Consumer Behaviour Paper

How we can reduce the yellow pages The use of internet Yellow pages reduces the use of printed yellow pages. In fact, with proper employee training, the business owners are assured of approximately 300% ROI for $12,000 modest investment (Amanda 2008). Switching to online yellow pages is a move that promotes a paperless society that is environmentally friendly.Advertising We will write a custom essay sample on Consumer Behaviour: Paper-less society through reduction of Yellow Pages and increasing online books specifically for you for only $16.05 $11/page Learn More After all, since the year 2007, print usage of the yellow pages stagnated at 13.4 billion according to Punjabi M. K. et al. (2008). This corresponds to a declining 87 per cent of people in the United States using the Print Yellow Pages since 2007. Thus, the use of online yellow pages proves that they are cheap, convenient and environmentally friendly. In fact, not only this fact results in a pa perless society because it also encourages green computing where papers and energy are conserved. Use of opt-in and opt-out strategy advances to reduce or ban print yellow pages delivery. For example, in San Francisco, one is required to opt-in in order to receive the print yellow pages; otherwise, such deliveries are banned since passage of the ordinance. The development of an online advertising campaign to search for engines as well as the internet yellow pages is significant in this endeavor. According to the report filed in the year 2000 (see Appendix), the use of online search engines resulted in 67 per cent including online yellow pages. On the other hand, the printed yellow pages had a response of 55 per cent as compared against the cost, convenience and user friendness (Chiras 2009). Ultimately, as it is suggested by Boutin (2011), 80 per cent of the directory costs are saved if yellow pages are recycled. The waste reduction initiative will cuts down on paper and yellow page s consumption by 25% compared to other newspapers covering 70 per cent. How we can expand online books rather than bookstores The online books are more accessible and interactive than the books in printed form at the bookstores. According to English.news.cn (Guanqun 2011), about 98 per cent of internet browsers experience stress-free access to any online books. The need to increase online books is essential in correspondence to the high level of interactive as the books range from audio books, practice books, videos and word definitions.Advertising Looking for essay on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More One can expand the online books over bookstores through indexing service. Immense steps have been undertaken by Eat Your Books to upload over 88,000 books coupled with 2000 indexed volumes. Online surfers just indicate in the site that books are theirs, thus, enabling them to have an access to a great variety of books. This builds a virtual bookshelf as an account for every user just like having a personal library or renting books from a bookstore. Online books enable readers to explore through millions of copyrighted books, browse passageways and buy copies. This was confirmed when Google paid $126 million (8.5 million pounds) to build a Book Rights Registry. The Book Rights Registry enables authors and publishers to register books and get reimbursement from the sale of books. Again, one can set up the user account to receive email access on new online books opposed to getting to the bookstore. The discounts offered in online books (30 or 40% off) make them cheaper than in any bookstore, which offers lower discounts at 20 % off (Guanqun 2011). Appendix Turn-Page 2011, Turn-Page Increases ad revenue. References Amanda, B., 2008. How to reduce your carbon footprint. New York: Crabtree Publishing Company.Advertising We will write a custom essay sample on Consumer Behaviour: Paper-les s society through reduction of Yellow Pages and increasing online books specifically for you for only $16.05 $11/page Learn More Boutin J.P., 2011. Yellow Pages Going Green. Life in Yellow A blog by Yellow Pages Group, [blog] September 1. Web. Chiras, D. D., 2009. Environmental Science. Burlington: Jones Bartlett Learning. Guanqun W., 2011. Traditional bookstores fight for survival as online book sales boom. English.news.cn, Web. Punjabi, M. K., Anderson T., Katz M., McMillan L, Petri G., 2008. New Research Shows Overall Yellow Pages Usage Growing — 17.2 Billion Searches in 2007. Yellow Pages. Web. This essay on Consumer Behaviour: Paper-less society through reduction of Yellow Pages and increasing online books was written and submitted by user Jadon Brooks to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Essay on Huangyo Ki

Essay on Huangyo Ki Essay on Huangyo Ki On Nov.4th 2008, a California ballot proposed an amendment to the California constitution called Proposition 8, also called the â€Å"California Marriage Protection Act.† This amendment added to Section 7.5 of the California constitution that â€Å"Only marriage between a man and a woman is valid or recognized in California.† The fight between the supporters and the opponents of the bill lasted for years. On Feb.7th 2012, a panel of the Ninth Circuit Court of Appeal declared Proposition 8 to be unconstitutional. This paper will discuss the conflict between the state court power and federal court power as well as the perspective of the Federalist. Publius promised people the ultimate power; he also had concerns over pure democracy. â€Å"A pure democracy†¦, who assemble and administer the government in person, can admit of no cure for the mischiefs of faction. A common passion or interest will, in almost every case, be felt by a majority of the whole; a communication and concert result from the form of government itself; and there is nothing to check the inducements to sacrifice the weaker party or an obnoxious individual.† Publius worried the majority would use their power to oppress the interest of the rest while the opinion of the majority might not be right. This majority tyranny occurs in Proposition 8 case. The supporters of same-sex marriage are the minority whose interests are overrode by the majority 52%. However, this result is inevitable because â€Å"Direct democracy is, by its nature, based on the principle of the

Organizational Power or Politics Term Paper Example | Topics and Well Written Essays - 750 words

Organizational Power or Politics - Term Paper Example They should serve as guiding principles for the success of an organization and particularly in managing and empowering employees. Power is such an important element for the success of an organization, but it is a broad concept at the same time. It could either harm or help an organization depending on how it is implemented. In the context of an organization, it is defined as the ability to do or acquire something (Nelson & Quick, 2011). In this definition, power is concerned on the capacity of an individual to influence and employ authority over a certain organization or group. In other words, there is a clear distinction between power, influence and authority. Power is the ability, influence is a process and authority is the right of a person to create impact on the lives of others (Nelson & Quick, 2011). Power can be significantly viewed as the ability to influence and employ one’s authority. Thus, power should consist of combined ability to apply influence and authority. It is in this reason why power is such an important concept that for a long period of time continues to be one of the most signific ant issues that need to be taken into account in leadership and other related essential activities within an organization. In this paper, the proponent tries to discuss and analyze the basic and essential concepts of power and political behavior in an organization based on the ideas of Nelson and Quick. The essay starts with the discussion of their ideas on power and political behavior, followed by analysis and conclusion. Nelson and Quick discuss important issues regarding power and political behavior primary within the context of a group or an organization. First, they place substantial distinction among the concepts of power, influence and authority. For them, each of these has different impact and usage. A manager may have the right to take control over employees but this would not

Historia Electronica Preface, Essay Example | Topics and Well Written Essays - 250 words

Historia Electronica Preface, - Essay Example However, all this is missed out in electronica why so much of it is characterized by naà ¯ve melodies that resemble chimes of a music-box. In electronica, the pigment is more essential that the lines and therefore complicated melodies would definitely hinder the materiality of the original sound. Due to the recent technology which includes the use of computers to serve the purpose of the guitar and digital signal processing, allow an outstanding display of timbral colors. In electronic music dance, every element functions as both rhythm and texture. On the other hand, melody is presented as simple, little vamps that function as rhythmic cogs which interlock, resulting to a groove. Drums patterns are mostly experienced in electronica music dance and the rhythmic subdivisions become more complex overtime. Electronic music dance portrays the aspect of being lost in music. People are carried away by the rhythmic sound as they are meditatively engaged in the sonic events that infuse more. Drug imagery comes out as a central aspect in electronic imagination, and this enumerates the loss of ego that makes one to be overwhelmed. In the hierarchy of senses, sight which is mostly privileged is overthrown as hearing is considered the most superior sense. This notion provides a good reason as to why light is not preferred in warehouse raves. The impression created out of this is that when visual is diminished, sound becomes more vivid. The audio-tactile which is a vibrational continuum acts as the amplifier and literally obscures retinal perception. The culture of the dance is about participation while the video is about spectatorship. If the club is more underground, it is likely to experience less visual distractions as there is less to be seen and the scene is more hardcore in electronic mu sic dance. Electronic dance music is closely connected to the drug culture. Even when the music is not meant to enhance drugs, it relays drug-like

Planning for Learning Essay Example | Topics and Well Written Essays - 2000 words

Planning for Learning - Essay Example Hence it is important to build a homework structure for them and that should find place in middle and high school. The important aspect to be observed is that the planning for learning should consider improvement but not perfection. The planning should consider recording, having the books necessary for learning, reviewing of the student's books, agreeing with the student to participate in the learning program, making them to follow assignments and study hours, keeping them honest in doing work, developing sustenance of attention to follow the planning, making the student to use a calendar to track long term assignments and periodically work on them instead of leaving them for the last minute. Another important aspect in planning a learning program is to assess the learner's needs and behavioural problems. The planning of programs for learning should be according to the assessment. The learning programs as part of the planning should follow inclusive teaching and learning strategies. The teacher should concentrate on managing the process as well as environment as the success of planning in case of ADHD students depends even on environment. At the end of the program it is necessary to assess the outcomes of learning programs. After that it is necessary for a teacher to reflect his/her performance for future practice (Arthur Robin, 2009). 2 Assessing Learners Needs Assessment can serve different purposes as it can grade the attainment of learners. In assessment teacher should consider emotional and practical needs of the student and plan accordingly. The communication that has occurred between teacher and the student helps in assessing his needs practically as well as emotionally. The important aspect in assessing is verbal questions by teacher to students and in the course trying to fulfil their emotional needs. By questioning, teacher can understand the lapses in understanding the problem by the student and that helps in developing a plan for learning for the students having behavioural problems like ADHD as they have attention deficit and, which results in lack of understanding. In addition to that practitioners found that the questioning involves the students and develops communication with teachers thus enabling them to know the points where the student lacks attention. One assessment a teacher can make by questioning is the difference bet ween the students who know and who can understand. If a teacher can find the students who just only know, he/she can plan a program that helps them in understanding the aspect and the concept of the lesson. According to David Edward Gray et al (2000), FENTO Standards for teaching recognise the importance of professional assessment of students that underpins learning as well as achievement. The assessment needs the verification of key elements like vocational curriculum, competencies, underlying knowledge and key skills. The authors of book 'Training to Teach in Further and Adult Education' state that assessment is a process by which evidence of student achievement is obtained as well as judged. It requires evidence and a scale of standards. The assessment includes the capability of the student, performance relative to his/her group and his

Patient Advisory Board Internship

Patient Advisory Board Internship Patient Advisory Board Internship at Zuckerberg San Francisco General Hospital For this cooperative education project I have chosen to write about my internship at Zuckerberg San Francisco General Hospital (ZSFGH). I was chosen for this internship from a pool of pre-medical student applicants based on my resume, letter of interest and in person interview. The work was advertised as needing someone to run the formal Patient Advisory Board Council (PAC). I wasnt aware until my interview with the Medical Director and Floor Manager that I would be doing much more than running a once a month meeting. I would also be in charge of recruiting new members to the PAC, seeking out presenters and providers wishing for patient input, enrolling patients in and training them to use the online SF Health Network Patient Portal, running the monthly Diabetes in Motion Clinic, and doing various other small duties around the hospital. I had to commit to being available 30 hours a week that were flexible but must include Fridays. I was excited to be chosen for this opportunity to ha ve great potential in improving patient health and satisfaction at ZSFGH, San Franciscos community safety net hospital; while also growing my own knowledge of what it takes to provide high quality health services to underserved populations. Before being allowed to start my volunteering duties there were many steps I needed to tackle to be eligible to work with patients, both for my own safety as well as theirs. I had to find time to go to the hospital to procure blood work and testing to be sure I didnt have Tuberculosis or a list of other communicable diseases. I was required to take just over 10 hours of training geared to helping familiarize myself with the layout of the hospital; in addition to how to safely interact on a daily basis with the unique population at ZSFGH. My learning objectives were to understand what I would need to do in my daily work to knowledgably comply within HIPAA rules and NIH safety protocols. Method For my content for this report I performed research on site at my Internship. ZSFGH has an extensive medical library that is free and open to the public. The librarians are well versed in what is available in the event that I had any questions arise during my time there. The Volunteer Services Office also stocks many resources that are available for learning about how best to care for patients wellbeing and properly protecting their personal information online and in daily hospital interactions. I utilized both of these resources in my off-volunteer hours either before or after doing internship qualifying hours. Discussion Literature Review Initial Onboarding In order to be able to be an official volunteer at ZSFGH, I had to complete their online Volunteer Orientation Course. This took about 2 hours and was helpful in walking me through the layout of the SF Health Network as well as the buildings where I would be working. Also outlined were the health requirements of all volunteers in the network requiring blood work and vaccinations. After completing those steps I was assigned a volunteer identification number to be able to log my Internship hours and a badge identifying me as a Volunteer that also shows which clinic I am a part of, my flu-shot status and lists the hospital wide emergency response codes for easy reference. In order to be useful in my positions I needed to learn about the San Francisco Health Network Primary Cares missions and vision for providing the highest quality primary and preventative care to adults, regardless of ability to pay. There are 4 main aims of the clinic that follow from building a foundation of healthy, engaged, and sustained primary care workforce. To ensure an excellent patient experience, optimize access, operations and cost-effectiveness, have sustainable patient centered care and finally, to improve the health of the patients served. The specific clinic I was hired to do my internship with was the Richard Fine Peoples Clinic General Medicine Clinic (RFPC-GMC). This is a clinic consisting of mostly low income, homeless and immigrant patients. The Volunteer Services Office at ZSFGH assisted my learning about patient information security by providing some short video training from the SF Department of Public Health. (Public Welfare, 2009) This helped me learn what information qualifies as needing to be private and secured; treated as sensitive and protected health information. There is an established national set of standards for identifying protected patient health information (PHI) such as a patients demographic data relating to past, present or future medical needs. (The Health Insurance Portability and Accountability Act of 1996) It is anything that can be used to identify patients such as their first or last name, medical record number, phone numbers, email addresses, date of birth, Social Security Number or a ddress. Rules for handling such information is that you must never store PHI on an unencrypted computer, a flash-drive or take home files with PHI. If necessary for an email this information must be encrypted and titled as Secure. Written information must be disposed of in the locked to be shredded bins when no longer needed. Information can be stored on the provided work computer server only accessible by UCSF ward computers. (Burnap, 2012) Unlike a Kaiser or Sutter insurance network hospital or clinic, the SF Health Network is part of the citys health system that provides a significant level of care to low-income, uninsured, and vulnerable patient populations. ZSFGH is a unique in that it is also a training hospital tied with UCSF. Patients benefit from cutting edge training for their Doctors and Residents as well as generous philanthropic funding that the University benefits from annually. A large part of ensuring patient self-empowerment lies in building their networks and increasing accessibility to services, which this funding can bring. (Corburn, 2007) Patient Advisory Council Prior to working within the SF Health Network I was not aware that there were 26 clinics across the city. This aids in vastly improving patients access to care in or near their own neighborhoods. Each clinic was challenged with starting their own PAC in 2016. There are now 21 PACs across the city for various different types of clinics and patient populations including 2 in Spanish and 1 in Mandarin languages. Prior to instating these PACs much of the average providers knowledge of patient satisfaction was just word of mouth. The main motivating force behind coordinating clinic PACs is aimed at inviting longtime and new patients to provide input for quality improvement projects from the ground floor. Assessing involvement at the direct patient level can lead to fast strides in community health improvement. (Dannenberg, 2008) I was responsible for the outcome of the Richard Fine Peoples Clinic PAC. I needed to work on recruiting new and diverse members to the team and learn how to lead a group of people that is outside of my everyday socio-economic peer group toward a common goal. I looked to resources for what has worked for other projects for medical recruiting methods prior to mine. (Dannenberg, 2006) I had to coordinate presenters and inquiring providers to ensure that the board provides helpful information to both patients at the clinic and those within the larger health care network. While the focus was on our individual clinic, there is also a hospital wide PAC that was able to push forward any ideas we might have that would benefit the entire hospital population at ZSFGH. In addition to organizing the agenda for the PAC meetings, my duties involved gathering information from patients and providers that generated from our meetings to then enter them into other systems and/or up-channeling ideas inv olving specific patient populations and their recommendations and desires. Some more recent accounts of improving health at one community level have shown to have a positive impact on the entire city. (Bhatie,Corburn, 2011) I kept meticulous records of all agendas and minutes of every meeting for all attendees records as well as past and future reference needs of progress. I was also assigned to help the RFPC Residents on their new project concerning the SF Health Networks Patient Portal. They tasked me with recruiting current patients to enroll in the waiting room. The Patient Portal is a tool for empowering patients to be proactive regarding their own health. Most of my patients are housing insecure so I had to seek out examples of positive outcomes of patients evolving from homeless to housed and how to be aid those in transition. (Kessell, 2006) A few strategies for recruiting new patient advisors, portal users and clinic class attendees were given to me by the previous Intern that I was replacing. I had to meet quota goals for portal enrollees, training and tracking; recruit new patient users in clinic for the online Patient Portal and do some data entry for tracking contacts, new enrollees and demographics. I had to figure out the best way to narrow down how best to contact clinic patients to arrange one on one training sessions for the online Pa tient Portal. I looked into ways in which your immediate surroundings can shape your ideas of your own perceived ability to achieve healthy outcomes as guiding the ways I would approach patients. (Cummins, 2005) To keep the PAC running, I needed to also book conference rooms for upcoming meetings and was able to book a nice meeting room through December 2017 for ease of transition for the next intern. I made reminder calls and sent out an agenda one week prior to meetings to those members with access to email. I collaborated with members to see what topics they are interested in learning more about for upcoming meetings as I was responsible for coordinating them with presenters. (Dearing, 1996) I surveyed members about what their favorite snack foods were so I could best provide for our meetings. I was allowed to spend $50 for each meeting so we had quite an assortment of foods, all within reason of course as we are promoting healthy lifestyles after all. I guided the meetings but also recorded notes for action items to follow up on as well as to write minutes for future reference as available to the public. Diabetes in Motion Clinic The SF Health Network also has a Community Wellness Program branch that allows for patient learning on a variety of fronts from smoking cessation lectures to Zumba classes and nature walks. The Wellness Programs are offered at several clinics across the city and aim to provide and promote innovative services to staff, patients, their families and all San Franciscans. They are designed to be accessible culturally and linguistically as well as to all physical ability and/or limitation levels. The classes that are part of the Working on Wellness (WOW) Healing Moves, Active Living Initiative are open to all and free of charge. Another important part of my duties was to also work on chronic disease group visits in the diabetes clinic. It was important to help try and understand the unique hurdles specific to this particular patient population. (Bhatia, Seto, 2011) The Diabetes in Motion (DIM) Class was an extra duty inherited by me as the previous Practice Manager moved to Hawaii and requested that the incoming PAC Coordinator (me) adopt the class. This 2 hour class was held once a month and tasked with helping those with Diabetes, the pre-Diabetic and their caregivers better understand how to help improve their conditions. I noticed immediately that there might be low attendance, only 5-10 attendees, due to a lack of a unified agenda across the year of these classes. I researched ideas of how living in an urban environment can impact health and wellness differently than a more rural setting for insight into health problems. (Bodea, 2009) I decided that we would try breaking the class into 2 portions, a movement portion (due to the title) and a healthy eating portion. There was no dedicated staff and, as we had plenty of funding left in the available grant I was able to hire 2 local instructors. I hired Sylvie Minot, leader of the Syzygy Dance Project as an Exercise Instructor and Catherine McConkie, Founder of The Caregivers Table as our Nutritionist. Ms. Minot was able to lead progressive movement exercises that were accessible to all levels of mobility incorporating yoga, stretching and dance movements. The importance of exercise is shown across the lifespan. (Bauman, 2007) During the exercising portion of the class she would lead a discussion about the importance of incorporating movement throughout daily life. (Saelens, 2003) Ms. McConkie would follow for the second half of class with easy and affordable food ideas that she made during the class so the attendees could participate. In addition to making healthy options accessible, she would also pass around ingredients that might be new or unusual for the patients and discuss why certain foods are good or bad to eat. Eat Better, Feel Better! Colorful Choices is a San Francisco Health Service System program aimed at adding more fruits and vegetables to daily routines. I was able to team up with them for our classes to provide free fruits and vegetables to attendees. (Drewnowski, 2004) A $25 Safeway gift card was given to the first 22 participants that stayed for the entire class. Participants were able to take home a bag of food to make the recipe presented in class, for any who could not afford them on their own. (Kim, 2006) I created and distributed English and Spanish language flyers throughout the hospital as well as purchased the patient incentives, organized an agenda with the instructors and ensured 2 interpreters (Spanish and Mandarin language) could attend. Following each class I gathered receipts from all 5 of us leading the course to submit to our grant overseer for documentation and reimbursement. Our attendance went from a low average to roughly 30 patients per class in just 3 months. Patient Portal In addition to putting together the DIM and PAC monthly meetings I was assigned to work with the RFPC Residents that were writing a research paper on empowering patients to improve their own care knowledge. The biggest aspect of this was increasing patient awareness, enrollment and use of the SF Health Networks Patient Portal. This online tool enables patients to see all of their most recent and up to date data from any meetings with providers as well as testing and results. Not only can this aid individual improvement through expanded knowledge of care but it also provides an easily accessible list to give to out-of-network providers. The system also newly rolled out the ability to email your assigned provider. The system self regulates to ease provider burden by immediately rerouting easily accomplished tasks such as appointment scheduling or refill requests before any emails actually go to the provider. Initially, I was tasked with 10 hours per week of recruiting new enrollments in the Patient Portal system by visiting with people in the waiting room. With an iPad in one hand and flyers in multiple languages in the other, I spoke with each patient on hand to see if they were aware of the program and would like to enroll if not already. I tracked demographics for the residents as well as number enrolled by me or already. I also had proxy forms available if someone wanted their child or spouse etcetera to have access to their information due to any learning disabilities or language differences as the system is only currently in English. I was able to use Google Translate as well as my flyers in 6 different languages to speak with everyone in the room one by one. After doing this for 2 months the residents decided I should transition to training users to increase the amount of actual users of the system once enrolled. I utilized the electronic Clinical Works application (eCW) to resear ch which patients were already enrolled in the Portal. I would then call patients with appointments on a particular day for the next week as determined by the Residents until I found about 10 people willing to meet with me before or after their appointments. Together, we would then walk through accessing the system and what benefits and uses it provides to the patient. I would send training videos to anyone I spoke with that wasnt interested in meeting in person that they could view on their own if they so wished and they had access to my UCSF email if they had any further questions arise. The largest barrier to increasing user numbers or active users for the Patient Portal ended up being access to electronics and language barriers. The specific patient population at RFPC has phones that may or may not be web-enabled and a lot of them do not have computers or are computer savvy. In meeting with patients I was able to teach them how to recover their login information and perform simple computer navigation. I provided introductions to the hospital library where free computers are available all day that I had never seen full. The system is eventually scheduled to be accessible in Spanish and Mandarin sometime next year. Extra Tasks There were some one time tasks on my plate as well. I needed to accomplish the yearly update of the Clinic Care Team Boards. All of the providers are divided into one of three color care teams to help ensure that, even if you cannot visit your assigned Doctor, you will see someone familiar with them and your file. The previous boards were on a small black and white listing with a few pictures. I used the Adobe program InDesign to organize everyone by provider type, team, procured color head shots of all providers and found a local print shop to print each team board on a 3 x 5 color poster. I also needed to keep the waiting room stocked of specific informational flyers and magazines every few days. Results Participants Adult patients I was able to add to the PAC were recruited through various methods. Informational flyers were posted in the waiting room and at the pre-appointment health screening station. Providers were encouraged to mention the Council to patients they felt were well informed and/or had the desire to work on quality improvement projects for the Clinic. Most respondents that became full time members of the Council were older adults, 45-72 year old, 4 women and 6 men. Participants were compensated $10 and offered free food (cheese, meat, crackers, fruit, veggies, cookies and water) for their 90 minute participation at each meeting. 3 of the members additionally qualified for free Muni transportation vouchers and 1 for free parking passes. All participants were asked to read the agenda sent to them one week prior to each meeting to prepare any questions or ideas they might have on each topic scheduled to be addressed. Accomplishments Weve been able to get funding to remodel the waiting room with more comfortable furniture, a new color of paint on one wall (blue instead of white) and wall hangers to provide information of free local services available throughout the month. Weve also spearheaded projects such as surveys to fill out prior to your appointment while you wait in the waiting room and converting the waiting room television from daytime drama shows to clinic specific informational ticker that rotates from a video documentary about the namesake of the clinic to various free or affordable services offered throughout the city for the current month. Starting in April, we will be part of the coordinated effort to have Food Pharmacies across the network. In partnership with the SF Marin Food Bank, patients will be able to get a bag of free and healthy food after their appointments. PAC members will be available once a week to assist. Another issue raised was of transit safety. One of our members was on disability due to having been run over by a vehicle while she was legally using a crosswalk. The incident left her unable to work for over a year while undergoing multiple surgeries and a lengthy recovery. We had several presenters come to a meeting to get insight from our patients in regard to possible pedestrian improvements. (Mejia, 2017) The PAC raised money to have a portrait painted of our Clinics namesake, Dr. Richard H. Fine that it is to be hung in the waiting room. We are waiting on the display box that is being made to keep it displayed securely. Dr. Fine founded the General Medicine Clinic at ZSFGH, one of the first outpatient clinics in the nation at a Public Hospital that provides health care to underserved populations. He ran it for 25 years. To recognize and thank Dr. Fine for his acute discernment of patient needs, the General Medicine Clinic (GMC) was renamed as the Richard H. Fine Peoples Clinic (RFPC) in August of 2015 three months before his death. There is a wonderful documentary about his life that I was able to show the PAC members at the end of one of our meetings. (Biker with a Moral Compas: Dr. Dick Fine and the Evolving Culture of SFGH http://mission-healthequity.blogspot.com/2015/07/moral-compass.html) I was able to establish more clear and concise PAC values and guidelines as none had been expressed in writing prior to my tenure as leader. We were to work in partnership and collaboration to address systemic issues versus individual situations. We would do so by working in partnership with the clinic management to support the clinic mission and vision. We would represent the diverse socioeconomic and cultural needs and perspectives of RFPCs patients. We would seek the input of other patients to broaden perspectives. We also established term limits to facilitate turn over and diverse patient representation. Our meetings would create and maintain a safe environment for all members and guests to share ideas and points of view. Respect would be given to the confidential nature of information received at the meetings and we would review and sign HIPAA confidentiality agreements and release forms annually as opposed to only upon initial recruitment. As the PAC coordinator I worked hand i n hand with the Clinic Champion, Mr. Michael McGuire who, as the Practice Manager of RFPC was the link between the PAC and clinic leadership. He was able to provide some assistance to help me coordinate with staff and providers to ensure successful collaboration on PAC initiatives help me ensure progress was being made on PAC projects. DIM The grant to fund the DIM Clinic was picked up for renewal for next year and the instructors I chose were invited to stay and wished to do so. The dramatic increase in attendee numbers rose from 5 or 10 to upwards of 30 under my tenure. We received a lot of positive feedback from patients with successful weight loss and blood sugar stabilization. Patient Portal Recruiting Training I was able to interact with 815 patients in the waiting room and successfully enrolled 230 new Portal users. For online, in person training I spoke with 87 patients over the phone and met one on one with 34 for individualized training. This data will be included in the Residents research paper as well as my experiences with what the patient population specific challenges were for our Clinic. Conclusion I was able to impart some positive change within the community of ZSFGH during my Internship. I also learned several important lessons such as how communication can be difficult at times but its helpful to try to display an open and approachable demeanor. Patients may be upset when they do not receive what they have requested from staff, but remaining clam and expressing compassion can help diffuse and redirect the situation. Because of Dr. Fines close connections to the community, he was able to hear about subsets of people who were not seeking health care and make visible what was invisible to many. I am happy to have been a part of so many diverse projects to assist disenfranchised and marginalized populations of San Francisco. Empowering patients to be proactive about their own care and the outcomes they wish to see has been my main take away from this internship. Helping patients to see ways to incrementally improve their own physical and mental health can not only save money in treatments not needed down the line but also be the first steps towards becoming more independent and being well enough to provide their own income and stable housing. While the community wellness programs in San Francisco promote interventions aimed at addressing lifestyle issues such as diet and smoking, they also recognize the ways in which social determinants of health such as housing status, neighborhood safety, and access to affordable healthy food play a critical role in wellness promotion and encouraging healthy lifestyle choices. With this in mind, I worked to incorporate strategies such as public health education and advocacy in addressing poor health outcomes during my Internship. References Bauman A, Bull F. Environmental Correlates of Physical Activity and Walking in Adults and Children: A Review of Reviews. London: National Institute of Health and Clinical Excellence; 2007.Bhatia R, Corburn J. Lessons from San Francisco: Health impact assessments have advanced political conditions for improving population health. Health Affairs. 2011 Dec:30 (12):2410-18Bhatia R, Seto E. Quantitative estimation in Health Impact Assessment: Opportunities and Challenges. Environmental Impact Assessment Review. 2011. DOI:10.1016/j.eiar.2010.08.003Bodea TD, Garrow LA, Meyer MD, Ross CL. Policy and Practice: Socio-demographic and Build Environment Influences on the Odds of Being Overweight or Obese: The Atlanta Experience. Transportation Research Part A 2009:43(4):430-444.Burnap P, Spasic I, Gray WA, Hilton JC, Rana OF, Elwyn G. Protecting patient privacy in distributed collaborative healthcare environments by retaining access control of shared information. International Conferenc e on Collaboration Technologies and Systems. 2012:490-497 DOI: 10.1109/CTS.2012.6261095Corburn J, Bhatia R. Health Impact Assessment in San Francisco: Incorporating the Social Determinants of Health into Environmental Planning. Journal of Environmental Planning and Management. 2007 May:50(3):323-341Cummins S, Stafford M, MacIntyre S, Marmot M, Ellaway A. Neighborhood environment and its associations with self-rated health: evidence from Scotland and England. Journal of Epidemiology and Community Health 2005 59:207-213.Dannenberg A, Bhatia R, Cole B, et al. Use of Health Impact Assessment in the United States: 27 Case Studies, 1999-2007. Am J Prev Med. 2008 Mar:34(3):241-56Dannenberg AL, Bhatia R, Cole B, et al. Growing the Field of Health Impact Assessment in the United States: An Agenda for Research and Practice. Am J Public Health. 2006 Feb:96(2):262-70. Dearing JW, Rogers EM. Agenda-setting. Thousand Oaks, CA: Sage. 1996:5-20 Drewnowski A, Darmon N, Briend A. Replacing fats and sweets with vegetables and fruits a question of cost. American Journal of Public Health. 2004 94(9):1555-1559.Kessell ER, Bhatia R, Bamberger JD, Kushel MB. Public Health Care Utilization in a Cohort of Homeless Adult Aplicants to a Supportive Housing Program. J Urban Health. 2006 Sep:83(5):860-73Kim D, Kawachi I. A multilevel analysis of key forms of community- and individual- level social capital as predictors of self-rated health in the United States. Journal of Urban Health 2006 83(5):813-826.The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191 ÂÂ § 261-264Public Welfare, Department of Health and Human Services, 45 C.F.R. ÂÂ § 46 (2009). (C.F.R. is the Code of Federal Regulations) Mejia, P. Beyond the Traffic Report: The News About Road Safety and Vision Zero in San Francisco. Berkeley Media Studies Group. 2017 Jan:3-12Saelens BE, Sallis JF, Frank LD. Environmental correlates of walking and cycling: findings from the transportation, urban design, and planning literatures. Ann Behav Med. 2003;25(2):80-91.

My Last Duchess :: Robert Browning, My Last Duchess

Robert Browning is the author of "My Last Duchess" and he shows the audience how it is a dramatic monologue. In a class lecture, the professor had mentioned that the poem is set in the 15th century. During that time, it was common for a young woman to be arranged in a marriage. As the poem unfolds, the audience learns the speaker of the poem, Duke Ferrara, is talking to another male character and begins to tell the story of his previous wife. As they are standing in front of the portrait of the Duke's last wife, now dead, the Duke talks about her imperfections. The reader discovers that the ex-wife's "imperfections" were qualities such as generosity, courtesy to those who served her, and an overall respected woman. What follows are examples on the nature and personality of the Duke. Browning lets the reader to believe that the Duke has found flaws of his previous wife because she did not respect his rank and his power. More importantly, the Duke did not approve the behavior of his previous wife and will tolerate it again. As the story begins, the Duke is speaking to the other male character about the portrait of his previous wife. A painter by the name of Fra Pandolf had painted the portrait and it is said that Pandolf's hands may have wandered as well. The following lines can make the audience wonder about the relationship between Pandolf and the Duke's ex-wife. "That piece a wonder, now: Fra Pandolf's hands / Worked busily a day, and there she stands" (lines 3-4). The Duke is now left to wonder that if his ex-wife and Pandolf may have had a relationship of some sort. In the poem, the Duke does not reveal the painting to any person. He is the only person that is allowed to reveal the portrait from the curtains that cover it. Although he does not show anyone t he portrait, the Duke had revealed the painting to the other character. "The depth and passion of its earnest glance But to myself they turned (since none puts by The curtain I have drawn for you, but I) And seemed as they would ask me, if they durst" (8-11). The audience is learning very early in the poem that the Duke questioned his relationship with the Duchess in the portrait. It is at this moment in the poem that the Duke begins to tell the reasons he did not trust his ex-wife.

Why Support the Kidney Care Quality and Improvement Act

For the past years, health and health care have transformed to become the dominant economic and political issues in the United States and many other countries. Because most nations have experienced rapid rises in health care spending over the past 30 years, governments have assisted patients in their countries because the cost is simply becoming unaffordable for them.During the earlier times, provision of health care was a relatively simple matter. Doctors carried most of the equipment they used in a black bag and the same doctor was likely to attend a patient for most, or all, of her or his life. During those days the range of medical and surgical interventions was quite modest. Today, sophisticated diagnostic technology complements an extensive array of medical and surgical options making medical care a very complex, highly specialized, and costly commodity.One of the most alarming diseases that had burdened American people is kidney failure. According to a U.S. Newswire report (16 March 2005),   approximately 400,000 Americans currently suffer from kidney failure and of those, around 300,000 require dialysis several times a week, for an average of 3.5 hours per session. At the current rate of new cases — many the results of diabetes, obesity and hypertension — the number of patients is expected to quadruple to more than 2.2 million by the year 2030. Many experts recommended that early detection and better disease management is regarded as the best means to delay the onset of kidney failure.Definitely, kidney function is essential for life. Once a person’s own kidneys fail, some form of treatment is necessary if they are to go on living. Currently, there are two forms of treatment – dialysis (in which the kidney function is taken over by artificial means) and transplantation (in which another person’s kidney is used instead). Successful treatment – by dialysis or a transplant – now gives people with kidney fa ilure a new lease of life, sometimes for many years (Stein 2002, p. 122).However, death can be inevitable. Patients and families usually want to know how long a person can survive with untreated end-stage kidney failure. This too is variable, depending on the extent to which their old kidneys are working – and therefore the amount of urine that they pass. The kidneys may be able to get rid of some excess fluid, but unable to process waste products such as creatinine and urea, or salts such as potassium. It is the build-up of these substances in the blood (especially the potassium) that usually leads to death. This is why dialysis represents the success of our knowledge and skill in conquering a kidney illness. Dialysis is all about life. And, it could cost an insurmountable amount of money when someone goes to dialysis three times a week for the rest of his or her lifeIndeed, there is an immediate need to improve the government’s program that provides dialysis care for those with kidney failure. This is why the members of the U.S. House and U.S. Senate introduced bipartisan legislation to update the End Stage Renal Disease (ESRD) program, which 75 percent of the nation's dialysis patients rely on to live.This is called The Kidney Care Quality and Improvement Act of 2005, sponsored by Senators Rick Santorum and Kent Conrad, and Representatives William Jefferson and Dave Camp. This legislation would update Medicare's composite rate for ESRD — which does not automatically adjust for inflationary increases — as well as provide for important education and preventative programs to help stem the rising tide of kidney failure in the United States (U.S. Newswire, 16 March 2005).The primary reason for health care is to prevent or cure diseases or attend to people with chronic or terminal illnesses. It may be possible, however, for health care costs to undermine the soundness of what our pockets can afford, and such an eventuality would be und esirable. Hence, a pressing issue entails how to achieve a situation in which expensive medical care can continue to be available while, at the same time, the total cost of health care is scaled back so as to keep this cost in line with the overall rate of skyrocketing prices.For instance, Talladega in Alabama has only two dialysis units and there are almost 100 patients that cramp the two units. With The Kidney Care Quality and Improvement Act of 2005 patients will be assured for better care among patients stricken with kidney disease through improvements in Medicare and enhanced education programs, which would prevent numbers in Talladega County from growing any more. Although the act currently sits in a Senate committee awaiting approval, that’s not stopping local doctors from offering warnings to at-risk patients.Ghayas Habash, a nephrologist, said that the main thing people need is to get the message across to people at risk for kidney failure, those with diabetes, hyper tension, black people and those with a family history. If only we address these people aggressively, we can prevent a lot of kidney failure (Casciaro, 18 August 2005).True enough, medical costs have more than doubled over the last decade, and health insurance premiums have risen nearly five times faster than wages. Americans are spending far more on health care than residents of any other industrialized country while receiving lower-quality care overall. Meanwhile, big U.S. businesses that provide health coverage to workers complain that the high costs are crippling their ability to compete with companies abroad whose workers get government-subsidized care.The Bush administration is encouraging consumers to switch to consumer-directed health plans, whose high co-payments would force them to shop for more cost-effective care. But critics argue that individuals can do little to control costs. Instead, they argue, the plans would primarily benefit the wealthy and that society must make hard choices about which care should be paid for by public and private dollars (Clemmit, 7 April 2006).The overwhelming amount of health care purchased in the United States is paid for by the government through Medicare and Medicaid or by privately owned health-insurance companies. Both Medicare-Medicaid and health insurance firms employ personnel, process claims, and issue payments. Their procedures and personnel are expensive and add to the cost of health care without actual medical benefit to anyone.Proposals have been made to dismantle the so-called third party infrastructure and change to a single-payer system in which government would provide and pay for health care. Taxes would be adjusted to cover the costs and administrative bureaucracy would be kept to a minimum so as to maximize efficiency. While a single-payer system has obvious merits, a national consensus in favor of such a system has not emerged. Thus, the problem of health care dollars paying for administrative infr astructure remains, and there is no clear indication as to how to resolve it.For kidney patients, The Kidney Care Quality and Improvement Act of 2005 is long overdue because dialysis is not an option but a necessity for them to continue living. This legislation modernizes the Medicare ESRD program by: ·    creating public and patient education initiatives to increase awareness about Chronic Kidney Disease (CKD) and to help patients learn self-management skills; ·      ensuring patient quality through improvements in the ESRD payment system, including establishing an annual update framework and evaluating the effect of the new Physician Fee Schedule G-code visit requirements; ·      providing Medicare coverage for CKD education services for Medicare-eligible patients; ·    establishing an outcomes-based ESRD reimbursement demonstration project; ·    aligning incentives for physician surgical reimbursement for dialysis access to promote quality and lower costs;  ·      establishing a uniform training for patient care dialysis technicians; and ·    improving ESRD coverage by removing barriers to home dialysis and creating an ESRD Advisory Committee (RPA Website, 2006).Some critics have argue about the use of CKD education. In deeper analysis, CKD education is very crucial because people need to know the things about it prior to developing kidney failure but there is no funding for education that could have helped prolong your kidney function. This Act will be beneficial not only for CKD patients, but also for people who may be at risk. This act will definitely enable people that you (or your loved one) can get more treatments. With the current policy, most people cannot avail the dialysis they need because Medicare doesn't pay for more than 3 treatments a weekAs quality of care is everyone’s privilege, Medicare reimbursement should be updated annually for dialysis clinics just like it is for other providers. Medicare's low reimbursement could result to employer health plans paying more than their share and private companies have to pay higher. This would be a heavy burden for people with CKF because they need to pay higher premiums or their health coverage is reduced, or sometimes employees with CKF or employees that have dependents with CKF have the risk to lose their jobs because of the high costs on their part.Kidney patients need life-saving treatments that need to be improved because their lives are on the line and it is sapping them out of their funds because of the costs. Enacting Kidney Care Quality and Improvement Act of 2005 should therefore be prioritized and Congress should not think twice. Everything should be done to help CKF patients combat this lethal disease, and support them with all our efforts to get better treatments before it is too lateReferencesClemmitt, M. (2006, April 7). Rising health costs. CQ Researcher, 16, 289-312. Retrieved September 12, 2006, from CQ Researcher Online, http://library.cqpress.com/cqresearcher/document.php?id=cqresrre2006040700.Renal Physicians Association (RPA). (2006). The Kidney Care Quality and Improvement Act of 2005 Bill #S.635. Retrieved September 12, 2006, from RPA Website at http://capwiz.com/renalmd/issues/bills/?bill=7319331&size=fullStein, A. (2002). Kidney Failure Explained. London: Class Publishing.U.S. Newswire. (2005, March 16). Members of Congress Announce Bipartisan Legislation to Update, Improve Kidney Care Quality and Ensure Access to Dialysis. Retrieved September 12, 2006 at http://www.prnewswire.com/products-services/reach-us-media-bloggers.htmlpublic-interest-newslines-2.htmlGetRelease.asp?id=44507

Signal Units Involved during World War II Essay Example

Signal Units Involved during World War II Essay Example Signal Units Involved during World War II Essay Signal Units Involved during World War II Essay ATZH-LCB-B29 January 2012 SUBJECT: Chapter review of Getting the Message Through, Chapter VIII. 1. Chapter VIII is about signal units involved during World War II. Throughout each phase of the conflict, new problems and difficulties arose that could only be overcome through hard work, ingenuity and extreme bravery. The huge scope of the war on numerous continents tested the will and determination of the signal corps. 2. The first real need for signal support was hemisphere defense. This included protecting the Panama Canal from bombings, the British supply line by way of Greenland and the Japanese invasion of parts of Alaska after bombing of Pearl Harbor. They installed radar along the coasts and ran thousands of miles of wire through the frozen terrain of Alaska. On Puerto Rico, Signal Units provided aircraft warnings and communication support to help protect the Caribbean. 3. The first Signal units to actually face the enemy were in the Pacific. After the Pearl Harbor bombing, the Japanese began invading the Philippine Islands. They forced General McArthur to retreat to the Bataan Peninsula and finally Corregidor. Not all of the soldiers could get away. Lt. Gen. Wainwright was in command of the garrison and ventually moved his headquarters underground into the Malinta Tunnel. Col. Theodore Teague was commanding signal officer and once the Japanese invaded the tunnels, he ordered his signal soldiers to destroy all equipment. To keep communications going in the Philippines, the Signal Corps created the 978th Signal Service Company out of largely Filipino volunteers. They worked hand in hand with the guerilla fghters that resisted the Japanese invaders. These volunteers helped pave the way for the eventual Allied liberation of the Philippines. 4. The Signal Corps became involved in a grander scale of combat operations in North Africa. General Dwight D Eisenhower was the overall Allied Commander of invasions of Morocco, Algeria and Tunisia. His chief Signal Officer was Brig. Gen. Jerry V MateJka. The first big test was operation TORCH, in which the Signal Corp was to provide communications for the amphibious assaults. Numerous problems arose from failure to keep the sea water from damaging equipment to the equipment itself being too heavy. They eventually set up permanent ACAN stations. Another issue was the different codes and call signs used by the British Army and Navvy, Royal Air Force and the Army Air Forces. Signal soldiers had to be adaptive and learn on their feet. 5. In helping to plan the Invasion of Normandy on the European front, the Signal Corps became part ot the Services ot Supply. Brig. Gen. illi m S Rumbougn became the theaters chief signal officer. He was faced with signal planning for the largest military operation of the war. This included establishing system of priorities for telephone traffic and allocating frequencies for the 90,000 transmitters needed for the operation. He also created the Joint Assault Signal Company OASCO) to provide signal support for the amphibious assaults at Omaha and Utah beaches. Also, wenty-eight signal men from the 101st Airborne Signal Company were the first signal men to land in France. They flew in with their SCR-449 radios on gliders. Multichannel radios were first incorporated in the Normandy invasion. 6. Once Hitler committed suicide and Germany surrendered, the Signal Corps put all their resources in support of the Pacific campaign to finish off the Japanese. The jungles of the numerous islands provided many issues with radio communications. To get the message through, miles and miles of wire were run through the trees without proper equipment. The SCR 300 radio was used to communicate with aircraft or arrangement of supply drops for the advancing Allied forces. The Signal Corps had also built their own signal fleet equipped with VHF radio relay sets. Their flagship, the Apache, was specifically devoted to public relations. After the ferocious battle of Iwo Jima, the Signal Corps began planning the communications for the proposed invasion of Japan called Operation OLYMPIC. The dropping of atomic bombs on Hiroshima and Nagasaki brought the war to a quick conclusion. The Signal Corps performed their last duty by broadcasting the formal Japanese surrender proceedings aboard the USS Missouri to all the world.

Parenting Disabled Infants essays

Parenting Disabled Infants essays Raising a disabled child is a difficult task, and it is accompanied by many trials and tribulations for the individuals parenting the child. Reproductive technology now allows humans to see the future that lies a head for their fetus. Abnormalities can be detected by different types of prenatal diagnostic testing (PDT) methods including such tests as amniocentesis and chronic villus sampling (Lawson, 2001). The majority of women who do discover that their fetus carries an abnormality after undergoing PDT decide to abort (Lawson, 74). The lack of desire to continue the growth of a disabled fetus by the participants of Lawsons study will be explained by examining the personal goals that individuals have surrounding parenting and the affects of the type of disability. Lawson argues that the underlying motives behind prenatal testing are often that disability can reduce quality of life to an extent that non-existence is preferable to living with a disability, and or that the burdens of parenting a disabled child outweigh the joys (Lawson, 2001, p. 74). A recent study reports that mothers of disabled children were shown to report significantly more physical health complaints, and higher levels of depression, stress, anxiety, and emotional distress than mothers of non-disabled children (Pelchat, Richard, Bouchard, Perreault, Saucier, Berthiaume, et al. 1999, p. 378). This directly explains the reduced quality of life that the participants in Lawsons study describe. Lawson states that many theories which deal with raising disabled children contain a cost benefit analysis factor (Lawson, 2001, p. 74). Individuals weigh the advantages and disadvantages of having children in order to make a reproductive decision (Lawson, 2001). When evaluating the cost benefit analysis of raising a disabled child it was found that rewarding aspects of raising a disabled child ...

Workplace Violence Essay Example | Topics and Well Written Essays - 1500 words

Workplace Violence - Essay Example Workplace violence is a growing concern for employers and employees all over the world (OSHA, 2002). Though any worker can be subjected to workplace violence, some occupations place certain individuals at increased risk of violence. Workers who deal with money, who deliver goods, passengers or services, those who work alone or work with small groups, workers who work late in the nights or early hours in the morning are at increased risk of workplace violence. Others at risk are those who work in areas with high crime rates, in community settings and in health care and social services. Psychiatric evaluators, nurses, water utility employees, TV cable installers, letter carriers, taxi drivers, retail workers and probation officers are also at risk for violence (OSHA, 2002). 1. Type 1: Violence by criminals who are not associated with the workplace, but enter the workplace with intentions of robbery or any other such crime. This type of violence accounts for about 80% of workplace homicides. Taxi drivers and late-night retailers are at increased risk of this type of violence. The motive in this type of incidents is usually theft and in many cases the criminal will be carrying dangerous weapons like gun. 2. Type- 2: Violence by the receivers of service against the service providers. Examples of this type of violence are violence against doctors or nurses by the patients, violence against teachers by the students and violence by the customers against the retailers. Even police officers, security guards, correctional officers and mental health workers are at risk of this type of assault. The largest number of victims facing this type of violent behavior are those in healthcare services. 4. Type- 4: Violence stemming from a personal relationship: The violence is committed by an individual who has no direct association with the workplace but is personally related to one of the workers either through marriage or

Report Essay Example | Topics and Well Written Essays - 4250 words - 1

Report - Essay Example Part 3 includes a discussion on reflective practices, learning, learning styles and models of learning along with a discussion on reflective writing. The report is concluded by summarizing the overall insights from the write up. Motivation is a well-known and well defined theoretical construct that finds wide application in learning. It is a major construct that is used to define human behaviour. This involves both the internal as well as external factors that stimulate energy and desire among individuals or groups of people to be interested in any subject, role or job and remain committed and interested in the job, subject or role and also, to make suitable efforts to attain a particular goal. Motivation is considered to be a result of the interactions between the conscious and the unconscious factors within an individual. The factors that can create motivation are the expectations and personal objectives of a person of a group, the reward or incentive value of the objective and the intensity of the need or desire to attain the goal. These factors are the key deciders of motivation level within a person or a group because these are the basic reasons that a human being has for behaving in a particular manne r. An example may be that a student gives extra time to study a particular subject in which he/she wants to get a good grade. Motivation can be segregated into two major types. These are inherent motivation and extrinsic motivation. Inherent motivation is that type of motivation which is driven by any interest or delight of the person in the assignment itself. Inherent motivation exists within a person and does not depend on the external factors and the desire for recognitions and rewards. On the other hand, extrinsic motivation comes from the influence of the external factors like recognitions, rewards as well as negative factors like punishment and misbehaviour. The factor of competition is an important extrinsic motivator because