”No Hindu, No Muslim, No Christian, We are just Indian. “

Respected judges, respected teachers and dear audience. Today we gather here to celebrate one of the National festivals of India, it isRepublic day. It is a great opportunities for me, as you allowed me to share few words on this occasion.On this day, it was January 26, 1950 we declared our country as a Republic country by adopting our own constitution. Actually, thepreparation of our constitution was over earlier than this date but we choose January 26 for this, because this date has its own significance earlier than this day. It was January 26, 1930 on the bank of river Ravi, our freedom fighters pledged to attain â€Å"Sampurna Swaraj† and started new agitations to make India freedom from the British Rule. So, on 1950 on this day we declared our India as a Sovereign, Democratic and Republic.As this festival is related to our nation, it is celebrated all over our country. It celebrated in schools, colleges, government and nongovernment offices and industries. It becomes a pu blic festival as every Indian celebrates it. On the eve of this day, our honourable President gives a message to the nation. In his/her message he/she analyses the achievements of government and gives indications towards the future plans of the government towards the welfare of our country.All over the country people celebrates this festival. In national capital Delhi, there is a grand celebration. People from every corner of the country come here to participate in the grand Republic day celebration. The grand celebration occurs at the India Gate and Rajpath of New Delhi. The entire route is decorated with our national flags. Many foreign delegates also come to witness India's progress on this occasion.At the beginning of the celebration, our Prime Minister salutes the martyrs of soldiers who laid their life lives for our country on Amar Jawan Jyothi, at the India Gate. Then he moves towards the celebration†¦

The Effects of Steroids on the Human Body and Steroid Abuse

The Effects of Steroids on the Human Body and Steroid Abuse by Athletes For many years, the use and abuse of anabolic-androgenic steroids have been linked closely to athletes. Steroids come in different forms. They can be taken in pill form or injected straight into the user’s muscles by a needle. There are many sports that are associated with steroid abuse like weightlifting, basketball, and track and field. Anabolic-androgenic steroids are synthetic forms of male sex hormones, like testosterone.They speed up the growth and development process of muscles in the body. Steroids were originally developed around the 1930s in order to treat hypogonadism, which is a disease that prevents the male testes to not produce enough testosterone for its functions. Once scientists began to test steroids on animals, the same effect of increased muscle size was present in the animals. This immediately led to the abuse of steroids by body and weight lifters, and then closely followed by athletes from all kinds of different sports to enhance their performances.Whet her the user is male or female, certain sexual mannerisms of the male body will begin to produce in their body. There are several temporary and permanent side effects of abusing steroids. Temporary side effects include acne, increased breast size in men, and aggression. The sebaceous glands in the skin become inflated with excessive steroid use. Once this happens, the oils in the glands are increased which causes the skin to break out with acne. Another effect would be gynecomastia (increased breast size in men).This occurs when the body converts extra testosterone into female hormones, like estrogen, and female breast tissue is sometimes formed creating breasts on the man. Females will also experience male characteristic changes to their bodies. They might notice that their voices may be deepening because the testosterone from the steroids sends male signals to the brain. Facial hair and body hair with begin to grow rapidly on the female’s body, along with coarse skin and sh runken breasts. Both men and women will experience â€Å"roid rage† which is a heightened aggression for no certain reason.This anger can lead to irritability, stress, and violence. The long term side effects can include HIV, cardiovascular problems, stunted growth, and weight problems. HIV, not taken very seriously by must steroids abusers, is one of the most dangerous and deadliest side effects of steroids. This is because people don’t think they can get HIV even though most of the time they are sharing their needles with a numerous amount of other users. HIV could be spread from one person to another just by using one needle.Using steroids can increase one’s blood cholesterol which can lead to heart problems, heart attacks, and even strokes. The new weight of the user’s muscles puts an unnecessary strain and pressure on the heart, because it has to pump more blood to so much more tissues in the muscles. Stunted growth mainly affects teenagers going thr ough puberty because once the brain senses a certain amount of hormones in the body; it sends a message to the bones to stop growing to the teenager will most likely be shorter than the average height for their gender, ge, and weight. One last long term side effect of using steroids would be weight gain and other weight problems. People who eventually stop abusing steroids often end up having a weight problem. If they bulked up with lots of muscle, these muscles will turn to an absurd amount of fat on their body. They also have an issue with losing the excess fat because the muscles were so used to being injected with steroids. The World Anti-Doping Agency (WADA) has written a list of banned drugs that all athletes are not allowed to use to enhance their performance.The list includes steroids that can be taken orally or steroids that can be injected by a needle into the abuser’s muscle. There have been thousands of athletes that have been banned from the respective sports bec ause of doping (using steroids) while training and/or participating. Several doping scandals in the athletic world have unfortunately come up in the past. One example would be the steroid scandal of Marion Jones. She had won the 100 meter dash, 200 meter dash, and the 4Ãâ€"1 meter relay in the Sydney Olympics.Around 2005, there was an investigation to see whether she was doping or not. Marion denied ever using steroids before or during the Summer Olympics. But in 2007, she admitted in court that she lied to the investigators and two grand juries saying she had in fact used steroids during the Summer Olympics. Because of this confession, she was sentenced to six months in 2008 prison for lying to the prosecutors who were investigating her case. In an interview with Oprah, Marion Jones admitted that she most likely could have won in the Sydney Olympics without the use of steroids.Honestly, if she was confident enough to know that she was going to win without doping, what was the poin t of taking steroids in the first place? It makes me sad to hear that there are hundreds of thousands of doping scandals like this and even in other sports. If you’re good enough in what you’re doing, I think that you don’t need to over-do it by adding steroids into the mix. Marion was stripped of her gold medals from Sydney. Nowadays, WADA and other anti-doping agencies are cracking down harder on drug testing athletes several times before and after games and races.If you know you’re not good enough and you feel like you have to take steroids, don’t bother wasting your time because sooner or later someone is going to find out and you’ll end up embarrassing yourself and your family. It feels better to win knowing that all you did was work hard, keep to eating a healthy diet, and train as much as you could, instead of getting lazy and buying steroids. I understand people need to see that they are â€Å"the best† instead of just believi ng it, but there are other ways to improve your performance and do well in whatever sport you play.

History Paper

According to Pane’s account, what part did caves play in human origins? 1b. What happpened to Machochael and the men who left the cave to go fishing? If when they went out at night and was not able to return befiore the sun rose, upon seeing the light, as punishment since they were not allowed to see it, were immediately transformed into those trees that yeild plums. These grow spontaneously on that island in great quantity, without being planted. 1c. How did their acts alter the world? 1d. Why did the Taino go on pilgrimages to Iovanaboina? 1e. Why were zemis important? 2a.Pane says the Taino told him that men left the caves â€Å"without their women,† How did women come to populate the earth? 2b. Does the narrative suggest that men and women were created more or less as equals? 3a. This Taino origin story emphasizes that humann beings were â€Å"transformed† in numerous ways to shape the world. Why did these transformations occur, according to the narrative? 3b . How did theese transformations influence humans who were not transformed? 4a. In what ways is Pane’s religion evident in his account of Taino origins? 4b. Do you think Pane was a reliable recorder of Taino beliefs? c. What parts of Pane’s account, if any, seem credible to you? Why? 5a. Since Tainos † never had writing among them and everything is preserved by memory,† do you thing the stories the Taino told Pnae were credible accounts of ancient beliefs?5b. What evidence suggests that Taino believed these stories? 5c. Is there evidence that their origin narrative had ancient roots? 5d. On the other hand, is there evidence that they might have invented the narrative to please or satisfy Pane? 1a. According to this narrative how did human beings arrive in the world? b. What was the significance of the â€Å"great tree which every year bore corn used for food† and of the angry young men? 2a. Who does the narrative say created the earth, and why? 2b. W hat relationship existen between animals and the earth? 3. According to the narrative, how did human beings reproduce? Why? 4a. How did Othagwenda (Flint) and Djuskaha (Little Sprout) differ? 4b . Why were those differences important? 5a. Who does the narrative identify as God? 5b. What difference did it make? 1. According to Genesis, how and why did God create the world? 2.Were plants, animals, and human beings in this account more or less equal in God's eyes? No they were not equal. God said have dominion over the fosh of the sea, and over the fowl of the air, and over ever living thing that moveth upon the earth. 3. Why did God command human beings to â€Å"Be fruiful, and multiply, and replenish the earth, and subdue it: and have dominion†¦ over every living thing that moveth upon the earth†? 4. Did God make different demands on men and women? Why? 5a. Why did God forbid Adam and Eve to eat from the tree of the knowledge of good and evil? 5b.Why did they disobey God? 5c. How did God punished them? 6. How might the Genesis account of human origins have influenced Europeans as they encountered peoples in Africa and the New World? 1a. According to Aristotle, why were some people â€Å"natural slaves†? 1b. Who were these people? 1c. Why was slavery for them natural? 1d. Why was slavery â€Å"beneficial and just† for them? 2a. How would you argue against Aristotle's defense of natural slavery? 2b. Did he make false assumptions? 2c. Were his arguments illogical? 2d. Can you argue against his view starting from his assumptions? How? 3a.To what extent did Aristotle believe that it was good and just for vitors in war to enslave their captives? 3b. Was slavery for Aristotle anything other than the superior power of the master over the slave? 3c. What arguments did Aristotle make against the claim that â€Å"all slavery is contrary to nature†? 3d. Do you find his arguments convinving? Why or Why not? 4a. How did the relation of master to slave differ from that of man to woman, husband to wife, parent to children, and statesman to citizens, according to Aristotle? 4b. In what sense were â€Å"all housholds†¦ monarchically governed†? c. Since Aristotle argued that â€Å"the relation of male to female is naturally that of the superior to the inferior, of the ruling to the ruled,† would he claim that women were natural slaves? 1a. What are the major differences and similarities among these creation myths? 1b. How do their views of human beings compare to Aristotle's? 2a. The creation narratives descibe a world before humans existed. To what extent were humans a force for good in the world? 2b. How did humans' power compare to that of nature of zemis or the creator? 2c. Did Aristotle's views differ? If so, how and why? 3a.How do the views of women and men in the creation my ths compare to Aristotle's views? 3b. What do they reveal about gender roles and expectations among Native Americans and Europ eans? 4. Because the creation narratives and Aristotle's Politics originated in oral rather than written communication, to what extent can these documents be accepted as expressions of the views of common folk among the Taino, the Seneca, and Christians? 5. To what extent might the creation myths and Aristotle's views about masters and slaves have influenced the begavior of Native Americans and Europeans when they encountered one another?

Celluar pathology Assignment Example | Topics and Well Written Essays - 3000 words

Celluar pathology - Assignment Example By studying the density of blood vessels resulting from evaluation (Nico et al. 2008). Nico in particular describes the issue of micro vessel or microvascular density as being the gold standard with respect to the morphological assessment of angiogenesis in In addition to describing the physiological mechanisms, It is also possible to make generalizations concerning high levels of angiogenesis and specific types of carcinomas, specifically cancers of the prostate or the breasts – characterized by high levels of micro vessel formation. Considerable research has been devoted to the characterization of breast cancer, with confirmation of the importance and predictive power of angiogenesis in the tumorigenesis process. There is considerable support for the utility of micro vessel density analysis as a predictive methodology for these tumors, with historic evidence that angiogenesis precedes the malignant transformation of mammary cells into fully cancerous carcinomas arising from relatively benign papillomas. (Srivastava et al. 1988). There is little doubt that higher rates of angiogenesis do indeed correlate with the emergence of certain tumors, but at present the connection may not be absolute: breast cancer studies indicate that lesions with the highest amount of micro vessel density do carry the greatest risk of breast cancer, but it is not entirely certain whether there is an absolute threshold of density that transfection of cancerous tissue with factors antagonistic to angiogenesis decrease the probability of further growth and malignancy (Miller & Sledge, 2003). This is compelling evidence describing particular mutation of a particular oncogene. As cells continuously grow and divide in the millions over many years, each replication event creates a probability that the right (or wrong) mutation will occur in cells that already carry some growth irregularities. If this chain of mutations is not counteracted by surgical or curative methodologies, then

Ethics, Morals, and Criminals Research Paper Example | Topics and Well Written Essays - 1500 words

Ethics, Morals, and Criminals - Research Paper Example A few examples to mention could be company ethics, professional ethics, family ethics, or school ethics those who are participants in such establishments or institutions should have to adhere to. The outcome of such outlook is individual moral codes or values do not change often, while ethics can change depending on what the particular participation of individuals are. Accordingly, what ethics refers to is right way and wrong way of doing things or acceptable and unacceptable behavior in a given setup such as a workplace. Sources such as Josephine had what he called the Six Pillars individuals can use to improve their ethical approach when they make decisions. These Pillars are trustworthiness, respect, responsibility, fairness, caring, and citizenship. Keeping them in mind while making decisions will enable individuals to harbor an ethical approach all the time. Individuals could also learn ethical norms starting from their own homes and then can capitalize on what they encounter in schools, churches, and eventually in the various social settings they could participate in. This means that individuals will start to make themselves familiar with what is right and wrong starting from their childhood. ... The reason for that could be the action might have overridden the legal rules that are put in place to govern individual behavior. However, ethics and moral are much broader than laws introduced by a given body such as a government and ethics and moral values are different from laws. The reason for that is a given action might be considered to be adhering to what the law requires, but when looking at the end result it is possible to find out it was unethical and vice versa where some actions might be illegal, but ethical. This kind of approach might be applicable in organizations where it is possible to engage in unethical behavior in order to benefit oneself or through a process of carrying out one’s duty when, for example, a medical practitioner carries out abortion some consider to be unethical or when a criminal lawyer has to defend a criminal that he or she knows could have committed a given crime, simply because their professional ethics require them to do so. There is a lso an outright criminal activity that could take place at workplace where at a higher level some company or government officials would decide to benefit themselves wrongfully by breaking company ethics codes or government regulations and policies. At a lower level employees could engage in larceny that will force them to break the law, as well as break the ethical code of the company they work for that forbids such activity, while at the same time they disregard their own moral values. Criminals When it comes to those labeled as â€Å"common criminals† the reason behind their action is more complicated than applying the rules of ethics and moral, because some of them, for various reasons explained below might not even be aware of the existence of

Collective bargaining Term Paper Example | Topics and Well Written Essays - 3000 words

Collective bargaining - Term Paper Example However, in the modern era of 21st century, he is well informed about his rights. Some researchers are of the view that, the legislation of collective bargaining has adversely affected the efficiency of the organization in America; because of this reason, China and other surrounding countries have a cost advantage due to their economical labor. On the other hand, human rights organizations played a prominent role in compelling US government to devise laws supporting employees’ rights. The major areas in which these laws apply are minimum wage rate, safety, and right to have emergency leave when required. This paper will analyze the level of practical application of these laws within American society. The four compulsory issues that should be resolved via process of collective bargaining are 1) Wage Rate 2) Holidays 3) Insurance 4) Performance Management. Following is the brief description of these components. Wage Rate Compensation should be disclosed by the management of the organization, in front of the chosen representatives of the labor union. At the same time, union leaders should accept these remunerations, prior to their implementation. Holidays The weekend comprising of two holidays is mandatory for any organization under US federal labor law. On the other hand, leaves should also be provided to employees in case of illness and emergency. The nature of these leaves should be decided through mutual consent between management and union leaders. Insurance Organizations are supposed to provide health and life insurance to their employees under labor act 1947. Nevertheless, employees have a right to forego this facility, in exchange to a higher pay. Timing Management and union are expected to decipher, the regular timings dedicated to organizational operations on daily basis, they must also decide the mechanism and level of compensation in case of over time. Performance Management Managers should also present a detailed mechanism of performance manage ment in front of the employees; on the other hand, the basis of promotion must be clarified prior to the employment. Literature Review This section is been dedicated to analyze existing literature on the topic of collective bargaining. The most important ingredient to foster, the process of collective bargaining is honesty (Adelhelm). Management must take some sober steps towards, facilitating the employees, through providing them a friendly working environment. At the same instance, the ability of the labor-law enforcement agencies, to implement the laws developed; to help employees to spend a smooth life is critical (Estlund). However, these practices are not implemented in an above-mentioned manner, because a new employee has to accept, the prevailing environment in the organization, therefore, there is a little opportunity for him to decide the terms of the employment. Nonetheless, these laws permit workers to halt working, over an issue of wage rate, with the management, but go vernment also gave the right to organizations, that they can replace their workforce, after paying numeration to these workers, according to the terms and conditions of employment contract (Singh and Jain). This observation illuminated the fact that organizations have the right to terminate troubling employees. Along with this, the biasness of law towards organizations is also highlighted, because legal environment blessed the commercial entities, with the power of eliminating employment of their

LM1 Assignment Example | Topics and Well Written Essays - 1750 words

LM1 - Assignment Example This is also evident as the book looks at how the public servants interact with each other in the organization and outside the organization (Denhardt, 2013). â€Å"This book is about human behavior in public and non profit organizations, schools, and healthcare organizations. Its purpose is to provide information and perspective that enhance our understanding of our own behavior and our ability to influence the behavior of others† .pg 1 The goal in this book is to look at factors which affect behavior of workers in any public organization. It also looks at how these factors affect practices in these administrations. This book also tries to examine modern-day approaches to management and leadership. Its goal is also to increase an understanding of the main behavioral principles which base the personal, interpersonal and public leadership skills. It tries to develop an appreciation on the importance of analyzing management issues at the point of an individual’s behavior and how this can influence action and analysis at the organizational level. â€Å"†¦To develop an appreciation of the value of analyzing management problems from the standpoint of individual behavior and how that perspective can augment action and analysis at the organizational level†. pg2 Cognitive knowledge is the mental process of knowing that includes awareness, judgment and perception reasoning (Denhardt, 2013). Cognitive knowledge of basic techniques is the first level of development skill in any area. However, this works well in combination of behavioral skills as people need these skills to enable them accomplish the technical moves. â€Å"The first level of skill development in any discipline involves cognitive knowledge or an intellectual understanding of the basic technical skills that the discipline requires†¦ But cognitive understanding alone is not enough. People also must develop the behavioral

HR in Service Industry Assignment Example | Topics and Well Written Essays - 4000 words

HR in Service Industry - Assignment Example The human resource department is held accountable for making sure that the job of administration in the company is performed in a manner that is relevant and that the operations of the company are in line with the law that governs the running of the business in the country of base. This will ensure that the company does not run in to trouble with the authorities over illegal running of the business and that they are not hiring employees in a way that does not relate with the law. The human resource department in the organization gives provision for incentives like promotions to employees by evaluating their work, it ensures the safety of the employees and the procedure that information in the company flows is guarded and follows certain guidelines, the human resource department caters for employees who are on vacation or who are sick, the department ensures that they are replaced for the time being and that their work is done properly (Goeldner, 2009 p89). This kind of human resource management is a highly active method of managing people in an organization. It needs the human resource managers to be able to think ahead of all employees and other personnel in the company. The managers in this unit are needed to be able to do better planning and come up with methods to grow the organization, to be able to design methods to satisfy the needs of the employees to ensure that they are able to work well without second thoughts about working in the organization. The human resource managers also ensure that the employees of the company are able to discharge their duties properly by being able to hire people who know how to discharge their duties and being able to train the employees so that they will discharge the duties of the organization properly. The strategy that the human resource managers will use in ensuring the employees add value to the organization will determine how business is carried out in the organization. This will also affect the value of the organiza tion. All the organizations that manage to meet the requirements and the needs of their employees are able to cultivate an atmosphere in the work site that will result in to exceptionally enjoyable productivity. The human resource department is the best place to start ensuring that the needs of the employees are well catered for. By being able to incorporate strategies that will result in to better productivity in the company the company will have to invest well in its dealings and all that work that it is required to do to make sure that the needs of the employees are satisfied. The company should come up with methods of ensuring that they are able to retain all the skilled employees and be able to train other skilled employees to ensure that they are capable of helping the company to be profitable. By doing this, the hotel will be able to retain several of its employees; this will in turn make sure that the company will not spend more money on hiring of and training the new employ ees to the level of performing. When the human resource department starts to plan, they have to consider on what the employees need are and

Combahee River Collective Essay Example | Topics and Well Written Essays - 250 words

Combahee River Collective - Essay Example Furthermore, they were committed to working on issues such as abortion rights, rape, sterilization abuse, rape and battered women. Pertaining to Black Nationalism, the collective affirmed its involvement in movements that were involved in the liberation for the Blacks. However, the black feminists asserted that they were disillusioned by the tactics employed by such movements in attaining their goals. Evidently, the collective noted that the politics in such movements were mainly racist and anti-sexist in nature. In relation to socialism, the collective asserts their belief in work being organized for the collective benefit of the workers and not solely for profit for the bosses. Moreover, the collective reiterates the equal distribution of material resources among those who create them. The collective was strongly in opposition to lesbian separatism as advocated by white females. On the contrary, it called for unity among all black feminist irrespective of sexual

Cisco Australia Case Study Example | Topics and Well Written Essays - 3000 words

Cisco Australia - Case Study Example The company could well be on its way to wearing Australia's best employer crown. So what is Cisco all about Cisco, which was founded in 1984 by two computer scientists from Stanford University, began life as a manufacturer of routing systems. Since it sold its first router in 1986, the company has more than lived up to its vision of 'Changing the Way We Live, Work, Play and Learn'. Apart from its core development areas of routing and switching, Cisco has now branched into various technology-related fields like IP communications, wireless LAN, home networking, application networking services, network security, storage area networking and video systems. The company, which has its corporate headquarters in San Jose, California, soon became one of the leaders in the global networking industry with a presence in over 115 countries. Today, it has a 47,000-strong employee base. Using the acquisition-partnership route, Cisco managed to make inroads into multiple fields. Today, Cisco's products provide solutions to a wide range of customers from business enterprises like corporations and government agencies to educational and research institutions. In 1994 Cisco set up base in Sydney, Australia, which was one of the company's first operations outside the United States. Today, Cisco Australia operates from around six cities and has over 600 employees on its payrolls. Australia is home to the company's Asia Pacific Technical Assistance Centre and Customer Assurance Group. Here's a list of the awards that the decade-old Cisco Australia won: Prime Minister's Award for Community Business Partnerships in August 2001. No 1 in the Hewitt Associates survey "Best Employers to Work for in Australia" in the under 1,000 employees category in 2002 and 2003 MAS National Award for Corporate Citizenship at the 2005 Australian HR Awards. [B(1.1)] Does Cisco Fit The New Workplace One of the main reasons for Cisco's almost meteorical rise to success was its ability to adapt to the new work order. Around 15 years ago, the same time that Cisco began operations; the new workplace became an important word in management parlance. Computers and the Internet were changing the way the world worked. Managers realized they needed to implement solid workplace strategies, to provide the infrastructure for enabling global, 24x7 work processes and remote collaboration "anytime, anyplace." (Aperture Technologies 2006, online ) This 'anytime, anyplace' strategy proved extremely beneficial for both organizations and their employees. It gave them considerable freedom, as they could now be mobile and work from just about anywhere. Freed from geographical and time constraints, an organization's managers could employ qualified people from just about anywhere in the world. A look at Cisco's growth graph during the past 20 years shows that in just over a decade, the company had spread its wings across continents. It managed to get the best in terms of qualified employees and a bigger customer base. A downside of this new workplace was that it put a strain on the companies' infrastructure and also affected workplace dynamics. This meant that enabling and empowering employees with a superior workplace was of paramount importance to the

The State of Occupational Injury Management in Our Organization Essay Example for Free

The State of Occupational Injury Management in Our Organization Essay

The Glands Menagerie Essay Example for Free

The Glands Menagerie Essay A Streetcar Named Desire was written by Tennessee Williams in 1947, eliciting the most critical commentary of any of his works, as well as being highly divisive: upon its release, one reviewer defined it as the product of an almost desperately morbid turn of mind1; George Jean Nathan criticised the unpleasant2 nature of the play, calling it The Glands Menagerie'3. Williams focus on realism, and the subsequent omission of clear-cut protagonists and antagonists in Streetcar, also drew glowing reviews, from the pre-eminent theatre critic Brook Atkinson, for example, who called Williams a genuinely poetic playwright whose knowledge of people is honest and thorough4. This difference in opinion does not stop at subjective criticism of the play, but even the specific genre which Streetcar falls into. Many assume it to be a tragedy of some type, and there is indeed much to commend this view. However, the ambiguous nature of many aspects of the play and Williams inclusion of alternate dramatic devices has led many to believe that Streetcar should not be classified as a tragedy, but as a melodrama. In any tragedy, the tragic protagonist is of vital importance: everything is centred on the protagonist, their flaw and subsequent downfall. However, in Streetcar, there is large uncertainty as to who this tragic protagonist actually is. This equivocacy may be observed in the difference in artistic opinion between the plays original director, Elia Kazan, and the plays second director, Harold Clurman. Elia Kazan was a close friend of Tennessee Williams, who told him to ensure that Blanche (had) the understanding and compassion of the audience without creating a black-dyed villain in Stanley5. Indeed, from his directors private notebook, published in 1976, it is clear that Kazans sympathies lie with Stanley, who he sees as defending his household against the corrupting influence of Blanche: for instance, Stanleys seemingly crude violation of Blanches belongings in an attempt to find legal papers and his later physical violation of her person would have been justified in Kazans eyes, as the social incorrectness of Blanches intrusion into his domestic kingdom and subsequent undermining of his authority and values (Well if youll forgive me hes common! He acts like an animal Stanley Kowalski survivor of the Stone Age! , Dont hang back with the brutes! ) outweighs the respective incorrectness of his retaliatory actions (Come to think of it maybe you wouldnt be bad to interfere with ). As such, Kazans direction dictated that Stanley be the victim of Blanches actions. It was even reported that some members of the audience cheered the rape of Blanche in Kazans production, with critic Signi Falk noting the waves of titillated laughter (which) swept over the audience 6. In direct opposition to Kazan, Clurman reallocated the role of victim to Blanche, positing that Streetcar portrays the crushing of sensitivity (Blanche) by brute force (Stanley), therefore portraying the rape as such instead. These contradictory interpretations illustrate the crucial problem in labelling Streetcar as a tragedy, at least in a strictly Aristotelian sense: there is no singular, defined hero or heroine, both can be interchangeably depicted as victim or antagonist. There is even discussion as to whether Stanley and Blanche represent either. Williams himself seems to support this: I dont want to focus guilt or blame on any one character but to have it a tragedy of misunderstanding and insensitivity to others 7. This has only confirmed the ambiguous nature of the play, fuelling and perpetuating the uncertainty surrounding it and taking it even further away from the Aristotelian tragic ideal. Additionally, Aristotle dictated that tragedy should chart the demise of a great person, as he argued that their cataclysmic downfall due to hamartia would evoke higher pathos in the audience; Williams focuses instead upon the demise of people in the dregs of society, ensuring that there is no way that Streetcar could possibly be considered to be a strictly classical tragedy. However, it is still possible to identify aspects of classical tragedy in Streetcar, which further heightens the vagueness surrounding the genre which Streetcar finds itself in. There is, for example, evidence of anagnorisis leading to peripateia, a tragic device which Aristotle considered to be the mark of a superior tragedy: In Scene Three, after Stanley beats Stella and realises the error of his ways, he breaks into sobs and telephones Eunice, who has taken Stella in, in an attempt to talk to (his) baby, to no avail. This is arguably Stanleys lowest point, as Stanley has alienated Stella, leading to one of the iconic moments in American drama: Stanleys heaven-splitting cry of STELLL-AHHHHH! an outburst of animal desperation. This moment, then (if Streetcar is considered to be a battle between Blanche and Stanley for Stellas affections), is a victory for Blanche. However, in Scene Ten, the roles are reversed: Blanches telephone call for help is unsuccessful, and she is arguably at her lowest point of the play here, as Stanley shatters all her illusions and pretensions (Not once did you pull any wool over this boys eyes! ), uncovering her multitude of lies, which makes Blanche face the reality of the threat Stanley poses to her (i. e. anagnorisis). So, while it is plain that Streetcar is by no means a classical tragedy, it does include facets of tragedy as defined by Aristotles Poetics. There is perhaps a more credible case for Streetcar being a tragedy in a slightly broader sense: that is to say, encompassing the characteristics of modern domestic tragedy. Arthur Miller summed up the essence of domestic tragedy in his work Tragedy and the Common Man: It is time, I think, that we who are without kings, took up this bright thread of our history (tragedy) and followed it to the only place it can possibly lead in our time the heart and spirit of the average man 8. The conclusion of Brook Atkinsons review of the opening night reflected this sentiment: Out of poetic imagination and ordinary compassion (Williams) has spun a poignant and luminous story9. Miller argued against the Aristotelian ideals concerning tragedy: where Aristotle believed tragic heroes had to be of high social standing (for reasons above stated), Miller proposed that tragic heroes could be formed out of the working classes. Domestic tragedies of this nature became popular in the 19th and 20th centuries as a result of writers such as Miller, portraying the breakdown of a social construct, emphasising the distortion and destruction of domestic order. Streetcar could, then, be construed as a domestic tragedy, as it portrays the demise of the social system from the old agrarian South (as represented by Blanche) and the rise of the post-war urban industrial society (as represented by Stanley). Furthermore, Streetcar concerns the fates of Blanche and Stanley in the main, Stanley being irrefutably lower class; although Blanche is not as straightforward to categorise according to class, at the beginning of the play, Blanches demise has already occurred: she has already fallen from her previously high status, having lost her estate and fortune. Therefore, although Streetcar charts her descent into insanity, it does not show her fall from a high position in society, again rejecting the Aristotelian norm. It therefore seems as though Streetcar could easily be defined as a domestic tragedy, a judgement Dan Isaac agrees with: Streetcar is a modern tragedy, and Blanche DuBois tragic flaw is hubris pride of intellect and pride of sexual prowess10 If one tragic hero can be singled out, then it is possible to find their personal hamartia, and Streetcar becomes a domestic tragedy with aspects of classical tragedy. However, one prominent feature of Streetcar has yet to be introduced into the debate, and that is the huge emphasis on melodrama and expressionism.

Analysis of Infosys Technologies Limited

Analysis of Infosys Technologies Limited Infosys Technologies Ltd. was inaugurated in 1981 by seven people with US$ 250. Today, it is a global leader in the ‘next generation of IT and earning revenues of US$ 6.04 billion. Infosys designs, defines and delivers technology-enabled business solutions for Global 2000 companies. Infosys provides a complete range of services by leveraging its dominion and business expertise and strategic alliances with leading technology providers. The objective of this assignment is analysis of Infosys Technologies Limited which provides consulting and IT services. Infosys has been the first one in this field to offer innovative solutions to its clients. The company offers ample range of software services, namely application development and maintenance, independent validation services, infrastructure services, corporate performance management, packaged application services and product engineering and systems integration. Infosys established the Global Delivery Model (GDM), which emerged as a disturbing force in the industry leading to the rise of offshore outsourcing. The GDM is based on the formula of taking work to the site where the best talent is available, where it makes the best economic sense, with the least amount of acceptable risk. Infosys has a world-wide footprint with 64 offices and 63 development centers in US, India, China, Australia, Japan, Middle East, UK, Switzerland, Germany, France, Netherlands, Poland, Canada and many other countries. Infosys and its subsidiaries have 130,820 employees working with it as on March 31, 2011. Infosys takes delight in building strategic long-term client relationships. EVALUATING THE ENVIRONMENT EXTERNAL ENVIRONMENT PESTLE ANALYSIS PESTEL ANALYSIS: There are many features in the macro-environment with the intention of the conclusion of the executive of several organizations. PESTEL ANALYSIS OF INFOSYS TECHNOLOGIES LTD. The PESTEL analysis of Infosys Technologies Ltd. is as follows: (P)olitical While discussing PESTEL analysis of Infosys Technologies Ltd. firstly I discuss political aspect of PESTEL analysis of Infosys Technologies Ltd. As part of the countrywide movement and revolutionize, Infosys Technologies Ltd. is immediately one pattern of dense that are triumphant in equally types of business that is familial and worldwide commerce (2003). The positive aspects of the political analysis of Infosys Technologies Ltd. are that Indian political structure is considered stable enough expect the fact that there is a fear of hung parliament. Government owned companies and PSUs have decided to give more IT projects to Indian IT companies. The negative aspects of the political analysis of Infosys Technologies Ltd. are that U.S. government has declared that U.S companies that outsource IT work to other locations other than U.S. will not get tax benefit and terrorist attack or war. (E)conomic While discussing PESTEL analysis of Infosys Technologies Ltd. secondly I discuss economic aspect of PESTEL analysis of Infosys Technologies Ltd. The positive aspects of the economic analysis of Infosys Technologies Ltd. are that Domestic IT Spending(Demand): Domestic market to grow by 20% and reach approx USD 20 billion in 2008-09 NASSCOM. Decline in real estate prices has resulted reducing the rental expenditures and due to recession, the layoffs and job-cuts have resulted in low attrition rate. Along with that economic attractivenessdue to cost advantage and other factors is also a positive factor. The negative aspect of the political analysis of Infosys Technologies Ltd. is of global IT spending trends. (S)ocial While discussing PESTEL analysis of Infosys Technologies Ltd. secondly I discuss economic aspect of PESTEL analysis of Infosys Technologies Ltd. The positive aspects of the economic analysis of Infosys Technologies Ltd. are that English is widely spoken language in India, English medium being the most accepted medium of education. Thus, India boasts of large English speaking population.Regarding educationa number of technical institutes and universities over the country offer IT education are there and working age population is also a constructive societal factor. (T)echnological While discussing PESTEL analysis of Infosys Technologies Ltd. secondly I discuss economic aspect of PESTEL analysis of Infosys Technologies Ltd. The positive aspects of the economic analysis of Infosys Technologies Ltd. are telephony that is India has the worlds lowest call rates (1-2 US cents). India expected to have total subscriber base of about 500 million by 2010. ARPU for GSM is USD 6.6 per month. India has the second largest telephone network after china. Tele-density 19.86 %. Indian technology also give a chance to enterprise telephone services, 3G, Wi-max and VPN are poised to grow. Another positive aspect of Indian technology is the Internet Backbone. Due to IT revolution of „90s, Indian cities and India is well connected with undersea optical cables. Along with that new IT technologies like SOA, Web 2.0, High-definition content, grid computing, etc and innovation in low cost technologies is presenting new challenges and opportunities for Indian IT industry. (L)egal While discussing PESTEL analysis of Infosys Technologies Ltd. secondly I discuss economic aspect of PESTEL analysis of Infosys Technologies Ltd. The positive aspects of the economic analysis of Infosys Technologies Ltd. are that IT SEZ requirement ofIT companies can set up SEZ with minimum area of 10 hectares and enjoy a host of tax benefits and fiscal benefits. Contract / Bond requirements: Huge debates surrounding the bonds under which the employees are required to work, which is not legally required. IT Act like Indian government is strengthening the IT act, 2000 to provide a sound legal environment for companies to operate esp. related to security of data in transmission and storage, etc.Companies operating in Software Technology Park (STPI) scheme will continue to get tax-benefit till 2010. (E)nvironmental While discussing PESTEL analysis of Infosys Technologies Ltd. secondly I discuss economic aspect of PESTEL analysis of Infosys Technologies Ltd. The energy efficient processes and equipments that companies are focusing on reducing the carbon footprints, energy utilization, water consumption, etc. PORTERS FIVE FORCES MODEL (INDIAN IT INDUSTRY) Threat of Substitutes: While discussing the Porters analysis of Infosys Technologies Ltd. the very first point of discussion is threat of substitutes. Regarding threat of substitutes other offshore locationssuch as Eastern Europe, the Philippines and China, are emerging and are posing threat to Indian IT industry because of their cost-advantage. However, this should have an impact only in the medium to long term. Along with that pricequoted for projects is a major differentiator, the quality of products being same. Bargaining power of supplier: While discussing the Porters analysis of Infosys Technologies Ltd. the second point of discussion is bargaining power of supplier. Due to slowdown, the job-cuts, the layoffs and bleak IT outlook and supply of IT professionals is no longer that favorable to employees. Availability of vast talent pool that is fresher and experienced is also increase buying power of supplier. Bargaining Power of Customers: While discussing the Porters analysis of Infosys Technologies Ltd. the third point of discussion is power of buyers. Large number of IT companies vying for IT projects resulting in high competition for projects. On the other hand huge decline in IT expenditure: Indian IT sector is dependent on USA and BFSI in particular for majority of its revenues, and with the recent financial crisis, the new spending from these has reduced tremendously. However, for the existing products and services, the clients continue the old companies. Barriers to Entry: Low While discussing the Porters analysis of Infosys Technologies Ltd., the next point of discussion is a new entrant that isLow capital requirements and large value chain which provide space for small enterprises. Along with that MNCs are ramping up capacity and employee strength. Rivalry among Firms: High While discussing the Porters analysis of Infosys Technologies Ltd., the last point of discussion is rivalry among firms.Commoditized offerings, ‘low-cost, little-differentiation positioning, high industry growth and strong competitors like few numbers of large companies. SWOT ANALYSIS OF INFOSYS (S)TRENGTHS Leadership in sophisticated solutions that enable clients to optimize the efficiency of their business. Global and 24/7 delivery capability excellent internet backbone and telecommunications facilities enabling companies to develop 24/7 delivery capabilities from India itself Commitment to superior quality and process execution Infosys has quality standards such as CMM Level 5i to differentiate from other competitors Strong Brand and Long-Standing Client Relationships Status as an employer of choice Ability to scale Innovation and leadership. Cost advantage Presence of Infosys in India is key to its success Breadth of service offering end to end solutions including high end services like IT consultancy and KPO. (W)EAKNESSES Excessive dependence on US for revenues 67 % of revenues from USA. Excessive dependence on BFSI sector for revenues 36 % of revenues from BFSI. Banking sector is facing a crisis globally and is going to spend less on IT. Weak player in domestic market. Only 1 % of revenues from India low as compared to peers Low R D spending as compared to global IT companies only 1.3 % of total revenues Rising wage bill 42.9 % to 44.8 % of revenues Low expertise in high end services like Consultancy and KPO. revenues to be hit hard for Infosys High rates of attrition Although slowdown in global economy has lowered attrition rate but the industry still faces high attrition rates as compared to other sectors. Decreasing competitive advantage rising salary expenses is taking away the cost advantage enjoyed by Indian companies (including Infosys). (O)PPORTUNITIES Domestic market set to grow by 20%. Expanding into new geographies Europe, Middle East, etc Infosys is cash rich (Around US $ 1 Billion) Acquiring companies to increase expertise in Consultancy, KPO and package implementation capabilities Opening offices and development centers in cost advantage countries such as those in Latin America and Eastern Europe. (T)HREATS Intense competition in the market for technology services could affect cost advantages. High dependency on a small number of clients, and the loss of any one of the major clients could significantly impact business. Termination of Client contracts can typically be terminated without cause and with little or no notice or penalty. Global economic slowdown may continue for several years hence low IT spending globally. US Govt. against outsourcing. Shrinking margins due to rising wage inflation. Rupee-dollar movement affects revenue and hence margins. Increased competition from foreign firms like Accenture, IBM etc. Increased competition from low-wage countries like China, Indonesia etc. INFOSYS BCG MATRIX INDIA The Boston Matrix catalog occasion in collection which is total 4 groups, exposed on corporation of Market Growth and Market Share: BCG MATRIX ANALYSIS OF INFOSYS TECHNOLOGIES LTD: Dogs: While discussing BCG Matrix for Infosys Technologies Ltd firstly Dogs are discussed. When market share as well as market growth both are low then the circumstances is known as dogs. If we apply this on Infosys Technologies Ltd none is applied under dogs. Cash Cows: While discussing BCG Matrix for Infosys Technologies Ltd. secondly cash cows are discussed. When market share is high and market growth is low then the situation is known as cash cows. Here, Infosys Technologies Ltd is this situation is applied on maintenance application and development software products. Stars: While discussing BCG Matrix for Infosys Technologies Ltd. thirdly Stars s are discussed. When market split and market enlargement both are high then the situation is known as stars. Here Infosys Technologies Ltd.BPO is come under stars. Question Marks: While discussing BCG Matrix for Infosys Technologies Ltd. fourthly and finally question marks are discussed. When market share is low and market growth is high then the situation is called question marks. Question marks are also known as problem child. Consulting KPO and package information are considered as question marks here. McKinseys 7 S Model Strategy Infosys has adopted a client-focused strategy to achieve growth. Rather than concentrating on numerous small organizations, it concentrates on limited number of large organizations globally. In order to gratify its clients, the company stresses on custom-built software. Another contrasting factor for Infosys is that it commands premium margins. Company does not adjusts over margins beyond a certain point and sometime prefers to walk-out rather than compromise and adjust on quality for low-cost contracts. This has helped in establishing an image for quality driven model rather than cost-differentiating model. Increase business from existing and new clients Expand geographically Enhance solution set: Stresses on emerging trends, new technologies, specific industries and pervasive business issues. Develop deep industry knowledge Enhance brand visibility Pursue alliances and strategic acquisitions Leadership Style Infosys believes that leadership is one of the most primary and essential ingredients of organizational success which is provided by its Chairman, N R Narayanmurthy. Leadership is based on high business vision and prevailing supportive styles. There is attention on developing leadership qualities among employees. For this purpose, it has constituted â€Å"Infosys Leadership Institute†. Top management lays stress on open door policy, continuous sharing of information, takes inputs from employees in decision making, and builds personal empathy with employees. Staff (Human Resources) Since Infosys is in knowledge-based industry, it focuses on the quality of the human resources. Out of total employees of the organization, about 90 per cent are engineers. At the entry level, it lays stress on selecting candidates who find the companys meritocratic culture satisfying, superior academic records, technical skills, and high level of learn ability. The company also stresses on training and development of its employees on constant basis and spends about 2.65 per cent of its profits on up gradation of employees skills, and around 50% as employee costs. Shared Values Values are essential part of Infosyss organizational culture. In fact its tagline characterizes how much emphasis it lays on basic values. The basic values are: Customer Satisfaction: A commitment exceeding customer expectations. Leadership by Example: A commitment to set principles in business and transactions and be an exemplar for the industry and teams. Integrity and Clarity: A commitment to be worthy, sincere and open in our dealings. Fairness: A commitment to be impersonal and transaction-oriented, thereby earning trust and respect. Quest of Excellence: A commitment to strive continuously, to regularly improve ourselves, our teams, our services and products so as to become the best. Organizational Structure The company has adopted a free form organization devoid of hierarchies. Everyone is known as assistant irrespective of his position in the company. Software development is undertaken through teams and the content of teams is based on the principle of flexibility. A member, who might have been team leader in one project, may be substituted with another member of the same team for another project. This system not only helps in developing the feeling of equality but also helps in developing project leaders. Skills From last year, Infosys has made it mandatory for every employee to clear a predefined certifications, domain as well as technical, in order to be eligible for appraisal. This is just one of the initiatives taken by Infosys which signifies the efforts taken for building competencies. Apart from internal initiatives like knowledge management, Infosys has been CMM-Level 5 certified for its process capabilities. Infosys has entered the Balanced Scorecard Hall of Fame for Executing Strategy for achieving breakthrough performance results using the Balanced Scorecard (BSC). GRAND STRATEGIES Ansoffs Matrix: Current Market New Market Current Product Market Penetration Strategy Market Development Strategy New Product Product Development Strategy Diversification Strategy MARKET PENETRATION STRATEGY: Current Markets: While discussing market penetration strategy the first point of discussion is current markets. For Infosys Technologies Ltd current markets are USA and Europe. Products: While discussing market penetration strategy the second point of discussion is products. For Infosys Technologies Ltd products are ADM, BPO, KPO, consultancy services (in BFSI, manufacturing and retail) and software products (financial products). Recommendation: While discussing market penetration strategy the third point of discussion is recommendation. For Infosys Technologies Ltd as most large clients in US and Europe are cutting costs, Infosys needs to be more aggressive on cost and quality front. Result of strategy: While discussing market penetration strategy the last point of discussion is result of strategy. For Infosys Technologies Ltdthe result of strategy is unlikely to yield good results. MARKET DEVELOPMENT STRATEGY: New Market: While discussing market development strategy the first point of discussion is new markets. For Infosys Technologies Ltd new markets are India, Middle-east and Australia. Current Product: While discussing market development strategy the second point of discussion is current product. For Infosys Technologies Ltd current products are ADM, BPO, KPO, consultancy services (in BFSI, manufacturing and retail) and software products (financial products). Recommendation: While discussing market development strategy the third point of discussion is recommendation. For Infosys Technologies Ltd current markets since these are fast developing IT market, Infosys needs a paradigm shift in focus from US and EU markets to these markets. Result of strategy: While discussing market development strategy the fourth point of discussion is result of strategy. For Infosys Technologies Ltd current markets are likely to yield good result. PRODUCT DEVELOPMENT STRATEGY: Current Market: USA and Europe New Product: Consultancy and package implementation services in relatively growing sectors esp. healthcare, life sciences and aviation sector, and KPO services. Recommendation: Concentrate on building expertise in these domains by strategic acquisitions. Result of Strategy: Likely to have good result. (Better the company acquired, the better the result). DIVERSIFICATION: New Market: India, Middle-east and Australia New product: Consultancy and package implementation services in relatively growing sectors esp. healthcare, life sciences and aviation sector, and KPO services. Recommendation: Changing Brand image from low value service provider to high value service provider. Result of Strategy: Difficult to achieve overnight (possible in long term). OTHER STRATEGIES: CONCENTRATION: 90% of Infosys revenues from American and European nations. VERTICAL INTEGRATION: Infosys recently made a bid to acquire a European major Axon consultancy to improve its business in European markets, but finally called off the deal due to high valuation. Otherwise, Infosys has always believed in organic growth. INNOVATION: The Software Engineering and Technology Labs (SETLabs) at Infosys is the center for applied technology research in software engineering and enterprise technology. SET Labs conducted 24 Innovation Workshops with customers from the US and Australia, to identify research collaboration possibilities. Infosys promotes a favorable work environment that encourages innovation and meritocracy. At the conclusion of this assignment I would like discuss the main points. Global sourcing strategy is aligned with business strategy. Enhancing operational efficiency and delivering value added services. Structuring processes and services into modules thus leading to enhanced flexibility and productivity. Aggressive focus on ERP solutions like Oracle and SAP.. this conclusion is based on the rigorous analysis and one can learn for the conclusion to expand into high end consulting. Consolidation and Strategic acquisitions are essential for future growth of revenues.Shift in focus from low cost advantage to high quality services. Quick adoption to high growth markets is necessary.

Christianity :: Papers

Christianity As Christians we believe that God has a plan and that the death of Jesus was for the benefit of humankind. Jesus said he had to suffer and die as he had been sent on a mission of self-sacrifice. So he had not come to lord it over people, rather, he had come to serve; and he had come to sacrifice his life - a sort of ransom - to benefit people. Mk 10:41-45 Jesus relieved pain and he removed suffering. He spent more time doing this than anything else. E.g. Jairus' Daughter, Calming the Storm and healing blind Bartimaeus. Jesus forgave sin, which was the main cause for much suffering and all Christians believe that God was incarnated, on Earth, as Jesus himself. Prior to his death Jesus experienced; both emotional and physical pain. For example: when he was tortured and killed. Jesus experienced emotional pain when present in the Garden of Gethsemane. He was devastated by the thought of trial and death; he overcame this emotion by using the power of prayer. As Crucifixion grew on him "Father" he prayed, "my Father! All things are possible for you. Take this cup of suffering away from me. Yet not what I want, but what you want." Mk 14:36-37. Such quotes remind us that Jesus was human Unlike some, Jesus did not try to escape death, but accepted it gracefully. It was like he was portraying a message. He died for his beliefs; moreover, he accepted death as a way of life.

Rocketry :: science

Rocketry A rocket is a device that does not need atmospheric oxygen to burn its fuel, since it carries it’s own, either separately or in chemical combination with fuel. Rockets are propelled forward by gas or liquid being expelled backwards. Rockets work on a fundamental law of motion by Sir Isaac Newton that states, for every action there is an equal and opposite reaction. This helps explain how rockets fly on earth and in space. For example, the rocket fuel is exploded in a controlled way so that the exhaust gas or liquid is sent streaming down out the rocket nozzle and causing the rocket to accelerate up. Rockets are usually shaped like an arrow, with long and slender bodies and fins at the bottom. This shape provides stability for flying straight, and with low air resistance for flying fast. The evolution of the rocket has made it an irreplaceable tool in the exploration of space. For centuries, the ancient Chinese has used rockets for ceremonial and warfare purposes. The Chinese were the first known people to use and make rockets. Wernher Von Braun made a big advancement in rocketry during WWII when he built a rocket that was powered by ethyl alcohol and liquid oxygen. The rocket was called either A-4 or V2, and had a range of about 220 miles (350km), and a maximum height of about 162 miles (100km). This rocket was the main reason that the United States and Russia started the space exploration war. A solid propellant rockets posses more advanced fuels, designs, and functions than the early rockets, as does the Liquid fueled. Yet solid propellant rockets remain in wide spread use today, as seen in rockets including the Space Shuttle dual booster engines and the Delta series booster stages. A solid propellant is a monopropellant fuel, which is a single mixture of several chemicals. This fuel is in its solid state and has a pre-formed or molded shape. The interior shape of the core is an important factor in determining a rocket's performance. Solid fueled rockets are relatively simple rockets. This is their chief advantage, but it also has its drawbacks. Once a solid rocket is ignited it will use up all of its fuel and cannot be shut off. Another disadvantage is the danger involved in the premixed fuels of monopropellant rockets. The Saturn V moon rocket used nearly 8 million pounds of thrust requiring a high specific impulse liquid propellant.

Comparing the Grandmother in The Necklace and A Good Man is Hard to Fin

The Grandmother in The Necklace and A Good Man is Hard to Find The main characters Mrs. Loisel in "The Necklace" and the grandmother in "A Good Man is Hard to Find" are very similar because both these characters refused to admit to a mistake that they had made. They both had the same motivation prior to the mistake and they also had the same reason as to why they wanted to keep quiet about it. Although Mrs. Lisle's and the grandmother's penalties were different, it is still fair to compare the two because either way, dead or alive, both their lives were ruined. Mrs. Loisel and the grandmother are very similar due to the fact that they both had the same motivation prior to their accident. It was a selfish motivation that cost them their lives. Mrs. Loisel's character was selfish in "The Necklace" because instead of wearing flowers like her husband suggested, she chose to borrow her friend's jewelry. "You can wear some natural flowers. At this season they look very chic. For ten francs you can have two or three magnificent roses. 'No, she replied, there is nothing more humiliating than to have a shabby air in the midst of rich women.'" (67) This is truly an act of selfishness on Mrs. Loisel's part. If she wouldn't have been so arrogant, she could have just worn the flowers to the party and it would have saved her a lot of trouble. The grandmother's character in "A Good Man is Hard to Find" is also very selfish in her motivations. She felt she had to lie to her son, daughter-in-law and her grandchildren in order for her to be able to see that nice house again. "'There was a secret panel in this house' she said craftily, not telling the truth but wishing that she were, 'and the story went that all the family sil... ... comparable because like I illustrated before, they were both selfish people. All in all, these two characters were very similar. They both had the same selfish motivations. They both wanted something, and they didn't care what they did to get it. They also had the same reasons for keeping their secrets quiet, they were afraid of embarrassment. And in the end they both ruined their lives. Mrs. Loisel had to be a hard working woman for 10 years, which really took a toll on her. The grandmother was killed, as well as the rest of her family. If Mrs. Loisel and the grandmother would have told the truth from the start none of this would have happened. But now, just like most everyone in life, they were forced to pay the consequences for doing something wrong. Even though they didn't deserve the punishment they got, I guess it was all in the "luck" of the draw.

Machiavelli’s The Prince Essay

In Machiavelli’s The Prince, he plunged into how a prince could bulwark his position once he reaches the top. One of the many ways of how to secure a prince’s position is conquest by criminal virtue. In conquest by criminal virtue, Michiavelli said that a prince secures his position when he reaches the top because it takes a long time and a lot of hard work to prosper. So to make sure no one takes away their position, the prince crushes his opponents and earns obeisance from the people as much as possible. The prince also makes fewer compromises with their allies, trying to stand alone because he believes he is more sufficient and stronger than the others. A prince must also know how to reform orders. This may cause havoc because people who benefited the old order might oppose the prince but he must have the power to force the people to continue supporting him even though they are already having second thoughts. So why does this persist even though every politician and every citizen who thinks rationally knows that this is immoral. We humans are naturally driven by our hunger for power, fame and fortune. We set aside moral values and ethical values just to quench our self-interests. Politicians act on it because they know this is the easiest way to eliminate a threat. This is a permanent thing so when an enemy ceases to exist, he’s permanently gone from the competition and this gives the other politician a peace of mind because he knows that he will win for sure if he has no opponent. Citizens do not act upon this because first, citizens that belong to the lower class are afraid. How could they go against someone so powerful that this person could end their life with just a snap of their fingers? The span and extent of power of this kind of politician is vague that it might extend to having the upper hand and control over criminals and we never know what he will do just to preserve his power, fame and fortune. Second, most citizens who know about the wrong doings of this politician is paid and given a lot of consolations for their support and silence. As I said, we humans are naturally driven by our hunger by fortune. For people who do not work and believe in gaining money from a real job, this is the most convenient way of earning money because they don’t have to do anything but tay silent, run a few errands for the politician and write the politician’s name on their ballot every time he runs for a seat. There is also the fact that when local citizens support this politician, they are more secured and well protected. People who try to clash with these local citizens would already feel threaten beforehand because the politician will back them up in part of their deal for the secrecy of the politician’s dirty work. This is one of the most immoral acts performed in politics, but one that somehow we can never get rid of.

Introduction to Epidemiology

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