A Brief Note On Helicobacter Pylori - 1355 Words

HELICOBACTER PYLORI Helicobacter pylori have been implicated in cases of chronic gastritis, peptic ulcer diseases( includes duodenal and gastric ulcers). Even though these diseases were linked to stress factors, in 1983, Australian microbiologists Warren and Marshall proved that gastritis and peptic ulcer diseases were infectious diseases caused by a bacterium (1). This bacterium has also been linked to gastric carcinoma and Mucosa associated lymphocyte (MALT) lymphoma (2) This organism was formerly classified under the genus Campylobacter because scientists found a campylobacter-like bacterium in the gastric mucus of patients with chronic gastritis. It was thus formerly called Campylobacter pylori, however, further study of the organism at genetic level by analyzing a sequence of the 16s rRNA gene necessitated the formation of a new genus, hence the name Helicobacter pylori (3). Helicobacter pylori is a Gram negative spiral shaped microaerophilic rod (4). The term microaerophilic means that the organism requires small amounts of oxygen to survive. It is also a rapidly motile organism due to the multiple polar flagella (4). The bacterium is approximately 3Â µm long and 0.5Â µm in diameter. The organism has 4-7 polar sheathed flagella which helps it to move in the gastric mucus in the stomach (3). It is also a fastidious organism. This means that it requires special nutrients to grow. The common media for isolation include Skirrow’s medium with vancomycin, polymixin B,

Gender Discrimination Free Essays

Social stratification is the structured form of social inequality within a ranked group of people that bring about unequal financial rewards, such as a person’s income, and power or property, which is brought upon by wealth in a society. The social stratification systems come in many different ways and forms. For example, slavery, castes, social class, race, and gender are just some of the issues that are affected by stratification. We will write a custom essay sample on Gender Discrimination or any similar topic only for you Order Now This essay will particularly focus on the issue of stratification by gender, or in other words, gender inequality. Gender inequality or also known as gender stratification, is the unequal distribution of a society’s wealth, power, and privilege between females and males. (Scott and Schwartz, 2000). When the issue is approached, it is evident that the majority of the women are the oppressed as in turn the men being the oppressor. This idea of the oppressed vs. the oppressor is evident throughout history; even in religious terms, some can date back to God’s creation. For example, in the Bible, God had caught Adam and Eve eat from the tree of the knowledge of good and evil, which was forbidden. It is written in the Bible, â€Å"To the woman he (God) said, I will greatly increase your pain in childbearing; with pain you will give birth to children. Your desire will be for you husband, and he will rule over you. † (Genesis 3:16). Around the mid-nineteenth century until nowadays, three beliefs about women and men have prevailed as part of biology or evolution. One, men and women have different psychological and sexual natures, two- men are inherently the dominant or superior sex, and three – both male female difference and male dominance are natural. † (Bem, 1993). Considering these three beliefs, women experience gender inequality in different environments, stereotypes, and occupations. For example, women are stereotyped to be only a stay at home wife and to be in an environment where they are responsible for cleaning the house, cooking dinner, and taking care of the children. Nowadays, there are more women known to have jobs and not a stay at home wife, but yet they are still responsible, or show some responsibility for cleaning the house, cooking dinner, and taking care of the children. As for occupations among women, they experience the limitations of the occupations available. Women also experience less pay or earnings, and the devaluation of their work by society. An article, Social Class and Gender, written by Nancy Andes, expresses occupational stratification by gender inequality through the comparison of three theoretical frameworks or perspectives. The first theoretical framework is the sex segregation model, which is where sex is the only characteristic that affects the placement of a worker into a profession or occupation. The second theoretical framework is the pure class model, which is where the workers’ position of determined by their status or position in the society and how much authority and ownership they possess. The third theoretical framework that is used is the integrated gendered social class model, which is where gender and class perform together that affect the positioning of women and or men in the labor force. After Andes introduces the three theoretical frameworks, she explains each frameworks or approaches in depth, in relation to a table that expresses the earnings and occupations of men and women. The source of the table, or known as empirical evidence, is taken from the UC Bureau of the Census in 1989. The table expressed many different types of employment in the labor force. Within that employment of occupation, the table included the percentage of women within that occupation, women’s annual earnings within the occupation, and even the men’s annual earnings in that same occupation. Read also: Our Changing Society How to cite Gender Discrimination, Essay examples

A Domestic Dilemma by Carson M Essay Example For Students

A Domestic Dilemma by Carson M Essay Carson McCullers story A Domestic Dilemma depicts a family torn by both compassion and suffering. Martin, a loving and understanding husband must deal with his familys problems. Martins wife, Emily, distraught by her new environment, initiates her familys difficulties with her drinking habits. The story examines a familys severe problems, and yet also illustrates the depth of love and loyalty that allows people to survive adversity. McCullers examines within the depth of one family how the full spectrum of love can destroy the romantics of love. The conflicts in the family surround Martin and Emilys relationship. Emilys drinking habits initiate a confrontation with Martin. When Martin inquires about his wifes earlier drinking, she immediately responds because I drink a couple of sherries in the afternoon youre trying to make out a drunkard in a sharp, unforgiving tone(99). According to Roberta Caplan, some people may drink abusively during a personal crisis and then resume normal dri nking (Groiler) which explains Emilys rhythmic sorrow filled with alcohol(102). In addition, fear and worry for his wife an children make Martin feel uneasy. Returning from work a year ago, Martin stumbled upon his children crying and his wife intoxicated after the baby had been dropped on her frail skull(100). Martin then hired a maid in order to watch the children and look after Emily(100). Significantly, the settings effect on the familys relationship demolishes their closeness. Martins surroundings seemed vast and somehow desolate because he is aware of his wifes displeasure living up north (97). Being away from her family and friends in Alabama, Emily takes out her frustration of her new environment on her family(100). Many flaws exist within this family;however, the family still seeks comfort in one another. Although Martins family faces dilemmas, the love in the family remains evident. Initially, the devotion that Martin shows towards his children illustrates his good nature. Martin views his childrens faces as radiant as flower petals, equally loved (103). Moreover illustrating his love for his children, Martin kissed the tiny hand that lay palm-upward (103). Furthermore, Martins hope to hold his family together exhibits his affection for his family. Martin constantly attempts to calm his wife in order to avoid displays of anger(101). Please go upstairs,(101) Martin begs of his wife so the children do not get upset seeing their mother frustrated. Lastly, the physical and emotional desire for Emily that Martin has, further shows how he cares for his family. Comforting his wife, Martin exhibits his love for her(104). Martin watched Emily as she slept and his old anger vanished(104). McCullers fully examines the immense complexities of love(104) in depicting both the conflict an love within one family, and how this can tear a family apart. Problems such as drinking excessively cause relationships to deteriorate. The dependence on each other and love for one another holds a family together. Ultimately, McCullers past encounters with alcohol and family drove her to write this story which shows that the choices people make vary depending on their intentions(Groiler). A Theme AnalysisofCarson McCullersA Domestic DilemmaRobert Brown10/20/97Bell 5

Narrative Essay on a Good Day! free essay sample

I was going with my family. So finally, the day was here and I was in India on December 19th 2012. My friends and cousins were at the airport to pick me up, they were very happy, and surprised to see me after a long time. It was a very warm welcome with handmade flower necklaces. They knew I was coming so they already cleaned my house and it was ready for me. It was very different feeling living in that house after living in United States and also the weather was different than United States. After they dropped me off at my house, I got freshen up, and then all my relatives, friends, and neighbor started coming to my house to see me. They were very happy. Then my mother’s family who lives in India, they came to see from another city. I got so emotional after seeing them. It was the best feeling seeing your family after so many years and my mom cried so much after seeing her mother. We will write a custom essay sample on Narrative Essay on a Good Day! or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page It’s a very different experience talking to them on phone from U. S. A and meeting them face to face in India. Then we all went out to have lunch with my mother’s family and my friends. I was craving for pure Indian food taste so I had so many different kinds of dishes. We had South Indian food, Gujarati Thali (full Dish), and my favorite Indian Chinese cuisine. We had so much while having lunch. Everyone was sharing their stories and taking about random stuff. Then we all came back to our home and took a nap since we were excused from flying in plane for 16 hrs. By the time we woke up it was a time for a dinner. Our neighbor invited us for dinner at their house, so we all got ready and left to their house. By the end of the night we had a wonderful experience and overall it was an interesting day. India has changed a lot since I left seven years ago. Now, they have shopping malls, huge buildings in the city, so many movie theaters, and also people are changing their living styles. It really was a different experience. I will never forget this day in my life, it was and it will be the best day from my entire life.

Free Essays on Young Goodman Brown And Heart Of Darkness

Joseph Conrad’s use of light and dark to represent good and evil in the Heart of Darkness helps in developing the theme and the plot of the novel. Conrad uses the symbol of light and darkness repetitively throughout the novel in order to disclose his insight to the reader. Conrad uses light and darkness when referring to the Thanes and Congo Rivers, the skin color of the whites and blacks, and shadows. Conrad’s use of light and dark is evident from the opening of the novel. The story opens on the calm Thanes River aboard the cruising yawl called the Nellie. All is calm on the water as the lights of London twinkle around the boat. The Thanes River, which is seen as calm, ‘civil’ and bright, is an obvious contrast to the Congo River that Marlow navigates in Africa. The Congo is full of darkness and fractiousness. Ironically, the bright Thane is described similarly to the dark Congo. In the closing lines of the novel, the Thanes seem to be flowing into the heart of an immense darkness. However, during the closing of the novel, in which the startling cruelty of the Europeans is divulged, the narrator describes the Thanes as strikingly different: immensely dark. Through the use of lightness and darkness Conrad suggests that regardless of where the white man exists, in civilized London or deepest Africa, he seems to bring darkness and cruelty to his fellow ma n. Conrad uses light and darkness in context of the color of skin of the whites and blacks, as well as the corresponding good and evil of their hearts. In contrast to the greed and cruelty of the white men in Africa, who greedily and recklessly seize ivory at the cost of a human life, Conrad depicts the black natives as having more self-control. The Manager is starving the cannibals on board Marlow's steamer to death, and although they eagerly eye the body of the dead Helmsman and also the physique of the plump Russian, they restrain their native urges and do not... Free Essays on Young Goodman Brown And Heart Of Darkness Free Essays on Young Goodman Brown And Heart Of Darkness Joseph Conrad’s use of light and dark to represent good and evil in the Heart of Darkness helps in developing the theme and the plot of the novel. Conrad uses the symbol of light and darkness repetitively throughout the novel in order to disclose his insight to the reader. Conrad uses light and darkness when referring to the Thanes and Congo Rivers, the skin color of the whites and blacks, and shadows. Conrad’s use of light and dark is evident from the opening of the novel. The story opens on the calm Thanes River aboard the cruising yawl called the Nellie. All is calm on the water as the lights of London twinkle around the boat. The Thanes River, which is seen as calm, ‘civil’ and bright, is an obvious contrast to the Congo River that Marlow navigates in Africa. The Congo is full of darkness and fractiousness. Ironically, the bright Thane is described similarly to the dark Congo. In the closing lines of the novel, the Thanes seem to be flowing into the heart of an immense darkness. However, during the closing of the novel, in which the startling cruelty of the Europeans is divulged, the narrator describes the Thanes as strikingly different: immensely dark. Through the use of lightness and darkness Conrad suggests that regardless of where the white man exists, in civilized London or deepest Africa, he seems to bring darkness and cruelty to his fellow ma n. Conrad uses light and darkness in context of the color of skin of the whites and blacks, as well as the corresponding good and evil of their hearts. In contrast to the greed and cruelty of the white men in Africa, who greedily and recklessly seize ivory at the cost of a human life, Conrad depicts the black natives as having more self-control. The Manager is starving the cannibals on board Marlow's steamer to death, and although they eagerly eye the body of the dead Helmsman and also the physique of the plump Russian, they restrain their native urges and do not...

Requisitos para Dreamers para sacar permiso para viajar

Requisitos para Dreamers para sacar permiso para viajar Los Dreamers, es decir, los muchachos indocumentados que llegaron a Estados Unidos siendo nià ±os, y que tienen DACA aprobado podà ­an  obtener un permiso para viajar fuera de los Estados Unidos y regresar si cumplà ­an una serie de requisitos.   Todo ha cambiado con las declaraciones del fiscal general Jeff Sessions con fecha del 5 de septiembre de 2017. Por otro lado, la orden judicial del juez William Alsup que reinstaura parcialmente DACA con fecha de 9 de enero de 2018, no protege a los jà ³venes que salen de Estados Unidos y posteriormente desean regresar. Por lo tanto en este aspecto en concreto no se modifica lo decido por gobierno en Septiembre de 2017. Asà ­, en primer lugar si un Dreamer habà ­a solicitado un permiso para viajar mediante el formulario I-131 y la solicitud tiene fecha de aprobacià ³n del 5 de septiembre o anterior, podà ­a viajar y en principio no deberà ­a haber problema. Sin embargo, como es un asunto delicado con consecuencias posibles muy graves, es una buena idea asesorarse con una organizacià ³n de apoyo a Dreamers o con un abogado y, en caso de duda, no viajar. Incluso se recomienda hablar con un abogado que està © presente en el aeropuerto el dà ­a del regreso, por si hubiera algà ºn problema. En segundo lugar si no ha pedido el permiso para viajar, no hacerlo despuà ©s de esa fecha, ya que no ser tramitado. En tercer lugar si se pidià ³ el permiso para viajar antes de esa fecha y se est pendiente de una respuesta hay que saber que el USCIS no aprobar el permiso, pero regresar el dinero pagado en concepto de cuota. Demanda de los estados en contra de decisià ³n de Trump de finalizar DACA 15  estados y el Distrito de Columbia   han sumado sus esfuerzos para presentar una demanda en contra del gobierno federal por la decisià ³n de Trump de finalizar el programa DACA. La demanda, que ha sido presentada en el Distrito Este del estado de Nueva York, est liderada por el fiscal general de ese estado y la de Massachusetts. Adems, se han unido los de Carolina del Norte, Connecticut, Delaware, Hawaii, Illinois, Iowa, Nuevo Mà ©xico, Oregà ³n, Pennsylvania, Rhode Island, Vermont, Virginia, Washington y el Distrito de Columbia. Los estados argumentan que la decisià ³n de Trump de finalizar DACA viola en dos ocasiones la Ley de Procedimiento Administrativo. Adems, violarà ­a la proteccià ³n otorgadas por la Constitucià ³n al  debido proceso. Finalmente, tambià ©n serà ­a contraria a la Constitucià ³n porque violarà ­a el derecho a la igualdad ante la ley. En este punto se argumenta que la decisià ³n de Trump tiene por objeto perjudicar a un grupo de personas por razones de su origen, ya que cuatro de cada cinco muchachos beneficiados por DACA son mexicanos o centroamericanos. Se espera ahora una batalla legal. Todo lo que sigue a continuacià ³n ya tiene solo un valor histà ³rico porque como se ha explicado, ya no se puede aplicar. La Accià ³n Diferida (DACA) como requisito  esencial para el permiso de viajar Los Dreamers  sà ³lo pueden solicitar el permiso para viajar si tienen ya en mano aprobada la Accià ³n Diferida, que se conoce en inglà ©s por las siglas de DACA. DACA es una medida adoptada por el Presidente Barack Obama el 15 de junio de 2012 que permite a los Dreamers que cumplen con ciertos requisitos de edad, residencia, estudios e historial aplicar por una semi- legalizacià ³n. En la prctica supone que el Dreamer al que se le concede la Accià ³n Diferida no puede ser deportado. Adems, pueden obtener una licencia de manejar sin restricciones, un Nà ºmero del Seguro Social, abrir una cuenta de banco y, en determinados casos, aplicar por un permiso de trabajo. Una vez que tienen DACA aprobado pueden solicitar,  previo pago de un arancel,  un permiso para viajar fuera de los Estados Unidos, que se conoce por su nombre en inglà ©s de  advance parole. Nunca pedir el permiso para viajar sin tener DACA aprobado ni tampoco si se est pendiente de su renovacià ³n. Quà © es este advance parole y quà © requisitos  aplican para los Dreamers El advance parole un permiso para  viajar fuera de Estados Unidos y, lo ms importante, regresar. Es una autorizacià ³n que tambià ©n aplica a otro tipo de migrantes, pero a cada categorà ­a les aplica distintos requisitos. No confundirse en este punto al llenar la peticià ³n. Se solicita rellenando el formulario I-131, que se conoce en inglà ©s por el nombre de Application for Travel Document.   Para los   Dreamers es necesario que el permiso para viajar se pida para un viaje en concreto. Excepto si se sabe con antelacià ³n que se necesita realizar varios viajes, por ejemplo, a varios seminarios. En este caso y si se sabe la fecha de cada uno, solicitar todos esos viajes en la misma aplicacià ³n al llenar el formulario I-131, explicando las razones de cada uno de esos viajes. Adems  no se puede viajar por cualquier razà ³n,  sino por una que encaje en alguna de las siguientes: Por cuestià ³n humanitaria, por ejemplo, para visitar a un familiar cercano enfermo.Razones educativas, como un semestre en el exteriorPor trabajo, como visitar clientes, un congreso, un seminario, etc. Es decir, no se puede viajar por vacaciones. Cuando se aplica enviar, adems del pago, la documentacià ³n que se pide. Tener en cuenta que si DACA fue aprobado por el Servicio de Inmigracià ³n y Ciudadanà ­a (USCIS) se necesita adjuntar una copia del documento que se conoce como I-797 Notice of Action, que es la carta en la que se notifica la aprobacià ³n de la Accià ³n Diferida. Por el contrario  si fue ICE quien concedià ³ la accià ³n diferida, se tiene que enviar la notificacià ³n de esta agencia en la que asà ­ consta. Documentos para el viaje de salida desde  Estados Unidos Hay dos posibles situaciones: Si un Dreamer viaja a su propio paà ­s, necesita el pasaporte de su paà ­s que debe ser vlido por al menos otros seis meses. Adems, necesita llevar el permiso de viaje aprobado.Por el contrario, si viaja a un tercer paà ­s, deber adems asegurarse de si necesita solicitar visa antes de viajar a ese paà ­s. Por ejemplo, para viajar a paà ­ses como Italia, Espaà ±a, Francia o Alemania, los cubanos y bolivianos necesitan visa Schengen. Si se viaja a Mà ©xico, un destino muy comà ºn desde los Estados Unidos, un buen nà ºmero de paà ­ses necesitan la visa, como por ejemplo Repà ºblica Dominicana, Guatemala, El Salvador o Cuba. Consultar siempre antes de viajar con la pgina web de la embajada del paà ­s que se desea visitar. Por supuesto no se necesita un permiso de viaje advance parole para dentro de los Estados Unidos, incluidos los estados de Hawaii y Alaska y el avià ³n. Y tambià ©n se puede ir sin problemas a los miembros de la Commonwealth de los Estados Unidos, como Puerto Rico, Guam, Samoa o Islas Và ­rgenes Americanas. Cà ³mo es el regreso a Estados Unidos para Dreamers con permiso para viajar Se puede ingresar por avià ³n, barco o por una frontera terrestre. Hay que esperar un control migratorio por parte de un agente de la CBP y otro aduanero, que pueden ser muy rpidos. Estos son los documentos necesarios: Pasaporte sin expirar con una validez mà ­nima de seis mesesEl premiso de viaje aprobado Adems  se recomienda llevar: Permiso de trabajo, si se tieneLicencia de manejar, si se tieneCopia del documento en el que USCIS aprobà ³ la peticià ³n de DACATodos los documentos que sirvan para probar la razà ³n del viaje al extranjero (invitacià ³n a Congresos, documentos mà ©dicos de situacià ³n de un familiar muy cercano, transcripciones de estudios, etc). Y por supuesto no est dems tener siempre a mano el telà ©fono de un abogado migratorio de confianza. Adems, por precaucià ³n dejar siempre una copia en casa en los Estados Unidos de todos esos documentos. En caso de robo, extravà ­o o problemas migratorios siempre est bien tener una copia donde aparecen datos como los nà ºmeros que lo identifican, fechas de aprobacià ³n, expiracià ³n, etc. El oficial migratorio har como mà ­nimo una pregunta. Cabe esperar que se refiera a la razà ³n del viaje, tiempo que se permanecià ³ fuera de los Estados Unidos, quà © se hace aquà ­, etc. Este es un listado de preguntas comunes a cualquier persona que llega  a un control migratorio  de los Estados Unidos.   Despuà ©s se pasar por un control aduanero. Quà © hay que tener en cuenta para no tener problemas con  permiso para viajar Estos son los consejos que se deben seguir: 1. Absolutamente sà ³lo permanecer fuera de los Estados Unidos dentro de las fechas aprobadas en el permiso para viajar. Por ejemplo, si se viaja a un congreso que finaliza un dà ­a en concreto, solicitar un par de dà ­as ms para el caso sorpresas de à ºltima hora que impidan viajar. Asà ­ siempre se tendrà ­an unos dà ­as de margen para bregar con imprevistos. 2. Planificar con tiempo. Chequear cundo expira el DACA que se tiene actualmente, ya que no se puede pedir un permiso de viajar si DACA est pendiente de ser renovado. Pedir el permiso para viajar al menos 90 dà ­as antes del viaje. 3. Si se llega por mar o aire, el oficial migratorio siempre estampar el pasaporte, quedando asà ­ constancia de la fecha de regreso a los Estados Unidos y, por lo tanto, de que se cumplià ³ con las fechas aprobadas en el permiso de viaje. En el caso de llegar por una frontera terrestre, es muy importante asegurarse de que tambià ©n sellan el pasaporte. Si no lo hacen, solicitar que asà ­ se realice. Asà ­ se evitan potenciales problemas en el futuro. 4. No viajar fuera de los Estados Unidos jams sin este permiso, ya que se dar por terminado DACA y pueden impedir el regreso. Pero,  ¿es conveniente viajar fuera de Estados Unidos? Hay bastante unanimidad entre los abogados y expertos en este tema para opinar que los Dreamers que han acumulado ms de 180 dà ­as (seis meses) de presencia ilegal en Estados Unidos sà ³lo deberà ­an aplicar tras consultar con un experto y entender quà © puede ir mal. La razà ³n es que puede suceder que aunque el advance parole les sea concedido puede que cuando intentan regresar a Estados Unidos y lleguen al control de inmigracià ³n se encuentren con la realidad de que se les aplica la norma conocida como castigo de los tres y diez aà ±os. Y todos los dà ­as se ven casos en las aduanas en los que inmigrantes con un advance parole en la mano se encuentran con la desagradable sorpresa de que no se les permite entrar a Estados Unidos, alterndose asà ­ de un modo significativo sus vidas. Quà © se recomienda hacer en estos casos En primer lugar resaltar que hay otros casos en los que estar sin estatus no equivale necesariamente a acumular dà ­a de presencia ilegal. Por ejemplo, la acumulacià ³n de dà ­as calificados como presencia ilegal no ocurre cuando el inmigrante es menor de edad. Pero una vez que se han cumplido los 18 aà ±os de edad, sà ­ que se acumula el tiempo. En estos casos es muy recomendable contactar con un abogado bueno experto en inmigracià ³n, y, a poder ser, en el tema de la accià ³n diferida. Y en una cita analizar con detenimiento cules son los riesgos, quà © puede pasar y las circunstancias del caso de cada uno. Y desde luego siempre asesorarse con un abogado en casos experiencias de arrestos, deportaciones previas, posibilidad de tener una orden de deportacià ³n pendiente o estar en el medio de un proceso de este tipo. Informacià ³n de interà ©s para Dreamers que desean viajar a otro paà ­s La US-Mexico Foundation est convocando anualmente programas, como Dreamers without Borders, para viajar a Mà ©xico a mexicanos con DACA que nunca han estado en su paà ­s desde que ingresaron a los Estados Unidos siendo nià ±os.   Finalmente  los interesados en las experiencias de otros Dreamers con advance parole, se puede consultar la pgina de Facebook Traveling Abroad with DACA. Este es un artà ­culo informativo. No es asesorà ­a legal.

Cost and Quality Anaylsis Research Paper Example | Topics and Well Written Essays - 750 words

Cost and Quality Anaylsis - Research Paper Example As a result, this scheme improves quality and at the same time minimises cost as opposed to having a fixed dollar contribution and granting only two plans (The U.S. Department of Health and Human Services, 2013). The other initiative is the adoption of health maintenance organizations (HMOs) and competition. HMOs are very useful in reducing costs in highly competitive markets by through practice of hospital visits instead of ambulatory. For example, the competition between HMOs in a competitive market leads to lowering of premiums while at the same time forcing individual HMOs to maintain high quality in their services so they can remain competitive. In addition, State mental health parity mandate and managed care is a good strategy for addressing quality and cost in healthcare. The introduction of a managed behavioural health care plan by an insurer has led to a 39 percent reduction in mental and substance abuse costs. The Commonwealth Fund -private The commonwealth sponsored its fi rst health care quality program in 2000, which has supported crucial research on the shortcomings and causes in health care delivery, while at the same time emphasizing on the importance of inventive interventions to improve health care information technology infrastructure, as well as reducing patience safety and hospital readmissions. By identifying keys and trends to success, this initiative is contributing towards the understanding of joint care models referred to as accountable care organizations (The Common wealth Fund, 2012). Analysis of the program’s State Action on Avoidable Rehospitalizations (STAAR) is the other initiative that was supported by the Commonwealth Fund, which has led to considerable reductions in hospital readmissions within 30 days of discharge. Research shows that those taking part in the STAAR initiative are more expected to espouse interventions such as enriched patient education, improved assessments of patients before they are discharged from ho spital, and improved contact with post-acute care providers before they are discharged (The Common wealth Fund, 2012). In 2005, a Patient-Centered Primary Care program was launched, which is principally committed to supporting of the patient-centered medical home, a model that is very promising. This initiative is helping the country-wide primary care practices to change into medical homes, which offer uninterrupted admission to coordinated care, hence improving health care quality and at the same time reducing health care expenditures per capita (The Common wealth Fund, 2012). Possible unintended consequences As discussed, there are many strategies that are implemented by both public and private health agencies in the recent years. Although some of these including certain employer contribution techniques, managed care for addressing the cost implications of parity mandates, and competition among HMOs - have been at least to a certain extent successful, many of the others have mixed results. In some situations, shifting economic conditions may result to negative consequences. Although the above discussed programs are meant to enhance health care provision while at the same time ensuring cost-efficiency health care practices, sometimes these outcomes have some unintended consequences (Boaden et al. 2008). This is especially because positive change in a particular area causes pressure in another area, mostly leading to undesirable results. For a case in point, an