Twentieth Century And Vatican II Essay - 2248 Words

TWENTIETH CENTURY AND VATICAN II The twentieth century was a witness to a new social organization of the state and the rising of totalitarian regimes, which represented a threat to the principles of the individual that the Church defended. Popes Pius XI and Pius XII defended the rights of each person in their statements. These notions signified also a development in the idea of religious freedom. However, it would be Pope John XXIII and the Second Vatican Council who would affirm clearly the stance of the Church on this issue. The totalitarian states claimed an ethical state that would be free from any kind of relationship with religions. Thus, religion became only a private practice in some European states. Meanwhile, the Catholic Church continued to demand a thesis/hypothesis kind of relationship with the states, which was in place since the nineteenth century. Herminio Rico S.J. explains in his book John Paul II and the Legacy of Dignitatis Humanae that the thesis principle was th at the Catholic Church was the true religion and as true religion, only she should be allowed to have public worship. In addition, the state should have the Church as the official religion and any other religions should be forbidden of worshiping in public to prevent the faithful to fall in error. Rico goes ahead to explain that the hypothesis was that exceptions to the thesis should be made in those places where the public order or severe animosity against the Church interfered with the idealShow MoreRelatedThe Catholic Church And The Church s Eucharistic And Juridical Ecclesiological1303 Words   |  6 Pagesearly centuries of the first millennium, the Catholic Church emphasized and supported a Eucharistic ecclesiology. Beginning around the seventh century, however, this notion of communion through the Eucharist generally receded in favor of an understanding of unity through the authority of the pope and the laws of the Church. This juridical, centralized perspective on Christian unity persisted as the Church’s primary view of ecclesiology up until the twentieth century, at the time of Vatican II. In theRead MoreTaking a Look at Vatican II1244 Words   |  5 Pages. The councils would publish texts and legislation that would become crucial to the development and operation of Christianity. The Second Vatican Council, or Vatican II, was the most recent ecumenical council. Vatican II is considered to be one of the major events of the twentieth century and impacted not only the church but also the modern world. Vatican II came to be through Pope John XXIII. 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The whole world went through drastic changes in the twentieth century such as the economic downfalls, destruction of governments, and failure of political systems. Through the economic and spiritual support of many different Catholic charities, such as The Knights of Columbus, the Catholic Church came to the aid of manyRead MoreMission, By Charmaine Warford1620 Words   |  7 Pagesnon-Christians. Is this true today? Before the Sixteenth century ‘mission’ was used to describe relationships within the holy Trinity. It was not used to describe an aspect of church life. The word ‘missio’ in Latin means ‘to send’, it was used to describe the sending of the Son by the Father, and also the sending of the Holy Spirit by the Father and the Son. 1. The Jesuits in Latin American in the late Sixteenth and early Seventeenth centuries started to use the term to describe the spreading of theRead MoreThe Palace Of Versailles As A Hunting Lodge1603 Words   |  7 PagesVersailles was built during the Baroque era in the seventeenth century. It was originally constructed as a hunting lodge, but eventually turned into one of the most marveled sights of Western Europe. The prices for the palace were enormous. Ranges are theorized to be between 2 billion dollars to trillions. However, this was a cost that the French were willing to pay for their noble King, which shows how much the King was lavished in seventeenth century France. 4. The designs for Versailles, both exteriorRead MoreThe Vatican And The Eastern Orthodox Church s Impact On The Modern Church2118 Words   |  9 PagesAguilar 1 Jason Aguilar Gary Tyra MILD 305 Church History 14 June 2016 Aggiornamento: the Vatican II and the Eastern Orthodox Church’s Impact on the Modern Church There are very few things in this world that are for sure. However, one of those things that can be counted on is, change. Change is inevitable. Change is unstoppable. Change does not ask for permission. People change, seasons change, times change, styles, change, and even the church changes. Aggiornamento, which means, â€Å"bringing up toRead MoreThe Catholic Church in Developing the Identity of The Republic of Ireland1732 Words   |  7 Pagespapacy, and with Ireland, the Church would come to achieve arguably the most Catholic country to exist in the world. The Republic of Ireland evolved through many centuries in order to achieve a true Irish State. The Anglo-Irish War proved significant in achieving the latter goal by ridding the southern sector of Ireland from the centuries of grueling oppressive rule and discrimination under Great Britain law. However, the freedom derived hindered a power struggle plagued by a partitioned Island andRead MoreOscar Romero and the Role of the Catholic Church in El Salvador1488 Words   |  6 Pagesthe Catholic Church: The Salvadoran Civil War The tragedies of the civil war in El Salvador brought focus to the many issues of oppression, under-representation, and inequality apparent amongst the Salvadoran working class during the later twentieth century. The outbreak of the war began much like civil wars in neighboring countries, consisting of the lower class demanding land and policy reformations, as elites feared the uprisings would result in socialist-geared politics that jeopardized theirRead MoreThe Vaticans View on the Israeli-Palestinain Conflict4506 Words   |  19 PagesIntroduction: The Roman Catholic Church has for centuries been involved in the struggle for the control of the Palestine, a struggle that historians call the great debate. During the twentieth century, especially after the state of Israel and the second Vatican council of 1961-1965, a major change took shape in regards to the direction of the Vatican’s political relations with key countries, namely Israel and Palestine. This change was for the most part based on three major factors: the church’s

The Nuiances of Common App Essay Samples Option 5

The Nuiances of Common App Essay Samples Option 5 Regardless of what topic you select, allow some time for extra editing. Have a look at this blog post for some advice on using an essay you've already written for another function. If you're not completely sure you've chosen the most suitable topic, you're not alone. Picking the topic for your own personal essay can feel like a substantial decision with a lot riding on it, but the truth is this choice isn't as final as it feels within this moment. It's very beneficial to take writing apart so as to see just the way that it accomplishes its objectives. It isn't important to us, whether you're too busy on the job concentrating on a passion undertaking, or simply tired of a seemingly infinite stream of assignments. While having the ability to write about whatever you wish sounds great in theory, some students findespecially at the start of the brainstorming processthat they are debilitated by the subject of your choice option for the reason that it offers an excessive amount of option. Even in these cases, the possible lessons to be learned are endless if you're prepared to consider creatively and imbue a tiny bit of cheeky humor in your private statement. The Foolproof Common App Essay Samples Option 5 Strategy The key issue is to gain something down! Someone who'd probably do great things later on. Nevertheless, as any non-straight person will say, it is a lonely life. Although my parents have lived in america for 20 d ecades, they've instilled in my brother and me their Japanese lifestyle. Common App Essay Samples Option 5 and Common App Essay Samples Option 5 - The Perfect Combination Vanessa's essay succeeds on several fronts. In general, she has written a fine essay, but it is not without a few short-comings. Note you do not need to have solved the issue, and a few of the greatest essays will explore problems which ought to be solved later on. Be certain that your essay captures YOU. Regardless of which it prompt you address, it is essential to give yourself time to think about the information you are conveying and what it reveals about you. Your essay is likely to change so much in the interim between your very first draft and last revision. There are a couple of essential things that go into a wonderful Common App essay. Whichever essay option you select, remember the function of the essay. What's more, there are lots of things you ought to do ahead of writing the essay. If you're one of the almost 1000 students every month who look for Common App Essay examples, you're certainly doing the proper thing, as there's a lot that you are able to learn from essay examples bad essays and good one. The Rise of Common App Essay Samples Option 5 I started to have a look at books from the school library and began reading the news religiously. As you pay for homework, we provide those options at no cost. Comparable to competitions, there are lots of opportunities for students to acquire their work out there. In theory, you accomplish the best honors later in your high school career, therefore the items at the peak of your list also needs to be the absolute most recent. Students lead busy lives and frequently forget about a coming deadline. C3 coursework numerical procedures. Common App Essay Samples Option 5 Fundamentals Explained These schools search for the best mixture of academic achievement and participation in extracurricular pursuits. Identifying your pre-professional interest on the application will make it possible for your advisors to supply you with a large array of support to see your objectives. Evaluate a substantial experience, achievement, risk you've taken, or ethical dilemma you've faced and its effects on you. Be ready for the next questions and prompts. Your capacity to be exact is essential for keeping the term count low. You should have your reasons, and our principal concern is that you find yourself getting a great grade. If this is the case, you've come to the correct location. So make the most of your capacity to say things fast. The Hidden Gem of Common App Essay Samples Option 5 Writing a standard app essay is an important portion of the application procedure, or so the preparation for it should start as early as possible. Don't forget that the Common App provides you with creative license. Before you may submit your application, you will need to gather your materials. The Common Application was produced by a non-profit institution with the aim of providing more equality in the college application procedure. If you believe you have the capacity to compose a Common App Essay that's on this level do it. Whatever you decide to select now will in no way negatively affect your Common App account down the street. There's no advantage or disadvantage to either application but you ought to apply through only 1 application platform. This is a more open-ended variant of the prior prompt.

Perspective Corporate Sustainability Driver â€Myassignmenthelp.Com

Question: Discuss About The Perspective Corporate Sustainability Driver? Answer: Introduction Organisational behaviour is very crucial for an organisation as it decides on the management and success of the business. On the other hand it is also important that the business conduct its operation in a sustainable manner. A move taken by the company towards operational sustainability has a direct impact on the organisational behaviour. Moreover, the culture followed in the company also influence the steps the company taken towards being sustainable (Lozano 2015). For example if the organisation has the aim to increase its profit at any cost then it will be environmentally less sustainable compared to those that keep their corporate social responsibility before other operations and strategy. The paper will research about the impact of organisational culture of Coca Cola on helping the company to be environmentally sustainable. Further it explains the way Coca Colas step towards sustainability will impact the organisational behaviour. Research Purpose The purpose of the research is explanatory that explains the sustainability framework of Coca Cola Company based on its organisational culture and motive. Research will also be conducted on the impact the sustainability steps taken by the Coca Cola Company has put on the organisational behaviour. It is important for every company it have a well framed motive towards corporate social responsibility in which business complies with the ethical standards of the environment. Coca Cola too has to have some social responsibility in its business operations that uses harmful materials or dispose harmful effect on the environment. Being environmentally sustainable will also help the company to earn long-term profit. Thus to know the social responsibility of Coca Cola a research will be conducted and the research will also be beneficial to know the benefits CSR has put on the company (Eccles, Ioannou, and Serafeim 2014). This research will not only benefit Coca Cola, it will also have positive effect on the other companies as well. Thus the main purpose of the research is to show the relationship between environmental sustainability and organisational behaviour. Research Limitations Research limitations is yet another important factor to be considered to complete the research successfully. Limitations of the research states the situations that might prove to be a hindrance in the research. As the research on the impact of environmental sustainability on organisational behaviour of Coca Cola Company will be a qualitative research, it will have limitation of population. It is not easy to research all the persons of the organisation in all the branches of the company to know about their culture. Another limitation that may prove to be a constraint is the time. Time is the most important factor in a research because all the research is conducted within a period of time and it has to be completed within that time. Limitation also lies in setting the research objective. It might happen that while doing the research objective may look very broad and lengthy. During collecting the data as well there might be few data that is not clear and reaching the objective is not e asy. Further, it might happen that the managers of the Coca Cola Company does not respond correctly or have filled the open ended questions in the questionnaire in a very diplomatic manner. These are some of the limitations that is faced during the research and thus steps are to be taken keeping these in mind. Sources of Data Data collection will be conducted with the help of primary research as it involves knowing the organisational culture and environmental responsibility of the Coca Cola Company. Internal information about the company about their CSR responsibility will not be available in the secondary sources. For primary research a questionnaire will be prepared consisting both open and close ended questions. Open ended question will help the respondent give their own view. While the close ended questions will be easy to answer and will consist of options that the respondent will have to choose (Silverman 2016). These questionnaire will be distributed to the managers of the company and to the employees as well. The questionnaire will be uploaded in various social media sites as well to know the perception customers are keeping about the sustainable responsibility Coca Cola is having in its organisation. Some of the secondary sources will also be considered to show the relationship between organisati onal culture and environmental sustainability activity. This will help the company to conduct an error free survey. Sources of data will be the managers and employees of the organisation, newspapers, magazines and also journals (Bryman and Bell 2015). The analysis on the other hand will be done in a descriptive manner so that it is easily understood by everyone. Coca Cola Company Coca cola is a well-known beverage drink brand serving various kinds of drinks to the consumers. It was founded in 1886 in Georgia to prepare non-alcoholic beverages for the consumers. The company operates its market by offering franchisee to the stores and outlets to sell their drinks. However, the drinks that are prepared by the company in their manufacturing units involve a lot of procedures. Bottling of their drinks are also done in their manufacturing unit. However, their operations also have a lot of impact on the environment due to the emission coming from the machines they are using (History 2017). The company also maintains some of kind of responsibility towards sustainability to the environment in their water stewardship, packaging and management units. Environmental Sustainability and Organisational Behaviour Environmental sustainability is a way of protecting the environment from all kinds of harmful effect that is coming from various kinds of manufacturing and production units. It is a step towards offering the best quality environment to the future generation (Norton, Hannes , and Neal 2014). Thus it is also the responsibility of the companies operating in various activities to maintain some limit of sustainability. Thus it is necessary for the companies to formulate their activity in accordance with the sustainability act by issuing new infrastructure and machines that could reduce the impact of harmful effect (Chang, Walters, and Wills 2016). However, it is seen that such changes also bring about an impact on the organisational behaviour as employees are not used to the new type of infrastructure at first. It takes time to train the employees and workers to adopt the changes that is best for the environment and also for the growth of the business (Darcy et al. 2014). Thus, behavioura l change of the organisation can help the company to continuously improve their environmental performance. Sustainability initiative taken by the company also depends on the organisational culture such as employee behaviour, managers behaviour, motive of the business and types of activities they are carrying out. Sustainability can be adopted by the organisation in various ways such as waste management programme, recycling programme and others (Marr 2015). Conclusion From the above analysis it can be deduced that it is necessary for the company to take up environmental sustainability steps and to formulate strategy to carry out sustainability successfully. The research is being conducted to see the impact organisational culture out on the environmental sustainability initiatives of Coca Cola and the impact it has on the employees and other members. For the research a primary data survey has been chosen with the help of questionnaire that will consist of both open ended and close ended questions. This will help the researcher to know the initiatives taken by Coca Cola in maintaining their CSR strategy and its impact on the companys growth over the years. This will show the importance of sustainability every company should accept in its operational work. References "History". 2017.The Coca-Cola Company. https://www.coca-colacompany.com/history. Bryman, Alan, and Emma Bell.Business research methods. Oxford University Press, USA, 2015. Chang, Victor, Robert John Walters, and Gary Brian Wills. "Organisational sustainability modellingAn emerging service and analytics model for evaluating Cloud Computing adoption with two case studies."International Journal of Information Management36, no. 1 (2016): 167-179. Darcy, Colette, Jimmy Hill, T. J. McCabe, and Philip McGovern. "A consideration of organisational sustainability in the SME context: A resource-based view and composite model."European Journal of Training and Development38, no. 5 (2014): 398-414. Eccles, Robert G., Ioannis Ioannou, and George Serafeim. "The impact of corporate sustainability on organizational processes and performance."Management Science60, no. 11 (2014): 2835-2857. Lozano, Rodrigo. "A holistic perspective on corporate sustainability drivers."Corporate Social Responsibility and Environmental Management22, no. 1 (2015): 32-44. Marr, Ana. "Tensions between financial and organisational sustainability: The problematic case of group-based microfinance and possible ways forward." (2015): 145-162. Norton, Thomas A., Hannes Zacher, and Neal M. Ashkanasy. "Organisational sustainability policies and employee green behaviour: The mediating role of work climate perceptions."Journal of Environmental Psychology38 (2014): 49-54. Silverman, David, ed.Qualitative research. Sage, 2016.

The Aztec Indians, Who Are Known For Their Essays (488 words)

The Aztec Indians, who are known for their domination of southern and central Mexico, ruled between the 14th and 16th centuries. Their name is derived from Azatlan, the homeland of the north. The Aztecs also call themselves Mexica and there language came from the Nahuatlan branch of the Uto-Aztecan family. The Aztecs were formed after the Toltec civilization occurred when hundreds of civilians came towards Lake texcoco. Late families were unfortunate and were forced to go to the swamp lands. In the swamp lands there was only one piece of land to farm on and it was totally surrounded by more marshes . The Aztec families some how converted these disadvantages to a might empire known as they Aztec Empire. People say the empire was partially formed by a deeply believed legend. As the the legend went it said that Aztec people would create a empire on in a swampy place where they would see an eagle eating a snake while perched on a cactus which is growing out of a rock in the swamplands. This is what priests claimed they saw while entering the new land. By the year 1325 Their capital city was finished. They called it Tenochtitlan. In the the capital city aqueducts (piping) were constructed, bridges were built, and chinapas were made. Chinapas were little islands formed by pilled up mud. On these chinapas Aztecs grew corn, beans, chili peppers, squash, tomatoes, and tobacco. Tenochtitlan (the capital city) was covered in giant religious statues in order to pay their respects to the gods. In the Aztec religion numerous gods controlled an Aztec's daily life. Some of these gods include: Uitzilpochtli (the sun god), Coyolxauhqui (the moon goddess), Tlaloc (the rain god), and Quetzalcoatl (the inventor of the calendar and writing). Another part of the Aztec religion was human sacrifices. For their sacrifices the priest would lay the man or woman over a convex (rounded) stone, then he would take a sharp knife and cut the victims heart out. They did this because they believed that good gods could prevent bad gods from doing evil things and they also believed that good gods got their strength from human blood and hearts so they had sacrifices in order to keep their gods strong. For major rituals warriors were sacrificed, for the warrior this was one of the greatest honors and for minor rituals prisoners were used. In an Aztec marriage the grooms shirt is tied to the brides dress in order to express there bonding and after the wedding incents were burned for 4 days before proceeding with the marriage. In 1519 Hernando Cortes, a Spanish explorer, led over 500 men into Aztec territory to search for gold. Aztecs thought he was a representative for a certain white skinned god so they respected him. It all changed when the Aztecs saw that Hernando was melting down their golden statues and shipping them back to Spain. The Aztecs decided to attack Hernando and his men. The Aztecs were successful and drove the Spanish away. In 1520 the Spanish attacked the Aztec's capital city and destroyed their civilization. That was the end of the Aztec's mighty empire had built so long ago.

everything is illuminated thesis paragraph Essay Example

everything is illuminated thesis paragraph Essay Example everything is illuminated thesis paragraph Essay everything is illuminated thesis paragraph Essay Essay Topic: Everything Is Illuminated Paragraph Jonathan Safran Foers Everything is Illuminated challenges the readers assumptions about the structure of time by creating neither a start nor a stop in the continuation of life. Throughout the end of the novel Foer emphasizes this non-linear nature through. Eeach generation featured described from Safran to present day Alex to Safrans life during the war criss-crosses illuminating the nature of time. Everything Is Illuminated explores the paradoxical idea that the world is both beginning and nding at the same time, all of the time. Jonathan Safran Foers Everything is Illuminated challenges the readers assumptions about the structure of time by creating neither a start nor a stop in the continuation of life. Throughout the end of the novel Foer emphasizes this non-linear nature through. Eeach generation featured described from Safran to present day Alex to Safrans life during the war criss-crosses illuminating the nature of time. Everything Is Illuminated explores the aradoxical idea that the world is both beginning and ending at the same time, all of the time. Jonathan Safran Foers Everything is Illuminated challenges the readers assumptions about the structure of time by creating neither a start nor a stop in the continuation of life. Throughout the end of the novel Foer emphasizes this non- linear nature through. Eeach generation featured described from Safran to present day Alex to Safrans life during the war criss-crosses illuminating the nature of time. Everything Is Illuminated explores the paradoxical idea that the world is both beginning and ending at the same time, all of the time. Jonathan Safran Foers Everything is Illuminated challenges the readers assumptions about the structure of time by creating neither a start nor a stop in the continuation of life. Throughout the end of the novel Foer emphasizes this non-linear nature through. Eeach generation llnear nature tnrougn. teacn generation Teaturea aescrlDea Trom saran to present the time.

Jen passe - French Expression

Jen passe - French Expression Expression: ... et jen passe Pronunciation: [ ay zha(n) pahs] Meaning: and thats not all, and all sorts of things, and so on Literal translation: and I pass over some Register: normal Notes The French expression et jen passe is a sort of verbal shorthand, a way of letting listeners know that you are skipping over boring or excessive details. The adverbial pronoun en replaces the implied word choses- the things youre skipping over. Example   Ã‚  Ã‚   Ce que Michel est raseur  ! Il na pas arrà ªtà © de parler de son divorce, dà ©mà ©nagement, licenciement et jen passe  !   Ã‚  Ã‚  Michel is such a bore! He droned on about his divorce, move, firing, and on and on! Variation   Ã‚  Ã‚   Jen passe et des meilleures - literally, I pass over some and better ones. Note that meilleures is feminine plural to agree with choses. Synonyms   Ã‚  Ã‚  et ainsi de suite  Ã‚  Ã‚  et bla bla bla (informal)  Ã‚  Ã‚  et cetera  Ã‚  Ã‚  et patati et patata (informal)  Ã‚  Ã‚  je vous fais cadeau des dà ©tails More Expressions with enExpressions with passerMost common French phrases

Final Project Assignment Example | Topics and Well Written Essays - 1750 words

Final Project - Assignment Example For example, if a caretaker of a child thinks that a child likes to play alone may be used to run an incorrect diagnostic to a child who has Autism or one who does not have Autism. Therefore, practitioners should understand that diagnosis does not necessarily provide families, other professionals, and teachers with relevant information about what requirements do the children needs, or the ability the students to enable them teach them in the best way possible. However, they are also as important since they will provide them with information about the child thus providing people with disabilities, educators, families, and other researchers with a common framework or language and connecting people to funding, resources, and services (Kluth 2010, pg. 11). In this case, the main section the author reveals his thoughts and feelings about the diagnosis of Autism is by providing the different characteristics of children living with Autism. These characteristics describe some of the diagnost ics outcomes that a practitioner can provide when diagnosing an individual. Some of these characteristics include sensory differences, leaning differences, movement differences, social differences, and interests and fascinations (Kluth 2010, pg.11). Movement difference is the first outcome diagnosis of individual likely to have Autism. In this case, it involves both atypical and excessive movement, and loss of typical movement. For example, this movement differences end to impede speech, postures, perceptions, actions, memories, and thoughts. In the diagnosis, that author outlines that a person suffering from Autism experiences these movement problems constantly, in addition, those people on the spectrum will also take many efforts even with the smallest tasks. Moreover, movement differences can result to difficulties in areas of movement such as combining, executing, starting, and stopping. On the other hand, auditory sensitivity is the other diagnostic result in people likely to h ave Autism. Some people will be disturbed by small sounds that others will not get to hear thus can cause a person in Autism has distress (Kluth 2010, pg. 11). Visual Sensitivity is also very common in people with autism, and they are sometimes very sensitive with certain types of colors. In this case, a person with autism may be suffering from being anxious and being fearful thus, the author reveals that visual sensitivity can be diagnosed on those individuals who have Autism (Kluth 2010, pg. 14). Sensory differences among people can be diagnosed as a personal suffering from Autism. One of the characteristics that individuals with autism can be diagnosed with thus; they cannot reveal signs of either a hypo or hyper-response. The other characteristic in this category is the sense that this group of people is vulnerable to for example, sensory overload due to the continued low-level bombardment (Kluth 2010, pg. 13). Lastly, social differences in various levels of the social life can help a practitioner diagnose a person suffering from autism. For example, people suffering from autism will not be interested in social relationships since they lack the necessary skills for successful social interactions, such as; they are bad in reading social signals (Kluth 2010, pg.

Fiscal Policy and Economic Growth Essay Example | Topics and Well Written Essays - 1250 words

Fiscal Policy and Economic Growth - Essay Example As the essay stresses countries exposed to large capital flows must avoid intermediate regimes. It is also necessary to adopt a corner regime. According to these proponents, corner regimes sustainable regimes for long run. It has been found that SEA countries also shifted from an intermediate regime to intermediate regime. A vast literature has been dedicated to found out the preferred choice of exchange rate regime. The fundamentals identified by the OCA approach has given some guidance for observed regime choices. In 1980s, studies were focused on the role of shocks on the choice of regimes. This research incorporates considerations for macroeconomic stabilization. According to the report findings the real shocks allow flexibility and symmetry of shocks produces OCA. Shocks have been appeared in countries which have weak financial institutions. The counties with weak financial institutions intervene in the market in order to shield banking industries which are confronting large exchange rate movements. There are many authors who agree SEA countries should adopt a currency basket system in order to gain and maintain exchange rate stability and flexibility. As far as the macroeconomics situations of SEA countries are concerned, the most reasonable choice is managed floating regime. It is because managed floating regime is fewer complexes than currency basket system agree that managed floating regime would be less complex than the currency basket ... In 1980s, studies were focused on the role of shocks on the choice of regimes. This research incorporates considerations for macroeconomic stabilization. Authors have argued that nominal shocks actually raise the possibility of a fixed regime. The real shocks allow flexibility and symmetry of shocks produces OCA. Shocks have been appeared in countries which have weak financial institutions. The counties with weak financial institutions intervene in the market in order to shield banking industries which are confronting large exchange rate movements. There are many authors who agree SEA countries should adopt a currency basket system in order to gain and maintain exchange rate stability and flexibility. As far as the macroeconomics situations of SEA countries are concerned, the most reasonable choice is managed floating regime. It is because managed floating regime is fewer complexes than currency basket system agree that managed floating regime would be less complex than the currency basket (Hossain, M. 2011). Financial liberalization index Figure 1 A cross-country index indicating financial liberalization has been used to identify the development in the sector. It ranges between 0 and 18 (Abiad, 2005). This index is made during the period or 1973 to 1995 (Figure 1 and 2). First figure studies three initial countries i.e. Indonesia, Korea and Malaysia. For the last three years FLI is assumed to be constant. These both graphs indicate the exchange rate regime in six countries. The figure indicates that till 1977 all three countries were focusing on fixed regime but due changing conditions in 1979 Indonesia and Korea shifted to intermediate regime. While Malaysia remained consistent to fixed regime. 1993 onwards all three

Homeless essay Essay Example for Free

Homeless essay Essay Most homeless people are responsible for their own problems. Do you agree? In this essay I will be pointed out facts about the homeless people in London and I will be analysing if it is there fault for being homeless or our fault. There are thousands of people who roam around the streets of London looking for a patch to sleep and somewhere to eat. Children and adults leave there houses because of family problems and many more scenarios. There are many people living around the streets of London and the world. They face problems that force them to leave there home and the majority of the time it is because of money problems and family problems. They leave houses to travel the streets and live in alleyways and face the whether which can turn bad in the winter. The question that I will investigate is it their fault that there homeless. The majority of homeless people are homeless because it has been their fault. Their problems that they have faced have pushed them to leave home and loose any luxuries they had. Any homeless people do not even try to gain a job to support them in any way. Many people think that they should get a job as many do have some qualifications that can help them. This is a sign of being lazy which cannot benefit them in any way and they deserve to be homeless if they act in this way. They clanger ways to get moneys from people by begging in crowded areas and doing an act to endure people to give money. This is the easy route out and if homeless people do this then no simperfy should be given. More than three hundred thousand was given to beggars over a period of two months n London and was spent on drugs and alcohol. This is a good example of why no money should be given to beggars, as they will only harm themselves and people around them. Many homeless people by the drugs because they fell that they have nothing and drugs might be a way to get a boost to survive day-to-day life on the streets. Many homeless people refuse shelter because they think that they can get by without them. This is a sign of being shellfish and people shouldn’t tolerate it. Many immigrants flee to the UK because they think that it is their escape route out of their country because of poverty or war. They come into this country and such onto our money that has been give. They stay homeless for a while and as soon as a chance comes they will take it. They should get out and get a job because it will help them and maybe their future family. Many homeless people who have no options available to them do drastic things to gain some money to support them for the day or week. Many professional all beggars get eighty pounds a day, which is tax-free. This is ridiculous as it is more than people get in a day for going out and doing work. This is a prime example as to why money shouldn’t be given to them. Some homeless people who want to get out of the situation cannot because they are too lazy to find out information about numbers to call for help such as childline and social services. There is an magazine that can help the homeless it is called the big issue and it aim to help the homeless by telling them what to do and numbers to call. It is a big help for people who want to get out of the situation. It is a free paper and could get homeless people back on a property. I think that some homeless people are to blame themselves, as they do not want help of any sort. In this part of the investigation I will be analysing the support side to this argument. There is another side to which I think that is to be announced about homeless people. The things that have happened to them are not their fault. This problem could of happened to anyone. This is why there are many charities open to help the homeless who will provide food and a shelter for them to sleep in. the big issue is a big help. Keith smith at thebig issue agrees that it is not fair to tell people that they mustn’t give money to beggars. The government has made a good contribution to this case, as ninety two per cent of families are now living in tempary accommodation in a good maintained house with a bath, bedrooms and living room. The government hopes to get as many homeless people into homes by 2010. This is a great achievement for the people who want to move home. There are many groups that go into the streets and provide food and shelter to the homeless. People should give money to charities because it will have more of an effect as if you give it to the homeless in person they could just by drugs or alcohol with it. I think in my judgement that homeless people are not to blame, as they cannot help was has happened to them. They need help, which is provided by different services. A small amount of money is all that is needed to support them. With a new priminister in power I think that he will tackle the problem in a quick way. He could bring the time from 2010 to now which could help the homeless even more.

Demand: One of the Pillars of Economics Essay -- Understanding Demand

Demand and Quantity Demanded There is a clear distinction between demand and quantity demanded; furthermore, they have their own significance in the economics arena. In economics, the term demand refers to the will associated with purchasing a product, which one can afford, meaning that the price must be contained within the fiscal reach of the consumer. Demand is also a combination of aspiration to possess something, capability to pay for it and the willingness to reimburse. An example is the ability of citizens to pay for education, as well as to buy basic-food staff. Quantity demanded (QD), on the other hand, refers to the entire number of commodities demanded at any one moment, for instance, people buying 3000 laptops when the price is $ 500 (Baumol and Blinder, 2008). QD depends on the worth of products, not considering market stability. Substitutes and Complement Products Substitutes are products that can replace each other and still gratify the desires that the intended product aimed at addressing (McKenzie and Dwight, 2006). A notable example is butter and margarine, which meet the same purpose of the consumers. It is notable that changes in price of one product will have a significant demand on the other. Complement products refer to a set of goods that are consumed jointly. A sole example is the printer and ink cartridges, which must be used together. Other examples include camera and film, together with computer and Microsoft programs. Amplification in price for one product will cause a decrease in demand of its complement. The Difference between Demand and Quantity Demanded Understanding the difference between the two aspects is critical in avoiding errors in economics. Demand is used to verify the marketplac... ...ed of another related product. Elasticity of demand is another fundamental aspect in demand since a proportionate change in one factor affects the demand of a product. There is price and income as well as cross elasticity of demand, in economics. Several factors do affect the demand of a product, and these include weather, price expectations, and the consumer count in the marketplace. Works Cited Baumol, William and Blinder A. (2008) Macroeconomics: Principles and Policy. 11th edition. Florence, Cengage Learning. McKenzie, Richard and Dwight R. (2006) In defense of monopoly: how market power fosters creative production. Michigan, University of Michigan Press Myers, D. (2004) Construction economics: a new approach. Oxford, Taylor and Francis Gwartney, James et al. (2008) Economics: Private and Public Choice. Florence, Cengage Learning.

Maiden Voyage by Denton Welch Essay

This passage from Maiden Voyage by Denton Welch is an account of an adventurous European boy in China who wishes to explore the different cultures and experience the extraordinary. Yet he is overwhelmed by the barbarity of the new culture and this reveals to the reader the unexpectedness of life from the boys perspective. Through the first person narrative and detailed descriptions of the events, various themes such as teenage rebelliousness, gap between different cultures and our limited knowledge is highlighted through different literary features such as contrast, colour imagery and metaphor. From the very beginning, the juxtaposition between the inside and the outside of the European villa accentuates the differences between two cultures. Inside the villa, where the foreigners live, seems to be more secure and settled as reflected by the reference to the stable doors. The boys observation of the signs of cultivation also hints the civilised European culture inside the walls. This perhaps links to Mr Butlers comment that foreigners are not very popular and people outside and foreigners have separate communities. The main character using moth eaten balls and the old tennis racket shows that young people like himself used to stay at the villa, but not for long periods of time it is where people dont appreciate the thoughts of the young. As the plot develops, the change in the setting is emphasized by imagery. Words such as a black speck and a dark boulder are colour imageries used to foreshadow the unfavourable and unexpected event. Outside of the European villa, the human head that the boy has found implies that the culture outside is in a way, barbaric. This is supported by cruel images such as odd white teeth stood up like ninepins in its dark, gaping mouth, its cheeks and shrivelled lips were plastered black with dried blood. These images not only highlight the unfortunate and unexpected events, but also give emphasis on difference between the two cultures. The boys fear and realisation of the hostility between cultures are conveyed from the head is described through imagery. Tall rank grass grew was dry and sharp as knives. Also the second mention of the insects reminds the boy of the head, causing the boy to feel more fearful. Through the main character, the author explores various themes of maturity  and our awareness of different cultures. Readers are able to observe that the main character seems to be a boy, from him playing tennis. It is shown that he is an adventurous person as he is [longing to explore]. He [hates] to be dependent on other people and says they would never want to do what I want to do- highlighting the theme of teenage rebelliousness and his desire to be independent. His unhappiness and dissatisfaction with his quiet lifestyle is suggested when [He hits] the balls fiercely against the stable doors. The boy feels imprisoned in a European villa and a line of poplars; the orderly line of poplar implies the structured and formal environment of the villa. For the boy, even the straight line of poplars is a sign of restriction and [imprisonment]. . As an act of rebellion, he does not want to listen to the elders, but carries out what he believes to be right, without rational thinking about the consequences. . From the action of the main character, the author highlights the themes of teenage rebelliousness, difference between two cultures and acceptance of a different culture. In the line, [he] let [himself] quickly out of the back gate, the back gate has an implication that it was done in secret. This once again reinforces the theme of teenage rebelliousness as this action was disapproved by Mr Butler and Mr Roote the adults. Despite his rebellious nature, however, his immaturity and lack of knowledge are evident in his initial response to finding the head. The rather naà ¯ve observation of the head, I saw that the object was not black but pink shows that he was not able to identify what he was seeing highlighting the boys unawareness of other cultures. This colour imagery used to describe the head, helps the reader picture the situation, and senses the shock that the boy feels. The line [he] stared at it stupidly until [his] numbed sensescan be interpreted as him being stupid and numb in the understanding of other cultures. When he finally finds out that it was a human head, [he jumps back]with [horror] and [terror]. Such shock from the discovery of a new culture highlights the unexpectedness of some events in life. The boys panic is emphasized through metaphors and diction in the passage. The first cur barked as a sound imagery, contributes to the fast-flowing and panicking situation where the boy is running away from the head. Also, the  wall is a metaphor for the separation between the two cultures. The tall rank grass that is dry and sharp as knives, shows that one culture is almost trying to repel the people from another. Also, knives are an image that conveys cruelty and hostility between the two cultures. The boys horrified action and shock contributes not only to the differences of two cultures but also the lack of endeavour to tolerate these differences. In the passage from Maiden Voyage, various themes such as expectations from different cultures, teenage rebelliousness and our limited knowledge are explored though a European boys horrifying experience. These themes are supported by a variety of literary features such as colour imagery, metaphor and contrast. The authors message that people should try to accept and understand other cultures is conveyed in the passage through highlighting these main themes. Text -Foreigners are not very popular here, Mr Butler told me at breakfast. So I dont think you ought to go out alone.My heart sank. I hated to be dependent on other people. They would never want to do what I wanted to do. I began to feel imprisoned. I took up the moth-eaten balls and the old tennis racket which were lying in the hall, and went into the garden. I hit the balls fiercely against the stable doors until I was too hot and unhappy to go on. I sat brooding on the steps. I might have been in Sydenham for all I could see a European villa and a line of poplars; yet outside lay a Chinese city which I was longing to explore. After lunch I decided that I could stand it no longer. Mr Butler and Mr Roote were still deep in their mornings discussion, so I let myself quickly out of the back gate and walked along the sandy lane which led into the country. Mr Butler could not mind my walking in the country, I thought. Everything was still and silent, in an early-afternoon torpor. The only sound came from the stunted bushes which squeaked and grated linguistically as the wind passed through them. Pillars and scarves of dust and sand rose up from the ground, eddying and swirling themselves into flat sheets which hovered  in the air. Harsh spears of grass stuck up through the sand. The soles of my shoes began to burn and I looked round vainly for some shady place. I enjoyed the dreamlike stillness and wanted to stay out for as long as possible. I thought that if I walked on I might find a place. The road led towards the hills. Across the sandy plain the city walls stood up like cliffs. Turrets and bastions were ruined cottages, crumbling into the sea. I walked on, fixing my eyes on a black speck some way in front of me. I wondered if it could be a cat crouching in the middle of the road; or perhaps it was a dark boulder. As I drew nearer, a haze of flies suddenly lifted, and I saw that the object was not black but pink. The loathsome flies hovered angrily above it, buzzing like dynamos. I bent my head down to see what it was. I stared at it stupidly until my numbed senses suddenly awoke again. Then I jumped back, my throat quite dry and my stomach churning. The thing was a human head. The nose and eyes had been eaten away and the black hair was caked and grey with dust. Odd white teeth stood up like ninepins in its dark, gaping mouth. Its cheeks and shrivelled lips were plastered black with dried blood, and I saw long coarse hairs growing out of its ears. Because it was so terrible, my eyes had to return to it whenever I looked away. I stared into its raw eye-sockets until waves of sickness spread over me. Then I ran. The whole plain and the bare hills had suddenly become tinged with horror. I found myself between high banks. I would soon be coming to a village. There were signs of cultivation. When the first cur barked, I turned and ran back the way I had come. I did not know what to do. I would have to pass the head again. I tried to avoid it by making for the city walls across the pathless sand. My feet sank in, and my shoes became full and heavy. My only idea was to get  back to the house. Tall rank grass grew in the shadow of the wall. It was dry and sharp as knives. I pushed through it, looking up at the towering cliff for a gate or steps to climb. Nothing else seemed to be alive except the insects. I could only hear their buzzing and the slap of them when they hit the wall. There was no gate. I began to feel desperate. I ran towards a bastion, wondering if I could climb up to it in any way. I knew that I could not. Denton Welch, Maiden Voyage (1943)

Prevalence and Associated Factors of Spiritual Needs Among Patients with Cancer and Family

Running head: PREVALENCE AND ASSOCIATED FACTORS OF SPIRITUAL Prevalence and Associated Factors of Spiritual Needs Among Patients With Cancer and Family Caregivers Prevalence and Associated Factors of Spiritual Needs Among Patients With Cancer and Family Caregiver Problem Statement Identify cancer patients and their caregivers spiritual needs and measure the prevalence of these spiritual needs. The patients and their caregivers can have similar spiritual needs that may require care. However, a nurse’s help with these spiritual needs, may not always be wanted. So how does the nurse identify the spiritual needs? If and when these needs are identified, how is the nurse to approach these needs? Study Purpose This study is significant to nursing because it reveals â€Å"nurses must be educated to recognize and nurture various spiritual needs† (Johnston Taylor, 2006, p. 734). Research Questions 1. ) How prevalent are the spiritual needs of patients with cancer and family caregivers, from their perspective? 2. ) What demographic and illness-related factors are associated with type and frequency of perceived spiritual needs? . ) What are the patients’ and family caregivers’ expectations regarding nurses addressing their spiritual needs? ((Johnston Taylor, 2006, p. 730) Hypothesis/Hypotheses The study hypothesis is all people have spiritual needs, but the importance varies as do their beliefs. The desire for nurses to assist in these spiritual needs vary according to what is the patient’s religion, are they an inpatient , and perception of an incurable disease. Study Variables The independent variable is the questionnaire. The dependent variables are the research participants. Conceptual Model/Theoretical Framework A theoretical framework was used to guide this study by examining peoples definition of spiritual needs, surveying oncology nurses, and looking at studies done measuring spiritual needs of cancer patients. The Institute of Medicine defined spiritual needs as â€Å"the needs and expectations that humans have to find meaning, purpose and value in their life† ((Murray, Kendall, Boyd, Worth, & Benton, 2004, p. 730). Whether religious or not, all people have various ways of believing to give their life purpose and meaning. Some may connect spiritually with what they call a higher power, nature, or other human beings. A survey was done in 1995 with 181 oncology nurses and their perception of patients spiritual needs. They identified factors as patients talking about God or faith, meaning of life, or hopelessness or guilt. But â€Å"also identified more subtle expressions of spiritual need (e. g. , anxiety, anger, restlessness, sadness, withdrawal, difficulty coping)† ((Johnston Taylor, Amenta, & Highfield, 1995, p. 730). There have been many studies done measuring spiritual well-being and quality of life, but there has been only one that focused on the spiritual needs of those with cancer. ((Moadel et al. , 1999, p. 730) Review of Related Literature The literature supports the need for this study because all people believe in spirituality in some form and have needs. Cancer patients in previous studies have discussed their spiritual well-being and quality of life, but only one study focused on their spiritual needs. As healthcare providers we need to become educated to these spiritual needs and how to address them. Study Design This study is a descriptive design because of the need to gain more information about spiritual needs in cancer patients and their family caregivers. And also if patients require or request a nurse’s care regarding their spiritual needs. At least 2 threats to the internal validity of this design would be selection due to inadequate number of non-Euro-Americans in the study and mortality due to the small number of research participants at 156 cancer patients and 68 family caregivers. There were no threats found to the external validity of this study design. Sample and Setting The sample included 156 cancer patients and 68 family caregivers. This sample of research participants represented the target population for this study by focusing on individuals and their family affected by cancer and their spiritual needs. The setting was appropriate because each individual was given the option to speak face to face with a research team member or take home the Spiritual Interests Related to Illness Tool (SpIRIT) questionnaire. They all chose the questionnaire that was developed specifically for this study. Each participant completed the questionnaire without help from the research team and then returned to a neutral party that was not a member of the research team and chosen by the institutional research board. Identification and Control of Extraneous Variables The one extraneous variable noted was the SpIRIT questionnaire had not be offered prior to this study. By using a neutral party to receive the completed questionnaires helped alleviate potential problems. Study Instruments/Tools Used the Spiritual Interests Related to Illness Tool (SpIRIT) questionnaire Data Collection/Methods The data collection methods were appropriate for this study because of offering this study without pressure to participate and to remain anonymous. Data Analysis Procedures The data analysis procedure was appropriate for this type of data collected because they measured the central tendency (average) from the SpIRIT and the Information About You form; checked all SpIRIT items and removed one item that correlated poorly; and performed a factor analysis to determine SpIRIT validity. Then computed coefficient alphas. Strengths The 2 major strengths of the scientific merit of this study were: * â€Å"Those that who perceive more spiritual needs may be most receptive to nurses’ spiritual caregiving ((Johnston Taylor, 2006, p. 733) * â€Å"Religious people (as indicated by frequency of attendance at religious services) not only are more apt to consider spiritual needs important but also have more * Desire for nurses’ assistance with such needs ((Johnston Taylor, 2006, p. 733) Limitations The 2 major limitations of the scientific merit of this study were: * Samples of patients and family caregivers were from cancer patients that were not life threatening. SpIRIT was a new test performed. Extent that study findings are valid are evidenced by the spiritual needs cancer patients and their family caregivers do have. The study findings are practical for nursing practice and education because the analysis suggest cancer patients that may be a higher risk for spiritual distress and would benefit from a more-focused spiritual assessment. Implications Implications for practice would be to include admission questions related to the patients spiritual beliefs and/or values; any special needs related to religion or spirituality. And follow-up to have their needs met, record on patient electronic medical record for all involved in care to continue same care throughout patient stay. Implications for education would be attend classes related to cultural and religious differences, meanings and needs. Implications for research would be to extend this study to a larger group and different cultures, religions, and terminally ill. References Johnston Taylor, E. (2006). Prevalence and Associated Factors of Spiritual Needs Among Patients With Cancer and Family Caregivers. Oncology Nursing Forum, 33 (4), 729-735. Johnston Taylor, E. , Amenta, M. & Highfield, M. (1995). Spiritual care practices of oncology nurses. Oncology Nursing Forum, 22(), 31-39. Moadel, A. , Morgan, C. , Fatone, A. , Grennan, J. , Carter, J. , & Laruffa, G. et al. (1999). Seeking meaning and hope: Self-reported spiritual and existential needs among an ethnically diverse cancer patient population. Psycho-Oncology, 8, 378-385. Murray, S. , Kendall, M . , Boyd, K. , Worth, A. , & Benton, T. (2004). Exploring the spiritual needs of people dying of lung cancer or heart failure: A prospective qualitative interview study of patients and their carers. Palliative Medicine, 18(), 39-45.

Example of Formal Letter †English (100 Level Course)

Example of Formal Letter – English (100 Level Course) Free Online Research Papers Example of Formal Letter English (100 Level Course) Dear Sir/Madam, I am writing with regard to your invitation for the readers of your magazine to write to you giving views about how governments and individuals could cooperate to protect the global environment which remains as one of the main problems of our planet’s longevity. In my opinion, we should oblige our respective governments to draw their attention a bit more to search, but in cooperation, not like in the UNO where powerful countries still impose their preferences not looking for an equilibrated world but for one where they keep on controlling the rest, for solutions to maintain our natural resources for as long as possible. As individuals it is our duty to do so. And it is governments’ obligation to donate a 0.7% of their GDP (Gross Domestic Product), an international regulation which serves for nothing else but as a demonstration of powerful countries’ ability and possibilities of breaking others’ rules. If at least this law was obeyed, third-world governments would be able to face up to the illegal smugglers who are destroying their national natural resources to profit nobody but themselves and this is something all of us are going to pay sooner or later. As inhabitants of this planet, the â€Å"blue planet† as it is known, and consumers of its resources we should set ourselves in a more far-sighted position to avoid finding ourselves later in a world where the only thing we can do is just sit back and watch time go as a consequence of our previous silliness. Maybe in a national ambit the government should begin spending some of our taxes in campaigns to raise the conscience of people but then do not being hypocritical and apply themselves to the international legislation. I firmly hope that this letter helps readers to begin at least to think about the issue and then, if possible, making the government see a face of the State’s duty that we usually hide in the shade. Yours faithfully Student Name Research Papers on Example of Formal Letter - English (100 Level Course)Comparison: Letter from Birmingham and CritoDefinition of Export QuotasAssess the importance of Nationalism 1815-1850 EuropeThe Effects of Illegal ImmigrationStandardized TestingQuebec and CanadaPETSTEL analysis of IndiaInfluences of Socio-Economic Status of Married MalesNever Been Kicked Out of a Place This NiceBionic Assembly System: A New Concept of Self

How to Complete a 1000-Word Essay

How to Complete a 1000-Word Essay How to Complete a 1000-Word Essay For some students, the number 1000 may seem quite frightening and impressive, and the assignment of a 1000-word essay can sound impossible to complete. However, we can assure you that there is nothing difficult and you can easily master the task simply by following a few rules. If you want to know more about such an essay, you should first know how much time you will need. Unfortunately, we don’t have a clear answer, as every topic and subject differs, and you may need a different amount of time and energy depending on your mood and aspirations. You may be so inspired that it will only take you a day to write a 1000-word essay on a topic you are interested in or you may require a month just to find necessary information. The main advice here is to always make one step further. Even if you feel like you are not in the mood or don’t know where to start, just keep going. You may need a bit more time to get started or to find necessary sources to start writing your essay. If you feel like you are about to drop everything, take a break, meet friends or grab a coffee to brighten your day and get fresh ideas. Useful tips on writing a 1000-word essay Select a proper topic. Most of the times, students should select a topic on their own and it is a big plus, as you can find the most suitable subject to discuss. However, you may find it challenging if you don’t know what your interests are. In such a case, you can select a topic, which has a lot of free materials and credible sources online. This will help you to collect the material and back your thoughts on academic data. However, try to choose a topic without an emotional involvement and subjectivity; Create an outline. Every paper should have a sort of a skeleton, which will make it much easier to write a 1000-word or any other essay. There are many websites and articles, which provide samples and outlines of such essays to give you a general idea about how to build your paper. Just follow their recommendations and you will find it very easy to complete a great essay; Don’t forget about the structure. As almost any other written assignment, your 1000-word essay should consist of such parts, as introduction, body and conclusions. The first section gives general information on the topic, catching interest of the audience and engaging the reader. The body paragraph is the biggest part of the whole paper and it states all your thoughts on the subject, backed with various arguments and facts. In conclusions you need to sum everything up, concentrating on the obtained results and making predictions for the future. Of course, this structure may differ depending on your topic, so you can search ‘100-word essay samples’ online and choose the one, which is similar to yours; Write an original essay. It may sound obvious but too many students neglect this simple rule, trying to download ready papers. On one hand, it may be a simple way out but it won’t contribute to your grades and definitely won’t help the future of the topic. Who knows, maybe your generated ideas will be so brilliant that they will change the industry? Believe in yourself and try to work on the subject on your own, avoiding temptation of downloading a ready paper. Once you have followed all these rules and created a proper structure, you will find it very simple to complete a 1000-word essay. The only question will be how to limit your original and fresh ideas to 1000 words.

Case study-Southwest Airlines Essay Example | Topics and Well Written Essays - 1250 words

Case study-Southwest Airlines - Essay Example It is a lucid fact that only a satisfied employee can have organizational commitment. ‘Organizational commitment’ is an attitude of an individual with a strong desire to remain a member of a particular organization with willingness to exert high levels of effort on behalf of the organization, accepting the values and goals of the organization. Incidentally, Organizational commitment can be expected only from a satisfied worker and a satisfied worker is always a motivated worker. If there is no conflict between group goals and personal goals of a member in a group, i.e. goals of an employee and an organization in which he/she works are complementary and not contradictory, then the employee is motivated to work for the goals of the company, because, by doing so, he will be achieving his own personal goals. Thus, success of an organization like Southwest Airlines has been on account of the apt application of the various concepts of organizational behaviour like Motivation, Decision Making, Group Behavior, Communication, Power and Politics, Organizational Structure, Organizational Culture, Human Resources Practices and Change Management. These core concepts of Management in Southwest Airlines have been elaborated in this study. Research proves that a motivated and productive employee experiences meaningfulness of the work done, experiences responsibility for the outcome of the work done and has high levels of knowledge of the results of the work performed (Hackman, 1976). Motivation is the core of management. The employee benefits in this organization are designed to balance the dissatisfiers and enhance the motivational factors as described by Herzberg (Fredrick Herzberg, 1959). One of the special benefits offered to employees working at Southwest is flying free effective from the first day of employment. Employees, spouses, eligible dependent children, and parents of Employees have unlimited

Should the EU be involved in a battle against the piracy problem in Essay

Should the EU be involved in a battle against the piracy problem in Somalia - Essay Example Even though only a political settlement in Somalia can bring a long-term resolution to this issue, the measures taken by the international community can significantly improve the situation (Middleton 10). The European Union Naval Force Somalia-Operation ATALANTA, launched by the European Council on the 8 of December 2008, aims to deter, prevent and repress acts of piracy and armed robbery off the Somali coast, and is a part of the global action conducted by the EU to deal with the Somali crisis (â€Å"Mission† 1). This operation has several benefits both for Somalia and for international entities affected by the issue of piracy. To start with, operation ATALANTA helps to protect vessels of the World Food Programme (WFP), which deliver food aid to displaced people in Somalia. Since the EU naval escorts for WFP ships began in November 2007, not a single pirate attack on a ship carrying WFP food has been reported. Under the operation ATALANTA, WFP has managed to deliver over 267. 000 metric tons of food to ports in Somalia. Given the increasing need for humanitarian assistance in Somalia, the EU operation contributes significantly to support for numerous victims of the Somali crisis (â€Å"Mission† 3). Moreover, operation ATALANTA protects vulnerable vessels in the Gulf of Aden and off the Somali cost. All shipping companies and operators that transit in this region have to register in advance of the website of the Maritime Security Center-Horn of Africa (MSC-HOA). This website facilitates the coordination of maritime traffic as it enables all vessels that observe EU NAVFOR recommendations to be aware of the arrangements taken. MSC-HOA also identifies particularly vulnerable vessels and provides them with close military protection, either from EU NAVOR, or other forces in the region (â€Å"Mschoa† 1). These arrangements significantly reduce the risks of pirate attacks or

Hinduism and Buddism Research Paper Example | Topics and Well Written Essays - 1000 words

Hinduism and Buddism - Research Paper Example The prayers are confirmed by marking Tikka, i.e., a red mark of vermilion on the foreheads. The goal of the narrator as a Hindu is to illuminate ignorance and become more spiritual. Discussion Questions 1. What cuisines are traditionally prepared at Diwali? 2. Why is Diwali celebrated at the end of year? 3. How many days does Dilwali continue for? 4. Is celebration of Diwali a means of spiritual revival for the Hindus? 5. How different is the celebration of Diwali between India and elsewhere? Strengths and Weaknesses a. I think that the video presented the topic well as whatever the narrator says, the video displays images with that. For example, when the narrator says that everybody gets into the prayer room, the video shows everybody assembling in it. Likewise, the coins are shown being washed in milk and being applied vermilion upon as the narrator explains what is happening. In addition to that, the accent and dialect of the narrator is such that each and every word is understand able. Secondly, the audience gets the complete concept of the Festival of Diwali as well as the underlying beliefs of the Hindus related to this event in a video of just 2 minutes and 4 seconds. Not only this, the video explains that the concept of gods in Hinduism is like a board of members, so that the audience does not get confused when the video shows the family first worshipping Lord Ganesha and then the Goddess Laxmi. b. It is a good video to show to those who do not know what is Diwali because it explains the concept of Diwali, shows a family praying upon and celebrating Diwali, discusses the significance of different gods and goddesses in Hinduism, and explains the reason Hindus illuminate their homes at this Festival. c. I had to do some further research to understand Diwali as this video did not discuss everything related to Diwali. One weakness of the video is that it only projects the perspective of the narrator. It would have been better if different family members were invited to express what meanings they associate with the event, though considering the time constraints, it seems justified. d. This video is useful for students and people belonging to all categories as all people in the video are dressed modestly, and there is no offence whatsoever. e. This video shows how Hindus get united at the Festival of Diwali and pray and celebrate it together. This spreads the message of tolerance, unity, and mutual harmony and understanding. Video II Video Summary This video covers Buddhism. The video shows paintings of the 500 disciples of Buddha in the North East India from the V century. In Sanskrit, they are called as Arhats. These disciples were intercessors and messengers of Buddhism. The idea was that they were enlightened while living among common people. These 100 paintings were compiled between 1854 and 1863. The paintings were intended to project Buddhist catechism. The essence of Buddhism is that materialistic world is deceptive and everythin g is in transition. The paintings depict the everyday lifestyle of the Buddhist disciples, their comfortable interaction with people as well as animals, and present a holistic picture of their culture. The paintings show everything from murder, wars, suicides, and fire breakouts to daily activities of the Arhats in a peaceful environment. Discussion Questions 1. What was the

Hack man and old hams Job Characteristic model

Hack man and old hams Job Characteristic model (JCM) has been used extensively for a long time as a outline to understanding five key charachteristics to promote satidfaction and motivation within a work place. These five factors are skill variety, taks identity, task significance autonomy and feedback from the job (Hackman and Oldham 1976) these characteristics in turn promote psychological states experience of meaningfulness, experience of outcome responsibility, and knowledge of results of work (Hackman and Oldham 1976). These states subsequently effect the outcomes; work motivation, performance, satisfaction within the work, low absenteeism, and turnover (Hackman and Oldham 1976). Hackman and Oldham proposed that when these five job characteristics and the work outcomes are combined to find motivating potential score (MVS), which can then be used measure the job will affect employees satisfaction, behavior , and desire to grow within their job. This theory was used as a framework for many years, generating a great deal of research. As a whole the JCM does maintain the prediction that when a worker is motivated, satisfied , and their performance is high, they see their job as high within The five key job characteristics, and mediates a more positive physical state. (Fried and Ferris 1986). However the JCM comes under scrutiny, due to the distinctiveness of the five job characteristics that it uses, it doesnt approach the job with the certainty that it can be changed. Within the five core characteristics Hackman and Oldham (1967) failed to recognize important features within a work place such as the social envirmonment and work context (Humphreys et al 2007) One of the limitations to the JCM that needed looking into more detail was the mediation of critical psychological states(CPS). Fried and Ferris (1987) found that although the JCM has stimulated over 250 published studies, only eight of these studies included the CPS. Hackman and Oldham originally stated that the CPS would each separately act as mediators, however Oldham(1996) later corrected this by stating that the true mediation model is different. Johns et al (1992) also backed this statement in their earlier research suggesting that experienced meaning was a particularly encompassing psychological state and it served as a mediator for all five motivational characteristics (Johns et al 1992 in Humphrey et al 2007 )Johns et al (1992) was not suggesting that the other states should be taken out but each contributes in their own way to the mediation development. Since Hackmans and Oldhams (1976) theory, other researchers have expanded on the JCM, as although it was evolutionary in expanding the understanding of occupational psychology it was also very limited. Humphreys (2007) meta analysis is a good example of this, as it has found enchanced characteristics than the initial core five that Hackman and Oldham (1976) came up with. One of the first important factors accounting for motivation which was stated earlier the social environment and work context (Humphrey et al 2007) both incrementally predicted enchanced motivation and positive behavior better than the original five core characteristics. Humohrey expanded on the importance of social environment, observing that social characteristics are extremely important factors to promote a positive environment at work motivational qualities, well beingness, and how meaningful the work is to the employee( Myers 1999). Because these characteristics reduce the likeliness of negative events happening at the work place, they therefore reduce the job stress on the employee. These are extremely imrotant factors in promoting occuopational health as Adler anKwon (2002 in Humphrey et al 2007 ) found that they also increase motivation and prosocial work behavior, promoting resilence, security , and positive moos on the job. When redesigning jobs, consultants might look at social characteristics such as organized team work, which promotes interdependence between associates. Furthermore interdependence offers social support and a network of co workers and supervisors to assist fellow employees and offer support when needed. This network of support also offers role identity and deal with concerns they have More generally working in a team just sustains the opportunity for social interaction, researchers have now started to emphasize the significance of team work and interdependence (Arthur, Edwards, Bell, Villado Bennet 2005). This also helps to clarify which roles the particular person fills. Which in turn allows for feedback to enhance perception of the individuals responsibility within a role . Biddle (1979 in Humphreys et al 2007) emphasized that social characteristics should improve and develop role awareness as employees roles become more evident with more contact with other people. Furthermore soci al characteristics enable interections between employees allowing them to learn from one another and gain valuable experience, that can only be sought from face to face interactions. This facilitates the employees to transfer implicit and explicit knowledge, so they can perform more effectively (Humphreys 2007). If employees find the social environment they work in to pbe a positive atmosphere and somewhere they like to work then there will be reduced absenteeism, and will want to carry on working for their employer or organization. Additionally as part of being in a group or team, jobs often require leadership, and group leadership ivolves teams with assorted skills from different division of an organization sucha s cross funsctional teams. Team work envolves sharing leadership roles, or envoles rotating different leaders, allowing team members to gain more experience and elevate power (Bens 2006)   Following this Humphreys et al (2007) found that work context actually accounts for more varience than social environment, Humphreys et al (2007) specifically looked at three work context characteristics these are physical demands, work conditions, and ergonomics. Physical demands indicate the actual amount of physical exertion or activity is required for the job This also looks at how much stamina, patience and activity one has to do with the job and if it is satisfactory for the individual. work conditions examines the physical environment that the employees work in, such as ; health hazards, temperature and noise (Edwards Scully and Brtek 1999). Ergonomics shows if the work allow for travel, stance and movement. All three of these characteristics take into account how the job is designed in terms of biological concerns(Campion 1988). If these three characteristics dont work in synergyand complement each other then the job will be physically unpleasant, and the employees will not find working there to be a positive experience, and absentee levels will rise. Following Hackman and Oldhams theory,. Humphreys meta analysis has allowed us to pinpoint specific out comes, and see where more research needs to take place in order to throuroughly and successfully redesign jobs to promote better health. However it also highlights gaps in research, still the outcomes are unknown and a gnereic model cannot always be used due to individual characteristics, it can only be used to pinpoint specific relationships. Bond and Bunce (2001)s longitudinal study, was a quasi experiment measured job stressers and strain using the occupational stress indicatior, job control, self rated performance and sickness absence, with participants that were particularly stressed within middle management employees working for a government minister, and a very strict control group. A Parcipitative action research program (PAR) was put in place to reduce the employees amount of stress. On the basis of Bond and Bunce (2001) findings , the comitee involved decided to develop proposals and action plans to increase workers jobcontrol over three problem areas: assignment distribution procedures, within-unit consultation and communication, and informal performance feedback(Bond and Bunce 2001). Subsequently in agreement with PAR the committee offered everyone in the different units a chance to give their opinion, and discuss the changes that they would like to improve the occupational health within the company, before the stratagies were finalized. And each Par unit had to meet specific goals set by the committee. The study found that giving the individual some power by being involved in the job redesign gives the indiviaul more job satisfaction. Furthermore it was the longitudinal and quasi experiment to prove that a work restructuring interventeion can reduce stress in the work place and mental health (Bond and Bunce 2001). However there are some problems with this experiment as it lack generalizability due to its common source bias, as the study has asked the individual and it is self report,a job analysis may have beena a better option when redesigning the work place as the results can be generalized more easily. However Bond and Bunces (2001) study is extremely interesting and shows progression in occupational health psychology. In conclusion Hackman and Oldhams (1967) study was very influential in occupational health psychology, and although now it can be criticised greatly for its limitations it is a framework that has just been improved upon time after time, promotiong mediation in job redesign throughout all occupations to make it more positive for the employee.  · ^ Ingrid Bens (2006). Facilitating to Lead. Jossey-Bass.  

Free Essays On Shakespeares Sonnet 65 :: Sonnet essays

Analysis of Sonnet 65 Since brass, nor stone, nor earth, nor boundless sea, But sad mortality o'ersways their power, How with this rage shall beauty hold a plea, Whose action is no stronger than a flower? Oh how shall summer's honey breath hold out Against the wrackful siege of battering days, When rocks impregnable are not so stout Nor gates of steel so strong but time decays? Oh fearful meditation! where, alack, Shall Time's best jewel from Time's chest lie hid? Or what strong hand can hold his swift foot back? Or who his spoil of beauty can forbid? Oh none, unless this miracle have might- That in black ink my love may still shine bright. This sonnet shares several similarities in imagery as sonnets 63 and 66, and also to the theme of time and Rome as seen in Spencer's translatory sonnet sequence, _Ruins of Rome by: Bellay_. To best understand this sonnet we must realize to what or whom the pronouns refer to. My explication relies on "their" in line 2 referring to both time and ruin, a theme sustained from sonnet 64. 1-2: 'Only depressing mortality can overturn the tyranny of time and ruin, considering that brass, stone, earth or sea cannot prevent it'. Thus, death is an escape from time and the ruin which it imposes. The second quatrain is reminiscent of the thematic imagery of Rome's susception to time in sonnet 9 of _Ruines of Rome_: "Why were not these Romane palaces / Made of some matter no lesse fime and strong? . . . All things which beneath the Moone haue being / Are temporall, and subject to decay." Echoing the elements in the first line of the sonnet, Shakespeare is iterating the inability to avoid and preve nt time. "Battering days" also shares this imagery as "Time's injurious hand crush'd"; which, to note further, appears as "iniurious time" in Spencer's work. Knowing this, he appeals to dreadful and injurious knowledge in line 9: 'where should we hide time's most precious jewel [our youth] from the vault it is held in'. the reason I believe the jewel to be a symbol of youth stems from sonnet 63, in which time steals "away the treasure of his spring." Spring here, and in many other sonnets of Shakespeare, refers to youth and sexual prime.

Introduction to Epidemiology

Aug 17 2011 Introduction to Epidemiology Epidemiology is considered the basic science of public health, and with good reason. Epidemiology is: †¢ †¢ †¢ A quantitative basic science built on a working knowledge of probability, statistics, and sound research methodology A method of causal reasoning based on developing and testing hypotheses pertaining to occurrence and prevention of morbidity and mortality A tool for public health action to promote and protect the public’s health based on science, causal reasoning, and a dose of practical common sense (2).As a public health discipline, epidemiology is instilled with the spirit that epidemiologic information should be used to promote and protect the public’s health. Hence, epidemiology involves both science and public health practice. The term applied epidemiology is sometimes used to describe the application or practice of epidemiology to address public health issues.Examples of applied epidemiology include the following: †¢ †¢ †¢ †¢ the monitoring of reports of communicable diseases in the community the study of whether a particular dietary component influences your risk of developing cancer evaluation of the effectiveness and impact of a cholesterol awareness program analysis of historical trends and current data to project future public health resource needs ObjectivesAfter studying this document and answering the questions in the exercises, you should be able to do the following: †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ Define epidemiology Summarize the historical evolution of epidemiology Describe the elements of a case definition and state the effect of changing the value of any of the elements List the key features and uses of descriptive epidemiology List the key features and uses of analytic epidemiology List the three components of the epidemiologic triad List and describe Hill’s criteria of causation Understand the natural history of disease and the three types of prevention Understand infectivity, pathogenicity, and virulence List and describe primary applications of epidemiology in public health practice List and describe the different modes of transmission of communicable disease in a population 1 Page 2 Applied Epidemiology I A number of exercises are provided. It is suggested you attempt to answer these questions and then compare your answers with those at the end of this document. Introduction The word epidemiology comes from the Greek words epi, meaning â€Å"on or upon,† demos, meaning â€Å"people,† and logos, meaning â€Å"the study of. Many definitions have been proposed, but the following definition captures the underlying principles and the public health spirit of epidemiology: â€Å"Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the cont rol of health problems. † (17) Key terms in this definition reflect some of the important principles of epidemiology. Study Epidemiology is a scientific discipline with sound methods of scientific inquiry at its foundation. Epidemiology is data-driven and relies on a systematic and unbiased approach to the collection, analysis, and interpretation of data.Basic epidemiologic methods tend to rely on careful observation and use of valid comparison groups to assess whether what was observed, such as the number of cases of disease in a particular area during a particular time period or the frequency of an exposure among persons with disease, differs from what might be expected. However, epidemiology also draws on methods from other scientific fields, including biostatistics and informatics, with biologic, economic, social, and behavioral sciences. In fact, epidemiology is often described as the basic science of public health, and for good reason. First, epidemiology is a quantitati ve discipline that relies on a working knowledge of probability, statistics, and sound research methods.Second, epidemiology is a method of causal reasoning based on developing and testing hypotheses grounded in such scientific fields as biology, behavioral sciences, physics, and ergonomics to explain health-related behaviors, states, and events. However, epidemiology is not just a research activity but an integral component of public health, providing the foundation for directing practical and appropriate public health action based on this science and causal reasoning. Determinants Epidemiology is also used to search for determinants, which are the causes and other factors that influence the occurrence of disease and other health-related events.Epidemiologists assume that illness does not occur randomly in a population, but happens only when the right accumulation of risk factors or determinants exists in an individual. To search for these determinants, epidemiologists use analytic epidemiology or epidemiologic studies to provide the â€Å"Why† and â€Å"How† of such events. They assess whether groups with different rates of disease differ in their demographic characteristics, genetic or immunologic make-up, behaviors, environmental exposures, or other so-called potential risk factors. Ideally, the findings provide sufficient evidence to direct prompt and effective public health control and prevention measures. Health-related states or eventsEpidemiology was originally focused exclusively on epidemics of communicable diseases3 but was subsequently expanded to address endemic communicable diseases and non-communicable infectious diseases. By the middle of the 20th Century, additional epidemiologic methods had been developed and applied to chronic diseases, injuries, birth defects, maternal-child health, occupational health, and environmental health. Then epidemiologists began to look at behaviors related to health and well-being, such as amount o f exercise and seat belt use. Now, with the recent explosion in molecular methods, Introduction to Epidemiology – Epi 592J Page 3 epidemiologists can make important strides in examining genetic markers of disease risk.Indeed, the term health related states or events may be seen as anything that affects the well-being of a population. Nonetheless, many epidemiologists still use the term â€Å"disease† as shorthand for the wide range of healthrelated states and events that are studied. Specified populations Although epidemiologists and direct health-care providers (clinicians) are both concerned with occurrence and control of disease, they differ greatly in how they view â€Å"the patient. † The clinician is concerned about the health of an individual; the epidemiologist is concerned about the collective health of the people in a community or population. In other words, the clinician’s â€Å"patient† is the individual; the epidemiologist’s â⠂¬Å"patient† is the community.Therefore, the clinician and the epidemiologist have different responsibilities when faced with a person with illness. For example, when a patient with diarrheal disease presents, both are interested in establishing the correct diagnosis. However, while the clinician usually focuses on treating and caring for the individual, the epidemiologist focuses on identifying the exposure or source that caused the illness; the number of other persons who may have been similarly exposed; the potential for further spread in the community; and interventions to prevent additional cases or recurrences. Application Epidemiology is not just â€Å"the study of† health in a population; it also involves applying the knowledge gained by the studies to community-based practice.Like the practice of medicine, the practice of epidemiology is both a science and an art. To make the proper diagnosis and prescribe appropriate treatment for a patient, the clinician comb ines medical (scientific) knowledge with experience, clinical judgment, and understanding of the patient. Similarly, the epidemiologist uses the scientific methods of descriptive and analytic epidemiology as well as experience, epidemiologic judgment, and understanding of local conditions in â€Å"diagnosing† the health of a community and proposing appropriate, practical, and acceptable public health interventions to control and prevent disease in the community. SummaryEpidemiology is the study (scientific, systematic, data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (patient is community, individuals viewed collectively), and the application of (since epidemiology is a discipline within public health) this study to the control of health problems. Evolution Although epidemiologic thinking has been traced from Hippocrates (circa 400 B. C. ) through Grau nt (1662), Farr, Snow (both mid-1800’s), and others, the discipline did not blossom until the end of the Second World War. The contributions of some of these early and more recent thinkers are described next. Hippocrates (circa 400 B. C. ) attempted to explain disease occurrence from a rational instead of a supernatural viewpoint. In his essay entitled â€Å"On Airs, Waters, and Places,† Hippocrates suggested that environmental and host factors such as behaviors might influence the development of disease.Another early contributor to epidemiology was John Graunt, a London haberdasher who published his landmark analysis of mortality data in 1662. He was the first to quantify patterns of birth, death, and disease occurrence, noting male-female disparities, high infant mortality, urban-rural differences, and seasonal variations. No one built upon Graunt’s work until the mid-1800, when William Farr began to systematically collect and analyze Britain’s mortalit y statistics. Farr, considered the father of modern vital statistics and disease surveillance, developed many of the basic practices used today in vital statistics and disease classification. He extended the epidemiologic analysis of morbidity and mortality data, looking at Page 4 Applied Epidemiology I he effects of marital status, occupation, and altitude. He also developed many epidemiologic concepts and techniques still in use today. Meanwhile, an anesthesiologist named John Snow was conducting a series of investigations in London that later earned him the title â€Å"the father of epidemiology. † Twenty years before the development of the microscope, Snow conducted studies of cholera outbreaks both to discover the cause of the disease and to prevent its recurrence. Because his work classically illustrates the sequence from descriptive epidemiology to hypothesis generation to hypothesis testing (analytic epidemiology) to application, we will consider two of his efforts.It is important to mention that at the time of John Snow’s investigations the most widely accepted cause of diseases, including cholera, was due to miasma, or foul air. Therefore most believed that cholera was transmitted by air, especially foul-smelling air near water. The germ theory, that disease was transmitted by microbes, did not gain acceptance until later in the 1800s. Snow conducted his classic study in 1854 when an epidemic of cholera developed in the Golden Square of London. He began his investigation by determining where in this area persons with cholera lived and worked. He then used this information to map the distribution of cases on what epidemiologists call a spot map. His map is shown in Figure 1. 1.Because Snow believed that water was a source of infection for cholera, he marked the location of water pumps on his spot map, and then looked for a relationship between the distribution of cholera case households and the location of pumps. He noticed that more cas e households clustered around certain pumps, especially the Broad Street pump, and he concluded that the Broad Street pump was the most likely source of infection. Questioning residents who lived near the other pumps, he found that they avoided certain pumps because the water they provided was grossly contaminated, and that other pumps were located too inconveniently for most residents of the Golden Square area.From this information, it appeared to Snow that the Broad Street pump was probably the primary source of water for most persons with cholera in the Golden Square area. He realized, however, that it was too soon to draw that conclusion because the map showed no cholera cases in a two-block area to the east of the Broad Street pump. Perhaps no one lived in that area, or perhaps the residents were somehow protected. Upon investigating, Snow found that a brewery was located there and that it had a deep well on the premises where brewery workers, who also lived in the area, got th eir water. In addition, the brewery allotted workers a daily quota of malt liquor. Access to these uncontaminated rations could explain why none of the brewery’s employees contracted cholera.To provide further evidence that the Broad Street pump was the source of the epidemic, Snow gathered information on where persons with cholera had obtained their water. Consumption of water from the Broad Street pump was the one common factor among the cholera patients. According to legend, Snow removed the handle of the Broad Street pump and aborted the outbreak. Snow’s second major contribution involved another investigation of the same outbreak of cholera that occurred in London in 1854. In a London epidemic in 1849, Snow had noted that districts with the highest mortalities had water supplied by two companies: the Lambeth Company and the Southwark and Vauxhall Company. At that time, both companies obtained water from the Thames River, at intake points downstream of London.In 18 52, the Lambeth Company moved their water works upstream from London, thus obtaining water free of London sewage. When cholera returned to London in 1853, Snow realized the Lambeth Company’s relocation of its intake point would allow him to compare districts that were supplied with water upstream from London with districts that received water downstream from London. Table 1. 1 shows what Snow found when he made that comparison for cholera mortality over a 7-week period during the summer of 1854. Introduction to Epidemiology – Epi 592J Page 5 Figure 1. 1 Distribution of cholera cases in the Golden Square area of London, August-September 1854 Table 1. Mortality from cholera in the districts of London supplied by the Southwark and Vauxhall and the Lambeth Companies, July 9-August 26, 1854 Districts with Water Supplied by Population Deaths from Mortality Risk per (1851 Census) Cholera 1,000 Population 167,654 844 5. 0 Southwark and Vauxhall Co. only Lambeth Co. only Both c ompanies Source: 27 19,133 300,149 18 652 0. 9 2. 2 Page 6 Applied Epidemiology I The data in Table 1. 1 show that the risk of death from cholera was more than 5 times higher in districts served only by the Southwark and Vauxhall Company than in those served only by the Lambeth Company. Interestingly, the mortality risks in districts supplied by both companies fell between the risks for districts served exclusively by either company.These data were consistent with the hypothesis that water obtained from the Thames below London was a source of cholera. Alternatively, the populations supplied by the two companies may have differed on a number of other factors which affected their risk of cholera. To test his water supply hypothesis, Snow focused on the districts served by both companies, because the households within a district were generally comparable except for which company supplied water. In these districts, Snow identified the water supply company for every house in which a deat h from cholera had occurred during the 7-week period. Table 1. 2 shows his findings. Table 1. Mortality from cholera in London related to the water supply of individual houses in districts served by both the Southwark and Vauxhall Company and the Lambeth Company, July 9August 26, 1854 Water Supply of Individual House Population Deaths from Mortality risk per (1851 Census) Cholera 1,000 Population Southwark and Vauxhall Co. 98,862 419 4. 2 Lambeth Co. Source: 27 154,615 80 0. 5 This further study added support to Snow’s hypothesis, and demonstrates the sequence of steps used today to investigate outbreaks of disease. Based on a characterization of the cases and population at risk by time, place, and person, Snow developed a testable hypothesis. He then tested this hypothesis with a more rigorously designed study, ensuring that the groups to be compared were comparable. After this study, efforts to control the epidemic were directed at changing the location of the water intake of the Southwark and Vauxhall Company to reduce sources of contamination.Thus, with no knowledge of the existence of microorganisms, Snow demonstrated through epidemiologic studies that water could serve as a vehicle for transmitting cholera and that epidemiologic information could be used to direct prompt and appropriate public health action. More information on John Snow can be found at: www. ph. ucla. edu/epi/snow. html In the mid- and late-1800’s, many others in Europe and the United States began to apply epidemiologic methods to investigate disease occurrence. At that time, most investigators focused on acute infectious diseases. In the 1900’s, epidemiologists extended their methods to noninfectious diseases.The period since the Second World War has seen an explosion in the development of research methods and the theoretical underpinnings of epidemiology, and in the application of epidemiology to the entire range of health-related outcomes, behaviors, and even kno wledge and attitudes. The studies by Doll and Hill (13) linking smoking to lung cancer and the study of cardiovascular disease among residents of Framingham, Massachusetts (12), are two examples of how pioneering researchers have applied epidemiologic methods to chronic disease since World War II. Finally, during the 1960’s and early 1970’s health workers applied epidemiologic methods to eradicate smallpox worldwide.This was an achievement in applied epidemiology of unprecedented proportions. Today, public health workers throughout the world accept and use epidemiology routinely. Epidemiology is often practiced or used by non-epidemiologists to characterize the health of their communities and to solve day-to-day problems. This landmark in the evolution of the discipline is less dramatic than the eradication of smallpox, but it is no less important in improving the health of people everywhere. Introduction to Epidemiology – Epi 592J Page 7 Uses Epidemiology and t he information generated by epidemiologic methods have many uses. These uses are categorized and described below. Population or community health assessment.To set policy and plan programs, public health officials must assess the health of the population or community they serve and determine whether health services are available, accessible, effective, and efficient. To do this, they must find answers to many questions: What are the actual and potential health problems in the community? Where are they? Who is at risk? Which problems are declining over time? Which ones are increasing or have the potential to increase? How do these patterns relate to the level and distribution of services available? The methods of descriptive and analytic epidemiology provide ways to answer these and other questions.With answers provided through the application of epidemiology, the officials can make informed decisions that will lead to improved health for the population they serve. Individual decision s. People may not realize that they use epidemiologic information in their daily decisions. When they decide to stop smoking, take the stairs instead of the elevator, order a salad instead of a cheeseburger with French fries, or choose one method of contraception instead of another, they may be influenced, consciously or unconsciously, by epidemiologists’ assessment of risk. Since World War II, epidemiologists have provided information related to all those decisions.In the 1950’s, epidemiologists documented the increased risk of lung cancer among smokers; in the 1960’s and 1970’s, epidemiologists noted a variety of benefits and risks associated with different methods of birth control; in the mid-1980’s, epidemiologists identified the increased risk of human immunodeficiency virus (HIV) infection associated with certain sexual and drug-related behaviors; and, more positively, epidemiologists continue to document the role of exercise and proper diet in reducing the risk of heart disease. These and hundreds of other epidemiologic findings are directly relevant to the choices that people make every day, choices that affect their health over a lifetime. Completing the clinical picture. When studying a disease outbreak, epidemiologists depend on clinical physicians and laboratory scientists for the proper diagnosis of individual patients.But epidemiologists also contribute to physicians’ understanding of the clinical picture and natural history of disease. For example, in late 1989 three patients in New Mexico were diagnosed as having myalgias (severe muscle pains in chest or abdomen) and unexplained eosinophilia (an increase in the number of one type of white blood cell). Their physicians could not identify the cause of their symptoms, or put a name to the disorder. Epidemiologists began looking for other cases with similar symptoms, and within weeks had found enough additional cases of eosinophilia-myalgia syndrome (EMS) t o describe the illness, its complications, and its risk of mortality.Similarly, epidemiologists have documented the course of HIV infection, from the initial exposure to the development of a wide variety of clinical syndromes that include acquired immunodeficiency syndrome (AIDS). They have also documented the numerous conditions associated with cigarette smoking—from pulmonary and heart disease to lung and cervical cancer. Search for causes. Much of epidemiologic research is devoted to a search for causes, factors which influence one’s risk of disease. Sometimes this is an academic pursuit, but more often the goal is to identify a cause so that appropriate public health action might be taken. It has been said that epidemiology can never prove a causal relationship between an exposure and a disease. Nevertheless, epidemiology often provides enough information to support effective action.Examples include John Snow’s removal of the pump handle and the withdrawal o f a specific brand of tampon that was linked by epidemiologists to toxic shock syndrome. Another example is the recommendation that children not be given aspirin due to its association with Reye syndrome. Just as often, epidemiology and laboratory science converge to provide the evidence needed to establish causation. For example, a team of epidemiologists were able to identify a variety of risk factors during an outbreak of pneumonia among persons attending the American Page 8 Applied Epidemiology I Legion Convention in Philadelphia in 1976, called â€Å"Legionnaire’s disease. However, the outbreak was not â€Å"solved† until the Legionnaires’ bacillus was identified in the laboratory almost 6 months later. Disease control, elimination, and eradication. The ultimate goal of epidemiology is to improve the health of populations and through the reduction in disease. The definitions of disease control, elimination, and eradication as applied to infectious diseases are given below. (Dowdle WR. The principles of disease elimination and eradication. MMWR 48(SU01);23-7, 1999. ): Control: The reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction. Example: diarrheal diseases.Elimination of disease: Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts; continued intervention measures are required. Examples: neonatal tetanus. Elimination of infections: Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts; continued measures to prevent reestablishment of transmission are required. Example: measles, poliomyelitis. Eradication: Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate effor ts; intervention measures are no longer needed. Example: smallpox.Extinction: The specific infectious agent no longer exists in nature or in the laboratory. Example: none. The above definitions are specific to infectious disease, but some of the concepts can carry over to other conditions, such as nutritional disorders, inborn errors of metabolism, and chronic diseases. Introduction to Epidemiology – Epi 592J Page 9 Exercise 1. 1 In the early 1980’s, epidemiologists recognized that AIDS occurred most frequently in men who had sex with men and in intravenous drug users. Describe how this information might be used for each of the following: a. Population or community health assessment b. Individual decisions c. Search for causes Page 10 Applied Epidemiology I The Epidemiologic ApproachLike a newspaper reporter, an epidemiologist determines What, When, Where, Who, and Why. However, the epidemiologist is more likely to describe these concepts in slightly different terms: c ase definition, time, place, person, and causes. Case Definition (â€Å"What? †) The identification of disease can be based on symptoms, signs, and diagnostic tests. A symptom is a sensation or change in health experienced by an individual. Examples of symptoms reported by an individual are a cough, fatigue, anxiety, and back pain. Signs, or signs of disease, are an objective evidence of disease observed by someone other than the affected individual, such as a physician or nurse.A case definition is a set of standard criteria for deciding whether a person has a particular disease or other health-related condition. By using a standard case definition we attempt to ensure that every case is diagnosed in the same way, regardless of when or where it occurred, or who identified it. We can then compare the number of cases of the disease that occurred in one time or place with the number that occurred at another time or another place. For example, with a standard case definition, we can compare the number of cases of hepatitis A that occurred in New York City in 1991 with the number that occurred there in 1990. Or we can compare the number of cases that occurred in New York in 1991 with the number that occurred in San Francisco in 1991. With a standard ase definition, when we find a difference in disease occurrence, we know it is likely to be due to a real difference or due to the quality of the disease reporting system rather than the result of differences in how cases were diagnosed. A case definition consists of clinical criteria and, sometimes, limitations on time, place, and person. The clinical criteria usually include confirmatory laboratory tests, if available, or combinations of symptoms (subjective complaints), signs (objective physical findings), and other findings. For example, see the case definition for rabies below; notice that it requires laboratory confirmation. Rabies, Human Clinical description Rabies is an acute encephalomyelitis that almos t always progresses to coma or death within 10 days of the first symptom.Laboratory criteria for diagnosis †¢ Detection by direct fluorescent antibody of viral antigens in a clinical specimen (preferably the brain or the nerves surrounding hair follicles in the nape of the neck), or †¢ Isolation (in cell culture or in a laboratory animal) of rabies virus from saliva, cerebrospinal fluid (CSF), or central nervous system tissue, or †¢ Identification of a rabies-neutralizing antibody titer greater than or equal to 5 (complete neutralization) in the serum or CSF of an unvaccinated person Case classification Confirmed: a clinically compatible illness that is laboratory confirmed Comment Laboratory confirmation by all of the above methods is strongly recommended. Source: 3 Compare this with the case definition for Kawasaki syndrome provided in Exercise 1. 3 on page 12. Kawasaki syndrome is a childhood illness with fever and rash that has no known cause and no specifically d istinctive laboratory findings.Notice that its case definition is based on the presence of fever, at least four of five specified clinical findings, and the lack of a more reasonable explanation. A case definition may have several sets of criteria, depending on the certainty of the diagnosis. For example, during an outbreak of measles, we might classify a person with a fever and rash as having a Introduction to Epidemiology – Epi 592J Page 11 suspect, probable, or confirmed case of measles, depending on what additional evidence of measles was present. In other situations, we may temporarily classify a case as suspect or probable until laboratory results are available. When we receive the laboratory report, we then reclassify the case as either confirmed or â€Å"not a case,† depending on the lab results.In the midst of a large outbreak of a disease caused by a known agent, we may permanently classify some cases as suspect or probable, because it is unnecessary and wast eful to run laboratory tests on every individual with a consistent clinical picture and a history of exposure (e. g. , chickenpox). Case definitions may also vary according to the purpose for classifying the occurrences of a disease. For example, health officials need to know as soon as possible if anyone has symptoms of plague or foodborne botulism so that they can begin planning what actions to take. For such rare but potentially severe diseases, where it is important to identify every possible case, health officials use a sensitive, or â€Å"loose† case definition.On the other hand, investigators of the causes of a disease outbreak want to be certain that any person included in the investigation really had the disease. The investigator will prefer a specific or â€Å"strict† case definition. For instance, in an outbreak of Salmonella agona, the investigators would be more likely to identify the source of the infection if they included only persons who were confirmed to have been infected with that organism, rather than including anyone with acute diarrhea, because some persons may have had diarrhea from a different cause. In this setting, a disadvantage of a strict case definition is an underestimate of the total number of cases. Exercise 1. 2In the case definition for an apparent outbreak of trichinosis, investigators used the following classifications: Clinical criteria Confirmed case: signs and symptoms plus laboratory confirmation Probable case: acute onset of at least three of the following four features: myalgia, fever, facial edema, or eosinophil count greater than 500/mm3 Possible case: acute onset of two of the above four features plus a physician diagnosis of trichinosis Suspect case: unexplained eosinophilia Not a case: failure to fulfill the criteria for a confirmed, probable, possible, or suspect case Time Onset after October 26, 1991 Place Metropolitan Atlanta Person Any Assign the appropriate classification to each of the person s included in the line listing below. (All were residents of Atlanta with acute onset of symptoms in November. ) Page 12 Applied Epidemiology I ID # 1 2 3 4 5 Last name Abels Baker Corey Dale Ring myalgia yes yes yes yes yes fever yes yes yes no no facial edema no yes no no no eosinophil count 495 pending 1,100 2,050 600 Physician diagnosis trichinosis trichinosis ? trichinosis EMS ? trichinosis Lab confirm yes pending pending pending not done Classification __________ __________ __________ __________ __________Exercise 1. 3 The following is the official case definition for Kawasaki syndrome that is recommended by CDC: Kawasaki Syndrome Clinical case definition A febrile illness of greater than or equal to 5 days’ duration, with at least four of the five following physical findings and no other more reasonable explanation for the observed clinical findings: †¢ Bilateral conjunctival injection †¢ Oral changes (erythema of lips or oropharynx, strawberry tongue, or fis suring of the lips) †¢ Peripheral extremity changes (edema, erythema, or generalized or periungual desquamation) †¢ Rash †¢ Cervical lymphadenopathy (at least one lymph node greater than or equal to 1. cm in diameter) Laboratory criteria for diagnosis None Case classification Confirmed: a case that meets the clinical case definition Comment If fever disappears after intravenous gamma globulin therapy is started, fever may be of less than 5 days’ duration, and the clinical case definition may still be met. Source: 3 Discuss the pros and cons of this case definition for the purposes listed below. (For a brief description of Kawasaki syndrome, see Benenson’s Control of Communicable Diseases in Man). a. Diagnosing and treating individual patients b. Tracking the occurrence of the disease for public health records c. Doing research to identify the cause of the disease Introduction to Epidemiology – Epi 592J Page 13 Numbers and RisksA basic task of a he alth department is counting cases in order to measure and describe morbidity. When physicians diagnose a case of a reportable disease they are suppose to report the case to their local health department. For most reportable conditions, these reports are legally required to contain information on time (when the case occurred), place (where the patient lived), and person (the age, race, and sex of the patient). The health department combines all reports and summarizes the information by time, place, and person. From these summaries, the health department determines the extent and patterns of disease occurrence in the area, and attempts to identify clusters or outbreaks of disease.A simple count of cases, however, does not provide all the information a health department needs. To compare the occurrence of a disease at different locations, during different times, or in different subgroups, a health department converts the case counts into risks, which relates the number of cases to the size of the population. Risks are useful in many ways. With risks, the health department can identify groups in the community with an elevated risk of disease. These so-called high-risk groups can be further assessed and targeted for special intervention; the groups can be studied to identify risk factors that are related to the occurrence of disease.Individuals can use knowledge of these risk factors to guide their decisions about behaviors that influence health. Descriptive Epidemiology In descriptive epidemiology, we organize and summarize data according to time, place, and person. These three characteristics are sometimes called the epidemiologic variables. Compiling and analyzing data by time, place, and person is desirable for several reasons. First, the investigator becomes intimately familiar with the data and with the extent of the public health problem being investigated. Second, this provides a detailed description of the health of a population that is easily communicated . Third, such analysis identifies the populations at greatest risk of acquiring a particular disease.This information provides important clues to the causes of the disease, and these clues can be turned into testable hypotheses. Time (â€Å"When? †) Disease risks usually change over time. Some of these changes occur regularly and can be predicted. For example, the seasonal increase of influenza cases with the onset of cold weather is a pattern that is familiar to everyone. By knowing when flu outbreaks will occur, health departments can time their influenza vaccination campaigns effectively. Other diseases may make unpredictable changes in occurrence. By examining events that precede a disease increase or decrease, we may identify causes and appropriate actions to control or prevent further occurrence of the disease.We usually show time data as a graph (Figure 1. 3). We put the number or risk of cases or deaths on the vertical, y-axis; we put the time periods along the horizo ntal, x-axis. We often indicate on a graph when events occurred that we believe are related to the particular health problem described in the graph. For example, we may indicate the period of exposure or the date control measures were implemented. Such a graph provides a simple visual depiction of the relative size of a problem, its past trend and potential future course, as well as how other events may have affected the problem. Studying such a graph often gives us insights into what may have caused the problem.Depending on what event we are describing, we may be interested in a period of years or decades, or we may limit the period to hours, days, weeks, or months when the number of cases reported is greater than normal (an epidemic period). For some conditions—for many chronic diseases, for example—we are interested in long-term changes in the number of cases or risk of the condition. For other conditions, we may find it more revealing to look at the occurrence of t he condition by season, month, day of the Page 14 Applied Epidemiology I week, or even time of day. For a newly recognized problem, we need to assess the occurrence of the problem over time in a variety of ways until we discover the most appropriate and revealing time period to use. Some of the common types of time-related graphs are further described below. Secular (long-term) trends.Graphing the annual cases or risk of a disease over a period of years shows long-term or secular trends in the occurrence of the disease. We commonly use these trends to suggest or predict the future incidence of a disease. We also use them in some instances to evaluate programs or policy decisions, or to suggest what caused an increase or decrease in the occurrence of a disease, particularly if the graph indicates when related events took place, as depicted in Figure 1. 3 (note the scale of the y-axis). Figure 1. 3 Malaria by year, United States, 1930-1990 Works Progress Administration Malaria Control Drainage Program Relapses from Overseas Cases 1000 Reported Cases per 100,000 Population 100Relapses from Korean Veterans Returning Vietnam Veterans 10 Foreign Immigration 1 0. 1 0. 01 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 Source: 9 Year Seasonality. By graphing the occurrence of a disease by week or month over the course of a year or more we can show its seasonal pattern, if any. Some diseases are known to have characteristic seasonal distributions; for example, as mentioned earlier, the number of reported cases of influenza typically increases in winter. Seasonal patterns may suggest hypotheses about how the infection is transmitted, which behavioral factors increase risk, and other possible contributors to the disease or condition.The seasonal pattern of an unknown disease is shown in Figure 1. 4. What factors might contribute to its seasonal pattern? From only the single year’s data in Figure 1. 4, it is difficult to conclude whether the peak i n June represents a characteristic seasonal pattern that would be repeated yearly, or whether it is simply an epidemic that occurred in the spring and summer of that particular year. You would need more than one year’s data before you could conclude that the pattern shown there represents the seasonal variation in this disease. Introduction to Epidemiology – Epi 592J Page 15 Figure 1. 4 Cases of an unknown disease by month of onset 450 400 350 300 Cases 50 200 150 100 50 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Source: 14 Month of Onset Day of week and time of day. Displaying data by days of the week or time of day may also be informative. Analysis at these shorter time periods is especially important for conditions that are potentially related to occupational or environmental exposures, which may occur at regularly scheduled intervals. In Figure 1. 5, farm tractor fatalities are displayed by days of the week. Does this analysis at shorter time periods suggest any hypothesis? In Figure 1. 5 the number of farm tractor fatalities on Sundays is about half the number on the other days. We can only speculate why this is.One reasonable hypothesis is that farmers spend fewer hours on their tractors on Sundays than on the other days. Figure 1. 5 Fatalities associated with farm tractor injuries by day of death, Georgia, 1971-1981 Source: 15 Page 16 Applied Epidemiology I Examine the pattern of fatalities associated with farm tractor injuries by hour in Figure 1. 6. How might you explain the morning peak at 11:00 AM, the dip at noon, and the afternoon peak at 4:00 PM? Figure 1. 6 Fatalities associated with farm tractor injuries by time of day, Georgia, 1971-1981 Source: 15 Epidemic period. To show the time course of a disease outbreak or epidemic, we use a graph called an epidemic curve.As with the other graphs you have seen in this section, we place the number of cases on the vertical axis and time on the horizontal axis. For time, we use either the time of onset of symptoms or the date of diagnosis. For very acute diseases with short incubation periods (i. e. , time period between exposure and onset of symptoms is short), we may show time as the hour of onset. For diseases with longer incubation periods, we might show time in 1-day, 2-day, 3-day, 1-week, or other appropriate intervals. Figure 1. 7 shows an epidemic curve that uses a 3-day interval for a foodborne disease outbreak. Notice how the cases are stacked in adjoining columns. By convention, we use this format, called a histogram, for epidemic curves.The shape and other features of an epidemic curve can suggest hypotheses about the time and source of exposure, the mode of transmission, and the causative agent. Figure 1. 7 Date of onset of illness in patients with culture-confirmed Yersinia enterocolitica infections, Atlanta, November 1, 1988-January 10, 1989 8 7 6 Thanksgiving Christmas New Year’s Cases 5 4 3 2 1 0 1 4 7 10 13 16 19 22 25 28 1 4 7 10 13 16 1 9 22 25 28 1 4 7 10 November December January Source: 18 Date of Onset Introduction to Epidemiology – Epi 592J Page 17 Place (â€Å"Where? †) We describe a health event by place to gain insight into the geographical extent of the problem. For place, we may use place of residence, birthplace, employment, school district, hospital unit, etc. , epending on which may be related to the occurrence of the health event. Similarly, we may use large or small geographic units: country, state, county, census tract, street address, map coordinates, or some other geographical designation. Sometimes, we may find it useful to analyze data according to place categories such as urban or rural, domestic or foreign, and institutional or noninstitutional. Not all analyses by place will be equally informative. For example, examine the data shown in Table 1. 3. Where were the malaria cases diagnosed? What â€Å"place† does the table break the data down by? Would it have been more or l ess useful to analyze the data according to the â€Å"state of residence† of the cases?We believe that it provides more useful information to show the data in Table 1. 3 by where the infection was acquired than it would have to show where the case-patients lived. By analyzing the malaria cases by place of acquisition, we can see where most of the malaria cases acquired their disease. Table 1. 3 Malaria cases by distribution of Plasmodium species and area of acquisition, United States, 1989 Species Area of Acquisition Vivax Falciparum Other Total Africa 52 382 64 498 Asia 207 44 29 280 Central America & Caribbean 107 14 9 130 North America 131 3 13 147 (United States) (5) (0) (0) (5) South America 10 1 2 13 Oceania 19 2 5 26 Unknown 6 2 0 8 Total 532 448 122 1,102 Source: 6By analyzing data by place, we can also get an idea of where the agent that causes a disease normally lives and multiplies, what may carry or transmit it, and how it spreads. When we find that the occurrence of a disease is associated with a place, we can infer that factors that increase the risk of the disease are present either in the persons living there (host factors) or in the environment, or both. For example, diseases that are passed from one person to another tend to spread more rapidly in urban areas than in rural ones, mainly because the greater crowding in urban areas provides more opportunities for susceptible people to come into contact with someone who is infected.On the other hand, diseases that are passed from animals to humans often occur in greater numbers in rural and suburban areas because people in those areas are more likely to come into contact with disease-carrying animals, ticks, and the like. For example, perhaps Lyme disease has become more common because people have moved to wooded areas where they come into contact with infected deer ticks. Although we can show data by place in a table—as Table 1. 3 does—it is often better to show it pictorial ly in a map. On a map, we can use different shadings, color, or line patterns to indicate how a disease or health event has different numbers or risks of occurrence in different areas, as in Figure 1. 8. Page 18 Applied Epidemiology I Figure 1. 8 AIDS cases per 100,000 population, United States, July 1991-June 1992 Source: 4For a rare disease or outbreak, we often find it useful to prepare a spot map, like Snow’s map of the Golden Square of London (Figure 1. 1), in which we mark with a dot or an X the relation of each case to a place that is potentially relevant to the health event being investigated—such as where each case lived or worked. We may also label other sites on a spot map, such as where we believe cases may have been exposed, to show the orientation of cases within the area mapped. Figure 1. 9 is a spot map for an outbreak of mumps that occurred among employees of the Chicago futures exchanges. Study the location of each case in relation to other cases and to the trading pits. The four numbered areas delineated with heavy lines are the trading pits.Does the location of cases on the spot map lead you to any hypothesis about the source of infection? Figure 1. 9 Mumps cases in trading pits of exchange A, Chicago, Illinois, August 18-December 25, 1987 #1 #3 #2 #4 Key: Pit areas are numbered and delineated by heavy lines. Individual trading pits within pit areas are outlined by light lines. Affected person (N= 43) Desk areas Source: CDC, unpublished data, 1988 Introduction to Epidemiology – Epi 592J Page 19 You probably observed that the cases occurred primarily among those working in trading pits #3 and #4. This clustering of illness within trading pits provides indirect evidence that the mumps was transmitted person-to person. Person (â€Å"Who? ) In descriptive epidemiology, when we organize or analyze data by â€Å"person† there are several person categories available to us. We may use inherent characteristics of people (for example, age, race, sex), their acquired characteristics (immune or marital status), their activities (occupation, leisure activities, use of medications/tobacco/drugs), or the conditions under which they live (socioeconomic status, access to medical care). These categories usually determine, to a large degree, who is at greatest risk of experiencing certain undesirable health conditions, such as becoming infected with a particular disease organism. We may show person-related characteristics in either tables or graphs.In analyzing data by person, we often must try a number of different categories before we find which are the most useful and enlightening. Age and sex are most critical; we almost always analyze data according to these. Depending on the health event we are studying, we may or may not break the data down by other attributes. Often we analyze data by more than one characteristic simultaneously; for example, we may look at age and sex simultaneously to see if the sex es differ in how they develop a condition that increases with age—such as with heart disease. Age. Age is probably the single most important â€Å"person† attribute, because almost every health-related event or state varies with age.A number of factors that also vary with age are behind this association: susceptibility, opportunity for exposure, latency or incubation period of the disease, and physiologic response (which affects, among other things, disease development). When we analyze data by age, we try to use age groups that are narrow enough to detect any agerelated patterns that may be present in the data. In an initial breakdown by age, we commonly use 5-year age intervals: 0 to 4 years, 5 to 9, 10 to 14, and so on. Larger intervals, such as 0 to 19 years, 20 to 39, etc. , may conceal variations related to age which we need to know to identify the true ages at greatest risk.Sometimes, even 5-year age groups can hide important differences, especially in children less than five years of age. Take time to examine Figure 1. 10, for example, before you read ahead. What does the information in this figure suggest health authorities should do to reduce the number of cases of whooping cough? Where should health authorities focus their efforts? You probably said that health authorities should focus on immunizing infants against whooping cough during the first year of life. Now, examine Figure 1. 11. This figure shows the same data but they are presented in the usual 5-year intervals. Based on Figure 1. 11 where would you have suggested that health authorities focus their efforts?Would this recommendation have been as effective and efficient in reducing cases of whooping cough? You probably said that health authorities should immunize infants and children before the age of 5. That recommendation would be effective, but it would not be efficient. You would be immunizing more children than actually necessary and wasting resources. Sex. In general, mal es have higher risks of illness and death than females do for a wide range of diseases. For some diseases, this sex-related difference is because of genetic, hormonal, anatomic, or other inherent differences between the sexes. These inherent differences affect their susceptibility or physiologic responses.For example, premenopausal women have a lower risk of heart disease than men of the same age. This difference is attributed to higher estrogen levels in women. On the other hand, the sex-related differences in the occurrence of many diseases reflect differences in opportunity or levels of exposure. For example, Figure 1. 12 shows that hand/wrist disorders occur almost twice as often in females than in males. What are some sex-related differences that would cause a higher level of this disorder in females? Page 20 Applied Epidemiology I Figure 1. 10 Pertussis (whooping cough) incidence by age group, United States, 1989 Source: 9 Figure 1. 11 Pertussis (whooping cough) incidence by a ge group, United States, 1989 Source: 9 Figure 1. 2 Prevalence of hand/wrist cumulative trauma disorder by sex, Newspaper Company A, 1990 Source: NIOSH, unpublished data, 1991 Introduction to Epidemiology – Epi 592J Page 21 You may have attributed the higher level of disorders in females to their higher level of exposure to occupational activities that require repetitive hand/wrist motion such as typing or keyboard entry. With occupationally-related illness, we usually find that sex differences reflect the number of workers in those occupations. You may also have attributed the higher level of disorders in females to anatomical differences; perhaps women’s wrists are more susceptible to hand/wrist disorders. Ethnic and racial groups.In examining epidemiologic data, we are interested in any group of people who have lived together long enough to acquire common characteristics, either biologically or socially. Several terms are commonly used to identify such groups: race, nationality, religion, or local reproductive or social groups, such as tribes and other geographically or socially isolated groups. Differences that we observe in racial, ethnic, or other groups may reflect differences in their susceptibility or in their exposure, or they may reflect differences in other factors that bear more directly on the risk of disease, such as socioeconomic status and access to health care. In Figure 1. 13, the risks of suicide for five groups of people are displayed. Figure 1. 3 Suicide death rates for persons 15 to 24 years of age according to race/ethnicity, United States, 1988 Source: 22 Clearly this graph displays a range of suicide death rates for the five groups of people. These data provide direction for prevention programs and for future studies to explain the differences. Socioeconomic status. Socioeconomic status is difficult to quantify. It is made up of many variables such as occupation, family income, educational achievement, living conditions, and social standing. The variables that are easiest to measure may not reflect the overall concept. Nevertheless, we commonly use occupation, family income, and educational achievement, while recognizing that these do not measure socioeconomic status precisely.The frequency of many adverse health conditions increases with decreasing socioeconomic status. For example, tuberculosis is more common among persons in lower socioeconomic strata. Infant mortality and time lost from work due to disability are both associated with lower income. These patterns may reflect more harmful exposures, lower resistance, and less access to health care. Or they may in part Page 22 Applied Epidemiology I reflect an interdependent relationship which is impossible to untangle—does low socioeconomic status contribute to disability or does disability contribute to lower socioeconomic status? Some adverse health conditions are more frequent among persons of higher socioeconomic status.These condition s include breast cancer, Kawasaki syndrome, and tennis elbow. Again, differences in exposure account for at least some of the differences in the frequency of these conditions. Exercise 1. 4 The following series of tables (Exercise 1. 4, Tables 1-4) show person information about cases of the unknown disease described in Figure 1. 4 on page 15. Look again at Figure 1. 4, study the information in the four exercise tables and then describe in words how the disease outbreak is distributed by time and person. Exercise 1. 4, Table 1 Incidence of the disease by age and sex in 24 villages surveyed for one year Males Females Age Group Population* # Cases Risk per Population* # Cases Risk per (years) 1,000 1,000