Tuesday, December 24, 2019

Racism in the United States Essay - 898 Words

In his essay, Robert Jensen claims that Caucasian Americans feel that in order to be considered a true American, your skin must be white in color. He uses hurricane Katrina as an example, saying that, ...one of the hurricanes most enduring legacies is the way it made visible the effect of racial and class disparities on who lived and who died... (Jensen, par. 1). According to what was shown on television, it would appear as though the black community garnered the bulk of the destruction, but when investigated closely, such an assumption would be proven to be absurd. Of course, racism has not been entirely eradicated from the American society, and no one racial group can honestly plead complete innocence to displaying racist†¦show more content†¦The fact is that the region most affected by the hurricane was home to economically depressed people of all colors. The author attempts to single out white Americans as the only group with issues in racism, but it is evident that reverse racism exists between minorities and whites. Such can be seen in hip-hop culture, which some believe was manufactured and bred for black people. I also find it to be interesting how some Hispanic groups neglect other races for not even speaking a specific dialect of Spanish. What either of these facts fails to point out is that being American has nothing to do with your skin color. A true American is a person born on American soil or legally awarded citizenship. An American also believes in the pillars that support our great society and is prepared to do whatever it takes to maintain the freedom that American culture implies. Evidence of the reverse racism, which I mentioned earlier, lies in the 2002 CBS News article, which states of an Iranian contractor, His competitor won that city project, by promising to subcontract more of the work to other businesses owned by minorities and women (Realities of Reverse Racism, par. 5). The type of racism that would classify this example is that of a personal bias towards aShow MoreRelatedRacism in the United States787 Words   |  3 PagesRacism is the trend of thought, or way of thinking, which attaches great importance to the notion of the existence of separate human races and superiority of races that are usually associated with inherited physical characteristics or cultural events. Racism is not a scientific theory, but a set of preconceived opinions they value the biological differences between humans, attributing superiority to some according to racial roots. Even in such ethnically diverse country as the United States, racismRead MoreRacism And The United States1053 Words   |  5 PagesMost countries would say that the United States does not have a culture, but it is actually the opposite. There are so many cultures the United States harbors that we cannot choose just one culture as our flag. Most of them are borrowed from other countries via immigrants but there is one culture specific to the Un ited States. Black Culture is unique to the United States, and it is faced with its possible destruction. The problem is prevalent enough to spawn TV shows and movies that discuss suchRead MoreRacism At The United States926 Words   |  4 PagesAfter being arrested in the United States, African Americans are 52% more likely to be detained than whites while facing a felony trial. For decades, Americans were being judgmental towards each other based on the complexion of another person’s skin. 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Corruption is the root of allRead MoreThe Racism Of The United States2154 Words   |  9 PagesPolitical Racism in United States Philosopher Kwame Gyekye defines the human affairs that means the experience of human beings. To distinguish relevant information and to dissect human activities, â€Å"essential universalism† and â€Å"contingent universalism† are defined its components and purpose with the limited discernment of humans and their undertakings. A large portion of this section is devoted the development of human behavior in this phenomena. My research paper will talk about the genre of racismRead MoreRacism During The United States1282 Words   |  6 PagesRacism in the United States Whites seemingly have always thought they were somehow superior to colored people. Whites in England conquered half the world just to show how powerful they were. Spaniards used Native Americans as slaves to mine gold in the early days of Mexico. America relied on slaves to farm for them or perform household chores. After slavery was abolished in most countries, racism prevailed. In the United States whites established the â€Å"Separate but Equal† idea. For example, whitesRead MoreRacism : The United States Of America885 Words   |  4 PagesRacism in The United States of America Racism has been part of American History since the beginning of the Countries origin. This issue includes the mistreatment of The Native Americans that were forced out of their lands and placed on reservations to black slaves being brought here from Africa. Throughout the history of this great nation people of the U.S. have moved away from these racist beliefs, yet, it is still a relevant issue in today’s society. Today slavery is no longer an institution, andRead MoreRacism Today in the United States1549 Words   |  7 PagesRacism Today in the United States After living in a place like Bend Oregon for 18 years I haven’t ever noticed a difference between blacks and whites. Bend has been said to be â€Å"one of the whitest places to live†, yet I never viewed a city by its race. Being racist to me meant that it was the whites who had a problem with the blacks and whites didn’t want anything to do with blacks. I hadn’t actually seen racism in action from anyone here. Now, after watching the film Crash and reading the essaysRead MoreRacism And Discrimination : The United States1260 Words   |  6 Pagesremember when racism and discrimination was an immense element that held people back in society. Race has always been a social construction in the United States, created in the minds of Americans and manifested through interactions but yet remains as a false determination of a human being. When we think back to earlier times many immigrants came over because of the â€Å"American Dream,† an idea that every citizen can have equal opportunities to achieve and live successful lives. The United States was the lighthouseRead MoreRacism And Ethnic Separation Of The United States1386 Words   |  6 PagesRacism and ethnic separation in the United States has been a noteworthy issue subsequent to the provincial period and the slave time. Legitimately or socially endorsed benefits and rights were given to White Americans that were not allowed to Native Americans, African Americans, Asian Americans, and Latin Americans. European Americans (especially Anglo Americans) were conceded select benefits in matters of training, migration, voting rights, citizenship, land procurement, and criminal method

Monday, December 16, 2019

Nursing Epidemiology and Health Free Essays

U N I T Concepts of Health and Disease arly peoples were considered long-lived if they reached 30 years of age—that is, if they survived infancy. For many centuries, infant mortality was so great that large families became the tradition; many children in a family ensured that at least some would survive. Life expectancy has increased over the centuries, and today an individual in a developed country can expect to live about 71 to 79 years. We will write a custom essay sample on Nursing: Epidemiology and Health or any similar topic only for you Order Now Although life expectancy has increased radically since ancient times, human longevity has remained fundamentally unchanged. The quest to solve the mystery of human longevity, which appears to be genetically programmed, began with Gregor Mendel (1822–1884), an Augustinian monk. Mendel laid the foundation of modern genetics with the pea experiments he performed in a monastery garden. Today, geneticists search for the determinant, or determinants, of the human life span. Up to this time, scientists have failed to identify an aging gene that would account for a limited life span. However, they have found that cells have a ? nite reproductive capacity. As they age, genes are increasingly unable to perform their functions. The cells become poorer and poorer at making the substances they need for their own special tasks or even for their own maintenance. Free radicals, mutation in a cell’s DNA, and the process of programmed cell death are some of the factors that work together to affect a cell’s functioning. I E CHAPTER Concepts of Health and Disease Georgianne H. Heymann Carol M. Porth 1 ogy. There has been an increased knowledge of immune mechanisms; the discovery of antibiotics to cure infections; and the development of vaccines to prevent disease, chemotherapy to attack cancers, and drugs to control the manifestations of mental illness. The introduction of the birth control pill and improved prenatal care have led to decreased birth rates and declines in infant and child mortality. The bene? ts of science and technology also have increased the survival of infants born prematurely and of children with previously untreatable illnesses, such as immunode? ciency states and leukemia. There also has been an increase in the survival of very seriously ill and critically injured persons of all age groups. Consequently, there has been an increase in longevity, a shift in the age distribution of the population, and an increase in age-related diseases. Coronary heart disease, stroke, and cancer have now replaced pneumonia, tuberculosis, and diarrhea and enteritis—the leading causes of death in the 1900s. This chapter, which is intended to serve as an introduction to the book, is organized into four sections: health and society, historical perspectives on health and disease, perspectives on health and disease in individuals, and perspectives on health and disease in populations. The chapter is intended to provide the reader with the ability to view within a larger framework the historical aspects of health and disease and the relationship of health and disease to individuals and populations, and to introduce the reader to terms, such as etiology and pathogenesis, that are used throughout this text. HEALTH AND SOCIETY HEALTH AND DISEASE: A HISTORICAL PERSPECTIVE The In? ence of Early Scholars The Nineteenth Century The Twentieth Century The Twenty-First Century PERSPECTIVES ON HEALTH AND DISEASE IN INDIVIDUALS Health Health and Disease as States of Adaptation Disease Etiology Pathogenesis Morphology Clinical Manifestations Diagnosis Clinical Course PERSPECTIVES ON HEALTH AND DISEASE IN POPULATIONS Epidemiology and Patterns of Disease Prevalence and Incidence Morbidity and Mortality Determination of Risk Factors The Framingham Study The Nurses’ Health Study Natural History Levels of Prevention Evidence-Based Practice and Practice Guidelines e concepts o f what constituted health and disease at the beginning of the last century were far different from those of this century. In most of the industrialized nations of the world, people now are living longer and enjoying a healthier lifestyle. Much of this has been made possible by recent advances in science and technol- T Health and Society Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obligated, at least for a spell, to identify ourselves as citizens of that other place. 3 4 UNIT I Concepts of Health and Disease After completing this section of the chapter, you should be able to meet the following objectives: ? Describe the concepts used to establish belief systems within a community and the effects on its health care practices ? Identify a disease believed to be generated by speci? c emotions and the characteristics ascribed to it ? Explain how m ythologizing disease can be detrimental to individuals in a society There is a long history that documents the concern of humans for their own health and well-being and that of their community. It is not always evident what particular beliefs were held by early humans concerning health and disease. Still, there is evidence that whenever humans have formed social groups, some individuals have taken the role of the healer, responsible for the health of the community by preventing disease and curing the sick. In prehistoric times, people believed that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be paci? ed or the evil spirits driven from the body. In time, this task became the job of the ealers, or tribal priests. They tried to pacify the gods or drive out the evil spirits using magic charms, spells, and incantations. There also is evidence of surgical treatment. Trephining involved the use of a stone instrument to cut a hole in the skull of the sick person. It is believed that this was done to release spirits responsible for illness. Prehistoric healers probably also discovered that many plants can be used as drugs. The communit y as a whole also was involved in securing the health of its members. It was the community that often functioned to take care of those considered ill or disabled. The earliest evidence of this comes from an Old Stone Age cave site, Riparo del Romio, in southern Italy. There the remains of an adolescent dwarf were found. Despite his severe condition, which must have greatly limited his ability to contribute to either hunting or gathering, the young man survived to the age of 17 years. He must have been supported throughout his life by the rest of the community, which had incorporated compassion for its members into its belief system. Communities such as this probably existed throughout prehistory; separated from each other and without any formal routes of communication, they relied on herbal medicines and group activity to maintain health. Throughout history, peoples and cultures have developed their health practices based on their belief systems. Many traditions construed sickness and health primarily in the context of an understanding of the relations of human beings to the planets, stars, mountains, rivers, spirits, and ancestors, gods and demons, the heavens and underworld. Some traditions, such as those re? ected in Chinese and Indian cultures, although concerned with a cosmic scope, do not pay great attention to the supernatural. Over time, modern Western thinking has shed its adherence to all such elements. Originating with the Greek tradition—which dismissed supernatural powers, although not environmental in? uences—and further shaped by the In? uences of zodiac signs on the human body. (Courtesy of the National Library of Medicine) ourishing anatomic and physiologic programs of the Renaissance, the Western tradition was created based on the belief that everything that needed to be known essentially could be discovered by probing more deeply and ever more minutely into the ? esh, its systems, tissues, cells, and DNA. 3 Through Western political and economic domination, these health beliefs now have powerful in? uence worldwide. Every society has its own ideas and beliefs about life, death, and disease. It is these perceptions that shap e the concept of health in a society. Although some customs and beliefs tend to safeguard human communities from disease, others invite and provoke disease outbreaks. The beliefs that people have concerning health and disease can change the destiny of nations. The conquering of the Aztec empire may be one example. Historians have speculated how Hernando Cortez, starting off with fewer than 600 men, could conquer the Aztec empire, whose subjects numbered millions. Historian William H. McNeill suggests a sequence of events that may explain how a tiny handful of men could subjugate a nation of millions. Although the Aztecs ? rst thought the mounted, gunpowered Spaniards were gods, experience soon showed CHAPTER 1 Concepts of Health and Disease 5 otherwise. Armed clashes revealed the limitations of horse? esh and of primitive guns, and the Aztecs were able to drive Cortez and his men from their city. Unbeknownst to the Aztecs, the Spaniards had a more devastating weapon than any ? rearm: smallpox. An epidemic of smallpox broke out among the Aztecs after their skirmishes with the Spaniards. Because the population lacked inherited or acquired immunity, the results were catastrophic. It is presumed that a quarter to a third of the population died from the initial onslaught. Even more devastating were the psychological implications of the disease: it killed only American Indians and left Spaniards unharmed. A way of life built around the old Indian gods could not survive such a demonstration of the superior power of the God the Spaniards worshipped. It is not hard to imagine then that the Indians accepted Christianity and submitted meekly to Spanish control. Although we live in an age of science, science has not eliminated fantasies about health; the stigmas of sickness and the moral meanings that they carry continue. Whereas people in previous centuries wove stories around leprosy, plague, and tuberculosis to create fear and guilt, the modern age has created similar taboos and mythologies about cancer and acquired immunode? ciency syndrome (AIDS). The myth of tuberculosis (TB) was that a person who suffered from it was of a melancholy, superior character— sensitive, creative, a being apart. Melancholy, or sadness, made one â€Å"interesting† or romantic. The general perception of TB as â€Å"romantic† was not just a literary device. It was a way of thinking that insinuated itself into the sensibilities and made it possible to ignore the social conditions, such as overcrowding and poor sanitation and nutrition, that helped breed tuberculosis. The infusion of beliefs into public awareness often is surreptitious. Just as tuberculosis often had been regarded sentimentally, as an enhancement of identity, cancer was regarded with irrational revulsion, as a diminution of the self. Current accounts of the psychological aspects of cancer often cite old authorities, starting with the Greek physician Galen, who observed that â€Å"melancholy women† are more likely to get breast cancer than â€Å"sanguine women. † Grief and anxiety were cited as causes of cancer, as well as personal losses. Public ? gures such as Napoleon, Ulysses S. Grant, Robert A. Taf t, and Hubert Humphrey have all had their cancers diagnosed as the reaction to political defeat and the end to their political ambitions. Although distress can affect immunologic responsiveness, there is no scienti? evidence to support the view that speci? c emotions, or emotions in general, can produce speci? c diseases—or that cancer is the result of a â€Å"cancer personality,† described as emotionally withdrawn, lacking self-con? dence, and depressive. These disease mythologies contribute to the stigmatizing of certain illnesses and, by extension, of those who are ill. The beliefs about health and disease have the power to trap or empower people. They may inhibit people from seeking early treatment, diminish personal responsibility for practicing healthful behaviors, or encourage fear and social isolation. Conversely, they also can be the impetus for compassion to those who are ill, for commitment to improving one’s own health, and for support of efforts to improve the health status of others. In summary, what constitutes health and disease changes over time. Prehistoric times were marked by beliefs that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be paci? ed or the evil spirits driven from the body. Tribal healers, or priests, emerged to accomplish this task. Prehistoric healers used a myriad of treatments, including magic charms, spells, and incantations; surgical treatment; and plant medicines. Throughout history, the concept of health in a society has been shaped by its beliefs about life, death, and disease. Some beliefs and customs, such as exhibiting compassion for disabled community members, tend to safeguard human communities and increase the quality of life for all community members. Others invite and provoke disease outbreaks, such as myths about the causes of disease. Even though science and technology have advanced the understanding and treatment of disease, misconceptions and fantasies about disease still arise. In previous centuries, diseases such as leprosy, plague, and tuberculosis were fodder for taboos and mythologies; today, it is cancer and AIDS. The psychological effects of disease mythologies can be positive or negative. At their worst, they can stigmatize and isolate those who are ill; at their best, they can educate the community and improve the health of its members. Health and Disease: A Historical Perspective After completing this section of the chapter, you should be able to meet the following objectives: Describe the contributions of the early Greek, Italian, and English scholars to the understanding of anatomy, physiology, and pathology ? State two important advances of the nineteenth century that helped to pave the way for prevention of disease ? State three signi? cant advances of the twentieth century that have revolutionized diagnosis and treatment of disease ? Propose developments that will both hamper and contribute to the promotion of health and the elimination of dis ease in the twenty-? rst century It has been said that those who do not know history are condemned to repeat it. There are many contributors to the understanding of how the body is constructed and how it works, and what disease is and how it can be treated, which in turn leads to an understanding of what health is and how can it be maintained. Much of what we take for granted in terms of treating the diseases that af? ict humankind has had its origin in the past. Although they are seemingly small contributions in terms of today’s scienti? c advances, it is the knowledge 6 UNIT I Concepts of Health and Disease produced by the great thinkers of the past that has made possible the many things we now take for granted. THE INFLUENCE OF EARLY SCHOLARS Knowledge of anatomy, physiology, and pathology as we now know it began to emerge with the ancient Greeks. They were the ? rst to recognize the distinction between internal and external causes of illness. To Hippocrates and his followers, we owe the foundations of the clinical principles and the ethics that grew into modern medical science. Hippocrates (460–377 BC) was a blend of scientist and artist. He believed that disease occurred when the four humors—blood from the heart, yellow bile from the liver, black bile from the spleen, and phlegm from the brain—became out of balance. These humors were said to govern character as well as health, producing phlegmatic, sanguine, choleric, and melancholic personalities. This belief paralleled the even older Chinese tradition, which was founded on the complementary principles of yin (female principle) and yang (male), whose correct proportions were essential for health. Hippocrates is identi? ed with an approach to health that dictated plenty of healthy exercise, rest in illness, and a moderate, sober diet. It was Aristotle (384–322 BC) who, through his dissection of small animals and description of their internal Hippocrates: A blend of scientist and scholar. Courtesy of the National Library of Medicine) anatomy, laid the foundations for the later scrutiny of the human body. For Aristotle, the heart was the most important organ. He believed it to be the center of the blood system as well as the center of the emotions. However, Aristotle’s main contributions were made to science in general. The person wh o took the next major step was Galen (AD 129–199), a physician to the emperors and gladiators of ancient Rome. Galen expanded on the Hippocratic doctrines and introduced experimentation into the study of healing. His work came to be regarded as the encyclopedia of anatomy and physiology. He demoted the heart—in his view, the liver was primary for venous blood, whereas the seat of all thought was the brain. He described the arteries and veins and even revealed the working of the nervous system by severing a pig’s spinal cord at different points and demonstrating that corresponding parts of the body became paralyzed. According to Galen, the body carried three kinds of blood that contained spirits charged by various organs: the veins carried â€Å"natural spirit† from the liver; the arteries, â€Å"vital spirit† from the lungs; the nerves, â€Å"animal spirit† from the brain. The heart merely warmed the blood. After Galen’s death, however, anatomic research ceased, and his work was considered infallible for almost 1400 years. As the great medical schools of universities reformed the teaching of anatomy in the early 1500s and integrated it into medical studies, it became apparent to anatomists that Galen’s data—taken from dogs, pigs, and apes—often were riddled with error. It was only with the work of Andreas Vesalius (1514–1564) that Galen’s ideas truly were challenged. Vesalius, professor of anatomy and surgery at Padua, Italy, dedicated a lifetime to the study of the human body. Vesalius carried out some unprecedentedly scrupulous dissections and used the latest in artistic techniques and printing for the more than 200 woodcuts in his De Humani Corporis Fabrica (â€Å"On the Fabric [Structure] of the Human Body†). He showed not only what bodily parts looked like but also how they worked. The book, published in 1543, set a new standard for the understanding of human anatomy. With this work, Vesalius became a leading ? gure in the revolt against Galen’s teachings. One of the most historically significant discoveries was made by William Harvey (1578–1657), an English physician and physiologist. He established that the blood circulates in a closed system impelled mechanically by a â€Å"pumplike† heart. He also measured the amount of blood in the circulatory system in any given unit of time—one of the ? rst applications of quantitative methods in biology. Harvey’s work, published in On the Motion of the Heart and Blood in Animals (1628), provided a foundation of physiologic principles that led to an understanding of blood pressure and set the stage for innovative techniques such as cardiac catheterization. With the re? ement of the microscope by the Dutch lens maker Anton van Leeuwenhoek (1632–1723), the stage was set for the era of cellular biology. Another early user of the microscope, English scientist Robert Hooke (1635–1703), published his Micrographia in 1665 in which CHAPTER 1 Concepts of Health and Disease 7 William Harvey’s most eminent patient, King Charles I, and the future King Charles II look on as Harvey displays a diss ected deer heart. (Courtesy of the National Library of Medicine) he formally described the plant cells in cork and presented his theories of light and combustion and his studies of insect anatomy. His book presented the great potential of the microscope for biologic investigation. In it, he inaugurated the modern biologic usage of the word cell. A century later, German-born botanist Mathias Schleiden (1804–1881) and physiologist Theodor Schwann (1810–1882) observed that animal tissues also were composed of cells. Although Harvey contributed greatly to the understanding of anatomy and physiology, he was not interested in the chemistry of life. It was not until French chemist Antoine Lavoisier (1743–1794), who was schooled as a lawyer but devoted to scienti? pursuits, overturned 100year-old theories of chemistry and established the basis of modern chemistry that new paths to examine body processes, such as metabolism, opened up. His restructured chemistry also gave scientists, including Louis Pasteur, the tools to develop organic chemistry. In 1796, Edward Jenner (1749–1823) conducted the ? rst vaccination by injecting the ? uid from a dairymaidâ€⠄¢s cowpox lesion into a young boy’s arm. The vaccination by this English country doctor successfully protected the child from smallpox. Jenner’s discovery led to the development of vaccines to prevent many other diseases as well. Jenner’s classic experiment was the ? rst of? cially recorded vaccination. Painting by Georges-Gaston Melingue (1894). The ? rst vaccination. Here Dr. Jenner introduces cowpox taken from dairymaid Sarah Nelmes (right) and introduces it into two incisions on the arm of James Phipps, a healthy 8-year-old boy. The boy developed cowpox, but not smallpox, when Jenner introduced the organism into his arm 48 days later. (Courtesy of the National Library of Medicine) THE NINETEENTH CENTURY The nineteenth century was a time of spectacular leaps forward in the understanding of infectious diseases. For many centuries, rival epidemiologic theories associated disease and epidemics like cholera with poisonous fumes given off from dung heaps and decaying matter (poisons in the air, exuded from rotting animal and vegetable material, the soil, and standing water) or with contagion (person-to-person contact). In 1865, English surgeon Joseph Lister (1827–1912) concluded that microbes caused wound infections. He began to use carbolic acid on wounds to kill microbes and reduce infection after surgery. However, Lister was not alone in identifying hazards in the immediate environment as detrimental to health. English nurse Florence Nightingale (1820–1910) was a leading proponent of sanitation and hygiene as weapons against disease. It was at the English base at Scutari during the Crimean War (1854–1856) that Nightingale waged her battle. Arriving at the army hospital with a party of 38 nurses, Nightingale found nearly 2000 wounded and sick inhabiting foul, rat-infested wards. The war raged on, deluging the hospital with wounded as Nightingale not only organized the nursing care of the wounded but also provided meals, supplied bedding, and saw to the laundry. Within 6 months, she had brought about a transformation and slashed the death rate from approximately 40% to 2%. 3 8 UNIT I Concepts of Health and Disease Florence Nightingale caring for wounded at Scutari, Turkey, during the Crimean War. (Courtesy of the National Library of Medicine) From the 1860s, the rise of bacteriology, associated especially with chemist and microbiologist Louis Pasteur in France and bacteriologist Robert Koch in Germany, established the role of microorganismal pathogens. Almost for the ? rst time in medicine, bacteriology led directly to dramatic new cures. The technique of pasteurization is named after Louis Pasteur (1822–1895). He introduced the method in 1865 to prevent the souring of wine. Pasteur’s studies of fermentation convinced him that it depended on the presence of microscopic forms of life, with each fermenting medium serving as a unique food for a speci? c microorganism. He developed techniques for culturing microbes in liquid broths. Through his work, he was able to dispel the disease theory that predominated in the mid-nineteenth century, attributing fevers to â€Å"miasmas,† or fumes, and laid the foundation for the germ theory of disease. The anthrax bacillus, discovered by Robert Koch (1843–1910), was the ? rst microorganism identi? ed as a cause of illness. Koch’s trailblazing work also included identifying the organism responsible for tuberculosis and the discovery of a tuberculosis skin-testing material. In 1895, German physicist Wilhelm Rontgen (1845– 1923) discovered X rays. For the ? rst time without a catastrophic event, the most hidden parts of a human body were revealed. Even though he understood that it was a signi? cant discovery, Rontgen did not initially recognize the amazing diagnostic potential of the process he had discovered. THE TWENTIETH CENTURY The twentieth century was a period of revolutionary industry in the science and politics of health. Concerns about the care of infants and children and the spread of infectious disease became prevailing themes in public and political arenas alike. It was during this time that private duty and public health nursing emerged as the means of delivering health care to people in their homes and in their communities. Social service agencies like the Henry Street Settlement in New York, founded by Lillian Wald, sent nurses into tenements to care for the sick. The placement of nurses in schools began in New York City in 1902 at the urging of Wald, who offered to supply a Henry Street nurse for 1 month without charge. 5 Efforts to broaden the delivery of health care from the city to rural areas also were initiated during the early 1900s. The American Red Cross, which was reorganized and granted a new charter by Congress in 1905, established a nursing service for the rural poor that eventually expanded to serve the small town poor as well. 5 Scienti? c discoveries and innovations abounded in the twentieth century. In the early 1900s, German bacteriologist Paul Ehrlich (1854–1915) theorized that certain substances could act as â€Å"magic bullets,† attacking disease-causing microbes but leaving the rest of the body undamaged. In 1910, he introduced his discovery: using the arsenic compound Salvarsan, he had found an effective weapon against syphilis. Through his work, Ehrlich launched the science of chemotherapy. CHAPTER 1 Concepts of Health and Disease 9 The operating room. With the advent of anesthesia, knowledge of how microbes cause disease, and availability of incandescent lighting in the operating room, surgery became an option for treating disease. Rubber gloves had not yet been invented and the surgical team worked with bare hands to perform surgery. (Hahnemann Hospital, Chicago, IL. Courtesy Bette Clemons, Phoenix, AZ) The ? rst antibiotic was discovered in 1928 by English bacteriologist Sir Alexander Fleming (1881–1955). As he studied the relationship between bacteria and the mold Penicillium, he discovered its ability to kill staphylococci. However, it was not until the 1940s that later researchers, who were searching for substances produced by one microorganism that might kill other microorganisms, produced penicillin as a clinically useful antibiotic. By the 1930s, innovative researchers had produced a cornucopia of new drugs that could be used to treat many of the most common illnesses that left their victims either severely disabled or dead. The medical community now had at its disposal medications such as digoxin to treat heart failure; sulfa drugs, which produced near-miraculous cures for infections such as scarlet fever; and insulin to treat diabetes. At the turn of the century, social service agencies like Henry Street Settlement in New York sent nurses into tenements to care for the sick. (Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 12]. Philadelphia: Lippincott Williams Wilkins) 10 UNIT I Concepts of Health and Disease With the discovery of insulin, a once-fatal disease known from antiquity no longer carried a death sentence. Working together, Canadian physician Sir Frederick Banting (1891–1941) and physiologist Charles Best (1899–1978) isolated insulin from the pancreas of a dog in 1921. The extract, when given to diabetic dogs, restored their health. In January 1922, they successfully treated a young boy dying of diabetes with their pancreatic extracts. Although still incurable, it became possible to live with diabetes. One disease that remained not only incurable but untreatable through much of the twentieth century was tuberculosis. With no cure or preventive vaccine forthcoming, efforts at the turn of the century were dedicated to controlling the spread of tuberculosis. It was then that an alliance between organized medicine and the public resulted in the formation of voluntary local organizations to battle the disease. These organizations focused on education to counteract the fear of tuberculosis; at the same time, they warned against the disease. In 1904, the local organizations joined together to form a national organization, the National Association for the Study and Prevention of Tuberculosis. In 1918, the name was changed to the National Tuberculosis Association, which was renamed the American Lung Association in 1973. 6 The national and local tuberculosis associations played a vital role in educating the public by running campaigns urging people to have skin tests and chest x-rays as a means of diagnosing tuberculosis. Once tuberculosis was diagnosed, an individual was likely to be sent to a sanatorium or tuberculosis hospital. There, good nourishment, fresh air, and bed rest were prescribed in the belief that if the body’s natural defenses were strengthened, they would be able to overcome the tuberculosis bacillus. For almost half a century, this would be the prevailing treatment. It was not until 1945, with the introduction of chemotherapy, that streptomycin was used to treat tuberculosis. Outbreaks of poliomyelitis, which had increased in the early decades of the 1900s, served as the impetus for the work of American microbiologist Jonas Salk (1914–1995). At its peak, the virus was claiming 50,000 victims annually in the United States. 3 Test trials of Salk’s vaccine with inactivated virus began in 1953, and it proved to prevent the development of polio. By 1955, the massive testing was complete, and the vaccine was quickly put into wide use. Surgical techniques also flourished during this time. A single technical innovation was responsible for opening up the last surgical frontier—the heart. Up to this time, the heart had been out of bounds; surgeons did not have the means to take over the function of the heart for long enough to get inside and operate. American surgeon John Gibbon (1903–1973) addressed this problem when he developed the heart-lung machine. Dramatic advances followed its successful use in 1953—probably none more so than the ? rst successful heart transplantation performed in 1967 by South African surgeon Christiaan Barnard (1922–2001). For centuries, the inheritance of traits had be en explained in religious or philosophical terms. Although English naturalist Charles Darwin’s (1809–1882) work dispelled long-held beliefs about inherited traits, it was Austrian bo- A tuberculosis skin testing clinic. (Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 49]. Philadelphia: Lippincott Williams Wilkins) CHAPTER 1 Concepts of Health and Disease 11 The â€Å"iron lung,† which used negative pressure to draw air into the lungs, was used to provide ventilatory support for persons with â€Å"bulbar polio. † (Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 91]. Philadelphia: Lippincott Williams Wilkins) anist Gregor Mendel’s (1822–1884) revolutionary theories on the segregation of traits, largely ignored until 1902, that laid the groundwork for establishing the chromosome as the structural unit of heredity. Many other scientists and researchers contributed to the storehouse of genetic knowledge. With the work by American geneticist James Watson (1928–) and British biophysicists Francis Crick (1916–) and Maurice Wilkins (1916–) in the early 1950s, which established the double-helical structure of DNA, the way to investigating and understanding our genetic heritage was opened. It is dif? cult, if not impossible, to single out all the landmark events of the twentieth century that contributed to the health of humankind. Among the other notable achievements are the development of kidney dialysis, oral contraceptives, transplant surgery, the computed axial tomography (CAT) scanner, and coronary angioplasty. Not all of the important advances in modern medicine are as dramatic as open-heart surgery. Often, they are the result of dogged work by many people and yield results only after a number of years, and then they frequently go unheralded. For example, vaccination programs, control of infectious diseases through improvements in sanitation of water and waste disposal, safer and healthier foods free from microbial contamination, identi? cation of health risks from behaviors such as smoking, and improved prenatal care all have saved many lives in the twentieth century. THE TWENTY-FIRST CENTURY The twenty-? rst century reveals new horizons, but also new problems. In greater numbers than ever, goods and people travel the world. There is unprecedented physical mobility—travel and migration from villages to cities and country to country—and interconnectedness. However, the bene? ts of physical mobility and interconnectedness are accompanied by risks. Diseases such as AIDS remind us that nothing is regional, local, or limited in its reach: contagious illness has a worldwide arena. The challenges of maintaining health and well-being in this global community are increasingly apparent. The inadvertent introduction of pathogens poses an unrelenting threat to public health, as does the deliberate use of microorganisms as weapons (see Chapter 18 for a discussion of bioterrorism and emerging global infectious diseases). In February 2003, the viral respiratory illness named severe acute respiratory syndrome (SARS) by the World Health Organization was ? rst recognized in China. 8 In the next few months, the illness swept through parts of Asia and spread to more than two dozen countries in North America, South America, and Europe. The disease was characterized by rapid onset and variable severity, ranging from mild illness to death. The prevention of SARS was a particular challenge because preventive interventions (e. g. , vaccines and antibiotics) were unavailable. Containment became a global collaboration, with public health authorities utilizing isolation and quarantine to focus delivery of health care to people who were ill and to protect healthy people from getting sick. During the February to July outbreak, more than 8000 people worldwide became infected, and more than 900 died. Commerce also is an integral part of the growing world community, bringing goods and services once unobtainable into the global marketplace. Expanded international trade also provides the vehicle for the unwitting introduction or transmission of disease. One such instance occurred in the spring of 2003 in the United States. A multistate outbreak of human monkeypox, ? rst identi? ed in the Democratic Republic of the Congo in 1970, was traced by investigators to pet prairie dogs. The prairie dogs became infected when they were housed or transported along with infected Gambian giant rats, dormice, and rope squirrels that were part of a shipment of small mammals from G hana. Spread of nonindigenous zoonotic pathogens to indigenous susceptible animal populations can be rapid and deadly. With such outbreaks lurks an additional danger—the potential for interspecies exchange, including between humans and animals such as pets. The widespread distribution of infected and potentially infected animals allowed epizootic spread of monkeypox through several states before effective interventions could be put into place. One of the challenges to the world health community will be to study the role of international travel and commerce in the emergence of infectious diseases through the dissemination of pathogens and their vectors throughout the world and then to develop long-term strategies of surveillance and intervention with the ultimate goal of curtailing their occurrence. In 1976, the World Health Organization (WHO) actually succeeded in eliminating smallpox from the face of the earth. 10 This triumph gave substance to the idea that other infections, like measles, also might disappear if suf? cient efforts were directed at worldwide campaigns to isolate and cure them. However, new infectious diseases, such as Lyme disease and Legionnaire’s disease, and new forms of old diseases, such as resistant strains of tuberculosis and malaria, have emerged and are readily spread 12 UNIT I Concepts of Health and Disease ing on Hippocratic doctrines and introducing experimentation into the study of healing. His work, gleaned through his role as physician to the emperors and gladiators of Rome and animal dissections, came to be regarded as the encyclopedia of anatomy and physiology and was considered infallible for almost 1400 years. Signi? cant challenges to long-held beliefs began with the work of Andreas Vesalius (1514–1564), professor of anatomy and surgery at Padua, Italy. His published work, On the Fabric [Structure] of the Human Body, showing how the parts of the body looked and worked, set a new standard for the understanding of human anatomy. Other significant early contributions were made by scholars such as William Harvey (1578–1657), the English physician and physiologist, who in his book, On the Motion of the Heart and Blood in Animals, provided a physiologic framework for the circulation of blood; Anton van Leeuwenhoek (1632–1723), the Dutch lens maker who refined the microscope and set the stage for the era of cellular biology; and Edward Jenner (1749–1823), the English country physician who conducted the first successful vaccination. The nineteenth century was a time of major discoveries that paved the way for understanding infectious diseases. Signi? cant contributions were made by such scientists as Joseph Lister, the English surgeon who concluded that microbes caused wound infections; German bacteriologist Robert Koch, who discovered the anthrax bacillus, thus identifying for the ? rst time a microorganism and the illness it caused; and French chemist and microbiologist Louis Pasteur, who developed the technique of pasteurization. Perhaps the most notable technical innovation of the century was the discovery of X rays by German physicist Wilhelm Rontgen. The scienti? undertakings and discoveries of the twentieth century were revolutionary. In 1910, Paul Ehrlich introduced chemotherapy, and in 1928, Sir Alexander Fleming discovered the ? rst antibiotic as he studied the relationship between bacteria and the mold Penicillium. Diseases that had once been fatal or crippling were managed or prevented by new advances, such as the discovery of insulin by Sir Frederick Banting and Charles Best in 1922 and the development of the polio vaccine by Jonas Salk in 1953. Technical innovations set the stage for new surgical techniques. The creation of the heartlung machine by American surgeon John Gibbon paved the way for coronary bypass surgery and the ? rst successful heart transplantation in 1967, which was performed by Christiaan Barnard, a South African surgeon. Other important advances included kidney dialysis, oral contraceptives, the CAT scanner, and coronary angioplasty. Public health programs also were responsible for greatly affecting the health of populations, such as those dedicated to increasing vaccination, improving sanitation of water and waste disposal, and identifying health risks. Knowledge about the in? uence of heredity on health and disease originated with Charles Darwin’s (1809–1882) evolutionary theories about inherited traits and with Gregor Mendel’s (1822–1884) theories on the segregation of traits, which laid the groundwork for establishing the chromosome as the structural unit of heredity. In the early 1950s, geneticist James Watson of the United States and British biophysicists Francis Crick and Maurice Wilkins presented their ? ndings on the double-helical structure of DNA. worldwide. The powerful interventions used to ? ght these infections have had the unexpected effect of accelerating their biologic evolution and making them impervious to one after another form of chemical attack. Pathogens also can be introduced into the food chain and travel worldwide. The discovery that beef from cattle infected with bovine spongiform encephalopathy (BSE) may be the source of Creutzfeldt-Jakob disease led many countries to ban beef products from the United Kingdom when BSE was found to be prevalent in English herds. The introduction of such pathogens can be the result of ignorance, carelessness, or greed. Tobacco is a product that serves as a pathogen. In a quest for ever-increasing pro? ts, the tobacco industry created a demand for its product by arti? cially raising the nicotine content of cigarettes so as to increase their addictive potential. This was done with the knowledge of the health risks of tobacco products, thanks to experiments conducted by the tobacco companies’ own medical scientists, but kept secret. If there is a blueprint for future advances, it is in the genes. The twenty-? rst century is destined to be dominated by advances in genetics. With the mapping of the human genome comes hope of cure for some of the most dreaded crippling and fatal diseases. The mapping of the human genome also has posed new ethical dilemmas, for with it comes the potential to predict the future health of persons based on their genes. It soon may be possible to differentiate between persons who will develop certain debilitating diseases and those who will not. Although advances in science and technology will continue to provide new treatments for many diseases, it has become apparent that there are more impressive rewards to be had by preventing diseases from becoming established in the ? rst place. Ultimately, maintaining health is more resource conservative and cost effective than relying on the treatment of disease. Many decades ago, we learned that even though the â€Å"magic bullets† such as antibiotics had the ability to cure what was once considered incurable, much of our freedom from communicable disease is due to clean water, ef? ient sanitation, and good nutrition. We have become increasingly aware of the importance of preventive measures against noninfectious conditions, especially cancer and coronary heart disease. There is no better way to prevent disease and maintain health than by leading a healthy life, and increasingly, it will be the individual who is responsible for ensuring a healthy passage through life. In summ ary, Greek scholars were responsible for establishing the fundamentals of anatomy, physiology, and pathology that served as the earliest knowledge base for understanding health and disease. It was Hippocrates (460–377 BC) and his followers who laid the foundations of the clinical principles and ethics that grew into modern science. Although his belief that disease occurred when the four humors—blood, yellow and black bile, and phlegm—became out of balance was disproved, his approach to health that dictated plenty of healthy exercise, rest in illness, and a moderate, sober diet remains valid. Galen (AD 129–199) took the next major step, expand- CHAPTER 1 The twenty-? rst century is predicted to be a time of great advances in the ? ld of genetics, already evidenced by the substantial mapping of the human genome that has taken place. Scientists look to genetic research to provide advances that not only will predict who may develop disease but also will provide new treatments for those diseases. However promising future advances may appear, it is readily apparent that prevention is an equally important tool in maintaining health. Concepts of Heal th and Disease 13 Perspectives on Health and Disease in Individuals After completing this section of the chapter, you should be able to meet the following objectives: ? State the World Health Organization de? nition of health ? Describe the function of adaptation as it relates to health and disease ? State a de? nition of pathophysiology ? Characterize the disease process in terms of etiology, pathogenesis, morphology, clinical manifestations, and prognosis ? Explain the meanings of reliability, validity, sensitivity, speci? city, and predictive value as they relate to observations and tests used in the diagnosis of disease What constitutes health and disease often is dif? cult to determine because of the way different people view the topic. What is de? ned as health is determined by many factors, including heredity, age and sex, cultural and ethnic differences, as well as individual, group, and governmental expectations. HEALTH The World Health Organization (WHO) in 1948 de? ned health as a â€Å"state of complete physical, mental, and social well-being and not merely the absence of disease and in? rmity. †10 Although ideal for many people, this was an unrealistic goal. At the World Health Assembly in 1977, representatives of the member governments of WHO agreed that their goal was to have all citizens of the world reach a level of health by the year 2000 that allows them to live a socially and economically productive life. 10 The U. S. Department of Health and Human Services in Healthy People 2010 described the determinants of health as an interaction between an individual’s biology and behavior, physical and social environments, government policies and interventions, and access to quality health care. 1 with which the need to adapt occurs (see Chapter 9). Generally speaking, adaptation affects the whole person. When adapting to stresses that are threats to health, the body uses those behaviors that are the most ef? cient and effective. It does not use long-term mechanisms when short-term adaptation is suf? cient. The increase in heart rate that accompanies a febrile illness is a temporary response designed to deliver additional oxygen to ti ssues during the short period that the elevated temperature increases metabolic needs. On the other hand, hypertrophy of the left ventricle is a long-term adaptive response that occurs in persons with chronic hypertension. Adaptation is further affected by the availability of adaptive responses and the ability of the body to select the most appropriate response. The ability to adapt is dependent on the availability of adaptive responses—the greater number of available responses, the more effective the capacity to adapt. Adaptive capacity is decreased with extremes of age and with disease conditions that limit the availability of adaptive responses. The immaturity of the infant impairs the ability to adapt, as does the decline in functional reserve that occurs in the elderly. For example, infants have dif? culty concentrating urine because of the immaturity of their renal tubular structures and therefore are less able than an older child or adult to cope with decreased water intake or exaggerated water losses. Similarly, persons with preexisting heart disease are less able to adapt to health problems that require recruitment of cardiovascular responses. Adaptation also is less effective when changes in health status occur suddenly rather than gradually. For instance, it is possible to lose a liter of blood through chronic gastrointestinal bleeding without developing signs of shock. On the other hand, a sudden hemorrhage that causes the loss of an equal amount of blood is apt to produce hypotension and circulatory shock. Even in advanced disease states, the body retains much of its adaptive capacity and is able to maintain the internal environment within relatively normal limits. DISEASE The term pathophysiology, which is the focus of this book, may be de? ned as the physiology of altered health. The term combines the words pathology and physiology. Pathology (from the Greek pathos, meaning â€Å"disease†) deals with the study of the structural and functional changes in cells, tissues, and organs of the body that cause or are caused by disease. Physiology deals with the functions of the human body. Thus, pathophysiology deals not only with the cellular and organ changes that occur with disease but also with the effects that these changes have on total body function. Pathophysiology also focuses on the mechanisms of the underlying disease and provides the background for preventive as well as therapeutic health care measures and practices. A disease has been de? ned as any deviation from or interruption of the normal structure or function of a part, organ, or system of the body that is manifested by a characteristic set of symptoms or signs; the etiology, pathology, and prognosis may be known or unknown. 12 The aspects HEALTH AND DISEASE AS STATES OF ADAPTATION The ability of the body to adapt both physically and psychologically to the many stresses that occur in both health and disease is affected by a number of factors, including age, health status, psychosocial resources, and the rapidity 14 UNIT I Concepts of Health and Disease f the disease process include the etiology, pathogenesis, morphologic changes, clinical manifestations, diagnosis, and clinical course. ity, the progression from fatty streak to the occlusive vessel lesion seen in persons with coronary heart disease represents the pathogenesis of the disorder. The true etiology of atherosclerosis remains largely uncertain. Etiology The causes of disease are known as etiologic factors. Among the recognized etiologic agents are biologic agents (e. g. , bacteria, viruses), physical forces (e. g. , trauma, burns, radiation), chemical agents (e. g. , poisons, alcohol), and nutritional excesses or de? its. At the molecular level, it is important to distinguish between sick molecules and molecules that cause disease. 13 This is true of diseases such as cystic ? brosis, sickle cell anemia, and familial hypercholesterolemia, in which genetic abnormality of a single amino acid, transporter molecule, or receptor protein produces widespread effects on health. Most disease-causing agents are nonspeci? c, and many different agents can cause disease of a single organ. For example, lung disease can result from trauma, infection, exposure to physical and chemical agents, or neoplasia. With severe lung involvement, each of these agents has the potential to cause respiratory failure. On the other hand, a single agent or traumatic event can lead to disease of a number of organs or systems. For example, severe circulatory shock can cause multiorgan failure. Although a disease agent can affect more than a single organ, and a number of disease agents can affect the same organ, most disease states do not have a single cause. Instead, most diseases are multifactorial in origin. This is particularly true of diseases such as cancer, heart disease, and diabetes. The multiple factors that predispose to a particular disease often are referred to as risk factors. One way to view the factors that cause disease is to group them into categories according to whether they were present at birth or acquired later in life. Congenital conditions are defects that are present at birth, although they may not be evident until later in life. Congenital malformation may be caused by genetic in? uences, environmental factors (e. g. , viral infections in the mother, maternal drug use, irradiation, or intrauterine crowding), or a combination of genetic and environmental factors. Not all genetic disorders are evident at birth. Many genetic disorders, such as familial hypercholesterolemia and polycystic kidney disease, take years to develop. Acquired defects are those that are caused by events that occur after birth. These include injury, exposure to infectious agents, inadequate nutrition, lack of oxygen, inappropriate immune responses, and neoplasia. Many diseases are thought to be the result of a genetic predisposition and an environmental event or events that serve as a trigger to initiate disease development. Morphology Morphology refers to the fundamental structure or form of cells or tissues. Morphologic changes are concerned with both the gross anatomic and microscopic changes that are characteristic of a disease. Histology deals with the study of the cells and extracellular matrix of body tissues. The most common method used in the study of tissues is the preparation of histologic sections that can be studied with the aid of a microscope. Because tissues and organs usually are too thick to be examined under a microscope, they must be sectioned to obtain thin, translucent sections. Histologic sections play an important role in the diagnosis of many types of cancer. A lesion represents a pathologic or traumatic discontinuity of a body organ or tissue. Descriptions of lesion size and characteristics often can be obtained through the use of radiographs, ultrasonography, and other imaging methods. Lesions also may be sampled by biopsy and the tissue samples subjected to histologic study. Clinical Manifestations Disease can be manifest in a number of ways. Sometimes, the condition produces manifestations, such as fever, that make it evident that the person is sick. Other diseases are silent at the onset and are detected during examination for other purposes or after the disease is far advanced. Signs and symptoms are terms used to describe the structural and functional changes that accompany a disease. A symptom is a subjective complaint that is noted by the person with a disorder, whereas a sign is a manifestation that is noted by an observer. Pain, dif? culty in breathing, and dizziness are symptoms of a disease. An elevated temperature, a swollen extremity, and changes in pupil size are objective signs that can be observed by someone other than the person with the disease. Signs and symptoms may be related to the primary disorder, or they may represent the body’s attempt to compensate for the altered function caused by the pathologic condition. Many pathologic states are not observed directly—one cannot see a sick heart or a failing kidney. Instead, what can be observed is the body’s attempt to compensate for changes in function brought about by the disease, such as the tachycardia that accompanies blood loss or the increased respiratory rate that occurs with pneumonia. It is important to recognize that a single sign or symptom may be associated with a number of different disease states. For example, an elevated temperature can indicate the presence of an infection, heat stroke, brain tumor, or any number of other disorders. A differential diagnosis that describes the origin of a disorder usually requires information regarding a number of signs and symptoms. For example, the presence of fever, a reddened sore throat, and positive throat culture describe a â€Å"strep throat† infection. A syndrome is a compilation of signs and symptoms (e. g. , chronic fatigue syndrome) that are characteristic of a speci? c disease state. Complications are possible adverse ex- Pathogenesis Pathogenesis is the sequence of cellular and tissue events that take place from the time of initial contact with an etiologic agent until the ultimate expression of a disease. Etiology describes what sets the disease process in motion, and pathogenesis, how the disease process evolves. Although the two terms often are used interchangeably, their meanings are quite different. For example, atherosclerosis often is cited as the cause or etiology of coronary heart disease. In real- CHAPTER 1 Concepts of Health and Disease 15 ensions of a disease or outcomes from treatment. Sequelae are lesions or impairments that follow or are caused by a disease. Diagnosis A diagnosis is the designation as to the nature or cause of a health problem (e. g. , bacterial pneumonia or hemorrhagic stroke). The diagnostic process usually requires a careful history and physical examination. The history is used to obtain a person’s account of his or her symptoms, their progression, and the fa ctors that contribute to a diagnosis. The physical examination is done to observe for signs of altered body structure or function. The development of a diagnosis involves weighing competing possibilities and selecting the most likely one from among the conditions that might be responsible for the person’s clinical presentation. The clinical probability of a given disease in a person of a given age, sex, race, lifestyle, and locality often is in? uential in arriving at a presumptive diagnosis. Laboratory tests, radiologic studies, CT scans, and other tests often are used to con? rm a diagnosis. Normality. An important factor when interpreting diagnostic test results is the determination of whether they are normal or abnormal. Is a blood count above normal, within the normal range, or below normal? Normality usually determines whether further tests are needed or if interventions are necessary. What is termed a normal value for a laboratory test is established statistically from test results obtained from a selected sample of people. The normal values refer to the 95% distribution (mean plus or minus two standard deviations [mean  ± 2 SD]) of test results for the reference population. 14 Thus, the normal levels for serum sodium (135 to 145 mEq/L) represent the mean serum level for the reference population  ± 2 SD. The normal values for some laboratory tests are adjusted for sex or age. For example, the normal hemoglobin range for women is 12. 0 to 16. 0 g/dL and for men, 14. 0 to 17. 4 g/dL. 15 Serum creatinine level often is adjusted for age in the elderly (see Chapter 36), and normal values for serum phosphate differ between adults and children. Reliability, Validity, Sensitivity, Speci? city, and Predictive Value. The quality of data on which a diagnosis is based may be judged for its reliability, validity, sensitivity, speci? city, and predictive value. 6,17 Reliability refers to the extent to which an observation, if repeated, gives the same result. A poorly calibrated blood pressure machine may give inconsistent measurements of blood pressure, particularly of pressures in either the high or low range. Reliability also depends on the persons making the measurements. For example, blood pressure measurements may vary from one observer to another because of the technique that is used (e. g. , different observers may de? ate the cuff at a different rate, thus obtaining different values), the way the numbers on the manometer are read, or differences in hearing acuity. Validity refers to the extent to which a measurement tool measures what it is intended to measure. This often is assessed by comparing a measurement method with the best possible method of measure that is available. For example, the validity of blood pressure measurements ob- tained by a sphygmomanometer might be compared with those obtained by intraarterial measurements. Measures of sensitivity and speci? city are concerned with determining how well the test or observation identi? es people with the disease and people without the disease. Sensitivity refers to the proportion of people with a disease who are positive for that disease on a given test or observation (called a true-positive result). Speci? city refers to the proportion of people without the disease who are negative on a given test or observation (called a true-negative result). A test that is 95% speci? c correctly identi? es 95 of 100 normal people. The other 5% are false-positive results. A false-positive test result, particularly for conditions such as human immunodeficiency virus (HIV) infection, can be unduly stressful for the person being tested (see Chapter 22). In the case of HIV testing, a positive result on the initial antibody test is followed up with a more sensitive test. On the other hand, false-negative test results in conditions such as cancer can delay diagnosis and jeopardize the outcome of treatment. Predictive value is the extent to which an observation or test result is able to predict the presence of a given disease or condition. A positive predictive value refers to the proportion of true-positive results that occurs in a given population. In a group of women found to have â€Å"suspect breast nodules† in a cancer-screening program, the proportion later determined to have breast cancer would constitute the positive predictive value. A negative predictive value refers to the true-negative observations in a population. In a screening test for breast cancer, the negative predictive value represents the proportion of women without suspect nodules who do not have breast cancer. Although predictive values rely in part on sensitivity and speci? city, they depend more heavily on the prevalence of the condition in the population. Despite unchanging sensitivity and speci? ity, the positive predictive value of an observation rises with prevalence, whereas the negative predictive value falls. Clinical Course The clinical course describes the evolution of a disease. A disease can have an acute, subacute, or chronic course. An acute disorder is one that is relatively severe, but selflimiting. Chronic disease implies a continu ous, long-term process. A chronic disease can run a continuous course, or it can present with exacerbations (aggravation of symptoms and severity of the disease) and remissions (a period during which there is a lessening of severity and a decrease in symptoms). Subacute disease is intermediate or between acute and chronic: it is not as severe as an acute disease and not as prolonged as a chronic disease. The spectrum of disease severity for infectious diseases such as hepatitis B can range from preclinical to persistent chronic infection. During the preclinical stage, the disease is not clinically evident but is destined to progress to clinical disease. As with hepatitis B, it is possible to How to cite Nursing: Epidemiology and Health, Essay examples

Saturday, December 7, 2019

Student Enrollment System Development in Java - myassignmenthelp

Question: Discuss about theStudent Enrollment System Development in Java. Answer: Introduction The Student information system is developed in order to easily insert, retrieve and manage the student data along with their academic details. We have used and implemented multiple classes in order to complete the tasks such as inserting student data, subjects and their enrollments in different courses. The project is developed using the Java swing Framework. Features of the developed system In order to create the GUI for the application we have used the JFrame which is the component of the Java Swing Class. The javax.swing.JFrame class is a container that inherits the java.awt.Frame class. This helps in developing the GUI for the applications and add different other components to the Jframe that builds the user form for the user through which they can interact with the application. The JFrame acts as the main window where components are added such as (buttons, labels, text fields or other I/O components). In this application, the main function is contained in the home class of the applications package. In this student subject and enrollment system we have added six buttons that will help the user to complete six different operations. These functionalities are, Insert Student details, Retrieve Student details, Insert Subject details for a new subject, Retrieve Subject details. In addition to that other functionalities like Inserting enrolment details, Retrieving enrolment details. Whenever a user clicks a button on the home page or the Main GUI of this application it will invoke a corresponding Jframe which will have different other components that will help the users to complete the operations. For this applications we have also implemented try-catch error handling options that will inform the user about any issues while operating the applications. Explanation for the used methods When the application is execute and the user clicks on the insert Enrollment button it will open a new Jframe which will contain two text fields and two buttons which are Subject code and Student ID who is enrolling to the subject when the user click on the submit it will lead to storing of the provided data to the Database when the application is connected to the database. Different classes are imported in other classes of this application package which required to call and complete the relevant data between the forms. The application is also implemented by using the Java event Listener and action listeners. The action listener is an interface which is used in order to receive the action events. At the point the action event happens as a result of users activity the related actionPerformed method is invoked in order to complete the specified steps. When the user clicks on the button to retrieve the data related to enrollment we have used the JRadioButton on the GUI so that the user can select according to which the user needs to retrieve the enrollment data. If the user selects the retrieval of data selecting the Student ID, then the application will show the subject to which the student is enrolled. On the other hand when the user selected the subject code then it will show the list of students who are enrolled under that specific subject. When the user clicks on the Insert Student, then in the next JFrame the users will need to provide the ID, family name, First name, address and phone number of the student. In order to store the data in the database. In order to retrieve data and show the selected data as for the students and subjects we have implemented three classes which are Enrolement, Student and subject. In order to save or store the data entered by the user it is important to connect the application using the JDBC connector. After the successful connection to the database the data from the different Jframe will be stored in the respective tables. Conclusion The core functionality for the proposed application is completed in the following parts. In the developed application it is possible to insert a new student or subject, retrieve the details of a student and enroll a student to a subject. Also the retrieve subject, enroll and student is implemented in similar way which are working properly. A new student or subject can be inserted and viewed. Furthermore the error handling for several issues are completely implemented for the application. Bibliography Almonte, N. A., Stubbs, W. R. (2014). U.S. Patent No. 8,863,015. Washington, DC: U.S. Patent and Trademark Office. Gibson, R. A. (2015). Building a Simple Global Security Application. In Swing for Jython (pp. 15-19). Apress. Mbarki, S., Laaz, N., Gotti, S., Gotti, Z. (2016). ADM-based migration from JAVA swing to RIA applications.International Journal of Information Systems in the Service Sector (IJISSS),8(2), 98-112.

Saturday, November 30, 2019

My Dog, My Best Friend free essay sample

There are few moments within a person’s life that can be considered life defining. For many people a life defining moment can consist of a new person into their life, or a new idea or invention that came to mind. For me my life defining moments are not all the same. While I have great moments and simple moments, many are so incredible that I could not begin to describe. However there is one moment in particular that is describable and very â€Å"life defining†. It was in the middle of sixth grade, my life was headed in a direction that was not suitable for a typical Christian teenager. I was slacking off in my work and my life was just not headed in the direction that is Christ honoring. I thought that it would take a miracle for me to get back on track. Well it was a far cry from a miracle but it was a life defining moment none the less. We will write a custom essay sample on My Dog, My Best Friend or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page I was about 13 and can still remember clearly the event and how it took place. I came home from school on the day of my birth with a long face and a heavy load on my shoulders. I’m not sure what was weighing me down, but I knew that something was dragging my spirit. Little did I know that it was all about to change, I walked through the door and entered my house to find my mom and my sister talking in the kitchen. I made it about half way to the couch when something attacked my leg. To my surprise it was a new puppy. This puppy was no ordinary puppy it was a germen short haired pointer. It had brown spots all over its white-hair body. Needless to say I was a bit surprised, but all in all I found this puppy to be a great stress relief, and I know I don’t have to tell you that a typical 13 year old has a ton of stress. Throughout the years this little puppy has become a great object of my affection, He has helped me out of many ordeals by both friendship and as an â€Å"scapegoat†. I have always found that I can talk to him no matter what and He always listens. While it is true dog is man’s best friend, this one has become like the brother I never had.

Tuesday, November 26, 2019

Nicaragua1 essays

Nicaragua1 essays Have you ever wanted to go to a place during our winter season that is warm or hot most of the year? Well, most people choose Florida, or California. But, why not go out of the country this winter and try the largest country of Central America, Nicaragua. I did lots of research on Nicaragua, and I hope you learn as much as I did. To begin my report, I will give you some brief history. The first inhabitants of Nicaragua were the Nicaro Indians. This way of life was blended with Spanish settlers when they first came. The name of this tribe was from a great Indian chief, whose name was also Nicaro. This chief was so famous that the country of Nicaragua was also gotten from his name. Next, I will tell you about the land of Nicaragua. It is located in Central America, and is the largest country there. It is on the continent of North America. Nicaragua is 50,193 square miles (130,000 square kilometers). Honduras borders Nicaragua in the north, and it is bordered by Costa Rica on the south. There are two oceans that border Nicaragua. On the east, there is the Carribean Sea and on the west is the Pacific Ocean. Nicaragua has many different types of land forms. There are mostly volcanoes, some active, behind the coastal plains and along the Pacific border. The active volcanoes cause some danger to the coastal cities, but there haven't been any serious accidents. The largest volcano in Nicaragua, the Santiago Volcano, lies south of Nicaragua's capital city. Lots of steam rises from the little holes that surround the volcanoes. East of these volcanic regions are the Central Highlands. This part of Nicaragua is rainy and has some evergreen and deciduous forests dotted around. The forest's floors are flat, not hilly like some other regions. Very few people live in this forest-like place. There are also some lakes in Nicaragua. One lake, Lake Nicaragua, is the largest one in Nicaragua and Central America. The other lake ...

Friday, November 22, 2019

How to Hydrate and Lubricate Your Dry Eyes

How to Hydrate and Lubricate Your Dry Eyes In order to keep your eyes hydrated, they need to stay lubricated. If you lose the lubrication, your eyes will get irritated very quickly. That can lead to eye strain and other problems. Follow these tips to help alleviate eye dryness and irritation. Keep Your Body Hydrated   If your body does not have enough water in it, your eyes will not have the moisture they need to stay sufficiently hydrated. Unblock Your Tear Ducts Your tear ducts can get stopped up. Try unblocking them to get your eyes natural lubrication system working again. Blink This may sound silly, but its an important reminder. If you are focused on something for a long time, such as a computer monitor, its likely that youre not blinking as much as you normally would- or as much as you need to sufficiently disperse your tears. Take a short break to rest your eyes. Use Artificial Tears Artificial tears are a good way to lubricate your eyes if you dont produce enough tears naturally. Make sure you use artificial tear drops, not red-eye reducers or other types of eye drops. These can dry your eyes out. Speak to your eye doctor about what artificial tears option might be best for you. Take Out Your Contacts   If you wear contact lenses, take them out for a while. Contacts dry out easily and require lubrication. Look into changing your contacts to a more breathable type of lens, and avoid sleeping in your lenses- even if you wear a type that allows you to do so. Sleep with Lubrication   If your eyes are dry while you are asleep, that irritation can carry through the day. Use of an eye mineral oil lubricant before you go to sleep can help. Talk to your eye doctor about the best type for your problem.

Wednesday, November 20, 2019

Optical Communication and Networks Essay Example | Topics and Well Written Essays - 3000 words

Optical Communication and Networks - Essay Example The concept of wavelength division multiplexing (WDM) and DWDM has also been introduced. Finally, the latest trends in optical communication and networks are briefly explained. Optical communication system is similar to any kind of communication system, as far as the basics are concerned. The major difference in optical and other communication models is the additional requirement of a source (for conversion of signal from electrical to optical domain), receiver (for conversion from optical to electrical domain) and use of fibre as media in place of conventional copper wire or microwave. The use of glass fibre or optical fibre features a number of advantages that make it a formidable media, in comparison to others. One of the most important assets of optical communication is the availability of enormous potential bandwidth to the tune of hundreds of GHz. The potential cannot be fully harnessed owing to electrical domain limitation. However, technologies like WDM or DWDM are evolving to optimize the available bandwidth usage. Being fabricated from glass, the fibre does no have earth loop or interface problem as are evident in electrical media. The optical communication is immune to interference from radio frequency and electromagnetic radiations or EMP (electromagnetic pulses) as they act as dielectric waveguides. There are practically insignificant radiations from fibre which enhance security of signal in a communication system. Other advantages include low weight, small size, flexible, reliable, easily maintainable, low transmission losses and cost effective. The requirement for capacity is increasing at a fast rate in the present day networks. Growth of worldwide web and Internet are the primary causes for this increase. Every four to six months, the need is almost doubling. Available broadband access technologies like Digital subscriber line (DSL), cable modems etc. provide bandwidths of 1Mbps and 28 to 56 kbps per user, respectively. With online businesses company networks with their distant locations and the clients, the bandwidth requirement is will soon rise to level where, the only solution would remain to switch to optical networks. Optical networks can be broadly divided into two generations. The first generation optical networks were solely used to enhance capacity to stand alone communication links while; the second-generation networks encompass the issues of routing and switching. In the subsequent paragraphs we will discuss optical communication and networks with reference to the various components and devices in greater details. We shall initially cover the basic theory behind transmission, attenuation and distortion of optical signal in the fibre. Optical Transmission Basics Optical fibre acts as a cylindrical waveguide with an inner core and outer cladding of differing refractive index as shown in Figure 1, core refractive index being greater than clad refractive index. The light traverses in the core as well as in the cladding. To illustrate the transmission of light, let's consider ray theory. Figure 1: Structure of optical fibre (adopted from Senior, John M.) The refractive index of

Tuesday, November 19, 2019

Sweetwater State Universitys Appraisal System Essay

Sweetwater State Universitys Appraisal System - Essay Example Decisively, the experts’ recommendations will have a definite impact through the proposed appraisal system because the administrators are required to pay more attention when evaluating their staff members. Moreover, through the vice president, the secretarial and clerical performance evaluation will be more productive and entail fairness to all the staff members. Â  Nonetheless, the proposed way of conducting the appraisal does not fully exploit the abilities of any appraisal; normally because the salary-increase aspect is still the core factor. Moreover, it will definitely increase a certain level of accuracy but there are limitations as the administrators will just examine a few things off the staff acting as the ‘deal breakers’. Resolutely, the feedback will not be fully valid especially because the university is using the graphics rate forms and the administrators are required to rank the staff by force. Â  The graphics rating forms are essential to the Sweetwater State University since it is easy and takes less time to develop, the administrators compare the staff quantitatively, and the forms do not give the administrators a hard time during the evaluation or when developing them. Additionally, the graphics rating forms are also a practice of fairness to the staff, simply because the evaluation follows the same criteria for all of them; moreover, most people agree that it is most valued and permissible but some question its development and validity that need clear guidelines.

Saturday, November 16, 2019

Dropout of school Essay Example for Free

Dropout of school Essay The Huffington Post recently ran an article entitled, Americas School Dropout Epidemic By The Numbers about Americas dropout problem. I would like to add my opinions about why children drop out of school. I am a professional educator who served as a classroom teacher, school counselor and school administrator in the New York City school system for over 33 years. I believe that there are five major reasons why children leave school: 1. The students themselves They make wrong decisions. They get involved with gangs, drugs/alcohol, get pregnant and commit crimes. Many have a poor school attitude and are frequently bored by school. They are disconnected to their families, school and life. They do not see the reasons they need to go to school. They are not involved in school activities and lack self-esteem. Some have been promoted lacking skills needed for promotion. Some have undergone major illnesses and have missed too many days of school and have been informed that they will be held back. Because of many of the conditions listed above, they have been suspended and have fallen behind in their work and see little purpose of returning to school. 2. The family they come from There is often a clash between the family values and those of the school. Frequently, their parents have dropped out of school themselves. The students come from families from low socio-economic backgrounds, where there are many other children. Older children often have to go to work in order to supply the family with much-needed funds for basic family needs or need to stay home to take care of younger siblings so that their parents can work. Many children come from non-English speaking homes with high mobility. Single parent homes have become the norm in the United States. Many children are products of divorce, separation or, sometimes, family violence. hey are not being raised by parents, but rather by aunts, uncles and grandparents. Families are not meeting some childrens basic needs of food, clothing and shelter. 3. The community they come from Many children live on the wrong side of the tracks in places where education is not valued, where drugs, gangs and violence abound. And where schools are low-performing, they often lack community and health support. 4. The schools they attend The schools are toxic to student learning, students, parents and staff. Students are suspended for minor infractions (such as talking back to the teacher), or placed in remedial classes. The schools have a culture of low expectations. They lack adequate guidance counseling. The curriculum is not relevant to the needs of the students being taught. Passive instructional strategies are being used without regard to individual student learning styles. Teachers are not trained in the latest teaching/learning/technology techniques. Funding is based on property values so that low-income neighborhoods receive less funding than wealthy neighborhoods. Because some states pass budgets in a less than timely matter, teachers are not hired in time producing over-sized classrooms. 5. The teachers they have The least-experienced, least classroom-trained teachers are often assigned to the most difficult schools. They enter the field with the expectation that they have been adequately prepared by the schools of education with the skills they need and they havent received. (See Arthur Levine, Educating School Teachers) They are leaving the field faster than colleges can prepare them. The teacher dropout rate is higher than the student dropout rate. Forty-six percent of teachers leave the field within five years. When asked why they leave, a majority state that they havent been properly prepared, have had increased demands placed on them because of high stakes testing and are not getting adequate support from their supervisors in dealing with classroom discipline. Like all generalities, there are exceptions to the information provided above. But, by and large, the statistics bear them out.

Thursday, November 14, 2019

Immanuel, Kant (1724-1804) Essay examples -- essays research papers

Immanuel Kant was born in 1724 in the East Prussian town of KÃ ¶nigsberg and lived there practically all his life. He came from a deeply pious Lutheran family, and his own religious convictions formed a significant background to his philosophy. Like Berkeley, he felt it was essential to preserve the foundations of Christian belief. Kant became Professor of Logic and Metaphysics at the University of KÃ ¶nigsberg in 1770 and taught there for most of his life. He was also greatly interested in science and published works on astronomy and geophysics. His three most significant works were published later in life. The Critique of Pure Reason came out in 1781, followed in 1788 by the Critique of Practical Reason and in 1790 by the Critique of Judgment. The Critique of Pure Reason is one of the most important works in the whole of philosophy. Unfortunately it is also one of the most unreadable - Kant himself described it as dry and obscure. Kant had generally been an outgoing and friendly man but towards the end of his life his mental faculties and his sight deteriorated badly. He died a shadow of his former self, aged 80. One of his most quoted sayings is carved on his gravestone in KÃ ¶nigsberg: "Two things fill my mind with ever-increasing wonder and awe, the more often and the more intensely the reflection dwells on them: the starry heavens above me and the moral law within me". IDEAS Kant believed that there are clear limits to what we can know. You could perhaps say that the mind's "glasses" set these limits. The philosophers before Kant had discussed the really "big" questions - for instance, whether man has an immortal soul, whether there is a God, whether nature consists of tiny indivisible particles, and whether the universe is finite or infinite. Kant believed there was no certain knowledge to be obtained on these questions. In such great philosophical questions, he thought that reason operates beyond the limits of what we humans can comprehend. At the same time there is in our nature a basic desire to pose these questions. When, for example, we ask whether the universe has always existed, we are asking about a totality of which we ourselves are a tiny part. We can therefore never completely know this totality. According to Kant there are two elements that contribute to our knowledge of the world - sensory perception and re... ...etimes you might only be kind and helpful to others because you know it pays off. It could be a way of becoming popular. But if this is your only motive you are not acting out of respect for moral law. You might be acting in accordance with moral law - and that could be fair enough - but if it is to be a moral action, you must have conquered yourself. Only when you do something purely out of duty can it be called a moral action. Kant's ethics is therefore sometimes called duty ethics. Kant also advocated the establishment of a "league of nations". In his treatise Perpetual Peace, he wrote that all countries should unite in order to assure peaceful coexistence between nations. He believed that man's "practical reason" would force the nations to emerge from the wild state of nature which creates wars, and make a contract to keep the peace. Kant recognised that this would take time to achieve but he saw it as our duty to work for the universal and lasting securing of peace. About 125 years after the appearance of Kant's treatise in 1795, the League of Nations was founded, after the First World War. After the Second World War it was replaced by the United Nations.

Monday, November 11, 2019

Persuading the Teacher to let me do my Research Paper on Prison Essay

Abstract   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The United States is currently facing an overcrowding crisis in its prisons today. Increased rate of crime and the refusal by the relevant state authorities to expand the number of correctional facilities has put a strain to the existing prisons. This has been recently been revisited in the national forums with calls from the concerned stakeholders to address the situation before it gets out of hand. Overcrowding according to prison authorities has reached peak levels to an extent that inmates are forced to share cells. The negative impacts of overcrowding are known and they include aggression and a higher likelihood of disease spreading (Paulus, P et al 112).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This situation needs to be arrested. There exist many strategies on the table that can be used to curb overcrowding. These would range from building new facilities, alternative correctional methods and proper designs of the correctional facilities. (www.johnhoward.ab.ca). The purpose of this short essay is to apply all the persuasive and writing schools acquired, use them to convince my instructor on why I should be allowed to tackle the above topic.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In this paper, I shall look at the resources that are they’re touching on this topic, and use them to present a solid case and position regarding the topic. This all is meant to prove to my instructor that this is a topic worthy tackling and that I am the right person. The possible thesis statement for the essay will be: The federal government should allocate adequate resources to alleviate the problem of overcrowding in our prisons. This thesis statement emanates form a personal belief and strong conviction that the situation as it stands in our prisons breeds more problem that it seeks to solve. The government has a key duty to provide essential services to all the citizens of this nation in spite of the status in life. The inmates are no lesser human beings than us ad deserve all the resources possible to make their stay in prison meaningful.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There are two very specific reasons that have aroused my intense interest of covering this specific topic. The first is my background and secondly is my interest in championing for human rights. Having been born and bred in a crime prone environment I have a first hand experience with criminals and a better understanding of why people indulge in crime. The political, social and economical factors that can lead to crime. The prisons are supposed to be correctional facilities and not to excessively punish and waste the potentials possessed by the inmates.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In writing this research paper I intend to utilize a large number of resources. The Internet and the library will provide a good source of information on overcrowding. Goggle scholar for example has lots of articles covering this topic. For example an article by Anne Bolduc â€Å"our crowded prisons† provides useful insights (Pg 45-57). From the library, a book by Stephen D, et al (America’s correctional crisis, Pg 12-56) focuses on the topic. There will be supplemented by other journal articles and materials from the web. This is an interesting topic and I plan to invest a lot of my time to expound more on the existing information. Works Cited Paulus, P, Cox V & McCain, G: Death rates, Psychiatric commitments, blood pressure and perceived crowding as a function of institutional crowding. Environmental psychology and non-verbal behavior, 3, 1978. 107-116 Prison overcrowding. John Howard Society of Alberta, 1996. Retrieved on 21/09/07 from http://www.johnward.ab.ca/pub/c42.htm Anne Bulduc. Our crowded prisons, animals of the American academy of political and social science. 1985, 45-57 Stephen D. Gottfredson, Sean McConville. America’s Correctional Crisis. Prison populations and public policy. Greenwood Press, 1987, 12-56

Saturday, November 9, 2019

Apple Swot

Apple SWOT In the 2011 Fortune 500 rankings Apple finished 35th, jumping from the 56th position it established the year before. As of January 2012 Apple surpassed Exxon to become the largest Corporation in the world. Apple’s rapid climb from virtual bankruptcy in 1996 is an incredible story. (Eberhard) Strengths: The products The company's reputation as an innovator Strong, loyal following Control over applications and operating systems Brand AwarenessWeaknesses – Apple's â€Å"All In† philosophy has some drawbacks – for example, my Windows phone will not sync on my Macbook. This perceived â€Å"if you're not one of us, you are one of them† mindset makes new converts to Apple products wary. Apple doesn't â€Å"fail† often but when they do it makes major headlines. Apple Maps served to show how big of a blunder one Apple branded failure can really be. (Goldman). The lack of forethought into the iPad.No matter how great of a success – an d it certainly is – Microsoft's Surface's screen size and inclusion of USB ports and a keyboard is going to make the next generation of the iMac – which could very well be a super charged iPad with all the required ports and a new OS – make Apple look like it is playing catch up instead of leading the innovation themselves. Closed source applications and operating system Brand perceived as â€Å"elitist† Diversity of products Cost of product vs. competitors Over saturation (iPhone)Opportunities – Apple is readying a Pandora like streaming music service and Apple TV could change the way we view our programing much in the same way the iPod and iTunes revolutionized the music business. Music streaming service Apple TV Shifting more production to US factories The Chinese Market yet to be fully tapped Integration with automakers Threats – Basically everyone who isn’t Apple – Google/Android, Microsoft/Windows 8, Samsung, the list goe s on – if you plug it in and talk, listen touch, type, or surf on it and it isn't an Apple, it is a threat to Apple.Apple's threats come from all directions because Apple not only produces product, it also produces all of the operating systems for it's product and tightly controls what content outside vendors can sell on the App Store. Changes in economy Changes in marketplace Chinese labor controversies Google's Android OS Microsoft's Windows 8 and Surface tablet Windows retail stores http://www. heavy. com/news/2012/12/google-maps-returns-to-iphone/ http://robeberhard. com/? page_id=130 Samsung SWOT Samsung was founded in 1938 as a fish and vegetable grocer. After the Korean War, Samsung's assets were divested and the grocery business was laid to rest.In 1969 SEC, the Samsung Electronic Corporation was created, beginning the Samsung as we know them today. Samsung now produces televisions, mobile phones, tablet computers, DVD and Blu-Ray players, MP3 players, cameras and sem iconductors. Over the years as they acquired new business and branched out into new ventures they have been subject to a variety of lawsuits involving copyright infringement, including those with watchmaker Rolex, mobile phone maker Ericsson and most recently Apple Computer. Apple recently surpassed Samsung to take the number one spot in marketshare in the mobile phone category. Tinari) Samsung's partnership with Google has provided a consistent OS (operating system) for it's mobile devices with Android. Android is an â€Å"open source† operating system, which, unlike Apple's, allows for third party users to openly contribute application and programs without company interference or oversight. While this gives users a wider variety of applications, there is no quality control over them, nor is there a way for Samsung to provide the customer service often required of these applications as Samsung has no part in their creation and distribution.Samsung recently won one of many la wsuits with Apple over the design of their popular Galaxy tablet. The recently released Microsoft Surface tablet and the Kindle Fire are Samsung's largest non-Apple competition in this market, however there are a number of super low cost tablets coming out of China that are also relying on the Android OS. These low cost, low quality tablets are forcing Samsung to advertise more aggressively to assure they are not lumped into this sub group of iPad knock offs. Strengths: Wide range of products Multiple partnerships with other brands, particularly Google and their Android operating system Growing marketshareHigh brand value Open source operating system Weaknesses: Lack of control over product once it's partners become involved Slow to release new product Lack of focus on one core product Lower price means lower perceived quality Complaints of not being â€Å"user friendly† Opportunities: Open more retail outlets Partnership with new brands means more innovation Reintroduce phon es with more user friendly interface Capitalize on Apple's failures Provide more customer service Threats: Continuing legal battle with Apple over copyright infringement Low cost competition in the tablet marketEmulation phones with Android OS weaken Samsung's image Microsoft's Surface tablet Windows Retail stores Changes in marketplace Changes in economy image: www. businessweek. com image: www. talkandroid. com image: www. obamapacman. com http://www. intomobile. com/2013/02/01/apple-grabs-34-mobile-market-share-passing-samsung-become-1/ http://www. businessweek. com/articles/2012-07-03/samsungs-smartphone-pitch-fuels-mobile-ad-boom http://www. talkandroid. com/154223-samsung-ramped-up-advertising-in-2012-outspent-apple-by-68-million/ http://obamapacman. com/2010/11/fail-samsung-galaxy-tab-flash-pop-up-ad-annoys-cnn-users/