Thursday, September 3, 2020

Patient Self Determination Free Essays

Persistent Self-Determination Act Project Scott Betzelos, Remedios C. Lazaga, Emelin Tan, Maya C. Richardson HCS/578 †Ethical, Legal, and Regulatory Issues in Health Care November 28, 2011 Susan M. We will compose a custom paper test on Persistent Self Determination or on the other hand any comparative theme just for you Request Now Kajfasz Patient Self-Determination Act Project †Advance Directives Congress established the Patient Self-Determination Act, a medicinal services strategy, as a major aspect of the Omnibus Reconciliation Act marked by President Bush in 1990. The demonstration became effective in 1991(Nathanson, 1997). As indicated by Nathanson (1997), the law plans to secure the patient’s option to settle on their own choices through cutting edge mandates. Advance mandates assign someone else to settle on choices for the person in question should a patient lose their dynamic limit. The Medicare and Medicaid programs built up a prerequisite that medicinal services suppliers must recognize the law through the execution of composed strategies and techniques that outline the patient’s rights (Nathanson, 1997). Hence, it is the duty of the medicinal services proficient to agree morally and lawfully as indicated by the strategies directed by the association. Nathanson (1997) understanding of the law attests that the patient must get exhortation and composed data about cutting edge orders delineating their entitlement to acknowledge or decline clinical treatment. The Patient Self-Determination Act prerequisite guarantees that social insurance experts get instruction and preparing that is fitting and in subjection with the particular laws, guidelines, hierarchical arrangements, and strategies. The Act requires each state to outfit medicinal services suppliers and organizations with a portrayal of the law. The Act likewise expects suppliers to give their patients data through different types of media, for example, the strategy of Concerned Home Care, Incorporated, (Concerned Home Care, Inc, 2011). How does this agency’s strategy impact your expert work? The Advanced Directive Policy makes a one of a kind doctor persistent relationship by putting the patient at the focal point of the social insurance dynamic procedure from the beginning of the relationship. The patient has a characteristic right to â€Å"accept or decline clinical treatment† through the detailing of an Advanced Directive. Through this strategy the hysician-understanding relationship starts with conversations that middle on the wants of the patient instead of the procedures of the medicinal services supplier. The Agency’s strategy commands that doctors, attendants, and other human services suppliers â€Å"provide the patient with composed data in regards to Advance Medical Directives and inquire as to whether he/she has arranged an Advance Directive; either a living will or strong intensity of lawyer. † Advance Directives permit patients to execute explicit limits for medicines toward the start of the clinician-understanding relationship. Previous development orders additionally engages patients since it permits relatives to talk for their benefit if they become weakened or incapable to render choices all alone. A patient’s clinical wishes were frequently appropriated for the use of serious and obtrusive medicines of the past. Advance Directive Policies changed this standard of care and allowed patients the chance to decide their own treatment plan. The inception of Do Not Resuscitate (DNR) Orders is an early case of Advance Directives. Later advancements grasp the consideration or rejection of explicit treatment meds, obtrusive methods, and care maps that can affect tolerant life span if confusions from sickness emerge. Composed Advance Directive Information shields the patient from individual inclination of staff individuals. The arrangement states â€Å"the staff part isn't approved to offer the patient guidance regarding progressed directives,† and â€Å"shall allude the patient to the Advanced Directive Questions and Answers area of the confirmation bundle and furthermore will illuminate the patient to look for additional data from the doctor. This further advances the conversations between the doctor and the patient at last guaranteeing that the wants and desires for the patient stay integral to the consideration map. Propelled Directive choices â€Å"require open correspondence between the patient and the human services team† (Burkhardt Nathaniel,â 2008, pp. 242-243). The Agency is likewise re quired to bring issues to light of Advanced Directive inside the network by remembering â€Å"Advance Directive data for its presentations,† either â€Å"in introductions made straightforwardly to the network individuals or in introductions made to different suppliers as well as different associations. Upgraded conversations with respect to Advanced Directives, end of life care and the patient’s wanted arrangement of treatment turns out to be a piece of the heath care provider’s relationship during an office or in home. The formation of transparent lines of correspondence animates sound conversations and fortifies the bond among suppliers and patients. Truth be told the term â€Å"physician-tolerant relationship† has perpetually changed with Advanced Directive approaches. It is all the more fitting that the wording mirrors the way that patients have more noteworthy command over their consideration. In this way the term ought to be â€Å"patient-doctor relationship,† putting the patient at the focal point of the social insurance continuum. As the patient focused relationship proceeds, the past â€Å"passive position† that makes it troublesome â€Å"to remain mentally and genuinely in charge of your own experience† will keep on advancing setting patients first and typical working methods second (Ashton Richards,â 2003, p. 7). What are the impacts of the expanding innovation of patient privacy and information security on human services associations? Social insurance associations face a tremendous errand of keeping up the protection of their patients with the assault of new innovation. This assignment includes guaranteeing that representatives have arrangements and systems to follow when utilizing new innovation to get to secured wellbeing data (PHI), faxing PHI, and utilizing the Internet. Human services associations and medicinal services suppliers have the obligation of executing a patient’s Advance Directives. Be that as it may, new innovation can offer approach to deviation to past practices and the paternalistic mentalities of certain clinicians may bring about dismissing a patient’s Advance Directives. A few clinicians may accept they recognize what is best for the patient since propels in innovation frequently raises trust that a supplier can decidedly affect or change a patient’s current ailment (Burkhardt Nathaniel, 2008). As per Miller and Tucker (2009), the utilization of electronic clinical records (EMRs) could lessen America’s yearly human services bill by $34 billion through higher wellbeing and proficiency yet just 41% of emergency clinics in the United States have received its utilization. Worries over adequately ensuring quiet protection and the expense of making sure about data have forestalled the across the board use all through the business. A prime case of the fulfillment of security concerns is the defeat of the Santa Barbara County Care Health Data Exchange in 2007 (Miller Tucker, 2009). The state commanded security channels yet the framework despite everything fizzled. New innovation requires security insurance gadgets to ensure PHI. This may compel social insurance associations to expand the paces of clinical record utilize just to keep monetarily above water. End The formation of Agency strategies has affected the doctor quiet relationship successfully enabling to control the course of treatment to patients. Basically, doctors have become consultants within the sight of Advanced Directives, respecting the wants of patients and their families. The arrangement of care changed with progresses in innovation. Data sharing and spread requires doctors and other human services suppliers to effectively explore between their new job as counsels and their responsibility to guarantee the best conveyance of care to their patients. Merging the two gives the best assurance that patients will have both their needs and needs met boosting the open door for positive wellbeing results. References Burkhardt, M. A. , Nathaniel, A. K. (2008). Morals and issues in contemporary nursing (third ed. ). Bricklayer, OH: Delmar Cengage Learning. Concerned Home Care, Inc. , (2011). Concerned Home Care Policy and Procedure Manual Harbor Beach, MI. : . Mill operator, A. R. , Tucker, C. (2009). Security insurance and innovation dissemination: The instance of electronic clinical records. The executives Science, 55(7), 1077-1093. Nathanson, M. D. (1997). Home Health Care Law Manual (fifth ed. ). Gaithersburg, MD. : Aspen Publication. Reference section I: Advance Directives for Concerned Home Care, Inc. [pic] Step by step instructions to refer to Patient Self Determination, Papers

Saturday, August 22, 2020

Difference of Marketing Product and Service Essay Example for Free

Contrast of Marketing Product and Service Essay An item is typically a thing that offered to individuals and for the most part is unmistakable. Essentially, the advertising of item is especially centered around 4P’s in showcasing blend in particular item, value, spot, and advancement (Ehmke Fulton Lusk, n. d. ). The advertiser needs to examine the significant interest of clients in a particular market so as to discover an item that can react the market request. Right off the bat, it is important for advertisers to concentrate on the quality just as dispose of the vulnerabilities of showcased items so as to improve items to satisfy customer’s need however much as could be expected. Furthermore, the cost is a significant factor in item showcasing on account of the cost must be set to coordinate with the buying intensity of an objective gathering. The advertiser ought to comprehend the nature cost of selling items. For instance, the aroma cost may be high since it is considered as extravagance great and the moment noodle cost may be low a result of it is considered as accommodation great. Thirdly, the spot of item advertising alludes to appropriation channels to convey and offer the item to clients. In conclusion, the advertiser likewise needs to make the advancement on the item so as to convince clients and propel the deal in a present moment. Then again, a help is the activity that accommodate clients and furthermore has an alternate qualities from the item (Milliman, 1997). Along these lines, the administration promoting is to some degree unique in relation to item advertising. The administration showcasing is commonly utilized assistance promoting blend or 7P’s which is reached out from 4P’s by including individuals, process and physical proof (Rafiq Ahmed, 1995). It is basic for any assistance industry to utilize proper staffs or individuals. Employing and preparing a decent staff will affect decidedly on the association in light of the fact that a large portion of clients will pass judgment on the nature of administration from staffs. In this way, an organization should recruit a staff that has relational abilities, relational abilities and great assistance realize edges so as to give high caliber of administration to clients. What's more, process is a framework used to help an organization in conveying the administration. Procedure likewise exhibits the general execution of the association. For instance, Macdonald purchasers will get the request inside 2 minutes. The advertiser needs to concentrate on the procedure because of meet the customer’s good getting the administration on schedule. In conclusion, physical proof is outside variables that identified with nature around an assistance territory affecting the customer’s impression. Fir Example, a Thai back rub and spa utilizes eye-discovering publicizing board situating before the shop and customary design and environment to draw in outside clients. To summarize, the advertiser for the most part utilizes 4P’s in item showcasing including item, value, spot and advancement. Then again, the administration advertising includes 7P’s which individuals, cost and physical proof were included. As a result of the distinction in attributes, there are more factors in administration advertising and the advertiser should more worry about the customer’s good during administration time. Henceforth, the administration showcasing is to some degree unique and furthermore more convoluted than item advertising. I think item and administrations showcasing are altogether unique in view of normal for itself. The principal normal for administrations showcasing is impalpability; it can't be seen, contacted or felt earlier utilization. On different hands, item showcasing is substantial, the client can contact, feel, taste or smell the item either previously or in the wake of buying. For instance, when clients stroll through an eatery, they may get the food smell from the café however they can't know how well of administration in the event that they don't accepting the menu. Besides, items can be put away so as to offer to the client in whenever while administrations advertising generally can't be stocked, they are transitory. Thus, the estimation of administration consistently exists exactly when it is required. In this way, it is by all accounts hard to coordinate gracefully with request in administration showcasing. Thirdly, the other contrast of item and administrations promoting is the degree of connection between the customer and supplier. Without a doubt, there is substantially more close to home contact required in administrations showcasing than item advertising. If there should arise an occurrence of item advertising, clients and venders may confront each other just once time when they are managing items and they may get no opportunity to see each other once more. Nonetheless, in administrations showcasing, purchasers and specialist organizations may need to see each other regularly all through until the agreement is finished or until the exact opposite thing that buyers hope to pick up from a specialist organization. There is a distinction in value setting between both showcasing. With item showcasing, the cost is anything but difficult to set by figuring from esteem, the quality of a brand, the nature of material and the interest in advertise. Besides, the client can request rebate from sellers so there is high adaptability and a standard in the value setting of item advertising. Then again, administration showcasing hushes up hard to set reasonably cost. Chiefly, administration organizations need to figure from the expense of recruiting representatives and adjusting time. A few organizations likewise charge introductory expense and administration duties to clients. Furthermore, the administration cost is viewed as less adaptable in light of the fact that generally customers can't request markdown from specialist organizations. Reference http://www.extension.purdue.edu/extmedia/EC/EC-730.pdf

Friday, August 21, 2020

Vignette Essay Example | Topics and Well Written Essays - 750 words

Vignette - Essay Example These laborers who are for the most part Mexicans and Hispanics have not been showing up toward the north. It is called attention to from the article that the large scale manufacturing ranches are feeling the mash of the expansion in nearby little homesteads. In view of the reduction in the wellspring of modest work, their produce is getting more costly than the neighborhood ranch produce which used to be increasingly costly. It is refered to in the article that â€Å"local ranch deals are getting increasingly steady, unsurprising and measurable† (Johnson, 2012). The developing pattern is that the Hispanics, who used to be low-wage workers, are currently turning out to be ranch business people through the help of preparing programs for starting ranchers. These ranchers are furnished with the agrarian expertise as well as given direction concerning the conveyance and showcasing of their produce. A few financial ideas and suggestions can be gotten from this article about little scope ranchers. One idea is about the hazard that a business visionary takes in making a speculation (Adomait and Maranta, 2011). It very well may be seen that the low-wage Hispanic ranch workers are facing a challenge in turning into a business person. They are contributing their time and exertion at cultivating in spite of the fact that they don't know whether the speculation is justified, despite all the trouble. It is a hazard to be chipping away at one’s own when one has no involvement with being a business visionary. The worker is facing this challenge with the expectation that he can profit by its normal return. Like the Hispanic rancher, Narendra Varma, the previous Microsoft supervisor portrayed in the article is additionally facing a challenge. He contributed $2 million from his reserve funds to a 58-section of land undertaking of little plots and new rancher preparing close to Portlan d. Since this endeavor might be a high hazard speculation for him, he clearly anticipates a higher pace of return, possibly higher than if he just put his cash in the bank. One imagines that if the pattern towards enterprise proceeds, the economy will be

Wednesday, August 12, 2020

Arguments and Essays - Which is Better For You?

<h1>Arguments and Essays - Which is Better For You?</h1><p>Arguments and Essays: The principle subject of the most recent years is composed papers, or contentious articles. These papers are tied in with giving an entirely different perspective to the conversation, and in some cases this may take a great deal of time and exertion. It really is ideal to have some genuine instances of influential article themes accessible in your work area.</p><p></p><p>Usually, the subjects which are related with various political developments and speculations and thoughts have been the subjects of discussion. These could be Constitutional rights, social equity, strict and social convictions and belief systems. These subjects can help you in your powerful exposition writing.</p><p></p><p>You will find that there are various alternatives that you will have for another point to expound on. Here are some examples:</p><p></p&g t;<p>Arguments: This is another name for composing a paper. You will have numerous styles for composing your contentions. These are generally utilized recorded as a hard copy the mass intrigue material.</p><p></p><p>In English, these are called contentions, and they are utilized to sum up a point, build up a thought, or present a hypothesis. Much of the time, this is utilized in basic exposition points, where the topic is introduced for the peruser to frame their own opinion.</p><p></p><p>Essay Topics: This is the place you can locate countless subjects that are utilized in an assortment of ways. It is additionally called an exposition. In spite of the fact that, these are progressively scholarly in nature, they can even now be utilized in the mass intrigue assortment of paper composing, to assist individuals with getting the hang of something new.</p><p></p><p>Essay themes are one of the essential reasons why exposition composing is famous in the present occasions. It will help you in making a contention out of a reality or a point. Individuals will like your article, in the event that it has valid statements, great subjects, and solid points.</p><p></p><p>List: This is additionally another type of a theme that is utilized recorded as a hard copy a paper. Nonetheless, you may have the option to utilize a solitary rundown at a time.</p>

Thursday, July 30, 2020

Business Management Essay Samples

<h1>Business Management Essay Samples</h1><p>It is normal information that there are numerous business the executives paper tests to look over when composing your school or college exposition. A business the executives paper might be a significant piece of your school or college application, and picking the best one for you can be a troublesome task.</p><p></p><p>Many understudies have really composed various articles dependent on their business the board coursework. A few expositions had more inventiveness than others, however every one of them figured out how to examine significant subjects that would be considered 'huge' in your business organization class. Obviously, the best exposition would have taken the most time, and it ought to have secured the fundamentals. We should take a gander at some business the board paper tests that you might need to use for your school essay:</p><p></p><p>No subject article This exa mple is ideal for somebody who is simply beginning. It takes the rudiments of business the executives and talks about those fundamental standards in extremely general terms. It can without much of a stretch be adjusted into a school or college paper on the off chance that you wish to do as such. The professionals of this example incorporate its adaptability and effortlessness, and its straightforwardness makes it simple to adjust to a few diverse essays.</p><p></p><p>MBA Business Management Essay-This paper presents a very much idea out diagram of MBA business the board. It takes the fundamentals of MBA business the board and delineates them with genuine models. The aces of this example incorporate its capacity to introduce an elevated level review of MBA business the executives, just as the way that it can undoubtedly be utilized as a school or college exposition. Its straightforwardness makes it simple to adjust it to various types of school or college essa ys.</p><p></p><p>MBA Business Management Essay - As the name recommends, this is a progressively broadened adaptation of the MBA Business Management Essay. Rather than having an expansive layout, it has a bit by bit procedure to follow, enabling the understudy to dive further into the subtleties of the different zones of MBA business the executives. The significant part of this example is its capacity to show an individual how basic reasoning can assist them with growing better MBA business the board. The stars of this example incorporate its capacity to grow the aptitudes of the business graduate, and the way that it tends to be utilized in a school or college essay.</p><p></p><p>The Business Management Essay-This is a diagram of the four head territories of business the executives. The benefit of this example is that it shows an individual how their coursework can lead them to ace these zones of business the executives. The primary f ocal point of this example is to show an individual how they can truly turn into an innovator in their field. The aces of this example incorporate its adaptability, adaptability, and in general effectiveness.</p><p></p><p>These are only a couple of the various kinds of business the board article tests that you can use for your school or college business organization courses. They each spread the nuts and bolts of business the board and can be utilized to show the understudies how to assess the necessities of an organization, and their devices and procedures to improve the organization's business. It is ideal to discover an example that can be utilized for every school or college composing assignment.</p>

Monday, July 20, 2020

English 101 Narrative Essay Topics

<h1>English 101 Narrative Essay Topics</h1><p>English 101 account exposition subjects are unquestionably the best ones to consider when composing a paper. The motivation behind why such a large number of individuals appreciate composing articles is that it is commonly viewed as a straightforward errand that can be performed by anybody. Be that as it may, not every person understands that they can compose effectively and with precision. Here are three English 101 story paper subjects that you should utilize in the event that you need to compose a noteworthy article that gets you noticed.</p><p></p><p>There are various reasons why this account exposition point is truly outstanding ever. Above all else, the storyteller is acquainted with the peruser before the individual in question offers an individual input regarding the matter. Furthermore, the storyteller offers a precise input on a particular circumstance and advances the realities in an un mistakable and sensible manner.</p><p></p><p>Some of different kinds of paper themes that you may discover fascinating include: Introduction, Rise and Fall, Clichés, Starting Over, Mass Accusations, Unsafe Operations, Advertisements, Legal Issues, Heroes, Aesop, Concept Creation, Drama, Education, Motivation, and Introduction of Technology. Every one of these papers can be arranged by how they start off and how they end. What's more, a portion of these exposition subjects depend on close to home encounters while others are established in present day topics.</p><p></p><p>Writing an article to communicate your sentiment about a specific circumstance or offering guidance for another person to carry out their responsibility is viewed as one of the most widely recognized types of composing a paper. In the event that you feel that you have the composing abilities and the character to take on this sort of composing, at that point this articl e subject might be the best for you.</p><p></p><p>You may likewise need to consider composing an exposition that starts with a rundown of conceptual things that portray a specific circumstance. This subject is very straightforward and can fill in as a reason for additional examination. It is likewise one of the simplest account article points to compose. This subject additionally begins with a presentation and depicts how current ideas have impacted that specific circumstance. It ought to be noticed that there are additionally numerous cutting edge methods that you can use so as to make your exposition more effective.</p><p></p><p>By understanding what these paper themes are, you can get into the way toward finding out about which one works best for you. There are a lot of various instances of article themes that you can utilize. For instance, on the off chance that you need a subject that depends on your own understanding, you can pic k the one that suits your needs.</p><p></p><p>Whatever exposition point you pick, you can utilize one of different themes above as a source of perspective. As a fledgling, you should realize that you can't simply aimlessly follow the entirety of the tips above without knowing anything about composition. Make certain to peruse bunches of compositions from different authors so as to discover how to appropriately structure your exposition and to figure out how to compose a paper that will rouse you to compose even more.</p>

Tuesday, July 7, 2020

Sat Essay Samples Answers Tips & Guide

<h1>Sat Essay Samples Answers Tips &amp; Guide </h1> <p>Going through some of the data inside this site will assist with guaranteeing it is more straightforward for you. We should consolidate the data above. Incredible news is here to remain. </p> <p>Or various aspects of the reaction's investigation are ridiculous subject to the content. That is the reason it's totally plausible to prepare for the exposition early. Another kind of proof that is frequently utilized as a substitute to established truths or measurements is the story. Real proof may likewise be looking like non-numerical information. </p> <p>Currently a dominant part of Ivy League schools don't request the composing area. On-line enlistment is finished on the site of the College Board. It's generally suitable for you to figure out how a school utilizes the composing test in confirmations before settling on the choice to never take it. The SAT test gave by College Board covers a wide choice of points. </p> <p>If you're ready to support that attitude, you'll have a chance of getting in. There are two sorts of imagining. You'll preferably need to create a couple of training papers before you sit for the real thing. Our current social tr oubles, which despite everything comprise of prejudice, need to get looked by people with social boldness like Atticus Finch and Guy Montag. </p> <p>No longer will you have to contend a point using invented models from either history or your very own life. Composing, on the other side, is very unique. As an approach to make a high understanding score, furthermore, it is imperative that you form a significant sum. Accomplish your scratch work directly on the test, not on discrete pieces of scrap paper. </p> <p>Also, guarantee you give yourself breaks! You have abundant opportunity to verify you understand the entry, and it's significant you do as such so as to get the most extreme perusing class score conceivable. Just take two or three minutes to make an unpleasant article program and it'll offer you center and course. You're given 65 minutes to complete the area. </p> <p>At times it can even address matured blunders in thought and set a conclusio n to wrong activities. Everything should lead back to the most significant point in some way. In two or three minutes, you may really be feeling more amiable. Fifty minutes may not have all the earmarks of being an exceptionally lengthy timespan to think of an elegantly composed answer, yet utilizing a quiet and rehearsed approach you will get the opportunity to uncover your absolute best work. </p> <p>The absolute first thing that you should observe is that the brief lets you know precisely what kind of components you should concentrate on to watch the manner in which the creator fabricates their contention. You will require a presentation, the significant body and an end. The inquiry isn't generally looking for your supposition. Think about the setting of the genuine world. </p> <h2> The Ultimate Sat Essay Samples Answers Trick</h2> <p>An layout additionally empowers you to design your composition by giving you a completely clear attention to co urse while changing from 1 point to the following. Your work is to portray the way the rhetor is endeavoring to convince their crowd. This one is vital, especially if it's the absolute first time you're reaching your educator. You might be shocked at how often understudies get their educator's name wrong. </p> <p>A genuine proportion of a mentor is the way the react when they have to reload the program and that is an expectation to absorb information. The most significant point is, you don't have to hold up until you locate the brief to think of a munititions stockpile of sorts of contention building strategies you may use to back up your focuses. Something which I feel that slaughters this supplier is they don't oversee people well in such a huge setting. In a muddled world, notwithstanding, participation is essentially bound to make noteworthy, enduring achievements. </p> <p>Finding out how to create proficient messages is an ability you may take with you i n the supposed genuine world. Like a large portion of various tests, you can improve your SAT scores through training. Preparing for the SAT is like reading for any tests. There are two strategies to enlist for the SAT test, on the web or via mail. </p> <h2>Details of Sat Essay Samples Answers </h2> <p>There are a lot of proposals that can aid the composition of a decent SAT test papers. Much like any exposition, it's basic not to meander aimlessly and hold fast to the basic focuses. Probably the best tip for composing SAT exposition answers is to show your jargon. You're given 50 minutes to complete the article. </p> <p>If you're perusing this guide, you in all probability need to exceed expectations on the SAT paper. Your paper rating will show up on each score report you send to universities, independent of whether the school requests an exposition. On the off chance that you might want to rehearse the new SAT paper, extraordinary news! Nonetheless, concerning composing a SAT paper you're doing this by hand and your grader will require so as to peruse your composition. </p> <h2> Choosing Good Sat Essay Samples Answers</h2> <p>Frequently the inquiry will be a yes or no kind of answer empowering you to compose a simple paper in a constrained amount of time. Responding to these inquiries implies you must have a gander at the bigger picture. All the inquiries in this part will test your ability to upgrade an entry's composing style. Peruse on to gain proficiency with the responses to these questions!</p> <p>At the base there's a starting passage with at any rate a sentence or two. Hold fast to the fundamental 5 section article organization and you will be in a situation to think about a quick blueprint in the blink of an eye in any regard. You may feel as though you need to start composing as quick as could be expected under the circumstances, yet be certain you completely handle the creator's contention altogether before starting. Change from the last passage inside this model (1 sentence).</p> <p>Taking test questions is a fantastic way to prepare for your SAT test. In addition, following your training test, you will get customized practice suggestions so it's conceivable to focus on what you missed. The SAT test is given multiple times each year in the usa. Most of the test remained precisely the same. </p>