Love Shouldnt Hurt Essays - Abuse, Behavior, Human Behavior

Love Shouldn't Hurt Domestic Violence is emotional or physical abuse or the threat of physical abuse, used by one person in a relationship to gain control over the other person.(1) Rich, poor, Jewish, Christian, homosexual, heterosexual, abuse comes from all shapes and sizes. Domestic violence is the most prevalent cause for injury to woman in the United States. Often incidents of abuse start small with an abuser slowly taking control, as the relationship intensifies, the frequency as well as the intensity of the incidents also steadily increase. The incidents are then preceded with a phase in which the abuser may apologize, claim it will never happen again, express regret, promise to change, and/or blame their partner for what occurred. It is not easy for a person who is being abused to just walk away, and someone fleeing from their abuser will often return repeatedly before making a complete break. At the point in which a person is ready to walk away, they are normally battered, their life in danger, with no self-confidence, feeling they cannot live without their abuser. To a person who is not in an abusive relationship it is easy to tell someone being abused simply to walk away, but that person either doesn't know they are being abused, won't except it, or thinks it is their fault and they deserve it. Basically it is not as easy as it sounds. Domestic violence can take a number of forms, including: physical behavior such as slapping, punching, pulling hair or shoving, forced or coerced sexual acts or behavior such as unwanted fondling or intercourse, or jokes and insults aimed at sexuality, threats of abuse -- threatening to hit, harm or use a weapon on another, or to tell others confidential information, and psychological abuse -- attacks on self-esteem, controlling or limiting another's behavior, repeated insults and interrogation. When all is said and done, wife-beating results in more injuries requiring medical treatment than rape, auto accidents, and muggings combined.(2) Although on the surface domestic violence can appear to involve only the two parties of the abuser and their victim, the effects of abuse branch out to incorporate, indirectly all of society. It is not just a personal issue. Abuse goes outside the house, and affects every aspect of the victims life, because abuse is not about hitting the person, it is about controlling their lives. A child, by definition, is a person who is dependent upon adults and the environment for not only physical, but for emotional sustenance as well. This includes emotional warmth and nurture as well as protection from both external and internal threats to a child's sense of safety, self-esteem and well being. A parent and the home should provides a child with a safe space in which to experience their many complex and often intense emotions. Aggressive, passionate, sad or painful feelings arise in all human beings. The infant, toddler, and young child are helped by care taking adults to accept and tolerate frightening impulses and feelings. A child's idea of self worth and of belief in one's own goodness and in the general goodness of others -- is thus a fragile entity. When the adult surroundings are full of conflict, fear and p ain, a child's growth and emotional well-being are clearly jeopardized. There is a public education campaign about domestic violence currently being conducted on the New York City subway system. The poster used in the campaign has a picture of a child who is described as a highly sensitive recording device capable of detecting and remembering the abuse that occurs in his or her home. As the poster suggests, if tension, anger, and violence are present in the home, a child will know about it -- whether or not he or she has witnessed it directly and whether or not abuse is openly discussed. Regardless of how much effort has been made by adults to shield and protect a child by making sure that the violence takes place in private and by keeping it a secret, when a mother is being battered, a child becomes a victim too. The difference between the child and the adult victim is that the adult is, at least to some

Why The Vegetarian Diet Is Best Essays - Diets, Intentional Living

Why The Vegetarian Diet Is Best Essays - Diets, Intentional Living Why The Vegetarian Diet Is Best Why the Vegetarian Diet is Best The vegetarian diet is becoming increasingly popular all the time. Is the vegetarian or meat diet better? A decade ago and earlier, the impression was that a vegetarian diet was lacking in the nutrients found in meat products. Today though, through research and nutritional science, it has been proven that all the nutrients found in meat can also be found in the correct vegetarian diet. Some may argue that by only consuming meat that is low in fat, meat and vegetarian diets have identical benefits. This is true only if one eats only very low fat meat. The lack of meat is not necessarily the main benefit of to the vegetarian. Vegetarians tend to eat more fruits, vegetables and grains that the meat eater. They also tend not to use tobacco and excessive alcohol. In addition, vegetarians tend to get more exercise. The term vegetarian can be misleading. This diet can take on many different variations. A fruitarian eats only fruits, seeds and nuts while the vegan eats these and vegetables, grains and legumes. A lacto vegetarian consumes the same as a vegan as well as dairy products. A lacto-ovo vegetarian follows after the lacto vegetarian but also includes eggs while the ovo vegetarian excludes dairy products. Finally, the partial vegetarian eats anything except red meat, or at least strictly limits it. Because the term vegetarian is used to cover all facets and variations, it is difficult to identify health benefits resulting from the vegetarian diet including all of the above. Most meat eaters do not realize that there are so many variations to the vegetarian diet, which makes accurate studies even more difficult. As a whole though, vegetarians tend to have less body fat than nonvegetarians. This is most likely due to the low fat and high carbohydrate content of their diet. Vegetarians usually have lower blood pressure than meat eaters because of lifestyle and diet. Other factors probably include exercise and resistance to smoking and alcohol intake. Coronary artery disease is directly related to saturated fat intake. In studies testing cholesterol levels, vegetarians beat out all others including those that only ate lean meats. Milk, however, lowers blood cholesterol, as does soy. Another benefit is the lack of digestive disorders among vegetarians. It is possible that this is directly related to the high fiber content consumed. The last main benefit of the vegetarian diet is its relationship to cancer rate reduction, especially colon cancer. People who develop colon cancer tend to eat more meat, less fiber, and more saturated fat than those without colon cancer. This is the same case with lymphatic cancer. The only advantage a meat eater might have over a vegetarian would be during pregnancy and childhood. Studies have shown that children grow best when they eat meat products. Likewise, vegetarian women may enter pregnancy too thin and be lacking in stores of nutrients. Obviously, there are advantages and drawbacks to both diets however I feel the vegetarian diets advantages greatly outweigh its shortcomings. Whether a meat eater or vegetarian, both diets can contribute to good health with proper planning.

30 Idioms About Common Shapes

30 Idioms About Common Shapes 30 Idioms About Common Shapes 30 Idioms About Common Shapes By Mark Nichol Figurative references to circles, squares, and triangles turn up in a variety of familiar expressions. Here’s a list of many of those idioms and their meanings. 1. To be a square peg in a round hole is to be someone who doesn’t fit in a particular environment, or in certain circumstances. 2. To go back to square one is to start over again because of a setback or an impasse. 3. The expression â€Å"Be there, or be square† alludes to often-lighthearted pressure to attend an event or suffer the consequences of being considered conventional and uninteresting. 4–6. To call something square, square something with someone, or square accounts is to agree with another party that neither party owes anything to the other one. 7. To circle around is to move in a circular motion to engage in reconnaissance or to figuratively evaluate a situation. 8. A circular argument is one in which the proposition is assumed to be true. 9. To come (or go) full circle is to figuratively return to one’s starting point. 10. Someone who could fight a circle saw is so tough that the thought of sparring with a deadly power tool does not faze him or her. 11. To say that something doesn’t cut any squares with one means that one refuses to be influenced. 12. To be fair and square is to treat everyone impartially. 13. To look someone square in the eye is to do so directly, indicating honesty. 14. A love, or eternal, triangle is a circumstance in which two people are in love with the same person. 15. To move in the same circles with someone is to have similar tastes and frequent the same locations. 16. Something on the square is done fairly, honestly, and openly. 17. To be out of square is to not be in agreement. 18. To run circles around (or run rings around) someone is to figuratively outcompete him or her to the extent that the other person seems to be standing still. 19. To run around in circles is to figuratively expend much effort with little result because of poor organization or planning. 20. A square answer is an honest one. 21. To square away is to rectify or put in order. 22. A square deal is a fair deal. 23. A square meal is a complete, nutritious set of food servings. â€Å"Three square meals† (often abbreviated to â€Å"three squares†) refers to the traditional daily schedule of breakfast, lunch, and dinner (or supper). 24. To square off is to prepare to fight or compete. 25. To square up is to settle or reconcile. It also means to confront someone or something courageously. 26. To square one’s shoulders is to literally straighten one’s shoulders before undertaking a difficult task or to figuratively prepare oneself for an effort. 27. To attempt to square the circle is to try to do the impossible. 28. To square something with someone means to obtain approval or permission 29. To speak or talk in circles is to discuss an issue or problem repetitively with no progress. 30. A vicious circle (or vicious cycle) is one in which solutions create new problems. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Expressions category, check our popular posts, or choose a related post below:English Grammar 101: Verb MoodPersonification vs. Anthropomorphism

English as a Global Language Essay Example | Topics and Well Written Essays - 1750 words

English as a Global Language - Essay Example This essay stresses that English is the most widely spoken language around the world and hence it makes it much easier to have it as a Global language. Other languages around the world are spoken by a very minuscule section of the population when compared to the whole world. A human being is perfectly capable of speaking more than one language and it is possible to keep local languages alive. Hence, learning English as an extra language would prove to be more a boon than a bane because it would ensure great progress. The advantages of global languages by far outweigh the disadvantages of having a global language. This paper makes a conclusion that people who do not know English are at a great disadvantage because they would not be in a position to communicate outside their home country and hence progress would be very slow. Migrating abroad or touring would not be fun and interesting if they do not have English as their Global language. English is a much easier language to learn in comparison to other world languages because it is simple and with easy to understand system of phonetics. The pronunciation and meanings of words are much easier to grasp which makes communication all the more easy. Other languages have a very complicated system of alphabets and phonetics and the pronunciation and meanings of words are not easily understandable. For this reason English is considered to be the most suitable language for use globally.

Islamic accounting & Financial reporting assignment

Islamic accounting & Financial reporting - Assignment Example However, it has a number of similarities that can be identified. The main difference between these two is can be seen in the focus each of the two standards. For instance, the ijarah contracts as standardized by the AAOFI are geared towards making it possible for the firm to be able to report its income in such a way that it shows the honesty of its operations, especially with regard to the principles outlines in the Quran. The IFRS standards on the other hand focus on the economic aspect of any business transaction between the firm and the customer. This means that minor differences will arise while trying to compare the two statements of accounts prepared by either of the standards. However, this does not lead to a full dichotomy of the two standards but only leads to some minor differences that can be reconciles when preparing he books of accounts. As has been discussed, ijarah is a form of banking arrangement that allows banks and individuals to gain some form of profit after giving a loan to another individual. Instead of the lender charging an interest, they enter into an agreement with the lessee. The agreement is made in a way that allows the lender to gain some profit by the end of the transaction. Basically, ijarah based contracts have two phases (Ismal, 2013). For instance, when a person goes to the banks to take a car loan in a Sharia compliant bank, the bank will finance the purchase of the car and instead of requiring the customer to pay interest, the bank will hire out the car to the customer. The first phase of the contract, there will be an agreement with regard to how long the lease period will last (Karim, 2010). Once the period of the lease is over and the cusromern has aid al the lease charges, the first contract ends the second contract, or the second phase of the ijarah kicks in. This second part of the ija rah is the sale of the car. The value of the car is priced by calculating the residual value of the

The Spirit of Disciplines By Dallas Willard Essay Example for Free

The Spirit of Disciplines By Dallas Willard Essay About the Author   Ã‚  Ã‚  Ã‚   Dallas Willard is known for his enthusiasm in the basic elements of true â€Å"Christianship†. Most of his writings pertain to the different characteristics and disciplines that a true Christian is expected to posses. Being a professor of philosophy, Dallas is also known for his being logical and practical in the process of his presentations of the truth about Christianity and the basic attitudes that are involved in being a real follower of the Christ. It could not be denied then that through his writings, he was able to inspire different individuals, even student who are at some point obliged to review his writings and comment on his idealisms in becoming the rightful Christians that they ought to be. His writings are considered enlightenment to the soul as they all pertain to the ability of man to reach the standards of God and fulfill his requirements to mankind. One of his most remarkable writings is the book entitled â€Å"The spirit of disciplines†. This book has been noted to have changed the views of people in the reality of being Christ-like in their ways of living. It has also been noted by several religious teachers to be a powerful material that have changed the attitude of many readers towards the responsibilities of being a Christian. About the Book   Ã‚  Ã‚  Ã‚   Published in the year 1996, â€Å"The Spirit of Disciplines† came in as a part of the Willard’s trilogy on Christianity which primarily includes his two major authored books entitled In Search of Guidance and The Divine Conspiracy. These particular books are indeed published to assist Christians find their way back to righteousness amidst all the challenges and the hardships that they need to face in living within the cruel world of the present society.   â€Å"The spirit of disciplines† particularly helps readers understand the different pointers of consideration that they need to learn to be able to create a much more considerable Christian-like personality within themselves. Content and Analysis   Ã‚  Ã‚  Ã‚   The entire context of the book deals with the different virtues of being a Christian. Among which includes the impending belief on the fact that by applying the disciplines of abstinence which includes solitude, silence, fasting, frugality, chastity, secrecy and   sacrifice a Christian would be able to bring out the fruits of the disciplines of engagement which in turn includes study, worship, celebration, service, prayer, fellowship, confession and submission. Through the application of these major virtues, Willard points out that the essence of true Christianity could then be established within the personality of a certain individual.   Ã‚  Ã‚  Ã‚   In this book, Willard also points out that there is an importance placed in the capability of a person to apply these major characteristics in his dealings with other people through his ministry. The Bible verse 1 Timothy 4:7 which reads: â€Å"But turn down the false stories which violate what is holy and which old women tell. On the other hand, be training yourself with godly devotion as your aim† has also been strongly used by Willard as the major basis of his thoughts that have been presented through the book that he has published. Personal Reaction   Ã‚  Ã‚  Ã‚   If the verse 1 Timothy 4:7 is continued until verses 8, 9 and 10, it would imply: â€Å"For bodily training is beneficial for a little; but godly devotion is beneficial for all things, as it holds promise of the life now and that which is to come.   Faithful and deserving of full acceptance is that statement.   For to this end we are working hard and exerting ourselves, because we have rested our hope on a living God, who is a Savior of all sorts of men, especially of faithful ones.†   Ã‚  Ã‚  Ã‚   Certainly the verses indicate that for one to be able to attain the absolute state of being a true Christian, he must be able to face the challenges of being a follower of the Christ through his ability of disciplining himself as an individual who is able to train himself in attaining the best results in his ministry. As the book of Willard points out, the application of ones’ learning and training as received from the principles of the Holy Scriptures shall be the main reason for a person to progress in becoming a Christian-like individual who is able to reach the standards of God that HE himself has provided for his disciples to follow.   Ã‚  Ã‚  Ã‚   True, reading this particular writing of Willard is indeed inspiring and beneficial especially for those who are enthusiastic enough in taking the necessary steps needed in becoming a real Christian. The essence of being a true follower of the Christ indeed lies on the ability of one to discipline himself accordingly to the ways of righteousness. Reference: Dallas Willard. (1996). The Spirit of the Disciplines. Hodder Stoughton Religious; New Ed edition.

Positives of TV :: Television

Many years ago, almost no one had a television set. Now there are more houses with TV than ever. There is a lot of discussion about whether television is a good or bad influence for family life. There are many negative points and also many positive ones. Now I will run through some of each. One of the first reasons why parents should limit the amount of time their children spend watching TV is that children read less and watch TV more and of course this will lead into a lack of exercise. Therefore parents should help their children watch TV and read equally. Plus encourage them to move a lot due to the increase in number of obese people and practice other activities. Another complaint is that there is too much violence and sexual reference that can be accessed easily by children, this can destroy a young child's mind easily. Watching violent television programs teaches aggressive attitudes and behaviors and the children might try to imitate the bad behavior that these programs show, and bad expression because they wants to act like them as adults by thinking this is the right thing. Moreover, parents must have control and know what programs their children are watching. TV has many positive points, as it is considered an extremely valuable machine that provides us with relaxation and education. For example, People who have been working hard all day will look forward to watch an episode of a favorite show. This period of relaxation will reduce their stress and leaves viewers refreshed and ready to take all works again. Besides it?s a good option for parents who are tried trying to entertain their kids, to sit them down in front of a cartoon to take some rest. However it must not be done frequently. Secondly, the most important point about television is getting education. Children can learn colors, numbers, and letters from programs that shows on televisions like Barney. Also, it provides us with valuable information by covering important events and current news.

Law and Society Essay

They had virtually no voice. Men were only expected to provide their wife with the necessities of life, and to protect her. This system or way of functioning was called â€Å"covert†. Women were expected to provide a welcoming home and a carefree environment for their husbands, when they returned from a â€Å"long hard day of laboring work. † Laws that were put into place in the early 1 9th century stated that married women were completely under the control of their husbands, much like a slave was under the control of his master.There was a hero that â€Å"If the man killed his wife, it is not really his fault, she must have done something wrong, but if a woman killed her husband, she is punished with an equal fate as it is a capital crime to â€Å"bite the hand that feeds you†. † Although some marriages were fine and worked out to the advantages if both partners, troublesome marriages were the issue. When a wife disagreed with her husband, she did not rea lly have any grounds on which to protect herself.Although assault was a crime under the law, the government barely enforced t when it came to domestic cases. Also, women were not allowed to really have any of their own money. The luxuries that they could enjoy were limited and under the complete control of what their husband would allow and pay for. If the two tried to divorce, she would be left with nothing and him with a fortune. Women's rights were stripped from her when she married. As Elizabeth Caddy Stanton said, â€Å"As a teacher of theology, medicine, or law, she is not known.He has denied her the facilities for obtaining a thorough education, all colleges being closed against her. † This quote represents how women were treated very similarly to inferior beings, much like slaves were, except with less cruelty. They were seen as not worthy of education. Quite frankly, as a feminist, I believe that men were afraid that women would overcome their abilities and surpass t hem in wealth and success. Women began to fight and stand up for themselves by educating themselves in the law and trying to find loopholes in it.One example of this was Harriet Douglas and Henry Kruger. Harriet loved Henry, but only agreed o marry him when she put him under the restrictions that the wife would usually be put under. Although their marriage did not work out, and Harriet still lost half of her property when they separated, she still set a standard and began a revolution for women's rights. Stanton pronounced her â€Å"Declaration of Sentiments† at the first women's rights convention in Seneca Falls, New York. She proposed twelve resolutions to a series of wrongs, and all twelve passed.Also, states began passing the Married Women's Property Act gave omen the ownership of the property they owned before their marriage. Following that act was the Earnings Act, which gave women the right to keep their income and wages from their job. Although women's rights saw many optimistic reforms in the late 1 9th century, there was still much to be done for equality. Women were still restricted in many ways, but they had taken an important step towards their goal. These reforms would take many, many years to come about, but their achievements thus far were phenomenal and had a big impact on the culture of America.

Obesity and Fast Food Essay

January 2009 Abstract. We investigate the health consequences of changes in the supply of fast food using the exact geographical location of fast food restaurants. Specifically, we ask how the supply of fast food affects the obesity rates of 3 million school children and the weight gain of over 1 million pregnant women. We find that among 9th grade children, a fast food restaurant within a tenth of a mile of a school is associated with at least a 5. 2 percent increase in obesity rates. There is no discernable effect at . 25 miles and at . 5 miles. Among pregnant women, models with mother fixed effects indicate that a fast food restaurant within a half mile of her residence results in a 2. 5 percent increase in the probability of gaining over 20 kilos. The effect is larger, but less precisely estimated at . 1 miles. In contrast, the presence of non-fast food restaurants is uncorrelated with obesity and weight gain. Moreover, proximity to future fast food restaurants is uncorrelated with current obesity and weight gain, conditional on current proximity to fast food. The implied effects of fast-food on caloric intake are at least one order of magnitude smaller for mothers, which suggests that they are less constrained by travel costs than school children. Our results imply that policies restricting access to fast food near schools could have significant effects on obesity among school children, but similar policies restricting the availability of fast food in residential areas are unlikely to have large effects on adults. The authors thank John Cawley and participants in seminars at the NBER Summer Institute, the 2009 AEA Meetings, the ASSA 2009 Meetings, the Federal Reserve Banks of New York and Chicago, The New School, the Tinbergen Institute, the Rady School at UCSD, and Williams College for helpful comments. We thank Cecilia Machado, Emilia Simeonova, Johannes Schmeider, and Joshua Goodman for excellent research assistance. We thank Glenn Copeland of the Michigan Dept. of Community Health, Katherine Hempstead and Matthew Weinberg of the New Jersey Department of Health and Senior Services, Craig Edelman of the Pennsylvania Dept. of Health, Rachelle Moore of the Texas Dept. of State Health Services, and Gary Sammet and Joseph Shiveley of the Florida Department of Health for their help in accessing the data. The authors are solely responsible for the use that has been made of the data and for the contents of this article. 1 1. Introduction The prevalence of obesity and obesity related diseases has increased rapidly in the U. S. since the mid 1970s. At the same time, the number of fast food restaurants more than doubled over the same time period, while the number of other restaurants grew at a much slower pace according to the Census of Retail Trade (Chou, Grossman, and Saffer, 2004). In the public debate over obesity it is often assumed that the widespread availability of fast food restaurants is an important determinant of the dramatic increases in obesity rates. Policy makers in several cities have responded by restricting the availability or content of fast food, or by requiring posting of the caloric content of the meals (Mcbride, 2008; Mair et al. 2005). But the evidence linking fast food and obesity is not strong. Much of it is based on correlational studies in small data sets. In this paper we seek to identify the causal effect of increases in the supply of fast food restaurants on obesity rates. Specifically, using a detailed dataset on the exact geographical location restaurant establishments, we ask how proximity to fast food affects the obesity rates of 3 million school children and the weight gain of over 1 million pregnant women. For school children, we observe obesity rates for 9th graders in California over several years, and we are therefore able to estimate cross-sectional as well fixed effects models that control for characteristics of schools and neighborhoods. For mothers, we employ the information on weight gain during pregnancy reported in the Vital Statistics data for Michigan, New Jersey, and Texas covering fifteen years. 1 We focus on women who have at least two children so that we can follow a given woman across two pregnancies and estimate models that include mother fixed effects. The design employed in this study allows for a more precise identification of the effect of fast-food on obesity compared to the previous literature (summarized in Section 2). First, we observe information on weight for millions of individuals compared to at most tens of thousand in the standard data sets with weight information such as the NHANES and the BRFSS. This substantially increases the power of our estimates. Second, we exploit very detailed geographical location information, including distances The Vital Statistics data reports only the weight gain and not the weight at the beginning (or end) of the pregnancy. One advantage of focusing on a longitudinal measure of weight gain instead of a measure of weight in levels is that only the recent exposure to fast-food should matter. 1 2 of only one tenth of a mile. By comparing groups of individuals who are at only slightly different distances to a restaurant, we can arguably diminish the impact of unobservable differences in characteristics between the two groups. Third, we have a more precise idea of the timing of exposure than many previous studies: The 9th graders are exposed to fast food near their new school from September until the time of a spring fitness test, while weight gain during pregnancy pertains to the 9 months of pregnancy. While it is clear that fast food is generally unhealthy, it is not obvious a priori that changes in the availability of fast food should be expected to have an impact on health. On the one hand, it is possible that proximity to a fast food restaurant simply leads local consumers to substitute away from unhealthy food prepared at home or consumed in existing restaurants, without significant changes in the overall amount of unhealthy food consumed. On the other hand, proximity to a fast food restaurant could lower the monetary and non-monetary costs of accessing unhealthy food. In addition, proximity to fast food may increase consumption of unhealthy food even in the absence of any decrease in cost if individuals have self-control problems. Ultimately, the effect of changes in the supply of fast food on obesity is an empirical question. We find that among 9th grade children, the presence of a fast-food restaurant within a tenth of a mile of a school is associated with an increase of about 1. 7 percentage points in the fraction of students in a class who are obese relative to the presence at. 25 miles. This effect amounts to a 5. 2 percent increase in the incidence of obesity. Since grade 9 is the first year of high school and the fitness tests take place in the Spring, the period of fast-food exposure is approximately 30 weeks, implying an increased caloric intake of 30 to 100 calories per school-day. The effect is larger in models that include school fixed effects. Consistent with highly non–linear transportation costs, we find no discernable effect at . 25 miles and at . 5 miles. The effect is largest for Hispanic students and female students. Among pregnant women, we find that a fast food restaurant within a half mile of a residence results in 0. 19 percentage points higher probability of gaining over 20kg. This amounts to a 2. 5 percent increase in the probability of gaining over 20 kilos. The effect is larger at . 1 miles, but in contrast to the results for 9th graders, it is still discernable at . 25 miles and at . 5 miles. The increase in weight implies an increased caloric intake of 1 to 4 3 calories per day in the pregnancy period. The effect varies across races and educational levels. It is largest for African American mothers and for mothers with a high school education or less. It is zero for mothers with a college degree or an associate’s degree. Overall, our findings suggest that increases in the supply of fast food restaurants have a significant effect on obesity, at least in some groups. However, it is in principle possible that our estimates reflect unmeasured shifts in the demand for fast food. Fast food chains are likely to open new restaurants where they expect demand to be strong, and higher demand for unhealthy food is almost certainly correlated with higher risk of obesity. The presence of unobserved determinants of obesity that may be correlated with increases in the number of fast food restaurants would lead us to overestimate the role of fast food restaurants. We can not entirely rule out this possibility. However, three pieces of evidence lend some credibility to our interpretation. First, we find that observable characteristics of the schools are not associated with changes in the availability of a fast food in the immediate vicinity of a school. Furthermore, we show that within the geographical area under consideration, fast food restaurants are uniformly distributed over space. Specifically, fast food restaurants are equally likely to be located within . 1, . 25, and . 5 miles of a school. We also find that after conditioning on mother fixed effects, the observable characteristics of mothers that predict high weight gain are negatively (not positively) related to the presence of a fast-food chain, suggesting that any bias in our estimates may be downward, not upward. While these findings do not necessarily imply that changes in the supply of fast food restaurants are orthogonal to unobserved determinants of obesity, they are at least consistent with our identifying assumption. Second, while we find that proximity to a fast food restaurant is associated with increases in obesity rates and weight gains, proximity to non fast food restaurants has no discernible effect on obesity rates or weight gains. This suggests that our estimates are not just capturing increases in the local demand for restaurant establishments. Third, we find that while current proximity to a fast food restaurant affects current obesity rates, proximity to future fast food restaurants, controlling for current proximity, has no effect on current obesity rates and weight gains. Taken together, the weight of the 4 evidence is consistent with a causal effect of fast food restaurants on obesity rates among 9th graders and on weight gains among pregnant women. The results on the impact of fast-food on obesity are consistent with a model in which access to fast-foods increases obesity by lowering food prices or by tempting consumers with self-control problems. 2 Differences in travel costs between students and mothers could explain the different effects of proximity. Ninth graders have higher travel costs in the sense that they are constrained to stay near the school during the school day, and hence are more affected by fast-food restaurants that are very close to the school. For this group, proximity to fast-food has a quite sizeable effect on obesity. In contrast, for pregnant women, proximity to fast-food has a quantitatively small (albeit statistically significant) impact on weight gain. Our results suggest that a ban on fast-foods in the immediate proximity of schools could have a sizeable effect on obesity rates among affected students. However, a similar attempt to reduce access to fast food in residential neighborhoods would be unlikely to have much effect on adult consumers. The remainder of the paper is organized as follows. In Section 2 we review the existing literature. In Section 3 we describe our data sources. In Section 4, we present our econometric models and our empirical findings. Section 5 concludes. 2. Background While the main motivation for focusing on school children and pregnant women is the availability of geographically detailed data on weight measures for a very large sample, they are important groups to study in their own right. Among school aged children 6-19 rates of overweight have soared from about 5% in the early 1970s to 16% in 1999-2002 (Hedley et al. 2004). These rates are of particular concern given that children who are overweight are more likely to be overweight as adults, and are increasingly suffering from diseases associated with obesity while still in childhood (Krebs and Jacobson, 2003). At the same time, the fraction of women gaining over 60 2 Consumers with self-control problems are not as tempted by fatty foods if they first have to incur the transportation cost of walking to a fast-food restaurant. Only when a fast-food is right near the school, the temptation of the fast-food looms large. For an overview of the role of self-control in economic applications, see DellaVigna (2009). A model of cues in consumption (Laibson, 2001) has similar implications: a fast-food that is in immediate proximity from the school is more likely to trigger a cue that leads to over-consumption. 5 pounds during pregnancy doubled between 1989 and 2000 (Lin, forthcoming). Excessive weight gain during pregnancy is often associated with higher rates of hypertension, C-section, and large-for-gestational age infants, as well as with a higher incidence of later maternal obesity (Gunderson and Abrams, 2000; Rooney and Schauberger, 2002; Thorsdottir et al. , 2002; Wanjiku and Raynor, 2004). 3 Moreover, Figure 1 shows that the incidence of low APGAR scores (APGAR scores less than 8), an indicator of poor fetal health, increases sharply with weight gain above about 20 kilograms. Critics of the fast food industry point to several features that may make fast food less healthy than other types of restaurant food (Spurlock, 2004; Schlosser, 2002). These include low monetary and time costs, large portions, and high calorie density of signature menu items. Indeed, energy densities for individual food items are often so high that it would be difficult for individuals consuming them not to exceed their average recommended dietary intakes (Prentice and Jebb, 2003). Some consumers may be particularly vulnerable. In two randomized experimental trials involving 26 obese and 28 lean adolescents, Ebbeling et al. (2004) compared caloric intakes on â€Å"unlimited fast food days† and â€Å"no fast food days†. They found that obese adolescents had higher caloric intakes on the fast food days, but not on the no fast food days. The largest fast food chains are also characterized by aggressive marketing to children. One experimental study of young children 3 to 5 offered them identical pairs of foods and beverages, the only difference being that some of the foods were in McDonald’s packaging. Children were significantly more likely to choose items perceived to be from McDonald’s (Robinson et al.2007). Chou, Grossman, and Rashad (forthcoming) use data from the National Longitudinal Surveys (NLS) 1979 and 1997 cohorts to examine the effect of exposure to fast food advertising on overweight among children and adolescents. In ordinary least squares (OLS) models, they find significant effects in most specifications. 4 3 According to the Centers for Disease Control, obesity and excessive weight gain are independently associated with poor pregnancy outcomes. Recommended weight gain is lower for obese women than in others. (http://www. cdc.gov/pednss/how_to/read_a_data_table/prevalence_tables/birth_outcome. htm) 4 They also estimate instrumental variables (IV) models using the price of advertising as an instrument. However, while they find a significant â€Å"first stage†, they do not report the IV estimates because tests 6 Still, a recent review of the considerable epidemiological literature about the relationship between fast food and obesity (Rosenheck, 2008) concluded that â€Å"Findings from observational studies as yet are unable to demonstrate a causal link between fast food consumption and weight gain or obesity†. Most epidemiological studies have longitudinal designs in which large groups of participants are tracked over a period of time and changes in their body mass index (BMI) are correlated with baseline measures of fast food consumption. These studies typically find a positive link between obesity and fast food consumption. However, existing observational studies cannot rule out potential confounders such as lack of physical activity, consumption of sugary beverages, and so on. food. 5 There is also a rapidly growing economics literature on obesity, reviewed in Philipson and Posner (2008). Economic studies place varying amounts of emphasis on increased caloric consumption as a primary determinant of obesity (a trend that is consistent with the increased availability of fast food). Using data from the NLSY, Lakdawalla and Philipson (2002) conclude that about 40% of the increase in obesity from 1976 to 1994 is attributable to lower food prices (and increased consumption) while the remainder is due to reduced physical activity in market and home production. Bleich et al. (2007) examine data from several developed countries and conclude that increased caloric intake is the main contributor to obesity. Cutler et al. (2003) examine food diaries as well as time use data from the last few decades and conclude that rising obesity is linked to increased caloric intake and not to reduced energy expenditure. 6 7 Moreover, all of these studies rely on self-reported consumption of fast suggest that advertising exposure is not endogenous. They also estimate, but do not report individual fixed effects models, because these models have much larger standard errors than the ones reported. 5 A typical question is of the form â€Å"How often do you eat food from a place like McDonald’s, Kentucky Fried Chicken, Pizza Hut, Burger King or some other fast food restaurant? † 6 They suggest that the increased caloric intake is from greater frequency of snacking, and not from increased portion sizes at restaurants or fattening meals at fast food restaurants. They further suggest that technological change has lowered the time cost of food preparation which in turn has lead to more frequent consumption of food. Finally, they speculate that people with self control problems are over-consuming in response to the fall in the time cost of food preparation. Cawley (1999) discusses a similar behavioral theory of obesity as a consequence of addiction. 7 Courtemanche and Carden examine the impact on obesity of Wal-Mart and warehouse club retailers such as Sam’s club, Costco and BJ’s wholesale club which compete on price. They link store location data to individual data from the Behavioral Risk Factor Surveillance System (BRFSS. ) They find that non-grocery selling Wal-Mart stores reduce weight while non-grocery selling stores and warehouse clubs either reduce weight or have no effect. Their explanation is that reduced prices for everyday purchases expand real 7 A series of recent papers explicitly focus on fast food restaurants as potential contributors to obesity. Chou et al. (2004) estimate models combining state-level price data with individual demographic and weight data from the Behavioral Risk Factor Surveillance surveys and find a positive association between obesity and the per capita number of restaurants (fast food and others) in the state. Rashad, Grossman, and Chou (2005) present similar findings using data from the National Health and Nutrition Examination Surveys. Anderson and Butcher (2005) investigate the effect of school food policies on the BMI of adolescent students using data from the NLSY97. They assume that variation in financial pressure on schools across counties provides exogenous variation in availability of junk food in the schools. They find that a 10 percentage point increase in the probability of access to junk food at school can lead to about 1 percent increase in students’ BMI. Anderson, Butcher and Schanzenbach (2007) examine the elasticity of children’s BMI with respect to mother’s BMI and find that it has increased over time, suggesting an increased role for environmental factors in child obesity. Anderson, Butcher, and Levine (2003) find that maternal employment is related to childhood obesity, and speculate that employed mothers might spend more on fast food. Cawley and Liu (2007) use time use data and find that employed women spend less time cooking and are more likely to purchase prepared foods. The paper that is closest to ours is a recent study by Anderson and Matsa (2009) that focuses on the link between eating out and obesity using the presence of Interstate highways in rural areas as an instrument for restaurant density. Interstate highways increase restaurant density for communities adjacent to highways, reducing the travel costs of eating out for people in these communities. They find no evidence of a causal link between restaurants and obesity. Using data from the USDA, they argue that the lack of an effect is due to the presence of selection bias in restaurant patrons –people who eat out also consume more calories when they eat at home–and the fact that large portions at restaurants are offset by lower caloric intake at other times of the day. Our paper differs from Anderson and Matsa (2009) in four important dimensions, and these four differences are likely to explain the difference in our findings. incomes, enabling households to substitute away from cheap unhealthy foods to more expensive but healthier alternatives. 8 (i) First, our data allow us to distinguish between fast food restaurants and other restaurants. We can therefore estimate separately the impact of fast-foods and of other restaurants on obesity. In contrast, Anderson and Matsa do not have data on fast food restaurants and therefore focus on the effect of any restaurant on obesity. This difference turns out to be crucial, because when we estimate the effect of any restaurant on obesity using our data we also find no discernible effect on obesity. (ii) Second, we have a very large sample that allows us to identify even small effects, such as mean increases of 50 grams in the weight gain of mothers during pregnancy. Our estimates of weight gain for mothers are within the confidence interval of Anderson and Matsa’s two stage least squares estimates. Put differently, based on their sample size, our statistically significant estimates would have been considered statistically insignificant. (iii) Third, our data give us the exact location of each restaurant, school and mother. The spatial richness of our data allows us to examine the effect of fast food restaurants on obesity at a very detailed geographical level. For example, we can distinguish the effect at . 1 miles from the effect at . 25 miles. As it turns out, this feature is quite important, because the effects that we find are geographically extremely localized. For example, we find that fast food restaurant have an effect on 9th graders only for distances of . 1 miles or less. By contrast, Anderson and Matsa use a city as the level of geographical analysis. It is not surprising that at this level of aggregation the estimated effect is zero. (iv) Fourth, Anderson and Matsa’s identification strategy differs from ours, since we do not use an instrument for fast-food availability and focus instead on changes in the availability of fast-foods at very close distances. The populations under consideration are also different, and may react differently to proximity to a fast food restaurant. Anderson and Matsa focus on predominantly white rural communities, while we focus on primarily urban 9th graders and urban mothers. We document that the effects vary considerable depending on race, with blacks and Hispanics having the largest effect. Indeed, when Dunn (2008) uses an instrumental variables approach similar to the one used Anderson and Matsa based on proximity to freeways, he finds no effect for rural areas and for 9 whites in suburban areas, but strong effect for blacks and Hispanics. As we show below, we also find stronger effects for minorities. Taken together, these four differences lead us to conclude that the evidence in Anderson and Matsa is consistent with our evidence. 8 In summary, there is strong evidence of correlations between fast food consumption and obesity. It has been more difficult to demonstrate a causal role for fast food. In this paper we tap new data in an attempt to test the causal connection between fast food and obesity. 3. Data Sources and Summary Statistics Data for this project comes from three sources. (a) School Data. Data on children comes from the California public schools for the years 1999 and 2001 to 2007. The observations for 9th graders, which we focus on in this paper, represent 3. 06 million student-year observations. In the spring, California 9th graders are given a fitness assessment, the FITNESSGRAM ®. Data is reported at the class level in the form of the percentage of students who are obese, and who have acceptable levels of abdominal strength, aerobic capacity, flexibility, trunk strength, and upper body strength. Obesity is measured using actual body fat measures, which are considerably more accurate than the usual BMI measure (Cawley and Burkhauser, 2006). Data is also reported for sub-groups within the school (e. g. by race and gender) provided the cells have at least 10 students. Since grade 9 is the first year of high school and the fitness tests take place in the Spring, this impact corresponds to approximately 30 weeks of fast-food exposure. 9 This administrative data set is merged to information about schools (including the percent black, white, Hispanic, and Asian, percent immigrant, pupil/teacher ratios, fraction eligible for free lunch etc. ) from the National Center for Education Statistic’s Common Core of Data, as well as to the Start test scores for the 9th grade. The location of the school was also geocoded using ArcView. Finally, we merged in information. 8 9 See also Brennan and carpenter (2009). In very few cases, a high school is in the same location as a middle school, in which case the estimates reflect a longer-term impact of fast-food. 10 about the nearest Census block group of the school from the 2000 Census including the median earnings, percent high-school degree, percent unemployed, and percent urban. (b) Mothers Data. Data on mothers come from Vital Statistics Natality data from Michigan, New Jersey, and Texas. These data are from birth certificates, and cover all births in these states from 1989 to 2003 (from 1990 in Michigan). For these three states, we were able to gain access to confidential data including mothers names, birth dates, and addresses, which enabled us both to construct a panel data set linking births to the same mother over time, and to geocode her location (again using ArcView). The Natality data are very rich, and include information about the mother’s age, education, race and ethnicity; whether she smoked during pregnancy; the child’s gender, birth order, and gestation; whether it was a multiple birth; and maternal weight gain. We restrict the sample to singleton births and to mothers with at least two births in the sample, for a total of over 3. 5 million births. (c) Restaurant Data. Restaurant data with geo-coding information come from the National Establishment Time Series Database (Dun and Bradstreet). These data are used by all major banks, lending institutions, insurance and finance companies as the primary system for creditworthiness assessment of firms. As such, it is arguably more precise and comprehensive than yellow pages and business directories. 10 We obtained a panel of virtually all firms in Standard Industrial Classification 58 from 1990 to 2006, with names and addresses. Using this data, we constructed several different measures of â€Å"fast food† and â€Å"other restaurants,† as discussed further in Appendix 1. In this paper, the benchmark definition of fast-food restaurants includes only the top-10 fast-food chains, namely, Mc Donalds, Subway, Burger King, Taco Bell, Pizza Hut, Little Caesars, KFC, Wendy’s, Dominos Pizza, and Jack In The Box. We also show estimates using a broader definition that includes both chain restaurants and independent burger and pizza restaurants. Finally, we also measure the supply of non-fast food restaurants. The definition of â€Å"other restaurants† changes with the definition of fast food. Appendix Table 1 lists the top 10 fast food chains as well as examples of restaurants that we did not classify as fast food. The yellow pages are not intended to be a comprehensive listing of businesses – they are a paid advertisement. Companies that do not pay are not listed. 10 11 Matching. Matching was performed using information on latitude and longitude of restaurant location. Specifically, we match the schools and mother’s residence to the closest restaurants using ArcView software. For the school data, we match the results on testing for the spring of year t with restaurant availability in year t-1. For the mother data, we match the data on weight gain during pregnancy with restaurant availability in the year that overlaps the most with the pregnancy. Summary Statistics. Using the data on restaurant, school, and mother’s locations, we constructed indicators for whether there are fast food or other restaurants within . 1, . 25, and . 5 miles of either the school or the mother’s residence. Table 1a shows summary characteristics of the schools data set by distance to a fast food restaurant. Here, as in most of the paper, we use the narrow definition of fast-food, including the top-10 fast-food chains. Relatively few schools are within . 1 miles of a fast food restaurant, and the characteristics of these schools are somewhat different than those of the average California school. Only 7% of schools have a fast food restaurant within . 1 miles, while 65% of all schools have a fast food restaurant within 1/2 of a mile. 11 Schools within . 1 miles of a fast food restaurant have more Hispanic students, a slightly higher fraction of students eligible for free lunch, and lower test scores. They are also located in poorer and more urban areas. The last row indicates that schools near a fast food restaurant have a higher incidence of obese students than the average California school. Table 1b shows a similar summary of the mother data. Again, mothers who live near fast food restaurants have different characteristics than the average mother. They are younger, less educated, more likely to be black or Hispanic, and less likely to be married. 4. Empirical Analysis We begin in Section 4. 1 by describing our econometric models and our identifying assumptions. In Section 4. 2 we show the correlation between restaurant location and student characteristics for the school sample, and the correlation between The average school in our sample had 4 fast foods within 1 mile and 24 other restaurants within the same radius. 11 12 restaurant location and mother characteristics for the mother sample. Our empirical estimates for students and mothers are in Section 4. 3 and 4. 4, respectively. 13 4. 1 Econometric Specifications Our empirical specification for schools is (1) Yst = ? F1st + ? F25st + ? F50st + ? ’ N1st + ? ’ N25st + ? ’ N50st + ? Xst + ? Zst + ds + est where Yst is the fraction of students in school s in a given grade who are obese in year t; F1st is an indicator equal to 1 if there is a fast food restaurant within . 1 mile from the school in year t; F25st is an indicator equal to 1 if there is a fast food restaurant within . 25 miles from the school in year t; F50st is an indicator equal to 1 if there is a fast food restaurant within . 5 mile from the school in year t; N1st, N25st and N50st are similar indicators for the presence of non-fast food restaurants within . 1, . 25 and . 5 miles from the school; ds is a fixed effect for the school. The vectors Xst and Zst include school and neighborhood time-varying characteristics that can potentially affect obesity rates. Specifically, Xst is a vector of school-grade specific characteristics including fraction blacks, fraction native Americans, fraction Hispanic, fraction immigrants, fraction female, fraction eligible for free lunch, whether the school is qualified for Title I funding, pupil/teacher ratio, and 9th grade tests scores, as well as school-district characteristics such as fraction immigrants, fraction of non-English speaking students (LEP/ELL), share of IEP students. Zst is a vector of characteristics of the Census block closest to the school including median income, median earnings, average household size, median rent, median housing value, percent white, percent black, percent Asian, percent.

The Body Snatcher Essay Example

The Body Snatcher Essay Example The Body Snatcher Essay The Body Snatcher Essay A gruesome story about Fettes and Macfarlane dissecting dead bodies at a medical university. Fettes is troubled when he realises the bodies have been murdered, he tells Macfarlane about what he thinks but Macfarlane pays no attention. Fettes is pushed to follow his career and neglects his conscience. Gray is introduced in to the story and seems to have control over Macfarlane; Gray embarrasses him and makes him pay for the bill. Later that night a new body is brought to them and it appears to be Grey. Fettes is suspicious that Macfarlane had killed him and is not sure what to do. Again he doesnt act and follows his career. Fettes and Macfarlane dig up a dead body in the graveyard. On their way back they realise the body had changed to someone elses. They then checked the bodys face and it some how was the body of Gray. In the opening paragraph the reader is introduced to Fettes and the undertaker, the landlord. We are told that Fettes is a drunken Scotchman and a man of education, he drinks five glasses of rum a night. This makes the reader wonder why Fettes drinks so much. We have the impression that he may be depressed. People still believe in the sanctity of and the content of the book does still tend to shock the reader. The book seems to tell the reader that crime and gangsters are the same thing because without crime you dont have gangsters and vice versa. The story is set in Edinburgh in 1828. NARRATIVE Every night in four friends (Fettes, the undertaker, the Landlord and the narrator) meet in the George to drink and talk. Fettes is an old drunken Scotsman but he is known to be clever. In his past he was a doctor and some people address him as one. He has a shadowed past and doesnt easily give in to a bribe. As the story progresses it starts to show that Fettes had a bad past. He knew Macfarlane in the past. Dr Macfarlane is shocked when he sees Fettes. Fettes studied medicine in his young days. The narrator is the one who finds out about Fettes past and tells it to the readers. Fettes was very clever in school and the teachers noted this he acted and behaved mature and was a good example for all the other students. He got lodged by Mr K in a room above the dissecting room his task was to open the door for body deliverers and pay them for the bodies. These bodies were the ones used in the dissecting lessons and they were usually homeless people who wouldnt be noticed or missed by any if they vanished. The body snatchers were usually gangsters or in some way affiliated to the mob. One day the body deliverers brought a body Fettes did what he usually did he checked the body if it was in good condition but this bodies was different it was of a girl and he immediately recognised her. He didnt know what to do so he paid the men and waited for Macfarlane to come. Once he told him Macfarlane told him that no-one would notice and that he should act as if he didnt know who she was. Even though Fettes was worried that someone would recognise her he still put the body out to be dissected. Every one got busy dissecting and no one recognised the girl. Fettes went to a popular tavern after work and met Macfarlane with a stranger named Gray. The stranger seemed to exercise a great deal of control over Macfarlane. Gray seemed to like Fettes and even told him about how he used to be a bad fellow. He ordered Toddy to get Fettes a drink or he would have to close the door. Macfarlane got angry because Gray called him Toddy and so makes a joke about dissecting dead friends. Gray ignores Macfarlane joke and invited Fettes to join them at dinner. He ordered a feast so great that it caused commotion in the tavern. After they finished eating Gray made Macfarlane pay for the feast. The three men then went around the taverns drinking, when Fettes left the group Gray was heavily drunk and Macfarlane wasnt happy for getting made to use his own money to pay for Grays expenses. At four oclock Fettes heard a knock on the door when he opened it he was surprised to find Macfarlane in a gig with a body bag. Inside the bag was a dead Gray Macfarlane told Fettes to take the body and pay him. Fettes was hit hard by the shock and did what he was told. Fettes is confused and starts drinking. The amounts of bodies available start decreasing and so the two men went into the country side to dig up dead farmers wife who died recently. The light started getting dim and it started raining. The got to the grave and so started they digging it didnt take long before they got to the casket.

Addressing Medication Errors Occurring in Nursing

In any healthcare scenario, the process of achieving effective therapeutic outcomes depends on various factors like treatment process, patient safety, communication, nursing care, drug interventions etc. (Fletcher, Fletcher & Fletcher, 2012). Any kind of minor or major mistake in any of these factors can lead to drastic loss of patient health and healthcare organisation. Out of these factors drug intervention or medication is the most fundamental requirement to achieve treatment. Any kind of mistake or negligence in drug intervention process can result in direct side effect on patient’s health (Grove, Burns & Gray, 2014). According to Raban & Westbrook (2014), medication error is reported to be a reason for thousands of demises and millions of hospitalisation globally. Hence, fixation of any medication error becomes a fundamental requirement in healthcare scenario. The medication administration and management is one of the fundamental nursing roles that critically depend on the nursing skills and knowledge. The nursing staffs have the responsibility to administrate, monitor and manage the drug intervention for hospitalised patients. Therefore, continuous observance, alertness and approaches are required in healthcare scenario to avoid the potential chances of medical error (Grove, Burns & Gray, 2014). According to Unver, Tastan & Akbayrak (2012) studies the proper definition for medication error is â€Å"any avoidable incident that risks to incongruous medication use causing or leading patient harm, although being under the control of medical professional, carer or consumer†. The medication error incidences are related to healthcare products, medical practices, medical prescriptions, procedures, nursing practices, product labelling, compounding, distribution, education, dispensing, monitoring, utilisation and communication. Any kind of negligence in these events can lead to medication errors. Therefore, adopting best possible strategies to avoid this medication error in healthcare scenario is one of the major priority concerns (Fletcher, Fletcher & Fletcher, 2012). As a registered nurse, it is been noticed in my clinical scenario that issue of medication error is gaining a possible position where around 60% risk event in hospital occur due to medication negligence’s in the nursing care unit. Some of the most common factors related to these medication errors are new staff, insufficient training, incorrect administration technique, prescription errors (incorrect dosage), expired medication usage, wrong patient identification, and preparation errors (mixing incorrect multiple medications, dose calculation errors). These factorial causes of medication error indicate nursing medication negligence in the clinical scenario. Therefore, it is critically required to minimise these events and manage medication error to improve medical care facility provided by nursing care unit. This Quality Improvement Project is specifically designed to manage this issue of medication error in healthcare scenario. The various negligence’s and issues in nursing care will be addressed as per the quality improvement process provided in this project to get a control over events of medication error in the organisation. The medication errors described above are clearly indicating the lack of knowledge, calibre and guidance provided to the nursing staff of the hospital. The administration, prescription and preparation errors directly specify the issue in nursing skills and practice. Therefore, this quality improvement project will work to improve the nursing skills by providing a Short-term Periodic Training (STPT) Program that will acknowledge the staff about different strategies to avoid such medication error while dealing with patients in the hospital. This nursing training program is safe and specifically developed to improve nursing practice within the short duration of time to improve medical care. The aim of this quality improvement project will be to implement Short-term Periodic Training Program (STPT program) to overcome nursing issues and mishandling that are increasing the risk of medication errors in healthcare scenario of selected organisation. The medication error is always considered to be a major clinical issue because it directly affects the patient safety and treatment process. Any kind of minor negligence in medication process is prone to develop major clinical consequences (Fletcher, Fletcher & Fletcher, 2012). This project will help to decrease the risk cases occurring due to medication errors caused by mishandling and negligence’s of nursing staff in the healthcare organisation. The Short-term Nursing Program will work to overcome the identified factors leading to the medication error in nursing care unit causing high risk to patient safety. Hence, this quality improvement intervention will help to overcome the medication error harming medical care process. The establishment of patient safety and health betterment is the very first priority of quality healthcare services management. There are various faults and errors that lead to the imbalance in quality outcomes where medication error holds a top most position. After doctors prescribe a medicine the major role players are the nurses whose fundamental work is to manage the treatment of their patient (Grove, Burns & Gray, 2014). According to a recent study related to Medication Safety in Australia provided by Chiang et al. (2010) the faults in nursing administration leads to 70% medication errors. Faults like wrong dose, wrong rate, wrong volume or dose incompatibility were reason of 90% medication error in nursing care unit resulting in surgical requirement, long patient stay and permanent health defects in the patients. Unver, Tastan, & Akbayrak (2012) studied the causes of medication error as per nurse’s viewpoint where the findings indicated more than ten leading factors of medication error responded by paediatric nurses. The major once were stress (70%), burnout (45%), complicated prescription (30%), unfamiliar medicines (40%), work pressure (35%), knowledge deficiencies (20%), and lack of facilities (4%). Further, in a survey studied by Pham et al. (2012) indicated that majority of nursing staff is not aware of the correct form of medication error. Only 20% nurses mentioned medication error as the wrong dose, incorrect time of dose, and wrong mode of transmission and wrong administration process. However, rest 80% of nurses mentioned medication error as lack of documentation and reporting as the medication error. Hence, this literature indicated a lack of proper nursing education that detects the wrong perceptions of nurses about medication error. Kalisch & Aebersold (2010) indicated that nursing experience and education is one of the critical factors that is directly linked to medication error. The less experienced and skilled nurses cause 50% of medication errors that includes wrong patient, incorrect dilution calculations, incorrect dosage, incorrect administration and improper reporting. Seys et al. (2012) supported by indicating that naà ¯ve nurses are generally not able to recognise their medication error as well as they lack proper knowledge in warrant reporting. This indicates a lack in professional training system of the healthcare organisation. In the study of Sears, Goldsworthy & Goodman (2010) related to nurse’s viewpoint on medication error, it is clearly indicated that lack of pharmacological knowledge is a major reason for medication error as per viewpoint of 237 professional nurses. Hence, this directly indicates a requirement of improved training intervention in nursing practice. Chhabra et al. (2012) studied in a survey that 80% of new nurses commit medication error in first six months of their nursing practice where 70% remained unreported by them and 10% caused serious health hazards to the patient. There are different strategies and programs implemented at various organisations in a different manner to cope up with the medication error. Agyemang & While (2010) Opine the use of different strategies to avoid three major causes that are knowledge gaps, performance lapse, and failure of the safety system of medication. The strategies of MEDMARX program are described below: - Further, Mueller et al. (2012) studied that E-learning is the most contemporary form of nursing education with the help of which nurses can get instant solutions for their issue related to medication process. This e-learning strategy helped to improve pharmaceutical knowledge and dosage calculation for nurses. The E-learning facility is new to nursing practices but possesses potential positive outcomes. Seys et al. (2012) studied the use of one nursing education program named as SCRIPT study that was developed to improve the issues like unreadable prescriptions, improper antibiotics documentation, and poor communication leading to medication error. The SCRIPT abbreviation was used in a manner to detail educational message about the program that indicated, S : Senior doctor cross-check, C: Check allergies, R : wRite indications for antibiotics, I: (Initial Date) of charting medicine in parenthesis, P: PRINT and sign your name, T: Appropriate Targets for infusions in the nurs ing practice. The post education results indicated a decrease in prescription error, dose infusions and communication errors. Mohammad et al. (2010) studied an Evidence-based quality improvement program (IQ program) used in hospitals of sixteen states where 30% of 616 critical care hospitals participated in program implementation. The findings indicated that project was successful in improving medication quality and safety in 90% of hospitals. The program used five strategies that are maintaining skilled nursing and pharmacist staff, use of pharmacological reconciliation techniques, implementing technological software’s (telehealth), improving nurse workflow and improving cultural defects in the organisation. Kwan et al. (2013) indicated that reviewing and updating service techniques with education and training on the periodic basis is effective to refine the nursing staff as per dwelling issues and problems in healthcare. This periodic training program can help to regularly update healthcare services as per the changing environmental complex situations. This Quality Improvement research proposal will work to rectify the on-going medication errors that clearly highlight a lack of pharmaceutical knowledge, skills and training in the nursing staff of the organisation. The identified issue are insufficient training, incorrect administration technique, prescription errors (incorrect dosage), expired medication usage, wrong patient identification, and preparation errors (mixing incorrect multiple medications, dose calculation errors) that are leading to medication error establishment. Therefore, to overcome these factors that dwell medication error a Short-term Periodic Training Program (STPT) will be proposed in this project that will help to overcome these issues in the clinical scenario. This STPT will be a short-term 5 days training that will be provided to nursing staff of organisation in every six months to address the identified medication errors. As per the detected causes of medication error, this STPT will be designed and modified in every 6 month period by the experts to upgrade the nursing education and knowledge to cope up with changing healthcare environment and to address the medication errors for medical care improvement. This STPT program will involve an array of five strategies where each strategy will be guided to nurses on each day of the program. These strategies will be produced as per the identified medication error and mistakes in healthcare functionality. The establishment of STPT program will help to achieve equilibrium to manage the regular issues in medication services as well as the program will work to regularly upgrade the skills, education and knowledge of nursing staff within the organisation. Hence, this intervention will provide a regular process to control the medication complexity and establish the proper working environment. This quality improvement intervention will be planned using PDSA approach to regularly analyse the outcomes of this program. According to Nakayama et al. (2010) P-plan, D-do, S-study and A-act is a cycle that helps to analyse the impact of any trail or change in particular scenario. The planning phase involves the planning of change, do phase involves the implementation of change, study phase is accessing or studying the outcomes of change, and act phase involve determining the modification required in next change cycle. PDSA is considered as the ideal model of improvement. Figure 1: PDSA approach for quality improvement (Source: Nakayama et al. 2010, p. 337) In this project, PDSA cycle will be used to implement and test the effect of STPT program for addressing medication error. The below provided is the PDSA design and processes that will lead to development and evaluation of quality improvement program STPT for addressing the medication error in the present clinical scenario.  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Determining the current approach  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Identifying the potential solutions For the planning phase, the required authorities that include management committee, medical specialists, senior nursing staff and senior pharmacist will be invited to attend a meeting where the medication issues identified will be discussed in details. The aim statement will be to educate nursing staff as per the identified medication error causes in the clinical scenario. The issues will be identifies using the baseline performance audit and health information data of the involved patients. As per the discussion, possible solutions or strategies will be identified to manage these issues. As the current issues are lack of pharmaceutical knowledge, skills and training in nursing staff the proposed training and education strategies are: -  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Educating about five rights of medication administration that are the right drug, right patient, right time, right route and right dosage.  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Educating about reconciliation procedures  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Educating about e-learning process to improve knowledge  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Educating about process to documenting medication information and reporting medication error  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Guiding about the use of drug guide and suggesting to carry it all the time (Jones & Treiber, 2010).  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Analyse the improvement theory  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Initiate the STPT program intervention  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Collect the data to analyse  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Document the collected information The education program will be conducted with complete medical, pharmaceutical and surgical nursing staff. The program process will be carried for five days (2 hours) where each day a particular strategy will be taught by nursing teachers to the staff using audio-visual presentations. The education program will be designed as time efficient and simple. After the completion of the program a feedback form will be generated that is required to be filled by each participant of the program. This feedback data will help to analyse the effectiveness of program among audiences. After the completion of the educational program, a post-intervention will be checked for next five-week to detect the improvements in medication errors.  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Studying and analysing the collected data  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Identifying the errors and improvements In this phase of PDSA analysis, the collected feedback and audit information will be analysed to detect the improvement in medication error factors, mortality and serious hospitalisation, and impact on nursing staff for the implemented STPT program.    ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Re-analysing the STPT program strategies  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Establishing future strategies This phase of PDSA cycle is to re-examine the error in program development and implementing the possible solution for mistakes detected as per analysis. The modifications will be made in program education strategies in the next STPT program as per the identified medication errors in clinical functionality. As per this quality improvement project of implementing a Short-term periodic training program to overcome medication error in organisation, it is expected that findings will demonstrate a clear decrease in the medication error events and improvement in patient safety. The PDSA approach applied for quality improvement development and analysis allows reviewing the program strategy in every periodic repetition of STPT program. Hence, this technique can be modified as per post education intervention outcomes using PDSA model of quality improvement. Fletcher, R. H., Fletcher, S. W., & Fletcher, G. S. (2012).  Clinical epidemiology: the essentials. Lippincott Williams & Wilkins. Grove, S. K., Burns, N., & Gray, J. R. (2014).  Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences. Agyemang, R. E. O., & While, A. (2010). Medication errors: types, causes and impact on nursing practice.  British journal of Nursing,  19(6). Chhabra, P. T., Rattinger, G. B., Dutcher, S. K., Hare, M. E., Parsons, K. L., & Zuckerman, I. H. (2012). Medication reconciliation during the transition to and from long-term care settings: a systematic review.  Research in Social and Administrative Pharmacy,  8(1), 60-75. Chiang, H. Y., Lin, S. Y., Hsu, S. C., & Ma, S. C. (2010). Factors determining hospital nurses' failures in reporting medication errors in Taiwan.  Nursing outlook,  58(1), 17-25. Jones, J. H., & Treiber, L. (2010). When the 5 rights go wrong: medication errors from the nursing perspective.  Journal of Nursing Care Quality,  25(3), 240-247. Kalisch, B. J., & Aebersold, M. (2010). Interruptions and multitasking in nursing care.  The joint commission journal on quality and patient safety,36(3), 126-132. Kwan, J. L., Lo, L., Sampson, M., & Shojania, K. G. (2013). Medication reconciliation during transitions of care as a patient safety strategy: a systematic review.  Annals of internal medicine,  158(5_Part_2), 397-403. Mohammad Nejad, I., Hojjati, H., Sharifniya, S. H., & Ehsani, S. R. (2010). Evaluation of medication error in nursing students in four educational hospitals in Tehran.  Iranian Journal of Medical Ethics and History of Medicine,  3, 60-69. Mueller, S. K., Sponsler, K. C., Kripalani, S., & Schnipper, J. L. (2012). Hospital-based medication reconciliation practices: a systematic review.Archives of internal medicine,  172(14), 1057-1069. Nakayama, D. K., Bushey, T. N., Hubbard, I., Cole, D., Brown, A., Grant, T. M., & Shaker, I. J. (2010). Using a plan-do-study-act cycle to introduce a new OR service line.  AORN journal,  92(3), 335-343. Pham, J. C., Aswani, M. S., Rosen, M., Lee, H., Huddle, M., Weeks, K., & Pronovost, P. J. (2012). Reducing medical errors and adverse events.  Annual review of medicine,  63, 447-463. Raban, M. Z., & Westbrook, J. I. (2014). Are interventions to reduce interruptions and errors during medication administration effective?: a systematic review.  BMJ quality & safety,  23(5), 414-421. Sears, K., Goldsworthy, S., & Goodman, W. M. (2010). The relationship between simulation in nursing education and medication safety.  Journal of Nursing Education,  49(1), 52-55. Seys, D., Wu, A. W., Van Gerven, E., Vleugels, A., Euwema, M., Panella, M., ... & Vanhaecht, K. (2012). Health care professionals as second victims after adverse events: a systematic review.  Evaluation & the health professions, 0163278712458918. Unver, V., Tastan, S., & Akbayrak, N. (2012). Medication errors: perspectives of newly graduated and experienced nurses.  International journal of nursing practice,  18(4), 317-324.

Chapter 10 and 11 Assignment Example | Topics and Well Written Essays - 500 words

Chapter 10 and 11 - Assignment Example Actually, Wilson invoked the principle of confidentiality and sought to use it against the mandate of the rule of law.   Particularly, Nixon sought to exploit the idea that the principle of confidentiality was abstract enough to conflict the rule of law.   Thus, to defend his decision not to hand over the documents, Nixon argued that the right to confidentiality was the most paramount legal term. It is a fact that by 1972, Nixon’s appeal had started to wane. This follows the fact that he had been elected in 1968 mainly because of his â€Å"Nixon Secret Plan† that would have seen him stop the Vietnam War immediately he became president. Because Americans were decisively against the Vietnam War, Nixon secured the largest victory in 1968. However, four years later, he had not yet stopped this war. Growing nationwide antiwar protests and demonstrations which Nixon described as ‘a tiny but vociferous’ minority was an indicator of this waning popularity. To counter this unpromising development, Nixon controversially stated that there was a silent majority that understood the need for his administration to keep the war going, as an end to peace and honor (Chafe, 2009). The recession that raised inflation and interest rates to double digits also helped puncture Nixon’s popularity. The Watergate scandal also serves as a clear testimony that Nixon himself seriously considered his waning popularity a reality. At the time, there was a serious economic recession that caused interest rates and the rate of inflation to soar. The situation was deplorable to an extent that even Nixon’s imposition of price and wage controls miserably failed. High rates of unemployment, the falling supply of oil that made oil became subsequently expensive and an array of environmental crises and serious catastrophes such as the 1979 Three-Mile Island Nuclear Accident aggravated this feeling of helplessness in America.    It was also at this time that the War in