Testimonial Hearsay as a Challenge in the Criminal Justice System


The high number of criminal cases puts a lot of pressure on the justice professionals to resolve the cases in time. However, in a hurry, some crimes may be under-punished or over-punished. Such cases may involve hearsay, which may not be admissible in a court of law. In a recent article, Tchividjian (2015) writes about child abuse prosecution whereby a three-year-old boy was assaulted by his mother’s boyfriend, leaving him with “visible whip marks on his face and upper back.” The boy told a teacher that Darius Clark also known as “Dee Dee” beat and burned his 22-month-old sister. However, the presiding judge ruled that the boy could not testify due to his young age (Tchividjian, 2015).

Although Clark was sentenced to 28 years in prison, an appellate court reversed his conviction on the basis that the teacher’s testimony regarding the boy was in violation of Clark’s “constitutional right to confront his accuser” (Tchividjian, 2015) thus sending the case to the United States Supreme Court. Tchividjian (2015) goes on to explain the testimonial hearsay, which is used out of court to prove a matter asserted in a statement. However, such testimonial hearsay statement is admissible in court if the defendant cross-examines the person giving the evidence. As such, if the “original declarant does not testify at the trial,” then the defendant’s constitutional right of cross-examination would have been violated.

Testimonial Hearsay

Testimonial statements are made to criminal justice professionals or government employees while hearsay statements are made to neighbors, friends, family, or co-workers. For testimonial hearsay to be admissible in court, the unavailability of the declarant or a beforehand opportunity for the declarant’s cross-examination according to the confrontation clause of the Sixth Amendment to the U.S. Constitution set in Crawford v. Washington, 541 U.S. 36 (2004). Therefore, the criminal justice system faces the problem of lack of the opportunity to confront and question the declarant on the statement they made out of court. Testimonial hearsay also affects the defendant in that they do not cross-examine the original declarant. Conversely, the victim of the crime may fail to get the proper justice since the declarant may possess crucial information regarding the case.

Additionally, criminal justice professionals may have problems differentiating between non-testimonials from testimonial statements, especially in child abuse cases since children are less likely to complain to the police. Further, the difficulty of discerning testimonial hearsay may lead to consternation for prosecutors. (Tchividjian, 2015) explains that testimonial hearsay may require a child to testify in court to reinforce their previous out-of-court statement. However, children find it difficult to give evidence in court thereby affecting child abuse prosecutions when determining who constitutes law enforcement.

Tchividjian (2015) notes that if the Supreme Court decides that child abuse disclosure is to be termed testimonial, then prosecutors would not be able to prove child abuse cases, especially for very young children or emotionally vulnerable children. However, the defendant may victimize the child thus avoiding prosecution because they would not be subjected to cross-examination exercise. There have been some cases in which criminal convictions have been overturned because out-of-court statements made by children were admitted after they failed to testify (Morin, 2005). Once a child makes a disclosure, the law enforcement should protect them from immediate harm. They should be taken to a child advocacy center for an interview, which should be videotaped. Such interviews should then be used as evidence against the defendant.

Courts should also hold that by exploiting a child’s vulnerabilities to ensure that they would not be available to testify in a trial, the defendant would have forfeited their confrontational rights. The ruling in the Crawford case can be termed as a significant loss of evidence from criminal trials. The out-of-court statements may thus be taken by government agents for them to be considered testimonial with the witness having expectations that the statement would be used during the trial.

The prosecution could combine elements of the government-centered standard and declarant-centered standard. Therefore, if the child foresees later prosecutorial use, then the declarant’s statement would be testimonial. Further, the criminal justice system should admit the child’s unsworn prior statement as substantive evidence. They could also adopt Rule 804(b), which permits the substantive use of a declarant’s statement taken by the police officer in the presence of the accused, even if the accused had the chance to deny or explain such statement (Fishman, 2010). The Criminal justice system should also create a permissive presumption explaining that the child was pressured by the defendant not to testify, and as a result, forfeiting the confrontational rights of the accused.

The Crawford ruling has affected the prosecution of child physical abuse and domestic violence, especially when children are the key witnesses. In some cases, a mother may be the victim, while her child, the witness. In such cases, if the mother is unavailable, the child may not cooperate, which presents a great challenge to the perpetrator’s prosecution and provision of justice to the victim. The criminal justice team handling the case should carefully document the child’s report soon after the first statement about abuse.

Healthcare Policy Formation and Analysis

Defining the Problem

The increasing awareness of the limits of individual health care necessitates a need for effective public health strategies. As such, researchers are coming up with medical technology to ensure earlier diagnoses, personalized treatments as well as other benefits for both clients and health caregivers. Such technologies include a new generation of gadgets and wristbands that record the number of steps one takes, sleep cycles, and heart rates. The technological changes are crucial in detection and prevention of congestive heart failure.

Therefore, this health policy framework looks into the technologies that healthcare practitioners can use in controlling congestive heart failure thereby enhancing the availability and quality of effective health care. For such to be achieved, knowledge on social, political, and organizational skills is important to bring these changes at both national and local levels.

Congestive heart failure is one of Medicare’s most costly diagnoses with the mortality being considerably high. As such, technology would give both the care team and the incessant patient information regarding the functioning of the compromised heart (Krumholz et al., 2007).

Evidence of the Problem or Need for a Policy

Congestive heart failure is a serious condition that represents the end-stage of many other cardiac diseases without a curative treatment. Upon diagnosis, the patient should take medication for the rest of their life to improve life quality and survival. The contributes to both the cost and burden of national healthcare expenditures, with an increasing number of older Americans hospitalized for heart failure than for any other medical condition. Therefore, the impact of the condition is expected to increase substantially with the aging of the population.

However, there is a pattern of wide variation in health care practice, which shows that medical practice has not kept pace with the changing technology for evidence-based practice in the United States (Walsh et al., 2012). Additionally, millions of people do not have access to necessary care thus suffer complications that add to costs and reduce their productivity.

Alternative Solutions to the Problem

Improved implementation of the current preventative therapies and measures and enhanced community-based cardiovascular health strategies can be used in the improvement of prevention and treatment of congestive heart failure. Primordial prevention strategies can mitigate the population burden of congestive heart failure by preventing Heart failure adverse risk factor development. Care coordination can be used as the alternative solution to the problem since it benefits patients by reducing the cost of care, decreasing medication discrepancies, and decreasing readmissions.

Alternative to the technological improvements are dietary and lifestyle changes, for instance, sodium restriction to decrease fluid retention, smoking cessation, and alcohol consumption limitation. It is also important to exercise daily weight monitoring to identify early fluid accumulation before the development of symptoms to reduce any chances of hospitalization. Aerobic exercise in stable patients, especially during cardiac rehabilitation program may also prove crucial.

Criteria for Choosing the Correct Solution from the Alternatives

Primary care physician rather than rehabilitation programs and heart failure clinics specialized in treating heart failure care in approximately 66 percent of the patients. Therefore, it is critical to change strategies toward increasing prevention instead of spending more money in expensive and less effective treatment measures (Sandhoff et al, 2008).  Therefore, controlling risk factors, such as obesity, diabetes, and hypertension is essential in preventing and delaying heart failure. New and improved systems to monitor patients with diagnosed heart failure would prove essential in choosing the correct solution from the alternatives.

Outcomes of the Policy Changes

Outcomes represent the healthcare delivery’s core of value. The outcomes, however, may have the tendency to bring about a single ideal outcome measure for the condition. The outcome would depend on the easy to agree upon measure. The policy changes would increase the costs of achieving outcomes involved in care. There arise shifting costs across parties by, such as raising patient co-payments for prescription drugs. As such, lack of proper measurement of costs goes against real value improvement due to the organization and payment for treatment.

The outcomes include reduced costs through early detection thereby limiting the complexity of care, as well as ensuring less need for subsequent care, early recovery, and less invasive treatment (Fonarow et al., 2011). As such, the outcomes would define patient value, such as death and survival. Other outcomes related to safety, such as the incidence of medical errors and their consequences would also apply.

The Trade-Offs of Not Having a Policy or Addressing the Problem

Lack of a policy may lead to treatment with a greater risk of care-induced illness for a complete recovery. Additionally, there would be a need for treatment that is more discomforting in the case of a complete recovery. The individual patients may also differ on the importance they place on specific measures and the different levels of the hierarchy. The degree and sustainability of health achieved would affect the discomfort of treatment willingly endured by the patient, for instance, some considerations may weigh seriously against the risk of recurrence of the condition.



Achieving the best health care technology will first depend discussing the barriers to its adoption. Practitioners should ensure that the appropriate use of technology is taken as an integral part of all policy development in health care. The policy would work to accelerate and increase the use of technology in the prevention and treatment of congestive heart failure. Further, it would ensure that the technologies are structured to facilitate innovation uptake as well as the adoption of appropriate technologies that consolidate access to innovation funding and R&D to provide the desired outcomes. The policy would help improve care coordination and communication and thus teach team member to focus more on the quality of care. Besides, it would increase access to cardiovascular care and expand services to more populations and other geographic areas.

Health Policy’s Intended Use and Its Effect on Direct Patient Care in the United States

The health policy on technological changes towards the prevention and treatment of congestive heart failure would help nurse leaders to think about how emerging technologies would be necessary for improving the nursing practice. Moreover, it would create leadership development programs and educational models essential to assuring that practitioners will have the required competencies to address such emerging technologies. Due to the uncertainty of the future, much of what the profession will experience in the future in the United States will be different from the past. The ability to apply and integrate rapid technological change would be essential in improving the prevention and treatment of the disease.

The policy will emphasize on value generation as the fundamental goal of any healthcare system. The driving force of the health policy formation will thus include measuring of value and improving it as the engine for every participant in the US healthcare system (Heidenreich et al., 2013). The policy will ensure that health care is organized around value to create excellent care and drive down cost. It will also align reimbursement with value to better the process of value improvement and increase the profit motive in healthcare delivery as a cost driver. As such, health workers, government, and employers can use the policy to make the measurement of value in health care regarding congestive heart failure a reality.


Advanced Academic Study and Writing

The management of international businesses represents a crucial element of the development of economies. However, the presence of different players performing different tasks complicates international business. The need for the management of international business requires organizations and institutions to ascertain the support and economic policy of the players regarding emergent situations (Dunning, 2001). As such, a researcher would want to indicate and interpret the motivations of international business concerning barriers, benefits, and problems. The proposed conceptual framework could thus be easily applied since it holds true to 90 percent of the economies.

The conceptual framework thus describes the existing practice, prescribes the future practice, and defines the main terms and underlying issues. It provides the basis for future debate concerning the concepts that can be used by other researchers to identify and broadly debate the issues in international business (Hedman & Kalling, 2003). Therefore, it is appropriate to apply the conceptual framework to advance the research. It is important to inquire about the determinants of the success and failure of companies around the globe. To answer such question, a look at the institutionalized view and resource-based views would prove helpful. Therefore, the framework identification would assist in defining the international business field to draw the attention of practitioners, scholars, and students.

The existing research on international business indicates a clear dichotomy between the focus on the activities on overcoming the barriers set by governments and activities that open up national boundaries (Dunning, 2001). However, research on international business shows that decision-making by firms applies uniformly. There should be an understanding of the foreign government and multinational corporations, and a bargaining relationship must exist to ensure that each achieves their goals. The constraints and goals of business show that companies and governments incur pressures from each other as well as from other participants, for instance, local firms.


International Business Annotated Bibliography

Mulugetta, A., Mulugetta, Y. and Tessema, A. (2016). Competitive Currency Devaluations, Quantitative Easing and Volatility of Exchange Rates. Journal of International Business Research, 15(1), pp. 15-31.

This paper uses a descriptive study to examine the exchange rate volatility before, during and after the great depression using forward and spot exchange rates relationships regarding direct and indirect market interventions used by central banks in both developed and emerging economies. The paper uses a panel of nine developed and nine emerging nations to ascertain the significance of multiplicative terms of the dichotomous variable and foreign exchange reserves, money supplies, and interest rates as the monetary policy variables. The authors use the Thompson-Reuters’ Data Stream to determine the key macro variables. The authors show that interventions by central banks during the recession period where highly effective when monetary policy tools were applied in the foreign exchange markets. The paper finds exchange rates to be more volatile for emerging economies. Using panel data on the emerging markets, however, does not provide clear interventions. The authors use scholarly sources to support the research arguments and thus provide credibility. The findings of the study can be used give the expected direction of interest rates in developed economies.

Calantone, R. J., Cavusgil, S. T., Schmidt, J. B. and Shin, G. (2004). Internationalization and the Dynamics of Product Adaptation— an Empirical Investigation. J Prod Innov Manag, 21, pp. 185–198.

This paper investigates the motivation of firms to adapting products for export markets and the performance implications arising thereof. The authors use survey mails in this quantitative survey to gather information from managers in both South Korean and theUnited States. Data is analyzed using structural equation modeling. The authors use scholarly sources to support the research arguments and thus provide credibility. The authors find out that a positive association exists between the product adaptation level o and at the project profitability level. Questionnaires, personal interviews are conducted to arrive at the findings. It is found that U.S. firms are more reactive in adapting products to export markets while South Korean companies re proactive. Responsive market organizations bearing customer-focused practices have greater international product adaptation. However, there were inconsistencies in results of the two surveyed countries. The findings of the paper can be used to create a market-responsive organization and thus help companies catch up with customer market changes thus enhance international business capabilities.


Patrol Allocation Decisions

All police departments grapple with the challenge of allocating their limited resources to meet law enforcement needs of the communities they serve. Crucial to alleviating the cost pressures the departments face is patrol force allocation. Most of the budgets go to salaries and expenses, such as fringe benefits, which mean that increases in personnel utilization efficiencies would result in dollar savings. As such, it is the duty of police chiefs to determine what the patrols will look like regarding when and where the patrols will take place. This paper, thus, seeks to outline how the Centervale Police Department should allocate patrol resources to serve the needs of Centervale best.

Patrols are meant to eliminate criminal opportunities by creating an impression of presence in the community. However, patrols do not decrease an individual’s desire to break the law but by diminishing the opportunities to commit a crime, they promote a sense of safety to residents (Frogner et al., 2013). As the assistant chief in the Centervale Police Department, CPD, one would develop a strategy that caters for both sides of the railroad tracks with fairness although with an emphasis on the crime-prone north.

The CPD assistant chief should allocate patrol resources to reassure visibility to the community, respond to emergency situations, and deter crime in the north side of the railroad tracks. Additionally, the allocation must take into consideration the complexities of the police patrol function. The allocation would depend on the officers available to immediately respond to an emergency, the array of tasks and performance objectives assigned to patrol, visibility in the community, the need to meet response time goals, and the need to perform proactive activities (Frogner et al., 2013). However, it is crucial to desist from allocating the patrol resources depending on police-population basis since both sides of the railroad tracks have an equal population but different crime rates.

The assistant chief would also consider using preventive and directed patrols. Random preventive patrol strategies aim to increase visibility in the community to deter crime and reduce the general public’s fear of crime. However, this method of patrols is ineffective at apprehending offenders. Directed patrols in Centervale would use hot spot policing approach by increasing the presence of uniforms on the northern side of the railroad tracks, where crime is most prevalent at night (Braga, 2005). However, that would come at a price to the south side since the residents of the south of railroad tracks contribute more to the town’s taxes. The assistant chief would have to use the money coming from the south side for crime deterrence in the north to prevent migration of criminals to the south.

Studies have shown a 23 percent decrease in violent crime in Philadelphia when directed patrol intervention was used in the intervention hot spots (Ratcliffe et al., 2011). Therefore, officers can be placed in hot spots on the northern side of Centervale, where 80 percent of the crime takes place. Conversely, hot spots would also be needed on the south side since there is 20 percent rate of crime with more hotspots at night than during the day. Therefore, the dosage of patrol in the area would be determined by the categories created from time spent in hot spots in addition to the crime calls related effects compared to the drive-by patrol results (Braga, 2005). The directed patrol officers would receive specialized training to enhance community involvement and support.

Concerning the broken windows model of policing, the assistant chief would focus on the importance of disorder in generating and sustaining crime (Fagan, Geller, Davies & West, 2010). Therefore, the assistant chief would work together with his task force to disrupt the process of fear and withdrawal from residents. The process would involve focusing on disorder and less severe crime in Centervale as well as promoting higher levels of informal social control to assist community members in taking control of their neighborhood and preventing serious crime from escalating (Fagan et al., 2010). The CPD can also apply zero-tolerance policing by aggressively policing against crime and every violator arrested.

Foot patrols would be effective in addressing minor crime and disorder problems on the beats, for instance, small-time drug dealers, prostitution, and loud youths. Addressing such small crimes would elicit interest from residents who would, in turn, feel safer and thus restore confidence in the police units and make the neighborhood safer by asserting informal social control. As a result, the residents would increase their property safety and thus attract other people and investors into Centervale. The foot patrol officers would become well known to the residents and thus increase the probability of closely working with the area residents to curb crime (Frogner et al., 2013).

The CPD would also ensure that notions of fairness and equity in the department are adhered to so as to encourage all the officers to take part in the policing function. The belief that officers are dealt with fairly would lead to acceptance of corrective actions and elicit positive attitudes towards the department. Further, resources should be allocated fairly according to the crime rate in the town to ensure that criminals do not move from one side of the railroad tracks to the other to commit a crime. Fair disciplinary actions should be taken to deter officers from engaging in a code of silence thereby undermining the whole process.

The response times would prove essential in the patrol resource allocation decisions. In Centervale, it takes ten minutes on average for an officer to respond to a call from dispatch on either side of the town. The response time should distinguish between emergency and nonemergency calls for service with the help of a priority system (Fagan et al., 2010). Additionally, the response time goals should determine the number of officers needed to meet the response time objectives. For instance, the response time goals for the southern part of the town would be set fairly high, and as such then fewer officers would be assigned to patrol such an area to meet this objective in comparison to the northern part. However, the department can modify the goals with any changes in policy.

The CPD assistant chief may also employ split patrols comprising of a reactive and proactive patrol units. As such, the proactive unit will take part in preventing action patrols while the reactive unit will answer all service calls (Fagan et al., 2010). Alternatively, the assistant chief may ask the units to switch roles or have the proactive units in directed patrol missions on a systematic basis. The assistant chief may also emphasize on two-man patrols in the south of the railroad tracks where 20 percent of the crime takes place while one-man patrols are conducted in the northern part. The one-man patrols would be useful in the crime-prone area because they have the advantage of doubling the number of patrols in the patrol force. They also make more arrests in addition to having fewer citizen complaints, as well as certain safety advantages.


Current Issues in the American Government

Social and Economic Inequality

America is the richest country in the world. However, the wealth is unevenly controlled by few individuals at the top of the economic pyramid. Therefore, wealth and income inequality is one of the current issues in America that the government should address. Statistics show a widening gap in income and non-wage income, such as returns on capital gains and investments (Hurst, 2015). For instance, between 1979 and 2007, the real incomes of the richest people in America tripled while the real incomes of the middle-class families increased by 25 percent, particularly due to increases in the hours worked and labor force participation (Gilens, 2012).

Apparently, the wealthy 5 percent in America account for over 60 percent of the country’s wealth. Economic inequality brings about social and political inequality as well as political polarization and gridlock thereby benefiting a few individuals. As a result, societies with equal distributions of wealth are more likely to experience political equality. Millions of Americans are still working longer hours for lower wages despite the massive productivity and advances in technology taking place in the country. The real median income of male employees is estimated at $783 less than in the 1970s while female workers earn $1,300 less than in 2007 (Gilens, 2012).

The billionaire class and the Wall Street brokers have engineered the rules to consolidate wealth amongst the most powerful and wealthiest people in the country. These people through their corporations are sending jobs abroad and enjoying tax havens while millions of Americans are jobless and children sleeping hungry.

According to a Gallup survey, 16 percent of Americans feel that the country’s central problem is the government, which includes the President, Congress or political conflict (Saad, 2016). The government has failed to protect the interests of the citizens by entrenching a culture of inequality. The American citizen, when asked about the problem, suggests that the government should raise taxes for individuals who earn more than $1 million annually as well as increase the federal minimum wage. Further, it would help reduce the gap if the government mandated employers to provide paid leave to parents of new children and workers caring for their sick loved ones in addition to paid sick leaves to workers (Hurst, 2015).
Reactions of a Modern Philosopher to the Issue

One of the philosophers who would be concerned with the state of inequality in America is Jean-Jacques Rousseau. Rousseau saw economic equality as a better way of promoting citizens’ freedom as well as securing the social conditions for satisfactory recognition (Neuhouser, 2013). Rousseau, himself, was a victim of inequality when his native city of Geneva transitioned from feudal to a capitalist economy. Rousseau held the opinion that governments should purposely strive to prevent extreme inequality of fortunes.

As currently is the case in America, Rousseau noted that the wealthy would use their power to shape the legislation to better their own interests at the expense of the poor. As he observes economically equal economies enact fairer laws to serve the general populace instead of a specific will of the privileged few (Neuhouser, 2013). Regarding the issue of civic concord, Rousseau points out that governments should set policies that end inequality.

Rousseau would ask for transparency and accountability in public-employee unions, who seem to pit private employees against public workers and non-union members against union members for political gains. Further, Rousseau would ask Americans to desist from trying to prove themselves better than others to ensure that the society does not reward distinction with wealth (Neuhouser, 2013). Therefore, Rousseau would advise those in government to acknowledge inequality in addition to confronting the dimensions of economic inequality.

Marxism Today


Marxism explains the development of human society. It uses a materialistic interpretation of historical development as well as social transformations to analyze societal conflicts and class relations (Törnquist, 2014). Marxism bears the idea that in a capitalist system of government, workers sell their labor, which ultimately translates into surplus value for the capitalist rather than the workers. Such an argument shows that capitalism is built on inequality, whose effects can shock economies, especially during financial crises. However, countries, such as India can benefit from Marxism and elevate the living standards of her citizens, who are serious impoverished.

The Effects Marxism in Today’s India 

India has been experiencing an economic turmoil accompanied by a wave of social and political unrest. The Congress is corrupt, and lack of a majority in parliament leads coalition partners to engage in regime blackmail. As the media and imperialist institutions pressurize the government to cut subsidies on basic needs and food to the people, there is no better time to opt for Marxism than today (Klikauer, 2015). The country is characterized by a bourgeoisie class that controls the political parties and the media at the expense of the people in addition to supporting Hindu fundamentalists who benefit from profits and exploitation of the people (Törnquist, 2014).

However, India would have to deal with the caste system, which entrenches class struggles and dynastic, nationalistic, and religious conflicts. The unemployed population would serve as a reserve army of labor, from whose competition for jobs would keep wages at the minimum. Once more jobs are created and workers get better remunerations for their labor, power would somehow move to the hands of the people as they seek to preserve scarcity (Klikauer, 2015). The people would have the power to vote for politicians who enact laws that have the interests of the proletariats at heart. The leaders, on the hand, by embracing Marxism would evolve to propagators of humanist ideas and rationalism.

Tocqueville’s View of India

Tocqueville argued that equality of conditions or democracy is central to most societies, which the people must try to make it work. Tocqueville would be surprised by the nature of democracy in India where people value the caste system, and people are not viewed as equals. The best things in life are the preserve of the upper castes with the lower caste being made to live a life of misery even if they are rich. Such is the power that has led to tyranny in India and forms a part of the country’s history. Additionally, Tocqueville would note the unchecked political power in India, where the upper class controlling the media and politics would lead to tyranny (Swedberg, 2009).

One would also notice that there is less independence of mind in India as the caste system spells out the life for every citizen. The resulting power for the upper class in the Indian society seems to dictate the marginalized individuals in the slums of various cities across the country as well as the unpopular minorities in the bottom castes (Swedberg, 2009). However, in some cases, India offers social mobility to those who want to work although the opportunities are limited. The entrepreneurial and creative Indians find better opportunities in other countries.

Radical equality would thus give rise to increased bourgeoisie materialism as well as individualism selfishness as witnessed in America, which India tries to emulate (Swedberg, 2009). Worth noting to Tocqueville would be the fact that not all Indians would enjoy the same rights and privileges, and thus a societal conflict would be inevitable at all times.


The Multilayered and Decentralized System of US Law Enforcement

In the United States, there is no single law enforcement agency bearing total jurisdiction to enforce all laws in all American states. Although the Federal Bureau of Investigations is considered as superior to other law enforcement agencies across the country, sometimes there arise conflicts regarding the cases that can be handled at the state level and those that are subject to Federal investigation.

As a result, some law enforcement duties should belong to the federal law enforcement while the police at the state and local levels should have defined roles to avoid conflict in law enforcement. Further, local problems should be solved using local remedies, which would oppose the argument of centralizing the police unit and moving all police powers to Washington, DC. Although conferring all police duties to the federal law enforcement would increase consistency and efficiency while at the same time reduce costs, it would diminish the local law enforcement in the community.

When there is a separation of the duties that the federal, state and local police should perform, a perception that the law enforcement officers policing their neighborhoods are accountable to the local people would be certain. Therefore, the people would maintain their trust to the local officers and thus increase the community policing efforts. The federal law enforcement should handle matters, such as immigration, which when left to the state police would increase the chances of racial profiling and violation of rights to freedom (Varsanyi, Lewis, Provine, & Decker, 2012). However, cooperation is needed between the police and the federal law enforcement to ensure smooth execution of policing duties.

The functions of the different law enforcement units should be clearly defined to avoid conflict as was the case in United States v. Lopez whereby a high school student from a Texan school was arrested for carrying a gun to school. He was charged with violation of state law which criminalizes the possession of guns on school premises. However, federal agents got involved with the case under the Gun-Free School Zones Act of 1990 and thus state authorities had to bow out. How the case was handled showed that the Federal law enforcement had outstepped its mandate and got involved in matters that were at the jurisdiction of the state law.

The federal law enforcement should stick to national security priorities, for instance, cyber-crime, counterintelligence, and counterterrorism. It should also enforce criminal matters regarding major theft or violent crime, white-collar crime, organized crime, civil rights, and public corruption. However, in the instances where there is substantial evidence that state, and local police units are acting in a manner to undermine investigations, then the federal law enforcement should get involved.

The United States should continue with the multiple layers of police agencies rather than centralize the national police agencies. However, one may argue that centralized police agencies providing a strong central control which multi-layered policing agencies cannot sustain since close control is exerted by a central authority which oversees policy, programming, procedure, and operations (Richman, 2000). The policing agencies should be independent in their duties although cooperation would be called for in certain circumstances. The United States system of policies is somehow fragmented and thus adopting a model that is a hybrid of both decentralized and centralized system would prove more effective (Richman, 2000).

Different police agencies should be linked to their specific geographic areas where they would exercise jurisdiction over such area. The federal law enforcement should deal with serious and organized crime while the local policies should be based on the preferences of the regional citizens. Centralizing the law enforcement would deprive the people their power in community policing although neglect of inter jurisdictional externalities occurs (Hathaway & Shapiro, 2011). Having a national police agency would lead to skewed allocation of resources to favor agencies that are viewed as belonging to the required majority.

Having a national police agency is only possible if the officers are well-educated and viewed as professional specialists. Thorough training and education would lead to better treatment of minorities, decreased dogma, fewer community complaints, higher aspirations, and increased use of discretion. Decentralization of policing, on the other hand, brings police closer to the community and thus tailor-make better law enforcement strategies for such a community (Richman, 2000). Police officers and detectives are engaged in the protection of lives and property. To become an officer or detective, one should have high school diploma or a college degree. They should be US citizens aged at least 21 years. The median annual wage is usually $60,270.

However, a multi-layered system of law enforcement is laden with the challenge of hindering the flow of intelligence within the United States law enforcement where state police department refuses to cooperate with the FBI by withholding information material to some cases. Centralizing the police agencies would decrease the police accountability for their policies and behaviors. It would diminish the effect of being subordinate to elected representatives, and the courts would also lose their power to safeguard the respect of due process by the police (Richman, 2000). Moreover, the further away citizens are from the government bureaucracy the lesser they would be responsive to getting involved with law enforcement. The multi-layered system of law enforcement, however, may allow for ethnically-composed policing elements.


Qualitative Reasoning and Analysis Topic: Patient Satisfaction and Impact of Clinical Outcomes


Patient satisfaction is based on clinical outcomes and is measured by how patients view the treatment, convenience, and communication they receive. The clinical outcome should be respectful and both patients and their families should feel that they received the treatment they desired.

Statement of the Problem

Since the effectiveness of a given health care intervention may differ substantially from the perspective of the giver or patient, a question arises as to whether the health needs being met. There exists a problem on whether the burden of the disease on the client’s quality of life has been minimized and if so was the care process satisfactory?

Phenomena under Study

This paper seeks to study patient satisfaction and the impact of clinical outcomes to identify the gaps in the current knowledge base and thus give future direction on patient satisfaction. It is also important to look at the relationship between patient needs, the quality of life and satisfaction.


Glickman, S. W. et al. (2010), upon conducting a study on patient satisfaction on how it relates with clinical quality and inpatient mortality found out that patient satisfaction for people with acute myocardial infarction is tied to improved adherence to guideline as well as decreased mortality rates. Zgierska, Rabago, and Miller (2014) found out that the use of patient satisfaction survey may lead to job dissatisfaction, inappropriate clinical care, and attrition among some physicians.  Garcia-Gutierrez et al., (2012), on the other hand, indicate that satisfaction with cataract extraction is related to clinical outcomes and patients’ expectations of their visual function improvement.

Research Gap and Future Directions

There exists a gap on whether researchers value comfort more than clinical outcomes in patient satisfaction surveys. However, satisfaction is subjective and different people hold different opinions on the issue. There is a need for researchers to investigate the methods that use patient care experience measures to enhance healthcare giver satisfaction, evidence-based clinical practice, and patient centeredness.


The Markets for the Factors of Production

What Determines a Competitive Firm’s Demand for Labor?

Demand for labor describes the amount of labor that firm is willing to employ at a given point in time (Tucker, 2013). The factors that determine the demand for labor include the number of labor workers are willing to supply at that wage and the real wage the firms are willing to pay for such labor. Other factors include the market-determined selling price of the firm’s output and the unit cost of capital.

Technology also determines a company’s demand for labor, through the price of outputs and determination of the marginal products. The changes in output price and technology change the value of marginal product. Installing robots in a factory would decrease the demand for labor as the robots would replace people.  Further, the demand for a firm’s outputs determines the demand for labor. A rise in the output price shifts the labor demand curve to the right since more labor would be demanded at each wage.

The wage rate determines the demand for labor since a firm would hire workers if the additional workers would add more to the firm’s income than costs. Therefore, profits would go up thus prompting the firm to hire the workers. As such, the demand for labor is inversely related to the wage rate as shown by the law of diminishing returns. Immigration, education levels, and age of the population would also determine the demand for labor as they would either increase or decrease the number of labor people are willing to supply to the market (Mulhearn & Vane, 2015).

How Does Labor Supply Depend on the Wage?

The labor supply represents the number of hours people are willing and able to work at a given wage rate. Labor supply depends on wage available in the markets whereby a rise in the wage in the alternative labor markets increase, workers will join the alternative markets thereby shifting the labor supply in the first market to the left. Conversely, decreasing the labor supply will lead to an increase in the wage rate, which explains why some professions, such as medicine and labor unions try to limit the number of workers they represent.

Higher wages will also entice workers to supply more labor since the work is more attractive compared to leisure. The result is a substitution effect. The supply curve for labor is thus upwardly sloping. However, rising wage rates lead to downward sloping labor supply curve since the individual supplies less labor at higher wages due to the income effect (Mulhearn & Vane, 2015). As a person grows richer they can afford leisure and thus may prefer leisure to work when compared to low-income earners.

What Other Factors Affect Labor Supply?

The market supply of labor depends on the number of qualified people willing to work, the difficulty in getting such qualifications and the non-wage benefits of a job. If the number of qualified individuals in a certain profession is low, the supply of labor will be low thus making the supply inelastic. Concerning the non-wage benefits, fewer people will be willing to take up unpleasant jobs, which remain lowly paid.

The wages and conditions of other jobs will also affect the supply of labor whereby if the working conditions are favorable, more workers will be willing to supply labor to the firm. The size of the working population will also determine the amount of labor available for supply in the market. Immigration and migration also affect the labor supply in the market (Tucker, 2013). Since most migrants tend to be of working age and from low-wage countries, they provide a ready market for labor.

Other factors, such as people’s preferences for work and work and leisure tend to affect the supply of labor. If workers prefer more work due to benefits, such as subsidized childcare, the supply of labor ultimately increases. Non-work benefits that entice people to increase their willingness to supply more labor include promotion prospects, holiday entitlements, and job security.

Consequently, having many dependents increases a person’s willingness to supply labor to a firm. The length of training workers determines the effective supply of labor both in the long-term and short-run. Barriers to entry into the labor market, for instance, due to strict qualifications needed also affect the labor supply in the market.

How Do Various Events Affect the Equilibrium Wage and Employment of Labor?

In the labor market equilibrium, the wage adjusts to balance the supply and demand for labor and as such the wage equals the value of the marginal product of labor. The demand for labor and the amount of labor supply will thus determine the equilibrium wage. Events, such as the retirement of a class of workers, such as the baby boomers and the changes in technology to enhance productivity will affect the employment of labor and equilibrium wage (Mulhearn & Vane, 2015). Following the retirement of workers, the equilibrium wage will rise while the employment of labor will fall. Technological advancements to increase productivity, on the other hand, would increase both equilibrium wage and employment of labor.

Increases in the supply of labor result in surplus labor thus exerting a downward pressure on wages. Firms see the profitability involved and hire more workers thereby lowering the value of the marginal product and as a result occasioning a diminishing marginal product, which gives the labor market new wage equilibrium. Labor supply results from a trade-off between leisure and work thus adjusting the price paid to each factor depending on their marginal contribution to production.


How Does Discrimination Affect the Amount of Money That a Person Earns?

Wage discrimination refers to a situation whereby similar workers are different remunerated depending on their age, gender, race, sexual orientation, or ethnicity rather than factors directly related to productivity. In wage discrimination scenarios, workers may earn lower wages in a particular job, or are assigned to low-wage jobs within firms, or even employed in low-wage firms.

Wage discrimination will thus affect the amount of money an individual makes because they will not apply for well-paying jobs as they know upfront that they will be discriminated against in the recruitment process (Hyclak, Johnes & Thornton, 2013). Similarly, people who have a history of wage discrimination will apply to low-wage jobs to avoid competition from the groups who are favored. Additionally, workers may collaborate to exclude those who they feel as different thus prompting firms to pay lower wages to the workers with less bargaining power.

Assuming that an employer discriminates against a certain group of people, the process of hiring certain kind of persons will make the organization have a segregated workforce. According to Becker’s model, discrimination does not pay whereby hiring workers of certain characteristics would make the employer pay a wage above the competitive wage thus fails to hire enough workers. The people who are discriminated against are likely to work in less-performing firms and thus end up getting lesser compensation compared to workers in firms that discriminate (Mankiw, 2009).

What Causes This Type of Discrimination?

Labor market discrimination refers to a situation whereby workers who are capable of producing the same number and quality of output are treated unequally by some observable characteristics, such as the color of their skin, gender, ethnicity, or age. In the United States, the labor market shows discrimination outcomes of Hispanics, Blacks, Whites, women, and men and the discrimination differences concern occupation, wage, education, employment, and workforce participation (Tucker, 2013).

A firm may favor workers with certain qualifications, which may discriminate against people who lack such skills and qualifications. Discrimination by qualifications is a form of premarket discrimination, which takes place before a worker can enter the job market. It also tends to discriminate against people depending on their impoverished neighborhoods, low parent health and education as well as unequal schooling systems.

Wage discrimination often takes place after the person has joined the workforce and results from legislation, imperfect competition, imperfect information, and prejudice (Mankiw, 2009). Some legislation may work against certain groups of people, such as immigrants to give preference to native workers. Further, imperfect information may be passed about an individual, which may make the employer discriminate against them and as a result prevent them from reaching a certain remuneration bracket either through permanent employment or promotions.

The action of firms to maximize their utility may lead to wage discrimination as they try to employ qualified workers, who happen to share common characteristics, hence prejudice. According to Becker’s taste model, employers and workers tend to have distaste for people from different ethnic backgrounds while consumers may dislike buying products from salespeople associated with certain characteristics (Hyclak et al., 2013).

Wage discrimination may also emanate from the employer’s ignorance as they may be unable to directly observe an individual’s productivity for characteristics, such as gender, race, and age. Therefore, through ignorance, the employers conclude that certain group of individuals are less productive and thus increase the chances of not hiring them even when they are competent and when hired they get paid less. Discrimination may also arise from occupational crowding effects whereby minorities and women are crowded into lower paying occupations.

What Do Governments Do to Try to Discourage Discrimination?

To discourage discrimination, governments pass legislations that offer equal compensation at work and discourage employers from engaging in such practices. The governments, through their rules and institutions, close the discrimination gaps thereby reflecting the power relations of society. For example, the United States federal and state governments prohibit pay or compensation discrimination through the equal pay Act, Title VII, ADEA, and ADA (Mulhearn & Vane, 2015).

The equal pay Act requires that people of both genders be compensated equally for equal work in the same establishment (Hyclak et al., 2013). According to the Act, the jobs need not be identical, although they must be substantially equal. The equal remuneration is thus determined by job content rather than job titles. Additionally, the Act mandates employers to desist from paying unequal wages to men and women who perform jobs that require substantially equal skill, responsibility, and effort and that are performed under similar working conditions within the same firm.

Title VII is contained in the Civil Rights Act of 1964 and was passed to deter wage discrimination in the workplaces. Other legislations include the Age Discrimination in Employment Act of 1967, ADEA and the Americans with Disabilities Act, ADA. Another piece of legislation is the Anti-Discrimination Act 1991, which prohibits discrimination based on sexual harassment and vilification in employment against the law (Mankiw, 2009). The Act applies in matters concerning termination of employment, terms and conditions of employment, and recruitment.

The Anti-Discrimination Act also gives employers the power to take appropriate action against supervisors who may engage in discrimination acts in the workplace. The employer may take disciplinary action against such supervisor or in serious cases dismiss them. The Act promotes equal opportunity principles and practices and thus increasing the productivity of a firm, smoothen work relations and avoid conflicts.

Governments also try to discourage pay discrimination by fixing the minimum wage on an annual basis (Tucker, 2013). The minimum wage specifies the amount of compensation each worker is liable to for the specified work performed. The employer cannot pay below the level set by the government. 

Are These Policies Successful in Your Opinion?

The policies are, however, successful because they have evidently led to decreased workplace conflicts, boosted workplace and market diversity, decreased the cost of training, improved client service delivery, and minimized the legal costs incurred. The policies have also led to reduced staff turnover as well as lesser disruptions. There is evidence of improved corporate image in firms which were traditionally known to discriminate against minority workers.

There are more employee entitlements than before as workers are minority workers and women now enjoy higher pay rates and leave provisions depending on their duties and responsibilities of the job rather than personal characteristics of individual workers. The laws governments pass also ensure that employers and organizations refrain from incorporating unlawful discrimination in their employment and management practices (Hyclak et al., 2013). Following the decreases in the number of litigations due to wage discrimination, one can say that the government policies on pay and compensation discrimination are a success.

Companies are less likely to discriminate against workers for fear of tainting their corporate image through bad press as civil cases are filed against them. To the victims of pay discrimination, companies are forced to pay remedies, which deter discrimination. These remedies include; promotions, front pay, reinstatements, hiring, back pay, compensatory damages, punitive damages, which affect a company’s profitability and overall image. The remedies may also be in the form of attorney fees, expert witness fees, and court costs.

Employers may be forced to post notices to workers addressing the violations of particular charges and providing advice on how to abstain from discrimination. The success of the government policies in combating wage discrimination can also be shown by the setting of the minimum wage rate for all employees (Mankiw, 2009).

How Is Poverty Measured in the US?  Is This an Effective Measurement?

The U.S. government measures poverty using income standard termed as the specific dollar amount that varies by family size but is the same across the continental United States. However, the measurement does not include other aspects of economic status, for instance, living in substandard housing or material hardship, debt, and financial assets. The current poverty measure was established in the 1960s based on research indicating that families spent about one-third of their incomes on food. Therefore, to set the official poverty level, economists multiplied food costs by three. Since the measurement was set, the figures are updated annually for inflation although they have remained unchanged.

The measurement compares pre-tax cash income against the threshold that is set at three times the cost of a minimum food diet and is updated annually using the Consumer Price Index for family composition, size, and age of the householder. The Census Bureau holds that households whose income is above 100 percent but below 125 percent of poverty are “near poverty” while those with incomes at or below 100 percent are considered “in poverty” (Hyclak et al., 2013).

However, the current measurement is deemed ineffective since it is flawed in the specific dollar amount is based on outdated assumptions about family expenditures. Statistics show that food accounts for only one-seventh of an average family’s expenses, with other costs, such as transportation, health care, child care, and housing growing disproportionately. Therefore, the poverty level does not show the true cost of supporting a family (Mankiw, 2009). Moreover, the current poverty measurement fails to adjust for the substantial variation in the cost of living between urban and rural areas or from state to state.

The poverty measurement technique used does not accurately count family resources. The measurement includes income sources, such as cash assistance, Social Security, dividends, interest, and earnings. The technique does not include the Federal earned income tax, thereby overstating the income for some families. Further, the poverty measurement does not take into consideration the assistance government gives to low-income families, for example, Medicaid, housing and child care assistance, and food stamps.

What are some of the Issues That the US Government Faces in Trying to Move People out Of Poverty?

It has been difficult for the U.S. government to move people out of poverty due to the declining work rates, the rise of female-headed families, the arrival of millions of immigrants with poor education and low skills stagnant wages, and inferior education in some states. Family composition plays an integral role in the fight against poverty as shown in the 2009 study which showed that the poverty rate for children in married-couple families was 11.0 percent compared to 44.3 percent for children in female-headed families (Mankiw, 2009). Therefore, rises in the number of families that are headed by female parents present a challenge in fighting poverty. The mothers have to work extra jobs to take care of their families, something that would have been greatly different had the children have two parents.

The problem of immigration presents a challenge to the government in combating poverty. For the past twenty years, over one million immigrants have obtained legal permanent resident status in the U.S. each year (Tucker, 2013). These immigrants are unable to find work or result to working in low-paying jobs, which do not change their poverty levels. The wage rate paid to some workers makes them unable to afford basic amenities, which is also a problem in the fight against poverty. Additionally, these people taking such low wages may have more than one dependent.

What are the Principal Challenges Faced in Moving from One Economic Class to Another?

When moving from one economic class to the next, people are faced with the challenges of increased equality, stagnant social mobility, as well as the rise of low-wage jobs without benefits. For the working poor, such factors adversely affect their ability to move forward and upward economically. For the middle class, on the other hand, the factors lead to susceptibilities to financial shocks, such as predatory mortgages, unexpected medical expenses, and job loss, which affect their ability to prepare for the future adequately.

Further, some individuals may be able to move to the middle class on paper, for example, due to their income levels, job titles, and education but may never experience long-term financial stability. The threat of economic insecurity is also a persistent problem for people seeking to transition to the next economic class. In 2010, 32 percent of the American households reported having sufficient emergency funds, which was a reduction from 38 percent in 2007 thus presenting a challenge in transitioning to a higher economic class.