Public Sector Budgeting Essay Example | Topics and Well Written Essays - 750 words - 1

Public Sector Budgeting - Essay Example In this respect, the conventional debate that rages on regard the amount of control measures that should be allowed in the execution of the budget amid the need to ensure accountability The challenge arises in the manner various agencies feel that they should be given the flexibility to operate effectively in the present dynamic world. However, Congress on the other hand, feels that giving much flexibility would be tantamount to the failure to perform its constitutional prerogative of implementing the rules that govern the budget process. It is felt that the smooth realization of certain objectives require a given amount of flexibility that is often disregarded by the public and policy implementers. Inasmuch as public funds should be safeguarded, it is imperative to realize that certain programs must always be undertaken with a given amount of flexibility contrary to which they are bound to fail. For instance in the department of defense (DOD), certain radical decisions have to be ma de in times of urgent need. In such a case, too many regulations might prove to be quite disastrous in the event challenges are realized in the process. Often, agencies are forced to utilize the full allocation they receive without the need to save any funds for future use. This normally arises out of the imminent fact that in the event of returning unused funds, they receive less in future allocations and are even scolded for asking for more if they could manage with less. One of the most challenging issues under budget execution is normally on the aspect of authorization (McCaffery & Mutty 2003). Indeed, before the disbursement of any funds, proper authorization must be done in order to ensure the funds are used appropriately. However, it is normally challenge given that the authorization stage normally involves s lot of bureaucracy and red tape. The manner some of the programs take a lot of time to get authorized clearly serve to demonstrate the very challenges created by too muc h regulations at the expense of the need for timely undertakings. In most instances, the execution process kicks off with the authorization from the Congress, before other subsequent steps follow. Therefore the timely execution of projects in the economy depends much on the speed of Congress in its deliberations (McCaffery & Mutty 2003). However, it rarely happens that Congress does the authorization on time. Being the initial stage of the process, delayed authorization finally translates into the lateness of all the subsequent stages so that execution of the program is delayed a great deal. The authorization of contingent programs normally creates much inefficiency to the execution of other projects in operation. In that regard, it becomes important to rectify some of the regulations that create the sense of commotion. In the same way the authorization should be done in a timely manner that enhances the fast execution of the projects. It is disheartening to seen the manner in which most government programs seem to stall out of the fact that their allocation has not yet been ratified by the authorities in order allow the disbursement of the funds. In a world of challenges and new realities, congressional managers must be faced to encounter the very limiting issues that normally characterize the implementation process (1999). However the rules,

Coursework Rates of reaction Essay Example for Free

Coursework Rates of reaction Essay Investigating the effect of concentration on the rate of reaction Skill(s) assessed: Topic C10 [Experiment 9 (in S4)] Investigating the factors affecting the rate of reaction IGCSE Coursework Skills C2, C3, C4 Some of the factors affecting the rate of a reaction that you have studied are:   Temperature   Concentration   Surface area Aim: Investigating the effect of changing the concentration on the reaction between calcium carbonate and hydrochloric acid, by collecting the carbon dioxide gas given off. CaCO3(s) + 2HCl(aq) CaCl2(aq) + H2O(l) + CO2(g) Hypothesis: My hypothesis is that as we increase the concentration of the HCl, the rate of the reaction will be faster; this is because more collisions will be present Materials: Small calcium carbonate chips Dilute hydrochloric acid (1 moldm-3) Distilled water Delivery tube Bowl Conical flask (100ml) Beaker Measuring cylinder (100 cm3) Stop watch Balance Clamp Clamp holder Safety Glasses. Method: 1. Collect all materials 2. Fill the bowl and the 100 cm3 cylinder with water 3. Holding the end so that the water doesnt go out, turn the cylinder upside down and place it down the bowl, keeping it still with the clamp, put the delivery tube at the hole of the cylinder 4. Weight 3g of small size calcium carbonate chips 5. Put on your safety glasses 6. Add the 3g of small carbonate chips into the conical flask 7. Add the HCl acid in the conical flask 8. Quickly afterwards put a cork so that you shut all air entries in the conical flask 9. At the same time as you place the cork, start timing how much it takes to get 50cm3 of gas 10. Repeat this experiment using different concentrations of HCl acid by diluting the acid with distilled water, to make it a fair test use always the same amount of chips and always reach 25cm3 in the measuring cylinder so that only concentration and not amount will affect the rate of reaction. 11. Record your results in a neat and tidy table Results: Table: Volume of 1. 0 mol dm^-3 HCl (cm^3) Volume of H2O (cm^3) Concentration of HCl (mol dm^-3) Time (s) to reach 50ml Time to reach 100ml   Graph: Anomalous Results: In this experiment we were lucky to find no anomalous results at all, everything went on as we planned it was going to go like. Conclusion: As you can see in the graph, our hypothesis was right, as we increased the concentration of the HCl acid in out experiment, more collision were happening and therefore the time for it to reach 50ml was becoming smaller and smaller, meaning that the reaction was becoming faster. So we end up with the conclusion; more concentration of acid = faster rate of reactions = more collision. We could also see in the trend/pattern that at first, when we started increasing by only 0. 2 in concentration, the time for it to reach 50ml decreased from 38 to 17 seconds, almost half of what it was before!. After a while, as we increased the concentration, the difference between the two concentrations began to get smaller and smaller, it first started at decreasing from 38s to 17s, then from 17s to 9s, 9s to 7s and from 7 to five seconds. At this last 2 differences, at the change from 0. 6 to 0. 8, and 0. 8 to 1 in mol dm^-3 of concentration of HCl, the difference was in both only of 2s, showing off that if the acid was yet too concentrated, and almost getting to being fully concentrated, the difference in time to reach the 50ml will become smaller and smaller. Evaluation/Improvement: The experiment was carried out really well, there was no significant anomalous result which indicated that we were doing the right thing, the experiment fulfilled our hypothesis decision, it went on as we planned it would. We should have repeated the experiment, repeating the experiment would have given us much more accurate results, and we have used the same balance for each measuring of calcium carbonate, so that we make it a fair test.

Trends in Broadcasting

Trends in Broadcasting Television broadcasting industry in India ia a very huge industry and has thousands of programs in almost all states of India. Almost half of the households in India own a television. In a research conducted in 2010, it was found that a total of 515 channels are available in the country out if which nearly 150 are paid channels. Indian television markets display today many of the attributes of the sector typical to broadcasting across the world, a mix of state-supported and advertising based services; a separate and growing segment offering scrambled services in return for subscription; a variety of distribution means. At the same time, Indian television has a number of unique characteristics that are the result of its size and history, source of funding, regulation and technology choices. In common with other Indian industries, the development of broadcasting has been coloured by Indias comparative isolation due to tariff barriers and other regulatory constraints. These impacted unevenly across television and related sectors, while Bollywood flourished in part because of the scarcity of non Indian content, Indian broadcasting was confined to a single service Doordarshan offered over some of the national territory. Without competition, Doordarshan could focus from the 1960s to the late 1980s on programmi ng that responded to the states development goals and secular messaging but ultimately proved to be unappealing to audiences. CURRENT SCENARIO. In India, the television broadcasting industry going through remarkable changes and it has now become one of the fastest growing sectors of the country. The main reasons for this are rising per capita/ national income, increase in the growth of economy and powerful macro-economic fundamentals, democratic set up, good governance as well as law and order position in the country. The Indian broadcasting industry plays a vital role in creating peoples awareness about state laws and policies and programs by providing education and information, besides creating healthy business environment within the country. Thus, it helps the people to be the active partner in the nation-building venture. At the present stage, in Indian television broadcasting industry there are almos110 million TV users in India, out of which almost 70 million are cable and satellite homes and rest 40 million are served by the public broadcaster. TRENDS IN INDIAN BROADCASTING INDUSTRY. Indian Broadcasters are now under increasing pressure to present superior quality content, as is reflected in some recent trends: Narrowcasting or launch of specialty or niche channels, which achieve faster breakeven (given the lower investment) focus also being brought onto regionalization and content creation for Tier II and Tier III towns. Launch of reality shows, despite the high investments required, to gain viewership; broadcasters are depending on reality shows for channel branding. Near immediate launch of movies on the broadcasting platform following theatrical release, although at high acquisition costs; however revenue potential of such broadcasting remains a challenge for the broadcasters despite the relatively high gross rating points (GRPs) of the programmes. Switchback to the outright exclusive rights model for movies to reduce fragmentation of viewership, albeit at higher costs. Increasing presence in the overseas markets so as to tap non-resident Indians (NRIs) who have been demanding Indian content; this along with dedicated local programming is opening up an additional revenue stream for Indian broadcasters. Overall, competition is expected to keep profitability under strain for most broadcasters, especially those in the GEC space(GEC refers to fiction and non-fiction shows; examples include, among others, Colors, Zee TV, Sony, Star Plus, and Imagine), over the near to medium term. ENVIORNMENTAL ISSUES. The television industry in India continues to undergo solid competition from the digital cable and satellite TV industries. The cable TV industry, in special, represents a bigger threat to future industry growth. A number of elements points to low development in advertising revenue, including forecast low economical growth, the declining total share of the TV audience, and competition from new media. The dim outlook for this industry has already prompted News Corp to expand its satellite TV interests. The onset of digital television may provide a much needed boost for demand. PORTERS FIVE FORCES ANALYSIS OF INDIAN BROADCASTING INDUSTRY. Bargaining power of Buyers. Strength of Force-High The bargaining power of customers determines that how much customer can impose pressure on the margins and volume of a industry. Viewers experience frequently change, providing little faithfulness to any particular network. Advertising buyers dictate television programming choices. The suppliers customers are bitty, so their bargaining power is low. The cost of switching from one supplier to another supplier is very high.. Bargaining Power of Suppliers . Strength of Force Low- Medium Since most suppliers to Broadcasters have either been acquired/ have a tie-up with the broadcasters, the bargaining power of suppliers is low. For ex- Viacom has acquired Paramount. However, Independent content providers pose a major challenge to online revenue model for broadcasters. The suppliers comprise a large number of small operators. The service is undifferentiated and can be replaces by substitutes. The customer has awareness about the production costs of the products. Threat of New Entrants. Strength of Force-Low If the competition with in an is higher then it is easier for other companies to enter this industry. In Indian television broadcast industry, new entrants could change major determinants of the market environment (e.g. price, market share and loyalty) at any time. There is always a hidden pressure for reaction and alteration for existing players in this industry. The threat of new entries will depend on the extent to which there are blockades to entry. These are typically High start-up capital is a big de motivator. It is difficult to access the distribution channels for new entrants. New entrant has a number of problems finding skilled employees, materials, and suppliers. Serviceable used equipment is expensive. Long-lasting economies of learning and scale also de motivate the potential new entrant. Economies of scale (minimum size requirements for profitable operations). Limited important resources, (e.g. qualified expert staff). Raw materials are controlled by existing players. Threat of substitutes. Strength of Force-Medium A threat from substitutes exists whenever there are alternate products with lower prices of better functioning parameters for the same purpose. They could possibly attract an important proportion of market volume and therefore reduce the potential sales volume for existing players. This category also associates to complementary products. Similarly to the threat of new entrants, the substitutes determined by factors like. The relative price for performance of substitutes. Current trends. Customers have to incur switching costs. Also, adequate substitutes are available. Possibly, One Broadcasting medium substitute for the other(movies as a replacement For TV) Pirated content is a decent(and free substitute). Other free time activities could be substitutes (concerts, games, gambling, gardening, sports, restaurants. COMPETITION IN INDIAN BROADCASTING INDUSTRY. As broadcasting is one of the main industry of any country, so like all other industries there is strong competition in Indian broadcasting industry. The entry of newer players in the Indian broadcasting industry has had the positive impact on expanding the overall market. For instance, since the launch of the new channels like GECs 9X, Colors, Imagine and Real, the overall GRPs have increased by around 30 per cent in less than a year, according to industry estimates. This has also helped in expanding the overall advertising volumes by 31% in 2009 over 2008. However, with the number of channels increasing significantly over the past decade (over 460 in 2009 from 120 in 2003), every broadcaster is struggling to retain its share of the advertising pie. Following the fragmentation of the advertising revenues, the viewership ratings and hence the placement of a channel have become even more important for broadcasters. In the highly cluttered GEC genre, the largest in the Indian broadcasting space, it has become critical for broadcasters to invest heavily in content development and acquisition so that they can differentiate themselves from their peers. In addition, GECs in particular, being highly dependent on mass segment viewership to attract advertisers, are being forced to incur large carriage fees for the placement of the channels on the prime band in view of the lower bandwidth availability on the analog distribution network. This high expenditure is slowing down the process of achieving breakeven for channels considerably. To leverage the benefits arising out of foray into regional markets, in general, the basic strategy followed by new entrants in regional markets is to first establish their presence through a GEC, a news channel and a movie channel, and then get into more niche categories. However, as regional markets begin to saturate, a closer evaluation of the regional markets potential would have to be done before launching a new regional channel. MARKET SHARE: Market share in Indian economy the service sector was drastically increased up to 2007 after words it decreased to 5.5% because of IT fall in India. In service sector the portion of media broadcasting was slowly increased in the year 2008 due to the floods and elections the media broadcasting industry was increased. The swift growth and change in the television broadcasting sector is composed of several essential characteristics: the emergence of mega global communication companies as a result of merger and acquisitions; privatization of existing broadcasting companies; the relaxation of foreign ownership restrictions; corporate investment in newer media such as cable and satellite television; and transnationliztion of advertising and its convergence with communication empires to create a demand for and to promote cultural products and other industries such as consumer goods and services GROWTH. The Indian television broadcasting industry consists of television distribution, advertising content and other services has reported a compounded annual growth rate(CAGR) of 13.8% over the period of 2005 to 2009 increasing to Rs 26,550 crores according to industry estimates.the industry continues to remain at an attractive mode of entertainment because of its reach and penetration. SWOT ANALYSIS. Weaknesses. Domination of 4-5 major players is a negative sign thus creating somewhat monopolized industry. Ongoing weakness of U.S. automakers will have an impact on advertising spending. Environmental issues. Full depending on power supply. Remote area can not be accessed Threats. Slowing Real GDP, inflation, and jobs concerns. Unstable outlook of the industry. Oil prices are beginning to rise, which will cause a decrease in available Challenges of Broadcast Industry and Opportunities for IT Solution Providers cash for consumers to spend. This is seen as advertisers insist that rates be based only on live viewing and not time shifted viewing. Threat of consumer shift towards alternatives. Strengths. Latest technology is used by the Industry. Strong expertise of broadcasters in core areas. Industry acceptance of fast changing requirements. Competitive pricing helps the end customer as do customized solutions. Box Office revenues are consistently growing. Opportunities. New broad casting companies are providing box offices also. Change in technology and in consumer wants and needs brings about new opportunities for growth and for different players to catch a larger share of the industry. Those who are able to create strategic partnerships and find alternative ways of doing business will thrive. Increasing no. of channels.

Race And Beauty in Toni Morrisons Novel The Bluest Eye Essay examples

Throughout Toni Morrison's novel The Bluest Eye, she captures, with vivid insight, the plight of a young African American girl and what she would be subjected to in a media contrived society that places its ideal of beauty on the e quintessential blue-eyed, blonde woman. The idea of what is beautiful has been stereotyped in the mass media since the beginning and creates a mental and emotional damage to self and soul. This oppression to the soul creates a socio-economic displacement causing a cycle of dysfunction and abuses. Morrison takes us through the agonizing story of just such a young girl, Pecola Breedlove, and her aching desire to have what is considered beautiful - blue eyes. Racial stereotypes of beauty contrived and nourished by the mass media contribute to the status at which young African American girls find themselves early on and throughout their lives. While the ideal of beauty is mass marketed the damage it does to society is devastating. By idealizing and pronouncing only one absolute standard of the "blonde and blue-eyed" as beautiful and good, it fosters the opposite and negative belief that young black girls would be defined as the opposite. For a young girl internalizing this it would be defined as the opposite. For a young girl internalizing this it would certainly develop a negative sense of self and worth. With black skin and brown eyes the young girl would find herself in a world where she could never find acceptance as someone physically beautiful and special. This stigma produces a feeling of absolute subservience and lesser purpose and worth creating a mindset of needlessness. A young African American girl would begin to feel invisible in these isolating conditions and create a world where esteem was non-existent. As noted by Gurleen Grewal: As Pecola demonstrates, this socially mandated charade of being something she is not (middle-class white girl) and of not being something one is (working-class black girl) makes one invisible, while the split mentality it entails approaches insanity (26). This belief that one is not worthy of a stereotype is completely devastating to the soul and eventual quality of life. The creation and belief in the mind of such a negative self-concept would produce a shame and anger oppressing the spirit of its true purpose by yieldi... ...era of an absent Shirley Temple contribute to Pecola's loss of insanity†¦" (22). The constant feeding of the media-contrived standard of beauty contributes heavily to the feelings of self a young black girl feels in society and these racial stereotypes nourished by the mass media creates a status at which young African American girls find themselves early on and throughout their lives. Works Cited Grewal, Gurleen. Circles of Sorrow, Lines of Struggle - The Novels of Toni Morrison. Baton Rouge: Louisiana State Press, 1998. Harris, Trudier. Fiction and Folklore: The Novels of Toni Morrison. New York: Chelsea House Publishers, 1990. Matus, Jill. Toni Morrison. Manchester: Manchester University Press, 1998. Mbalia, Dorothea Drummond. Toni Morrison's Developing Class Conscious. London: Associated University Presses, 1991. Miner, Madonne M. "Lady No Longer Sings the Blues: Rape, Madness, and Silence in The Bluest Eye" Toni Morrison. Ed. Harold Bloom. Chelsea House Publishers: New York, 1990. 85-99. Morrison, Toni. The Bluest Eye. New York: Hold, Rinehart and Winston, 1970. Rigney, Barbara Hill. The Voices of Toni Morrison. Columbis: Ohio State Press, 1991.

The Hunchback in the Park

The Hunchback in the Park My life makes me want to run away. I’ve got no place to go. No family, no house, no anything. All wiped out by a fire in 2001. I did not get any money paid out by the insurance company because they said the fire was an â€Å"act of God† caused by a lightning strike, which my insurance did not cover. Since then, I’ve been walking this park, alone and joked about by everyone who walks past me. Now I guess you’re wondering, why don’t I get a job? Why does everyone joke about me? Why do I not ask my family for help?Well, I have been applying for jobs, it’s just that no-one accepts me. I studied hard at school and I got decent grades, but no jobs are available to me. The answer to the second question is something that I just have to live with. During the fire, My face was horribly burned. This, added to the fact that I am short and have a hunchback, makes people fear me and run away or just shout abuse at me. Finally, the answer to the third question is that I simply do not have any. My parents died when I was two years old. I have no aunties, no uncles, nobody.There is one person in my life though. If there is anyone who could be â€Å"that special someone†, it’s her. She’s beautiful. Despite never talking to her, our eyes have met many times and it’s love at first sight. I just wish I could gather up the courage to finally talk to her. It has been a while since I’ve approached a woman without being slapped or ran away from. In fact, it has been a while since I have approached anyone. Any social interaction with the world feels awkward and scary because it has been so long.The only interaction I have with the outside world is through the local children who torment me each day. Each day, I sit on this bench starving. The only meals I eat are leftovers I manage to find in the bin. It is a miracle how I survive. How I have not died from dehydration, starvation or hyp othermia is a miracle. I have not had a shower in months. I just wish someone would take me home. Look – there's the woman! The woman which takes my breath away every time I see her. Maybe she could be the one to take me off the streets.Only if I could gather up the courage to approach her my life would not be as much of a mess and I could get my life moving in the right direction. OK, I'm going to do it this time. I'm going to talk to her! As I get off the bench, I spot the local children! Quick, hide! Those pesky local children are coming. Look at them, with their hoods up; with their phones playing out their angry music; with their hands in the shape of a gun. They make my life hell – even though I don’t provoke them.I can't run very fast due to my disability (which is my hunchback) so when the children chase me I can not get away. They circle me and torment me. One day, they pushed me over. It hurt and many people seen this, but no-one came to help me. I was shocked that no-one asked me if I was OK, this is one of the reasons I give up on the world. People are selfish and do not care about anyone else. Eventually, the children grew tiresome of mocking me and left – either that or they left because it was getting dark. So, here I am once again.Another lonely night, propped up against a tree, with no-one to hold. No family to wish goodnight. Oh, what I would give to feel loved again. Each day is a recurring nightmare, except I can't wake up. I'm going to make a promise to myself now, and it is that tomorrow I'm going to try turn my life around. I'm going to apply for a job and I'm going to ask the girl of my dreams to dinner. Oh, how wonderful life could become with those two simple things. â€Å"You! †, the park keeper says, as he pokes me with his pointed stick used for picking up leaves, â€Å"Time to move along. †.So my day begins, and I'm feeling slightly optimistic for once – knowing that today I will be once again attempting to sort out my life. You may be thinking, â€Å"Why do you think this attempt will be any different to your others? †, well I'm not too sure myself. All I know is that today I'm going to come across as a confident individual. I think this is what I have been lacking, but it is hard for me to be confident when I have the likes of those pesky children always tormenting me, insulting me and abusing me. Anyway, the first step in getting back on my feet is to get a job. The Hunchback in the Park The Hunchback in the Park My life makes me want to run away. I’ve got no place to go. No family, no house, no anything. All wiped out by a fire in 2001. I did not get any money paid out by the insurance company because they said the fire was an â€Å"act of God† caused by a lightning strike, which my insurance did not cover. Since then, I’ve been walking this park, alone and joked about by everyone who walks past me. Now I guess you’re wondering, why don’t I get a job? Why does everyone joke about me? Why do I not ask my family for help?Well, I have been applying for jobs, it’s just that no-one accepts me. I studied hard at school and I got decent grades, but no jobs are available to me. The answer to the second question is something that I just have to live with. During the fire, My face was horribly burned. This, added to the fact that I am short and have a hunchback, makes people fear me and run away or just shout abuse at me. Finally, the answer to the third question is that I simply do not have any. My parents died when I was two years old. I have no aunties, no uncles, nobody.There is one person in my life though. If there is anyone who could be â€Å"that special someone†, it’s her. She’s beautiful. Despite never talking to her, our eyes have met many times and it’s love at first sight. I just wish I could gather up the courage to finally talk to her. It has been a while since I’ve approached a woman without being slapped or ran away from. In fact, it has been a while since I have approached anyone. Any social interaction with the world feels awkward and scary because it has been so long.The only interaction I have with the outside world is through the local children who torment me each day. Each day, I sit on this bench starving. The only meals I eat are leftovers I manage to find in the bin. It is a miracle how I survive. How I have not died from dehydration, starvation or hyp othermia is a miracle. I have not had a shower in months. I just wish someone would take me home. Look – there's the woman! The woman which takes my breath away every time I see her. Maybe she could be the one to take me off the streets.Only if I could gather up the courage to approach her my life would not be as much of a mess and I could get my life moving in the right direction. OK, I'm going to do it this time. I'm going to talk to her! As I get off the bench, I spot the local children! Quick, hide! Those pesky local children are coming. Look at them, with their hoods up; with their phones playing out their angry music; with their hands in the shape of a gun. They make my life hell – even though I don’t provoke them.I can't run very fast due to my disability (which is my hunchback) so when the children chase me I can not get away. They circle me and torment me. One day, they pushed me over. It hurt and many people seen this, but no-one came to help me. I was shocked that no-one asked me if I was OK, this is one of the reasons I give up on the world. People are selfish and do not care about anyone else. Eventually, the children grew tiresome of mocking me and left – either that or they left because it was getting dark. So, here I am once again.Another lonely night, propped up against a tree, with no-one to hold. No family to wish goodnight. Oh, what I would give to feel loved again. Each day is a recurring nightmare, except I can't wake up. I'm going to make a promise to myself now, and it is that tomorrow I'm going to try turn my life around. I'm going to apply for a job and I'm going to ask the girl of my dreams to dinner. Oh, how wonderful life could become with those two simple things. â€Å"You! †, the park keeper says, as he pokes me with his pointed stick used for picking up leaves, â€Å"Time to move along. †.So my day begins, and I'm feeling slightly optimistic for once – knowing that today I will be once again attempting to sort out my life. You may be thinking, â€Å"Why do you think this attempt will be any different to your others? †, well I'm not too sure myself. All I know is that today I'm going to come across as a confident individual. I think this is what I have been lacking, but it is hard for me to be confident when I have the likes of those pesky children always tormenting me, insulting me and abusing me. Anyway, the first step in getting back on my feet is to get a job.

American health care Essays

American health care Essays American health care Essay American health care Essay Essay Topic: The Healers The Spirit Catches You and You Fall Down Refugees from Laos began immigrating to the United States in the 1970’s. Since then, over 100,000 Hmong have settled in the United States. Many came because they felt they had no other option. They could not return to their homes in Laos because they faced persecution, and they had to leave the refugee camps in Thailand due to closure. Anne Fadiman’s book, The Spirit Catches You and You Fall Down, explores a Hmong family, American health care, and the disastrous encounters between the two disparate cultures. Lia Lee, born in 1981, developed symptoms of epilepsy. However, by 1988, Lia was brain dead after years of misunderstanding, over-medication, and culture clash. Fadiman states that what the doctors saw as clinical professionalism, the Lees viewed as arrogance and cold indifference. Additionally, Fadiman shows readers how each party blamed the other for Lia’s illness, yet the assumptions and beliefs that each group brought to the doctor-patient interactions were never explored. American doctors saw Lia’s epilepsy as a neurological abnormality, but the Lees perceived Lia’s illness as a loss of her soul. They believed only appeasement of the lost soul and the restoration of spiritual order would cure their daughter. Although, Lia’s parents and her doctors both wanted what was best for Lia, lack of understanding led to tragedy. Anne Fadiman’s book, The Spirit Catches You and You Fall Down, reveals how the inability to communicate and the ignorance of cultural differences pr! ohibited the Lees and the medical staff from forming the cohesion necessary to save Lia’s â€Å"soul.† The field of Western medicine has a very distinct culture. Medical students and nurses are socialized into this culture while they are in training. Their view of clinical reality assumes that biological concerns are more basic, real, and clinically significant than psychological or sociological issues. The biomedical viewpoint does not accept alternative forms of healing or other healers. Western medicine is considered superior to other medical systems in the world, and because of this fact, other beliefs about causation, diagnosis and treatment of disease are disregarded and/or denigrated. This ethnocentric view is rigid and highly judgmental especially when treating patients from other cultures. Therefore, in the clinical setting, the applications of this theory includes the belief that patients should be prompt, comply with the doctor’s plan of treatment, subordination of health care workers to the doctors, and vigilant observation of the doctor’s instructions. If p! atients fail to comply with these expectations, doctors may feel personally and medically threatened and lash out at patients or health care workers. An example of a doctor’s frustration in treating Lia is apparent in the following excerpt: â€Å"People in the early years of their medical careers have invested an  incredible amount of time and energy and pain the their training, and they  have been taught that what they’ve learned in medical school is the only  legitimate way to approach health problems. I think that is why some  young doctors go through the roof when Hmong patients reject what we  have to offer them, because it intimates that what Western medicine has to  offer is not much† (Fadiman, 76). American health care professionals focus on the disease rather than illness, and concentrate only on the individual and not on the individual as part of a much wider social environment. Medicine focuses on the germ theory of disease. Doctors reach their diagnosis by using blood tests, x-rays, and other procedures. However, most non-Western cultures do not depend on the germ model, but instead believe that illness is caused by spirit possession, soul loss or breach of taboo. Many Hmong immigrants seek the help of traditional healers before they turn to Western medicine. This is only natural since their healing traditions have served them well for thousands of years. They trust and have confidence in these rituals while they are suspicious of the medical procedures, diagnostic tools, and treatment plans of Western medicine. â€Å"Most Hmong believe that the body contains a finite amount of  blood that it is unable to replenish, so repeated blood sampling,  especially from small children, may be fatal. When people are  unconscious, their souls are at large, so anesthesia may lead to  illness or death. If the body is cut or disfigured, or if it loses any  of its parts, it will remain in a condition of perpetual imbalance,  and the damaged person not only will become frequently ill but may  be physically incomplete during the next incarnation, so surgery is  taboo. If people lose their vital organs after death, their souls cannot  be reborn into new bodies and may take revenge on living relatives;  so autopsies and embalming are also taboo† (Fadiman 33). American health care providers are unaware of the isolation and fear the Hmong feel when they are unable to communicate in their native language. The inability to discuss their beliefs about illness and expectations regarding treatment leads to frustration and poor adherence to treatment plans. Lia’s mother, Foua, explains her daughter’s illness and the desire for American doctors to understand their point of view: â€Å"Your soul is like your shadow†¦[s]ometimes it just wanders off like a  butterfly and that is when you are sad and that’s when you get sick, and  if it comes back to you, that is when you are happy and you are well again†¦Ã‚  but the doctors don’t believe it. I would like you to tell the doctors to believe  in our neeb [or healing spirit]†¦the doctors can fix some sicknesses that  involve the body and blood, but for us Hmong, some people get sick because  of their soul, so they need spiritual things†¦it was good to do a little medicine  and a little neeb, but not too much medicine because the medicine cuts the neeb’s  effect†¦but the doctors wouldn’t let us give just a little medicine because they  didn’t understand about the soul† (Fadiman, 100). The conflicting paradigms that each member of these relations brought to the interactions are at the core of these great misunderstandings. Each group holds their beliefs to be true. The Lees remained suspicious of American doctors and American doctors continued to consider the Hmong an ignorant and backward people. Along the way, there was a lack of trust and respect between the family and doctors, and both groups blamed each other for the tragic results- Lia’s severe mental and physical disabilities. In Stress Management for Wellness, Walt Schafer describes the components of coherence as a feeling of confidence that stimuli deriving from one’s environment is predictable, structured and explicable, resources are available to meet the demands posed by the stimuli, and the challenges are worthy of investment and engagement (239). In addition, Schafer states that groups with a strong sense of coherence â€Å"experience significantly less burnout than those with a weak sense of coherence† (240). The doctors never felt Lia’s treatment at home was predictable or structured, neither did they feel there were resources available to meet the demands of communicating with the Lees, and the challenges to understanding their culture were never explored. In reflection, a doctor describes the gap as a â€Å"layer of saran wrap or something between us†¦we were reaching and reaching†¦but we couldn’t touch them. So we couldn’t accomplish what we were trying to do, which was take care of Lia† (Fadi! man, 48). In comparison, the Lees’ experience with the hospital and doctors was unpredictable, and without familiar structure. The hospital norms prevented them from using their customary resources of ritual and healers necessary for coping and helping during the healing process, and they dreaded the use of prescribed treatments. Because the doctors and the Lees lacked the elements of cohesion, their relationship was strained, untrusting, and uncompromising. All the benefits that accompany cohesion and the distress-resistance it offers was out of reach to all the players involved in Lia’s care. In the end, everyone lost a little bit of his or her soul.