In Opposition of an Amendment to Ban Flag Desecration :: Argumentative Persuasive Argument Essays

In Opposition of an Amendment to Ban Flag DesecrationIn 1876 a Constitutional amendment was proposed that would eliminate the Senate. In 1893, there was an amendment proposed that would get rid of the Army and the Navy, and another hotshot that would rename the country the United States of the Earth. They all sh are one common dominator they would do absolutely nothing to benefit the United States or its citizens. To this list another proposed amendment send packing be added the amendment banning desecration of the American wilt. in that respect have been less then 200 reported flag burnings in the more then 200 that America has existed. Congress is trying to protect the flag from something thats not even threatening it. In actuality, Congresss bill would threaten the flag more than any match ever would. The American flag stands for freedom, and in this Land of the Free, what could be more important then the right to express ones opinions? America is the only country in the world where citizens are guaranteed the right to protest the government If this protest happens to involve the desecration of the flag, then celebrate the fact that we live in such a country where we can do this without fear instead of condemning the action Not only would this bill undermine everything the constitution stands for, it would also destroy Americas notation of Rights. The Bill of Rights has survived for more than 200 years without being altered in any way. Making flag burning illegal would be the first swop ever to the first ten amendments, and would open the gateway to more changes in the future.Supporters of the bill have

Great Gatsby Letter :: Great Gatsby Letter

Dear Gatsby,I appreciate your care for our friendship, Im glad that what we break through with(p) means something to you as it has to me. I also see that you havent joined the rest of the flapper aristocrats, its good to know youre not at the shallow depths of their ignorant mentality. Anyways, I hope that your worries isnt the reason why turn over that our lives are so troubled all of the sudden. I know myself very well and I know that my life isnt twisted, and I know you well adequate to say that your life is not as troubled as you may think or seems. Everybody else living this wealthy luxury of a life has done something worse than anything you have done, used you for parties and drinking for one. One the other hand, the only crime youve commited is falling in love. I have seen Tom and Daisy unhappyly married cognise their real truths about each other myself, and their marriage is a farse. I have seen you and Daisy fullfilling that long mixed-up love you had for each other be fore war, wondering why you lost it to begin with. You and I know Daisy for what she really is, not for that superficial act to gain self-respect, you can make her truly happy again. As for me, I have seen everybody is East Egg. for what they really are, and Jordan is no

Money Can Buy Happiness! :: Happiness Essays

What is happiness? According to the dictionary, happiness is a mental or emotional state of positive or winning emotions. Now think closely, what does happiness mean to you? Many people say funds sewert procure you happiness, some people say it can. concourse say, How can you not be blissful when you have a ton of money? But people also say, Having too much money can get in the way of happiness. To me money is just green paper that lets you buy things you want and need. But can this green paper really buy you happiness? After reading this paper of mine, think about the question again and what do you believe is true.I am going to share with you a little story about someone that thinks money cant buy happiness. This story is written by a seventeen year older girl named Michelle who was asked this question for an interview for New York Daily News, so read and think about her storyI never really thought the expression, money cant buy happiness, was true. As an infant, just by observing the people around me, I observed when they would obtain money and a huge grin would spread across their face, the corners of their smile spreading from ear to ear. Whenever I would see that grin and a persons face rest up at the sight of a crisp, green bill it would make me believe that I had proved the famous expression wrong. Now that Ive grownup up and matured, my idea of that expression has changed. As of now, I am able to reflect on life much and look deeper into things and particularly into people more than I was able to do years ago. My ideas about this expression changed the most though because of the money situation my family had stumbled upon because of the failing economy. I remember being young when the economy was doing well and waking up to twenty gifts for each of my three sisters and I. We used to believe that all of those presents, brought in because of money of course, were the best part of waking up on Christmas. Of course all of those toys and material items would make a child happy however looking back it would only make them happy if it was given to them by somebody who bought it for them with love.

Reading Poetry by the Morning Moon :: Personal Narrative Essays

Reading Poetry by the Morning Moon Wind sweeps a stray cloud across the sky, exposing half of a gray-mottled moon. Its nine-thirty in the morning, and the moon looks like an island in a pellucid sea. Sitting in the covered crook of a hickory tree, my legs dangle above the creek. A walnut leaf drifts past, on its way through the valley, destined for the river and finally the bay. For a moment, I think of taking off my sneakers and socks, rolling up my jeans, and dipping my toes into the soft silt lining the creek bed. The meandering stream is only shin-deep and with four strides I could tantalize on the other shore. In the October chill, however, I reconsider instead, the smells - mud, fish, decaying leaves - intoxicate me.My tongue, every atom of my blood, formd from this soil, this air.I know its a romanticistic idea, reading Song of Myself on a stream bank. In fact, if Walt Whitmans spirit were to brush by me in the gusting wind, Id probably let out him say Close the book and w atch. Listen.A shriek pierces through the orange and gold treetops like a blast of steam escaping a teakettle. Looking up, I see the silver belly of a red-tailed hawk as it glides in circles below the moon.I fly those flights of a fluid and swallowing soul, writes Whitman. He, too, must have witnessed the swooping undulations of a ruddy-winged bird. His heart, like mine, unburdened.From my rough but solid seat in the hickory tree, I hear, at first, the sounds of Annvilles busy thoroughfare - the drone of engines, squealing brakes, the toll of a church bell. Soon, however, other noises trickle into my consciousness. Water over fallen branches. Staccato crackles of a squirrel in the brush. My own breathing. The world has been reduced to a microcosm in which I am the center. In this cosmos there are no thoughts of the future, only a mingling of the present and past.Maybe its my solitude, or by chance its the wind caressing my face with the smell of wet leaves, but I feel suddenly clo se to my home, a farm that is sixty miles western hemisphere and a mountain away from this hickory tree on the Quittie. Closing my eyes, I see the familiar wisp of smoke curling from our brick chimney, the crooked lightning rod on the barn roof, and the mountains that surround the valley, Hidden Valley, like the walls of Jericho.

Emersons Friendship Essays -- essays papers

Emersons Friendship I believe that in his essay, Friendship, Emersons primary(prenominal) point is that people should not be afraid to expand their friendly horizons. They should more try to open up and be honest with people. The essay investigates just how to be more open with others and gives tips on differentiating between true friends and those whom we just refer to as friends. There are galore(postnominal) people whom we speak to and collect on an everyday basis. In everyday conversations we show others that they are favored from the highest degree of passionate love, to the lowest degree of good-will, they make the sweetness of life. It is believed by many that our intellectual powers increase accordingly with our affection. In order for someone to take on another person as their friend there are certain(prenominal) things that one can search for. Suppose a stranger comes up to you and you are beginning a marvelous conversation, one in which you begin to fishy that he may be your new best friend, during this conversation or meeting you must think and observe him carefully. Once he b...

Emersons Friendship Essays -- essays papers

Emersons Friendship I believe that in his essay, Friendship, Emersons main point is that muckle should not be afraid to expand their friendly horizons. They should more than try to open up and be honest with people. The essay investigates simply how to be more open with others and gives tips on differentiating between true friends and those whom we just refer to as friends. There are many people whom we speak to and meet on an public basis. In everyday conversations we show others that they are favored from the highest degree of passionate love, to the lowest degree of good-will, they make the sweetness of life. It is believed by many that our intellectual powers addition accordingly with our affection. In order for someone to take on another person as their friend there are certain things that one dejection search for. Suppose a stranger comes up to you and you are beginning a marvelous conversation, one in which you begin to suspect that he whitethorn be your new best friend, during this conversation or meeting you must think and observe him carefully. Once he b...

Notes Business Communication

What was particularly interesting, meaningful and/or insightful in the readings/assignments for the week? * In what way(s) were you able to relate the weeks assignments to your workplace? * What did you learn that you would begin incorporating into your declare work style and environment? * What was the muddiest point? This week I liked reading about the difference between persuasion and manipulation. I found it to be very helpful to understand why some people engross one and only(a) over the other.Some people do not understand that in that location is a difference however, there is quite a big difference. Most people cogitate that the two go hand in hand that one is just a lesser form of the two. This week I related our discussion questions to my place of work by upping my persuasion tactics. People, statistically, respond better to persuasion then manipulation. Also explaining along with persuasion goes along way. When a coworker needed to understand something about a particu lar procedure that is in my neck of the woods I wanted it done how I do it.Therefore, persuasion of why my way works better explained in a learning manner went well. What I learned this week that I will apply to my work style is that when talking to someone of a challenging nature I can use facts. The muddiest point that I had trouble with this week was that some people think that if you show respect you will get it back. I do not think this is the case. Just because you show respect does not mean you will get it back. This does not mean you should stop.

Movie Review: In the Womb

In the womb the DVD Review A must see movie for future p atomic number 18nts Experiencethe life before fork out, The formation, a tincture by step in a film that ready not been seen like him. In the womb, was produced for National Geographic Channel . Its includesfeatures in advanced technology, simulations that charter beengenerated by echography photography in four dimensions. Before it takes its scratch breath, a human pamper has been finished an incredible transformation from a maven cell to a complex, self-sustaining organism.Watch this amazing process in real time inside the womb. Recommendation + personal experience I remember that s I realized that my wifes stomach size is what supposed to be my child, with Gods help,I studied this film, explaining me something that is very difficult for me person entirelyy to understand how our body produces live? How does it consort? If you think that I got it after seeing the film and that Iunderstood all of these scientific facts, then youre wrong, its lull seems like a crazy miracle that happens ace after the other in the all wide World.I sthrongly recommend everyone to see that movie, it shows the very little detailsof the processand even shows us the foetusina verity of positions, moves, making faces, etc that we cant see with off that film. you bequeath enjoy it. Sourcehttp//www. shvoong. com/exact-sciences/2000143-womb/ixzz2cqvNjWSF Maybe this has already been talked some and I missed it, exclusively I model I would let all of you ladies know ab appear a National Geographic special my husband re stacked for me to watch called In the Womb. I super recommend the film.Its a fairly new documentary about how babies develop and its quite interesting. I thought I would do a little retread for you all since some of you are midwives and others are looking for schoolingal videos. There are strong and bad things about the documentary, scarcely the end made me so very, very happy that Ive forgiv en the film all of its faults. Con The intro is of a woman in labor screaming bloody murder like they do in the movies epoch giving birth. Youll forgive this later, however. Read on. Con I kinda al near fell asleep at the beginning when they were covering conception.It was stuff weve all heard a million times in school, so it was pretty redundant. Get to the babies already Pro Some of the calculator graphics and filming was sincerely amazing. They use all new footage, no recycled stuff from other documentaries. Con Sometimes the film would state some fact and then not plump for it up in any way, so youd be left wondering gee, thats new. Where on earth did they get THAT? For example, during one part, they said that a woman is such(prenominal) likely to have a miscmarriage if she experiences stress, has an immune disorder, or if she has previously given birth to a boy.Now, Ive had three miscmarriages, so Ive read tons of information about it and never have I heard that giving b irth to a boy makes you more likely to have a miscmarriage. I thought wow, really? Whered they hear that? but they just went on to the undermentioned subject without explaining. Con 99% of the babies in the film are not real they are all rubber models (which look absolutely fantastically realistic, by the way) or these super creepy alien-looking computer generated babies that totally freaked me out. They were a bit disturbing looking.Con They stressed the nourish of ultrasound in the video and Im personally against it, but it doesnt lose a lot of points with me because a lot of women are pro ultrasound. Pro They did mention that ultrasound might be harmful, though it is not known to cause problems in babies. They in like manner mentioned that while we cant hear ultrasound, babies CAN because it creates an echo inside the water-filled uterus. They explained that babies run from it because it is super loud somewhat like standing next to a subway train. Pro They provided TONS o f the most amazing 4D footage of babies Ive ever seen.They had videos of babies only(prenominal) weeks old in the womb yawning, playing with their noses and feet, and twins interacting with each other. I cried at parts. Pro Aside from a brief (and very low- attain) clip where a doctor does a minor surgery on an unborn fetus along with a few short clips of doctors pperforming ultrasound, there were NO HOSPITAL SCENES or doctors in the film. Woot The outdo part ever The film follows only one start out through her pregnancy and ends with her giving birth. I grumbled my way through a few mildly irritating parts of the film, but whe I reached the end, I got a rather shocking surprise.When its time for the receive to give birth, you see her standing yes standing next to a bed in a birthing center giving birth. There is not one doctor in the room or a machine beeping of any kind, only the woman, her midwife, the cameraman, and the husband. There are no bright lights and its very qui et except for the womans screams. Then, to my utter delight, the storyteller informs the viewers that standing or squatting are the best positions in which to give birth and that it is better and more comfortable for the bring forth than laying on her back.I wish every proofreader could have been there with me as I whooped and hollered and punched my fists in the air in delight Imagine a mainstream documentary saying something like that The mishandle is flat handed to the mother through her legs and she sits on the bed with her newborn, a smile plastered on her delighted face. No one takes her baby away. The midwife waits to fuck the cord and then the mother is seen breastfeeding. WAY TO GO NATIONAL GEOGRAPHIC So yes, any midwives out there who are looking for a good educational video, Id have to say that this is the one.Its not about birth, its about development, but its the best Ive seen so far and its SO ultra pro-natural birth. ETA SORRY The Youtube link seems to have been taken down. Ill keep an eye out for any other sites hosting the full video -Amber National Geographic Channels In the Womb by Inbar MaayanKeywordsHuman development,Movies,foetus Written, produced, and directed by Toby Mcdonald, the 2005 National Geographic Channel filmIn the Wombuses the most recent technology to provide an intricate glimpse into the prenatal world.The technologies used, which include advanced photography, computer graphics, and 4-Dultrasoundimaging, help to realistically illustrate the process of development and to answer questions about the rarely seen development of a human being. The following description of the images and narrative of the film captures the major points ofIn the Womb, and of conceptusnic and fetal development, as they are seen at the outset of the twenty-first century, visualised in only 100 minutes. In the Wombopens with a glimpse of the maturefetusmoments before she is ready to emerge into the outside world.The narrator explains that at this last stage, she is equipped with all of the faculties necessary for full function outside thewomb. The main focus of the film, however, is the move leading up to these final moments, a journey that begins with just a single cell. This journey is viewed intermittently tthroughout the film using three-D and 4-Dultrasoundscanning techniques which show the baby contemptible. 4-D refers to a string of 3-D images taken in real time (time is the fourth dimension), thus creating a movie of in utero events.In addition, the process is simulated by computer imaging base on observations, giving a vivid portrayal of embryonic and fetal development. The developmental narrative begins with millions of swimmingsperm, and an ex purposeation of their unique purposecarrying the fathers genetic information to the moment ofconception. Thespermare produced in a manstestes, and their quality depends on his lifestyle choices they tend to be disgraced by the consumption of discordant drugs and by hea t, and stimulated by the consumption of coffee.A singlespermis filmed swimming across a black landscape, which accentuates the rapid, intricate movements of its tail. The tails flexibility allows thespermto progress approximately a tenth of an inch per minute. Millions ofspermare filmed as they appear in thevagina, many of them exanimate on their sides, with the vast crowd in the middle swimming toward theuterus, thefallopian tubes, and the crackpot, which looks like a moon-like orb nestled among its protective agents. Thisegg, like all her others, was formed during the mothers own time in thewomband has resided in her body ever since.The film suggests that in order to find theegg, thespermsniff it out using their figurative sense of smell. A graphical simulation shows thespermtraveling toward the awaitingegg, and one of them penetrating its outer mold. The bigger picture, in which the rest of thespermare for good shut out uponfertilization, is filmed. Another graphical simulatio n follows, illustrating the fusion of the fathers and the mothers genetic material at the moment ofconception. The narrator notes that this particular genetic combination has never before existed, and will never be duplicated in another human being.DNA, which carries the organisms genetic information and is bundled in the chromosomes, is depicted as a long, energetic helix that carries the more than 20,000genesthat make up an average human. Thesegenesare responsible for non-homogeneous characteristics and are unyielding by parental contributions. They are absolutely crucial to the development of new life. The various physical effects of genetic information are illustrated in the display of various shapes of eye, noses, hair, and other features.The great variability of genetic effects on appearance is depicted by the morphing of a face to show a vvariety of characteristics, both young-begetting(prenominal) and female. It is noted, however, that while the parents contribute equal a mounts of genetic information, it is the DNA from thespermthat determines the childs sex, via its twenty-third chromosome, which is either an X or a Y. Thegenescontributed by the parents more often than not predetermine the childs appearance and much of the childs personality and predisposition for certain diseases.After the illustration and explanation offertilization, a description of the fertilized eggs journey toward theuterusis accompanied by film footage of the process. As it sails along the fallopian tube on the first day of its journey, the single cell divides into deuce selfsame(a) cells. Cell division continues and by the fifth day, the resulting ball of cells is made up of about 100 cells and is called ablastocyst. At this stage, theblastocystwill split into deuce groups of cells the outer layer prepares to become theplacenta,umbilical cordand fetal membranes, and the inner layer prepares to become the embryo itself.The cells making up the inner part of the blastulaares tem cells, and have the ability to differentiate into all of the different types of cells that make up the human body. One week afterfertilization, theblastulareaches theuterus, where it will start to develop into a new human being. Three weeks intogestation,In the Wombsimulates the embryo folding inward and elongating as the basic body plan is determined. An actual embryo at this stage is shown and a basic spine is visible.The top of the embryo, destined to become the pass and brain, is indicated this region has already begun to generate mettle cellsby the fifteenth day of thepregnancy. Thesenerve cellswill proliferate and eventually become the brain and thecentral nervous system. The heart forms soon after this, and twenty-two geezerhood afterconception, begins to beat. This movement is initiated by a single heart cell which begins to beat and induces the cells around it to beat to the same rhythm. Close-up filming shows this pulse as heart cells proliferate and the organ contin ues to form.With the formation of the heart come thin veins and too soon blood cells responsible for transporting oxygen and nutrients the blood in these veins moves to the beat of the heart. During the early stages of development the heart beats relatively independently, though its function will later be carefully regulated by the brain. By the time the embryo is four weeks old, preliminary eyes have appeared on her head. These look like dark spots on a pale landscape of surrounding interweave on which the early contours of the forehead, nose, mouth, and other parts of the mature face can be seen.In addition, arm and leg buds emerge. The narrator mentions that even though thirty days have passed sinceconception, the embryo is approximately indistinguishable from the embryos of other mammals. The exchanges taking place in the embryosmorphologyover the following few weeks are shown through film progression. The face plates move in to better define facial features, arms and legs c ontinue to take shape, and the head becomes more clearly defined. At six weeks, the embryo is about an inch long, has a firmly rooted and visibleumbilical cord, and the outline of her fingers can be distinguished as well.The eyes have developed by leaps and bounds, although they are not save concealed by eyelids. The nostrils are now visible, wide-set down the stairs the eyes on a head that is giant in relation to the size of the body. By the end of eight weeks ofgestation, the embryo is called afetusand is no longer dependent on theyolksac that nurture it during theembryonic stage of development. Theyolksac, a balloon-like structure of tissue with visible veins, vanishes at this point and thefetusbecomes solely dependent on theumbilical cordrooted in theplacenta, and thus on the mothers blood for nutrition.A close examination of theplacentareveals intricate blood vessels transporting the nutrients necessary for the embryos growth, while keeping out many of the toxins present in the mothers own blood. Despite the placentas effectiveness, substances like drugs and alcohol cannot be completely be filtered out, and its up to the mother to limit her consumption of them. By nine weeks, the nervous system has developed dramatically and starts to allow thefetusto move. Although this movement, shown through computer simulation, is not yet connected to the brain, it premotes agility and further growth.After this point, the body will gradually come under the control of the brain. This change also has the effect of regulate heart rate, which may append to more than 150 beats per minute before cerebralregulation. A standardultrasoundis performed at the Create wellness Clinic in London at the conclusion of the firsttrimester, and the narrator explains howultrasoundwaves function to create the image on the screen. While a physician explains the various tests that can be done at this stage ofpregnancyusingultrasound, the babys heart can be seen contracting and distendi ng in the moving image.A step beyond standardultrasoundis the 4-D scan, which shows the three-dimensionalfetusmoving in real time. This tool allows for even more accurate evaluation of the fetuss health and development. It shows everything from thefetusmoving her arms to yawning or playing with her nose. Four-dimensional scans of various babies at different stages of development greatly expand the amount of detail that is visible to the world outside thewomb. The narrator also notes that this firstultrasoundscan is the first oopportunity to ascertain the number of fetuses present in thewomb.Four-dimensional scans also allow us to see the preliminary steps of a babys literal first steps. These are manifested in scans of eleven- and twelve-week-old fetuses kicking and get-up-and-go off the walls of theuterusas they exercise the use of their appendages. This movement is called the stepping reflex, and it is controlled by the fetuss nervous system. The five weeks leading up to this poi nt, weeks six through eleven, are considered to be the period in which thefetusundergoes the most dramatic transformations in its developmental journey.By the end of the eleventh week, all organs have formed, but thefetusis still tinyabout three inches longand thus must grow significantly before it can beviable. Sex is also determined at this point, and the sex organs producehormonesthat further regulate the sexual development of thefetus. Miscmarriage beyond this point is far less likely than during the first three months ofpregnancy, since thefetusis more stable. As time goes on, thefetuslooks more and more human, and her senses sharpen further.Simulation reveals highly developed hands and the hardening (ossification) of bones beneath the semi-transparent skin. The face looks far more human as well, with the eyes now closer together and the nose and mouth more defined. By this time, the brain controls most of the bodyincluding the heartthrough thecentral nervous system. Aside from seeing the heart, a Doppler probe is also used to hear what the fetus heart sounds like. It beats at a frantic 146 beats per minute, which the physician indicates is a healthy pace for afetusthis age.At four months, she not only has control of her heart rate, but she also begins to respond to physical stimuli and to move around a lot. She has also begun to develop proprioception, which is the awareness of the bodys position in its surroundings. She is shown feeling the sides of thewomband grasping at different parts of her body. Four-dimensional images of twins also reveal how interactive they are with each other identical twins, however, interact much more than do fraternal twins, who have a membrane separating them.This membrane is also visible with this more detailed scanning tool. Eighteen weeks afterconception, fetal movements become readily detectable to the mother. In addition, thefetusstarts digesting amniotic fluid as her digestive system begins preparation for the outside world. Another preparation has been revealed by 4-D scans, where thefetuscan be seen practicing the blinking reflex. Soon, she will even have her own fingerprints. At the conclusion of the secondtrimester, thefetusis fully formed but still needs to experience dramatic growth and to develop her senses.The film states that at this stage, she begins to taste flavors from her mothers food, and to hear the sounds that surround her cocoon, including the tone and cadence of her mothers region. Comfort with her mothers various sense-inducing habits may even prove conducive to more healthy development once the baby has been born. In the Wombalso notes that, as well as providing a preliminary basis for diagnosis of complications,ultrasoundscans also premote the development of parental attachment to the yet-unborn child.Ultrasound is thought to promote the relationship of the child with the parents, both in infancy and later in life. At twenty-four weeks, this relationship could begin prema turely, for it is at this point that a baby could survive outside of thewomb though still small and underdeveloped, with appropriate intensive care, she could be consideredviable. The greatest complications may arise due to the premature lungs, since the lungs only fully develop near the conclusion of thepregnancyand are filled with amniotic fluid until breathing begins.The eyes, which have been fully developed since the middle of thepregnancy, cannot see yet but are adorned with eyelashes by the twenty-fifth week. Babies are usually born with lighter-colored eyes than they will have later babies of Caucasian descent are often born with blue eyes, while babies of Asian or African descent first have darker brown eyes. These colors will often change or deepen during the first few months of life, as the pigments in the eyes are exposed to light, which is absent in thewomb. In the darkness of thewomb, babies in their finaltrimesterspend most of their time sleeping soundly.When they are awake, however, fetuses are often active, practicing their reflexes in response to provocations from outside thewomb. These include the startle reflex, when thefetusflings her arms out and over her head, and the swallowing and sucking process, crucial to nutrition outside of thewomb. The latter may be manifested in thumb sucking, which is thought to be sthrongly correlated with handedness during a persons life. Theplacentanot only conducts oxygen, nutrients, and flavors to thefetus, but it may also conduct the mothers mood. The ear or anxiety that a mother might experience cascade through, eventually causing the babys heart to beat faster as well. Serious and sustained stress or anxiety have been found to result in stress in the child and a higher risk for stress-related physical and mental health complications. medieval twenty-six weeks thefetusconcentrates almost solely on growth despite this, serious issues might arise even before birth. In the Wombshows Dr. Kypros Nicolaides of queers College Hospital in London diagnosing and pperformingin uterosurgery on afetuswhose intestines are obstructing lung growth.He performs this delicate surgery with the help of a fetuscope, which allows him to see inside thewomband is also used as a tool in the surgery itself. Nicolaides technique for treating this particular disorder has been met with a 50% increase in the survival rate of his prenatal patients. The last two months ofpregnancysee the final steps toward a healthy birth. During this time, thefetusdevelops a layer of insulating fat and has even been found to develop consciousness and memory. Thefetusmay remember and respond to familiar sounds such as her mothers voice or even her parents favorite music.If thefetusrecognizes music, she might even move in rhythm. Fast music has been found to stimulate and excite thefetus, which seems to be almost dancing in thewomb, while classical music will often have a calming effect. The development of all of these complex fun ctions prior to birth has also led some experts to posit that, developmentally, birth is not as significant as was previously assumed. This is because the brain of a maturingfetusis almost identical to that of a newborn. This ssimilarity is particularly striking considering the sighting of rapid eye movement (REM) in 4-D scans, since these are indicative of dreaming.From thirty-five weeks on, thefetuscould be fully structural and self-supporting (aside from its need for external nutrition and warmth). The film notes that though it is not yet certain what sets off delivery, the maturation of the lungs may play a key role. When mature, the lungs release a protein that affects thehormoneproduction of theplacenta, reducingprogesteroneproduction and initiating the production of oxytocin, which in turn triggers uterine contractions and inhibition of memory.These are useful when thecervixundergoes extreme wideningapproximately 10 cmas it conveys the babys large head out into the world. In the Wombhas now asleep(p) full-circle, arriving again at the time of delivery. To ease the pain of delivery and risks of complication, the mother in the movie delivers standing up and leaning forward with her legs spread obscure slightly. During this time, the baby releases large quantities of adrenalin, which keeps the heart pumping fast and prepares the lungs to take their first breathes of air. Soon, the babys head crowns and is followed by the rest of the body.As soon as the baby has emerged, it starts instant as its lungs fill with oxygen and it is exposed to the light and cold of the outside world. Theplacenta, now unnecessary, detaches from theuterusand exits the mothers body through the birth canal. In the Wombreviews the entire process of thepregnancyand highlights the grand achievement that is transformation from a single cell into an entirely new individual. The newly born baby depends on adults for warmth and nutrition, although all other functions rest solely in her tiny hands.

AMER and NASDAQ Comparison

Question No. 1Both AMEX and NASDAQ are stock exchanges that have evolved from the demands of the times. AMEX or the Ameri shtup Stock put back started out as a stock exchange in the streets, or in the curb to be more precise, dealing stocks of companies that are not important enough to be a member of the New York Stock Exchange (NYSE) (Psst, n.d., para. 6 and 7). NASDAQ or National Association of Securities Dealers automate Quotations System, on the other hand, was born after the advent of the computer age, answering the call of technology-based companies for a stock exchange of their own. Because of this, NASDAQs procedures differ from AMEX importantly ((Psst, n.d., para. 8 and 9).Another similarity between the two exchanges is their common competitor, the NYSE. The biggest companies are traded in the NYSE which accounts for its popularity. There are on-going plans to merge AMEX and NASDAQ in the quest of devising a stock exchange that is more competitive with the ever popular N YSE (Psst, n.d., para. 12). The two exchanges can compliment each other because of the different ways by which they conduct their business. These differences will be discussed in the later part of this paper.AMEX and NASDAQ each cater to a specific type of company. NASDAQ is preferred by firms the like Microsoft, Intel and Apple (Psst, n.d., para. 9). These companies are involved mainly in technology. They are more comfortable with the system used by NASDAQ since it is an exchange that uses computers in its operations. Since AMEX was created as an answer to companies who cannot get into the NYSE, AMEX listings include small and mid-cap companies, companies that are not qualified to join the NYSE. AMEX has an impressive listing of options and exchange traded trusts. AMEX specializes in energy companies, start-ups and biotech firms (Investigator guide on staff, n.d., para. 1).Question No. 2The differences between the operations of the two exchanges are many. AMEX operations is simi lar to that of a traditional exchange. There is a foot where the buying and selling takes place. Buying and selling are through personally with buyers and sellers gesturing their offer and acceptance. The system is more personal, the buyers and sellers interacting face-to-face. In fact, AMEX started by trading in the curb only to move on to a building of its own with its own storey. NASDAQ uses electronics in its operations. NASDAQ does not have a trading floor where buyers and sellers meet to conduct trade. Buyers use telephones and computer terminals which contains the information on the securities being traded in real time.NASDAQ used to be considered as an over the Counter Exchange, but as the term evolve over the years, NASDAQ is no longer considered as such. Initially, Over the Counter Exchanges are those which conduct trading without trading floors (Investigator guide staff, n.d., para. 3). Now, the term only refers to exchanges that trade stocks that do not qualify in any of the major exchanges (Investigator guide staff, n.d., para. 3). Since NASDAQ is considered a major exchange, it is no longer considered an Over the Counter Exchange. As stated above, the companies dealing in technology find the system of NASDAQ more efficient than that of AMEX.The system of NASDAQ, allows for a spread which is unbroken by the buyer or stock broker as part of his profit. A spread is the difference between the selling price and buying price. chthonic NASDAQs system, dealers and brokers are able to sell directly to the buyers through computers and are not required to disclose the amount with which sellers are willing to sell their securities. Dealers and stockbrokers can increase such cost provided there are buyers willing to buy the same, any difference is theirs to keep. Because the system is prone to abuse, the government has enacted regulations to govern trading done through this system. (Psst, n.d., para. 13 -16).Because of the difference with which the two e xchanges conduct their operations, the companies registered under them are from different industries. As mentioned above, NASDAQ specializes in companies engaged in technology, such as Microsoft and CISCO. On the other hand, AMEX specializes in energy companies and biotech firms.Question No. 3The collapse of Worlcom, Inc. and the conviction of its Chief Executive led to many losses not just in the telecoms industry but also in other industries. The fiasco that was Worldcom led to the revival and enactment of the Sarbanes-Oxley Act of 2002 (Belson 2005).. This piece of legislation provided for very specific write up and auditing guidelines and detailed corporate disclosure. While this legislations aims to protect investors from the creative and dubious accounting practices of some corporations, corporations find the law stifling (Belson 2005).Worldcom continued to exist after the fiasco, atavism to its former name MCI. While it used to be a huge corporation that gobbles up smaller telecoms on its path to dominance, it struggled to survive in a much diminished state. The bankruptcy of the company meant that many people lost their jobs, savings and retirement benefits. Many of those who had worked for the company for a long time constitute themselves starting over again.During its heyday, Worldcom tactics has forced AT&T and other telecom companies to drastically lower the costs of their services to be competitive (Belson 2005). AT&T needed to cut cost by reducing its work force. These events and several ill-timed investments led to the decline of the once mighty AT&T, a decline from which it never fully recovered.ReferenceBelson, K. January 18, 2005. Worldcoms audacious failure and its toll on an industry. Retrieved October 11, 2007 at http//www.nytimes.com/2005/01/18/business/18ebbers.html?pagewanted=1.Investor guide staff. n.d. Retrieved October 11, 2007 at http//www.investorguide.com/igu-article-423-investing-basics-amex-nasdaq-otc-and-other-exchanges.html .Pssssst wanna trade?. n.d. Retrieved October 11, 2007 at http//www.pbs.org/newshour/on2/money/amex.html.

Introduction to Epidemiology

Aug 17 2011 out driven appearance to Epidemiology Epidemiology is considered the basic science of public wellness, and with good reason. Epidemiology is A quantitative basic science built on a working companionship of probability, statistics, and sound re explore methodology A method of causal think based on developing and testing hypotheses pertaining to incident and prevention of morbidity and closing rate A tool for public health action to promote and comfort the publics health based on science, causal reasoning, and a dose of hardheaded common sense (2).As a public health discipline, epidemiology is instilled with the liven that epidemiological information should be purpose to promote and protect the publics health. Hence, epidemiology involves both science and public health practice. The term applied epidemiology is rough clock clippings used to get a line the natural c overing or practice of epidemiology to mouth public health issues. posers of applied ep idemiology include the fol petty(a)ing the monitoring of reports of communicable unsoundnesss in the conjunction the orbit of whether a cross dietary component shapes your lay on the line of developing bedcer evaluation of the effectiveness and impact of a cholesterol aw arness political platform analysis of historical trends and current data to project future public health resource strikes 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 facial expression explanation and state the effect of changing the measure 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 Hills 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 variant modes of transmission of communicable disease in a state 1 scalawag 2 utilise Epidemiology I A outcome of exercises ar come throughd. It is suggested you attempt to answer these questions and then comp ar your answers with those at the end of this document. accounting entry The word epidemiology comes from the Greek words epi, meaning on or upon, demos, meaning sight, and logos, meaning the study of. Many definitions have been proposed, but the following definition captures the beneathlying principles and the public health spirit of epidemiology 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 admit of health lines. (17) bring out term in this definition ref lect some of the chief(prenominal) principles of epidemiology. take away Epidemiology is a scientific discipline with sound methods of scientific inquiry at its constituteation. Epidemiology is data-driven and relies on a systematic and unbiased approach to the collection, analysis, and interpretation of data.Basic epidemiologic methods unravel to rely on careful observation and use of valid comparison groups to assess whether what was observed, such as the number of graphic symbols of disease in a particular area during a particular time period or the frequency of an exposure among someones with disease, differs from what might be expected. However, epidemiology withal draws on methods from separate scientific fields, including biostatistics and informatics, with biologic, economic, social, and behavioural sciences. In fact, epidemiology is often described as the basic science of public health, and for good reason. First, epidemiology is a quantitative discipline that relie s on a working fellowship 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 non just a research activity but an integral component of public health, providing the foundation for directing practical and fascinate public health action based on this science and causal reasoning. Determinants Epidemiology is as well as used to search for determinants, which are the causes and early(a) factors that forge the particular of disease and separate health-related events.Epidemiologists assume that illness does not occur randomly in a population, but happens completely when the right accumulation of risk factors or determinants exists in an individual. To search for these determinants, epidemiologists use analytic e pidemiology or epidemiologic studies to provide the Why and 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 some another(prenominal) so-called potential risk factors. Ideally, the findings provide sufficient order to direct travel and effective public health control and prevention measures. Health-related states or eventsEpidemiology was originally revolve abouted exclusively on plagueys 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 actual and applied to degenerative diseases, injuries, birth defects, maternal-child health, occupational health, and environmental health. on that pointfore epidemiologists began to look at behaviors related to health and well-being , such as amount of exercise and seat belt use. Now, with the recent explosion in molecular methods, intro to Epidemiology Epi 592J p sequence 3 epidemiologists can make important strides in examining genetic markers of disease risk.Indeed, the term health related states or events whitethorn be go steadyn as anything that affects the well-being of a population. Nonetheless, many an(prenominal) epidemiologists still use the term 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 detail and control of disease, they differ greatly in how they view the patient. The clinician is concerned somewhat 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 clinicians patient is the individual the epidemiologists patient is the commu nity.Therefore, the clinician and the epidemiologist have different responsibilities when faced with a soulfulness 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 signalizeing the exposure or source that caused the illness the number of other souls who may have been similarly exposed the potential for further hand out in the community and hinderances to prevent additional cases or recurrences. Application Epidemiology is not just the study of health in a population it also involves applying the intimacy 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 sequester treatment for a patient, the clinician combines medical (scientific) noesis with e xperience, 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 diagnosing the health of a community and proposing trance, practical, and acceptable public health interferences 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 inside public health) this study to the control of health problems. Evolution Although epidemiologic thinking has been traced from Hippocrates (circa 400 B. C. ) by Graunt (1662), Farr, Snow (both mid-1800s), and others, the discipl ine did not blossom until the end of the Second World War. The contributions of some of these early and much(prenominal) recent thinkers are described next. Hippocrates (circa 400 B. C. ) attempted to explain disease occurrence from a rational quite of a supernatural viewpoint. In his essay en named On Airs, peeings, 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 capital of the United Kingdom haberdasher who published his landmark analysis of death rate 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 worker variabilitys. No one built upon Graunts work until the mid-1800, when William Farr began to systematically collect and crush Britains mortality 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 P period 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 the father of epidemiology. Twenty old grow before the development of the microscope, Snow conducted studies of cholera bams both to discover the cause of the disease and to prevent its recurrence. Because his work classically illustrates the time from descriptive epidemiology to possibility 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 Snows inves tigations the virtually widely accepted cause of diseases, including cholera, was due to miasma, or foul publicize. Therefore well-nigh 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 real 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 icon 1. 1.Because Snow believed that water was a source of contagion for cholera, he marked the location of water pumps on his spot map, and then looked for a relationship amidst the distribution of cholera case households and the location of pumps. He noticed that much case households clustered around certain pumps, especi ally the unsubtle 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. perchance 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 their water. In addition, the brewery allotted workers a daily quota of malt liquor. Access to these uncontaminated rations could explain why none of the brewerys employees undertake 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 retravel the handle of the Broad Street pump and aborted the bam. Snows second major contribution involved another(prenominal) investigation of the same outbreak of cholera that occurred in London in 1854. In a London epidemic in 1849, Snow had illustrious that di fixeds with the highest mortalities had water supplied by two companies the Lambeth friendship and the Southwark and Vauxhall Company. At that time, both companies obtained water from the Thames River, at intake points downstream of London.In 1852, 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 Companys 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. shelve 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 render 1. 1 diffusion of cholera cases in the Golden Square area of London, August-September 1854 fudge 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 companies pedigree 27 19,133 300,149 18 652 0. 9 2. 2 P age 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 agreeable 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 touched 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 like except for which company supplied water. In these districts, Snow identified the water supply company for every house in which a death 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 private House Population Deaths from Mortality risk per (1851 Census) Cholera 1,000 Population Southwark and Vauxhall Co. 98,862 419 4. 2 Lambeth Co. reference point 27 154,615 80 0. 5 This further study added support to Snows 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, specify, 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 o f contamination.Thus, with no copeledge 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-1800s, 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 1900s, epidemiologists extended their methods to noncontagious 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 knowledge 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 1960s and early 1970s health workers applied epidemiologic methods to eradicate smallpox worldwide.This was an achievement in applied epidemiology of curious 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 everyday 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 the information generated by epidemiologic methods have many uses. These uses are categorized and descr ibed 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 service are available, introductionible, 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 enlarge? 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 decisions. 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 1950s, epidemiologists documented the increased risk of lung cancer among smokers in the 1960s and 1970s, epidemiologists noted a diverseness of benefits and risks associated with different methods of birth control in the mid-1980s, 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 pertinent to the choices that p eople 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 ( thoroughgoing(a) muscle pains in chest or abdomen) and undetermined eosinophilia (an increase in the number of one type of white decline 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 tolerable additional cases of eosinophilia-myalgia syndrome (EMS) to describe the illness, its complications, and its risk of mortality.Similarly, epidemiologists have documented the cours e 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 smokingfrom 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 ones 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 Snows removal of the pump handle and the withdrawal of a special 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 railroad tie 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 Legionnaires disease. However, the outbreak was not 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 step-down 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 o r 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 cistron in a defined geographical area as a result of deliberate efforts continued measures to prevent reestablishment of transmission are required. Example measles, poliomyelitis. annihilation Permanent reduction to zero of the worldwide incidence of infection caused by a specific agentive role as a result of deliberate efforts 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 to a higher aim 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 instance 1. 1 In the early 1980s, 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 case definition, time, place, person, and causes. Case Definition (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 report 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 199 1 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 sooner 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 rabidness below notice that it requires laboratory check-out procedure. Rabies, Human Clinical description Rabies is an acute encephalomyelitis that almost 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 nervousness 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 sustain Comment Laboratory halt 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 summon 12. Kawasaki syndrome is a childhood illness with fever and rash that has no known cause and no specifically distinctive 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 definitio n 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 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 wasteful 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 loose case definition.On the other hand, investigators of the causes of a disease outbreak motivation to be certain that any person included in the investigation really had the disease. The investigator will prefer a specific or 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 derogate from of the total n umber of cases. Exercise 1. 2In the case definition for an apparent outbreak of trichiniasis, investigators used the following classifications Clinical criteria Confirmed case signs and symptoms plus laboratory confirmation Probable case acute oncoming of at least three of the following four features myalgia, fever, facial edema, or eosinophil count greater than five hundred/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 capital of Georgia Person Any Assign the appropriate classification to each of the persons 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 mark tongue, or fissuring 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 Ca se 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 Benensons 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 health department is counting cases in order to measure and describe morbidity. When physicians diagnose a case of a reportable disease they are conceive of 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 utilitarian 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 ident ify 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 (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(a) 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 horizontal, x-axis. We often repoint 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 t he 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 conditionsfor many chronic diseases, for examplewe 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 the 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 kit and caboodle 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 years data in Figure 1. 4, it is difficult to conclude whether the peak in 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 years 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 cc 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, elevate 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 inju ries 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 1100 AM, the dip at noon, and the afternoon peak at 400 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 appropr iate 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 Years Cases 5 4 3 2 1 0 1 4 7 10 13 16 19 22 25 28 1 4 7 10 13 16 19 22 25 28 1 4 7 10 November December January Source 18 Date of Onset Introduction to Epidemiology Epi 592J Page 17 Place (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. , epend ing 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 discerp 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 place does the table break the data down by? Would it have been more or less useful to analyze the data according to the 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 diseas e. 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 breathing 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 subject 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 tableas Table 1. 3 doesit is often better to show it pictorially 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, lik e Snows 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 investigatedsuch 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 druthers 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 (Who? ) In descriptive epidemiology, when we organize or analyze data by 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 fitting infected with a particular disease organism. We m ay 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. get along 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 sexes differ in how they develop a condition that increases with agesuch as with heart disease. Age. Age is probably the single most important 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 physical response (which affects, among other things, disease develop ment). 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 p resented 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, males 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 age 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 instant hand/wrist motion such as typing or keyboard entry. With occupationally-related illness, we usually find that sex di fferences reflect the number of workers in those occupations. You may also have attributed the higher level of disorders in females to anatomical differences perhaps womens 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 b oth 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 untangledoes 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 conditions 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. Exercis e 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

Education and obesity Essay

Although many have studied the association in the midst of educational attainment and obesity, studies to date have not fully examined prior common causes and feasible interactions by race/ethnicity or gender. It is also not clear if the relationship between actual educational attainment and obesity is independent of the role of aspired educational attainment or expected educational attainment. The authors use generalized linear log link models to examine the association between educational attainment at age 25 and obesity (BMI 30) at age 40 in the USAs National Longitudinal Survey of Youth 1979 cohort, adjusting for demographics, confounders, and mediators. Race/ethnicity that not gender interacted with educational attainment. In a complete case analysis, after adjusting for socioeconomic covariates from childhood, adolescence, and adulthood, among whites only, college graduates were less likely than high school graduates to be weighty (RR = 0.69, 95%CI 0.57, 0.83).The risk rat io remained similar in two sensitivity analyses when the authors adjusted for educational aspirations and educational expectations and analyzed a multiply imputed dataset to hatch missingness. This more nuanced understanding of the role of education after controlling for a thorough set of confounders and mediators helps advance the study of social determinants of health and risk factors for obesity. viands in pregnancy and early childhood and associations with obesity in develop countries. Concerns about the increasing rates of obesity in developing countries have direct many policy makers to question the impacts of maternal and early child nutrition on risk of later obesity. The purposes of the review are to summarise the studies on the associations between nutrition during pregnancy and infant feeding practices with later obesity from childhood through adulthood and to identify potential ways for preventing obesity in developing countries. As few studies were identified in dev eloping countries, key studies in developed countries were included in the review.Poor prenatal dietary intakes of animation, protein and micronutrients were shown to be associated with change magnitude risk of adult obesity in offspring. Female offspring seem to be more vulnerable than male offspring when their mothers receive insufficient energy during pregnancy. By influencing birthweight, optimal prenatal nutrition might reduce the risk of obesity in adults. While normal birthweights (2500-3999 g) were associated with higher body mass king (BMI) as adults, they generally were associated with higher fat-free mass and lower fat mass compared with low birthweights (

Policing and Crime Reduction Essay

As the logic would imply, policing and criminal offense rates sport been estimate to be related in received ways. The public gener tout ensembley view that patrol powers depend on the quantitative aspect than on its qualitative characteristics. comparably to the perspectives of far that perceives quantity reigns victor in the end, the public indeed view that the quality of security depends mainly on the number of law of nature squad patrolling the area. in that respect has been a lot of research that discusses the possible effects of quantity of law of nature powers in reducing the crime rates. Various contributing factors have been considered in these studies in order to justify the rationale of this belief. However, the results still vary according to methodologies used, geographical area and socio-cultural atmosphere.In the course of our discussion, the primary topic shall center on this office of increasing legal philosophy officer count that induces reduction of crime rate. Analysis and interpretation of diverse data obtained through review of literature and records analysis shall be employed in order to validate the said claims. The following queries shall be answered throughout the discussiona. What are the pros and cons of increasing the quantity of police officers for policing purposes?b. Identify various theories and concepts related to the root word of policing, particularly community policing, hotspot theory & deterrence theory.c. How are the conditions of San Diego, NYPD and Kansas City PD in terms of crime reductions way sand in 1990s?d. Discuss and elaborate the study on foot patrol and New Jersey problem-oriented policingThe discussion of the over-essay shall focus on the above queries hence, these statements shall be the functional scopes of the entire study.The append of police officers in the streets only leads to of the two consequent effects either decrease of crime rates or blush much increase of crime casualties. Essentia lly speaking, one reason patrol activity may be less effective than desired is the lack of qualified resources to facilitate the proper service. Does adding more police suspensor bring down the crime rate?Discussion Pros and Cons of Increased PolicingIn general view the evidences and the studies that pertains to this subject is mixed. According to almost reviews, the number of law reinforcement officers in a jurisdiction seems to have probable unretentive effect on area crimes. Comparisons of police expenditures in U.S. cities indicate that cities with the highest crime rates also spend the approximately on police services. While these results are disappointing, a number of recent studies, exploitation various methodologies, have found that police presence may reduce crime levels and that adding police may bring crime levels down. In addition, increasing the size of it of the local police force may have other benefits for the overall effectiveness of the legal expert system (Siegel & Senna, p.182).Whether adding more officers to an already large police force causes crime to decrease however, is somewhat less clear. Studies of the marginal effect of police and crime suffer from a number of difficulties. First, not only might supernumerary police cause decline in crime, one might expect additional crime to result in the hiring of more police. This simultaneity effect makes it rattling complicated to sort out what causes what. The second problem is temporal order wherein cities with higher and lower levels of policing possesses indefinite data in terms of the addition of the police in cities with presently huge number of policing system, especially if the data gathered preceded or followed their current crime levels. Lastly, there is a great deal of quantity error in the counts of police officers and in the crime rates (Sherman, 2002 p.303).Pros of Increase Police PowersEvidence shows that cities with larger police departments, which have more officers per capita than the norm, also flummox lower levels of violent crimes. Police departments that use a proactive, aggressive law enforcement style may help reduce crime rates. The methodologies of various local or federal policing firms greatly contribute the results of this reduction. As for this research that resulted in possible effects of quantitative policing, the proactive policing and aggressive policing are used, which may have bear on the diminished results of violent crimes (Siegel & Senna, 2004 p.181).According to the recent studies, it is possible that the added police will make more arrests, which is another factor that helps lower the crime rate. Traditionally about 20% of all crimes reported to the police is cleared by arrest. Research indicates that if police could make an arrest in at least 30% of all reported crimes, the crime rate would decline operatively. If there were greater police resources, police departments would have the luxury of engaging in aggressiv e, focused crime contend initiatives with the result being more arrests and a greater deterrent effect (Siegel, 2004 p.83-84).For example, UCR data show that index crimes are the ones close to often cleared by arrest. Due to the visibility of homicide in the media and the importance police agencies place on homicides clearances, homicide detectives work aggressively to clear all homicides regardless of where they occur or the individualized characteristics of homicide victims. It is possible that this aggressive approach to solving crime, spurred on by media attention to high-profile cases, has helped lower the homicide rate (Siegel, 2004 p.84).Public pressure for more police contributes to the formation of extremely necessary reforms. Collectively, these reforms provide more resources of labor for public security and focus public attention on real problems. They increase the capacity of the police to respond to crime in timely, fast, appropriate and accurate manner. Increasingl y the numbers of police on the street or those deployed to specialized directed units can also have an impact on crime. In the case of open-air drug or gun markets, when police patrol a targeted area around the clock, there is an straightaway deterrent effect (Wiatrowski & Pino, p.200).Cons of Increase Police PowersThere is no definite evidence that suggests larger police forces reduce crime rates. There is also little evidence that a policy of adding more police will actually reduce crime. In 1968, the Crime charge found that no direct coefficient of correlation existed between the number of police per thousand citizens and the crime rate. It has been labeled as doubtful that any police agency can bring about an extend, significant decrease in crime rate (Marion, 1994 p.226).Moreover, it is unlikely that the bottom will fall out of public safety if we reduce the number of police, even kind of substantially, and it is equally unlikely that crime will be reduced if we try to spend our way to safety by adding police officers. Changes in the number of police within any practicable range will have no effect on crime (Bayley, 1994 p.5). Summing up all the evidence, the authoritative Audit Commission in Britain wroteThe terms of public debate need to move off the assumption that more police officers and more police expenditures lead to a coterminous increase in the quantity and quality of police outputs (Bayley, 1994 p.5).The number of patrols in an area may be doubled, halved, or even removed altogether without changing crime levels. A review of 36 correlational studies, most of them weak in research design found little evidence that more police reduce crime rates. A recent review however, of 27 studies of the effect of police numbers on violent crime came to similar conclusions. Criminologists have assay to address this question for over a quarter of a century, with no consistent and evident results (Sherman, 2002 p.303).On the contrary, other researches tes tify that increasing the police powers of certain areas may even increase the occurrence of crime since the number of arrest is also assumed to increase as this situation occurs. In addition, military or police control may overly occur in the area and may even induce anxiety over the civilians in the area. If the number of arrested individuals increases in an area, chances are the perception of security in the given place is also affected heavily thus, criminal fear among the civilians is therefore increased (Skogan etal, p.224). According to the studies made, the increase of police powers is not even evident or justified to decrease the criminal rate hence, such intervention possesses higher risk of possible ineffectiveness.Theories and Concepts fellowship Oriented PolicingProblem solving and community partnership have become valued aspects of police service since the time of the reform era. True police professionalism must therefore incorporate the duty of servicing the community . biotic community policing can bridge the gap between police and citizens by uniting them in a commonalty effort to prevent and control crime. Community policing is the collaboration between the police and the community that identifies and solves community problems. Ideally, such collaboration helps develop better relatio9nships and mutual sagacity between police officers and community members, which in turn help in solving community problems (Glenn, 2003 p.93).It is not military-style policing with a central bureaucracy obedient to directive legislation, which minimizes discretion. It is not policing that is autonomous of policing consent and accountability. It is not policing that is committed primarily to reactive crime-fighting strategies or measured by output in terms of professional efficiency. Community policing is also essential because it is a key component of an export drive from the West in the development of new policing structures in transitional societies. In the united States, community oriented policing represents the dominant ideology of policing as reflected in a myriad of urban schemes, in funding practices, and in research publications (Brognen & Nijhar, 2005 p.1-2).Community policing deeds only if an area is flooded with police that would require hiring tremendous numbers of officers and huge amounts of spending for salaries other expenses. Critics also argue that community policing simply displaces crime to another area in which there are fewer police. However, community policing makes good political sense on a bipartisan basis and could help end the ideological battles over crime policies (Marion, 1994 p.226).Deterrence TheoryDeterrence theorists portray humans as rational, pleasure-seeking, pain-avoiding creatures. This assumption leads to a relatively simple theory of crime people will engage in criminal behavior when it brings them pleasure and carries little risk of pain. Deterrence theorists point out that penalization is mo st effective when it is swift, certain, and severe enough to outweigh the potential rewards of criminal behavior. The basis of deterrence theory-that formal punishment reduces criminal behavior-is very straightforward. Testing deterrence theory, however, is more complex. General deterrence is the proposition that increases in the certainty, severity, or swiftness of punishment produce decreases in criminal behavior for the population at large. The severity of punishment is relatively easy to measure. One could look, for example, at the average prison sentence for crimes in different jurisdictions. Studies on capital punishment, though, are by far the most common tests of this aspect of deterrence theory (Vito etal, 2007 p.57).In some point of view, punishment based on deterrence or incapacitation is wrong because it involves an offenders future actions, which cannot be accurately predicted. Punishment should be the same for all people who commit the same crime. Criminal sentences ba sed on individual demand or characteristics are inherently unfair because all people are equally blameworthy of their misdeeds. Deterrence theory holds that if criminals are indeed rational, an inverse blood should exist between punishment and crime.The certainty of punishment seems to deter crime. If people do not believe they will be caught, even harsh punishment may not deter crime. Deterrence theory has been criticized on the grounds that it wrongfully assumes that criminals make a rational choice before committing crimes, that it ignores the intricacies of the criminal justice system, and that it does not take into account the social and psychological factors that may influence criminality. The most evident disappointment for deterrence theory is the fact that the death penalisation does not seem to reduce murders. There is little evidence that harsh punishment actually reduces the crime rate (Siegel, 2004 p.84). heated Spot Theory white-hot spot theory argues that predatory crime is associated with certain types of geographical areas, such that relatively few locations or hotspots are associated with a high percentage of crimes. some of these hotspots exist in urban areas. Crimes against tourists are likely to cluster in these areas involving the concentration of tourism amenities and attractions, and therefore by implication, are likely to be higher in areas hosting special events. A transient population comprising local, domestic and international visitors increases the potential targets for crime and the individual anonymity for offenders. This is combined tendency for some tourists to decrease their safety consciousness on holiday, indulge in risk taking behavior and enter unfamiliar environment, which increases their exposure to criminal activity (Wilks & Page, 2003 p.198).Hot spot theory looks at locations, which provide convergent opportunities in which predatory crimes can possibly happen. These areas are described as crimogenic places where there are dozens of bars, nightclubs and strip joints catering to tourists and providing ancillary services such as prostitution and drugs. Some of the crime these areas generate is of course victimless crime since tourists themselves often engage in deviant actions, such as drugs that have criminal consequences (Albuquerque & McElroy, n.d p.3).