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Customers want to receive their healthcare close to their homes moduretic 50 mg low price, with minimal disruption to their family life and work schedules. They also want to maximize the value they receive for their healthcare expenditures. The transformation of baby boomers from patients to customers clearly has significant implications for healthcare marketing. During the last two decades, Americans experienced a major trans- formation in the delivery and financing of care. A new generation of therapeutic techniques was introduced along with a new generation of phar- maceuticals; the delivery of care shifted from primarily an inpatient setting to an outpatient setting; and the manner of financing care was modified as managed care became a dominant feature of the healthcare landscape. At the same time the healthcare institution experienced shifting power relationships as the unfettered influence of the physician was challenged by other competing providers and as third-party payers began to increas- ingly set the parameters for reimbursement, and hence the delivery of care. Employers, who were bearing most of the cost of private insurance, began to play a more active role, bringing about numerous changes in the delivery of care. The high and unassailable status of the physician came into question during the last years of the twentieth century, as the fallibility and limita- tions of medical care were documented. The introduction of increasing numbers of female and foreign-trained physicians into the medical frater- nity also led to a changing image of the physician. Baby boomers, armed with information from the Internet, influenced the shift away from the dependent patient to an aggressive consumer patient demanding a role in the therapeutic process. The changes that have taken place in healthcare over the last two decades or so have been numerous and dramatic. These changes have served 66 arketing Health Services to transform the healthcare industry of the early 1980s into a quite dif- ferent creature. Lack of space in this book does not allow a review of all of the changes that occurred during the last decade and a half, but some of the more important ones are listed below, along with their signif- icance for healthcare marketing.
Planar diving in which the diver changes shape from fully ex- tended (a) to tucked configuration (d) through intermediate shapes (b) and (c) generic moduretic 50mg on line. The moment of inertia Ic of the athlete in the layout position was 134 lb-in-s2 and in the tuck position 34 lb-in-s2. Solution: Once the swimmer is airborne the only force acting on him is the gravitational force passing through his center of mass, and as there is no external moment acting on him while he is airborne, his angular mo- mentum with respect to his center of mass must be constant: Hc 5 Ic v e 3 5 134 lb-in-s2 322p (s21) e 3 5 34 lb-in-s2 3 v e 3 v 5224. Once the an- gular momentum is set, then it remains constant until the diver encoun- ters the water. Note that during the fraction of a second when the swim- mer switches from the layout position to the tucked position, his body is changing shape and therefore cannot be idealized as a rigid body. In that brief time period, Hc 5 Ic v e will not hold, because it was derived un- 3 der the assumption that all the various segments of the body rotated with the same angular velocity. This is clearly not the case when the thighs and lower legs are moving toward the trunk as the diver assumes the tuck position. The feet of a gymnast of mass 2m and height 2L are attached to two rings as shown in Fig. The gymnast is let go from rest in the horizontal position as indicated in the figure. To as- sess the loads carried by her abdominal and back muscles during the swing, let us model the gymnast with two rods (OA and AB) connected by a hinge at point A. The point O represents the feet, and we assume it to be stationary in the reference frame E. When these two rods let go from rest in the horizontal configuration, will they begin to rotate as one solid body? Newton’s third law dictates that the resultant force AB exerts on OA must be equal in magnitude but opposite in direction of the force OA exerts on AB. We use the equations of motion for the cen- ter of mass of each rod (points D and E in Fig. Bodies in Planar Motion (a) e2 L/2 L/2 e1 O A B (b) F O D A R 1 1 F mg R 2 2 (c) A E B R1 R2 mg FIGURE 4.
All too often careers advice concentrates too much on these practicalities order moduretic 50mg on-line,implying the only criteria for choosing future doctors are whether they can fill out an impressive application form and get themselves selected. This detracts from the more important process of your addressing medicine’s suitability as a career for you,and your suitability to be a doctor. Only after giving this serious consideration should you consider the details of application and selection set out in this chapter. Unfortunately, the qualities which count for most in medicine are not precisely measurable. The measurable—examination performance at school—neither necessarily relates to these qualities nor guarantees intellectual or practical potential. Stewart Wolfe, an American physician, was right to ask: Are the clearly specified and hence readily defensible criteria those most likely to yield a wise and cultivated doctor—a person capable of dealing with uncertainty, of compassionate understanding and wise judgment? Can an ideal physician be expected from an intellectual forme fuste who has spent his college years only learning the "right answers"? Furthermore, there is no acceptable objective measure of the quality of the doctor against which to test the validity of selection decisions. In this sea of uncertainty it is not surprising that selection processes are open to criticism. None the less, few patients would choose a doctor without meeting him or her first and a strong argument can be made for discovering the people behind their UCAS forms, if only briefly. Also, many applicants think that they should have a opportunity to put their own case for becoming a doctor. Selection for interview (and at some schools for offer without interview) is made on the strength of an application submitted through UCAS. An application completed partly by the applicant and partly by a referee, 44 APPLICATION AND SELECTION usually the head or a member of the school staff, who submits a confidential reference. Altogether, about 12 000 home and European Union applicants compete for over 6000 (soon to be 7000) places to read medicine at United Kingdom universities, together with about 1500 overseas students who compete for about 330 places. Deans and admission tutors who have to scan a thousand or two application forms (which they receive reduced in size from the original application) simply do not have time to spend deciphering illegible handwriting. Personal details The first section of the UCAS form presents the personal details of the applicant, including age on 30 September of the coming academic year.