the two main types of transactions affecting accounts payable: acquisitions and cash disbursements. The following are furnished as background information: A summary of key information from the audit of the acquisition and payment cycle and accounts payable in the prior year, which was extracted from the previous audit firm’s audit files (Figure 10-12) A flowchart description of the accounting system and internal controls for the acquisition and payment cycle (Figure 10-13,p. 34)—the flowchart shows that although each of the company’s three divisions has its own receiving department, the purchasing and acco unts payable functions are centralized The purpose of Part III is to obtain an understanding of internal control and assess control risk for Pinnacle Manufacturing’s acquisition and cash disbursement transactions. Required a. Familiarize yourself with the internal control system for acquisitions and cash disbursements by studying the information in Figure 10-12 and Figure 10-13. FIGURE 10-12 Information for Audit of Accounts Payable — Previous Year . Prepare a control risk matrix for acquisitions and a separate one for cash disbursements using Figure 10-5 on page 308 as a guide. A formatted control risk matrix is provided on the textbook Web site. The objectives should be specific transaction-related audit objectives for acquisitions for the first matrix and cash disbursements for the second matrix. See pages 608–612 in Chapter 18 for transaction-related audit objectives for acquisitions and cash disbursements. In doing Part III, the following steps are recommen ded: (1) Controls a.Identify key controls for acquisitions and for cash disbursements. After you decide on the key controls, include each control in one of the two matrices. b. Include a â€Å"C‚† in the matrix in each column for the objective(s) to which each control applies. Several of the controls should satisfy multiple objectives. (2) Deficiencies a. Identify key deficiencies for acquisitions and for cash disbursements. After you decide on the deficiencies, include each significant deficiency or material weakness in the bottom portion of one of the two matrices. Answer:During a meeting with the facilities director, you learn that the board of directors has decided to raise a significant amount of debt to finance the construction of a new manufacturing plant for the Solar-Electro division. The company also plans to make a considerable investment in modifications to the property on which the plant will be built. Auditing Presentation and Disclosure. a. Completeness T he auditor should ensure that all required disclosures related to accounts payable and purchases have been included in the notes to the financial statements. Required disclosures include: 1.Payables by type (trade, officer/ employee, affiliates) and term (short-term and long-term) 2. Purchase contracts and purchase commitments. 3. Related party purchases and payables 4. Expenses by segment b. Valuation, Allocation and Accuracy The auditor should read the footnotes and other information related to accounts payable and purchases to determine whether the information is accurate and presented at the appropriate amounts. c. Rights and Obligations and Occurrence The auditor should compare disclosures to other audit eveidence to ensure that all disclosed information related to accounts payable and purchases has occurred. . Understandability and Classification The auditor should read all accounts payable and purchase related disclosures to ensure that they are understandable. The auditor sh ould determine whether material long-term payables or non-trade payables require separate disclosure. b. Include a â€Å"D‚† in the matrix in each column for the objective(s) to which each significant deficiency or material weakness applies. (3) Assess control risk as high, medium, or low for each objective using your best judgment. Do this for both the acquisitions and cash disbursements matrices.Control risk is to be assessed as high therefore as auditor, I would increase my risk sampling. Expenditure Cycle A. Internal Control- Purchases The following functions in a purchase transaction should be segregated: 1. Purchase Requisition The purchase requisition starts the purchasing cycle. The department in need of the asset or services sends a properly approved, serially numbered requisition to the purchasing department. The requisitioning department should not have the authority to actually place the purchase order. This would indicate a weakness in internal control. 2. Purchase OrdersThe purchasing department should place the order only after giving proper consideration to the time to order and the quantity to order. The purchasing department should also obtain competitive bids from various suppliers to make sure that the best price is obtained. The purchase order is issued only after proper approval. For internal control purposes, it is best that pre-numbered purchase orders can be used. There should be multiple copies that will be sent to: (i) the requisitioning department; (ii) the vendor; (iii) the receiving department; and (iv) the accounting department.If the purchase order is canceled, all copies should be recalled and filed so that every purchase order number is accounted for. 3. Receipt of Goods or Services The copy of the purchase order sent to the receiving department serves as an authorization to accept the goods when they arrive. It is preferable that the copy not indicate the quantity ordered. Thus, the receiving department is forced to count the goods upon arrival. A receiving report is prepared by this department and forwarded to the accounting department. The goods are forwarded to the requisitioning department .B. Internal Control – Accounts Payable The accounting department has three functions: (i) to record the payable, (ii) to approve the invoice for payment; and (iii) to record the payment after it is paid by the Treasurer. 1. Recording the Payable The copy of the purchase order sent to the accounting department notifies them that there will be a future cash disbursement. The receiving report is compared with the purchase order and the vendor’s invoice as to the quantity to prevent payment of charges for goods in excess of those ordered and received.The accounting department records the goods as received in inventory, and records a payable. 2. Approving Invoice for Payment and Recording Payment When the invoice arrives, the accounting department approves it by matching the invoice, purchas e order, receiving report, and (sometimes) the requisition. When payment is made, the payable is reversed. The accounting department should ensure that the invoice amount is correct, and that it accurately reflects any purchase discounts, before approving it for payment. C. Internal Control – Cash DisbursementsIt is best for internal control purposes to pay invoices by check. For effective internal control, the functions of approving the payment and signing the checks should be segregated. Approved voucher packets (matched invoice, purchase order, receiving report, and requisition) prepared by the accounting department (Accounts Payable) are received by the Treasurer, who prepares, signs, and mails the checks and cancels all supporting documents after payment. Paid vouchers are returned to the accounting department for posting of the payment and filing of the documents.

Big Time Toymaker Essay

The theory to practice scenario between Big Time Toymaker and Chou in my opinion entered into a contract in two separate occasions. The first time was the verbal agreement Big Time Toymaker (BTT) made with Chou three days before the 90 day period ended and then there was the email Chou received that gave him the terms, time frame, price and obligations; at this point Chou felt that there was an actual contract. The one fact that could help Chou in this case is that he has an email to prove that there was some sort of intent there from BTT regarding a contract. On the other hand the one thing that may count against Chou is that he never received anything in writing, which would be the actual contract. The fact that both parties were communicating by email does impact my analysis. Companies send emails to one another all the time discussing terms and agreements and the fact that they had spoken and made a prior agreement verbally counts as the initial agreement and the email would be follow up. A contract consists of all parties that are involved to have a signature and if they verbal agreement would not have taken place before the email then my decision would be different. I feel that Chou has the right to feel that he was entering into a contract with BTT but should have followed up for a written contract. The role of fraud has played a role in this scenario according to the Uniform Commercial Code (UCC), the sale of goods for more than $500.00 and any lease transaction for goods of $1000.00 or more (Melvin,2011). In this scenario Chou received $25,000.00 in exchange for the negotiation rights for 90 days from BTT. This is not a mistake under the doctrine of mistake because in order for this to take place there would need to be a unilateral mistake made in the contract and there was not one and neither was there an actual written contract. If there was an actual contract there could have been laws applied towards strict liability as well. For the sake of argument assuming that the email served as a sufficient contract then BTT was in breach of the contract. BTT was in breach by not distributing the game as they agreed. With BTT breaching the contract Chou can seek compensation for any damages and any loss.

Business Crime Case Study Example | Topics and Well Written Essays - 1750 words

Business Crime - Case Study Example Before proceeding to the topic of Christies Ltd. and business crime, it is important to understand how and why the Theft Act 1968 came into existence. This Act was original for it was the first British legislation, which the dealings of criminal law accessible to all citizens and not just limited to attorneys. An article from bbc.co.uk (2001) tells this history: Before 1968, theft and other, similar, offences were governed by a mass of conflicting legislation and common law and was over-complex. Before 1968, if 'ownership' passed by means of deception, the offence was 'obtaining by false pretences'. If 'possession' was passed, the offence was 'larcency by a trick'. Other offences existed, including 'larcency by a servant', 'fraudulent conversion' and 'embezzlement'. It had reached the point where it was harder to discover which crime the accused may have committed rather than whether or not the accused was guilty. The 1968 Theft Act, as well as the 1971 Criminal Damage Act, did much to overcome this problem. All previous theft legislation and common law were overruled, resulting in the creation of the first codified definition of law in England and Wales.... codified definition of law in England and Wales. Understanding the history of the Act allows one to understand why it was and still is needed. Now we shall begin the discussion of Christies Ltd. The situations at hand and the topic of this piece of writing are now presented: Business Crime--Christies Ltd 4 Phil Jackson has approached David asking for a higher salary, as he believes he is underpaid. David refuses. Phil then decides to augment his salary in a number of ways:(A) Phil decides to open a flower stall at the weekend. He obtains a large selection of daffodils and tulips from the roadside and aims to sell these at 2 per bunch.(B) Phil decides to go for a drive through the countryside. He sees anunattended pick up truck loaded with live wild pheasants. Phildecides to put these into his own vehicle, intending to sell them to a local butcher.(C) Phil decides to enter the safe of Christies Ltd and look at the plans for a new "HyperScoop". He draws the design of the scoop andoffers it for sale to Scooperman Ltd, a direct competitor ofChristies Ltd. The Theft Act 1968 lists the basic definition of the word theft. According to this Act, a person is guilty of theft if "he dishonestly appropriates property belonging to another with the intention of permanently depriving the other of it; and 'theft' and 'steal shall be construed accordingly". Let us look at the term "permanently depriving" more closely in order to gain abetter understanding of theft and dishonesty. Webster's II New Riverside Dictionary(1984) defines the word permanently as "lasting

Comparitive Politics Assignment Example | Topics and Well Written Essays - 1250 words

Comparitive Politics - Assignment Example In Comparative Politics, there are two core approaches; the area studies and the cross-national approach. The cross-national approach in Comparative Politics deals with the study of many nation-states with the purpose of addressing certain theoretical questions that apply broadly. In this approach, the tools used in most cases involve empirical data subjected to quantitative analysis. The area studies method places more emphasis on in-depth analysis within a specific region or the borders of a particular country. With this approach, the necessary tools, in most cases, involves the researcher immersing himself into the culture and language of the region under study. It is important to study states because their power faces considerable threats from growing interconnections and interdependencies and international agreements and arrangements. These threats limit the ability of states to control their individual affairs. These threats include multinational corporations, non-governmental organizations and bodies operating on a global scale. This is evident from the rise of terrorism and other vices, which are not restricted to countries any more. However, states retain the power and responsibility to protect their citizens and undertake other national duties by virtue of having supreme power within their jurisdictions. States are still important, therefore forming the point of departure and focus for comparative approach to government and politics. Comparative Politics has six main approaches: Institutionalism, Systems theory, Governance, Marxism, Structural functionalism, Institutionalism and Corporatism. Institutional analysis forms the basis of Comparative Politics (Caramani, 2). Comparative Politics is a science because it is guided by various theories (Caramani, 25). Alasdair MacIntyre first raised the question of the possibility of Comparative Politics being a science. The deduction he provided in his analysis was that there was

Public Relations Situation Assignment Example | Topics and Well Written Essays - 1000 words

Public Relations Situation - Assignment Example They could also sound offensive depending on choice of words used in relation to the culture of the target audience. It should be noted that cultural diversity encompasses differences in language, religion, beliefs, social aspects, race and ethnicity as noted by Chia and Synnott (2009). Some of these factors are easy to change and some are not. This means that the public relations professionals should be able to adjust to the cultural aspects of the various audiences of an organisation. Grunig and Toth (2006) explain that they should be able to demonstrate an awareness, understanding and sensitivity to their cultures and interactions between the various cultures. It should also be noted that the audience in public relations are more fluid and this requires adequate response to this. This can only be achieved if there is sufficient flexibility among public relations to adapt to a changing world. Effective public relations professionals or departments are those that have recognised and acknowledged the important fact that discrimination is unhealthy for business. They should also have recognised the importance of taking advantage of a multi-cultural communities and how fast this opportunity is growing. Hain (2008) points out that if public relations professionals or departments were to realise this, they would be able to enable their firms or clients to exploit the cultural diversity in their society or target region. As noted in the introduction, situation analysis is where an organisation evaluates the main communication issues it faces. An awareness in cultural diversity increases the competency of public relations practitioners to note these issues and advice organizations on how to respond... The paper makes a conclusion that each organisation has its own expectations, values and beliefs that shape its public relations. Cultural awareness among public relations practitioners is therefore important in ensuring that the messages they give about the organisation responds to cultural diversity while maintaining consistency with the beliefs, values and expectations of the organisation. For example if organization believes in and values a diverse workforce, then the organisation’s public relations department will have more authority to include practitioners from varied backgrounds and standpoints. The paper approves that multicultural awareness increases the professional relevance of public relations practitioners. It also markets them due to increasing demand by many companies to appeal to the local and global multicultural communities. The paper describes the main thing behind variations in culture is differences in perspectives leading to differences in preferences. This makes cultural awareness a critical competency among public relations practitioners and the public relations department personnel. The awareness of cultural diversity increases the professional relevance of public relations practitioners because of the increasing diversity both in the local and international communities. In order to gain a competitive advantage and increase their market shares, public relations firms takes advantage of the growing cultural diversity and targets or hires people of immigrant origin.

Evolution of Management Accounting discipline and it's relationship Essay

Evolution of Management Accounting discipline and it's relationship with other functions in organisations - Essay Example For example, business organisations are now more concerned with maximising the stakeholders’ value instead of profit maximisation. Besides, they have recognized their responsibilities towards society, community, corporate and environment. Now, they aim to develop their organisational structure and strategies that strive to meet these responsibilities. In this respect, different aspects of management accounting play very crucial role. It is one of the primary areas that help to meet objectives of corporate governance and strategic formulation process. This paper will attempt to present critical analysis of management accounting by pointing out its important aspects. At first, the evolution of management accounting will be analysed by figuring out its influencing factors. It will also discuss the historical background of the present management accounting system. ... This section will try to develop certain recommendations for bringing further development in modern management accounting. In order to support the critical analysis and discussions, proper evidences will be provided. Finally, the entire discussion, analysis and major outcomes will be summed up in conclusion. Evolution of Management Accounting Before presenting the evolution and historical development of managerial accounting, it is necessary to understand the term ‘management accounting’ because this term includes two major concepts of business organisational activities. Robert S, Kaplan identified two major areas of management accounting and these are cost accounting and management control (Kaplan, 1984). These two areas are very vital for organisational success. Management accounting process is helpful in executing cost accounting and management controlling activities. R. N. Anthony defined that â€Å"management accounting is concerned with accounting information that is useful to management† (Banjerjee, 2005, p.2). T. G. Rose elaborated that management accounting is meant to adopt and analyse the accounting information for better diagnosis and explanation for assisting managements in decision making process (Palanivelu, 2007, p.289). Many critics and scholar observes the cost accounting, financial accounting and management accounting as different areas of finance. However, this can be interpreted as the traditional concept of management accounting. This concept was in trend prior to 1980s before the modernisation of cost accounting and management control. Thomas Johnson traced that US corporations started to focus of management accounting during 1850-1925 as this field was very important for the growth and development

Identify one major political event in an African country Essay - 1

Identify one major political event in an African country - Essay Example The main objective of the paper includes making the exploration of the actual political scenario of the Libyan politics, which had experienced a significant blow during the last few years in the name of so-called ‘awakening of the Arab nations’ for introducing imperative alterations to the Afro-Arab politics to a great extent. The paper will also examine the reasons behind the unexpected revolt against the Qaddafi regime. The paper is also interested in investigating into the external factors, including the US role, in respect of toppling the Qaddafi regime for the establishment of a pro-American political system in the lines adopted by the European powers of colonial era for turning the weak and backward states to be their subjugated domains in order to introduce and enforce the policies of their choice as well as to force the small countries for developing social, economic, business and trade relations with the USA. Hence, the paper will portray a comprehensive scenari o paving the way towards 2011 revolt in Libya in the light of internal and external factors controlling and regulating the rebellion and rebels at large. Muammar Qaddafi served as one of the most dominant and influential figures of the twentieth century Afro-Arabian political world, which left indelible impact of his political and strategic achievements in the entire region during the second half of the last century till the first decades of new century. By dint of his exceptional intellect, deep foresight and outstanding wisdom, he successfully played the role of a central figure in the national politics of Libya for over four decades, where he was the sole decision-maker of the fate of his country and its masses at large. Though, apparently, he was considered to be unconquered and supreme in national politics, who would sustain power till the last day of his life, Qaddafi became the victim of purported Arab Spring appeared by the mid of December 2010 with the big powers in

Give a topic Essay Example | Topics and Well Written Essays - 500 words

Give a topic - Essay Example the 19th century, slavery and slave trade, creation of institutions based on religious revolutions were just but a few of the things that brought about the formation of different cultures. European influence in the region may have prompted the adoption of Western culture, therefore; eroding the African culture and traditions (Shillington 764). This paper will examine the influence that came about as a result of the European movement in the African region, and how this influence shaped modern African society. The events that may have led to the interaction between the African and the European in the 14th to the mid-20th century may have been the finding of man’s first remains in the region of Tanganyika. It was during this time that expeditions were carried out by many of the European influences that came to Africa. It was the crusade by David Livingstone against the infamous slave trade that led to the discovery of some of the remains of man. Slave trade was common among the people in this region as there were bargains that were struck by Arab traders in the region in exchange for common goods and services. During the German invasion, local traditional structures were disregarded and eradicated (Shillington 879). The same thing was happening in the neighboring East African region, Kenya, where the British had taken control. The political, social, and economic structure of the regions changed as the colonialists made a play at the regions’ economic well-being. Africa was rich in raw materials and minerals, and the colonialists used these to enrich the mother countries. Labor was found from the local people, and it came cheap. The family structure was changed drastically as able-bodied men were shipped away to work for their colonial masters, hence; changing the social structure. The political structure became that of the colonialists, and many of the structures being seen today are still from the colonial era. Local and traditional heads were done away with

Ethics of Marketing to Schools in America Essay Example for Free

Ethics of Marketing to Schools in America Essay Public schools across America are struggling with their budgets and looking to outside corporations for help. Conveniently, private corporations realize the potential buying power of students and have decided that elementary schools are the best channel to reach them. It has become routine for corporations to market there products in schools, and in exchange these schools receive various financial benefits. This new partnership has become the focus of much controversy as 80% of Americans feel that corporations should have no place in schools (). The two most cited concerns are the health of children and the growing commercialization of schools. This paper looks at this issue in detail by answering the following two questions. Is it ethical for corporations to market products in schools? What is the most socially responsible course of action for corporations to take? This paper will use a utilitarian and distributive justice framework to prove that marketing in schools is unethical and propose that the most ethical arrangement is to make schools commercial-free zones. This paper will also discuss the issue of corporate social responsibility through shareholder and stakeholder lenses to prove that there is a strong business case for corporations to? Children in schools are marketed to in a variety of ways. Schools can participate in incentive programs where a school receives funds to take part in a specific activity such as collecting box tops (). Some corporations offer free educational materials to schools that promote their corporate message. Pepsi encourages a thirst for knowledge on a popular textbook cover(). Each year over half of the students in schools in the United States receive free textbook covers(). McDonalds, Burger King and Dominos sponsor reading projects in schools with free meals(). Other schools receive free electronic equipment like computers and satellites for participating in programs like channel one. This is an arrangement where school receive free electronic equipment for having their students watch a 10 minute broadcast of which 2 minutes are corporate sponsored commercials (). All of these marketing techniques pose there own unique ethical dilemmas, however the most controversial type of marketing in schools today is the use of exclusive agreements. This is when corporations give schools a percentage of their profits in exchange for the right to be the sole provider of a product or a service(). The most prominent example of this is the soft drink company, Coca-Cola and their exclusive distribution rights with schools. As a result, Coca-Cola advertisements have become the most visible types of advertisements in schools today (). A US National School Health Policies study found that students could purchase soft drinks in 60% of elementary schools and 83% of middle schools (). Of these schools over 85% were under an exclusive contract with the Coca-Cola company (). For the aforementioned reasons the remainder of this paper will use the soft drink giant Coca Cola as a symbol to make it easier to understand the larger debate of marketing in elementary schools. A deontological framework can not determine whether this issue is ethical or unethical. In 1990 under $100 million was spent on advertising targeted at kids, just a decade later that number was up more than twenty times to over $2 billion (). This large increase in spending indicates that there is a strong motivation for corporations to market to youth. One way to determine if marketing in schools is ethical is to deconstruct these motivations through a deontological framework. The motivation for companies to market in schools could be a philanthropic opportunity to contribute to education. However, I do not believe this because companies like Coca-Cola make schools sign exclusive agreements, which means that they block competition and are profitable. I believe the main motive for companies to market to youth is to make money. Marketing to students in schools is an effective strategy as it reaps both short and long term rewards. Children in elementary schools have a lot of spending power. Kids ages 4-12 spend $40 billion each year (). Furthermore, these same kids influence $600 billion of household spending (). It is wise for companies to try to earn a share of this large market. Surprisingly, the sales of sodas in schools account for a miniscule slice of soda sales worldwide, less than 1 percent of sodas 66billion dollar industry (). Clearly profit in the short run is not the main motivating factor for companies like Coca-Cola. Marketing in public elementary school promises long run benefits. Soft drink companies can create brand loyalty with their consumers at an early age. In other words, they foster and retain a captive audience for its products. If you consider the cutthroat competition among soft drink makers for customers, this brand loyalty becomes a vital business pursuit. A deontological framework can better help us deconstruct the ehics of marketing to youth purely for financial reasons. Specifically, this paper will employ some of W. D. Ross duties. It can be argued that marketing in schools violates the duty of non-malefiicence (to do no harm). Some children will substitute a nutritious meal for a sugar laden soda. That is harmful to their health. Marketing in schools also violates the duty of gratitude. It does not thank customers for their business by protecting their health. Instead, companies like Coca-Cola continue to aggressively market their unhealthy product to vulnerable youth. On the other hand, if one considers a corporation a person, then a corporation fulfils Rosss duty of self-improvement by marketing in schools. It improves its own condition by increasing its profits in the short and the long run. Additionally, if a company honestly abides by the contract it signs with a school then it is upholding Rosss duty of fidelity. The framework of deontology is inadequate to determine the ethics of marketing in schools because it presents us with conflicting duties and no hierarchy to put them into. There is an incompatible difference between the various duties. However, this situation did not become controversial simply because some believe that a corporation might have bad ethics, instead people are worried about the consequences of marketing in schools. A utilitarian framework shows us that marketing in schools is unethical. Marketing in elementary school is controversial because it offers many direct benefits to schools, but negatively impact students. Through a utilitarian framework this paper will deconstruct the pros and cons of the scenario to determine whether marketing in schools is ethical. This paper will conduct a cost-benefit analysis to determine what results in the greatest good for the greatest number of people. The main players that benefit in this scenario are schools, shareholders of the Coca-Cola company, and employees. All of these players benefit in financial terms. Vending machines are a valuable source of revenue for schools. They support programs that might otherwise go unfunded. Elementary schools have reason to be concerned about their finances, the state of California cut the elementary school budget by $10 billion dollars in 2003 (). If a school district signs an exclusive contract with a soft-drink company it can generate an additional $3 million per year (). School districts receive all of this money for virtually no additional work on there part. This is why the cliche that: one day our schools will have all the money they need, and the Air Force will have to hold a bake sale to buy a bomber could become true (). Company shareholders benefit in the long run if we assume that marketing in schools create brand loyalty among consumers. Company employees also benefit from the sales of sodas in schools, simply because their company is continuing to be competitive in the marketplace and provide work for them. However, the positive impact of selling sodas in schools impacts company employees considerably less than other players in this scenario, because these employees will not be receiving a pay raise as a result of this practice. While there are some positive effects of marketing in schools, I feel that the cons greatly outweigh the benefits. Students bear the burden of the negative effects of marketing in schools. Marketing to youth perpetrates problems of childhood obesity, materialism, eating disorders, violence, and family stress (). This is especially problematic because children are more cognitively immature and prone to believe that products marketed in school carry their schools endorsement. For instance, if a school sells soda it signifies that it is acceptable to consume drinks that are high in sugar and have poor nutritional quality. A childs health is not an acceptable trade-off for increased revenues. Childhood obesity is an epidemic in America. One-quarter of children in the United States are overweight which means they are at risk for lifelong health problems such as diabetes, high blood pressure, and cavities (). Competitors also suffer in this scenario because ? exclusive agreements create a monopoly on a school and therefore promote unfair competition and can charge whatever price they want. The difficulty of examining ethics from a utilitarian perspective is that is impossible to predict the future. It is not clear how much the financial revenue schools gain from executive agreements helps them to fulfill their purpose of teaching. It is also not clear how high the correlation is between marketing in schools and negative outcomes like obesity. What is known is that most of the negative consequences (and there are a lot of them) fall on the shoulders of the students. Having the burden of this issue fall on the shoulders of millions of students nationwide is bad for society as a whole. Children need to be educated in a healthy atmosphere so that they can become productive members of society one day. It is detrimental to the future if children are not provided with the best learning environment possible. The best learning environment possible is one that is free from commercial influences. The Distributive Justice framework shows that monopolies are unethical. According to John Rawls we should determine ethical dilemmas like whether marketing in schools is ethical by making the decision from behind a veil of ignorance. The distributive justice framework tries to ensure that the interests of the worst off in society are considered. According to this theory, students well-being should be put before business interests because students are the most vulnerable group in this scenario. However, there is an inherent conflict of interest within this framework. Corporations believe that marketing in schools is ethical because they are exercising their 1st amendment right to free speech. Everybody has this right, thus they are utilizing the equal liberty principle: equal rights to liberties as long as all may be provided such liberties. The problem is that not even all corporations are being provided the liberty of free speech. As previously mentioned Coca Cola has an exclusive agreement with 85% of elementary schools in America, this is just a nice way to say that Coca Cola has a monopoly on the elementary school market (). Companies that engage in exclusive distributive contracts are trying to block competitors. They can not justify this action on the ground that they need to do this to spur innovation, they want a monopoly so they can control the school market. Thus the difference principle comes into play because the inequality that these companies are creating in the market place needs to be addressed. The most ethical thing to do is to make schools commercial free zones. Marketing in schools is unethical. The most ethical thing to do is to make elementary schools commercial-free zones. Students should be able to pursue learning free of commercial influences and pressures. Eighty percent of adults in the United States agree that schools should be commercial-free zones as well (). While this may be the most ethical course of action, it seems highly unlikely as marketing in schools has become entrenched. Schools continually need more money and the government is unable to provide it. If marketing in schools must continue at the very least it should be regulated. It does not seem probable that the industry will regulate itself, so it should be subject to more government oversight. Right now there is very little the government has done to restrict marketing in schools. Laws forbidding it are perceived to be a breach of the 1st amendment. A study found that only nineteen states currently have statues or regulations that address school-related commercial activities (). This number includes states that have statues that encourage commercial activities. The government should establish an independent commission to regulate marketing in public schools. This agency should make regulations that encourage schools to provide a healthy learning environment for students. The agency could regulate the sale of foods high in fat, sodium, and sugars. For example, it could decide that vending machines can not be stocked with sodas; however juices (100%) and water could still be sold. There would be greater social acceptance of this issue if it were implemented more appropriately. The business case for CSR prevails. This paper has established that the most ethical thing for corporations to do is to stop marketing to students in schools, or at the very least to regulate what they market to children. If a company were to stop marketing to children for the aforementioned ethical considerations it would be following a normative line of reasoning. The company would be interested in doing the right thing for society with little regard for how the proposition would effect its own bottom line. While I would applaud its efforts on a moral basis, this would be a very poor reason to engage in Corporate Social Responsibility. There needs to be a business incentive for corporations to engage in Corporate Social Responsibility. A company has to be successful financially if it is going to survive in the long run. However, there is always a business case for corporate social responsibility with respect to companies that sell consumer products. In the long run the closer a company aligns with the values of society the more successful it will be. Good ethics and good business are mutually reinforcing. In this case 80% of society wants commercial-free schools or at least commercialism that is regulated. It is socially responsible for a company to accommodate the wishes of society because it is in their long run interest to build a good reputation. A company like Coca-cola may be more successful at recruiting, retaining, and engaging with its employees and customers if it demonstrates that it is socially responsible. Critics might argue that this is just mere window dressing. However, a good reputation leads to higher sales in the long run. Both shareholder and stakeholder frameworks would support the business case for corporate social responsibility in this scenario. Milton Freidman is an advocate of the shareholder theory which maintains that a companies corporate social responsibility is to maximize profits without breaking the law or violating basic rules of society. Coca-Cola is not breaking any laws by marketing in schools, it is merely exercising its first amendment right to free speech. It is also not violating any social norms, children get to choose whether they want to buy unhealthy products. On one hand it may seem that Freidman would say that corporations should continue to market in schools because they are making a profit and therefore helping society. However Freidman would agree that companies need to balance there short term gains against their long-term interest. In this case, Freidman would advocate for the restriction of marketing in schools because it is in the long run self-interest of the company because companies like Coca-Cola needs to reassure their customers that they care about them. . An alternative approach to corporate social responsibility is the stakeholder theory. This theory maintains that companies should balance the interests of all stakeholders involved. In this scenario the stakeholders would be the students (customers), parents, teachers, corporations, suppliers, employees, shareholders, and society. Students are harmed by marketing in schools because marketing is correlated with problems like obesity and materialism. On the other hand these same students benefit because their schools are receiving additional funding for programs. Parents suffer because they have less control over what their children are exposed to, and it could undermine their values. Shareholders may benefit in the short run from marketing in schools, but in the long run the values of the company must be aligned with society if it is going to succeed. Therefore, the stakeholder theory would advocate a business case for Corporate Social Responsibility as well: to limit marketing in schools. Marketing in schools is a complex issue with many players. In this case, students are the most important players because schools are public institutions and schools are supposed to make students a top priority. Marketing in schools can not stop on its own, it needs to be either strictly prohibited or at the very least limited by the government.

Hospital Web Application Design for Elderly Patients

Hospital Web Application Design for Elderly Patients The aim of this project is to develop an elderly friendly web application which can be used to book hospital appointments online and also interact with Doctors via skype. It also can be used by doctors to maintain patient records which can be given read access to patients to their records. This aim also needs us to answer few things and the first one would be to address the needs of ageing population in learning how to use a computer if they dont know already and also using a web application which would cater their needs and make their lives easy. We will also discuss the specific difficulties faced by the ageing population in learning computer skills which will in turn help them using a web application easily. Older adults and technology Health takes a down turn when a person gets old and in the future years the number of older adults are going to increase according to many statistics. This could lead to being hospitals and clinics overfilled and become more in demand. Due to several factors, older adults will need supervision in their health from proper health care practitioners (Codreanu Florea, 2016). Perception of control is one of the most important factors in determining ones place on a social environment. To keep up with the new technologies younger generation use older generation are learning new computer technology faster than the younger generation (Morrell, 2002). To avoid themselves from socially isolating in this day and age older adults learn computer skills and also learn how to use internet. And some even contradict Morrell saying that older adults learn computer skills slower due to physiological changes which makes their learning process slow. Older adults can integrate with the modern society by learning how to use new technology and also know how to learn new stuff from internet on their own. There are many E-learning programs which can be used by the ageing population to learn anything. Most of the times older adults make the government of a country to to question its own policy towards people working after they retire. In the same way, they should also be able to integrate with the rest of the society to use latest web applications which are in the market and adapt to them and for them to adapt to it, the application creators should focus that there are plenty of older adults as well who might use their application in a day to day basis. To dive deep into the discussion of why web applications should be older adult friendly we will discuss the myths around older adults using web applications, how older adults are engaging themselves in learning latest technology and also the obstacles they face in using a web application (Githens, 2007). The goal of this project is to focus on the guidelines to be followed which can make the older adults involve in using web applications and also focus on other opportunities related to it in the favor of older adults and companies which develop web applications. How retirement is changing? Life expectancies have been increasing which has also increased the retirement years proportionally. Due to this the older adults value, all the benefits they get from employment after retirements such as financial, social, physiological and many more. Those employments may be full-time, part-time, paid, unpaid or even a temporary employment (Hale, 1990). With this and also seeing organizations dealing with new talents due to reduction of experienced workers due to retirement we could say that retirement is an outdated concept (Stein and Rocco, 2001). With the research done in the past decade it is seen that the new talents also want to be working after they retire, which is about 80% in 2005 (Dychtwald, 2017). With this spirit the notion of retirement will be transformed in the future as these new talents are the ones which bring big changes in the current world. The world-wide web or as we call the internet is not just for the younger generation. With many new applications like Quora, Facebook and many more we have seen that the internet is accepting individuals all around the world irrespective of the age and it is also seen that there has been an increasing number in the people of older age group. To determine the exact number would be difficult as any precise number which comes up will be obsolete after it gets recorded.

Essay on Satire - Voltaires Candide as a Satirical Peice :: Candide essays

Voltaire's Candide as a Satirical Peice The novel Candide by Voltaire is a great peice of satire that makes fun of the way people in medievil times thought. The book is about a man, Candide, and his misfortunes. Throughout the book Candide has countless things go wrong in order to show that this is not "the best of all possible worlds" Voltaire is trying to make a point through the exaggeration of the inhumanities of man in a humorous way. The story begins in a castle in Westphalia. Candide is convinced by Cunegonde to take a lesson in "experimental physics". The two are caught and Candide is kicked out of the castle. While Candide is suffering from hunger and cold he is met by two men who trick him into service in the Bulgarian army. Candide has a terrible time in the army, he tries to escape, and he is punished severely. During the confusion of war Candide manages to escape. Time passes and Candide meets some other interesting individuals and has one bad experience after the next. One day Candide meets a woman who takes care of him and this is none other than Cunegonde. They amuse each other with stories of misfortune and travel around the world. At every place Candide goes something unthinkable seems to happen to him. Candide meets several people along the way who all have their own interesting story of misfortune and the inhumanities of mankind. Candide ends up on a small farm, married to Cunegonde and living with two philosophers. He argues with others at the end of the book if this really is the best of all possible worlds and they conclude the we must "work without reason" and "must cultivate our garden". In this novel Voltaire is extremely influenced by his frame of reference and mindset. He finds room to include almost all of his political views. He takes Candide on a journey through all of the wrongs he beleives in the world in order to prove that it was not the best of all possible worlds. He shows us the inhumanities of man through war and social interaction. He basically paints an exaggerated picture of the wrongs of medievil people.

The Realm of Sisterhood in Mary Leapor’s Poetry Essay -- Biography Bio

The Realm of Sisterhood in Mary Leapor’s Poetry For a woman writer to be read by her peers in eighteenth century England was somewhat unusual. For this woman to procure some kind of living from her writing was even more remarkable. But for such a woman to claim both these accomplishments, with writings attacking the very state of women no less, was extraordinary. Yet Mary Leapor was this woman. Not only did she herself defy society in remaining unmarried for the whole of her short life, but she also took up the call to fight for women everywhere. Her answer to the oppression of society was to find solace in the bonds of sisterhood. The radicalism of Leapor’s encouragement has long been a source of discrepancy for her critics, and there exists a wide array of interpretations. The question lies within the definition of the female relationships she so wholeheartedly promotes. The varying interpretations include everything ranging from Leapor as promoting lesbianism, to simply promoting good female friendships. Adrienne Rich termed this range of womanly bonds the â€Å"lesbian continuum,† and explains it as the inclusive realm between â€Å"consciously desired genital sexual experience with another woman,† and â€Å"the sharing of a rich inner life, the bonding against male tyranny, the giving and receiving of practical and political support† (51). The question remains: where does Leapor belong on this continuum? Critic Donna Landry places Leapor in the realm of replacing heterosexual union with something closer to homosexual tendencies, while Richard Greene offers a far more platonic view of things. In applying Rich’s tenets of a range, it is possible to read Leapor as somewhere between Landry and Green, and as enco... ...ress, 1995. Greene, Robert. Mary Leapor: A Study in Eighteenth-Century Women’s Poetry. New York: Oxford University Press Inc., 1993. Harris, Jocelyn. â€Å"Sappho, Souls, and the Salic Law of Wit.† Anticipations of the Enlightenment in England, France, and Germany. Ed by Alan Charles Kors and Paul J. Korshin. Philadelphia: University of Pennsylvania Press, 1987. Landry, Donna. â€Å"Mary leapor Laughs at the Fathers.† The Muses of Resistance: Laboring Class Women’s Poetry in Britain, 1739-1796. Cambridge: Cambridge University Press, 1990. 78-119. Rich, Adrienne. â€Å"Compulsory Heterosexuality and Lesbian Existence.† Blood, Bread, and Poetry: Selected Prose 1979-1985.† New York: W.W. Norton & Company, 1986. Wahl, Elizabeth Susan. Invisible relations: Representations of Female Intimacy in the Age of Englightenment. Stanford: Stanford University Press, 1999.

The Controversy Around Banning Books Essay -- essays research papers

The subject of censorship is a very controversial one, especially the banning of books. Many people believe they must protect themselves and others from the "evils" of many classic books and works of art because they can be deemed "indecent" in one way or another. Many believe that this is absurd and censorship in its current form is a violation of our First Amendment right to free speech. Personally, I align myself with the latter, however I do feel there are occasions where censorship is justifiable. The censorship of books is a division of censorship that, apart from Internet censorship, receives the most publicity. Banning books is the most popular form of such censorship. Many banned books are literary classics, such as The Catcher in the Rye, by J.D. Salinger, which was listed as the number 6 most challenged or banned book in a list compiled by the American Civil Liberties Union in 1997. This book has been banned from school libraries all over the country because of the main character's teenage angst, which many feel is too graphic for teenagers, and its profanity. Profanity, whether it be frequent or a rare occurrence, is a characteristic of many literary classics, as is the use of racial epithets.In the book Huckleberry Finn by Mark Twain (ranking number 2 on the list), an epithet is use many times over to describe the people of color in the book. Now since the book was published in 1885 and such language was common at the time, I do not belie...

Million Dollar Baby

The theme of this story is achieving the American Dream of riches and fame, it’s also about the need for love and support. Frankie is a brilliant but unsuccessful boxing trainer who train a lot of excellent boxers but lack of success. Maggie is a natural boxer who tirelessly trains each day in Frankie’s gym even though he has rejected her requests that he trains her. She is at the age of 32 believes she has one last chance to make a life for herself in boxing. They are the loneness people that try to find meaning in their life. Both of them want success! Frankie is estranged from his daughter, who returns his many letters that all are unopened. Beneath his crusty exterior is a man crying for the love and acceptance of his daughter, so he goes to church every single day. There is an aching void in his heart. Maggie is a waitress from a white trash family. Her mother only cares about her welfare. Nobody cares about her in the family. She also lack of family love but she treats her family very well because of her strong will. Maggie dedication and hard work influence Frankie’s mind and he agrees to train her, but only in the basic and then he will turn her over to another trainer. At this point Frankie is still afraid to open himself up to Maggie who follows every word of his advice. As Maggie fights her way up in her boxing, Frankie establishes a parental relationship with Maggie. While Maggie’s mother ridicules her success is the ring, Frankie eventually arranges a million dollar fight for Maggie and they actually success. Also the movie always mentions the guy who is called Danger. He is a innocent and optimistic young boy who always come to Frankie’s gym to practice but is not a nature boxer. Being successful in boxing is also his dream. The remorseless fact blows him into the depth of despair. Although he comes to the gym every day to practice, he can’t even fight back to the black guy. Now he know boxing is not as easy as his imagination. For this reason he disappears some days. But eventually, he comes back with his confidence. This is the irony in this story, even though you work hard, it’s not always a good outcome. He realized that he is not suit in boxing but the worshipful part is he still coming to practice tireless when he is awakened by Mr. Scrap. At least he flights for his dream and doesn't live in a ordinary life like Maggie’s mother. Maggie’s mother doesn’t have a job because she is lazy and she lives on the welfare. She doesn't have a dream and doesn't care about her own daughter. The only thing she concerns is money even though her own daughter is on the verge of death. At the top of the life of Maggie’s boxing, she is being a paralytic by the accident. The pain is intolerable for Maggie, she ask for ending her life. She does the most valuable thing in her life that she is satisfied with the brilliant achievements in the twinkling of an eye. She enjoys the process of boxing that she has never ever been regret of being a boxer. Lying on the bed is against to her believe – never have a original life. People in the world all are never and ever be the same because of difference dreams. They are finding the meaning of their lives. Maggie chooses to end of her life to wind up her finally dream. This story tell us, everyone has a right to pursue the dream. Just go for it, it might be failure but at least we try and our life will be unordinary. If we keep proceeding in the way of our dream, even though we fail we still get more than the other who live in an ordinary life.

Chemistry of Anti-money Counterfeiting Technology Essay

I. Abstract Counterfeiting money is a big business for criminals. Nearly $70 million of fake currency gets used daily, costing consumers millions. In the present day, there are many new technologies that have been discovered and studied in order to help put counterfeiters out of business. Our currency is something that we must protect, which is why these technologies and discoveries are very important in the safety and development of our economy. The new generation of Philippine banknotes includes new and more advanced technology to ensure the safety of the genuine Philippine banknotes. This is to prevent money counterfeiting in our country. These new features include more advanced photo editing, which features micro printing on the different images and texts on the banknotes, a unique rough texture, a new system of serial numbering, advanced security fibers and security threads, watermark technology, and optically variable ink. These are the most advanced and efficient methods of preventing mon ey counterfeiting today. Provided in this paper is a detailed explanation and description of each security precaution and a detailed review of the methods used to execute them. II. Denominations of Currency The new generation Philippine banknotes composes of the denominations twenty, fifty, one hundred, two hundred, five hundred, and one thousand peso bills. The new twenty-piso bill honors President Manuel L. Quezon, the first President of the Republic of the Philippines on the front of the bill while the reverse shows the image of the breathtaking Banaue Rice Teraces and the Palm Civet from the Cordilleras. The fifty-piso bill commemorates President Sergio Osmeà ±a who led our country at the critical stage of World War II. The reverse shows an image of the Taal Lake, one of the world’s smallest active volcanoes and the Maliputo Fish. The one hundred-piso bill pays tribute to President Manuel Roxas who prioritized the crafting of the Central Bank charter then provided the leadership for the reconstruction of our country after the devastation of the Second World War. On the reverse, the near perfect cone-shaped Mayon Volcano and the Butanding or Whale Shark is also featured. The two hundred-piso bill features President Diosdado Macapagal who restored the celebration of Philippine independence on June 12. The reverse features the unique icon of Bohol, the Chocolate Hills and the Tarsier. The five hundred-piso bill is a salute to the champions of Philippine democracy, Senator Benigno Aquino Jr. and President Corazon Aquino. The reverse features the Puerto Princesa Subterranean River National Park. Finally, the one thousand-piso bill features three of our war heroes, Chief Justice Jose Abad Santos, Josefa Llanes Escoda, and General Vicente P. Lim. The reverse features the Tubbataha Reefs National Marine Park and the world famous South Sea Pearl. Figure 1 The money denominations come in specific color schemes of orange for the twenty-piso bill, red for the fifty-piso bill, violet for the one hundred-piso bill, green for the two hundred-piso bill, yellow for the five hundred-piso bill, and blue for the one thousand-piso bill. III. Security Features The Philippine Banknote or the Philippine Peso Bill finds the need to be current with the use of new technology to enhance the security of banknotes to remain impossible to replicate by criminals. The new generation Philippine banknotes incorporates the latest available technology in banknote security. This is the reason that they have developed new designs and upgraded the security features of all our banknotes. A. Photo Editing The Central bank of the Philippines uses a special photo editing software to ensure specific prints that are impossible to copy by criminals. Some of these specifications include nano prints on the images, lines, and words on the banknotes. B. Texture The note is not smooth to the touch, but a bit rough. This is because the bank notes are made of 80% cotton and 20% Philippine Abaca. Aside from that, the raised prints that are embossing from the Intaglio printing process give the bill a unique tactile feel. Intaglio printing is a printing technique in which the image is incised into a surface. Normally, copper (Cu) or zinc (Zn) are used, and the incisions are created by etching ot engraving the image. In printing, the surface is covered in ink and then rubbed vigourously with tartalan cloth or newspaper to remove ink from the surface, leaving it in theincisions. The very sharp printing obtained from the intaglio process is hard to imitate by other means. Intaglio also allows for the creation of latent images, which are only visible when the document is viewed at a very shallow angle. Figure 2 C. Serial Numbers The serial numbers are composed of one or two prefix letters and six to seven digits in asymmetric or increasing size. Serial numbers are not difficult to forge; yet they make banknotes easier to track and audit. Figure 3 D. Security Fibers The paper used to print our currency has tiny threads of fibers embedded into the paper. These red and blue fibers glow under ultraviolet light. If the bill has no red and blue fibers that glow, then it is probably a fake bill. Fluorescent marks are the invisible phosphor dyes on banknotes that glow under UV or blacklight. This glow will be visible under a money detector device. There are two kinds of security fibers. The first one is the visible security fibers. These are easily seen in current Philippine banknotes as the blue and red fibers that are randomly spread throughout the front and back of the paper. The other kind is the invisible security fiber. These glow a fluorescent yellow under ultraviolet light. Genuine security fibers in Philippine banknotes can be easily plucked out (yes, try it!) with the aid of a needle. Counterfeit money usually only prints the fibers on paper, thus they cannot be plucked out. Figure 4 E. Watermarks The watermark shows a shadowed image of the portrait and the banknotes’ denomination on the blank space when viewed against the light from either side of the bill. This is possible due to paper density variations. Figure 5 The word â€Å"Pilipino†, written in our ancient Filipino alphabet, Baybayin, can be seen in its complete form when the banknote is viewed against the light. F. Concealed Value When the banknote is rotated at a 45-degree angle and tilted downwards, we can see the concealed denominational value super imposed on the smaller version of the portrait. Figure 7 G. Security Threads Both the twenty-piso and the fifty-piso have a 2mm wide security thread that can be visible when viewed against the light. The one hundred, two hundred, five hundred, and one thousand-piso bills have a 4mm wide stich-like security thread embedded on the bill and when viewed from different angles, its color changes from red to green. The embedded security thread is a special thread vertically implanted off center of the note during the manufacture of the banknote paper. The front of the thread carries a clear text – the initials of the Bangko Sentral ng Pilipinas (BSP) and the numeric denomination of the bank note. The back of the thread is also printed with the initials BSP. There are two kinds of security threads. One is a thin aluminum (Al) coated and partly demutualized polyester film thread with microprinting, which is embedded in the security paper as banknote or passport paper. The other kind of security thread is the single or multicolor sewing thread made from cotton or synthetic fibers, mostly UV fluorescent, for the bookbinding of passport booklets. Figure 8 H. Optically Variable Device Patch The five hundred-piso bill and the one thousand-piso bill have the optically variable device patch, a reflective foil. For the five hundred-piso bill, it reveals the small BSP (Bangko Sentral ng Pilipinas) logo and the blue parrot, while the one thousand-piso bill reveals the small BSP logo and the South Sea Pearl inside a clam. The patches change color from red to green when the note is rotated 90-degrees. Figure 9 I. Optically Variable Ink A security feature exclusive to the one thousand-piso note is the optically variable ink for the embossed denomination value on the lower right corner on the face of the banknote, which changes color from green to blue when it is viewed in different angles. Color changing inks are inks containing pearlescent pigments that change color when viewed at a different angle. The color of the ink does not actually change, but the angle of the light to the viewer’s eye changes and thus creates the change in color. A number of types are available, including green to purple, gold to green and green to lilac. Optically variable inks (OVI) are very expensive inks applied on banknotes as a security feature. So far, only the 1000 peso bills have this. There are two versions of OVI printing on the 1000 peso banknotes. This is an excellent security feature because counterfeiters will need a lot of effort and money to replicate it. They are called optically variable inks because tiny flakes of color-shifting film are incorporated in the intaglio ink. Thus, prints of OVI change color when viewed from different angles.