The Silver Bullet free essay sample

While people refer to a dog as man’s best friend, I have found that my most dependable friend has been my car. But this romance between my 2001 Chevrolet Cavalier and I didn’t begin with love at first sight. As a matter of fact, this friendship started off with a lot of animosity. It was January, and I was a 16 year old with a plastic ID that represented the key to the open road. I was just missing one important item, and that was a car. Fortunately, my giving parents promised me a vehicle. I began my own car shopping at a well-known website, Lamborguini.com. I found plenty of safe, reputable cars that my parents could trust with their eldest and only son in the driver’s seat. Little did I know that my parents’ search for cars started at Craigslist, where they specifically searched for cars under $1,500. When my parents brought home the silver, 4-cylinder, stick shift, two-door 2001 Chevrolet Cavalier with 115 thousand miles, I continually thanked them but it was with a small sense of reluctance. We will write a custom essay sample on The Silver Bullet or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page While I expressed appreciation for the Cavalier, in the back of my mind I began scrutinizing my new vehicle for its imperfections. I ended up finding aspects of my Chevrolet that I initially tagged as imperfections, but these were the characteristics of my car that I have grown to love. Each trait of uniqueness in my Cavalier represents my personality from head to toe. Specifically, my stick shift Chevrolet Cavalier tends to produce a bumpy ride. Therefore, the stick shift of my car can equate to my problem-solving abilities. No matter the difficulty of a challenge, I always persevere so that I may complete anything that I have started. Looking at my heat and air conditioning on my Chevrolet Cavalier, I quickly discovered a minor glitch within the power of the fan that blows the air into the car. The problem was that my heat would only work if I had the fan turned all the way up. So it was either freeze in winter, or I would have to endure a 20 mph blast of heat. But as I continued to deal with this malfunction, I found another similarity between my â€Å"silver bullet† and I. As I had mentioned, a task I have began is as good as done. But the thing is, I don’t just like to simply complete an obstacle I encounter. I want to fulfill a task with my utmost ability and efficiency. Like my heater in the Cavalier, my fan of work-ethic only runs at its highest potential. Finally, the fact that I had to manually roll down the windows proved to be a bit of an inconvenience. Nevertheless, I found yet another resemblance between the timeless Chevrolet Cavalier and myself. Like the windows of my car, my attitude towards everything I do is done through my own abilities. I am never looking for shortcuts, because I always want to learn and better myself as an individual. So if a certain assignment calls for rolling up your sleeves, getting dirty, and applying critical thinking skills. You better believe that I am always up for that sort of challenge. Through t he quirky attributes of the Chevrolet Cavalier, I discovered my own identity and what I am capable of. I am dependable, yet sporty. I am all business, yet I have my share of fun. I try to look good, yet I don’t mind getting dirty. Basically, not even a dating site could match a better couple than my Cavalier and me.

Perfect Crime Essays

Perfect Crime Essays Perfect Crime Essay Perfect Crime Essay Genre:Crime thiller Story draft: Two cops were deliberately challenged by an unknown figure to solve few crimes committed by him. Each of this crime leads to the identity of the villain. He wants the cops to admit that hes the perfect crimester. 1st crime:Bank robbery Using sonar technology(dark knight),villain gets the 3d map of the bank. On the day of the execution,2 masked mens glides from one roof to the banks roof. 1 of them heads to the ventilation and the other heads to the telephone and security alarm system of the bank. nd robber dis-alarms the security system and the other adds chloroform to the air ventilation system. After 10 minutes,2 robbers enters the bank and they lock up the front door indicating its close. All four of them rushes to the vault and starts drilling. Click. Vaults open as the four robbers rushes and starts filling the cash in a garbage bag. They rush to the back emergency door and place the garbage bags filled with money in the trash bin and runs away i n taxi. Moments later,police comes to the crime scene and starts to rush into the building. A garbage truck comes by and collects all the trash and leaves. 2nd crime:Gold bar heist While closing hours,the owner of a big jewelery shop was waiting for the arrival of huge amounts of gold bars illegally brought in from africa. The owner had the company of four call girls who was flirting with him. The owner receives a text message saying that the golds have arrived. He heads down to assist them to unload. Soon as the unloading finishes,the owner heads up stairs where the call girls were waiting for him. 1 of them seduces him and lays him on the bed while another girl gave him a pill claiming that it was a erection enhancement pill. The owner takes the pill and sleeps off. The girls head down and doing all the neccesary stuffs like shutting of the cameras and security alarms,filling all the gold bars in a bag and leaving the place within 15 minutes Hero arrives at the first crime scene analyzing the details. Heroin analyzes the second crime scene.

My personal statements Statement Example | Topics and Well Written Essays - 500 words

My statements - Personal Statement Example This will enable me pursue my dream career and enable me to make significant contributions in the area of study. My educational qualifications are outstanding and in line with the requirements for the Masters in Agriculture Economics. I attended Bashu High School in China between September 2006 and July 2009 and got my high school degree. Since I am a foreign student, I studied English as my second language at the Central Center for English as a Second Language (CESL), University of Arizona between January 2010 and May 2010. I hope to complete my Bachelor, Major in Agriculture Economic and Management, Minor in Japanese and Administration management between August 2010 and May 2014 (expected). This proves that I have the intellectual capabilities to pursue the Masters in Agricultural Economics. Additionally, I have pursued other courses that are related to the field of agricultural economics that will positively towards my course. These courses make up important aspects of the course I need to study. These courses include future goods, financial management in agribusiness and a biology plant course (James, 2013). This goes ahead to prove my extensive knowledge in agricultural economics. I have two years experience in weed control, proficiency in English, Japanese and Chinese. I am also highly skilled in various computer applications and this will help me in conducting research in various topics in the agricultural economics. My work experience as an accounting assistant in Accountant assistant Chongqing Bank between June 2010 and December 2010 helped me gain valuable lessons in the field of economics and also enabled me to develop teamwork and leadership skills. I was also a leader of the Agricultural Club in high school and this further developed my interest in Agriculture. I enjoy outdoor activities and sports and this has facilitated how I manage my time between learning and extra- curricular activities. I have been able to combine sports and excel in

Assessments used to determine if a students has a learning disability Assignment

Assessments used to determine if a students has a learning disability - Assignment Example The IQ-accomplishment discrepancy model evaluates whether there is a noteworthy distinction between a childs scores on a test of general insight. In the event that an understudys score on the IQ test is no less than two standard deviations higher than his or her scores on an accomplishment test, the understudy is depicted as having a huge error in the middle of IQ and accomplishment and, accordingly, as having a learning incapacity. According to Ellison & Semrud-Clikeman (2009), these methods may not be as effective because the child may face other challenges such as language barrier or other forms of disability. Use data from a perception in routine classroom guideline and checking of the youngsters execution that was done before the kid was considered for an assessment, as in a reaction to intercession model. In the event that a kid is not as much as school age or out of school, a evaluator must watch the youngster in a situation fitting for an offspring of that age. Using RTI evaluates the general and overall performance and behavior of the student. Academic achievement in academics is factored in as well as examining the progress of the child in relation to pre set standards and benchmarks. The rate of the child’s learning as well as the level need to be considered. The child needs to be observed in a class setting. This provides direction on whether to consider the child when the child does not achieve sufficiently for their age or does not meet state-approved evaluation level standard in either or more of the following areas, when provided with appropriate direction and knowledge necessary for the childs age or state-approved evaluation level benchmarks: Oral expression, Listening understanding, Written expression, Basic perusing expertise, Reading familiarity abilities, Reading perception, Mathematics estimation and Mathematics critical thinking. The general behavior of the child must be

International Logistics Essay Example | Topics and Well Written Essays - 2000 words - 1

International Logistics - Essay Example The uniqueness that this store offers and its efforts to make it different and better than what is already being offered have made the retailer a success. When the company emphasizes on being better than ever, this means that they are actually keeping themselves updated with the pace of change that is taking place in its surrounding. Retail industry of UK is very competitive and the industry is facing many challenges currently too. But Morrisons has managed to deal with these challenges in a quite efficient manner. One of the biggest challenges in retail food industry is to provide fresh food to customers and Morrisons has always believed in providing the best quality and fresh food to its customers and they manage it through their efficient supply chain system which also acts as their competitive advantage in retail market (Morrison’s, 2002). Morrisons believes in providing premium quality food to its customers and to achieve this goal, Morrisons is ready to take necessary st eps. The retailer collects freshly produced foods from local markets which are later further processed according to the manufacturing procedures of the organization. This process is done to preserve the freshness of food and to store it safely in warehouse. Morrisons uses its own temperature controlled warehouse to maintain food’s freshness and it has its own packaging plant as well. The prime motive of Morrisons is to deliver the best customer service. Customer satisfaction is of utmost importance for the organization. It serves as a point of difference for their organization as the way they treat their customers simply differentiates them from their competitors (Lovelock, and Wirtz, 2011).. Especially when a company is operating in service sector, then it has to focus on customer service in order to be successful in the long run (Lovelock, and Gummesson, 2004). For the provision of best customer service, employees are trained; employees are always kept motivated so that the y are able to deliver in the working time. Performance benchmarking is done in order to be competitive and to gain greater market share and to perform better than previous performances. All of these steps taken by the organization play a significant role in affecting customer service positively. SITUATION ANALYSIS Morrisons is counted as one of the big names in United Kingdom’s retail sector. Despite of the fact that Morrisons is one of the big names, this year sales of Morrisons faced decline as compared to the sales of previous years. Due to this there is a drop in Morrisons customer’s confWidence. Now these two factors are areas of concern for the management of Morrisons (BBC News, 2012). The market environment is getting tougher day by day. Competitors are constantly bringing up new offers and products to compete successfully in market and to capture greater market share. Competitors are performing better and trying to take and maintain lead in retail business, in such environment, there is a great pressure on Morrisons to deliver more than expected. The reason diagnosed for the decline in sales of Morrisons was their lack of performance in trading market. This reason has resulted the company to lose its market share to 11.5%. The market share of the company was 12% last year (BBC News, 2012). These are some serious issues that need to be resolved in order to be the market leader in retail category and to defeat giants like Tesco, ASDA and Sainsbury. Apart from the mentioned

Effects of Adverse Perinatal Outcomes (APO)

Effects of Adverse Perinatal Outcomes (APO) Specific Aims Adverse perinatal outcomes (APO) include infants birth defects, maternal pregnant and obstetric complications. Birth defects, including major congenital malformation (MCM) and minor anomaly (MA), become the leading causes of infant morbidity, mortality, and years of potential life lost in the United States.1 Low birth weight (LBW), abnormal condition of new born (ACNB), preterm birth, and Developmental Delay or Disability (DDD) are also birth anomalies that impacts the infants health.2-5 The association of in utero exposure to teratogenic medications with infant birth defects and other anomalies has been widely investigated.6,7 The literature has shown that taking antiepileptic drugs (AEDs) poses an increased risk of having child with congenital malformations in women with epilepsy.79 The most common MCMs caused by in utero exposure to AEDs are orofacial clefts, cardiac abnormalities, neural tube defects, urologic defects, and skeletal abnormalities.80 In utero exposure to valproate, the most teratogenic AED, was associated with elevated risk of impaired cognitive function for children at 3 years of age, and reduced cognitive abilities for children at 6 years old.98,101 However, study results for many medications, such as antidepressants, opioids, antipsychotics, and antibiotics, are inconsistent for fetal safety.[1*-8*] The limited data source and rare incidence of birth defects, ACNBs, and other anomalies restrain the study power, and makes some studies inconclusiv e.8-10 Our long term goal is to determine the association between teratogenic effects of medications that mothers exposed during pregnancy and infants birth defects. The major objective of this study is to build a linked database in Rhode Island (RI) to facilitate the subsequent research on teratogenic effects of medication in RI population. The birth defects and birth certificates data from the Department of Health (DoH) and pharmacy claims from the Medicaid program offer an essential resource to investigate these aims. The availability of hospital diagnoses and birth records offers a significant advantage for investigating birth defects with corresponding clinical conditions in large population with a longitudinal approach. Our team is well suited to conduct this research given extensive expertise in contemporary pharmacoepidemiology, many years of experience on drug safety research, prior drug utilization and birth defects study with the linked data from another state, and clinical expertise from obstetric and gynecologic physicians. Our specific aims are to generate a linked data and investigate the medication utilization and assess the corresponding birth defects with the following efforts: Aim 1: To build a linked database that includes mothers medications prescribed during pregnancy and subsequent adverse perinatal outcomes. We hypothesize that the data from two state departments can be internally linked using identifiers. Mothers medication prescriptions will be extracted from Medicaid claims provided by the RI Executive Office of Health Human Services (EOHHS). The adverse perinatal outcomes include: MCMs, MAs, abnormal conditions of new born, fetal death, and low birth weight, and maternal adverse pregnancy and obstetrical complications. All of these outcomes will be obtained from birth certificates, institutional and professional claims that are collected and managed by RI Department of Health (DoH). These two parts of data will be linked by the deterministic or probabilistic linking strategy using mothers medical record number, name, and date of born. We will apply for IRB approval with a waiver of informed consent by RI DoH, EOHHS, Brown, and URI. Aim 2: To characterize the patterns of medication use in women during pregnancy. We hypothesize that medication use in women during pregnancy changes in recent years. Many medications, such as AEDs, statin, or angiotensin converting enzyme (ACE), have been classified as teratogens and categorized as D or X by the Food and Drug Administration (FDA). However, studies have found that these teratogenic drugs still have been prescribed to pregnant women.5-7 Some medications with contradictive results reported from the literature may have increased use in pregnant women. We will examine the prescribing patterns of these medications in pregnant women with varied age, race, comorbidities, co-medications, as well as medication types and doses. The utilization pattern will be delineated in secular trends and mapped geographically, as will facility, provider, and state-level variations. Aim 3: To assess infants birth defects and birth anomalies using advanced statistical model. We will identify all corresponding birth defects, including MCM, MA, LBW, ACNB, DDD, preterm birth, and fetal death and compare the birth defect rates in mothers with varied demographic characteristics and medication exposure. Previous studies have suggested that the LVM can be used to combine four specific birth defects together to create a severity index.16-18 We hypothesize that this LVM can be improved and optimized to combine any number of components with a proper weight on severity and frequency to evaluate the overall health status of infants. B. Significance and Innovation Birth defects occur in 3 5% of children born in the United States and account for 20% of all infant deaths.1,2 During 2010-2012, RI DoH identified 1,390 newborns with at least one birth defect.3 The rate of birth defects in RI increased by 14.2% from 2008 to 2012.3 It was reported that 2-3% of birth defects are due to teratogen-induced malformations, which refer to malformations resulting from environmental or in utero exposure to teratogens.4 In the United States, about 3 million people currently live with teratogen-induced malformations.4 The FDA defined the pregnancy category to enforce the labeling of drugs with respect to their effects on pregnant women. Some medications, such as AEDs, statin, or ACEs, have been classified in FDA pregnant category D or X due to their teratogenic effects. Previous studies reported a two- to three-fold increase in the malformation rate among infants with in utero exposure to AEDs.21,22,81,82 The incidence rates in infants with in utero exposure to AEDs were 3.1% to 9.0% for MCMs, 37% for one MA, and 11% for two MAs.21,80-83 The risk of malformations for infants with in utero exposure to valproate is 7.3-fold higher than that of non-exposed, and 4-fold higher than those exposed to all other AEDs.7 Some widely used medications, such as antidepressants, opioids, antipsychotics, and antibiotics, tend to have increased utilization in pregnant women while the results from teratogenic studies are controversial and inclusive.[1*-8*] It is difficult to distinguish between the real non-inferior results and power deficiency owing to rare outcomes. It has led to an urgent need to determine the fetal safety of these medications and prevent teratogenic medications prescribing to pregnant women. However, the limited data source and rare incidence of birth defect outcomes impact the study power, and makes studies inconclusive.8-10 Traditional claims data (data from Medicaid or private health plans) is not suitable for birth defect research as it only contains medical information for either mother or infant, not both. Birth certificates or birth defects data doesnt include mothers medication information. As such, to investigate utilization patterns and teratogenic effects of medications, we need to link mothers pharmacy claims with infants birth defects assessments. The linkage should be conducted in a secure data server with patients identifiers. The main goal of this proposed one-year pilot study is to collaborate with the RI EOHHS and RI DOH and generate a linked statewide dataset that includes mothers pharmacy claims and infants birth defect outcomes. This linked dataset will facilitate the researchers in Brown and URI to conduct studies regarding drug-induced birth defects in RI and provide a potential for combining RI linked data with the linked data from other states to conducting drug teratogenic studies in large population. Innovation This proposed study will generate a linked data with combining Medicaid pharmacy claims from the RI EOHHS and birth certificates and birth defects from the RI DOH. This would make RI become the fourth state that possesses the linked mother-infant data in the United States, besides California, Texas, and Florida. Our approach will provide a large linked dataset to facilitate the researchers from URI and Brown to conduct drug-induced birth defects studies. This linked dataset will provide a potential for future drug teratogenic research in large population with combining the RI linked data with the linked data from other states. Our approach will employ state of the art, innovative pharmacoepidemiologic study designs and statistical models, to improve the study power and efficiency. A latent variable model will be employed in this study to combine all birth defects outcomes into a continuous severity score to assess the overall infants morbidity and mortality. C. Approach Data Sources This study is based on a statewide, retrospective 11-year data sources: RI birth certificates and birth defects from January 1, 2006 to December 31, 2016. In Rhode Island, birth certificates are collected in the hospital within 24 to 48 hours after the baby birth. The RI DoH collects and manages birth certificate data for all infants born in RI. Birth dates and places for infants, and demographic characteristics for infants, mothers, and fathers are all recorded in birth certificates. The RI Birth Defects dataset consists of birth defects registry data prepared and maintained by RI DoH. Infant birth defects, including MCMs and MAs, were identified 0-365 days after live birth from hospital inpatient and outpatient claims. This study includes infants who were born in RI between January 01, 2006 and December 31, 2016. Medication information will be provided by the RI EOHHS. The data is comprised of eligibility, medical, and pharmacy claims for services from inpatient hospitals, outpatient clinics, emergency rooms, and pharmacies from January 01 2005 to December 31 2016. Brief demographics for enrolled members are included in Medicaid claims data, such as age, gender, race, residency, etc. Medicaid claims data do not include claims for managed care or Medicare enrollees. We excluded patients with dual eligibility, and thus restricted the drug exposure cohort to pregnant women who were only in the fee-for-service or primary care case management program. Each data source will be cleaned first, and then linked with other corresponding datasets using a multi-step linkage approach in which three methods of linkage are applied in sequence Deterministic, Fuzzy Matching, and Probabilistic.156 Records will be first matched deterministically, based on exact matches of unique combinations of personal identifiers including Social Security Numbers, Date of Birth, and Mothers Names (used for the linkage of BVS to Medicaid only). Records that cannot be exactly matched due to missing or poor data quality will be linked using Fuzzy Matching.156,157 Fuzzy Matching allows at least one occurrence of Social Security Number digit transpositions, name misspelling, or day or month errors in birth date fields.157 Remaining unmatched records will be linked using probabilistic techniques, based on statistical weighting of combinations of personal identifiers. Probabilistic linkage involved a two-step process. 1) Deterministic matching from the first merging step empirically derived weights to the non-missing fields based on successful linkages. 2) After the unlinked data matched with several records by weights, the matches with the highest statistical probability (indicating by high weights) will be chosen. The record remained unmatched when no high weights could be obtained. Study Cohort This study includes female Rhode Island Medicaid enrollees who were older than 15 years of age, delivered a live singleton infant between January 01, 2006 and December 31, 2016, and are enrolled in the Medicaid program as identified by pregnancy status. The study cohort of mother-infant pairs will be generated by linking the Rhode Island Medicaid claims data and Rhode Island Birth defects data using strategies described above. Many women joined the Medicaid program after becoming pregnant. We excluded the women who were enrolled in Medicaid program after a positive pregnant test. More exclusion criteria for maternal-infant pair include: mothers with less than 6 months of Medicaid eligibility before pregnancy; mothers who lost Medicaid eligibility during pregnancy; mothers with dual enrollment with Medicare, HMO, or other private health plans; mothers giving multiple births; mothers with diabetes mellitus (ICD-9-CM: 249.x, 250.x, 790.29, or used of any antidiabetics during baseline), hypertension (ICD-9-CM: 401.x, 416.x, 796.2, , 997.91, 459.3, or used of any antihypertensive drugs during baseline), or HIV pre-pregnancy (ICD-9-CM: 042, 079.53, V08, V01.79, 795.71, or used of any antiretroviral drugs); Infants who were twins, triplets, quadruplets or more; outliers involving infants with birth weight less than 350 g or above 6000 g; mothers or infants missing critical information, such as infants birth weigh t, mothers demographic information, or perinatal medical information. Only less than 1% of infants are missing birth weight records in the birth certificate, these will be excluded from the study.20 Overall Study Design This is a retrospective cohort study based on linked mothers Medicaid claims and state birth registry data. The infants birth date will be the study index date. The drug exposure window will be defined as the subsequent 9-month pregnancy period after the first day of mothers last menstrual date. We will use a 6-month baseline period prior to the first date of mothers last menstrual date to obtain the baseline demographic and clinical information. Birth defect outcomes will be detected 0-365 days after the live birth. The entire study period lasts from January 01 2005 to December 31 2016. Drug Exposure Pharmacy claims in Medicaid have been approved as an accurate source for the assessment of drug exposure in observational studies.158 Mothers medication exposure during pregnancy will be obtained from Medicaid pharmacy claims using NDC codes for filled prescription medications, and the number of days for which the medication is supplied.160 The birth anomalies are associated with exposure during entire pregnancy, MCM relates to the teratogen exposure during the first trimester, and MA and LBW associates with the maternal medication exposure at the third trimester.161 Maternal medication exposure during entire pregnancy period can affect the occurrence of varied birth defects. The exposure window, thus, will be established as a period of 14 days prior to the first day of the mothers last menstrual period (LMP) to the date when infant is born. The drug exposure will be defined as any one dose of study medications dispensed during the exposure window, including which the medication is d ispensed before the exposure window but its supply days cover at least 1 day of the exposure window. Adding 14 days prior to the pregnancy is to include the conception period and the residual effects of medications. Sensitivity study will be conducted to examine the different definitions of medication exposure windows. The mothers LMP will be obtained from birth certificates. If the dates are not available in birth certificates (about 13% of LMP in birth certificates are missing), then this information will be imputed from clinical estimates.163-165 The literature suggests that LMP from birth certificates and clinical estimates agrees within 2 weeks.166 Outcome Assessment In this study, we will identify all individual adverse infant outcomes: birth defects (involving MCM and MA), ACNB, LBW, DDD, and preterm birth from the DoH birth defects data. MCM is defined as an abnormality of an essential anatomic structure that is present at birth and interferes significantly with function and/or requires major intervention.38,39 MCM includes heart malformations, urological defects, oro-facial defects, neural tube defects, and skeletal abnormalities, etc..38,40,41 Drug-induced MCMs mostly occur between the third and eighth week of gestation.44 Any impairment before three weeks is more likely to result in fatality. The fetus becomes less sensitive to teratogenic effects after the eighth week, when the organs have developed. 2-1 delineates the time window of exposure to teratogens and associated MCMs and MAs.44 MA, also called minor congenital malformations, is the abnormal morphologic feature that does not cause serious medical or cosmetic consequences45. Identification of MA can be difficult due to the definition and the easy-variable occurrence area.46 Approximately 70% of MAs occur on the face or hands.46 The prevalence of MA is less than 4% in the general population, and varies by race, ethnicity, and gender.45,46 In healthy newborns, about 15% to 20% have one MA, 0.8% have two MAs, and 0.5% have three or more MAs.46 MA mostly occurs after the eighth week of gestation, which is so-called fetal period.44 The use of teratogens during this period may induce MAs by disturbing the growth of tissues or organs.44 ACNB includes seven medical conditions for new born infants. Infants birth weight less than 2500g, 1500g, and 1000g are categorized respectively as low birth weight (LBW), very low birth weight (VLBW), and extremely low birth weight (ELBW). Infants with low birth weight are likely to be born before 37 weeks of pregnancy. In 2009, 8.16% of live born infants showed low birth weight.50 The high risk of infant mortality and morbidity associated with low birth weight has been documented.51 Although this positive association has been ameliorated over time with improved perinatal technology and intensive care, low birth weight and prematurity still have been identified as risk factors predisposing to cardiovascular dysfunction, lung disorder, hypertension, type 2 diabetes, renal diseases, autism, and developmental delay.52-56 MCM, MA, DDD, and fetal death will be collected from birth to the first 365 days of life using the ICD-9 CM code (740-759.9, 315, 768.0, 768.1) from inpatient and outpatient claims. ACNB and preterm birth will be identified from Rhode Island birth certificatedata, and one year follow ups in infant hospital discharge data. Infant birth weight is accurately recorded in the birth certificate.19 It was noted in previous studies that these birth defects outcomes are highly related to each other.59,70-75 MCM, MA, VLBW, and ELBW relate to significant morbidity, mortality, and childhood disability or serious pregnancy or obstetric complications. 58,70-75 About 6-42% of evolving cognitive dysfunction, 9-26% of neurosensory disabilities, 1-15% of blindness, and 0-9% of deafness occurred in infants born with VLBW and ELBW.71 A significantly higher risk of DDD was found in infants born with MCM (prevalence rate: 8.3, 95%CI: 7.6-9.0).72 A 44% 86% of mortality rate occurs in infants with ELBW (500-750g).73 Moreover, infants with 1, 2, or 3 MAs had a risk rate of corresponding MCMs at 3%, 10%, or 20%, respectively.46 Some risk factors, such as infant gender, maternal age, race, social-economic status, BMI, smoking, alcohol use, nulliparity, comorbidity, and comedication during pregnancy are risk factors for all of these outcomes.75-78 Latent Variable Model Liu and Roth developed an LVM to incorporate four important BD outcomes into a single measurement, the infant morbidity index, to describe an infants overall tendency to BD.13 We will apply this model to combine all birth defects outcomes defined in this study into a continuous index of overall adverse perinatal outcome (APO) in this study. The combined outcome will be evaluated in terms of validity and reliability to ensure the appropriate use of this new methodology. MCM, MA, ACNB, Fetal Death, and DDD will be categorized as a binary variable, and assumed Bernoulli distributed.21 Four levels of LBW will be modeled as a multinomial variable since the four birth weight categories are mutually exclusive and each has its own probability. The summation of the individual probabilities of birth defects outcomes equals one. The unobserved index score will be assumed log-normally distributed. Based upon the assumption of local independence, responses of individual component outcomes are independent given the latent variable.22,23 Thus, the overall probabilities of component outcomes conditional on the latent variable are equal to the products of conditional probability for each individual component outcome.21 Based on the local independence and Bayes rule, the joint distribution for component outcomes can be expressed as an integral of product of multinomial variable for conditional distribution of each component outcome and marginal distribution of latent variable.22-24 Marginal distribution of the latent variable is described as log normal. Given the observed outcomes, we can obtain the posterior distribution of the latent severity score. Furthermore, we assume that the conditional distribution of each categorical observed outcome is nonlinear function of the latent variable.13 The conditional distribution of observed outcome and the latent variable will be linked by two parameters in the non-linear function.The probability of any specific observed outcome equals to 0 when the value of the latent variable equals to 0 because the latent variable accounts for all variation of the observed component outcomes and the relationship among these component outcomes.13 In the non-linear function, the probability of an infant having an individual birth defect outcome is assumed zero if the latent variable is zero, and every normal level (no birth defect or normal weight) will be treated as a reference. The latent variable positively associates with observed outcomes. The larger the latent variable, the higher the probability of the observed outcome.13 Latent Trait Model will be conducted using SAS Proc IML. The proportion of each outcome combination will be calculated. Then each parameter will be estimated using the iteration function for EGNLS starting from iteration 0 with initialized value until the stepping coefficient is less than 10-9. The final results are the estimates of all parameters. The estimate of latent variable will be obtained by entering the computed parameters into posterior function.13 Sensitivity Studies In order to examine the proper definition of exposure window, sensitive studies will be conducted with the exposure window defined as the period of 3, 7, 21, or 30 days prior to the first day of the mothers LMP to the infants birth date. D. Timeline Table. Study Timeline of the Study. Time Period Study Progress Before 07/01/2017 Obtain IRB approval from URI, Brown, RI DoH, and RI EOHHS. Complete DUA with RI DoH and RI EOHHS. 07/01/2017 08/01/2017 Complete data linkage for specific aim 1 08/01/2017 10/01/2017 Complete data cleaning, manipulating, variable editing, and analyses for demographic and clinical characteristics 10/01/2017 01/31/2018 Complete specific aim 2 02/01/2018 02/28/2018 Submit an abstract to the annual meeting of International Society of Pharmacoepidemiology (ISPE) 03/01/2018 06/30/2018 Complete specific aim 3 and submit a journal article

Sam Bass :: essays research papers

Spencer Nottingham 11/25/99 Language Arts Per 8 Sam Bass Two Column notes Location Guardians Biographical Information †¢ Sam Bass was born in the town of Mitchell Indiana on July 21, 1851. †¢ Later Bass Moved to the state of Texas where he took up the business of train robbing †¢ Sam's parents died when he was a youth, his mom Jane, in 1861, Dad Daniel, in 1864. †¢ Sam and his Twelve siblings moved in with relatives. Poor Sam was sent to his uncle David L Seeks whom deprived Sam of a proper education and made him work on the farm when he was old enough. †¢ While working as a teamster at the age of eighteen he drove a herd of cattle to Denton Texas and stayed working for the local Sheriff, WF "dad" Eagan. †¢ When Sam saved up enough money he bought a prize winning horse that won him enough money to quit working for Eagan. †¢ With the money he had Sam started mixing with the "rowdies". †¢ One day Sam And Underwood, one of the "rowdies" bought melons from the local store, and in an attempt to slice his Bass dropped the melon causing two blacks to turn around and stare at the men. Bass and Underwood started throwing stones at them and were chased out of town by the sheriff and from then on Bass was known as an outlaw. †¢ As an outlaw Bass formed a gang made of four men Tom Nixon, Bill Heffridge, and Jim Berry. The Gang would rob stagecoaches but when the money got low they concentrated †¢ on trains †¢ The Bass gangs first big train strike was on a Union pacific carrying money from Wells Fargo going west. The gang boarded the train at a water stop in Big Springs Neb. On Sep. 19, 1877, taking more than $60,000 in newly minted twenty- dollar gold pieces, an additional $1,300 from passengers, and $450 from the mail car. Following the robbery Basses first gang split up and most of the gang was captured bu lawmen save Bass. †¢ When the first Bass gang split Bass composed an new gang of Frank Jackson, Tom Spotswood, Henry Underwood, Tom Johnson, and the Traitor Jim Murphy who would later betray Bass and set Bass up for his, Jim Murhys own advantage. They started on stagecoaches too but when the take was only $43 dollars they swore to concentrate on trains. †¢ There were many robberies before the one that would turn the gang upside-down.

Who S The Real Terrorist

In the video they make strong arguments on what errors is and who are the terrorist. The video does indeed reach its audience and provides a clear message. Ethos The Classroom debate scene doesn't introduce anybody however it does show credibility threw out the video and uses well known actors. The scene in itself shows a lot of credibility ultimately because it is set up as a classroom discussion, setting. The instructor also shows he knows what he is talking about simply because he is throwing out data with numbers. Ultimately numbers make's anything more credible and sometimes even more believable.The student who is shown on the video who is defending the Muslims is a Hindu actor named, Ivies Oberon. While the professor is a well- known star named USAF All Kahn. The rest of the classes are random pro American actors that no one really knows. The audience will automatically agree with the famous and well-known actors. Whereas with the random students who the audience isn't familiar with them will most likely disagree with them. For instance companies use this strategy. They use role models and well known celebrities. For example Lebanon James a well-known basketball player is sponsored by Nikkei, McDonald's, and Coca-Cola.The Meany's intention is target there audience and get there point across. Considering there point being that if, Lebanon James eats or wears this so should you. That's how they attempted to manipulate there targeted audience and get their message across just like in the Exurban debate scene. This automatically gives the actors more credibility in the sense that they actually know what they're talking about unlike the underground actors, consequently takes away their credibility. As a result the actors being used can make their argument stronger and credible.Logos The video scene begins when the teacher states that â€Å"Islam is a religion that reaches peace and tolerates† (Exurban-Classroom Debate Scene, . 32 seconds). As soon as th e instructor finishes one of the students exclaims â€Å"if Islam truly is a religion that preaches peace how come they have the world's most trouble spots like the west bank, Afghanistan, Pakistan, and Iran there all plagued with Islamic terrorism. † (Exurban-Crisscross Debate Scene, . 37 seconds). The student uses a faulty deduction in here statement, she uses composition.She is assuming that all terrorist are Muslims by generalizing that the world most trouble spots are all thanks to Islamic terrorism. Threw UT the movie scene there is quite a lot of logical appeal. The video shows its logical appeal in various ways. They persuade the audience by exposing the United States and claiming that the US is only in the Middle East for the oil and that the Taliban was a creation of the CIA in other words it can be characterized as a lie since there really is no proof or it can also be an appeal to anonymous authority.Despite that, the video gives numbers and compare how more peopl e die in Afghanistan bombing than in 9-1 1 . The student compares how much people have died in Afghanistan bombing being which as more than 15,000 while 9-1 1 had around 3000. The logical appeal is clearly valid and effective to the audience since they support their statements and provide information. To sum it up at the end of the video the student even ends with logical appeal by stating that just because there elites and wear a fancy suit doesn't make them any different than other terrorist.This must have been one of the strongest logical appeal that one of the students states. It makes the audience kind of remove that blind fold that the government has had them have on. It changes the perspective and in a way makes the targeted audience open there eyes. Pathos The emotional appeal is clear throughout the video. You can see the anger in the student who argues how American's are the real terrorist oppose to the other students who are against the Islam religion, they show an expres sion of being worn out of the argument.The student showing his anger convinces the audience in the way of how tired he is of Americans showing there hypocrisy on how the terrorist are Islam religion. While the student who are expressing themselves as worn out help out the argument even more by showing how he has exposed them, which truly will impact the audiences . The video ends with the pro Muslim student showing his anger. His expression makes it look like all Muslims are fed up with Americans stepping in their soil and taking advantage and just bombing there country.The student makes the argument more emotional and appealing as well as the depressing background music. Conclusion In conclusion the movie scene covered the three different rhetorical strategies by either supporting its argument or not making it weaker. The artifact does indeed reach its purpose in persuading and convincing its audience since its argument is based on facts. The video mainly mention on owe the US was bad and are terrorist and gave little information on how Muslims are also terrorist.

Free Essays on Johannes Kepler

Johannes Kepler Johannes Kepler was born on December 27, 1571, a premature child. He was born in Weil, in Swabia, a wine region in Southwest Germany not far from France. Kepler waent to the University of Tuebingen, a Protestant institution, where he studied mainly theology and philosophy, but also mathematics and astronomy. After Kepler graduated from Tuebingen, he was offered a professorship of astronomy in faraway Graz, Styria where he went in 1954. One of the duties of this Professorship was to make astrological predictions. While lecturing to his math class in Graz, contemplating some geometric figure involving Concentric Circles and triangles on the backboard, Kepler suddenly realized that figures of the type shown here determine a definite fixed ratio between the sizes of the two circles, provided the triangle has all sides equal, and a different ratio between the sizes will occur for a square between the two cirtcles, another for a regular pentagon. He really believed in the Copernicah Sy stem, so he saw the planetary orbits as six concentric circles. He felt the universe would somehow show mathematical beauty of symmetry. He suggested that the orbits might be arranged so that regular polygons would just fit between adjacent ones, and maybe somehow this reflected some invisible underlying structure holding it all together. Disappointingly, he found it just didn’t work the ratio’s where wrong. Then he had another inspiration. The universe was three-dimensional, and instead of thinking about circles, he should be thinking about spheres, with the planetary orbits along the equators. The anologue would be two concentric spheres with a tetrahedron between them, so that the outer sphere passes through the verticles of the tetrahedron, and the inner sphere touches all its sides, but is completely contained in the tetrahedron. There were just six planets, so five spaces between spheres, and there are just five regular solids... Free Essays on Johannes Kepler Free Essays on Johannes Kepler Johannes Kepler Johannes Kepler was born on December 27, 1571, a premature child. He was born in Weil, in Swabia, a wine region in Southwest Germany not far from France. Kepler waent to the University of Tuebingen, a Protestant institution, where he studied mainly theology and philosophy, but also mathematics and astronomy. After Kepler graduated from Tuebingen, he was offered a professorship of astronomy in faraway Graz, Styria where he went in 1954. One of the duties of this Professorship was to make astrological predictions. While lecturing to his math class in Graz, contemplating some geometric figure involving Concentric Circles and triangles on the backboard, Kepler suddenly realized that figures of the type shown here determine a definite fixed ratio between the sizes of the two circles, provided the triangle has all sides equal, and a different ratio between the sizes will occur for a square between the two cirtcles, another for a regular pentagon. He really believed in the Copernicah Sy stem, so he saw the planetary orbits as six concentric circles. He felt the universe would somehow show mathematical beauty of symmetry. He suggested that the orbits might be arranged so that regular polygons would just fit between adjacent ones, and maybe somehow this reflected some invisible underlying structure holding it all together. Disappointingly, he found it just didn’t work the ratio’s where wrong. Then he had another inspiration. The universe was three-dimensional, and instead of thinking about circles, he should be thinking about spheres, with the planetary orbits along the equators. The anologue would be two concentric spheres with a tetrahedron between them, so that the outer sphere passes through the verticles of the tetrahedron, and the inner sphere touches all its sides, but is completely contained in the tetrahedron. There were just six planets, so five spaces between spheres, and there are just five regular solids...

Types Of Budgeting Example

Types Of Budgeting Example Types Of Budgeting – Coursework Example Types of Budgeting Types of Budgeting One significant difference between rational and incremental budgeting models is the comparative level of difficulty. The rational budgeting model is a lengthier, more costly procedure although it offers businesses more alternatives in terms of working in manifold areas with little financial resources (Cropf, 2008). On the other hand, the incremental budgeting model is suitable for little change since the most recent budget and there are extra financial resources to spend. New business objectives, episodes of financial difficulty, and creative approaches are hard to put up using the incremental budgeting model. One advantage of the rational budgeting model is savings, whereby every agency and task financed can account for every dollar spent easily (Cropf, 2008). A disadvantage of rational budgeting is possible, lengthy bureaucratic procedures that can be overwhelming. Rational budgeting models are used often by public agencies and involve complex protocols where even the agencies themselves are not certain they will be financed at all. An advantage of the incremental budgeting model is stability. Incremental budgeting is a stable procedure where the project’s individual share of the entire budget will not increase or decrease drastically (Cropf, 2008). A disadvantage of incremental budgeting is unnecessary funding. Since this model serves to stabilize sections or elements of a project, incremental budgeting processes end up financing these elements simply because they were underfunded in the past. As a result, efficiency is not a factor. An improvement I would make to the rational budgeting model is to reduce political processes and increase the involvement of special groups that decide the parts of a project worth financing (Cropf, 2008). For the incremental budgeting model, I would allow agencies or sections of a project to account for their previous uses of budget in order to determine the current or future allocat ions.ReferencesCropf, R. (2008). American public administration: public service for the 21st century (1st Ed). New York, NY: Pearson Longman.

The Emergence of a Hookup Culture in Contemporary American Culture Essay

The Emergence of a Hookup Culture in Contemporary American Culture - Essay Example One of the factors that could have contributed to the growth of the women’s liberation movement is the loss of traditional gender roles in modern American society. While previously women were confined to their homes, they were now gaining recognition in their greater roles for the development of the society, and for the first time their functions were not limited to traditional homemaker and child-rearing roles. There were more women seen in public doing things that were expected to be done by men, such as getting a college degree, working in an office, or under public service. These women were able to achieve something, which also gave them the mindset that they can do anything that a man can do, aside from the traditional gender roles that were assigned to them. Having an advanced education opened up not just the avenues for other career opportunities, but this also changed how many women view relationships, including sex. This shift from being an at-home person to being see n in public did not only give additional career choices for women, but also additional freedom in relationships, whether sexual or romantic in nature. Starting from the 1960’s when the concept of dating was starting to lose its hold on college culture, the idea that having non-committal sex with others becomes a much more lucrative choice for most people, especially women since there is no hassle of having to choose between getting tied down to a relationship or having to bear children over expanding careers (Bogle 2007: 779). This way of thinking has made most women liberal in terms of their sexual freedom, and it is assumed that the engagement to such behaviors was not only rebellious in nature, but also helped in spreading the culture of casual sexual encounters since there were many people who were much more open-minded about it (Shukusky and Wade 2012: 495). Despite the fact that there has been an increase in the number of women engaging in casual sexual encounters, ther e has been an observed trend in the slow progress of moving from

Medical Information Confidentiality Research Paper

Medical Information Confidentiality - Research Paper Example The questionnaires were distributed in five primary care clinics. The receptionists in these clinics were requested to issue questionnaires to all the patents who visited the clinics. The survey was intended to run for three weeks and it was aimed at collecting 100 questionnaires (Whiddett et al. 532). Patients were requested to answer all the questions and put them in a collective box in the respective clinics. Alternatively, they could return them using pre-paid envelopes. The research team did not monitor the issuance of the questionnaires or make attempts to identify repeat respondents and non respondents (Whiddett et al. 532). This was the major limitation facing the exercise however; it did not impact on the findings as the sample size was adequate. The survey was representative enough as the clinics were chosen to represent a wide range of demographics. The questionnaire covered three key areas. These are basic demographics, attitudes towards sharing different kinds of informa tion and patients’ knowledge towards information sharing practices. Secondly, secondary data was used to complement the findings that were obtained from the survey. The information will be collected from a peer reviewed sources, credible internet sources and medical journals that have conducted similar studies. A comprehensive study of past case studies reveals that medical confidentiality in the health sector is at a risk of getting eroded due to the use of the current technology. The respondents are wary about sharing their personal information to various parties and the study reveals that most of them are not aware of the increasing information sharing practice in the medical field (Levenson 20). Data Collection Instrument: Questionnaire Tick the appropriate answer 1. My age is: 18 to 30 years 30 to 60 years Above 60 years 2. I am Male Female 3. My ethnicity or race? (Tick one) White Americans Black Americans Asian Americans Hispanic and Latino Americans Other 4. How much information do you have concerning those who can access your medical records? Nothing Something A lot 5. Are you aware of the NHI number? Nothing Something A lot 6. I am comfortable with confidential health information being shared between the following groups. Health administrators Yes Maybe, if consulted first No Don’t know Health professionals Yes Maybe, if consulted first No Don’t know Researchers Yes Maybe, if consulted first No Don’t know Other bodies (Insurers) Yes Maybe, if consulted first No Don’t know 7. I am comfortable with confidential health information being shared to the following groups as long as it does not contain my personal information. Health administrators Yes Maybe, if consulted first No Don’t know Health professionals Yes Maybe, if consulted first No Don’t know Researchers Yes Maybe, if consulted first No Don’t know Other bodies (Insurers) Yes Maybe, if consulted first No Don’t know Question Specificat ions The first question is important since it helps to establish the link between the age of the respondents and their level of awareness concerning confidentiality of medical information. In addition to, it helps to establish the age bracket that attends the clinics often. The second question concerning gender helps to determine the relationship between gender and attitudes towards medical information confidentiality. The third question is aimed at finding out the level of awareness about medical confidentiality (Whiddett et al. 534). It also gives information on varying attitudes across ethnic groups. In a nutshell, the first three questions are interested in determining the primary demographics which