American Intervention Essay -- essays research papers

American Intervention Domestically and Internationally The United States and its people take great self-respect in knowing that the U.S. is the greatest nation in the world. That is why its our duty to pay back the rest of the world when conflicts arise. American culture and ideals ar as well as thought to take precedents over all other cultures and ideals. In the book, The Spirit Catches You and You Fall down, written by Anne Fadiman, there are m whatever great examples of how American culture is implementd on the people residing with in its enclosed boundaries. The U.S. going to war in Vietnam is also a great example of how the U.S. tried to impose American values on the less fortunate. Through understanding Americas so called duty in Vietnam one can interpret the disturbance of American idealism in the life of a Hmong family. Lia lee, a little Hmong girl, has a severe case of epilepsy. She is the daughter of Nao Kao and Foua lee who are among the many Hmong refugees that fl ed to the U.S. The Hmongs are very simple and proud people. They take pride in the fact that they have never been ruled by anyone. Even though they have been operate away and separated many times they always seem to find themselves and their culture, never seemingly adapting to the major culture. Even when French missionaries settled in their subject field and brought their western ideals, medicine, religion, and values they never really accepted them. Fadiman stated in her book that in reality, no Hmong is ever fully converted (35). The Hmong believe that the gay soul is a prized possession and should always be kept happy. They believe that the soul has a domain where it rests usually where they were born. After a Hmong woman gives birth, the father digs a hole and buries the babys placenta. If it was a girl, her placenta was buried under her parents bed if it was a boy, his placenta was placed in a place of greater honor, near the base of the houses central wooden pillar. (5) O nce a Hmong dies, it is believed that they must retrace his or her life path and reunite with his or her placenta, in order to be prepared for the dangerous journey ahead of them before they reach the sky and meet their ancestors. The Hmongs also believe in animal sacrifice, which is method of keeping dabs (evil spirits that try t... ...spThe U.S. trying to police the world was a duty that was given and definitely not ignored. Although some American ideals and values are truly superior to others, they should not be enforced on the world. In the case of the Lee family, ignorance played a big role. perhaps if the doctors at MCMC, or even the citizens of Merced, had known a little more about Hmong customs and rituals then all of the problems that the Lees or any of the other Hmongs encountered could have been avoided. Another major problem that caused grief was the language barrier, hence the fact that attending physicians cant be blamed for their decisions. In the case of the U.S. i nvolvement in Vietnam, the Vietnamese were given the opportunity to rule themselves. Even though Communism isnt the best way for a rural to gain its independence, it was a reason for the Vietnamese to fight. The U.S. had many casualties and a federal budget that was deeply injured. Back home, these occurrences seemed like an endless war with no unmistakable reasons. Even though in both cases the U.S. was trying to look for the welfare of the Lee family and for the Vietnamese, their complete and total assistance was not necessary.

Unemployment Essay -- essays papers

Un battleDefinition of Un employment The unemployment tread is the percentage of the US labor force that is unemployed. It is calculated by dividing the look of unemployed individuals by the sum of the account of people unemployed and employed. An individual is counted as unemployed if they are over the age of 16 and actively looking for a job, but cannot find one. Students, who contract not to work, and retirees, are not counted in the unemployment consecrate. In surround 2001DescriptionTotal civilian population 211,171,000(Excluding those under 16, members of the military, and persons in institutions)- Not in mash force 69,304,000 (Retired, students, individuals choosing not to work)= assiduity force 141,868,000(Total population minus those not in labor force)- Employed 135,780,000(Individuals with jobs)= Unemploye 6,088,000 (Individuals without a job and actively searching)Unemployment Rate =6,088,000 135,780,000 + 6,088,000 = 4.3% The unemployment rate for t he month of troop 2001 was 4.3 percent, a tenth of a point increase from the January and February 2001 rate of 4.2%. The number of individuals employed decreased by 86,000. An unemployment rate of 4.3 percent for March 2001 is the highest unemployment rate since July 1999, but only slightly higher than the 3.9 to 4.1 percent range from October 1999 to the end of 2000. Prior to that, the unemployment rate had been in a steady decline since briefly after the last recession in 1990-1991. The average monthly increase in employment was approximately 155,000 in 2000 and 220,000 in 1999. For almost ten years, unemployment has locomote and the number of employed persons has change magnitude by more than 15 million. In March 2001, the number of jobs decreased by 86,000, the largest monthly decrease since 1991. Job losses were most prominent in the manufacturing sector (81,000 jobs), but there were also losses in the retail trade sector (46,000 jobs). These losses were partiall y offshoot by employment increases experienced in the construction and finance sectors. Growth in employment in 2000 was 1.9 million in 1999, the increase in employment equaled 2.8 million. Changes For most of 2000, unemployment remained between 3.9 and 4.1 percent of the labor force. In the first three-quarters of 2000, the numbers of individuals in the labor force were i... ...te of growth in real gross domestic product change magnitude to 3.9, with the last three years being over 4.3 percent per year. A five percent increase from 1999 to 2000 is the highest level of yearly increase since 1984. The recent up trend (until the last two quarters) in economic growth has been accompanied by increases in the rates of growth of consumption spending, investment spending and exports. productiveness increases decreases in unemployment, expansion in the labor force, and increases in the amount of capital have allowed real gross domestic product to grow at faster rates. Yet d uring this very(prenominal) time period, consumers have reduced their savings.Conclusion After reviewing the unemployment, inflation and the GDP history of the last decade it is obvious why the United States economy has been rank number one in the world. The economy has averaged a 5% or less unemployment rate, a 3.5% or less inflation rate and a GDP rate that has fluctuated from 2.2% to 5% throughout the nineties. The future outlook of the next decade is promising, however, many economists are skeptical when asked if this trend can continue at its present-day(prenominal) rate. References www.econedlink.orgwww.economicsameria.org Unemployment Essay -- essays papersUnemploymentDefinition of Unemployment The unemployment rate is the percentage of the US labor force that is unemployed. It is calculated by dividing the number of unemployed individuals by the sum of the number of people unemployed and employed. An individual is counted as unemployed if they ar e over the age of 16 and actively looking for a job, but cannot find one. Students, who read not to work, and retirees, are not counted in the unemployment rate. In March 2001DescriptionTotal civilian population 211,171,000(Excluding those under 16, members of the military, and persons in institutions)- Not in Labor force 69,304,000 (Retired, students, individuals choosing not to work)= Labor force 141,868,000(Total population minus those not in labor force)- Employed 135,780,000(Individuals with jobs)= Unemploye 6,088,000 (Individuals without a job and actively searching)Unemployment Rate =6,088,000 135,780,000 + 6,088,000 = 4.3% The unemployment rate for the month of March 2001 was 4.3 percent, a tenth of a point increase from the January and February 2001 rate of 4.2%. The number of individuals employed decreased by 86,000. An unemployment rate of 4.3 percent for March 2001 is the highest unemployment rate since July 1999, but only slightly higher than the 3.9 to 4 .1 percent range from October 1999 to the end of 2000. Prior to that, the unemployment rate had been in a steady decline since unawares after the last recession in 1990-1991. The average monthly increase in employment was approximately 155,000 in 2000 and 220,000 in 1999. For almost ten years, unemployment has fall and the number of employed persons has increased by more than 15 million. In March 2001, the number of jobs decreased by 86,000, the largest monthly decrease since 1991. Job losses were most prominent in the manufacturing sector (81,000 jobs), but there were also losses in the retail trade sector (46,000 jobs). These losses were partially moon-curser by employment increases experienced in the construction and finance sectors. Growth in employment in 2000 was 1.9 million in 1999, the increase in employment equaled 2.8 million. Changes For most of 2000, unemployment remained between 3.9 and 4.1 percent of the labor force. In the first three-quarters of 2000, the numbers of individuals in the labor force were i... ...te of growth in real GDP increased to 3.9, with the last three years being over 4.3 percent per year. A five percent increase from 1999 to 2000 is the highest level of yearly increase since 1984. The recent upward trend (until the last two quarters) in economic growth has been accompanied by increases in the rates of growth of consumption spending, investment spending and exports. productivity increases decreases in unemployment, expansion in the labor force, and increases in the amount of capital have allowed real GDP to grow at faster rates. Yet during this same time period, consumers have reduced their savings.Conclusion After reviewing the unemployment, inflation and the GDP history of the last decade it is obvious why the United States economy has been ranked number one in the world. The economy has averaged a 5% or less unemployment rate, a 3.5% or less inflation rate and a GDP rate that has fluctuated from 2.2% to 5% throughout the nineties. The future outlook of the next decade is promising, however, many economists are skeptical when asked if this trend can continue at its electric current rate. References www.econedlink.orgwww.economicsameria.org

Story Of A Dead Man :: essays research papers

Story of a Dead ManMy name is Pierce Montgomery. I hail from a small village town just after-school(prenominal) of London. Seven years ago I was a young boy who set out for adventure to the new world. Today I write this as an old man. The following is my story of our colony at Roanoke and the series of tragic events that beset it.The journey to the new world was a long and tedious superstar. I was part of an expedition downstairs the authority of John White. From what I remember if my journey I sailed on a ship named Dorothy. The quarters were very fix and smelled of mildew. The ship was full of a variety of different people. There were carpenters, like myself, farmers, fisherman, and explorers. There were also some people who wad no real calling being on the expedition. Aristocratic people, who had no concept of work, but were there just to have a good time, hunt, and search for spoils of the new world. These people were one of the main reasons we struggled so much founding a colony. It took over three months to reach the new world and when we did I had never been so glad to give ear land in my life. It was summer when we arrived so the weather was very cooperative. The first order of business for us was to build shelters and find a fresh water source. Luckily for us there was a stream near by. I being a carpenter helped build makeshift homes out of wood and rope. farmers tilled fields and fisherman found the best spots to throw their lines. By fall the colony was up and running relatively smoothly. Everybody did their handle of work except for the people from aristocratic people from England. There were fights almost daily about the laziness of these people. They took far more from the colony than they put fundament in. On the other hand they were the ones who financed our trip to this beautiful new world.Winter was a very tough time for us. Our crops died and we were very low on food. Our shelters collapsed under the weight of the snow and we didn t have enough warm clothing. Fourteen colonists died during this time. It was then that we made first contact with the savages. They called themselves the Croatoan and were apparently from a small island placed in the bay.

Homosexual Undertones in the Movie, Bride of Frankenstein :: Movie Film Essays

Homosexual Undertones in the Movie, Bride of FrankensteinJames Whale recreates the original horror of Frankenstein with his sequel Bride of Frankenstein, in which Henry Frankenstein at one time again tries to play God with the addition of an Eve to his already thriving Adam. Henry Frankenstein...may attempt to reverse the Original Sin and re-enter the community by acquiescing to the horror clich that there are things we are not meant to know--except that his initial hubristic motive was not just to figure out(p) eternity but to create life without the service of process of any Eve (he wants to be as God in a double sense), and when in the sequel he manages to get married it is a sure bet that more or less Dr. Praetorius will force him into an all-male effort to create a bride for the monstrosity (Kawin 683). Unfortunately, the creation of Eve does not necessarily mean that her heart will belong to Adam. When the female monster first lays eyes on Monster, she lets out a blood-cur dling scream. Thus, showing that love cannot be created, just like a person should not be created out of the dead. The only successful loving family relationship of the film is between Monster and the blind hermit, which is viewed as a satire against heterosexual family values by critics. It is a satire because the heterosexual relationships in the film fail. For example, the relationship between Henry Frankenstein and his bride is doomed because of the kidnapping and blackmailing, which is destined to ruin even the most solid relationship. Also, the relationship between the male and female monsters is not meant to be because the female monster will not stop screaming, thus making Monster set unload to the laboratory causing their deaths. Thus, the only relationship that thrives is between the two loners. The relationship only thrives until society discovers them and deems their friendship unnerving, which parallels the way in which society viewed, and in close to ways still view s,

The Advantages of E-Textbooks Essay examples -- Educational Technology

Imagine a day when youngsters would leave for school carrying nothing more than an electronic device deliberation less than one pound. The advent and growing popularity of electronic textbooks whitethorn make this a reality sooner rather than later. No more students trudging around with 20 pound backpacks strapped to their backs. No more lockers jammed with textbooks and notebooks. The benefits of transitioning to e-textbooks are many and provide advantages for both students and educators.Electronic textbooks can be updated faster than traditional textbooks and can in any case provide resources that traditional books cannot supply. Because reprinting textbooks is expensive, they are rarely corrected and schools frequently have outdated versions that are 5 10 years old (Acker, 42). The information in traditional textbooks is often obsolete and the pictures can be very dated. For example, Pluto is still listed as a plant in our solar scheme in many science books even though i t was decided in 2006 that it is actually a dwarf planet. In some cases, a textbook may be updated every hardly a(prenominal) years, but many high schools do not purchase the new edition because of the high cost involved. In our original economy, many schools can neither justify nor afford the several hundred dollars it would cost to purchase a new edition for just a few changs. With e-texts, corrections and updates can be made quickly and at a fraction of the cost of their printed counterparts. In addition, e-textbooks include more than just the words. The nature of literacy is changing it includes not only text but also symbols and visual images or icons that make up graphic user interfaces. (Hassell, 117) Visual images and icons can be imbed on practically every electronic ... ...irst generation of digital natives. New York Basic Books, 2008. Print.Shepperd, James A., Jodi L. Grace, and Erika J. Koch. Evaluating The Electronic textbookbook Is It Time To Dispense With The Paper Text?. Teaching Of Psychology 35.1 (2008) 2-5. Academic Search Elite. Web. 8 May 2012.Technology in the Middle Blog Archive Digital Literacy 101 Class dismiss But Not Over. Technology in the Middle . N.p., n.d. Web. 23 May 2012. .Virtual textbooks gain popularity in class - News - The University Echo - Student hebdomadally of the University of Tennessee at Chattanooga . The University Echo - Student weekly of the University of Tennessee at Chattanooga. N.p., n.d. Web. 7 May 2012. .

The Advantages of E-Textbooks Essay examples -- Educational Technology

Imagine a day when youngsters would leave for school carrying nothing more than an electronic device weighing less than one pound. The advent and evolution popularity of electronic textbooks may make this a reality sooner rather than later. No more students trudging around with 20 pound backpacks strapped to their backs. No more lockers crowd together with textbooks and notebooks. The benefits of transitioning to e-textbooks argon many and provide advantages for both students and educators.Electronic textbooks can be updated faster than traditional textbooks and can also provide resources that traditional books cannot supply. Because reprinting textbooks is expensive, they are rarely corrected and schools frequently have outdated versions that are 5 10 years old (Acker, 42). The information in traditional textbooks is often disused and the pictures can be very dated. For example, Pluto is still listed as a plant in our solar system in many science books charge though it wa s decided in 2006 that it is actually a dwarf planet. In some cases, a textbook may be updated every few years, plainly many high schools do not purchase the new edition because of the high cost involved. In our current economy, many schools can neither warrant nor afford the several hundred dollars it would cost to purchase a new edition for just a few changs. With e-texts, corrections and updates can be do quickly and at a fraction of the cost of their printed counterparts. In addition, e-textbooks include more than just the words. The nature of literacy is changing it includes not only text besides also symbols and visual images or icons that make up graphic user interfaces. (Hassell, 117) Visual images and icons can be found on practically every electronic ... ...irst generation of digital natives. New York Basic Books, 2008. Print.Shepperd, James A., Jodi L. Grace, and Erika J. Koch. Evaluating The Electronic Textbook Is It Time To Dispense With The Paper Text?. Teac hing Of Psychology 35.1 (2008) 2-5. Academic appear Elite. Web. 8 May 2012.Technology in the Middle Blog Archive Digital Literacy 101 Class Dismissed But Not Over. Technology in the Middle . N.p., n.d. Web. 23 May 2012. .Virtual textbooks gain popularity in class - News - The University Echo - schoolchild weekly of the University of Tennessee at Chattanooga . The University Echo - Student weekly of the University of Tennessee at Chattanooga. N.p., n.d. Web. 7 May 2012. .

Spot The Difference Attitudes towards people onwelfare benefit in the 19th and 21st centuries

To be clear on the mickle who receive welf be benefits, it is necessary to divide everyone into classes. Even if people abjure to admit they are in a class there are clear characteristics of what class they belong to. This division that is still progressive now, was even to a greater extent operable in the 19th century. It was a way of look that the higher you were in the social class and hierarchy, then the more successful and prosperous you were to become in life.It was also some times a case of where you lived. It was Charles Booth that marked on maps of London where each social class lived. Places like Mile subvert Road and Orsman Road contained the vicious poor, the people at the bottom of the hierarchy. They were labelled as The lowest class which consists of some occasional labourers, street sellers, loafers, criminals and semi-criminals. Their life is the life of savages, with vicissitudes of extreme hardship and their only luxury is drink.Although this may seem that B ooth is being snobbish, it was noted that Booth had sympathy for the poor. He worked with the lower class, and reported that it wasnt unendingly necessary to have money to be happy. He described that although the poor were more credibly to die of disease and less likely to survive, he fancy that they seemed to be happier, without nurses and servants etc. That the rich are more likely to suffer from being spoiled than from harshness, that the simple natural lives of working-class people tend to their induce and their childrens happiness more than the artificial complicated existence of the risk.Now in the 21st century, these locational divides are still in place, although the locations of the vicious poor have changed. While it is more noticeable in the 19th century maps, the upper class and lower class virtually side by side, it is possible that people were more unbidden to tolerate each other, nowadays there are more clear divisions. This change could be due to peoples toleran ce and attitude towards different classes.However, it seems more unpatterned that there are different attitudes towards social classes. Usually, people arent willing to live near people of a lower class, places like council estates accommodate people of the homogeneous status, but they are prepared to pay tax incomees towards their welfare and benefits.During the 1800s the conditions of the workhouses, and the relief from the administration or parishes was of little help. People still struggled to make ends meet. The rule was that no one got supra the lowest workers wage, which was 12s to 15s a week. It was said that for a comfortable life, a worker needed a wage of 30s a week, concluding that few people had a comfortable life.In 1885, it was reported that 25% of the existence lived in poverty, however, after Charles Booth investigated, and wrote Labour and Life of the People, he found that actually 35% of the universe of discourse were in poverty.In simple terms, it was harder to receive help in the 19th century. Today there are fourteen types of benefits, including benefits in kind for employees, child maintenance, council tax benefit, disability and carers benefits, housing benefit, incapacity benefit, income related benefits, invalid care allowance, mothers, widows and families benefits, retirement allowance, statutory sick pay, unemployment benefit, unfit for work benefits and war pensions and industrial injuries.While in the 19th century, it was an innovation to have the poor integrity, at once there are 2.7 million people claiming incapacity benefit, and the government are trying to reduce this number.1.610% of the population are on incapacity benefit this is an immense difference from what it was in the 1800s. Although there are so many types of benefits, the government has become more active in getting people into work.The attitude of the government is that they need as many people in work as possible they have introduced schemes much(prenomin al) as EMA, some amour that would never have been thought of in the 19th century. Peoples attitude was that the government were doing something about the increasing poverty, at the expense of the economy.But why is the government making changes to benefits? The bottom line is that society has a responsibility to care for those unable to work.The government have introduced new schemes to prevent people from abusing benefits, the same thing that the government did in the 1800s when welfare was introduced. The changes proposed are likely to separate the seriously disabled or those suffering from terminal conditions such as cancer, who are marvelous ever to return to work, from those claiming to be incapacitated by a bad back or depression.Peoples attitudes have changed enormously from the 1800s to the present day. In the poor law days, going into the workhouse was shameful people did as much as they could to prevent this, it was the lowest they could go. The workhouse conditions were t errible, starvation was often a common factor, families were separated and peoples dignity and rights werent an issue.Peoples attitudes today have changed a great deal over the years not because welfare benefits have changed, but because peoples basic human rights have become more of a factor. It is expected that people who cant feed and look after themselves or their family, can receive help from the government. This way of thinking has developed partially from the original poor law. People started thinking that they needed to help others, even if it meant paying in taxes.Today, although people arent proud of receiving benefit, it has become more acceptable it is possible for people to stay on benefits their whole lives however, it costs the government 12 billion a year to fund benefits. This extra spending has been criticised by certain groups.thither a lot of differences between 19th and 21st century welfare benefit. Peoples attitudes today mean that it is common for people to re ceive benefits. They know that they can aim in a form and receive at least 55 a week, not including child allowance. Today people can live further as well as people who work, which has caused some protest.While it seems that in the 19th century, welfare was a last resort, they didnt want to receive help, partly because the prototype of help sometimes wasnt better than being left to starve.From old maps of London, it can been seen that people used to live close to others of different classes, while today, it is more likely that people move to places that are within the same income bracket. This displays another way that attitudes have changed, that people arent willing to live near people who cannot support themselves, or they live near people of similar means.However, some similarities can be found, although it can be assumed that today attitudes have become more relaxed, todays government tries to remain vigilant as it was years ago. The government are aware of people mistreatin g the benefit, and so have chosen the attitude to fight those who misuse it. This could implicate imprisonment and fines etc.People had more of a superior attitude towards people on benefits in the 1800s, it was assumed by some that these poor were as well lazy to work and the same can be said for today.But the underlying principle still remains, in the 19th century and 21st, welfare benefits are aimed to help people, and although people may have different feelings about those dependant on welfare, the benefits will still remain in place.

Gender Roles and the Perception of Women Essay

There was a time that having a daughter born to a family evoked much grace than congratulations from the community. Sons were define more for they were inviteed to bring practical help towards augmenting the family income through physical labor, as well as ensuring that the family name lives on with his progeny. (Feminism) Daughters were valued only for the potential honor they could bring the family with a erect marriage. In olden days, a good marriage was non necessarily defined by the couples happiness but rather was deemed as such if both families stand to benefit from the union.Usually benefits would be measured in wealth, coalition or business. Marriages then were basically mergers. Women were not expected to pass on anything other than the mastery of domestic duties and union with a suitable economize. After marriage, the only duties that a woman is supposed to fulfill are to look after the needs of her husband and give birth to as many children as possible with pi ck to the birthing of sons. The 1920s and 30s saw a wave of feminism that sought to overturn the traditional gender role assigned to women.They viewed patriarchy as oppressive to women and advanced the thinking that women are complements of males and therefore should be treated as equals. The 1920s also saw a major achievement for women in the United States with the passage of a law that allowed for womens suffrage. (Feminism) The Second World War in the 1940s also provided women with the opportunity to wax their worth outside their duties as homemakers. They started signing up as army nurses, members of womens corps and fermenters in factories that provided supplies and ammunition to the boys overseas. Even with this however, women however experienced secernment at the hands of employers who believed that it was the mens role to earn money for their families. Those that were hired still had to face inequality in wages as their work were deemed easier compared to the mens. (Ac ker 46) It has continually been an uphill climb for women in the assertion of their salutarys and the fight for identity and equality. Despite the many progresses made by women since the olden days, some cultures still place more premium on males.Sandra Cisneros account (Kirszner, 96-99) of being and born and living in a traditional, patriarchal society in the 1950s file that even with the many new freedoms and rights accorded to women, their roles were still defined by marriage and domestic duties. What I didnt realize was that my father thought college was good for girls good for finding a husband. After tetrad years of college and two more in graduate school, and still no husband, my father shakes his head even promptly and says I wasted all that education. (Kirszner 97)The selection further goes on to relate the attempts made by Cisneros in getting her father to acknowledge her achievements and herself as more than only a daughter. She necessitateed to BE his daughter in every sense of the word and enjoy the same pride her father has in her brothers achievements. I often witness the hunch posture, from women after dark on the warrenlike streets of Brooklyn where I live. They seem to set their faces on neutral and, with their purse straps strung across their chests bandolier style, they forge ahead as though bracing themselves against being tackled.(Kirszner 242) In Brent Staples observations in the Black Man effect in altering a public space (Kirszner 240), he presents the image of a woman who is determined to move forward yet remains aware of the possible challenges to her progress. While in the story the context women is defined in is couched in terms of potential threat from street violence and crimes, one could almost picture the same definition as applicable to the grim and set determination of the feminists who steadfastly battles for womens rights and progress.It has been many years since women achieved a major victory in suffrage and set ab out to establishing their identity in society. Yet in some cases, there seem to be some women who remain oblivious or at least, not benefited by the new stature and rights women have been able to claim through years of struggle with a male-dominated society. In Anna Deavere Smiths Four American Characters monologue (2005) she shares a conversation she had with an elderly philosopher friend she had, Maxine Green. In the conversation, Smith asked Green What are two things that you dont know and still want to know? Green replies Personally I still feel that I have to curtsy when I see the president of our University and I feel that I ought to get coffee for my male colleagues even though Ive outlived most of them. Smith deciphers this up with the characterization of Maryland convict Paulette Jenkins. Paulette Jenkins represents the women in abusive kin who suffer in silence. She never spoke out because she didnt want people to know that there was something wrong with her family. She took her husbands abuse and allowed him to do the same to her childrenchildren that she had in the belief that it would soften her husband.What would make a man do such a thing? At the same time, what would make a woman stand by helplessly as her husband beats up her children and herself? Conflict in relationships between men and women are believed to stem from four main reasons mens jealousy, mens expectation of women and domestic work, mens sense of right to punish their women, and the importance to men of insist and keeping their authority. Women on the other hand, are kept silent due to feelings of shame and responsibility (Dobash, and Dobash 4). More often than not, the women feel that they deserved whatever the husband did to them.This acquiescence may be due to their cultural orientation of women as subservient wives. Upbringing and cultural orientation can do much to cultivate a persons understanding and acceptance of gender roles. (Dobash, and Dobash 4) However, there is always the freedom of choice and personal introspection, which should allow individuals to reason out right and wrong and the applicability and rationale of traditions for themselves. The case of Sandra Cisneros is the perfect illustration of this. Despite being brought up in a highly patriarchal household and culture, she chose to follow her own desire and achieve in her own right.In the end, she managed to earn her fathers respect and acknowledgment that she, as a woman, can accomplish and gain honor and pride for the family. Regardless of background, doctrine or culture, everyone, man and woman, has that same choice in choosing how their manhood or womanhood will be defined in their lives.Works Cited Acker, Joan. What Happened to the Womens Movement? -An Exchange. Monthly Review Oct. 2001 46. Questia. 28 Sept. 2007 . Feminism. The Columbia Encyclopedia. 6th ed. 2004. Questia. 28 Sept. 2007 . Dobash, R. Emerson, and Russell P. Dobash. Women, Violence, and Social Change. New Yor k Routledge, 1992. Questia. 28 Sept. 2007 . Kirszner, Laurie. Patterns for College report 10th ed. New York Bedford/St. Martins. 2006. Mcneill, William H. Violence & Submission in the Human Past. Daedalus 136. 1 (2007) 5+. Questia. 28 Sept. 2007 . Smith, Anna Deveare. Four American Characters. 2005 TED. com. 27 Sept 2007 http//www. ted. com/index. php/talks/view/id/60

My Happy Husband

My Happy Husband In life, gayytimes we meet unused people who could change our lives for better or worse. I met my conserve in the place that I work and since that day we keep back become the most indwelling friends in the world. I believed my hubby is one of the happiest men alive he is funny, positive, inspiring, spiritual, and friendly. He is a very funny person. All the time he has a positive attitude. He inspired me to be the beaver. He is a spiritual serviceman. He is a friendly person. All these qualities pay off Christian so special. My husband is the most adorable man.He is quite severe looking. He is six feet t every(prenominal), weighs one hundred seventy seven pounds. He has a round face with minuscule brown eyes, olive skin, and curly dark hair like many Spanish people. His hair is black with a fewer silver strands throughout. He speaks in a soft voice as if he was whispering, and constantly uses his hands when he speaks. He has a great sense of style, so he eternally looks well dressed even in casual clothes, and his cologne smells sweet barely masculine. For me he is the most attractive man. Chris is the funniest person.My husband has no problem getting others to laugh with him. It is hard to have a bad day when the person that I spend my life with is constantly smiling because he looks at the problems from a different angle, and he is confident that he will find the solution immediately. For example, on Thanksgiving Day, we were on a road trip to North Caroline. My husband was driving for twelve hours, but he was making jokes the whole journey. That was very entertaining for the children. We thoroughly enjoyed this trip because the time passed so fast. His human entertains our friends, as well.Frequently we go out with our friends, and he is the center of attention because of his cheerful personality and entertaining way that he talks. One of his favorites remarks is I take my wife to different move of the world every year, but s he still somehow manages to find her way back. I just to hear that and laugh because he buttocksnot move a musclebuilder without me. I feel so proud of him because he perpetually bops how to put a smile on my face. I believe that it is important to forever and a day have a positive attitude, and I learned from my husband to have a good floor of view in any circumstances.His positive feeling is strong, and it can spread to the people around him. To explain, my husband has a stressful job, and everyday he gets up early to meditate because meditation establishs him relax and positive. Even if I come home with a negative attitude, he frequently changes the way that I gestate because he makes me understand that nothing that happened outside can ask my positive thinking, and it is true. Also, he finds solutions rather than problems. He was weighing two hundred and twenty pounds, and one day he decided to lose weight. He lasted his bout with exercises and diet he lost fifty pou nds.He teaches everybody to not have fears. For this reason in any difficult or bad circumstances that we have, he always has a positive mindset with a wise solution. This positive emotion makes me to admire my husband more. I consider that my husband is the most inspiring man that I have seen. I am proud of Chris for achieving his goals and finishing his c areer as an Electrical Engineer. He motivates our children to be successful and great human beings. Moreover, he encourages us to finish and never smash up and put a lot of effort in what we do.He also proves to his children that nothing is impossible, that we only need some motivation to accomplish our goals. Similarly for me, whenever I feel like giving up, or have a question or any concern, I know I can always ask him for advice. I have also learned that sometime I have to put other needs before of my own, but not to the point they will be to take advantage of me. Also, He is strong during hard times and extremely determined to achieve anything. I hold him in great esteem for how he stands up or for what he believes in, and he will never back down. I have always admired his open mind, compassion, and sense of understanding.In every aspect of my life my husband continuously pushed me too excel in everything that I want to do. He inspires me to start college, and he motived me to begin my new journey. He inspires me so much that now I am becoming a new person with different point of view. Furthermore, Chris is a very spiritual person. He often says, spiritual is not only to be a religious people, it is to have peace between souls and mind. These are not just words because he actually does what he meetings. As an example, he gets up early in the morning to meditate and pray to give thanks for the day.Meditation helps him to be calm and relaxed during the day, so if I ask something of him at any time, he does it without selfish interest. At some point I think nothing is bad for him. His friends always loo k for him when they have marital or work problems because they consider that he is the most appropriate person to give them good advice and keep secrets. Also, my husband has a passion to help people to learn how to be spiritual and know himself inside out. This quality is the most important refer that he has. Christian is the friendliest man I have ever met.Anyone who knows him sees that he is absolutely outgoing with everybody. I am very lucky to have a good friend like him. I remember six months ago, when I thought he forgot my birthday because he did not call me, like he does every morning before I start working. When I came back home he had organized a wonderful party with my family and friends. He loves to make parties with a lot of people because he is a really sociable person. He is very unique. He constantly organize meetings at his work an invited all the people around the world. I am truly blessed to have in my life someone who is sociable and hospitable.Not only is Chri stian my best friend, but also he is the best friend for our sons. Concluding this essay, I can describe my husband as the happiest man in the world, and I see that this man is a very funny person. All the time he has a positive attitude. He inspires me to be the best. He is a spiritual man. He is my best friend. What I would say to anyone who is unhappy is that you need to fix that like my husband says, happiness comes from within not without. He is right. No one can make you happy, no one, but you. For all the reasons and comments that I share in this paper I think my husband is role model to fallow. 1225

An Analytical Study Of Alternative Energy Environmental Sciences Essay

In today s industrial society, the hereafter of the planet and its resources argon ever several(prenominal)thing that is in the heads of humanity leaders. The natural resources of the planet ca nt last everlastingly and solutions ar seeking to be frame. While some states be on the manner to a greener manner, early(a) states lag behind and are utilizing up finite resources. Researching interchange energies could hold its benefits but some argument if its cost and new(prenominal) complications might outweigh the benefits.As with every new thought that comes to light, there are two or more than sides and sentiments of what is right. One side is that non-renewable dodo fuels are traveling to stop and new beginnings of renewable motive demand to be incorporated into today s universe. In a book by David Craddock, Shane Jordan writes a preface or so transposition energies. He states that the universe has two option of where to travel following ( 12 ) . One option has pollut ion, agony, and resources decea whistle, while the other has brush skies and oceans and a brighter hereafter. He argues that it is a large determination to do and trust the right pick made. Resources are dwindling and fuels that are utilise today are holding an consequence on the environment around us. He argues that concourse construct been utilizing up fossil fuels with no respect for the effects to come, as he points out world-wide heating. In the past old ages, nation have been seeking to alter the beginning of our expertness to something renewable and non harmful to the environment. New beginnings of postcode have been found and renewable energies are the fasted work outing susceptibility beginning today.Renewable energy is easy replenished. Beginnings from nature exchangeable air current, solar, tidal, and moving ridges quarter be used to power things and are non harmful to the environment. With lifting costs of fossil fuels, these new beginnings of alternate energ y are nevertheless more appealing. David Craddock argues that we are sing planetary energy and pollution jobs because we are so dependent on fossil fuels ( 16 ) . These fuels are over 80 per centum of the worldwide energy ingestion. If we had renewable, alternate energies to utilize so there would be less dependence on things that we can neer acquire back once more. He declares that when fossil fuels are burned, they release rough chemicals into the air and atmosphere. This amendss people and the environment in the coarse tally and it is already taking its toll. He argues that it is non a inquiry of if fossil fuels give run out, but when ( 17 ) .The new alternate energy beginnings can be found about any propose. Solar, water system, and air current can be found fundamentally anyplace on the planet. Unlike today s energy, where two tierces of oil are found in the Middle East and are exposed to oil invasions. Renewable energy is in high sentiment to the public but public function aries and politicians are more wary and hesitating the brand the change because of the cost associated with it. Craddock states that renewable energy costs have gone down and will go on to worsen ( 19 ) . Particularly with fossil fuels consume and their cost rise, alternate energy, like solar, air current, and H2O, is the clear and logical option. He even states that different beginnings have different costs and benefits and one beginning whitethorn be better than the other ( 18-19 ) .While some protest planetary heating, others have Numberss that might call on the carpet those who think it is a myth. in the beginning the industrial revolution, the Earth s ambiance contained 280 parts per million of C dioxide. That was good sum Once we started firing coal and gas and oil to power our lives, that 280 figure started to lift. When we began mensurating in the late fiftiess, it had already reached the 315 degree. Now it s at 380, an increasing by approximately two parts per million yea rly . Since some deny planetary heating and believe the beginnings of energy we have now are all right, this grounds shows that temperatures are lifting and there is more C dioxide in the ambiance and ice on the Earth is runing which causes the H2O degrees to lift, seasons, and rainfall forms ( McKibben 5 ) . Therefore, protagonists of alternate energy see these Numberss and hunt farther for solutions and the convince those opposed to utilizing alternate energy.While some argument the cost of alternate energy, the other side argues that the equipment to utilize the energy is the cost and the existent energy is free. Harmonizing to McKibben, The monetary value tag end for the planetary passage will be in the millions of dollars. Of class, along the manner it will ramp up countless new occupations, and when it is complete, it may be a often more elegant system. His point is that air current, Sun, and other natural resources are free and states ca nt command it or have it ( 5 ) . It is argued that in the long tally, the cost will be less and it will last for much weeklong than fossil fuels used today. As quoted above, there will no longer be battles over fuels. In past and present, there are wars over oil and some of these issues could be resolved if there were renewable energies to be used without international trading or struggle ( McKibben 5-6 ) .Even though fossil fuels are non renewable, their power is undeniable. Natural beginnings ca nt vie with their powerful flawlessness, but with more development, flawlessness could be possible. Some natural beginnings, like air current, are merely useable in some countries. But when they are used, they work sincerely good. Even in the past 10 old ages engineering for energy has grown significantly. No affair the pick of what is made, the monetary value of gasolene and energy will travel up and the effects of either pick ca nt be given to the future coevalss ( Nersesian 382 ) .Since renewable and alternate energ y is a gigantic argument around to universe, some states are following new ways and it has an affect on the planetary economic system. Asia has espouse new engineerings to convey H2O to drier topographic points and bring forth energy from it ( Moeller 17 ) . With this illustration, other states are besides get downing to integrate new things that will preserve energy. The UK could be in front since they could hold zero C emanations by 2030. The scheme is called Zero Carbon Britain 2030 and they would trust merely on renewable energies like solar, air current, and H2O ( Eisberg 12 ) .With this new thought and survey, some people for the acceptance of alternate energy think that this is hopeful and it gives support to their cause. Though the UK is little, turn outing that alternate energy beginnings could power the state shows that it is possible and within range in the non excessively distant hereafter. Whether or non it the new scheme is adopted can be a mark as to if the renewab le beginnings are effectual and efficient. But if it is set in topographic point, it could get down other states into developing their ain program to hold zero C emanations and lower the pollution from their state ( Eisberg 12 ) .Since the cost is a immense portion of the what makes people against renewable energy, doing a higher cost to foul and utilize fossil fuels could be a manner to actuate people to exchange. Some think that impose C emanations. But if this happened, it could be hurt alternatively of aid. Peoples who are hapless would merely acquire poorer and there would necessitate to be a manner to presage out how to non make more harm than good ( McKibben 7 ) . McKibben besides stated that possibly revenue enhancements on things that benefit people be quash such as payroll checks and things that do nt profit us be taxed, like C emanations ( 7 ) . This could besides convey on many jobs and to the highest degree significantly, would nt travel over good with people or pol iticians ( McKibben 7-8 ) .On the other side of the alternate energy argument are those who think people should society with fossil fuels. The chief statement against alternate and renewable energy is the high cost. Some argue that solar energy, for illustration, is 10 times higher in cost than fossil fuels. Robert L. Bradley Jr. argues that renewable energy is twice every bit expensive as fossil fuels and three times more expensive as excess electricity, on norm. He besides argues that the renewable energy market is besides non every bit competitory as dodo fuels which may give monetary values of alternate energy beginnings high ( Bradley 1-5 ) .With concerns over the monetary value of new energy beginnings, some offer thoughts for solutions to take down costs. Harmonizing to Christopher Simon, To forefend lifting monetary values, demand for fossil fuels must be curtailed and the development of feasible replacings fuels must quickly continue ( 6 ) . With today s pitiless unive rse economic system and money system, some believe that this will neer be possible. With the inexpensive monetary values of oil and other dodo fuels compared with renewable energies, it seems improbable that there could be an efficient passage. Some say that while demand creates supply, the demand is nt high plenty to compare the cost to alter the fuels used. Besides, that even if there were to be a planetary passage, the energy created would nt be able to cover the demand for energy ( Simon 7-9 ) .The cost of alternate fuels is the chief concern of people when they hear about alternate energy and it is non without ground. Jonathan Katz provinces, The primary challenge for all types of alternate energy is cost, and in peculiar it s cost comparative to stuffy fossil fuels. There is an copiousness of agricultural waste that could be converted into biofuel, but the cost of biofuel is more than petroleum-based fuels, so there is a limited biofuel market. The selfsame(prenominal) can be said for municipal waste, solar energy, air current power, etc .the processing required to change over it to a useable signifier is often expensive due to the cost of equipment, limited production graduated table, etc. ( 2 ) .Because alternate energy, renewable energy, and planetary heating are a ample portion of what is heard on the intelligence and in the media, people ever hear about it on manner or another. When a subject that has more that one side arises, one side can dominate the other. Some people that think planetary heating is non a job are unremarkably set aside and non heard from regardless of if their statement has merit ( Derr 9 ) . Derr besides states that in response to Al Gore s carry about planetary heating, An Inconvenient Truth, a British telecasting manufacturer created a film rebuting Gore s statements. Many people have non heard of this film because he was non allowed to demo it ( Derr 9 ) . Adding to this, maintaining one side of the statement in the dark is one of the grounds why some argue that the argument is colored and unjust. With the media being such a immense portion of what people see, hear, and believe, some think that this is why all of the grounds why they think alternate energy is non needed is because if this ( 9-10 ) .Derr argues that clime alterations are a portion of how the planet plants and are a natural portion of the Earth s life. Harmonizing to Derr, The current warming dip dates merely about 1975. Before that, a marked chilling period get downing about 1940 led scientific consensus of the 1970s to proclaim planetary chilling and possibly the first marks of an ice age ( Derr 10 ) . He states that history is full of periods like today that were warmer than they were in the yesteryear. Geologist have proven that big clime alterations have dated all the manner back to prehistoric culture. They determined this by analysing tree rings, ice-core samples, and ocean-bottom deposit. Scientists have determined th at these swings come on every 1500 old ages and the forms have nil to make with what people do or set into the air and the clime alterations come before additions in C dioxide ( Derr 10 ) . Harmonizing to those who have similar point of views, researching alternate energy is a waste of clip and money because the clime alteration is a natural regular recurrence and will travel through its natural procedure as it has done in the past ( 10-11 ) . This sentiment could surely hold an consequence on the public and alteration whether or non new alternate energy could be incorporated into mundane life.Others believe that new energy beginnings are out at that place but the current 1s, like solar, air current, and H2O, are non the serve. One point of view is that we should alternatively look into new beginnings to change over into fuel. Fabien Deswarte thinks that things like wheat, wood, wheat berry and other things should be used and converted into bioethanol. By tackling cellulose alte rnatively of amylum, we could happen a manner to utilize nutrient and waste to fuel today s society. Harmonizing to protagonists of this statement, utilizing these new engineerings could be more effectual and will last longer because people ever will be devouring and utilizing agribusiness.With today s ever-changing society, new energy beginnings are everyplace. Everyone has a different point of view and plausible solution. Keeping with present industries could harm the environment but the solutions presented may non be one hundred per centum effectual. With clip, honing of current solutions is coming and the issues could be worked out. Such a major subject as alternate energy will non happen an reply shortly but advancement in the field is ever something that is in the hereafter. By looking at all the facts and point of views, people can make up ones mind for themselves what actions to take and how to promote alteration or deficiency of alteration to their day-to-day lives.

President John Kennedy Was a Great President

The task of the leader is to get his mass from where they are to where they have non been (Henry). This retell from Henry Kissinger is a representation of the Kennedy term in office. electric chair Kennedy took the ball to a whole new level he succeeded in many tasks in his short time as president. rear F. Kennedy was great president because of his involvements in the Cuban Missile Crisis, the Space Race, the Civil Rights Movement, and the quiescence army corps.On October 22, 1962, president John F.Kennedy informed the world that the Soviets were building secretive missile bases in Cuba, very close to Florida. President Kennedy decided to take the pink of my Johnful despatch in discourse is major crisis. As President, his first move was to talk to Premier Nikita Khrushchev and demand the removal of all(prenominal) missile bases, and deadly content in Cuba. Secondly, President Kennedy had U. S. forces nigh the worldplaced on alert. More than 100,000 troops deployed to Fl orida for a possible invasion of Cuba. Additional naval vessels were ordered to the Caribbean.B-52s loaded with atomic weapons were in the atmospheric state at all times. (The World). He ordered a naval quarantine/blockade on Cuba to pr hithertot Russian ships from bringing additional missile and edifice materials to the island (Goldman). Because of President John Kennedys strong efforts to prevent this huge nuclear war, two main things came out of it. One of which is the Nuclear Test Ban Treaty. On August 5, 1963, the United States, Soviet Union, and United Kingdom signed the Limited Nuclear Test Ban Treaty.This treaty prohibits nuclear weapons tests or other nuclear explosions under water, in the atmosphere, or in outer musculus quadriceps femoris, allows underground nuclear tests as long as no radioactive debris falls outside the boundaries of the nation conducting the test, and pledges signatories to work towards complete disarmament, an end to the armaments race, and an en d to the contamination of the environment by radioactive substances. (Nuclear). Also, because President John Kennedy decided to take the peaceful route to settling this dis givee, he prevented a huge nuclear war from happening, maybe even another World War.Premier Nikita Khrushchev described it as, The two most muscular nations had been squared off against each other, each with its finger on the button. (Nuclear). If this other World War or massive nuclear war would have occurred, only think of where we would be today. The founding of the Peace corps is one of President John F. Kennedys most enduring legacies. (Founding). As soon as President Kennedy became the President, he vowed to help Americans be active citizens. One of his first moves in office was to create the Peace Corps.The way he came up with this idea of the Peace Corps was when he spoke to students at the University of Michigan during a campaign speech and challenged them to live and work in other countries to ded icate themselves to the cause of peace and development. (Peace). The main purpose for this was so Americans can volunteer to work anywhere in the world where assistance is needed. (John F. Kennedy, the 35th). This answers President Kennedys call to ask not what your country can do for youask what you can do for your country. (Founding). President John Kennedy was very involved in the Peace Corps.He got to know all of the volunteers very well. Peace Corps volunteers became known as Kennedys Kids because if the special bond President Kennedy felt with them. Volunteers in the Peace Corps help people of interest countries meet their needs for trained workers, they help others understand the Americas better, and also to help people of America understand those of other countries. In the 1960s, the Peace Corps was immensely popular because of his campaign speech at the college, which encouraged newly graduated college students to join and help around the world.From that point in time, t he Peace Corps continue to grow. Today, more than 195,000 volunteers have served in over 139 host countries to work on issues ranging from AIDS education to information technology and environmental preservation. (Peace) Todays world is a lot contrastive compared to the world in the 1960s. The Peace Corps continually change with the times. People still volunteer as much, and even more than they did in the 1960s. Issues in other countries have severed over time, but because of the Peace Corps, people can help lessen this severe issue.The belong effect of President Kennedys involvement is that because volunteers traveled around the world, we now know more about others cultures and traditions. The volunteers of the Peace Corps would live in different host countries, and adapt to their surroundings. They would learn multiple traditions and witness many cultural practices. When volunteers would return home, they would share their many experiences with family and friends, thus causing i t to be spread and learn throughout the world. In the late 1950s, the Space Race was initiated when the Soviet Union launched Sputnik, the first artificial Earth satellite.From that point on, the Soviet Union and United States set about off to be the first country to land on the moon. President Kennedy feared that if the United States were not the first to land on the moon, that everyone would see them as a weak country that is behind communist Russia (Mills), and he did not want that image for his country. On whitethorn 25, 1961, President Kennedy submitted the lunar landing program to coitus (Mills). In a meeting between President Kennedy, vice president Johnson, and Premier Khrushchev, they all decided that conquering home was a huge ordeal. two countries wanted to show their military strength and scientific superiority. Premier Khrushchev wanted to show that communist technology was superior. jibe to President Kennedy, No single space project in this period will be more imp ressive to mankind, or more important for the long-range exploration of space. And none will be so difficult or expensive to accomplish (Mills). Without President Kennedys persistent thrive to enter space, we wouldnt be where we are today. Before his time, space travel was just a dream.Sadly, on November 22, 1963, President Kennedy was shot and killed in Dallas, Texas for a NASA meeting of some sort. His vice president, Lyndon B. Johnson, however, carried on his lunar landing wish. Finally, in 1969, astronaut Neil Armstrong was the first man on the moon, thus ending the space race between Russia and the United States. Landing on the moon was the story of the century. According to a Jefferson City, MO newspaper, the walk on the moon, although viewed via television, still seems like a chapter from Jules Vernes fantasies. If the moon-walk not been televised, we believe there would be many in the world who still would be doubting (Mills).The placement of the flag on the moon was an unfo rgettable sight- one which will be long remembered by man, especially the thankful and proud Americans. In President Kennedys campaign for president, he promised executive, moral, and legislative leadership to combat racial discrimination (John F. Kennedy John). One of his first actions was to appoint many African Americans into office. One of which was Thurgood Marshall, a federal judge, and he directed the NAACP.Because of all of this, African Americans felt as if they actually had friends in the justice department. In May of 1961, the Kennedy Administration sent officials to protect Martin Luther King, Jr. from a mob during the freedom rides (John F. Kennedy John). His Civil Rights Address was a turning point for the country, and this also meant that President Kennedy could potentially lose the south and his 1964 election, or it would dead lock congress (John F. Kennedy John). Everything that President Kennedy did for this Civil Rights Movement helped change the course of discri mination in the world.He put a stop to public display of discrimination by passing the Civil Rights Act of 1964, which also attempted to deal with the problem of African Americans world denied the right to vote in the South. Also, his brave Civil rights Address, which could have cost him his election, moved an immense amount of people. It changes their minds on the topic of discrimination, and in todays world, discrimination is very slim. In all of these events in history, President Kennedy changed the world for a better. From preventing a huge nuclear war from happening, to stopping discrimination President Kennedy is the definition of a great president.

Epo in Sport

Competitive athletes ar constantly in search of ways to buy the farm better, seeking a slight edge everywhere their closest competition. They atomic number 18 leading to practice for countless hours, put themselves by rigorous train and follow a very strict diet. Those who are passionate about their sport are all toldowing to do just about anything to improve performance, except just how far are athletes willing to go? With recent advancements in sports science, it has become possible to alter some elements of human physiology.The human body has been meticulously studied over the years, and as a result we are able to comprehend how complex systems function enabling the human body to perform unreserved everyday functions, as well as, impressive athletic performances. Science has discove exit there are ways to improve the physiology of the human body to enhance athletic performance. By carefully tailoring specific functions to enhance a specific task an athlete will most l ikely be able to get the one up on the competition.Science has excessively discovered there are dangers associated with tampering with these complex systems that keep the human body alive and well. Unfortunately, some athletes fire the physiological bumps/ professional repercussions and indulge in enhancing some physiological processes in order to gain a slight edge against the competition. Today, as well as in the past, sundry(a) sporting organizations have had to deal with performance-enhancing issues through testing of their athletes, yet these people continue to seek out ways to sneak downstairs the wire, un watched.One example of athletes trying to beat the system is that of the recently publicized performance-enhancing dispute with kin doping in the sport of cycling, namely the use of recombinant human erythropoietin (Robinson, Mangin, and Saugy 2003). The following will discuss the function of erythropoietin, its uses in medicine and athletics, the benefits and risks of artificial on with testing methods for detection of nonlegal use. In order to perform in endurance sports, in effect(p) oxygen delivery from lungs to muscles is crucial.The cells responsible for oxygen delivery are erythrocytes, or red extraction cells. The functional portion of the red broth cell that acts as an oxygen carrier is the protein scintilla hemoglobin (Kraene, mo and Deschenes 2012). hemoglobin is a four part haem-iron containing protein, with two alpha and two beta subunits associated with each molecule. Hemoglobin accounts for 99% of the protein composition of an erythrocyte (Lippi, Franchini, Salvengo et al). Circulating dividing line contains approximately 40-45% red blood cells in its composition (Kraene, Fleck and Deschenes 2012).The hemoglobin associated with each red blood cell has a specific mechanism for pick-up and delivery of oxygen. This mechanism depends on varying physiological body conditions during which oxygen has differing semblance for the h emoglobin molecule. The conditions at which affinity for oxygen is high include lower body temperature, low carbon dioxide, and low 2,3-diphosphoglyerate (Elliott 2008). As these are the conditions put together in the lungs, plentiful oxygen will bind to the hemoglobin for transport to the tissue cells in the body.In the tissue where carbon dioxide concentrations are high, body temperature adds, higher hydrogen ion and ,2,3-disphosphoglycerate concentrations, oxygen affinity for hemoglobin is reduced, resulting in the delivery of oxygen to tissues (Elliott 2008). During physical exercise, the bodys consumption of oxygen is increased due to the demand of working muscles. As a result of this process, the carrying capacity of hemoglobin is adjusted automatically to deliver adequate oxygen to the muscle tissues (Lippi, Franchini, Salvango et al 2006).Applying this principle of supply and demand, to an endurance sport, one tush see how an athletes aerobiotic training regime aims to peak the efficiency of the process of oxygen delivery from lungs to muscle tissue. To maximize the process of oxygen delivery, a high number of locomote erythrocytes is desired, resulting in more available hemoglobin and therefore more oxygen quarter be delivered to working muscles. Red blood cell (RBC) production, called erythropoiesis, is carefully controlled and monitored by the body (Lippi, Franchini, Salvango et al 2006).This monitoring system involves oxygen-sensing cells to detect hypoxia (low oxygen concentration) in the body. During oxygen deprivation, a nerurosecretory mechanism is activated through chemoreceptors found in the carotid body ( in the carotid artery found in the neck) and in the lungs. If out of balance, the body undergoes rapid cardiopulmonary adjustments to compensate for the flow stress of hypoxia (Kraene, Fleck and Deschenes 2012). One of the occurrenceors present during hypoxia is the hypoxia inducible factor, HIF-1.This molecule acts as a transcript ion factor for controlling several genes (Lippi, Franchini, Salvango et al 2006). When oxygen levels are low, the enzymes that normally inhibit HIF-1 vacate their activity. The HIF-1a molecule becomes available is now capable of binding with HIF-b to cross the nuclear membrane of the cell and promotes gene transcription (Lippi, Franchini, Salvango et al 2006). One of the main code events that occurs as a result of the gene transcription is production of erythropoietin (Epo).This endogenous Epo is then produced in the body, specifically in the peritubular capillary-lining cells of the renal cortex of the kidneys, with minute amounts produced in the liver and brain (Kraene, Fleck and Deschenes 2012). When the Epo molecule is synthesized, the composition is initially a 193 amino group acid molecule that eventually is released as a 165 amino acid protein with much of the total molecule composed of saccharide (Lippi, Franchini, Salvango et al 2006). The release of Epo from the kidney to the blood then stimulates erythropoiesis in the bone marrow (Kraene, Fleck and Deschenes 2012).Science advancements in the 1980s have led to a synthetic form of Epo known as recombinant human Epo (rHuEpo) (Spedding and Spedding 2008). It was first introduced by a team of researchers at the northwest Kidney Centres, who conducted clinical trials that resulted in the first successful artificial form of this hormone (Eichner 2007). The production of rHuEpo, from mammalian cells to treat anemic patients was approved by the U. S. Food and DrugAdministration in 1989 (Elliott 2008). Today human recombinant erythropoietin is available in a variety of forms.It is synthesized with an amino acid sequence identical to that of endogenous erythropoietin, with slight differences in composition of carbohydrate portions of the molecule (glycosylation) (Lippi, Franchini, Salvango et al 2006). Alpha and beta erythropoietin are produced from Chinese hamster ovary cells with the only differences bei ng a slightly longer half-life and slight difference in molecular weight (Lippi, Franchini, Salvango et al 2006). Another form of Epo is Erythropoietin gamma. It is produced from a different host cell and as a result has a different glycosylation form (Lippi, Franchini, Salvango et al 2006).Erythropoietin delta, yet another variation of the synthetic hormone, is the most recently introduced form. This type is produced from human cells, and has identical amino acid and glycosylation patterns as endogenous Epo, with a longer half-life of 18-20 hours compared to the 7-12 hour range of alpha and beta forms (Lippi, Franchini, Salvango et al 2006). The current research is clinically testing a protein called Continuous Erythropoietin Receptor Activator (CERA). This protein has a half-life of 133-137 hours, which equates to less frequent dosing.CERA unlike other synthetic forms of this hormone, has very mild case-effects and has yet to produce any serious adverse effects (Lippi, Franchini , Salvango et al 2006). This type of synthetic Epo may be the best option available for patients who require treatment for anemia (low hemoglobin levels). Unfortunately, some people suffer anemia due to various medical issues such as kidney disease, chemotherapy for cancer, HIV, blood loss, et cetera (Kraene, Fleck and Deschenes 2012). The bodys demand for Epo becomes more significant when such medical conditions arise.Often times Epo needs to be artificially supplemented to compensate for the lowered hemoglobin production/ hemoglobin loss (Catlin, Fitch and Ljungqvist 2008). Originally, recombinant human erythropoietin was developed as a substitute for endogenous Epo for those who suffered from vicarious blood conditions. It is highly effective in increasing hemoglobin levels, and as a result has numerous benefits such as, reduction in demand blood transfusions, restoring energy levels, increase in exercise capacity, improves cognitive function and overall quality of life improve ment (Elliott 2008).When administering this hormone, the dose, frequency of governing, the rate of rise of hemoglobin and rate hemoglobin levels are strictly controlled (between 10-12g per 100mL), slightly lower than the range for normal range of 13-15g per 100mL. The lower range is maintained in order to keep the risks and side effects of the rHuEpo minimal (Lippi, Franchini, Salvango et al 2006). Careful monitoring and control is apply to maximize the benefits for patients while minimizing the risks.Recombinant Epo not only benefits those who are suffering a blood condition but it has significant benefits to athletic performance (Elliott 2008). It is used amerciablely as an ergogenic aid primarily in endurance sports, such as cross-country skiing, track, swimming, and most notoriously, cycling (Bento, Damasceno, Neto 2003). One study, as renowned in Exercise Physiology (Kraene, Fleck and Deschenes 2012), that involved well-trained male endurance athletes administered recombi nant human erythropoietin 3 times a week for 30 days or until hematocrit levels reached 50%.The following resulted an average hematocrit increase of 18. 9% (range of 42. 7-50. 8%), cycling time to enfeeblement had increased 9. 4% (12. 8-14. 0 minutes longer), and cycling VO2 peak had increased 7% (range of 63. 8-68. 1 ml/kg/min). Another study also noted in Exercise Physiology (Kraene, Fleck and Deschenes 2012) gave low-dose subcutaneous injections of rHuEpo over a 6 week period to moderately to well-trained athletes and what resulted was a 6-8% increase in VO2 peak, time to enfeeblement on a treadmill increased 13-17%, and hemoglobin concentration and hematocrit both increased by approximately 10% each.The use of recombinant human erythropoietin is found to have clear benefits in athletic performance, with higher trained individuals exhibiting enhanced results. At an elite level, where competition is so close, it is tempting for athletes to gain an edge over their competition tho ugh the use of rHuEpo. There is a certain amount of pressure on athletes in cycling to use ergogenic aids due to the fact that so many of the sports top competitors are using it to boost performance (Vogel 2004). In cycling, the abuse of this ergogenic aid has recently come to light in the media.Although many benefits can be reaped in athletic performance from recombinant erythropoietin, it is not without risks. When synthetic forms were first introduced, many of the risks were unknown to athletes and use was not medically monitored as would be the case with an anemic patient. As a result, sudden heart attacks occurred that led to more than a dozen deaths of Dutch and Belgian cyclists (Vogel 2004). Their deaths were connected to inappropriate administration of rHuEpo. This form of Epo had not yet been clinically studied from an athletic perspective.The combination effect of increasing hemoglobin to well above normal range along with other factors associated with endurance sports, ma kes tampering with the bodys natural blood physiology dangerous and potentially deadly (Robinson, Magin and Saugy 2003). Myocardial infarction, cerebrovascular disease, transient ischemic attack and venous thromboembolism were all found to be potential events associated with the misuse of rHuEpo (Catlin, Fitch and Ljungqvist 2008). Due to the increase of red blood cells, the blood becomes more viscous and leads to an increased frequency risk of thrombotic events.There have also been proven reports of increased risk for migratory thrombophlebitis, microvascular thrombosis and thrombosis of cerebral sinuses, retinal artery, and temporal veins. The increased blood viscosity also increases systolic blood pressure during sub-maximal exercise and increases platelet reactivity resulting in risk of more blood clotting (Bento, Damasceno, and Neto 2003). One of the most serious risks found to be associated is that of red cell aplasia in which red blood cell formation ceases. Although rare but ife-threatening, this condition was found to be linked to the use of subcutaneous alpha-Epo (Lippi, Franchini, Salvango et al 2006). Anemia may also develop in individuals who mis-use rHuEpo after they discontinue the hormone, as it causes progressive erythroid marrow exhaustion due to prolonged periods of use. more or less other risks and side effects include headache, muscle cramps, incomplete deviation of red blood cells, convulsion, and upper respiratory tract infections (Kraemer, Fleck and Deschenes 2012). The risks of using rHuEpo are more significant for athletes than average patients who are using for treatment.Athletes pushing to increase hemoglobin outside of a normal range run the risk of heartrending circulatory/blood abnormalities. Testing for the use of criminalize erythropoietin in sports has been an ongoing challenge. As quickly as testing laboratories can produce testing methods for banned substances, new ways to slide under detection are being found (Cazzola 20 00). It is difficult to directly identify rHuEpo as it has a relatively victimize half-life in most forms, for example an administration of 50 IU/kg given subcutaneously has a half-life of approximately 35. hours, and intravenous administration has a half-life ranging from 4 to 7 hours (Lippi, Franchini, Salvango et al 2006). Athletes could selectively time the administration of Epo and combined with concealing strategies to slip under the wire. As a result, laboratories are required to look at specific biomarkers that indicate past or current use of rHuEpo (Delanghe, Bollen and Beullens 2007). Human recombinant erythropoietin was initially a challenge to detect as various forms are extremely similar to that of endogenous Epo (Skibeli, Nissen-Lie and Torjesen 2001).As it is a rising issue in sport, laboratories are required to find better ways to detect the illegal use of rHuEpo. Initially as a measure to deter doping and identify usage, cutoff levels of hematocrit (the percentage of red blood cells in the blood) were established in some sports (Adamson and Vapnek 1991). For example, the International Cycling Union established cutoff hematocrit levels of 47% for women and 50% for men. This method was flawed, as it sometimes produced false positive results in athletes with of course high hematocrit levels (Casoni, Ricci, Ballarin et al 1993).Currently, there is no foolproof testing method to detect the use of recombinant human erythropoietin. A combination of verifying and direct testing is currently the most effective method to identify blood dopers (Cazzola 2000). Indirect testing uses a blood sample and is based on the analysis of hematological parameters, including measures of hemoglobin, hematocrit, soluble transferrin receptors, serum Epo, percent reticulocytes, and macrocytes (Delanghe, Bollen and Beullens 2007).Changes observed in the above measures are often a result of introducing recombinant Epo to the body and can be used as an indirect marker to detect the substance (Skibeli, Nissen-Lie and Torjesen 2001). There is a reference range of parameters set for this form of testing, one indicating current use of Epo while the other can indicate recently discontinued use of Epo (Parisotto, Wu, Ashenden et al 2001). Indirect testing has the advantage of being able to detect Epo use several weeks after it has been administered, however the disadvantage of possibly producing false-positive results (Delanghe, Bollen and Beullens 2007).Changes in the measuring parameters used in indirect testing can also be the result of the bodys natural modifications from training methods such as altitude training (increasing RBC levels due to lower oxygen at higher altitude, a naturally occurring body compensation) (Kraemer, Fleck and Deschenes 2012). Indirect testing is useful in being a primary indication of recombinant erythropoietin use, yet it is not completely reliable.If use of Epo is suspect after using indirect testing methods, direct testi ng will follow to confirm or deny the results (Birkeland and Hemmersbach 1999). Direct testing for recombinant Epo involves the collection of a urine sample. The urine sample needs to be fairly large (20ml) and strongly concentrated (between 700-1000 fold) (Elliott 2008). The approved test that uses the direct approach is based on differences in glycosylation between endogenous Epo and artificial forms (Elliott 2008).The recombinant and endogenous forms of erythropoietin have varying isoelectric points (pI). Using isoelectric focusing (IEF), the isoelectric points can be determined (Skibeli, Nissen-Lie and Torjesen 2001). The normal range for the pI of endogenous Epo is 3. 7-4. 7, while alpha and beta Epo have a slightly higher range of 4. 4-5. 1. The Aransep form of Epo has 2 extra N-glycosylaton sites in order to increase its stability, resulting in a pI range of 3. 7-4 (Parisotto, Wu, Ashenden et al 2001).In order to see the isoforms of Epo, double immunoblotting is used in combi nation with monoclonal anti-Epo antibodies. The interaction of the antibodies with the recombinant forms of Epo shows if illegal forms are present in the urine (Skibeli, Nissen-Lie and Torjesen 2001). The purpose of the double immunoblotting technique is to avoid secondary antibodies interacting with proteins in urine and affect the test. A technique known as chemiluminescence is used on the blot to image the Epo (Skibeli, Nissen-Lie and Torjesen 2001).Direct testing can detect most forms synthetic Epo. When a test is found to be positive for an illegal form of Epo, a second test is performed due to the fact that occasionally enzyme activity causes a shift in the electrophoretic banding pattern of the molecule (Parisotto, Wu, Ashenden et al 2001). Additional stability testing is performed where the urine sample is incubated overnight in an acetate buffer and rHuEpo. If a banding shift is observed during the isoelectric focusing, it can be determined that the sample is negative for r HuEpo (Parisotto, Wu, Ashenden et al 2001).The direct testing method is currently the most reliable and approved approach and can be used during competition and off-competition periods (Elliott 2008). The development of recombinant human erythropoietin was originally an approach to treat low hemoglobin levels in anemic patients. The athletic gains that can be exhibited through introducing rHuEpo have caused abuse at the elite level in many sports. Other than disqualification and loss of credibility as an honest athlete, there are also medical risks associated with tampering with the bloods physiology in artificial ways.A combination of testing methods is currently used to identify those using rHuEpo as an ergogenic aid, as there is no iodin test that can clearly deny of confirm use. New ways to slip under the wire with testing are being discovered and used by athletes and laboratories are constantly working to keep up. The use of recombinant human erythropoietin is a serious issue of misconduct in sport and needs to be ended in order to keep competition ethical and fair.

Analysis: Hospital Nurse Staffing and Quality of Case Essay

Hospitals with low shield staffing levels tend to have high range of poor enduring outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections, agree to search funded by the Agency for healthc atomic number 18 Research and Quality (AHRQ) and others. Yet increasing staffing levels is not an easy task. Major factors contributing to begin staffing levels include the inevitably of to solar days higher alertness forbearings for more fright and a nationwide gap between the number of available positions and the number of registered have gots (RNs) qualified and will to fill them. This is evident from an average va drive outcy rate of 13 per centum.This report summarizes the findings of AHRQ-funded and other inquiry on the relationship of blow staffing levels to ominous patient outcomes. This precious information can be used by decisionmakers to make more informed choices in terms of adjusting nurse staffing levels and increasing nurse recruitment tranc e optimizing part of cargon and improving nurse satisfaction. continue over the next two decades. A Federal Government adopt predicts that hospital breast feeding vacancies will r for each one 800,000, or 29 percent, by 2020.2 The number of nurses is expected to grow by tho 6 percent by 2020, while demand for care for compassionate is expected to grow by 40 percent. The most recent research shows a jump of 100,000 RNs, or 9 percent, in the hospital RN workforce between 2001 and 2002 because of increased demand, higher pay, and a weakening economy. However, since almost all of theMaking a DifferenceLower levels of hospital nurse staffing are pertaind with more ominous outcomesPage 3 Patients have higher acuity, yet the skill levels of the nursing staff have declinedPage 5 Higher acuity patients and added responsibilities increase nurse workloadPage 5 Avoidable unfortunate outcomes such as pneumonia can raise treatment costs by up to $28,000Page 6 Hiring more RNs does not dec rease profits Page 6 Higher levels of nurse staffing could have positive impact on two quality of care and nurse satisfactionBackgroundPeriods of high vacancy rank for RNs in hospitals have come and gone, but the current shortage is different. check to a 2002 report by the workforce commission of the American Hospital Association, the nursing shortage reflects fundamental changes in population demographics, career expectations, work attitudes and prole dissatisfaction.1 In fact, the present situation may wellAuthor Mark W. Stanton, M.A. Managing Editor Margaret Rutherford Design and Production Frances Eisel Suggested citation Stanton MW, Rutherford MK. Hospital nurse staffing and quality of care. Rockville (MD) Agency for Healthcare Research and Quality 2004. Research in Action Issue 14. AHRQ Pub. No. 04-0029.increase came from RNs over age 50 who returned to the workforce and a greater influx of foreign-born RNs, this does not alter the structural features in the long term the aging of the nurse population and the increasing unwillingness of preadolescent women to consider nursing as a profession.3 Todays surdies are further complicated by other changes in hospital care, such as new health check technologies and a declining average length of stay, that have led to increases in the amount of care required by patients while they are in the hospital. New medical technologies allow many less seriously ill patients who previously would have received inpatient functional care to receive care in outpatient settings. Also, patients who in the past would have continued the early stages of their recovery in the hospital, today are discharged to skilled nursing facilities or to home.During the layover 1980-2000, the average length of an inpatient hospital stay fell from 7.5 days to 4.9 days.4 An important consequence of these changes is that hospitals have a higher overall concentration of toot people who need more care. Various groups, including the American Hospital Association, the Joint Commission on the Accreditation of Healthcare Organizations, and the Institute of Medicine (IOM), have expressed their associates somewhat the evolving nursing crisis. The IOM issued a report in 1996 that recognized the importance of determining the appropriate nurse-patient ratios and distribution of skills for ensuring that patients receive quality health care.5 Its report highlighted the fact that research on the relationship between The nurse workforce and nurse staffing levelsthe level of staffing by nurses in hospitals and patients outcomes has been inconclusive. The IOMs analysis of staffing and quality of care in hospitals reason by calling for a systematic effort at the national level to collect and analyze current and relevant data and develop a research and evaluation agenda so that informed policy development, implementation and evaluation are undertaken in a timely manner. To begin to meet that need, AHRQ-funded research and other res earch have pursued a number of different paths.Hospital nurse staffing and nursing- beautiful outcomesHospital nurse staffing is a matter of major concern because of the effects it can have on patient safety and quality of care. Nursing-sensitive outcomes are one indicator of quality of care and may be specify as variable patient or family caregiver state, condition, or perception responsive to nursing intervention.6 Some indecent patient outcomes potentially sensitive to nursing care are urinary tract infections (UTIs), pneumonia, shock, upper gastrointestinal bleeding, longer hospital stays, failure to rescue, and 30-day mortality.a Most research has focused on adverse rather than positive patient outcomes for the simple reason that adverse outcomes are much more likely to be documented in the medical record. aFailure to rescue is defined as the death of a patient with a lifethreatening complication for which early identification by nurses and medical and nursing interventions c an influence the risk of death.The nurse workforce consists of clear nursesregistered nurses (RNs) and license practical nurses (LPNs)and nurses aides (NAs). Both RNs and LPNs are licensed by the State in which they are employed. RNs assess patient needs, develop patient care plans, and administer medications andtreatments LPNs protract out specified nursing duties under the direction of RNs. Nurses aides typically carry out nonspecialized duties and personal care activities. RNs, LPNs, and nurses aides all provide direct patient care. RNs have obtained their education through three different routes 3-year diploma programs, 2-year associate degree programs, and 4year baccalaureate degree programs.Almost a third of all RNs have a baccalaureate degree, and 7.6 percent of hospital nurses have advanced utilisation credentials (either a masters or doctoral degree). LPNs receive 12-18-month training programs that emphasize technical nursing tasks. Nurses aides are not licensed but man y acquire certified nurse aide or nursing assistant (CNA) status after proving they have certain skills related to the requirements of busy positions. Nurse staffing is measured in one of two basic ways Nursing hours per patient per day. The nurse to patient ratio. Nursing hours may refer to RNs only to RNs and LPNs or to RNs, LPNs, and nurses aides.2www.ahrq.govA broad array of research on this topic has found an association between lower nurse staffing levels and higher rates of some adverse patient outcomes. A new evidence report entitled The Effect of Health Care Working Conditions on Patient Safety, produced by an AHRQfunded Evidence-based Practice Center (EPC), reviewed 26 studies on the relationship between nurse staffing levels and measures of patient safety.b Most of the studies examined nurse staffing levels and adverse occurrences in the hospital setting, including in-hospital deaths and nonfatal adverse outcomes such as nosocomial infections, pressure ulcers, or falls . The EPCs researchers found that lower nurse-topatient ratios were associated with higher rates of nonfatal adverse outcomes.7 This was true at both(prenominal) the hospital level and the nursing unit level. With regard to in-hospital deaths, however, the evidence does not consistently show that lower nurse staffing levels are associated with higher mortality.The largest of these studies on nurse staffing (jointly funded by AHRQ, the Health Resources and Services Administration, the Centers for Medicare & Medicaid Services, and the National Institute of Nursing Research) examined the records of 5 million medical patients and 1.1 million working(a) patients who had been treated at 799 hospitals during 1993.6,8 Among the studys principal findings In hospitals with high RN staffing, medical patients had lower rates of five adverse patient outcomes (UTIs, pneumonia, shock, upper gastrointestinal bleeding, and longer hospital stay) than patients in hospitals with low RN staffing.c M ajor surgery patients in hospitals with high RN staffing had lower rates of two patient outcomes (UTIs and failure to rescue). Higher rates of RN staffing were associated with a 3- to 12-percent reduction in adverse outcomes, depending on the outcome. Higher staffing at all levels of nursing was associated with a 2- to 25-percent reduction in adverse outcomes, depending on the outcome. Table 1 illustrates some of the major findings. For example, the researchers found that medical patients in hospitals with high RN staffing were 4-12 percent less likely to develop UTIs than medical patients in the comparison group.Lower staffing levels are linked to higher adverse outcome rates The EPC report included five studies funded by AHRQ that examined the relationship between adverse patient outcomes and hospital nurse staffing. All five studies found at least some association between lower nurse staffing levels and one or more types of adverse patient outcomes. How often do such adverse nu rsing-sensitive patient outcomes occur in hospital care? Different studies report change adverse event rates, which vary by the type of patient (medical or surgical) as well as other factors. For example, UTIs occur in from 1.9 percent to 6.3 percent of surgical patients and pneumonia in 1.2 percent to 2.6 percent of surgical patients.8-10 bTable 1. Percent reduction in rates of outcomes among medical patients in hospitals with high nurse staffing (75th percentile) compared to the rates in hospitals with low nurse staffing (25th percentile) Amount by which rates are lower forIn order to improve the quality and delivery of health care operate, AHRQ has sponsored a series of evidence reports that are based on rigorous, comprehensive reviews of relevant scientific literature. These reports are developed and written by after-school(prenominal) research and academic organizations designated as Evidence-based Practice Centers (EPCs). The reports emphasis is on explicit and detailed do cumentation of methods, rationale, and assumptions.The goal of these reports is to provide the scientific foundation that public and cloistered organizations can use to develop their own clinical practice guidelines, quality measures, review criteria, and other tools to improve the quality and delivery of health care services study measured RN staffing as hours per day and as the RN proportion of nursing hours. Hospitals with higher hours of RN staffing (75th percentile) had an average of 9.1 hours of inpatient RN nursing per patient day, while those with lower RN staffing (25th percentile) had an average 6.4 hours of inpatient RN nursing per patient day. Hospitals with a higher proportion of RN staffing (75th percentile) had an average of 75 percent of inpatient nursing hours provided by RNs, while those with lower RN staffing (25th percentile) had an average of 62 percent of nursing hours provided by RNs.Outcome in medical patients Urinary tract infection Upper gastrointestinal b leeding Hospital-acquired pneumonia Shock or cardiac arrestHigh RN staffing 4-12% 5-7% 6-8% 6-10%High staffing, all levels (RNs, LPNs, aides) 4-25% 3-17% 6-17% 7-13%c ThisNote Difference is expressed as a range of set (e.g., 4-12 percent) because several statistical models were used in evaluating the relationship between nurse staffing levels and each adverse event. Source Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and patient outcomes in hospitals. Final report for Health Resources and Services Administration. Contract No. 230-99-0021. 2001. Harvard School of Public Health, Boston, MA.www.ahrq.gov3 medical exam patients in hospitals with high levels of total nurse staffing (RNs, LPNs, and aides) were 4-25 percent less likely to develop UTIs than patients in the comparison group. A similar analysis was performed for the smaller group of surgical patients (Table 2). Surgical patients in hospitals with high RN staffing had a 5-6 percent lower rate of UTIs and a 4 -6 percent lower rate of failure to rescue than surgical patients in the comparison group.dPneumonia rates are especially sensitive to staffing levelsThree AHRQ-funded studies found a significant correlation between lower nurse staffing levels and higher rates of pneumonia. The first study found that adding half an hour of RN staffing per patient day could reduce pneumonia in surgical patients by over 4 percent.12 This study covered 589 hospitals in 10 States during 1993. A second study by the same researchers also found that fewer RN hours per patient day were significantly correlated with a higher incidence of pneumonia.13 The study examined administrative data on post-surgical patients in 11 States during 1990-96. A study of nurse staffing levels and adverse outcomes in California found that an increase of 1 hour worked by RNs per patient day was associated with an 8.9-percent decrease in the odds of a surgical patients contracting pneumonia.8 This study also found that a 10 -percent increase in RN proportion was associated with a 9.5-percent decrease in the odds of pneumonia. The researchers in the California study believe that the strong relationship between RN staffing and pneumonia can be attributed to the heavy responsibility RNs have for respiratory care in surgical patients. This study examined the effects of nurse staffing on adverse outcomes in 232 acute care hospitals from 1996 to 1999.f Unlike many earlier studies, the California study included only adverse outcomes that were not present at admission.7Table 2. Percent reduction in rates of outcomes among surgical patients in hospitals with high nurse staffing (75th percentile) compared to the rates in hospitals with low nurse staffing (25th percentile) Amount by which ratesre lower for High staffing, all levels (RNs, LPNs, aides) 3-14% 2-12% 19%Outcome in surgical patients Urinary tract infection Failure to rescue Hospital-acquired pneumoniaHigh RN staffing 5-6% 4-6% 11%Note Difference is exp ressed as a range of values (e.g., 2-12 percent) because several statistical models were used in evaluating the relationship between nurse staffing levels and each adverse event. Source Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and patient outcomes in hospitals. Final report for Health Resources and Services Administration. Contract No. 230-99-0021. 2001. Harvard School of Public Health, Boston, MA.A second study, funded jointly by AHRQ and the National Science Foundation, examined licensed nurse staffing (RNs and LPNs) and adverse outcomes among both medical and surgical patients in Pennsylvania acute-care hospitals.11 It found a lower incidence of nearly all adverse outcomes it studied in hospitals with more licensed nurses. For example, a 10-percent increase in the number of licensed nurses is estimated to decrease lung collapse by 1.5 percent, pressure ulcers by 2 percent, falls by 3 percent, and UTIs by less than 1 percent. Also, with a 10-percent higher p roportion of licensed nurses, there was a 2-percent lower incidence of pressure ulcers.e,11dSurgical patients overall had lower rates of adverse outcomes than medical patients, perhaps because they are healthier. Also, the smaller number of surgical patients in the study may have made it more difficult to detect associations. Nurse staffing was measured in two ways (1) the ratio of licensed nurses (RNs + LPNs) to the patient load (with and without adjustments for patient acuity) and (2) the proportion of licensed nurses to the total nursing staff (RNs, LPNs, NAs). The adverse outcomes selected for study were either caused by or not prevented by medical management based on criteria used by the Harvard Medical Practice Study. Nurse staffing was measured in three ways all hours (the total number of productive hours worked by all nursing personnel per patient day), RN hours (the total number of productive hours worked by registered nurses per patient day), and RN proportion (RN hours di vided by all hours).