Price Elasticity Essay

*** 1st November 2012 Examine whether the price elasticity of demand for rice is likely to be elastic or inelastic. Price elasticity of demand is the measure of how much of the quantity demanded changes in regards to a change in price. The PED is measured by the following formula: % Change in Quantity Demanded of the product/% Change in Price. If the PED is less than 1, the good is inelastic- indicating that there is a smaller change in quantity demand compared to the price change. When the PED is greater than 1, the good is elastic- meaning the quantity demanded will change significantly compared to a small price change.The price elasticity for rice could vary throughout several regions- but it can be argued that it is mainly inelastic because of the necessity of the product and the value the product holds in many households. However, in many regions, rice has proved to be elastic because of the number of close substitutes it has. The percentage change in price is greater than the p ercentage change in quantity demanded The percentage change in price is greater than the percentage change in quantity demanded To begin with, the price elasticity of demand for rice can be deemed inelastic.Clearly, various households consume rice on a regular basis. Research shows that rice is a staple good, or a main element in one’s diet, in â€Å"34 of the world’s countries. † With such a culture and mindset, households would unwilling to alter their demand for rice. Since rice is so commonly consumed, it is considered a necessity amongst households. Families of East-Asian descent, especially, are the largest consumers of rice- and eat rice in every meal. For instance, the price of a rice pack could be increased to $2. 50 from $2. 00; the change in price will be 25%.For a necessity product, the low reluctance of changing to another product would result in a smaller percentage change in demand- forcing the PED to be less than 1 and for rice to be inelastic. A lthough the necessity of rice does change from consumer to consumer and nation to nation, in a growing population in the East, rice has become more of a necessity than any other staple food. Since rice is engrained into cultural roots so deeply, a long-term substitute cannot be found- making the good inelastic in the short run and long run.In addition, the price elasticity can directly depend on the development of a nation. If the country is developed, and per capita incomes are high, rice will be inelastic. Since the price of rice takes up a very small proportion of the family income, the household is unlikely to change to an alternative- enforcing a lower percentage change in quantity demanded than percentage change in price. On the other hand, if the country’s economic development is low, or a low GDP per capita, the price of rice may have a significant portion of the average man’s income.As a consequence of a price change, then, the consumer will look for substitut es and alternatives for rice, as he or she will not be willing to pay that extra amount. In Bangladesh, for example, where rice is considered a staple food, the per capita income is $750USD. A bag of rice costing $24USD would be 3. 2% of an average Bangladeshi man’s salary- in contrast to an American who earns $48,450USD would spend 0. 05% of his salary in purchasing the same bag of rice. To summarize, a nation’s per capita income has a direct impact on whether or not a good such as rice is elastic or inelastic.As the price may decrease for rice, the quantity demanded might increase more significantly as buyers of the substitutes may start buying the product that has cut of its price. As the price may decrease for rice, the quantity demanded might increase more significantly as buyers of the substitutes may start buying the product that has cut of its price. However, rice can be considered elastic due to several reasons. Firstly, one particular brand of rice would have countless substitutes. There are bags of rice that are different in quality, different in quantity, different in flavor, different in place of growth, etc.When exposed to a change of price, a consumer will inevitably gain the inclination to substitute his or her initial product with an alternative that is priced lower to what the new price is of the previous good. Since the substitutes of rice are very similar to rice itself, if not the same product itself, people will be willing to change from one brand to another. The more substitutes there are for rice, in other words, the more elastic the PED will be, as the percentage change in quantity demanded will be greater than the percentage change in price.Quantity demanded, in other words, will decrease drastically if there are many substitutes, as consumers will shift from rice to the substitute product there is. If the price reduces, as well, many consumers will shift from the substitutes and consume the product that has cut of its p rice. In conclusion, although many substitutes can be found for rice, populations around the world eat rice incessantly. Since this continuous consumption has led to rice becoming a necessity, in most parts of the world a change in price will not affect the change in quantity demanded- making rice mostly inelastic.

Life of a Military Child Essay

It is often stated that soldiers who fight for our country make several sacrifices. While many have made the ultimate sacrifice, there are many more people who are affected by their service than just themselves. Children that belong to parents that have served or have parents currently serving are forced to overcome many obstacles. Not only are they forced to spend large amounts of time separated from their parent/parents, but they are forced to also move and adjust to unexpected changes frequently with no warning. Whether it is ever made known or not, when a solider enlists into any branch of the military, their family enlists as well, and just as they make a sacrifice so does their children. They often sacrifice time bonding with their parents, convenience of stability, and sometimes their wants and needs. Children that belong to a parent that have served or parents that are serving are forced to overcome many obstacles. Military children must adjust to a new life when their parents are away. Sometimes it’s their mother, sometimes it’s their father, but there are many cases where there are both parents away at the same time. The children are separated for various reasons to include their parents going to the field for weeks at a time, and sometimes they are sent overseas on dangerous deployments for up to 15 months at a time. Those children spend a great deal of days and nights worrying and wishing they could see and spend time with their parents. Soldiers are also sometimes sent on hardship permanent changes of station where they aren’t allowed to take their family members for up to 1 year. Almost daily military children are forced to wake up early and go to bed late because their parents work from 6:30 in the morning to after 5:00 in the evening. Military children are also forced to move around a lot. A soldier can receive orders to relocate within a 3 to 6 month window of reporting. Many times they do not have an option so they can be sent anywhere in the world. They could go from the east coast to the west coast or even overseas to Germany or Japan. When soldiers receive their PCS (Permanent Change of Station) Orders, the children are usually uprooted, and they may have to frequently adjust to new people and schools. Because these changes can occur every 2 to 3 years, many times the children are greatly affected because they have to make new friends everywhere they go only to possibly leave those friends and lose contact when the next orders are released. Although military children endure many changes throughout their parents’ time in the service they have many positive attributes because of those constant changes. Most military children are very flexible and adjust very well to change. They are also very well rounded and are usually more outgoing because they meet new people very frequently. What can also sometimes happen however is that they can have separation anxiety and possibly get into more trouble because of the constant changes. Many times the situation can go either way. It is always up to the parent however to do everything that they possibly can to make the child’s life as comfortable as possible and to keep an open relationship when dealing with the affects of being a military child. Although military children sometimes endure a great amount of transitions they have proven to be very successful in life regardless of their childhoods and they usually look back and appreciate their time spent in many different locations.

Summary Martin Luther King Letter

Magda Castillo Matthew Mayo English 1301 18 February 2013 Summary of Martin Luther King, Jr. â€Å"Letter from Birmingham Jail† The purpose of this letter is that Martin Luther King Jr. wanted to inform and prove a point to the people that were against his thoughts and beliefs. Through out his letter he wrote with lots of passion and intelligence. At times he might’ve even felt disappointed and angry but none the less very formal and with good manner. This letter was made out to the people that were upset for the actions that he did and for what he was fighting for. More Summary of Devil at My HeelsThe first argument that he appointed was in regards to the letter he received from the clergymen. In this letter that they wrote to Martin Luther King Jr. summarized the idea that Mr. King should just go back to where he lives and forget the whole mess that has caused him to go to jail in Birmingham. So to begin off the response, Mr. King first talks about how he arrived to Birmingham and the reasons why. Someone with higher authority had told him to go there to fix the situation that was going on with the segregation and the differences between the white race and the black race.He was there to come to some compromise between the two races in reasonable ways. Martin talks about how he will also keep fighting for his people no matter what the consequences are. Lastly, he defends himself by saying that any body that lives inside their home country is not considered and an outsider if is still in their country. He says that because the clergymen consider him an outsider just because he lived in a different city and his family is waiting for him back home. Throughout his letter, Martin also argues that his actions are not unwise and untimely.His actions are unwise because he uses nonviolent direct action as the only way when negotiating doesn’t work. He believes that this direct action creates some tension that can make the white people consider them to negotiate or come to some reasonable terms with the black folk. Then he talks about how his actions are not untimely. He states some facts that African Americans have been waiting for more than three hundred years for their rights. He also mentions that when people ask him to wait, wait always means never. Another topic he makes a point about is that he talks about just and unjust laws.He agues that the morally, just laws are God’s laws which are equal to everyone. But segregation laws are unjust laws. He also states that unjust laws don’t follow the democratic p rocess in which black people are not allowed to vote because of segregation. He continues on by saying that a law can just be on paper, but can be function unjustly. He makes his point by saying that they should break laws that are unjust so they can become truly just. He shows some examples like the Old Testament, early Christians in Rome, Boston Tea party, and etc. Martin Luther King Jr. oes on his letter also talking about how he is disappointed in the church because they should see the justice in his movement and should help him out but they don’t do anything. But that will succeed without their help. He mentions how he wants to do this nonviolently because it will bring good attention rather than doing things violently and not right. Mr. King also brings a good point of the things that happened with Adolf Hitler. He sees the hypocrisy in our country. The United States army fights against Hitler because he is getting rid of all the Jews, just because.But yet in the United States, segregation against the black people is going on. Its like the United States is Hitler and the Jews are the black people. In conclusion, he sends this letter to the clergymen with all these points and arguments on why he is in Birmingham. He states reasons why he will keep fighting for his beliefs. Mr. King shows different examples of how segregation has been a problem and why it should be gone. He shares his thoughts and opinions to anyone that would hear him out and help his movement in any way.

Risk Management Processes Essay Example | Topics and Well Written Essays - 2000 words

Risk Management Processes - Essay Example Risk has been known to be unavoidable; as a result, every individual and organisation needs to ensure that they manage risk to a level which is tolerable or acceptable depending on its â€Å"risk appetite†. Resources available for managing risk are finite. Therefore, individuals, entities and organizations should strive to achieve an optimum response to risk, prioritised according to an evaluation of the risks. Risk Management There has been various definition of risk management. Eppler and Aeschimann (2008) defined risk management as ‘an effective method that is critical in minimizing hurting effects of risks and optimizing the benefits of risky situations’. Risk management can be deduced to mean taking measures that are defined and should be able to reduce the potential risky results of specific action in various socio-political and economic climates. Identifying, analyzing, minimizing and monitoring risk is the very essence of risk management. Risk management i s the process of helping organisations and managers make the best use of resources available to them given unpredictable situations. When organisations apply risk management, they address systematically the risks that face their events and processes. The ultimate goal of managing risks is to achieve augmented benefit across portfolio of their activities (IRM, 2002). Risk management process entails activities aimed at assessing risk, and engaging in activities that help reduce risk to levels that are acceptable and able to maintain the level of risk. Eventually, an organisation would ensure that risks are analyzed in relation to existing potential benefits, putting into consideration existing alternatives, and, finally, implementing the best course of action according to management goals. Risk management involves the process of risk analysis that studies people’s interactions and various risks in relation to their surroundings. It is believed that humans are responsible for cr eating risks while at the same time bearing its burdens or at the same time assume both roles in their quest of trying to reduce personal risks. In any organisation, risk analyses that are effective should be able to involve all relevant fields including social science, natural science and engineering (Fischhoff, 2005). Risk management is known to be different in many organisations depending on its size, type, outcomes, the purpose of their existence and the role they play especially in delivering goods or services. Organisations that exist in the private sector main purpose is mainly directed towards enhancement of shareholder value; at the same time organisations in the public sector main objective is to deliver services for the benefit of the public. Whatever the type and purpose of the organisation, achieving and delivering their objectives is surrounded by uncertainty that would bring about threats to success at the same time provide opportunities for increasing success. Risk m anagement consists of the process of analyzing and interpreting risk, at the same time, it also involves the process of identifying and analysing details and level of formation of systems. The subject also includes the process of collecting and analyzing data on different component of risk and finally, interpreting the Risk Assessment output. In risk management, risk mitigation involves the selection and implementation of security controls to reduce

Monopolistic behavior of facbook, is it a monopoly Essay

Monopolistic behavior of facbook, is it a monopoly - Essay Example 3). A monopoly refers to a market with only one seller of a particular good or service. A monopoly is characterized by a single seller in the market and, therefore, no competition. In connection to this, the seller makes abnormal profits as a result of market domination. Abnormal profits are realized because there are many buyers in the market, and the seller is the price maker. Moreover, the seller controls the good or service prices in that market; there is information asymmetry; consumers do not have complete information; the product does not have close substitutes and there are barriers to entry. (Sexton 332) An oligopoly is a market that is dominated by few sellers. It has two to ten firms in the business competing with each other. Oligopoly mostly results from collusion where several firms come together to form a single firm and, therefore, reduce competition. Oligopolies compete on the basis of prices, technological innovation, quantity, reputation, or advertising. Oligopolies are characterized by few firms in the business such that the actions of one firm influence those of another. The products may be homogenous or differentiated; there is non-price competition where firms compete on other terms apart from prices including differentiated products, loyalty schemes or advertisement; oligopolistic firm are so large that their individual actions affect the market conditions; the firms have perfect information, but buyers have imperfect information. (Sexton 332-333). From the description Facebook is not a pure monopoly since there are other firms in the business as twitter, LinkedIn and MySpace among others. It would be considered a leading oligopoly since collusion and acquisition of other firms has given it an advantage over other social network firms. However given the recent efforts example buying Oculus Rift and WhatsApp there is concern that this

A Reflective Analysis on the Assessment and Management for ankle Essay

A Reflective Analysis on the Assessment and Management for ankle injury - Essay Example The placement experience obtained through patient assessments and management resulted into a better nursing intervention based on the pre-existing nursing knowledge for the future improvements. According to National Institute for Clinical Excellence (2004), reviews ankle joint injuries management in healthcare facility as a nursing responsibility aimed restoring the physiological function of the a ankle joint after an accident or injury has occurred. For the future practice, the nurses should reflect on the clinical experiences, concepts and understandings during the ankle injury assessment and management an adaptive response of care. Therefore, for this reflective analysis, the GIBBS model of reflection is used serving as a turning point in of ankle injury and related risks conditions assessment and management reflective analysis. GIBBS model of reflective analysis is a model of choice since it links the trainee nurses to their nursing practice, supervisors and their patients providing a systematic reflective of all the procedures and processes that were conducted in my nursing practice. For confidentiality and privacy of my nursing training experience, the name of the client, health facility, and the location has been made anonymous based on the reflective analysis for nurses’ survival in the word (Richards & Edwards, 2012). Ankle sprains are the most common sporting and UCC injuries anatomically and physiologically occurring as the tearing of bone-bone ligaments connection that stabilizes the ankle joint. My mentor reminded me that, the ankle injury causes destabilization of the hinge joint formed by fi bula, tibia and the talus bones resulting in structural disarrangement, fractures and deformity of the bones and ligaments around the ankle joint. Through the department orientation I learned that, the risks factors for the ankle joint injuries in United Kingdom are

Humanitarian Military Action Essay Example | Topics and Well Written Essays - 2500 words

Humanitarian Military Action - Essay Example The purpose of this paper is to explore why humanitarian military action is controversial in the eyes of some, and how humanitarian military action can be useful in some situations. Using this as a basis, it will then explore the situations in which humanitarian military action has been successful and what conditions link these occasions. The same process will be completed for the failures, to provide a full overview of humanitarian military action and how best to judge whether it is the right choice in a certain situation. When Humanitarian Military Action is Accepted Many feel that there are situations where military action in the pursuit of protecting human rights is necessary. If, for example, a powerful regime is violating human rights of the citizen or resident, then many feel a more powerful or enlightened government should approve military action for the protection of these people. Humanitarian military action is also often approved with the aim of installing democracy in a c ountry where it has not previously been the primary political system, with the attempt of improving the lifestyle, conditions and rights of the residents. It can also be to protect neighbouring countries or political forces who may be at danger without such intervention1. The central dogma of humanitarian intervention is that it is protective and so any attempts for military action without this cannot be classified as humanitarian. Evidently, this definition is broad enough that humanitarian intervention may be viable in the eyes of some, whilst not in others, and this is amongst the reasons why it can be unsuccessful. Why Humanitarian Military Action is Controversial Humanitarian military action is considered useful in many situations, but it is not without controversy. Many feel that it is an oxymoron, as military action will undermine the living conditions and lifestyle of those in combat and those surrounded by the action2. In this case, the military action can perhaps be percei ved as going against the values of humanitarianism. In some cases, military action may provoke a civil uprising or the instillation of a new political regime that violates human rights more than the previous, which can again cause the action to be considered futile and damaging. There are also those who believe that geographical areas should be left to their own devices to evolve into the political system that is right for them3. In fact, proponents of this position often believe that democracy is not necessarily right for every country, and that forcing it upon citizens is a violation of human rights itself. One main reason why humanitarian intervention has become more likely in recent decades is that political and technological developments have allowed many events to be judged on a world stage and to found a modern international system. Politics has to carefully consider other nations. Despite this development, many feel that it is appropriate for each sovereign state to have imm unity against intervention despite any atrocities carried out by any governmental system in place there4. It can also be suggested that the reigning regime in these opponents feel that they are correct in their views but do not feel the need to perform military intervention on the Western world. Either way, this ability and right to rule alone as is seen fit by ruling governments is seen as both part of the international stage and an anathema to it. The Conditions for Success or Failure of Humanitarian Mili

Project Management Challenges Research Proposal

Project Management Challenges - Research Proposal Example For Project Managers to work effectively, collaboration with Functional manager is mandatory. Let’s understand who functional managers are and how they differ from project managers. Functional managers are those who are managing the core operations of the business and are appointed permanently, usually for a longer period of time. On the other hand, Project Managers are appointed for a particular task such as building a new branch, constructing a port etc. Project Managers are usually appointed for a particular period of time whose job is completed after the completion of the project. Any organization may choose from various combinations of power strategy that are assigned to the Functional Manager and the Project Manager. These types are Weak Matrix, Balanced Matrix, Strong Matrix and Projectized (JOSH, 2009). Project Managers might be dependent on Functional managers for various things. For example, Project managers usually borrow staff from functional managers when they are short of team members. Sometimes, the project manager is a functional manager too where he/she performs the additional job of a project manager. For example, a restaurant business wants to expand its business in another city. The CEO might appoint the Operation Manager of the main branch, the additional task of Project Manager for building the design, processes, menu, hiring employees etc of the new branch in this new city. Appointing your own Functional Manager as the Project Manager is helpful in various ways. The Project Manager, in such cases, knows the culture, system, processes, vision, and mission of the company. It will also save cost as hiring a new project manager will cost a hefty amount and your own functional manager might not need that much amount. It is necessary for functional management to effectively coordinate, communicate and work collaboratively with the project management team. Project Managers might need a lot of information from the functional managers for v arious things. The authorities given to project managers are usually restricted, especially the cost and expenditure control, legislative decision making etc for the reason that Project Managers might not have sufficient experience of handling specific tasks. Thus, usually, financial controls are not given to the PM. However, many Project Management specialists say that they should have control over costs and expenditure within a specified and agreed limit. This should be one reason why Functional Manager must collaborate closely with the project manager and understand their compelling issues. The ultimate aim of a Project Manager is to make happy the project sponsors and all stakeholders included through efficient completion of the project without consuming an excessive amount of money and time.  

Biology journal report Essay Example | Topics and Well Written Essays - 250 words

Biology journal report - Essay Example With Grey literature as the primary data source, the researchers found 104 genetic tests that are in development. 68% of these tests were found in LexisNexis and Cambridge Health Institutes (CHI) databases, 38% from 8 more Grey literature databases. 4% were obtained through alternative resources like opinion leaders interviews and national conferences. 76% of the total tests being developed were limited to only 5 of the ten most common cancers in terms of mortality. Most of these tests only appeared to be related to cancer diagnosis and management, but no clinical validity has been established yet. The authors of the article found LexisNexis and CHI databases as the most useful to their project. The authors discussed limitations of this research. The researchers relied highly on Grey literature where LexisNexis and CHI were the primary sources of cancer genomic tests in development (68%) (Chin, Wessler and Chew, Genetic Test for Cancer). In addition, three-quarters of the genomic cancer tests in development addressed in this article were for only 5 of the ten most dangerous cancers in deaths. There may be other tests in development present in other literature sources (other than Grey Literature databases) that may address more of the lethal cancers. Identification of such tests can be crucial as it will give hope that in the near future, a solution may be provided for at least the worst cancers in terms of lethality. Hence, more research in more sources is essential. The authors also appreciated that almost all of the cited developing genetic tests only appear to be related to management and cancer diagnosis as no clinical validity has been established yet. This implies tha t data analysis in this article may be misleading as it relies on assumption that those tests are linked to cancer diagnosis and management. This article shows that currently available tests for prevention and treatment of cancer are few. More cancer preventive genetic

Socio- economic class can affect the health of individuals discuss Essay

Socio- economic class can affect the health of individuals discuss - Essay Example These three components of socioeconomic position influence an individual’s life chances and living standards. Each of them can act as a reference point when constructing hierarchical classification of socioeconomic position. For example, people can be classified based on skill level from unskilled manual jobs to professional jobs or from low income to high income (Liu, 2011, P.258). Occupation, educational achievement and income capture critical dimensions of people’s material and social endowment, and also act as substitute for other unmeasured progressions which profiles an individual’s health. In this respect, researchers aim to capture unmeasured factors, which vary in line with these three factors when they classify individuals or households using them. The common trend is that people in higher socioeconomic groups tend to have better health and fewer disabling conditions that those in lower groups. Health inequalities are evident from the beginning of life as exemplified by gradients in birth weight, which influence cognitive and physical development (Lu and Jonsson, 2007, P.267). Social economic status (SES) is often implicated as a cause of health disparities among different groups. It can be defined as the relative position of a household or an individual in a hierarchical society, based on their access to wealth, prestige and power. SES is related to health status and captures an individual’s or groups ability to access basic resources required to achieve and maintain good health (Lu and Jonsson, 2007, P.267). There is a strong correlation between health outcomes and income, educational achievement, wealth, community environment and race or ethnicity. People with higher incomes, higher educational qualification and those who live in a healthy and safe environment have on average longer life expectancies and better health outcomes. On the other hand, those with low

A Concerted and Cogent Effort Needed to Establish Equality in Society Essay Example for Free

A Concerted and Cogent Effort Needed to Establish Equality in Society Essay The concept of establishing equality among all members of the society is as old as the history of civilization – the list of dos and donts of several cultures also emanate out of that, before the dominant groups of the societies convert them as doctrines to maintain their dominance over the minorities. However, the voice of the concerned humans also rise from time to time, like what is now being heard under the titles like human rights or living wage. Though usually dubbed as a means of meeting the basic living requirements, living wage aims at facilitating humans to earn their lives to fulfill what Maslow (1943) described in his hierarchy of needs, which comprises of five sets of needs such as basic needs (air, water, food, clothing and shelter), safety and security needs, social needs, esteem needs and self-actualization needs. Thus the concept of living wage raises issues of human rights with special emphasis on the right to survival and dignity. This article thus explores three situations depicted by three researchers to underpin the drivers of inequality in general. India is Plagued by Caste-concept and Exploitative Colonial Ruling Style In spite of being officially a staunch supporter of human rights with a clear backing from its constitution, India is still plagued by the legacies of the Hindu caste system and exploitative format of British ruling style, if the findings of Channa (2010) have anything to go by. He points out with evidence that there is a huge gap between the constitutional vision and the ground-level realities regarding the social and economic situation in India, where it clearly fails to reason why the majority of its population still reels under below poverty line, save providing living wage. Channa points out that legislation or legal strictures prove insufficient against the power of social will in India, which needs to be transformed to a state where the dominant groups of the society will unlearn the caste and exploitative colonial ruling concepts and perceive the real-time need of restoring the human status of its fellow countrymen. South Carolina Suffers from Contradictory Legislations The issue of living wage gets another dimension when it is seen from interpretive and political economic anthropological perspectives, where Kingsolver (2010) comes up with the instance of South Carolina, the area which tops in the number of people living in poverty due to high unemployment rate. Here the solution lies in enforcing legislated living wage that would prioritize human needs over the issue of earning profit. Kingsolver argues that the elimination of contradiction in the laws on tax or right to work appears to be the first step towards achieving a legislated living wage, otherwise the age-old conflict between the logics of social welfare and the welfare of capital will continue to be at loggerheads in this region. Exploiters in the Avatar of Corporate Giants Bensen (2010) shows how biocapitalism of the corporate giants like Philip Morris is actually a veiled threat to the normative functioning of the society, where it violates not only the ethical standards of living, but also carries on with the tendency of exploiting the human capital, let alone ignoring the issue of social equality. For example, the placement of tobacco auction warehouses as well as the leaf-processing plants in North Carolina are strategically placed in predominantly Black residential areas to get low-skill workers at a minimum rate and to profit more by saving the expenditure on workplace conditions. Conclusion All the three papers reviewed above analyze social dynamics of stigmatization under different contexts, where India suffers from the legacies of age-old caste system and exploitative British ruling strategies, while North and South Carolina suffer from racial discrimination and corporate manipulation. Such state of affairs only consolidates the impression that rules to establish human rights cannot be effective unless the mindset of the dominant groups are transformed, and for that matter, UN should steer a cogent and cohesive campaign across the globe on establishing human rights. References Benson, P. (2008). Good clean tobacco: Philip Morris, biocapitalism, and the social course of stigma in North Carolina. American Ethnologist, Vol. 35, No. 3, pp. 357-379. Channa, M. S. (2010). What do people live on? Living wages in India. American Anthropological Association, Vol. 31, No. 1, pp. 15-28. Kingsolver, A. (2010). Living wage considerations in the right-to-work state of South Carolina. American Anthropological Association, Vo. 31, No. 1, pp. 30-41. Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50, pp. 370- 396.

Impressions of what life was like for the colonists Essay Example for Free

Impressions of what life was like for the colonists Essay Life in the new world for the colonists was like nothing that individuals in today’s society can understand. After taking the Would You Have Survived the Colony quiz on the website, it is easy to see that surviving the colonial atmosphere might have been one of the most difficult tasks on earth. This is because of the differences in culture, in food, in work load, and with other important aspects of life that would take an awful lot of adjusting. When the Europeans came across the pond to colonize America, they had a lot of adjusting to do, as well. The first way that they had to adjust to the new world was with the environmental changes. Life in America was rough because of all of the elements. Europe was a flat area with a lot of rain and average weather. When they came to America, they had to put up with mountains, with rivers, and with lots of other elements. There was also the animals that they had to adjust to. Because the United States was just being colonized and modernized, lots of wild animals were running around where people were living. Among them were predators like bears and big cats. When people went out to find food or to cut wood, they had to put up with this nuisance. This was how life was so difficult and it was something that people of today’s culture would struggle with. When taking that quiz, I thought about the clothes that people would wear if they had to go back to that time. I like to be in nice clothes. Though I do not have to have the latest in fashion, I do like to keep up with the times. Back then, the clothes had to last a long time and they had to be able to stand up to the elements. People had to track through the woods, so the clothes had to be able to put up with that challenge. Since there was no air conditioning or heating at the time, the clothes also had to be much more of an insulator in the difficult times. This would be a difficult adjustment for someone like myself if I were to go back in time. The last and most important thing is the overall work ethic and lifestyle that would have to be employed. Every time those people wanted something, they had to work hard for it. If they wanted a fire, they had to cut down some wood and start the fire. If they wanted to eat something, they had to go kill it and cook it. There were no fast food restaurants to go grab food at. Today, people go to work in order to make money to buy nice things. Those people had to go to work in order to keep themselves and their families alive. That was in addition to actually protecting themselves from the elements and the things in the environment that were so difficult. Overall, life in the colonial period was difficult and it would definitely be an adjustment for anyone who had to go back in time and face it. The differences in the economy and with the environment are so profound that people had to go through a whole lot each and every day. The main difference is that there were no days off if you felt bad or simply needed some rest.

Risk Factors For Neutropenic Fever Health And Social Care Essay

Risk Factors For Neutropenic Fever Health And Social Care Essay Cancer patients, who receive cytotoxic antineoplastic therapy sufficient to harmfully affect myelopoiesis and the developmental integrity of the gastrointestinal mucosa, are at high risk for invasive infection due to the translocation of colonizing bacteria and/or fungi across intestinal mucosal surfaces. Since the level of the neutrophil-mediated component of the inflammatory response are typically attenuated in neutropenic patients 1, physical findings of exudate, fluctuation, ulceration or fissure, local heat, swelling, and regional adenopathy are all less prevalent in the neutropenic patient1. Thus, fever might be the earliest and only sign of a severe underlying infection 2. With the increasing use of myelo-suppressive agents in the treatment of neoplastic and nonneoplastic diseases, the increased rate of infection in patients with neutropenia has been clearly established 3. Sadly, many of these commonly fatal infections go unrecognized until autopsy 4. Therefore, in order to avoid unfortunate outcomes such as sepsis and possibily death, it is critical to recognize neutropenic fever early and to start empiric systemic antibacterial therapy promptly. It is also crucial to assess the risk of serious complications in patients with febrile neutropenia, since this assessment will dictate the approach to therapy, including the need for inpatient admission, IV antibiotics, and prolonged hospitalization 2. An overview of the concepts related to neutropenic fever, including definitions of fever and neutropenia and categories of risk are reviewed here. The risk assessment and the diagnostic approach to patients presenting with febrile neutropenia are also discussed. This topic also provides a general approach to the management of neutropenic fever syndromes in cancer patients at high and low risk for complications, and the prophylaxis of infections in such patients. DEFINITIONS Fever: The definition of fever as an indicator of infection in patients with neutropenia has varied. Carl Wunderlich proposed in 1868, that the mean normal body temperature was 37 ¿Ã‚ ½C (98.6 ¿Ã‚ ½F) with an upper limit of normal of 38 ¿Ã‚ ½C (100.4 ¿Ã‚ ½F), above this limit, fever was defined 5,6. Although it has been observed that there is a range of normal body temperatures, according to a survey of 270 medical professionals, 75 percent of subjects reported that normal body temperature is 37 ¿Ã‚ ½C (98.6 ¿Ã‚ ½F)5,7. While, a survey of members of the British Society for Hematology concerning their institutional definitions of fever identified ten definitions of fever, ranging from a single temperature >37.5 ¿Ã‚ ½C to either a single temperature >39 ¿Ã‚ ½C or two successive temperatures >38.4 ¿Ã‚ ½C 5,6. Despite these beliefs, the mean oral temperature was reported as 36.8 ¿Ã‚ ½0.4 ¿Ã‚ ½C (98.2 ¿Ã‚ ½0.7 ¿Ã‚ ½F) with a range of 35.6 ¿Ã‚ ½C (96.0 ¿Ã‚ ½F) to 38.2 ¿Ã‚ ½C (100.8 ¿Ã‚ ½F), after observation of 148 healthy adults ages between 18 and 40 years 6. The definition of fever in neutropenic patients, according to The Infectious Diseases Society of America, was proposed as a single oral temperature of >38.3 ¿Ã‚ ½C (101 ¿Ã‚ ½F) or a temperature of >38.0 ¿Ã‚ ½C (100.4 ¿Ã‚ ½F) sustained for >1 hour2. Similar definitions have been provided from South America, Europe, and Asia. It has been approved to use this definition of fever in neutropenic patients9 ¿Ã‚ ½11. Neutropenia: The definition of neutropenia differs from institution to institution, but it is usually defined as an absolute neutrophil count (ANC) The absolute neutrophil count (ANC) is defined as the product of the white blood cell count (WBC) and the percentage of polymorphonuclear cells (PMNs) and bands: ANC = WBC (cells/microL) x percent (PMNs + bands)  ¿Ã‚ ½ 100 Based upon the level of ANC, neutropenia is categorized as mild, moderate or severe. An absolute neutrophil count between 1000 and 1500/microL corresponds to mild neutropenia. While, an ANC between 500 and 1000/microL corresponds to moderate neutropenia. Severe neutropenia is usually defined as an ANC As the neutrophil count drops below 500 cells/microL, the risk of clinically serious infection increases and is higher in those with a prolonged duration of neutropenia (>7 days). However, the risk is also related to the adequacy of the marrow reserve pool of granulocytes. Two terms, leukopenia and granulocytopenia are often used interchangeably with neutropenia, although they are somewhat different:  ¿Ã‚ ½ Leukopenia is defined as a low total white blood cell count that may be due to any cause such as lymphopenia and/or neutropenia; yet, almost all leukopenic patients are neutropenic since the amount of neutrophils is so much higher than the amount of lymphocytes.  ¿Ã‚ ½ Granulocytopenia is defined as a reduced absolute number of all circulating cells of the granulocyte series (neutrophils, eosinophils, and basophils); yet, almost all granulocytopenic patients are neutropenic since the amount of neutrophils is so much higher than the amount of eosinophils and basophils.  ¿Ã‚ ½ Agranulocytosis is defined as the absence of granulocytes, but the term is often inaccurately used to denote severe neutropenia. CATEGORIES OF RISK RISK FACTORS FOR NEUTROPENIC FEVER The risk factors for the development of neutropenic fever can be divided into three sub-categories including patient-related, disease-related and anti-cancer treatment-related predictors. Patient-related predictors include: age = 65 years, female sex, high body surface area, poor performance status based upon preexisting active comorbidities (e.g., cardiovascular, pulmonary, renal, endocrine, etc.) and poor nutritional status12 ¿Ã‚ ½19. Disease-related predictors include: Elevated lactate dehydrogenase (LDH) in patients with lymphoreticular diseases, bone marrow failure due to replacement of hematopoietic tissue by anomalous tissue which is know as myelophthisis19, lymphopenia20,21 and advanced stage of the underlying malignancy 13,16,20 ¿Ã‚ ½22 Treatment-related predictors include: administration of the planned dose-intensity of high-dose chemotherapy regimens15,20 ¿Ã‚ ½23 and failure to administer prophylactic hematopoietic growth factor support to patients receiving high-risk regimens14,21. RISK OF SERIOUS COMPLICATIONS This risk assessment is essential to determine the management of patients, including the need for inpatient admission, IV antibiotics, and prolonged hospitalization. High-risk patients require hospital admission for IV antibiotics, and often a prolonged length of stay. In contrast, low-risk patients may be treated as outpatients with oral antibiotic after a short period of observation or hospitalization. Definitions of low-risk and high-risk patients: The Infectious Diseases Society of America (IDSA) and National Comprehensive Cancer Network (NCCN) use different definitions in their guidelines:  ¿Ã‚ ½ Low-risk patients are those who are expected to have neutropenia (absolute neutrophil count [ANC]  ¿Ã‚ ½ High-risk patients are those expected to have neutropenia (ANC 7 days. While, neutropenic febrile patients with comorbidities or evidence of significant hepatic or renal impairment are considered high risk, regardless of the duration of neutropenia. Some experts have identified patients at high risk as those who are expected to have profound neutropenia (ANC = 100 cells / microliter) for > 7 days on the basis of experience that these patients are more likely to have serious and potentially fatal complications2,24. Nevertheless, formal studies to clearly differentiate between patients with a neutrophil count Some studies combine these groups to define high-risk patients. Deep prolonged neutropenia (ANC = 100 cells / microL expected to last > 7 days) is more likely to occur in the pre-transplant hematopoietic cell transplantation (allogeneic in particular) and in patients undergoing induction chemotherapy for acute leukemia. Risk based on underlying disease Patients who suffer from neutropenia after induction chemotherapy for acute myelogenous leukemia or as part of the conditioning regimen for allogeneic hematopoietic stem cell transplantation (HCT) are at a high-risk for serious infections. Other factors that are considered as high-risk status include gastrointestinal and oral mucositis, uncontrolled cancer, chronic obstructive pulmonary disease, advanced age and poor functional status. Patients receiving consolidation chemotherapy for leukemia or undergoing autologous HCT may also have long periods of neutropenia, but seem to be at somewhat lower risk, especially if they received prophylactic hematopoietic growth factors. In contrast, patients with solid tumors are mostly at low risk for serious infections. Guidelines An assessment of risk (high versus low-risk) for medical complications related to neutropenic fever should be obtained at the initial assessment of neutropenic fever episode. The Infectious Diseases Society of America (IDSA), the European Society for Medical Oncology (ESMO), the National Comprehensive Cancer Network (NCCN) as well as the American Society of Clinical Oncology (ASCO)2,24,25 , has recommended this. The IDSA and ASCO defined high-risk neutropenic patients as those who are expected to have profound neutropenia (ANC = 100 cells / microliter) for > 7 days or those with evidence of current comorbidities or hepatic or renal dysfunction2,24 . The National Comprehensive Cancer Network (NCCN) has used similar criteria for definition, but also includes a category of intermediate risk [21]. Multinational Association of Supportive Care in Cancer (MASCC) risk index that can be used as an alternative to clinical criteria, is a validated tool to assess the risk of medical complications associated with neutropenic fever (calculator 2)26 ¿Ã‚ ½29 . IDSA Risk assessment: The Infectious Diseases Society of America (IDSA) has established the following criteria for the definition of high risk or low risk patients with neutropenic fever 2: High-risk febrile neutropenic patients are defined as having one or more of the following criteria: ? Profound neutropenia (ANC = 100 cells / microliter) expected to last for > 7 days. ? Proof of current comorbidities, such as (but not limited to): ? Hemodynamic instability ? Oral mucositis limiting swallowing or gastrointestinal tract mucositis causing severe diarrhea ? Gastrointestinal symptoms such as abdominal pain, nausea and vomiting or diarrhea ? Changes in neurological status or mental appearance of new onset ? Intravascular catheter infection ? New pulmonary infiltrates or hypoxia ? Underlying chronic lung disease ? Signs of hepatic insufficiency (serum transaminase> 5 times normal) or renal insufficiency (creatinine clearance Low-risk febrile neutropenic patients are expected to have a relatively short duration of neutropenia for 7 days or less, with an absolute neutrophil count (ANC) Patients with evidence of severe sepsis (sepsis syndrome in end organ dysfunction) should be considered at high risk and managed as in-patients with initial intravenous antibacterial empirical treatment. While, patients with signs of septic shock should be managed in an intensive care unit based upon goal-oriented therapy30 . NCCN risk assessment The National Comprehensive Cancer Network (NCCN) has developed certain criteria to classify patients as high risk or low risk, which must be performed during the initial evaluation [21]. High-risk febrile neutropenic patients are those having one or more of the following criteria: [21] ? The patients are hospitalized at the time of the development of fever ? Evidence of significant medical comorbidity or the presence of clinical instability ? Expected profound prolonged neutropenia (ANC = 100 cells / microliter expected to last> 7 days) ? Hepatic insufficiency (serum transaminase> 5 times normal) or renal insufficiency (creatinine clearance ? Any patient with leukemia not in complete remission, or any non-leukemic patient with signs of disease progression after more than two courses of chemotherapy. ? Any complex infection such as pneumonia at clinical presentation ? Alemtuzumab (antineoplastic agent) in the last two months ? Grade 3 or 4 mucositis ? MASCC risk index score Low-risk febrile neutropenic patients are those who do not meet any of the criteria for high-risk described above and meet most of the criteria as follows [21]: ? Ambulatory status at the time of the development of fever ? No acute comorbid illness requiring hospitalization and close monitoring ? Expected short duration of severe neutropenia (ANC = 100 cells / microliter should last for 7 days or less) ? Good performance status (Eastern Cooperative Oncology Group [ECOG] 0-1 (Table 2)) ? No hepatic or renal insufficiency ? MASCC risk index score of = 21 risk index Intermediate risk neutropenic patients are defined as those meeting one or more of following criteria: [21] ? Patients undergoing autologous HCT ? Lymphoma ? Chronic lymphocytic leukemia ? Multiple Myeloma ? Patients receiving purine analogue therapy ? The expected duration of neutropenia is 7 to 10 days For patients at intermediate risk, the NCCN recommends consideration of fluoroquinolone prophylaxis. Multinational Association of Supportive Care in Cancer (MASCC) score As an alternative to the IDSA and NCCN risk assessments described above, the MASCC risk index is validated for assessing the risk of medical complications associated with febrile neutropenia. Using the MASCC risk index, the following features are assessed and given a weighted score2,26 : ? Burden of disease (clinical condition of the patient at the time of presentation with neutropenic fever): ? No symptoms or mild symptoms (5 points) ? Moderate symptoms (3 points) ? Severe symptoms or dying (0 point) ? No hypotension (systolic blood pressure> 90 mmHg) (5 points) ? No chronic obstructive pulmonary disease COPD (4 points) ? Solid tumor or hematologic malignancy without prior history of fungal infections (4 points) ? No dehydration that requires parenteral fluids (3 points) ? Ambulatory status at the time of the onset of neutropenic fever syndrome (3 points) ? Age The highest possible score is 26. Patients with a score = 21 are considered to be at low risk of serious medical complications, and for whom outpatient treatment with oral empirical antimicrobial can be safe and effective29 . While, patients with a score The MASCC risk index has classified 98% of patients as low-risk and 86% as high risk with a sensitivity and specificity of 95%, and positive and negative predictive value of 98, and 86 percent, respectively 28. Patients with complicated infections have been reclassified as high risk for serious medical complications, which further increased the predictive value of the model. Complicated infections include non-necrotizing skin or soft tissue infection (SSTI) of >5 cm diameter, necrotizing SSTI of any size, grade 2 oral mucositis, sepsis syndrome or the presence of a visceral site of infection. [28]. The classification error rate has been 10 to 29 percent. [4] In addition, the MASCC risk index can predict the probability of death as follows:27 ? Score = 15: 29 % ? Score = 15 but ? Score = 21: 2 % The MASCC risk index has been criticized for the lack of a standard definition of this criterion the burden of febrile neutropenia, which could be a source of confusion2, or it could be interpreted differently by different clinicians. I addition, the MASCC risk index does not include the duration of neutropenia as a criterion, though it is considered as an important predictor of risk2. The MASCC risk index has been also criticized because it was developed using heterogeneous patient populations; thus, it might not function optimally in all populations. For example, in a retrospective study of patients with solid tumors who seemed to be clinically stable, the MASCC risk index had a low sensitivity to detect complications (36 percent)31. The low sensitivity was likely to be attributed to the fact that patients were all outpatients, and the rates of hypotension, dehydration and invasive fungal infections were low; hence, only three criteria were present to distinguish prognosis. The serious medical complications are provided by the MASCC risk index as follows 26: ? Hypotension defined as systolic blood pressure ? Respiratory failure defined as arterial oxygen pressure ? The admission to ICU ? Disseminated intravascular coagulation ? Presence of confusion, delirium, or altered mental status ? The development of congestive heart failure documented by chest imaging and requiring treatment ? Bleeding diathesis sufficient to require a blood transfusion ? Electrocardiogram changes or arrhythmias requiring treatment ? Renal failure sufficient to require an investigation and / or treatment with IV fluids, dialysis, or other intervention ? Other complications judged serious and clinically significant by the health care team All patients who were treated with systemic antineoplastic therapy six weeks prior to a systemic inflammatory response syndrome (SIRS) are assumed to have neutropenic sepsis syndrome until proven otherwise. SIRS is defined by the presence of two or more of the following conditions: temperature >38 ¿Ã‚ ½C or 90/minute, respiratory frequency > 20/minute, PaCO2 Patients presenting with altered mental status, hypotension, hypoxia, oliguria or any other sign of new organ impairment must be managed emergently for severe sepsis. RISK OF TREATMENT FAILURE The risk of failure to respond to initial empirical antibacterial therapy is a composite outcome to be considered clinicians. Treatment failure is proposed if one or more of the following events occur within 30 days after the start of treatment 33,34: ? Persistence, progression or recurrence of signs of infection ? Modification of the initial empirical antibacterial treatment ? Readmission to the hospital for outpatients ? Death Patients with documented clinical or microbiological infections are more likely to be at risk for treatment failure, clinical or microbiological than for unexplained neutropenic fever (39 against 18 percent33. High-risk patients are more likely to be at risk for treatment failure than those with low risk. For example, patients with hematologic malignancies have a higher percentage of treatment failure than those with solid tumors (44 against 18 percent) 33. Observations have shown that among all febrile neutropenic patients at low risk of medical complications, adult patients at higher risk for treatment failure than children with 16% against 5% respectively34. PREVENTION In order to prevent neutropenic fever and infectious complications in patients at increased risk, the administration of an antimicrobial drug should be used as a prophylaxis. Antibacterial prophylaxis Pseudomonas aeruginosa and other gram-negative bacilli is the target of the antibacterial prophylaxis, because these pathogens are virulent and may cause life-threatening infections. INDICATIONS The beneficial effect on clinical outcomes has been sought from the administration of prophylactic antibacterial agents. The fluoroquinolones, levofloxacin (500 mg orally once daily) and ciprofloxacin (500 mg orally twice daily) have been the most studied antibacterial agents. Levofloxacin in particular is preferred in patients at increased risk for oral mucositis-related Streptococcus viridans infection 2. Results have been mixed with respect to effectiveness and have incited concern about toxicities and antibacterial resistance35 ¿Ã‚ ½37. A systematic monitoring of the prevalence of fluoroquinolone resistance among gram-negative bacilli should be done, at the intitutions that use fluoroquinolone prophylaxis. Based upon the available data, high-risk neutropenic patients defined by those who are expected to have an absolute neutrophil count Fluoroquinolone should be used with caution in patients at risk of a prolonged QT interval particularly in those who may require other QT prolonging agents, such as voriconazole. In addition, the potential to promote resistance among gram-negative and gram-positive should be considered when deciding whether to give a fluoroquinolone prophylaxis or not37. Concerns about the possibility of increasing the risk of Clostridium difficile infection has also been present, though this has not been proven in neutropenic patients receiving fluoroquinolone prophylaxis37. The use of prophylactic agents in institutions and geographic areas where the levels of resistance to fluoroquinolones are high is less likely to be efficient36,38.The use of antibacterial prophylaxis varies from one center to another with some centers avoiding such practices. For most patients with chemotherapy-induced neutropenia expected to be of short duration particularly patients with solid tumors, the use of antibacterial prophylaxis is not recommended. TIMING The ideal timing for the initiation and cessation antibacterial prophylaxis has not been sufficiently studied2. Many clinicians begin anti-bacterial prophylaxis, the first day of chemotherapy or the day after the administration of the last dose of chemotherapy cycle. Antibacterial prophylaxis is usually withheld when neutropenia resolves, or when empirical antibacterial regimen is initiated for patients who become febrile during neutropenia. Antifungal prophylaxis Among cancer patients and HCT recipients, a high rate of life-threatening invasive fungal infections such as candidemia has been observed since the late 1980s, which incited interest in antifungal prophylaxis for patients receiving chemotherapy. Antiviral prophylaxis INFLUENZA Annual immunization with an inactivated influenza vaccine is recommended for all cancer patients undergoing treatment2. The influenza vaccine is generally administered >2 weeks before the initiation of chemotherapy or, when circumstances dictate, between chemotherapy cycles and at least seven days after the last cycle. However, the best timing for such immunization has not been established2. All family members and other close contacts should get annual immunization too. HSV and VZV Reactivation of herpes simplex virus (HSV-1 and HSV-2) and varicella-zoster virus (VZV) occur commonly in HCT recipients who are not receiving prophylaxis and are important causes of morbidity. However, reactivation of both HSV and VZV infections can be effectively prevented with antiviral prophylaxis. Antiviral prophylaxis with acyclovir (400 mg orally three to four times daily or 800 mg orally twice daily) or valacyclovir (500 mg orally once or twice daily) is recommended in all patients who are seropositive for HSV and who are undergoing allogeneic HCT or induction chemotherapy for acute leukemia39. Antiviral prophylaxis with acyclovir or valacyclovir is also recommended in all HCT recipients who are seropositive for VZV. Based upon randomized trials, benefits of antiviral prophylaxis in these populations have been demonstrated; thus, recommended41. CMV CMV prophylaxis is indicated for HCT recipients because they are at are at significant risk for reactivation. In contrast, prophylaxis is not indicated in patients with chemotherapy-induced neutropenia, because it does not occur commonly. HEPATITIS B Antiviral prophylaxis should be considered for the following categories of patients and should be sustained for at least six months after the completion of chemotherapy40 : ? Patients receiving chemotherapy who have a previous history of hepatitis B virus infection, due to the risk of reactivation and hepatic failure. ? Patients with elevated circulating hepatitis B DNA or detectable levels of circulating hepatitis B surface antigen (HBsAg) ? Patients with a previous history of infection with detectable levels of antibody to HBsAg or to hepatitis B core antigen. This has been demonstrated to be able to reduce the risk of reactivation from 24 to 53 percent to 0 to 5 percent. Colony stimulating factors Granulocyte colony stimulating factors (CSFs) have been widely evaluated for prophylactic use following the administration of intensive cytotoxic chemotherapy when neutropenia is expected (primary prophylaxis). CSFs have been also evaluated for their prophylactic use during retreatment after a previous cycle of chemotherapy that caused neutropenic fever (secondary prophylaxis), and have been shown to minimize the extent and duration of severe chemotherapy-induced neutropenia in afebrile patients (afebrile neutropenia). Their use is not recommended in febrile chemotherapy-induced neutropenia2. However, prophylactic use of granulocyte CSFs has not been shown to have an effect on survival in most clinical situations. PRIMARY PROPHYLAXIS Primary prophylaxis denotes the use of granulocyte CSFs during the first cycle of myelosuppressive chemotherapy in order to prevent neutropenic complications. The goal of primary prophylaxis is to decrease the incidence of neutropenic fever and the need for hospitalization, to maintain dose-dense or dose-intense chemotherapy strategies that have survival benefits. Updated 2010 guidelines from the European Organization for Research and Treatment of Cancer (EORTC), the Infectious Diseases Society of America (IDSA), consensus-based guidelines from the National Comprehensive Cancer Network (NCCN), and The 2006 guidelines from the American Society of Clinical Oncology (ASCO), all recommend primary prophylaxis when the expected incidence of neutropenic fever is over 20 percent, to reduce the need for hospitalization for antibiotic therapy2,22,41. These recommendations are based upon randomized trials that have shown that primary prophylaxis was cost effective when the risk of neutropenic fever with a specific regimen was over 20 percent42,43 . In contrast, guidelines recommend against the routine use of granulocyte CSFs for primary prophylaxis in adult patients receiving chemotherapy regimens with an anticipated low probability ( However, when the anticipated risk of neutropenic fever is between 10 and 20 percent, the decision of primary prophylaxis should be individualized and may be appropriate in a number of clinical settings in which patients are at risk or increased complications22,41 :  ¿Ã‚ ½ Age >65 years  ¿Ã‚ ½ Preexisting neutropenia  ¿Ã‚ ½ More advanced cancer  ¿Ã‚ ½ Poor performance and/or nutritional status  ¿Ã‚ ½ Renal or hepatic impairment  ¿Ã‚ ½ In the case of epithelial ovarian cancer  ¿Ã‚ ½ Extensive prechemotherapy surgery, particularly if it included a bowel resection. In patients receiving concomitant chemoradiotherapy for either head and neck cancer or lung cancer, the use of granulocyte CSFs has been associated with adverse outcomes, therefore, it better be avoided. Despite the lack of comparative data from randomized controlled trials, that could recommend one CSF over the other for prophylaxis of infection during chemotherapy-induced neutropenia, in practice, most institutions use G-CSF. SECONDARY PROPHYLAXIS Secondary prophylaxis denotes to the use of a granulocyte CSF in subsequent chemotherapy cycles after a prior cycle has caused neutropenic fever. Secondary prophylaxis with CSFs reduces the risk of reccurence of neutropenic fever by approximately one-half 44. ASCO and EORTC guidelines recommend that secondary prophylaxis with granulocyte CSFs be limited to patients for whom primary prophylaxis was not given and who experience a neutropenic complication from a prior cycle of chemotherapy if neutropenic fever would prevent the administration of full dose chemotherapy and if reduced dose intensity might affect treatment outcome22,41 . TIMING G-CSF and GM-CSF therapy is usually initiated 24 to 72 hours after cessation of chemotherapy and is frequently continued until the absolute neutrophil count reaches 5000 to 10,000/microL. A reasonable alternative is continuation until clinically adequate neutrophil recovery. MANAGEMENT Initial Assessment Since, fever might be the first and only sign of infection in a neutropenic patient, its occurrence should be considered a medical emergency. Therefore, empiric broad-spectrum antibacterial therapy should be started immediately after blood cultures have been obtained and before any other investigations have been completed. The Infectious Diseases Working Party of the German Society of Hematology and Oncology and the Northern Ireland Cancer Network has recommended this. It has been recommended that empiric broad-spectrum antibacterial therapy should be administered within 60 minutes of presentation for all patients suffering from neutropenic fever at presentation. (algorithm 1) Diagnostic Approach At presentation, a detailed history and physical examination should be done, as well as a complete laboratory, microbiologic and imaging work-up for all febrile neutropenic patients. The table below summarizes the diagnostic approach to patients with febrile neutropenia.

The Technique of Role Playing :: essays research papers

The Technique of Role Playing   Ã‚  Ã‚  Ã‚  Ã‚  One of the techniques used most often by theatre high school teachers is role-playing. The reasons that this technique is often used are numerous. When students read a text silently some of the nuance contained in the meaning can be lost. This is particularly true when dealing with a play, or anything containing multiple characters. Reading the piece aloud can help them to understand the connotation as well as the denotation. In the theatre, how a passage is spoken will determine the feeling that it carries with it. Lines of dialogue can suddenly become funny or sad once given inflection. This is the prime reason role-playing is used. The prime time that this technique is employed is when teaching the works of Shakespeare.   Ã‚  Ã‚  Ã‚  Ã‚  The usual set up for a role-playing exercise is as follows: first the teacher will have the students read the text by themselves, then he/she will define any strange or outdated language used in the text. Often with Shakespeare students find the use of the King’s English confusing and therefore do not understand the piece. Once the terms used are understood, the teacher can ask students to read sections aloud that they may hear how the words flow together. Then two or more students are chosen to act out the section with some minimal movement. This added blocking creates the idea that the dialogue motivates the actions.   Ã‚  Ã‚  Ã‚  Ã‚  When doing this type of activity it is best to employ a combination of two different teaching philosophies. One of them is Pragmatism and the other is Idealism. Idealists value the mind and concepts over all things. In this exercise, it is important to keep this sort of attitude. Students may not always understand the full meaning of the text. Often their young lives do not contain enough experience to comprehend the decisions, or actions that characters make. That is why it is more important that the class grasp the idea of motivated action. The intended meaning of a line will determine how the other characters perceive and react to it. This also lends itself to the idealist precept that life should be guided by thought.   Ã‚  Ã‚  Ã‚  Ã‚  The Pragmatism inherent in the exercise comes in to play when dealing with the conclusions reached in class. All of the conclusions reached are subject to change with the individual reciting the piece. That is why theatre teachers often show more than one performance to the class.

Hidden Horrors in Shirley Jacksons The Lottery Essay -- Shirley Jacks

Hidden Horrors in Shirley Jackson's The Lottery Shirley Jackson's short story "The Lottery" presents conflict on more than one level. The most important conflict in the story is between the subject matter and the way the story is told. From the beginning Jackson takes great pains to present her short story as a folksy piece of Americana. Slowly it dawns on us, the terrible outcome of what she describes. From the first sentence of the story, The morning of June 27th was clear and sunny, with the fresh warmth of a full-summer day; the flowers were blossoming profusely and the grass was richly green. We are given the feeling of being in an idyllic, rural world. She enhances this feeling with little vignettes that are almost cliched in their banality: the little boys guarding their pile of stones in the town square; the towns-people gathering and interacting with each other as if they were at a country fair; Mrs. Hutchinson arriving late because she hadn't finished the dishes; even the good-natured complaining of Old Man Warner. All of these scenes and vignettes are used effectively to put us at our ease and to distract us from the horror that is to come. In depicting this home-spun American scene with its horrible underlying secret Shirley Jackson is commenting on the hidden horrors of our every day life. It is no coincidence that the victim of the stoning is a woman. Jackson uses this character, Tessie Hutchinson, to comment on the sacrificial role that women play in American society. We first meet Tessie Hutchinson when she arrives late for the lottery. It is significant that she has just come from washing her dishes. This is one of the most basic jobs of housework. Wiping her hands on her apron and apologizin... ...iety that Shirley Jackson belonged to, and commented on in her writing, was one that depended on women for their work. It also demanded that a woman sacrifice herself and her ambitions, if they included anything besides raising a family, to the god of domesticity. Jackson starkly portrays the sacrifice that has been a part of the lives of all women. Tessie Hutchinson screams, "It isn't fair. It isn't right," just before she is killed. This could be said, and has been said, about the lot of women in post-world war II America. In 1948, when Jackson wrote this story, Americans were listening about as much as the townspeople listened to Tessie Hutchinson before stoning her to death. Works Cited Jackson, Shirley. "The Lottery." Literature: Structure, Sound, and Sense. 5th ed. Ed. Laurence Perrine. San Diego: Harcourt, Brace, Jovanovich, Publishers 1998. 180-186

Post-Traumatic Stress Disorder Essay example -- Post-traumatic stress d

There are hundreds of different kinds of psychiatric disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). One of them is called Post-traumatic stress disorder (PTSD). Based on the research, post-traumatic disorder usually occurs following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape (Harvard Women’s Health Watch, 2005). The purpose of this paper is to discuss the risk factors, pathophysiology, clinical manifestation, diagnostic criteria and tests, treatment, prognosis and future research and approaches to treat this psychiatric illness of post-traumatic stress disorder. Risk Factors As to all other kinds of disorders, determining the risk factors is a major influential aspect of a person’s life in exposing herself to such diseases and illnesses. The factors that put people at risk for post-traumatic disorder are having a history of physical, emotional and sexual abuse. In addition to that, people who have been abused as children or who have had other previous traumatic experiences at a time in their lives are more highly to develop the disorder (Harvard Women’s Health Watch, 2005). Other risk factors that contribute to PTSD include motor vehicle crashes, disasters, torture, and comorbid substance abuse (Miller, 2000). The most common precipitating events for PTSD in women were rape and physical assault. For men, physical assault and other traumas were the most prevalent. However, both genders are at heightened risk for PTSD when it comes to motor vehicle accidents. These are the major risk factors people may face that predict the likelihood of post-traumatic stress disorder to occur. Furthermore, according to Harvard Women’s Health Watch 2005, people do not necessary have to encounter the traumatic events directly in order for PTSD to develop. Pathophysiology Until now, there has not been a definite understanding of how post-traumatic stress disorder occurs in the brain. The exploration into its pathophysiology is fairly recent. However, there is research around it discussing about PTSD’s pathophysiology and coming to a complete understanding. In a normal person without the disorder, a stress hormone, adrenaline, releases from the body and prepares it to flee o... ...ive therapy is say to process â€Å"the strengthening of a cognitive plan that can guide thinking and behaviour in future potential encounters with trauma†¦,† (Wells & Sembi, 2004, p. 308). Future research also includes postmortem brain studies because it is significant in understanding psychiatric disorders to the neurobiology level (Soboslay, Martin, & Kleinman, 2004). Scientists are attempting to determine which treatments work best for which type of trauma. Works Cited Thomas Miller, Assessment of Life Stress Events: the Etiology and Measurement of Traumatic Stress Disorder International Journal of Social Psychiatry, Vol. 38, No. 3, 215-227 (1992) J Behav Ther Exp Psychiatry. 2004 Dec ;35 (4):307-18 15530845 (P,S,E,B) Metacognitive therapy for PTSD: a preliminary investigation of a new brief treatment. [My paper] Adrian Wells, Sundeep Sembi Deep-Soboslay A, Martin CE, Kleinman JE. The development of a posttraumatic stress disorder brain collection. Psychiatry. 2004 Winter;67(4):416-8. Harvard Women's Health Watch http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch_resources.htm Diagnostic and Statistical Manual of Mental Disorders, 4th ed.

Compulsory Sports Educaion Essay

Education should mean a perfect balance between imparting physical and academic education to the child. Education means all round development of personality i. e. physical, mental, aesthetic and spiritual. As children grow, they need balanced development of both the body and the mind especially up to the teens when they spend a major part of the day in school. At least one hour of sports of any kind is essential to recharge the minds of the children for better concentration. Schools are not for studies only. This narrow sense of education is to be corrected in the minds of the parents as well. Of course, sports and games would be followed by schools depending on the sports infrastructure they possess. In today’s enclosed colonies with severe crunch of playing fields, sports in schools can be extremely beneficial for children. Considering the fact that the obesity graph for children has been growing drastically since the past few years, the value of sports for children in the school cannot be underratedr. Undoubtedly, games and sports help in recreation and are very good for de-stressing, encouraging team building and also teaching them to accept defeat. Sportsmanship and team spirit displayed by the players on the field can be imbibed by the students. Their display of punctuality and self-discipline could be adopted for betterment. Moreover, exercise invigorates the mind and body and helps to keep fit. Making sports and extracurricular activities mandatory at the school enables kids to realize their own strengths and that is what schools are for. When young kids enter school they are unaware of their strengths and are still developing interest in various things. If extracurricular activities would not be compulsory at school many kids will never get a chance to try them out. Sports should be made compulsory in schools to introduce a healthy lifestyle to all the school going children. However, there should be more variety of sports and activities like swimming, tennis, track and field, weight lifting (gym), as well as competitive and noncompetitive games. Outdoor games are recreational and they ensure that children are exposed to fresh air and exercise, which they may not get at home. The TVs and computers are dragging the students away from any form of physical workout. Unfortunately, in our country the state of sports is dismal and sportspersons lack proper training and sponsorship. Most of the schools lack the area and the infrastructure for sports. The State governments, school boards and Sports Authorities of India should enact laws to make sports a compulsory subject in schools and also provide financial assistance to schools. So, schools must consider the fact that games are not just wastage of time rather they are such rare treasures that shape the future prospect of a student. So students, Play games, not only to hit, But also to be 100% fit.

MRI Radiation – Dangers & Benefits

Magnetic resonance imaging (MRI) is a new technology for making images of the brain and other parts of the body. The technique depends on detection of a phenomenon called nuclear magnetic resonance, and also sometimes called NMR scanning. The discovery and development of MRI imaging is one of the most spectacular and successful events in the history of medical imaging. The nuclei of some atoms in the body are composed of numbers of nuclear particles. Such nuclei can be detected by sending weak energy signals through very strong magnetic fields. The MRI machine consists of a set of powerful magnets and a source of energy in the same general range used for broadcasting radio. The radio signal is affected in predictable ways by the number of odd-numbered nuclei in its path (Oldendorf; Boller, Grafman and Robertson). The MRI Procedure The MRI contains the massive main magnet, which is always on. The unit structure is approximately six or seven feet high and equally wide. As a patient, you will lie on your back on a special table that slides into the magnet through a two-foot-wide tunnel in the middle of the machine. Whether you go in head or feet first depends on the tissue being imaged. Be prepares for a loud knocking noise; this is not a silent machine. The loud knocking noise is caused by the gradients (small magnets) expanding against the supporting brackets. The MRI scanner will able to pick out voxels (three-dimensional cubes) maybe only one millimeter on each side. It will make a two-dimensional or three-dimensional map of tissue type. The computer will integrate this information and create two dimensional images (the usual) or three-dimensional models. The whole procedure takes from 30-60 minutes (Moe). Advantages and Disadvantages Due to the nature of the magnetic probe used in MRI, this technique possesses several fundamental advantages: 1) tissue can be characterized in a number of ways, 2) any plane can be imaged 3) bone is invisible, so all anatomic regions can be examined, and harper images are produced 4) no contrast medium is required and 5) there is no ionizing radiation, which makes it safe for children and for repeated scanning of the same person 6) the level of detailed exceeds the detail of other imaging techniques. At the present time, there are also several disadvantages 1) he complexity and high cost 2) the long scan time, 3) the noise isolation experienced by patient during scan and 4) the exclusion of substantial fraction of patients dues to pacemakers, metallic artifacts, and inability to cooperate. Furthermore, magnetic strength can be a dangerous thing. Stories abound the magnet’s power to pull metal objects (such as paper clips, keys, scissors, stethoscopes, IV poles, and even oxygen tanks) toward the patient and into the machine. Even worse, accidents have occurred with metal inside a patient. After an MRI, a metal worker went blind because the magnet moved microscopic metal particles in his eyes, damaging their surrounding structures. A survivor of and aneurysm died during an MRI because the magnet tore off the metal clips holding together a blood vessel in her brain, causing her to bleed to death. The patient must stay absolutely motionless during the procedure. (Minor motion does not have as much impact on a CT scan.) Therefore, a sedative is often necessary for a child having an MRI scan. The first three of these are under active development, and improvement can be expected. However, gradient coil noise, pacemakers and metallic artifacts are more fundamental problems for which solutions are not yet apparent (Stergiopoulos). MRI in association with CT Magnetic resonance imaging is another method for displaying anatomy in the axial, sagittal, and coronal planes. The slice thickness of the images vary between 1 and 10 mm. MRI is especially good for coronal and sagittal imaging, whereas axial imaging is the forte of CT. One of the main strengths of MRI is its ability to detect small changes (contrast) within soft tissues, and MRI soft tissue contrast is better than that found in CT images and radiographs. CT and MR imaging modalities are digital-cased technologies that require computers to convert digital information to shades of black, white and gray. The major difference in the two technologies is that in MRI the patient is exposed o external magnetic fields and radio frequency waves, whereas the patient is exposed to x-rays during a CT study. The magnetic fields used in MRI are believed to be harmless. MR scanning can be a problem for people who are prone to develop claustrophobia because they are surrounded by a tunnel-like structure for approximately 30-45 minutes. The external appearance of an MRI scanner or machine is similar to a CT scanner with the exception that the opening is the MR gantry is more tunnel-like. As in CT, the patient is comfortably positioned supine, prone, or decubitus on a couch. The couch moves only when examining the extremities. The patient hears and feels a jackhammer-like thumping while the study is in progress. The underlying physics of MRI is complicated and strange-sounding terms proliferate. Let’s keep it simple: MRI is essentially the imaging of protons. The most commonly imaged proton is hydrogen, as it is abundant in the human body and is easily manipulated by a magnetic field. However other nuclei can be imaged. Because the hydrogen proton has a positive charge and is constantly spinning at a fixed frequency, called the spin frequency, a small magnetic field with a north and south pole surrounds the proton. Remember that moving charged particles creates a surrounding magnetic field. Thus, these hydrogen protons act like magnets and align themselves within an external magnetic field or the needle of a compass. In the MR scanner, or magnet, short bursts of radio frequency waves are broadcast into the patient from radio transmitters. The broadcast radio wave frequency is the same as the spin frequency of the proton being imaged (hydrogen in this case). The hydrogen protons absorb the broadcast radio wave energy and become energized, or resonate. Hence, the term magnetic resonance. Once the radio-frequency wave broadcast is discontinued, the protons revert or decay back to their normal or steady state that existed prior to the radio wave broadcast. As the hydrogen protons decay back to their normal state or relax, they continue to resonate and broadcast radio waves that can be detected by a radio wave receiver set to the same frequency as the broadcast waves and the hydrogen proton spin frequency. The intensity of the radio wave signal detected by the receiver coil indicates the numbers and locations of the resonating hydrogen protons. Although human anatomy is always the same no matter what the imaging modality, the appearances of anatomic structures are very different on MR and CT images. Sometimes it is difficult for the beginner to differentiate between a CT and an MR image. The secret is to look to the fat. If the subcutaneous fat is black, it is a CT image as fat appears black on studies that use x-rays. If the subcutaneous fat is white (high-intensity signal), then it has to be an MR. next, look to the bones. Bones should have a gray medullary canal and a white cortex on radiographs and CT images. The medullary canal contains bone marrow, and the gray is due to the large amount of fat in bone marrow. On a MR image, nearly all of the bone appears homogenously white as the bone marrow is fat that emits a high-intensity signal and appears white. Also, on MR the cortex of the bone will appear black (dark or low intensity signal), whereas on CT images the cortex is white. Soft tissues and organs appear as shades of gray on CT and MR. Air appears black on CT and MR. air appears black on CT and has a low-intensity signal (black or dark) on MR (Moe). Intraoperative MRI At present, MRI is, by far, the most useful imaging modality for visualizing intracerebral tumors. It provides the most clear, detailed, and comprehensive diagnostic information regarding the tumor ad surrounding normal structures. The introduction of MRI and image-guided technology into the operating room thus allows the surgeon to use high-quality, current image data that reflect the surgical reality of brain tissue deformations and shifts that occur after the bone flap has been turned, the dura opened, and the resection begun. Today’s intraoperative MRI systems can be classified into two main groups: 1) the high field strength systems and 2) the low compact systems. Both types of systems have advantages and disadvantages. The high-field strength systems (0.5-1.5 T) are typically mounted on a stationary gantry and have gradient capabilities sufficient to produce full head images of quality comparable to that of diagnostic MRI. Magnetic resonance imaging can satisfy these requirements for therapy. It has excellent anatomic resolution for targeting, high sensitivity for localizing tumors, and temperature sensitivity for online treatment monitoring. Several MRI parameters are temperature sensitive; the one based on the proton resonance frequency allows relatively small temperature elevations to be detected prior to any irreversible tissue damage. Thus, the location of the focus can be detected at relatively low powers, and the accuracy of targeting can be verified. In addition, using calibrated temperature-sensitive MRI sequences, focal temperature elevations and effective thermal doses may be estimated. Such thermal quantification allows for online feedback to ensure that the treatment is safe, by assuring that the focal heating is confined to the target volume and below the level for boiling. Thermal assessment predicts effectiveness by assuring that the temperature history is sufficient to ensure thermal coagulation (Moore and Zouridakis). Conclusion Since the first availability of commercial instruments at the beginning of the 1980s, clinical MR has expanded rapidly in terms of both medical applications and the number of units installed. First considered to be expensive method to create images of inferior quality, it has since established itself as a clinical tool for diagnosis in previously inconceivable applications, and the potential of the method is still not exhausted. MRI has led to the first-scale industrial application of superconductivity and has brought about a grater public awareness of a physical effect previously known only to a handful of scientists. Up to now, the growth and spectrum of applications of MR have exceeded all predictions. The most recent development is that of rendering brain functions visible. Cardiac MR can display coronaries and analyze perfusion of the myocardium and hemodynamics of the heart. Thus, MRI is entering the domain of nuclear medicine. An interesting new application of MRI is its use as an imaging modality during minimal invasive procedures such as ablation, interstitial laser therapy, or high intensity focused ultrasound. With temperature-sensitive sequences, the development of temperature and tissue damage can be checked during heating and destroying of diseased tissue. The sensitivity of MRI to flow helps the physician to stay away from vessels during an intervention. MRI is also used for image-guided surgery, e.g., resection of tumors in the brain. Special open systems have been designed for such purposes, and dedicated non magnetic surgery tools have already been developed (Erkonen and Smith). Works Cited: Boller, Franà §ois, Jordan Grafman, and Ian H. Robertson. Handbook of Neuropsychology. Vol. 9. New York: Elsevier Health Sciences, 2003. Erkonen, William E., and Wilbur L. Smith. Radiology 101: The Basics and Fundamentals of Imaging. 2nd ed. New York: Lippincott Williams & Wilkins, 2004. Moe, Barbara A. The Revolution in Medical Imaging. New York: The Rosen Publishing Group, 2003. Moore, James E., and George Zouridakis. Biomedical Technology and Devices Handbook. New York: CRC Press, 2004. Oldendorf, William. Basics of Magnetic Resonance Imaging. Boston: Springer, 1988. Stergiopoulos, Stergios. Advanced Signal Processing Handbook: Theory and Implementation for Radar †¦ New York: CRC Press, 2001.      

This briefing is in relation to the Inquiry into Skills Shortages in Rural and Regional NSW

This briefing is in relation to the Inquiry into Skills Shortages in Rural and Regional NSW. This paper will outline the problems around the methods used by training organisations including TAFE to assess skill needs in rural and regional NSW and their response. This paper will also look into what the causes of these problems are, who are the stakeholders and how are they affected and recommendations on solutions. BACKGROUND: The communities of rural and regional areas recognise that the supply of skilled tradespersons in their communities does not meet the current demand and that skill shortages are projected to increase. 2In the context of the Riverina Institute Griffith is a medium sized campus that has demonstrated significant and sustainable growth over the past five years. Over the past 6 years the campus has experienced a significant increase in facilities and a concomitant increase in full time and part time teaching staff. To address the growing demand for skilled and well trained staff in the region Griffith campus has consistently amended its course offerings and has, on many occasions, provided extra courses to meet unexpected demand particularly in the trade areas. This is a good example of how much tafe applicant numbers are increasing in rural areas however not all tafe facilities are able to have the funds to support these numbers such as the above example of Griffith campus. 1Futher research in relation to concerns of skills shortages has demonstrated there is a great need to increase the amount of trained tradespersons in the workforces. This also requires the improvement of retention rate during training to reduce occupational wastage as qualified tradespersons leave the industry. There is a fundamental need to ensure that their will be jobs available in the area of where the training took place. This is to prevent skilled trades people leaving rural areas for city life. STAKEHOLDER ANALYSIS AND CURRENT SITUATION: Individuals – Without a strong working force the economy of a rural community is bound to drop. More people will lose their jobs and families will have to move to find work. Regional Industries – Many regional industries are desperate to expand, but are being hampered by a lack of skilled labour. Councils – A current situation can be seen Wagga Wagga NSW. 3This area is seen as an agricultural powerhouse creating up to $6.5 billion per year. But the hearing has demonstrated that the region's future growth may be limited by a shortage of workers. Stakeholders in the Riverina believe that a lack of affordable housing and limited training opportunities are significant barriers to the recruitment of workers in rural areas. 3For example one of the country's largest chicken meat processors, Bartter Enterprises, already employs more than 1,000 people across the region. The company hopes to increase production from 420,000 to 750,000 birds per week. But their human resources manager John Davis says that depends on being able to source workers. The Riverina wine industry has also experienced significant growth, along with it, an increased demand for workers. 3For example, 10 years ago Casella Wines employed 14 people; today however they have a workforce of 500. Paul Foley is the human resources manager for another of the region's major wineries, De Bortoli Wines. 3He says the winery will employ an extra 80 people for four months during vintage, but recruitment of those workers is a major problem. While the skill shortage is already starting to bite, Leeton Shire Council is looking to the future. General manager of Leeton Shire Council Ray Pluis says local training opportunities are important for retaining young people in regional centers. This is the third public hearing held as part of this New South Wales parliamentary inquiry. The inquiry's chairman, Labor MLC Tony Catanzeriti, is playing down suggestions the withdrawal of state government services is partly to blame for the difficulties in attracting skilled workers to regional areas. CAUSES: Research of submissions and hearings indicates many causes to skills shortages in rural areas. 4For example Peter Louis & Co submission highlights that withdrawal and reduction of services provided by government agencies and public corporations such as medical services, banking facilities and post offices has impacted on rural communities with people forced to relocate. This is a valid argument as people will would to live in areas that have necessities such as medical centers and post offices easily available. Not only will people leave an area to get closer to these facilities but also people will not even bother moving to a rural area if it is lacking of such facilities. This also states that the campus of tafe in Illawarra confirmed that whilst TAFE provided many course not all of them were specific to the area. 4Also the tafe kept no record of students who completed and whether they stayed or left the area. This causes the problem of not allowing statistics to be examined to get an accurate understanding of the educational needs in rural areas. This also is an extremely good point and the basis of a strange argument. How can the tafe possibly know to what extent its passing students are having on the rural community if they keep no record of what the students achieve after accomplishing their education? 5Mr Bill Archer in his submission highlights two major causes of unskilled workers in rural areas. The first major cause is the distance that an apprentice in the rural areas would have to travel to receive an education. The further the distance the more it will cost the apprentice to travel so therefore becomes another incentive to not bother receiving an education. 7Transport has got to be one of the most major causes of skills shortages in rural areas the requirement for apprentices to travel such large distances to get to college is a major problem. Many rural areas have a very limited access to frequent public transport. Also transport subsidies are not available to young people if the vehicle they have access to is not in their name and even if they are entitled to it, the amount is pitifully inadequate. Public transport is a very important requirement as there are many dangers of country driving for young inexperienced drivers with early starts, late finishes and long distances. 7These present very real Occupational Health and Safety risks. 5The second major cause is that once an apprentice receives the education they need they are then able to move to the city were they can make more money doing their job. This is a major incentive for skilled workers to leave the rural areas and therefore leaving many jobs in rural areas left open with nobody with the skills to work them. This effects many stakeholders. The owner of the business who had spent the last few years training the apprentice must now start the cycle again. The community also suffers as there is one less person providing a service. That is why the government must find efficient ways of keeping skilled workers in rural areas as they are fundamental to the survival of the community. Tafe teachers however in their submission do not believe that these are the major causes of skill shortages in rural areas. 7Their members point out that there are large shortages in areas where pay and conditions are poorest, eg a lot of qualified mechanics aren't working in their trade areas, because they can earn more money driving a truck. It is therefore not just a matter of addressing skills shortages but also pay conditions and how vocations are perceived by the public. The issue of public perception of skilled trades people has not been addressed successfully by governments. RECOMMENDATION: Set forth are a number of recommendations as to the problems Councils in regional areas should encourage â€Å"stay local and contract local businesses.† The government should provide funding to provide a Rural Work Income Insurance policy to assist tradesmen in situations that they cannot work as are establishing a new business. Encourage major employers to establish 12 month contracts, particularly in rural areas. This will help to increase not only employment but also the economy of the community. Contracts will keep people in the area and as the business grows more jobs become available. Which leads to people moving to the area specifically for work. Encourage training organizations like the Charles Sturt University and Tafe's to develop seminars and spend time to educate businesses within rural areas to adopt new business practices, Governments should make sure that rural areas have all the facilities required to encourage population growth in that area. Facilities such as medical centers, post offices and schools, should be located in all rural towns. Government should place more funding into Traineeships. 1Traineeships are ideal for employers who have a specific need for one Trainee in a given area. Traineeships can be offered/conducted in a variety of ways with the main option taken by employers being an ‘On the Job† Traineeship. By providing Funding to Tafe institutions and providing employer incentives to business's that provide traineeships to unskilled workers will be a major step in reducing the current problem of unskilled workers. 6Another recommendation would be the implementation of more courses done through distance correspondence. This allows students in rural areas to do courses from home. Thus distance would no longer be a barrier in the prevention of education for skilled workers. However for the on the job training the Government should allocate funds to areas in desperate need to provide frequent transport to further encourage people to do studies.