High Performance Timer in Delphi - TStopWatch

Elite Timer in Delphi - TStopWatch For routine work area database applications, adding a solitary second to an errands execution time infrequently has any kind of effect to end clients - yet when you have to process a huge number of tree leaves or produce billions of one of a kind irregular numbers, speed-of-execution turns out to be increasingly significant. Timing Out Your Code In certain applications, exceptionally exact, high-accuracy time estimation strategies are significant and fortunately Delphi gives an elite counter to qualifyâ these times. Utilizing RTLs Now Function One choice uses the Now work. Presently, characterized in the SysUtils unit, restores the current framework date and time. A couple of lines of code measure passed time between the beginning and stop of some procedure: var  â start, stop, passed : TDateTime;​ start  â start : Now;  â //TimeOutThis();  â stop : Now;  â elapsed : stop - start; end; The Now work restores the current framework date and time that is exact up to 10 milliseconds (Windows NT and later) or 55 milliseconds (Windows 98). For exceptionally little stretches the exactness of Now is once in a while insufficient. Utilizing Windows API GetTickCount For much increasingly exact information, utilize the GetTickCount Windows API work. GetTickCount recovers the quantity of milliseconds that have passed since the framework was begun, yet the capacity just has the exactness of 1 ms and may not generally be precise if the PC stays fueled up for significant stretches of time. The passed time is put away as a DWORD (32-piece) esteem. Hence, the time will fold over to zero if Windows is run ceaselessly for 49.7 days. var  â start, stop, slipped by : cardinal; start  â start : GetTickCount;  â //TimeOutThis();  â stop : GetTickCount;  â elapsed : stop - start;/millisecondsend; GetTickCount is additionally restricted to the exactness of the framework clock (10/55 ms). High Precision Timing Out Your Code On the off chance that your PC underpins a high-goals execution counter, utilize the QueryPerformanceFrequency Windows API capacity to communicate the recurrence, in tallies every second. The estimation of the check is processor subordinate. The QueryPerformanceCounter work recovers the current estimation of the high-goals execution counter. By calling this capacity toward the start and end of a segment of code, an application utilizes the counter as a high-goals clock. The exactness of high-goals clocks is around a couple hundred nanoseconds. A nanosecond is a unit of time speaking to 0.000000001 seconds or 1 billionth of a second. TStopWatch: Delphi Implementation of a High-Resolution Counter With a gesture to .Net naming shows, a counter like TStopWatch offers a high-goals Delphi answer for exact time estimations. TStopWatch measures passed time by including clock ticks in the hidden clock component. The IsHighResolution property shows whether the clock depends on a high-goals execution counter.The Start strategy begins estimating slipped by time.The Stop technique quits estimating passed time.The ElapsedMilliseconds property gets the complete slipped by time in milliseconds.The Elapsed property gets the all out passed time in clock ticks. unit StopWatch;interface utilizes Windows, SysUtils, DateUtils;type TStopWatch class  â private     fFrequency : TLargeInteger;     fIsRunning: boolean;     fIsHighResolution: boolean;     fStartCount, fStopCount : TLargeInteger;  â â â procedure SetTickStamp(var lInt : TLargeInteger) ; â â â function GetElapsedTicks: TLargeInteger;    function GetElapsedMilliseconds: TLargeInteger;    function GetElapsed: string;â â public  â â â constructor Create(const startOnCreate : boolean bogus) ; â â â procedure Start;â â â â procedure Stop;â â â â property IsHighResolution : boolean read fIsHighResolution;    property ElapsedTicks : TLargeInteger read GetElapsedTicks;    property ElapsedMilliseconds : TLargeInteger read GetElapsedMilliseconds;    property Elapsed : string read GetElapsed;    property IsRunning : boolean read fIsRunning;  end;implementation constructor TStopWat ch.Create(const startOnCreate : boolean bogus) ;start  â inherited Create;   fIsRunning : bogus;   fIsHighResolution : QueryPerformanceFrequency(fFrequency) ;  â if NOT fIsHighResolution then fFrequency : MSecsPerSec;  if startOnCreate then Start;end;function TStopWatch.GetElapsedTicks: TLargeInteger;begin  â result : fStopCount - fStartCount; end;procedure TStopWatch.SetTickStamp(var lInt : TLargeInteger) ;start  â if fIsHighResolution then     QueryPerformanceCounter(lInt)  â else     lInt : MilliSecondOf(Now) ; end;function TStopWatch.GetElapsed: string;var  â dt : TDateTime; start  â dt : ElapsedMilliseconds/MSecsPerSec/SecsPerDay;  â result : Format(%d days, %s, [trunc(dt), FormatDateTime(hh:nn:ss.z, Frac(dt))]) ; end;function TStopWatch.GetElapsedMilliseconds: TLargeInteger;begin  â result : (MSecsPerSec * (fStopCount - fStartCount)) div fFrequency; end;procedure TStopWatch.Start;begin   SetTickStamp(fStartCount) ;   fIsRunning : valid; end;procedure TStopWatch.Stop;begin   SetTickStamp(fStopCount) ;   fIsRunning : bogus; end;end. Heres a case of use: var  â sw : TStopWatch;   elapsedMilliseconds : cardinal; start  â sw : TStopWatch.Create() ;  â try     sw.Start;  â â â //TimeOutThisFunction()     sw.Stop;     elapsedMilliseconds : sw.ElapsedMilliseconds;  â finally     sw.Free;  â end;end;

Assessment of Patients Perceptions

Caring has been broadly talked about in the human services callings, particularly in nursing which is viewed as one of the mindful callings (Boykin and Schoenhofer 2001). Watson (1985) depicts mindful as an ethical perfect of nursing. As per Watson, caring jam human respect in fix ruled medicinal services frameworks and turns into a standard by which fix is estimated (Watson 1988c, p. 177). Research writing demonstrates that the evaluation of nature of care from the patient’s point of view has been operationalised as patient fulfillment (Dufrene 2000). Medical caretaker caring has been identified with quiet fulfillment in western writing (Wolf et al 2003; Wolf et al 1998; Forbes and Brown 1995; Boyle et al 1989). There are such huge numbers of elements that impact patients’ impression of care given by the other gender. A portion of these are: Age, ethnicity, sex, financial and wellbeing status. The most steady finding has been identified with age. More seasoned patients will in general be progressively happy with their medicinal services. Studies that have seen ethnicity have commonly held that being an individual from a minority bunch is related with lower paces of fulfillment. Studies on the impact of sexual orientation demonstrate that ladies will in general be less fulfilled and different examinations show the inverse. Most examinations have discovered that people of lower financial status and less training will in general be less happy with their human services. Different investigations have indicated that more unfortunate fulfillment with care is related with encountering stress, melancholy, dread or sadness, as is having a mental finding, for example, schizophrenia, post-awful pressure issue or medication misuse. Wellbeing status can extraordinarily impact fulfillment of an individual (Hall, 1990). It is critical to look at the connections of medical attendant minding to quiet fulfillment in Cape Coast as a result of serious staff deficiencies, overwhelming remaining task at hand, and low compensations in Cape Coast Hospitals. Nursing writing had since quite a while ago perceived significance of these discernments as main considerations militating against fast and powerful assistance conveyance in the consideration condition. One of the basic jobs and morals of the medical caretaker is to treat all patients independent of their sexual orientation, shading, belief, political tendency and strict affiliations. Excellent medical attendant customer correspondence is the foundation of the craftsmanship and study of nursing. It significantly affects quiet prosperity just as the quality and result of nursing care, and is identified with patients’ in general fulfillment with their consideration. The upkeep of high medical caretaker quiet correspondence additionally relies upon the attendant and patient. The nature of care in a medical clinic has been demonstrated to be affected by a few variables including: deficient nursing staff, absence of standard water gracefully on wards, a lot of nursing documentation, too long holding up time, and absence of specific attendants. In Ghana, there is emergency in nurture customer correspondence proof from four sources. These are close to home perception, stories from customer and their families, media reports, and authority wellbeing reports. In spite of the fact that there is sufficient proof to show that most medical attendants are females, one can't limit the tremendous administrations that male medical attendants give independent of their sex. The regularly expanding number of female medical attendants contrasted with male medical caretakers in our wards, combined with persistent disappointment toward treatment got has brought up a great deal of issues regarding whether there is an apparent thought that male medical attendants offer better consideration or something else. With the presentation of Health Insurance a couple of years prior, more patients report to the medical clinic and are likewise deliberately mindful of their privileges and duties as patients and thus will interest for better assistance conveyance from parental figures. As of late, understanding disappointment has been on the authority in a few emergency clinics across Ghana including University of Cape Coast Hospital. This has raised a ton of worries about the recognitions patients have with respect to the consideration given by male medical caretakers.

The Day The Devil Struck Heaven Essay free essay sample

, Research Paper The Day The Devil Struck HeavenIt was a restless dim. The screens pummeled, the Lightning split, everything was terrible. Silk had become alive once again for the finishing up appear down to try to interfere with the magnificent Gatess of Eden that prevent him from raising each holy messenger. Glossy silk and his group of Devil # 8217 ; s started their fly through the sky towards paradise to possess Eden. In Eden, God was in request and the entirety of the heavenly attendant # 8217 ; s were fixing for Christmas. All through the Eden # 8217 ; s, non one Angel was found non working by any stretch of the imagination. God felt that Satin had wanted another invasion, and thoroughly understood it, he was readied. Silk deliberately set the warlords and prepared for the attack. They held hatchet and spear, holding each reason to destruct all the holy messengers of the Heaven # 8217 ; s. The warrior # 8217 ; s had a mass gathering and got fire in their savage mixers prepared to fight to the p erish. We will compose a custom exposition test on The Day The Devil Struck Heaven Essay or then again any comparative subject explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page God was in a profound request and the holy messengers thought something was inaccurate. They asked God, and God said to go all through the land and express all that the Devil is going to attack. The heavenly attendant # 8217 ; s proceeded to ascend the same number of minds as they could, while God looked for the great beyond. He new that is heading out to go on, and he wasn # 8217 ; t certain when. God had all the blessed messenger # 8217 ; s travel into the mixers of everybody and have so bow and ask in soundless petition. Christmas Eve had arrived and Christ was making a trip to hold his birthday, yet the Devil and his quick ones to kill the entirety of the holy messengers would in the blink of an eye bungle it. What the Satan didn # 8217 ; T know was that it was difficult to murder a holy messenger, for a heavenly attendant couldn’t execute a Satan. A heavenly attendant would console the devil’s aggressors thus would divert them from dim to noticeable radiation. No different creatures had this force yet the unadulterated angel’s, and Christ. Jesus was the Right manus of God, the Godhead warrior. He was murdered for other people, thus made others see God. He could be wherever at whenever in any area with anybody. Only 2 heavenly attendant # 8217 ; s had the ability to turn Satin back to God, and would keep up him as a holy messenger. God would watch and when the full Warrior s of Satin were gone to the noticeable radiation, Christ would descend and transform the Satan into a heavenly attendant. The warrior # 8217 ; s assaulted in a full penetrate and the heavenly attendants were prepared. Individually, the warriors were transformed into heavenly attendants, and flown prior God to be given the discernment and the force it took to be a blessed messenger. Losses for the Devil were going to a maximal and no heavenly attendant was harmed. At that point the Satan saw that he couldn # 8217 ; t win, so he brought his clench hand up in torment, crushed it into the land, and went to lapidate. Christ uncovered the three to the Devil , so took care of him the holy observance and made him a heavenly attendant. That is the thing that happens when you attempt to win against God. God would neer stress over anybody again. Still some warrior # 8217 ; s were lost in the pastures of snake pit, yet Christ returned to Earth, lectured, and kicked the bucket for our wickednesss. Yet, this clasp passed on from characteristic perish, rescuing the universe from underhandedness, with the goal that none would violate no more.The End

Als aE Essay Writing - 6876 Words

Understanding How to Teach Paragraph and Essay Writing MR. REJULIOS M. VILLENES Instructional Manager, Lopez West District Division Enhancement Training of ALS Coordinators and Mobile Teachers Ouans Farm, Lucena City 13 November 2011 PARADIGM ON TEACHING PARAGRAPH WRITING TO ALS LEARNERS Teaching Paragraph Writing Effectively Where to Start and When to Teach Diagnosing Learner’s Difficulties ïÆ' ¼ Understanding Our Learners ïÆ' ¼ Psychological Philosophical Factors ïÆ' ¼ Data Analysis and Problem Intercession ïÆ' ¼ Going Back to Basics What to Teach Writing Paragraph, ALS AE Essay Writing ïÆ' ¼ Understanding a Paragraph and an Essay ïÆ' ¼ Constructing and Forming Paragraph ïÆ' ¼ Making Paragraphs an Essay ïÆ' ¼ Writing with Discipline How to Teach and Assess 1.†¦show more content†¦Ã¯â€š § Constructivism ïÆ'Ëœ Learning is the process of adjusting one’s mental modes to accommodate new experience. ïÆ'Ëœ Learning takes place through giving instructions. paragraph writing †¢ rmv111311 WHERE TO START AND WHEN TO TEACH DIAGNOSING PROBLEMS AND DIFFICULTIES 2. Psychological and Philosophical Factors ï‚ § Progressivism ïÆ'Ëœ Emphasizes â€Å"change† and â€Å"growth† ïÆ'Ëœ Focuses on the learner as a whole rather than of the teacher ï‚ § Essentialism ïÆ'Ëœ Concerns with the fundamental of education skill and knowledge ïÆ'Ëœ Focuses on the â€Å"basics† – reading, writing, speaking and arithmetic paragraph writing †¢ rmv111311 WHERE TO START AND WHEN TO TEACH DIAGNOSING PROBLEMS AND DIFFICULTIES 3. Data Analysis and Problem Intercession ï‚ § Recording the Data for Analysis and Intervention ï‚ § Planning for Intercession (Topics to be discussed as a Prerequisite in Writing an Essay) paragraph writing †¢ rmv111311 WHERE TO START AND WHEN TO TEACH DIAGNOSING PROBLEMS AND DIFFICULTIES 4. Going Back to Basics ï‚ § Teaching the Prerequisites of Making a Paragraph ïÆ'Ëœ Reading and writing skills ïÆ'Ëœ Phoneme, morpheme, clause, syntax, punctuations paragraph writing †¢ rmv111311 PARADIGM ON TEACHING PARAGRAPH WRITING TO ALS LEARNERS Teaching Paragraph Writing Effectively Where to Start and When to Teach Diagnosing Learner’s Difficulties ïÆ' ¼ Understanding Our Learners ïÆ' ¼ Psychological Philosophical Factors ïÆ' ¼ Data Analysis and ProblemShow MoreRelatedEssay on How To Write Using the APA Writing Style1597 Words   |  7 Pages The APA writing style is most commonly used to cite sources for psychology, education, and social sciences and is also the official writing style of the American Psychological Association. The General APA Organizational Guidelines are basic guidelines that explain how to write a research paper in the APA format. 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Proof Beyond a Reasonable Doubt in Criminal Trials

In the United States court system, the fair and impartial delivery of justice is based on two fundamental tenets: That all persons accused of crimes are considered to be innocent until proven guilty, and that their guilt must be proven â€Å"beyond a reasonable doubt.† While the requirement that guilt must be proven beyond a reasonable doubt is meant to protect the rights of Americans charged with crimes, it often leaves juries with the momentous task of answering the often subjective question — how much doubt is â€Å"reasonable doubt?† Constitutional Basis for Beyond a Reasonable Doubt Under the Due Process Clauses of the Fifth and Fourteenth Amendments to the U.S. Constitution, persons accused of crimes are protected from â€Å"conviction except upon proof beyond a reasonable doubt of every fact necessary to constitute the crime with which he is charged.† The U.S. Supreme Court first acknowledged the concept in its decision on the 1880 case of Miles v. United States: â€Å"The evidence upon which a jury is justified in returning a verdict of guilty must be sufficient to produce a conviction of guilt, to the exclusion of all reasonable doubt.† While judges are required to instruct juries to apply the reasonable doubt standard, legal experts disagree on whether the jury should also be given a quantifiable definition of â€Å"reasonable doubt.† In the 1994 case of Victor v. Nebraska, the Supreme Court ruled that the reasonable doubt instructions given to juries must be clear, but declined to specify a standard set of such instructions. As a result of Victor v. Nebraska ruling, the various courts have created their own reasonable doubt instructions. For example, judges of the Ninth U.S. Circuit Court of Appeals instruct juries that, â€Å"A reasonable doubt is a doubt based upon reason and common sense and is not based purely on speculation. It may arise from a careful and impartial consideration of all the evidence, or from lack of evidence.† Considering the Quality of Evidence As part of their â€Å"careful and impartial consideration† of evidence presented during the trial, jurors must also evaluate the quality of that evidence. While first-hand evidence such as eyewitness testimony, surveillance tapes, and DNA matching help eliminate doubts of guilt, jurors assume — and are typically reminded by defense attorneys — that witness may lie, photographic evidence can be faked, and DNA samples can become tainted or mishandled. Short of voluntary or legally-obtained confessions, most evidence is open to being challenged as invalid or circumstantial, thus helping to establish â€Å"reasonable doubt† in the minds of the jurors. Reasonable Does Not Mean All As in most other criminal courts, the Ninth U.S. Circuit Court also instructs jurors that proof beyond a reasonable doubt is a doubt that leaves them â€Å"firmly convinced† that the defendant is guilty. Perhaps most importantly, jurors in all courts are instructed that beyond a â€Å"reasonable† doubt does not mean beyond â€Å"all† doubt. As Ninth Circuit judges state it, â€Å"It is not required that the government (the prosecution) proves guilt beyond all possible doubt.† Finally, judges instruct jurors that after their â€Å"careful and impartial† consideration of the evidence they have seen, they are not convinced beyond a reasonable doubt that the defendant actually committed the crime as charged, it is their duty as jurors to find the defendant not guilty. Can Reasonable Be Quantified? Is it even possible to assign a definite numeric value to such a subjective, opinion-driven concept as reasonable doubt? Over the years, legal authorities have generally agreed that proof â€Å"beyond a reasonable doubt† requires jurors to be at least 98% to 99% certain that the evidence proves the defendant to be guilty. This is in contrast to civil trials on lawsuits, in which a lower standard of proof, known as a â€Å"preponderance of the evidence† is required. In civil trials, a party might prevail with little as 51% probability that events involved actually occurred as claimed. This rather wide discrepancy in the standard of proof required can be best explained by the fact that persons found guilty in criminal trials face far more severe potential punishment — from jail time to death — compared to the monetary penalties typically involved in civil trials. In general, defendants in criminal trials are afforded more constitutionally-ensured protections than defendants in civil trials.   The Reasonable Person Element In criminal trials, jurors are often instructed to decide whether the defendant is guilty or not by applying an objective test in which the defendant’s actions are compared to those of a â€Å"reasonable person† acting under similar circumstances. Basically, would any other reasonable person have done the same things the defendant did? This â€Å"reasonable person† test is often applied in trials involving so-called â€Å"stand your ground† or â€Å"castle doctrine† laws that justify the use of deadly force in acts of self-defense. For example, would a reasonable person have also chosen to shoot his or her attacker under the same circumstances or not? Of course, such a â€Å"reasonable† person is little more than a fictional ideal based on the individual juror’s opinion of how a â€Å"typical† person, possessing ordinary knowledge and prudence, would act in certain circumstances. According to this standard, most jurors naturally tend to consider themselves to be reasonable people and thus judge the defendant’s conduct from a viewpoint of, â€Å"What would I have done?† Since the test of whether a person has acted as a reasonable person is an objective one, it does not take into account the particular abilities of the defendant. As a result, defendants who have shown a low level of intelligence or have habitually acted carelessly are held to the same standards of conduct as more intelligent or careful persons, or as the ancient legal principle holds, â€Å"Ignorance of the law excuses no one.† Why the Guilty Sometimes Go Free If all persons accused of crimes must be considered innocent until proven guilty beyond a reasonable doubt, and that even the slightest degree of doubt can sway even a reasonable person’s opinion of a defendant’s guilt, doesn’t the American criminal justice system occasionally allow guilty people to go free? Indeed it does, but this is entirely by design. In crafting the various provisions of the Constitution protecting rights of the accused, the Framers felt it essential that America apply the same standard of justice expressed by renowned English jurist William Blackstone in his often-cited 1760s work, Commentaries on the Laws of England, â€Å"It is better that ten guilty persons escape than that one innocent suffer.†

Analysis Of The Movie Bill Mcmahon - 2066 Words

Summary and main characters The main characters in the movie are Bill McMahon, Nick Campbell , whilst there are a few other characters that play a significant role such as Stuart, Neha and Mr Chetty. The story is about two friends who have lost their jobs as salesmen and are looking for other jobs, they aren’t very skilled or intellectual but they have very good people skills. They get the opportunity to apply for an Internship at Google, one of the most technologically advanced work places, yet they aren’t tech savvy at all. They form a team and bring a bunch of individuals who would otherwise have no chance, together . They compete in a series of challenges to win an opportunity to be an intern at Google. Throughout the story we see how the team unites and wins the challenges. Bill loses a challenge for his team and decides to leave but Nick is able to convince him to come back, and eventually against all odds they win the internship. Setting The movie is set in the Google headquarters, it is an extremely modern work environment, it is not your normal conventional workplace and because of this it allows for creative thinking. The workplace allows the workers to be themselves and this promotes individuality and this is what Google is about. The setting shows how quickly buisnesses have progressed and Google is a prime example of this, by keeping up with current trends they have made themselves more appealing. Nick and Bill are both shocked with the environment that theyShow MoreRelatedEssay on Framing the User: Social Constructions of Marijuana Users9798 Words   |  40 PagesNever in history have so many mothers been ax-murdered, so many virgins lured into white slavery, so many siblings decapitated, as in the heyday of Anslingers anti-marijuana campaign. The spirit of the era was most perfectly captured in the 1936 movie classic Reefer Madness, in which casual marijuana use was shown to lead swiftly to murder, rape, pro stitution, addiction, madness, and death (1981:5051). Marijuana was a good target because it was believed that its use was largely confined to immigrantsRead MoreBusiness Journalism in India26104 Words   |  105 Pagesimportant than ever for business journalists to pull it all together, to provide the insight and understanding in the best days, the wisdom, that will be necessary. The world doesn’t need more information. It needs more understanding, more insight, more analysis. What is the Finance Commission? The Finance Commission is constituted by the President under article 280 of the Constitution, mainly to give its recommendations on distribution of tax revenues between the Union and the States and amongstRead MoreStarbucks Corporation12076 Words   |  49 Pagesorganizations like the WTO, World Bank, and IMF of promoting corporate globalization by supporting trade liberalization, by promoting export-based economic development, and by facilitating foreign direct investment. According to an organization that bills itself as Mobilization for Global Justice: Most of the world s mo st impoverished countries have suffered under IMF/World Bank programs for two decades: they ve seen debt levels rise, unemployment skyrocket, poverty increase, and environments devastatedRead MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 Pagesof systematic study. Identify the major behavioral science disciplines that contribute to OB. Demonstrate why few absolutes apply to OB. Identify the challenges and opportunities managers have in applying OB concepts. Compare the three levels of analysis in this book’s OB model. MyManagementLab Access a host of interactive learning aids to help strengthen your understanding of the chapter concepts at www.mymanagementlab.com cott Nicholson sits alone in his parents’ house in suburban Boston

Canadas Health Care System free essay sample

Canada’s health care system â€Å"can be described as a publicly-funded, privately-provided, universal, comprehensive, affordable, single-payer, provincially administered national health care system† (Bernard, 1992, p. 103). Health care in Canada is provincial responsibility, with the Canada Health act being a federal legislation (Bernard, 1992, p. 102). Federal budget cuts, has caused various problems within Medicare such as increased waiting times and lack of new technology. Another problem with Medicare is that The Canada Heath Act does not cover expenditures for prescriptions drugs. All these issue has caused individuals to suggest making Medicare privatized. Although, Canada’s health care system consists of shortcomings, our universal comprehensive health care system is not crisis. The following paper will discuss how the federal-provincial relations and media have aided to these problems. Lastly, throughout the paper intergovernmental solutions to these issues will be presented. The 1867 Constitution Act did not assign responsibility for health care to either provincial or federal governments, but it did assign the responsibility of hospitals towards provinces, thus health care in Canada has become under provincial jurisdiction (Stamler, Yiu, 2005 p. We will write a custom essay sample on Canadas Health Care System or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page 17). In addition, â€Å"the Canadian Constitution has an equalization clause requiring provinces to provide â€Å"reasonable comparable levels of public service for reasonably comparable levels of taxation† (Stamler, Yiu , 2005 p. 17). Despite it being under provincial jurisdiction, the federal government has been involved in funding and making sure the services are available. Since territorial and provincial wealth differs, the federal government’s role is to equalize services across provinces. The federal government does this two ways: â€Å"first by contributing money (in effect, transferring money from wealthier to poorer provinces), and second, by stipulating specific conditions that provinces must meet in order to receive that money† (Stamler, Yiu , 2005 p. 17). Roy Romanow, the premier of Saskatchewan argues that Canada does not have a universal health care system but â€Å"14 public health care systems – one for each province and territory and one for the federal government to provide funding, regulation, and administration† (Romanow, 2005, p. 3). The fourteen systems are tied together by Canada Health Act, 1984. The Canadian Heath Act states that â€Å"all citizens are entitled to a core of medically necessary services, delivered by physicians and hospitals† and paid through progressive taxation measures (Romanow, 2005, p. ). In addition, the Act outlines five principles: â€Å"it must be universally accessible, comprehensive in nature, portable between provinces, delivered without direct charge to patients, and publicly administered† (Romanow, 2005, p. 3). Therefore, each province decides on how to administer funds, subsidize, and deliver additional public health care services such as prescription drug plans, home care, mental health care, long-term care, and community care services† (Romanow,2005, p. 3). The federal government used to provide approximately a third of the money to provinces on health care costs, but during the 1990s due to budget deficits the federal government cut heath care funds towards the provinces (CBC News Online, 2006). The federal government cash contribution between 1997- 1999 was $12. 5 billion (Stamler, Yiu , 2005, p. 19). In addition, yearly increases in health spending averaged 11. 1% from 1975 to 1991, but dropped to increases of 2. 5% annually in the late 1980s and early 1990s† (Canadian Doctors of Medicare, 2009). In 2003, Roy Romanow released a report on fixing Medicare. At the same time, Ottawa cut 16 percent of its share and in order to increase Ottawa’s share to 25% Romanow recommended an infusion of federal dollars (CBC News Online, 2006). This led to the first Ministers gathering in 2003. This gathering was â€Å"described as the most important session on health care since Canada adopted Medicare† (CBC News Online, 2006). The outcome of the meeting led to â€Å" $16-billion, five-year Health Reform Fund for primary care, home care and catastrophic drug coverage, $13. 5 billion in new federal funding to the provinces over three years, $2. billion cash infusion for 2003 , $600 million for information technology and $500 million for research† (CBC News Online, 2006). At the end this plan did not carry out because the Premiers received half of what was suggested and the territorial leaders did not sign the agreement. The territorial leaders felt that Ottawa was being inflexible and that â€Å"the north would be receiving the same amount of money per capita as the rest of the country, despite the much higher costs of delivering health care in Canadas most remote regions† (CBC News Online, 2006). In addition, the deal had no accountability strings attached (Doctors of Medicare, 2009). Furthermore, during the 2004 election, the Liberals indicted the Conservatives of wanting to turn Medicare into a two-tiered system (CBC News Online, 2006). After the election, Prime Minister Martin assembled the first minister’s conference on health care. The federal government and provinces` `agreed to a $41-billion infusion into the system over 10 years† (CBC News Online, 2006). The agreement included â€Å" $3. billion over two years in additional transfers to the provinces and territories, an escalator clause that automatically boosts transfers by six per cent a year to keep up with rising health costs, $4. 5 billion over six years for a special fund to reduce waiting times for treatment. In addition, a National Wait Times Strategy was developed for five priority areas: cancer care, cardiac treatment, diagnostic tests such as MRIs, joint replacements and cataract surgeriesâ⠂¬  (CBC News Online, 2006). Yet despite these conferences, the promises were not fulfilled. The 2003 and 2004 agreements did not specify if the money was to be targeted toward particular needs (eg. training health personnel), innovations (eg. chronic disease management) or provided accountability to ensure that money was allocated towards these areas (Doctors of Medicare, 2009). Financial cuts by the federal government have resulted in many problems in the health care system such as long waiting lists and lack of new technology. In addition, the problem with The Health Canada Act is its failure to include prescription drugs. Lastly, the media gives the public the false notion that Medicare is in a crisis by exaggerating these issues. In addition, all these problems have caused individuals to suggest having Medicare privatized. The next section of this paper will look at these subjects in more detail. Long waiting lists One of the criticisms of Medicare is the â€Å"long waits to see a specialist, get diagnostic tests and undergo elective surgery† (CBC News Online, 2006). Patients have to wait several months for elective surgery and diagnostic procedures (Bernard, 1992, p. 105). One common explanation in justifying increased wait times is a growth in aging population increases demand for surgery (Priest, Rachlis, Cohen, 2007, p. 8). In fact this is not true. The increase for more surgeries is due to more advanced technology (Priest, Rachlis, Cohen, 2007, p. 8). Modern technology has allowed one to receive services which were not available fifteen years ago. Thus, â€Å"the health care system is asked to perform more surgeries simply because it is more capable than ever of relieving patients’ pain and suffering and increasing their quality of life† (Priest, Rachlis, Cohen, 2007, p. ). † Another key contributor to waitlists is that most surgeons do not work as a team with nurses and other health professionals (Priest, Rachlis, Cohen, 2007, p. 9). For instance, there is not a designated person who makes sure that patients are socially, psychologically, and physically, prepared for surgery (Priest, Rachlis, Cohen, 2007, p. 9). By health care officials working together to make sure that patients can cope at home after the surgery, it will decrease the chances of re-admission. Another alternative is having health care personnel conducting work on the telephone. A Dartmouth University study found that health care costs were reduced 30% when health personnel called their patients for follow up visits (Rachlis, Evans, Lewis, Barer, 2001, p. 35). One last problem aiding to long waiting times is the shortage of family doctors. Statistics show that between 2001 and 2004, family doctors decreased the number of patients they were taking and by the end of 2004; more than 4 million Canadians did not have access to a family doctor (Zitner, 2007). The shortage of doctors is because â€Å"provincial governments have reduced medical school enrolments and post-graduate training programs since 1993† (CBC News, 2006). Between 1991 and 2000, the number of medical-school admissions was reduced by 14% and foreign-trained doctors found it increasingly difficult to earn Canadian licences† (McParland, 2008). One obvious solution to the lack of doctors would be increasing medical school and post-graduate enrolments (Rachlis, Evans, Lewis, Barer, 200 1 p. 33). Graduate students outside of Canada have suggested â€Å"approving extraordinary licensing procedures and increasing post-graduate training opportunities to facilitate the entry to practice of foreign-trained doctors† (Rachlis, Evans, Lewis, Barer, 2001 p. 33). Another suggestion is for provincial governments to exempt tuitions and allow medical schools to determine their own admission levels (CBC News, 2006). Furthermore, provinces and regional provinces have also implemented community programs. For example, Edmonton’s Choice program offers out of hospital services care for patients who have chronic illness and frailty (Rachlis, Evans, Lewis, Barer, 2001, p. 3). Another example is Hamilton’s Let Me Decide program which allows patients and their families decide the appropriate level of intervention at the end of life (Rachlis, Evans, Lewis, Barer, 2001, p. ). In addition, â€Å"the overall health care costs were 33 percent lower for the Let Me Decide participants who also used 61 percent fewer acute hospital days† (Rachlis, Evans, Lewis, Barer, 2001, p. 23). Thus, if a similar program could be put in effect across the country it would free up 1,700 to 1,800 acute care beds (Rachlis, Evans, Lewis, Barer, 2001, p. 23) . By implementing services like Edmonton’s Choice and Hamilton’s Let Me Decide programs it will lessen the burden of hospitals, allowing patients to receive better care (Rachlis, Evans, Lewis, Barer, 2001, p. ). Furthermore, such programs save the government money which could be allocated towards other areas of Medicare such as updated technology. Lack of New Technology Another criticism is that there is limited access to expensive, high-technology medical equipment in Canada. When compared to the United States, Canada technology is not as abundant (Bernard, 1992, p. 105). â€Å"This is because the provincial governments seek to control rising health costs by allocating the use of technology among hospitals in any given region. In the U. S. such decisions about the purchase of new technology are made by individual hospitals seeking a competitive advantage in the marketplace. â€Å"This often leads to a proliferation of high-cost technology which is, arguably, unnec essary† (Bernard, 1992, p. 106). In addition, inadequate financial support for preventive and chronic care makes it harder for doctors to provide high-quality care (Health Management Technology, 2009). The 2009 Commonwealth Fund International Health Policy Survey found that when compared against other countries Canada falls behind in using electronic medical records (EMRs). Approximately, 46 percent of Canadian doctors use EMRs, compared to 99 percent in Netherlands, 97 percent in New Zealand and 96 percent in the United Kingdom (Health Management Technology, 2009). In addition according to the Organization of Economic Cooperation and Development (OECD), â€Å"the number of MRI units in Canada (6. 2 per million people in 2006) lags the OECD average (10. 2 per million), and the number of CT scanners (12 per million people in 2006) also lags the OECD average (19. 2 per million)† (Esmail, 2008). Using outdated technology causes a slower recovery rate and patients have to visit the doctor often (Esmail, 2008), which in turn can increase the number of medications prescribed. Increase Costs of Medications Another problem with Medicare is Canadians may not be able to afford the medications they need. The Canada Health Act â€Å"covers medically necessary hospital, physician and surgical-dental as well as limited long-term care services, but not prescription medication† (Dewa, Hoch and Steele, 2005, p. 96). Studies show that prescription drugs are increasing at a fast rate and â€Å"between 1984 and 2001, total expenditures on drugs increased an average of 12 percent† (Dewa, Hoch and Steele, 2005, p. 497). In addition, studies show that most of the increased costs are due to prescribing of newer, more expensive, drugs that are as effective as older drugs (Rachlis, Evans, Lewis, Barer, 2001, p. 37). Many individuals receive coverage through private insurance compani es such as employment-related packages. Statistics show that â€Å"about 65 percent of working-age Canadians has some form of private drug insurance, 10 to 20 percent have incomplete coverage, particularly for drugs with exceptionally high costs, and 10 to 20 percent of Canadians have no drug coverage of any kind† (Hanley, 2009). Studies show that those who are most likely to be insured are individuals from lowest income groups (Dewa, Hoch and Steele, 2005, pg 508). This may also be because of the difference between provinces. For example, studies by Dewa, Hoch and Steel (2005 p. 08) show that residents of Alberta are more likely to report being insured compared to British Columbia and the reason is because British Columbia has deductible attached to its plan. The Report by Romanow, offers a wide range of solutions such as modernizing The Canada Health Act by expanding coverage and renewing its principles. Therefore, it makes sense to include prescription drugs in The Canada Health Act (Dewa, Hoch and Steele, 2005, p. 506). In addition, prescription drugs should be geared towards a national system where all provinces agree on one structure (Dewa, Hoch and Steele, 2005, p. 507). It is important to remember that Canadas universal Medicare is â€Å"built on the belief that universal access to healthcare is a right of all its citizens† (Dewa, Hoch and Steele, 2005, pg 510). Yet, majority of Canadians depend on employment benefits to cover prescription drugs while publicly funded drugs are available to the aged, and poor (Dewa, Hoch and Steele, 2005, pg 510). Lack of new technology, long waiting lists, and not having prescription drugs covered are solvable problems Canadas heath care system faces. These problems are blown out of proportion by media stories, making the public believe that Canadas Medicare is in a crisis. The next section discusses the role media plays in misleading the public. Media Exaggeration Many academics argue that the Medicare system has done what it has promised and the media exaggerates Medicare problems. Many other countries such has Europe and America have had these problems â€Å"yet the Canadian â€Å"crisis† was wide ly reported in the North American media as indicating the impending collapse of Medicare† (Rachlis, Evans, Lewis, Barer, 2001, p. 2). Furthermore, the media focuses more on the â€Å"crisis† of Medicare than the initiatives which have been suggested. For instance, during 1999/2000 Canada experienced influenza season in which the media exaggerated the overcrowding in hospitals. During this incidence, Saskatoon, Calgary and Edmonton found solutions to this problem by â€Å"implementing timely and comprehensive immunization and flu control initiatives within long-term care institutions† (Rachlis, Evans, Lewis, Barer, 2001 p. 2). The media did not focus on the initiatives developed by these provinces but instead diverted the public`s attention on the issue of overcrowding. In addition, media also exaggerates the increased wait times. It is true that waiting times have increased but to what extent is unknown because in Canada data on wait lists is not regularly updated (Rachlis, Evans, Lewis, Barer, 2001 p. 2). The data that is available shows that waiting times have increased but they are not as severe as stated by critics. In addition, according to studies, there are shortage of doctors in certain areas in Canada, but overall there has been had an increase in doctors (Rachlis, Evans, Lewis, Barer, 2001). Despite Media claims Canada has had implemented a number of programs to decrease waiting times. Some programs include are, The Ontario Cardiac Care Network, The Western Canada Waiting List Project, and Ontario’s Joint Replacement Network (Rachlis, Evans, Lewis, Barer, 2001). Furthermore, the Canadian Nurses Association (CNA) outlines some services which should be available to Canadians beyond physicians and hospital care. These services include: â€Å"a national pharmacare program that addresses prescribing practices, drug pricing and equity in coverage across the continuum of care and between jurisdictions† (CNA, 2008, p. 1). The CNA argues that privatization will not solve the problem and our current health system is â€Å"sustainable through better financial management† (CNA, 2008, p. 1). Governments should work with stakeholders and the public when making decisions about policies regarding finances of health services (CNA, 2008, p. 2). In addition, another solution for the long-term care shortage â€Å"would be to foster a range of publicly-subsidized supportive housing and long-term care options in partnership with Regional Health Authorities and non-profit societies† (Vogel, and Cohen, 2000). Furthermore, recently the federal/provincial/territorial agreement on primary health care resulted in the federal government supplying $200 million. Hopefully the money given â€Å"will improve access to all health care services, enhance the satisfaction of providers and reduce pressures on various parts of the system, such as emergency departments and hospitals † (Rachlis, Evans, Lewis, Barer, 2001, p. 44). One must keep in mind that though the federal and provincial governments have implemented programs and funds towards health care â€Å"the task of reforming primary health care is not an easy one† (Rachlis, Evans, Lewis, Barer, 2001, p. 4). Despite, having federal budget cuts in Medicare, there are options available such as increasing student enrolments in medical schools or promoting services such as Edmonton`s Choice program. Despite having these options many individuals believe that privatization is the best option to restoring Medicare. Privatization of Medica re The lack of public funds is leading long term care facilities towards privatization. In British Columbia, the government has not spent any money on buildings and equipment. For instance, in 2000 about 7,000 seniors were waiting for one of BCs care beds (Vogel,, and Cohen, 2000). Despite having government budget cuts, privatization is not an effective solution due to many reasons. For one, privatization costs more and this can be seen by comparing the health care costs between Canada and the United States. â€Å"While Canadians spend 8. 7% of their Gross National Product on health care, or the equivalent of $ 1,483 (U. S. ) per person, the U. S. spends 11. 8% of the GNP, or $ 2,051 per person for a health care system that doesnt provide health care for all† (Bernard, 1992, p. 02). The high costs in the States is due to higher administrative costs in a system comprised of numerous competitive insurance firms, hospitals, clinics (Vogel, and Cohen, 2000). Another reason not to have Medicare privatized is because it does not cause efficiency. For instance, cataracts surgeries in Calgary which are purchased from private companies are more expensive and have longer waiting lines (Stamler, Yiu , 2005, p. 29). In addition, in the public health system officials are accountable to their patients and public employers (Vogel, and Cohen, 2000). Lastly, privatization would not shorten waiting times but increase them. This is because if practitioners are working in the private sector, they will not be available in the public one, thus increasing waiting time (Stamler, Yiu , 2005, p. 29). Therefore, a public health care system should be in place because it is more effective and efficient. Conclusion The federal government is responsible for the Canada Health Act and the provinces have discretion over the health services provided. Canadas universal Medicare has allowed Canadians to have access to health care and at a lower price compared to private health care in the United States. Federal budget cuts have increased waiting lists, and have caused individuals to suggest privatization. In addition, using old technology aids to the problem of â€Å"long waiting times, less efficient use of medical resources, and less timely and sophisticated diagnosis and treatment† (Esmail, 2008). In addition, there is a need for a national strategy for prescription drugs. Furthermore, some individuals have suggested that the media focuses on the problems of Medicare but not on the initiatives the government has implemented. Although, there are problems in Medicare, they are not severe and are solvable. The solution is that federal, provincial, and local jurisdictions should work together in making sure all Canadians receive health care services (CNA, 2008, p. 1). New policy initiatives need to be discussed and â€Å"proper evaluation is best accomplished in organizations controlled by communities, such as health care co-operatives† (Zitner, 2007). Other solutions include, having home or community alternatives which are cheaper compared to having individuals stay in a hospital when they are dying or adding more care beds. Another solution would be to having â€Å"more comprehensive range of health care professionals, including community pharmacists, integrated in a primary health care organization† (Rachlis, Evans, Lewis, Barer, 2001, p. 43). If funding can be available to such organizations, the wait lists would decrease and patient care would be more efficient (Rachlis, Evans, Lewis, Barer, 2001 p. 43). In sum, with time every policy needs to be updated and reformed and the same holds true for Canadas Medicare. With modern times comes a demand for more effective and efficient health care. In addition, government providing money does not solve problems within Medicare (Rachlis, Evans, Lewis, Barer, 2001, p. 6). Governments should decide where the money is needed and Canadians should have a voice in notifying governments where to allocate the money (Rachlis, Evans, Lewis, Barer, 2001, p. 6). Canada’s universal comprehensive health care is not in â€Å"crisis†, it just needs reforming. Innovative models are not in short supply. The sustainability of Medicare depends on our willingness to act on what we already know† (Rachlis, Evans, Lewis, Barer, 2001, p. 43). Work Cited Bernard, E. (1992). The Poltiics of Canadas Health Care System. New Politics, 101-108. Canadian Doctors for Medicare, . (2009). The Case for medicare. Retrieved from http://www. canadiandoctorsf ormedicare. com/caseformedicare. html#1990s Canadian Nurses Association, Initials. (2008). Financing Canadas Health System. Canadian Institute for Health Information, 1-4. CBC News Online. 2006, August 22). 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(2005). Community Health Nursing: a Canadian Perspective. Philadelphia: Pearson Prentice Hall. Vogel, D. , Cohen, M. (2000, January 1). Healthy solutions to the crisis in medicarehttp://www. policyalternatives. ca/publications/commentary/healthy-solutions-crisis-medicare. Retrieved from http://www. policyalternatives. ca/publications/commentary/healthy-solutions-cr