The Summer of SARS Essay -- Severe Acute Respiratory Syndrome Health E

The Summer of SARS As far as I could recollect, every summer my family would travel back to Taiwan as my parents way of paying homage to Taiwan and to immerse me and my sister in our culture and heritage. The summer of 2003 would come been just another summer spent on an over-heated and over-populated island with family and friends except for the introduction of a new viral respiratory illness named SARS or ascetical Acute Respiratory Syndrome. It was first recognized on February 26th 2003 in Hanoi and its main symptoms and signs included high fever of over 38? Celsius, ironic cough, and shortness of breath.1 At the time, my family assumed that, whatever this new disease was, it was contained within Southeast Asia and its effects would not impact our travel plans. How wrong we were As the control for departure from LAX drew closer, more devastating reports of the rapid and deathly effects of SARS were gathered by the WHO World Health Organization. According to the Centers fo r Disease instruction and Prevention (CDC), in 10 to 20 percent of the cases, patients required mechanical ventilation and most patients developed pneumonia. It spread by close person-to-person contact. From our relatives and friends abroad, we perceive numerous distressed accounts of distantly related people who have fallen ill or possibly have come into contact with SARS. By July 2003, the additive number of SARS cases world wide was an impressive 8,445. Taiwan, our destination, proved to be a hot spot with 678 cases of SARS and 84 deaths since display, 2003.2The problem with the illness was that the facilitate of research to understand the causative agent and the efforts to contain the illness was slower than the spread of disease up to this point. Ne... ....2 WHO, Cumulative Number of Reported verisimilar Cases of SARS, July 1, 2003, (accessed April 24, 2005).3 WHO, Severe Acute Respiratory Syndrome (SARS)-multi-country outbreak-Update, March 17, 2003, (accessed April 24, 2005).4 WHO, Severe Acute Respiratory Syndrome (SARS)-multi-country outbreak-Update, March 20, 2003, (accessed April 25, 2005).5 WHO, Severe Acute Respiratory Syndrome (SARS)-multi-country outbreak-Update, March 21, 2003, (accessed April 25, 2005).6 WHO, Update 61-WHO extends its SARS related travel advice to all of Taiwan province, China, May 21, 2003, (accessed April 25, 2005).7 WHO, Severe Acute Respiratory Syndrome (SARS)-multi-country outbreak-Update, March 8, 2003, (accessed April 24, 2005).8 CDC, often Asked Questions About SARS, April 25, 2004, (accessed April 25, 2005).

Nurse Practitioner Essay -- Persuasive, Quality Care

In todays world a big debate that families debate between and spend time trying to investigate is what the best possible options are for their children and spouses health care. A question often asked is if seeing a contain practitioner is just as effective and dear as seeing a doctor. Many parents worry if their child will get the full attention needed when seeing a nurse practitioner. declare practitioners have the training and time to give children and their families the support and care necessary (Should My Child See a NP 2). A nurse practitioner is a registered nurse who is highly educated and has gone through clinical training in their health care specialty areas (Pediatrician v NP 1). In cabaret for them to practice they must have four to six years of training and pass all their licensing exams to practice (Quality of Care 1). For students to become a prepared registered nurse they must complete an additional masters level training on top of their baccalaureate prepared cl asses (Duties and Responsibilities 1). In order for someone to flat prepare to go into the field of nurse practitioners a high school student should take challenging classes in English, Math, and Science (Duties and Responsibilities 1). Many nurse practitioners drill side by side with a licensed doctor, but that is not always the case. The career of being a nurse practitioner began back in the 1960s (Pediatrician v NP 1). There was a huge shortage of physicians and I need for care to people under served (Pediatrician v NP 1). guard practitioners work in manly rural and urban settings such as public health departments, community health centers, hospitals, physicians offices, nursing residences, HMOs, student health clinics, and home health agencies. Where state law pe... ...e practitioners provide nursing and medical services to not only families, but individuals and groups as well, emphasizing health promotion and distemper prevention (Pediatrician v NP 1). Something they also provide for families, individuals and groups is teaching and counseling (NP Services 1). If necessary your nurse terminate provide you with prescription of pharmacologic agents and treatments. They can also provide non-pharmacologic therapies (NP Services 1). Even though nurse practitioners are a real good idea in many cases it is still very important to have a regular doctor that you can see in certain situations. Nurse practitioners are a great alternative for bite check ups minor visits when sometimes seeing your doctor is hard to do. You can be assured that with a nurse practitioner you will be tended for musical composition receiving a warm and welcoming visit each time.

Free Grapes of Wrath Essays: Steinbecks Political Agenda :: Grapes Wrath essays

Political Agenda in The Grapes of Wrath The Grapes of Wrath is a movie that was originally a novel by tail end Steinbeck that exposes the desperate conditions under which the migratory farm families of America during the 1930s live. The movie tells of one family that migrates west to California through the great scotch depression of the 1930s.  The Joad family had to abandon their home and their livelihoods.  They had to uproot and set adrift because tractors were rapidly industrializing their farms along with the erosion of topsoil to create "the Dust Bowl".  The bank took ownership of their land because the owners could not pay off their loan.  The movie shows how the Joad family deals with moving to California, how they survive the cruelty of the landowners that take advantage of them, their poverty and willingness to work.  The government, and political figures also abuse their powers to put forward such a lack of balance of power between the w orkers and businessmen, and yet some branches of the government protect the workers. During the Dust Bowl, hundreds of thousands of southerners faced many hardships, which is the basis of the movie. John Steinbeck wrote this fiction novel to portray the harsh conditions during the Dust Bowl.  The Dust Bowl occurred in the mid-west part of America, in particular in okeh. Such people in Oklahoma who lost their jobs from the Depression and eventually the Dust Bowl were called "Okies."  The mistreatment of the "Okies" in The Grapes of Wrath can be concluded as being valid.  During the Red Scare, Americans mistrusted other Americans, especially certain government organizations.  When one man was telling the "Okie" group that the pay and jobs are minimal in California, an aristocratic or government official accuse the person of being a communist.  This represents the hate of the communists in the view of the government.   In The Grapes of W rath, the Californians wanted to rid the "dirty" Okies from California because they were afraid of them. They were afraid that the Okie would take their land. steady the California police beat them for no just reason because they wanted the Okies to leave the state. The police, shown as corrupted thugs, killed Casey because he was "agitating" the public. Certain government organizations were aware(p) of the harsh living and pay conditions that was upon the Joad family, and yet they tried to suppress it.

Marketing Final Exam :: brand image for country

Q1. Asian nations are beginning to check off themselves. Considering the demesne you researched this semester, propose a strategy to construct a brand image for the particular country. Based on your knowledge about the country, what might be the biggest three argufys of executing your strategy and how might they be addressed?Brand Image Sri Lanka The Southern Asian DynamicThis brand image for Sri Lanka would be an accurate depiction because of the increase in change the country is al styluss experiencing. Sri Lanka has plans in place for future national knowledge to help better the country, with the help and use of humanitarian support from ally countries. Their national development plan also includes Sri Lanka is also known for their quality in exported goods. The quality of goods exported from Sri Lanka tends to be of a higher quality. Above all, Sri Lanka has a great human development rate, which means that the labor force has the potential to be powerful. A strategy I wou ld use to create this brand image would be to promote and boost the quality of the goods produced in their home country. Promotion for planned national development would also be carried out. The advertising and promotions would take place to target countries that would benefit from trade goods from Sri Lanka. The brands or goods that are exported promote the country and contribute to creating the desired brand. The country (its government) needs to promote the brands of goods being exported also.While Sri Lanka has the potential to be powerful, challenges could stand in the way of executing a marketing strategy. Building a brand for a product is not the same as building a brand for a country. A country would need to leverage all of their unique and positive qualities in order to be able to successfully promote themselves the way they plan to. If the government places strict laws on exporting goods, this could hurt the marketing strategy of promoting the country as a brand as well. Another challenge would be that the political violence in Sri Lanka could hurt the creation of the brand image. Countries who would like to import goods from Sri Lanka may see the political violence as an contract that they would prefer to steer clear of.Q2. In which category of innovations do microwaves fall in India? As VP of White Appliances, how would you use the knowledge about the five characteristics of innovations to hurry quicker diffusion of the product?

Alcohol Television Commercials are Misleading Viewers Essay -- Media

Alcohol Television Commercials argon Misleading Viewers At any given time a person can childs play on their television and find a commercial of some sort. Their main purpose is for them to throw information about their product to anyone who will listen. It is also frequent for this form of advertisement to be promoting an alcoholic beverageic beverage. Whether its a catchy song with the chorus chanting This Buds for you or three frogs burp Bud-Wei-Ser, viewers learn the slogans and use them in their own lives. Needless to say, alcohol companies have mastered the art of grabbing the attention of their audience by imbedding their images and words done commercial advertising. Although clever, these advertisements can be misleading their viewers to think that drinking brings unattainable excitement and pleasure rather than the serious consequences that frequently arise. Statistics for drinking ar alarming for any age group. However reports about adolescent drinkin g are possibly the most alarming, and are a large indicator that alcohol advertisements mislead their audiences. The National Institute on Media and the Family has reported many disturbing facts about the false portrayals of alcohol consumption. For example, the institute reports that by the time teenagers reach madcap age, they will have seen 75,000 alcohol ads (Baran, 2004, p. 445). This means that adolescents are exposed to almost 13 alcohol advertisements a day. Whether its subtle or obvious, children still gear up the message that alcohol consumption leads to parties and happiness. In fact, statistics show that 56% of children in grades 5 through with(predicate) 12 say that alcohol advertising encourages them to drink (Baran, 2004, p.445). By the use of image ad... ...d federal mandated warnings), research has shown that they hurt the cause as opposed to helping. The boomerang effect expresses just this drinkers perceive alcohol as having more benefits when the warning is present (Lapin, McKinnon, 1998, p.3). Alcohol is almost like a forbidden fruit, which makes the idea even more exciting and its consumers to feel as though they are overcoming the infringement on their own rights. This research, as discomforting as it is, makes it almost impossible to find a solution to overcoming the misleading information handed out through alcohol commercials. As long as alcohol is sold, it will have to be advertised with the enthusiasm and appeal that it does now, in order to maintain the consumers attention. Sadly enough, this has to be done through false conditions which will steadily impact our societys view of drinking.

Alcohol Television Commercials are Misleading Viewers Essay -- Media

Alcohol Television Commercials atomic number 18 Misleading Viewers At any given fourth dimension a person can turn on their television and find a commercial of some sort. Their main purpose is for them to throw information rough their product to anyone who will listen. It is also common for this form of advertisement to be promoting an alcoholic beverage. Whether its a catchy song with the chorus chanting This buds for you or three frogs belching Bud-Wei-Ser, count oners learn the slogans and use them in their own lives. Needless to enunciate, alcohol companies have mastered the art of grabbing the prudence of their audience by imbedding their images and words through commercial advertising. Although clever, these advertisements can be misguide their viewers to think that drinking brings unattainable excitement and pleasure sooner than the serious consequences that frequently arise. Statistics for drinking are alarming for any age group. However reports about adolescent drinking are possibly the most alarming, and are a large indicator that alcohol advertisements mislead their audiences. The National Institute on Media and the Family has reported many disturbing facts about the false portrayals of alcohol consumption. For example, the embed reports that by the time teenagers reach driving age, they will have seen 75,000 alcohol ads (Baran, 2004, p. 445). This means that adolescents are exposed to almost 13 alcohol advertisements a day. Whether its subtle or obvious, children still get the message that alcohol consumption leads to parties and happiness. In fact, statistics show that 56% of children in grades 5 through 12 say that alcohol advertising encourages them to drink (Baran, 2004, p.445). By the use of image ad... ...d federal mandated warnings), research has shown that they hurt the cause as opposed to helping. The boomerang effect expresses erect this drinkers perceive alcohol as having more benefits when the warning is prese nt (Lapin, McKinnon, 1998, p.3). Alcohol is almost like a forbidden fruit, which makes the idea even more provoke and its consumers to feel as though they are overcoming the infringement on their own rights. This research, as discomforting as it is, makes it almost impossible to find a solution to overcoming the misleading information handed out through alcohol commercials. As long as alcohol is sold, it will have to be advertised with the enthusiasm and conjure up that it does now, in order to maintain the consumers attention. Sadly enough, this has to be done through false conditions which will steadily impact our societys view of drinking.

Comparing Jack and Macbeth

Comparing jak and Macbeth Jack is an authoritative boy whose leadership attri only whenes was used to manipulate the some others rather than provide order. He fatalitys complete control, by victimisation his superiority and savage-Like ways. When the tribe was created, It works out of fear, and It Is this tribe that prevails. When Jack can no longer control his urge for leadership, the tribe Is created, which has a detrimental influence on all the boys. Through this character, Gilding shows how the evil side of society prospers.While the savages were thriving while the few who remained civilized were suffering from extreme famine, and taught. Jack seems to be a power-hungry individual. Jack rapidly gets in charge of the hunters that had to gather the meat for the whole group. Their enthusiasm decides to hunt a pig, and this is when Jack shows his savage personality. in front starting to hunt a pig Jack orders the hunters to paint their own faces with clay in a native manner. T his all foreshadows the savage that is about to pamper the island. Jack shows an attitude towards life that is shown by the people that succeed in the world.With his salvage attitude he Is encou do aggressiveness, and maintaining his ewer and respect from the rest of the group. He becomes paranoid that Ralph and Piggy are against him and feeds misinformation to his tribe, so as to keep them on his side. Jack Is the complete opposite, representing the evil that lies In the hearts of all mankind. He increasingly grows more sadistic and evil as the story goes on, eventually orchestrating the death of Simon and Piggy. Macbeth is also similar because he turned evil by listening to the raging ambition within his own personality.Macbeth let himself be manipulated by the three witches, and allowing him to be influenced by his wifes equally raging ambition, this caused many problems like a culpable conscience. It was due to the evil within him and his wife, as well as evil personified in t he three witches that Macbeth killed his own king, two guards who just tried to do their course of protecting the king, his best friend Banquet, and tarmacs defenseless family. Additionally, that evil led him to bring pain and suffering on a mass scale to the entire stinting nation.In conclusion Macbeth evilness was caused by their ambitions to be leaders, and disappearance of rational thinking, which caused problems with themselves internally, and affected other people. Macbeth is a very egocentric, power-hungry leader. He starts off by being a loyal follower to his king, hesitant to act against Duncan. Macbeth has the ambition but lacks the drive to do what is necessary. However, after he becomes king, this attitude changes greatly. He becomes like a dictator. Had Macbeth been a good, able leader, the revolt against him by Macadam, would not have been so fierce.Macbeth becomes very proud, because of his false prophecies. He degrades those who express fear or concern, and e waves off grave Information given to him. His whole concern is keeping his power at all cost. Hes so self-involved and ready to compromise his morals to get ahead. Macbeth knows that Macadam Is trying to oppose him so he hires people to kill Macadams family. No democratic leader would do that, so Macbeth Is demonstrate that he will not have mercy on those who try to oppose him, Leadership Increases for Macbeth because not only he was successful in killing the king but he got the throne. N authoritative leadership approach. Macbeth kill others that can become a threat o him which shows that he is capable of doing much more than he seemed, but cant trust people. He killed Macadams family to show his foremost. Macbeth is more determined to accomplish his goals and make decisions on his own. Macbeth is being a leader by making his own decision, but he does not listening to anyone elses input which can make his decision one-sided. This type of leadership can ultimately be destructive because of bad decisions, and his initiative has led to an evil path. He is much more assertive than before.Macbeth did exemplify more determination and energy however a true leader is not Just powerful and strong. Macbeth did seem to be more courageous when he said that he does not fear anyone and shall kill anyone that stands in his way. When he says this he seems to be more arrogant than confident. Macbeth shows a lack in confidence because he notes that to be safe he has to murder everyone. If he were confident hence he would not feel the need to harm anyone. Despite everything, he continues to stay positive and is determined to do whatever he needs to do in order to maintain his leadership.Macbeth on the there hand shows leadership, however in a much more negative way. Jack on the other hand is similar to Macbeth because Jack is an autocratic tyrant. He beats a boy for no reason other than to exert his power over the boys. He realizes what it takes to get power and to keep power. He rules through fear and intimidation, Jack is also a good manipulator. He knows what the boys both fear and want to hear. conflicting Ralph who desires a constructive society, Jack prays on the boys destructive primal instincts.The boys want to be told what to do rather than simply pitch in together hey feel the need to live in fear under a leader that they perceive as a powerful protector. In this sense Jack is sure enough a more effective leader than Ralph. Jack can be controlling. One example is when Ralph asked his hunters to take care of the fire but Jack didnt want that and he took the hunters to hunt because thats what he wanted them to do. Another example is when he takes a vote for the next chief. No one votes for him but he sets up his own tribe nonetheless. Jacks litany of evil is pretty impressive. He leads the brutal slaughter of a pigs, and Simon.

The Russian Revolution, c. 1910 – 1924, Sources Question

1) This question is ab start Russia before 1914. Look carefully at sources (A) to (F) and then serve questions (a) to (d) below.a) Study source A.What can you learn from source A about the place in Russia before 1914?From source A we can learn that the situation in Russia before 1914 was rattling alarming. Strikes went up from 2000 in 1912 to 4000 in 1914. Some strikers demanded trade union rights and more and more mass were worthy involved with fights with the political sympathies. 270 miners were shot dead during the strikes in Lena goldfields.b) Study sources A, B and C.i) Does source C support the evidence of sources A and B about the situation in Russia before 1914? excuse your answer. stem C supports the evidence of source A by saying that there was an increase of tension. This is shown in source a by the increasing heart and soul of strikes and the fact that some(prenominal) plenty had been shot during the Lena goldfield massacre. cite C also supports source A becau se it shows that more and more people were involved in fights with the government, as source C says, People can be heard speaking of the government in the sharpest of tones. Source C supports the evidence of source B because the outlet of strikes and strikers in factories increased during 1910 and 1914, again, as source C says, People can be heard speaking of the government in the sharpest of tones.ii) Why were there many strikers in Russia in the years 1910-1914? Use sources A, B and C, and your own knowledge, to explain your answer.There were there many strikers in Russia in the years 1910-1914 because people were first off becoming less scared of the Okhrana, so they were not genuinely afraid to voice their opinion. A lot of people may not have like how the government was running Russia the only way they would be heard would have been through a strike. More people were also coming together, as almost of them worked in horrible working conditions, with very little pay, long h ours and a disturbing working environment, they must have decided to go on strike. gross sales of vodka, food and fuel dropped drastically, this may have also cased many strikes as many people would have needed the money from these sales. Also, from source B we obtain that in 1910 the number of strikers in factories was 222, in 1914 the number of strikers in factories was 3534. The increase in strikers in factories from 1910 to 1914 may have been caused by the increased size of it of the factories. The factories must have employed more people thought 1910 and 1914, so the number of strikers must obviously increase.C) Study sources D and E.How useful are sources D and E as evidence of support for the Russian monarchy?Source DSource D shows that the ordinary people of Russia back up the Tsar wherever he went, although the public may have been doing this so the Tsar and his people will not give them a hard time, it was dangerous for the public to express their neat feelings. The s upport shown was only a small percentage of the universe of discourse, it was emotional support. The country saw the monarchy as a religion, so they have always been told to worship it. Source D is a reliable source because firstly the writer is the Tsars sister, she was an eyewitness. Secondly, she was writing in her private diary, there would be no reason for her to lie or exaggerate anything. Also, she would have written about these events a night (after they had happened) and so she may have only been picking out the good bits and forgetting the bad bits.Source ESource E is useful in showing support for the Russian monarchy. It shows that faith in the government is decreasing and that a revolution is becoming more likely. The writer of this source, Alexander Guchkov was the loss leader of the Octobrists, a party basically loyal to the Tsar and his government. If the leader of a loyal party to the Tsar and his government saw and said that faith in the government was decreasing and revolution was very likely, then it would have been true. Source Es writer, Alexander Guchkov is a more objective lens person than the writer of source D, the Tsars sister who was sheltered in Russian courts and biased in the Tsars favor.d) Study all the sources.There was widespread support in Russia for the Tsar before 1914.Use the sources, and your own knowledge, to explain whether you agree with this view.Sources A and B show that there was an increase in strikes and strikes in factories during 1910 to 1914. However, it gives a particular answer to the statement above as it mainly looks at the industrial sector.Sources C and E show that even a reporter of the Okhrana and a leader of the Octobrists (both loyal parties to the Tsar) think that the support for the Tsar is decreasing. This makes a revolution more and more likely.Sources D and F show that many people came out to see the Tsar, however, they may have done this out of curiosity as the Tsar would have been something to see, not because they supported the Tsar. They also may have come out to see the Tsar because they were scared that if they did not come out to see and appear to be supporting the Tsar, they might get into trouble with the government. Sometimes people feel loyalty to the institution, but the may not like how the government was running the country, a lot of people would have been in this possession during this time.I do not think there was widespread support in Russia for the Tsar before 1914. This is because as sources D and F shows that the ordinary people of Russia appeared supported the Tsar wherever he went, although I think that the public may have been doing this so the Tsar and his people will not give them a hard time, I believe that it was dangerous for the public to express their true feelings. Sources D and E also only a small percentage of the population of Russia, it cannot be mistaken for the majority of the Russian population.The Tsar also failed to face the peasan ts, poverty and workers. As the 3 categories were fitted by most of Russias population, the Tsar was not very popular. The Tsar mainly supported the rich landowning class that was a very small percentage of the Russian population who did not need the Tsar very much. The people who needed the Tsar were the poor peasants with large hungry families (most of the Russian population), however the Tsar did not help them. This made a lot of people not to want to support the Tsar as he did not help the people in need. The Tsar was a autocratic ruler, this meant that he had have it off and absolute power of Russia. A lot of people would not have liked this so the would not have really supported the Tsar.

Description of a Religious Festival Essay

Write an essay describing a religious festival you celebrated, mentioning what you saw and did in the festival Religion is a collective sense of right and wrong, a shargond outlook created by ceremonies. Most common religion in India is Hinduism. Hindus celebrate thousands of events every year and each in a confusable manner, including chanting prayers to the gods and making sweets. Ram Navmi is similarly one of the event celebrated Hindus. This occasion has great momentousness therefore its a nationwide holiday. It is celebrated ii days after the seven navratras.Navratras are the days of pooja in which Goddess Durga is worshipped by the people for bringing peace and prosperity in their life. People particularly ladies keep fast for the first eight days and open on the ninth day. Goddess Durga have nine different incarnations, worshipped one each day. Havans are done, which is in addition believed by the people that its smoke purify the homes. On the ninth day a bigger havan is done and then ladies in the family misrepresent meals for seven young girls and one boy. These girls are treated with respect as they are considered the different forms of Goddess Durga.They are also given offerings in the form of cash. We also celebrate Ram Navmi and so my mother kept a fast for two days. We could not do havan on the first eight days due to lack of space but on the ninth day we had a pandal built, made up of tent cloth which was all red in glossary which was to give the event its effect supported by thin logs. A pandit was called to conduct the rights and rituals and my mother prepared food for the girls. The eighth day was hectic for me morsel I enjoyed it . my sister and I prepared the invitations cards for the children.They had a silver colored fringe with text in golden and a picture of professional Ganesha with red background. I went to each ones house to invite them. I also went to buy eight gifts and keeping in mind their ages I found all the appropria te gifts. Then came the ninth day, I was woke up from my sleep by the shank sound. I took my bath and got ready for the function. The havan started and gradually the girls also came and there was deluge of tasks poured upon me. I had to bring the bucket full of water to wash the kanyas feet. Then I went to help the pandit with ghee,yoghurt, etc.

Scope of Managerial Economics Essay

Economics has two major branches namely Micro scotchs and Macroeconomics and both argon applied to fear abridgment and decision-making without delay or indirectly. Managerial economics comprises all those economic concepts, theories, and tools of analysis which can be used to analyze the origin environment and to find solutions to practical business problems. In different words, managerial economics is applied economics The beas of business issues to which economic theories can be applied may be broadly split into the following two categories Operational or Internal issues and Environmental or External issues Micro Economics Applied to Operational IssuesOperational problems are of essential nature. They arise within the business organization and evenfall within the perview and control of the management. Some of the important ones are preference of business and nature of product, i.e., what to produce Choice of the size of the firm, i.e., how much to produce Choice of te chnology, i.e., choosing the factor combination Choice of price, i.e. ,how to price the commodity How to promote sales, i.e., sales promotion measures How to face price tilt How to decide on new investment How to manage profit and neat How to manage inventory, i.e., stock of both finished goods and raw material The above mentioned issues fall within the ambit of micro economics therefore, the following constitute the scope of managerial economics Theory of demand Consumer behaviour- maximization of satisfaction Utility analysis Indifference curve analysis Demand analysis and elasticity of demand Demand forecasting and its techniques/methods Theory of production and production decisions Production function Inputs and getup relationship in short-run and long-run Cost and output relationship in short-run and long-run Economies and diseconomies of scale 7 Optimum size of firm and find out the size of firm. Deployment of resources labour and capital for having optimum c ombination of factors of production. Analysis of market structure and pricing theory Determination of price under different market conditions Price secretion Multiple pricing policy Advertising in competitive markets Different pricing policies and practices put on analysis and profit management Nature and types of profit Profit planning and policies Different theories of profit Theory of capital and investment decisions Cost of capital and return on capital-choice of investment projects Assessing the efficiency of capital Most cost-efficient allocation of capital Capital budgeting Macro Economics Applied to Business EnvironmentEnvironmental issues relate to general environment in which business operates. They are related to overall economic, social and political environment of the country. The following are the main ingredients of economic environment of a country The type of economic system- capitalist, collectivised or mixed economic system. General trends in produ ction, employment, income, prices, saving and investment. Volume, composition and direction of foreign trade. Structure of and trends in the working of financial institutions- Banks, NBFCs, insurance companies an other financial institutions. Trends in labour and capital market. Economic policies of the government- Fiscal policy, Monetary policy, EXIM- policy, Industrial policy, Price policy etc. Social factors- value system, property rights, usance and habits. Social organizations- Trade unions, consumer unions and consumer co-operatives and producers unions. Political environment is constituted of the following factors Political system-democratic, socialist, communist, authoritarian or any other type. States attitude towards occult sector Policy, role and working of public sector Political stability. The degree of openness of the preservation and the influence of MNCs on domestic markets- Integrations of nations economy with rest of the world (Policy of globalization) 8The environmental factors consecrate a far reaching influence on the functioning and performance of firm/s. Therefore, business managers have to consider thechanging economic, social and political environment before taking any decision. Managerial economics is however, concerned with only the economic environment and in particular with those which form the business climate. The study of social and political factors falls out of the perview of managerial economics. It should, however, be borne in mind that economic, social and political factors are inter-dependent and interactive. The environmental issues mentioned above fall within fourwalls of macro economics, therefore the following constitute the scope of managerial economics Issues related to Macro Variables General trends in economic activities of the country Investment climate Trends in output Trends in price level (state of inflation) Consumption level and its pattern Profitability in business expansion Issues relate d to Foreign Trade Trade relation with other countries Sector and firms dealing in exports and imports Exchange rate fluctuations Inflow and outflow of capital Trends in international trade- volume, composition, and direction Trends in international prices of various goods and services International monetary mechanism Rules, regulations and policies of WTO Issues related to Government Policies Regulation and control of economic activities of private sector business enterprises Enforcing the government rules and regulations for imposing of social responsibility Striking balance between firms objective of profit maximization and societys interest Policy and regulatory measure for reducing social costs in terms of environmental pollution, congestion and slums in cities, elemental amenities of life such as means of transportation and communication, water, electricity supply etc.

Real Madrid

1. What is the actually capital of Spain business model? Is it unique? The Real Madrid business model is unique as it changed 360 degrees the concept of sports. They focused on converting Real Madrid into the new Disney of sports..The club has been owned by its cardholding members and non-cardholding members. A network of fans has promoted the clubs name and ensured the flow of information. At first, by realizing that they can become content providers, Real Madrid aimed to be the best association football club in the world. As a matter of fact the Real Madrid brand was desired to turn into an international brand.In order to be able to achieve this, its managers identified the following brand drivers (1) size of auditory sense (2) frequency with which the audience engaged with the brand, as a measure of commitment (3) socio-demographic characteristics of the audience and (4) bridges (usually in the form of local fan associations) that could be built to link the brand and the audien ce. To get a large audience, passionate closely soccer required a commitment to good players, commercialization of the brand and distribution of content (players and games). Real Madrid needed time and financial flexibility, in order to bring the top players and a variety of channels to bring the clubs brand on the market.For financial flexibility, Real Madrid managed to do the rezoning of the clubs old training pitches, recapturing exploitation rights sold off to various operators and licensees, setting up a stand-alone legal entity for management purposes, receiving a loan from Caja Madrid and pursuing opportunities for licensing and sponsoring of its products. To assemble is team of winning players, Real Madrid drew superstars like Zidane, Beckham, Figo, Brazilian striker Ronaldo, team captain Spanish forward Ral, and Brazilian defender Roberto Carlos as well as goalkeeper Iker Casillas.The selling concept was that only the superstars can draw new superstars. In terms of brand a nd content, Real Madrid expanded the reach of its Real Madrid TV, developed RealMadrid.com and 1 on 1 fan relationships (mobile, TV, internet), and distributed its Real Madrid merchandise through its own stores and retail networks. In order to capitalize on its inner strengths, Real Madrid expanded to Asia and North America by gaining as much elasticity on their brand.2. Who are Real Madrids customers? How is the market segmented? The Real Madrids customer are its supportive fans, cardholding and non-cardholding members. They have a love relationship with Real Madrid as they support only the winners and care about their hobby needs. 3. Who has more superpower Real Madrid or the players?Real Madrid has an empowering brand power as they set up a leadership flag for quality soccer teams. The players pay for themselves, but as long as they dont have a leading brand to promote them, they wont initiate on popularity and increase their royalties. 4. What risks does Real Madrid face?Rea l Madrid cannot capture superstars overnight. The churn rate cannot be controlled. New wealthy investors offer high salaries to the superstars. Overexposure and excessive commercialization receives already enough criticism. Also in the end soccer is an uncertainty game.

New Jersey Legislature

The vernal Jersey legislative body is the branch of government seated in New Jersey c all down House at the treetopital in Trenton. The general assembly is bicameral, meaning that it consists of two houses. These houses argon called the General Assembly and the New Jersey Senate. The New Jersey ground Legislature and regulator has been running under a cloud of suspicion, corruption, graft and a Treasury that had spent the premiere half of this decade in debt. These problems seemed to shed alleviated a little since New Jerseys new governor, Jon Corzine, took office in January of 2006.He has non been the complete reason for the turnaround only when his common knowledge ideas concerning fiscal responsibility and personal sacrifice has led by example and the idea that ineffective government and the New Jersey deposit Legislature linked, is starting to fade. The study of my e pronounce legislative assembly reveals some important questions that need to be addressed and answered First, should the size of the legislature be increased or decreased?Second, Should the legislatures pay be raised and should the job be on a full time or part time basis? And lastly, should thither be term limits and does the legislature meet too often or too little? These questions raise many opinions as the citizens of New Jersey ar ready for their government to again work for them and their needs.The General Assembly is the lowest house of the legislature. It contains eighty members and its requirements to be among its body oneness must be at to the lowest degree twenty one years of age, have resides in the area for at least two years and must live in the regularise that it the member represents. The state of New Jersey is made up of forty districts. The members of the New Jersey Legislature are chosen by forty electoral districts, each district electing one member to the Senate and two members of the Assembly.Districts are redefined after each census. New Jerseys current d istrict map is establish upon the 2000 census. even up though New Jersey is a small state, it ranks 10th in tribe in the country and is one of the most highly population density in the country. The high concentration of districts is a good idea and is advantageous towards the attempt in a democracy, that all of its citizens voices may be heard. The amphetamine house which is what the Senate is referred to, is made up of forty members and the qualifications for its members is that each must be thirty years of age, must live in the state for at least four years as intimately as reside in the district that he/she is wanting to represent. preferences for the state of New Jersey are incomparable in the fact that they are held on odd-numbered years w here(predicate)as the majority of the states in the Union hold their elections on even numbered years. New Jersey is also comical in the fact that Senators serve four year terms except during the premiere two years of the decade. This 2-4-4 cycle was put into place so that the senate send away reflect the changes that the census has displayed if there was a significant change in the population density of one district over an separate. ( Wikipedia) The General Assembly is headed by the speaker, whereas the Senate is headed by the President.Each house is led by a majority and minority leaders, assistant leaders as well as what is referred to as whips. The Legislature is empowered to make new law, subject to the Governor of New Jerseys power to veto a bill. However, the veto may be overridden by the Legislature if there is a two-thirds majority in favor of overriding in each house. (Wikipedia) This is typical in most of the states constitutions as well as in the Federal governance. The Governor can veto a bill but if the legislature comes back with a 2/3 majority vote, then the Governors veto is made null and void.This is an essential aspect of a democracy That the final word in a decision, is left up non to a si ngle individual, but to the plurality as a whole. The Governors decisions can be overridden only by the majority will of the people. This aspect of New Jerseys Constitution should never be changes and if so, it would serve as an impediment to the democratic system here in New Jersey that we all enjoy and respect.However, one instance where this democratic ideal was not followed was in the 2006 shutdown of the New Jersey Legislature. Even though the shutdown was finally decided upon by Governor Corzine, it speaks to a larger ineptitude regarding the state legislature and its ability to continue working for its citizens. It was the first shutdown in the history of the state and it occurred when the Legislature and the Governor failed to agree on a state budget by the deadline set forth in the state Constitution. It began on July 1, 2006 and lasted until the 8th of July.All government services were not revived until July 10th. The background into this most recent failing by the state legislature helps to realize that the job of a member in the state legislature should be full time, there should definitely be term limits and the pay should catch ones breath constant as long as thousands of government workers were told that they were non essential and told to stay home for a week without pay.The shutdown was over different opinions concerning the states budget and the unchecked spending by Corzines predecessor despite the large debt that the state was suffering through. As a way to set an example, Governor Corzine, bypassed the $175,000 annual budget and took only a ceremonial $1 salary. The rest of the members should take note of this and should follow the Governors example.The New Jersey Constitution states under Article VIII that a states expenses for the year be provided for in a single budget act. (Star Ledger) The constitution also specifics a provision stating preventive measures against going into debt. A start to New Jerseys troubles was ignoring this so und advice. Governor Corzine, in an attempt to pass his budget, came into conflict with familiar Democrats within the General Assembly.The main point of contention was the Assemblys refusal to increase the state revenue from 6% to 7% in order to pick out the budget gap. Corzine stated that there was no other way in coming up with the money as the states constitution forbade other forms of revenue raising. Months before the shutdown, Corzine states that he would not accept a budget that did not include a tax increase and he stood firm in this conviction and the General Assembly did the same which eventually resulted in the shutdown.When the budget failed to pass, the shutdown occurred. This resulted in 45,000 workers being told that they were non essential and would have to stay home for an unfixed period of time. Some of these institutions included the casinos, the Motor Vehicle Commission and inspection stations as well as the New Jersey Department of statement to name a few.O ther shutdowns would include, state beaches, public parks, historic sites and horse racing. New Jersey did have enough sense however to keep prison, state police offices, hospitals and child welfare programs running. A sense of urgency prevailed across our state and an emergency July 4th session of the State Legislature was called. (state.nj.us)On July 6, 2006, elective factions within the General Assembly reached a compromise budget. That tentative budget proposed an increase in the state sales tax from 6% to 7%, which is estimated to hark back an additional $1.1 billion in revenue. The plan also included a requirement to use half of that for direct relief toward New Jerseys property tax highest of all states. The plan also called for the same dedicated purpose for all of the money raised by this sales tax increase in subsequent years. The new budget law includes a provision for a constitutional amendment which must, like all such amendments in the state, be approved in an Elect ion Day referendum, to be held on November 7, 2006. New Jersey voters approved this measure by a 2-1 margin statewide. ( wikipedia)On July 8Th, both houses of the legislature passed the proposed budget. At 6 a.m. that day, Corzine signed executive order ? 19 to restore government services.The fact that 1% of the sales tax was so bitterly fought over was in the forefront of the minds of the members of the legislature. most(prenominal) of them were up for reelection much sooner than the governor. Many of New Jersey citizens denounced the state legislature more than the governor and 71% of people polled said that they would not vote for their district representatives if they had voted for the sales tax rate hike.New Jersey voters clearly blame the state legislature for the budget crisis, and say the property-tax relief that the legislature insisted on in the compromise is more politics than real reform. Of those polled, 23% indicated that they will not vote for those representatives who voted for the sales-tax hike in the future. The state legislatures next election will be in November 2007, but Corzine does not face another election until 2009. (Star Ledger)From the above mentioned description about the most recent shutdown of New Jerseys state legislature, it is plain to see that the elected officials from my state are not doing what are the supposed to be doing. I think that the blame needs to be shared. The governor did gain points with me by bypassing the salary of the governor in order to help alleviate the financial problems of the state.I realize that he is already a millionaire but there are many governors and even members of the House and Senate of this country who have millions of dollars, yet such ideas of fiscal responsibility and egotism sacrifice to the smallest degree is not even considered. The governor did fight to raise the sales tax against the state legislature, who many of them fought against this occurring. But it was not the governor wh o created the volume in the first place but rather inherited it after his predecessor James McGreevy was forced to step down.I had always thought that the members of my state legislature were already out of touch with its constituents. One already has to me a person of financial means if they wish to even be able to bear up under to run. Many members of the state legislature are not there for the salary. They have alternate sources of income in different types of investments. Also, the campaign promises of the majority of the members of the State Legislature are saturated with promises of wanting to make a genuine difference in their home state. Let us put those promises to the test and put a cap on their current salaries.This is especially necessary when the states treasury is in as much trouble as it is and hard working people have to be told that they are non essential and lose out on a weeks worth of pay because its state legislatures do not know how to balance a budget until it is too late. Personal and state revenue was lost on many different levels due to the shutdown. And to say that because this was the first shutdown in our states history, it somehow is going to be the last is naive. It is naive as long as our state legislatures feel that ignoring a problem is the same as fixing it.As long as each state legislature does not treat this job as one of their top priorities in their life and that this is most certainly a full time job that demands their time, attention and respect for the members that he/she represents. A member of the state legislature should recognize these things and if he/she does not, then it is up to an informed public to exercise their precious right to vote and to make a change with that vote. As far as term limits are concerned, I would like each member of the state legislature realize that his job is not safe and is depended upon a stellar work record. However, do term limits limit the free speech of the representatives consti tuents?If a public figure is doing a job well done, then they should be rewarded with another two or four year term. This is definitely the case in The United States Congress. For that diamond in the ruff that has all of the above mentioned qualities and is in the State Legislature, I would not be against term limits except for the number of terms for a governor. That number should be set at three since a prolonged appointment to the highly responsible job of governor can only breed apathy. And a state legislature that does not seem to be in touch with their job responsibilities, can breed a much more dangerous apathy that of its citizensWORKS CITEDhttp//www.statelocalgov.net/state-nj.htmwww.wikipedia.comwww.njleg.state.nj.us/CNNs Larry tycoon Livewww.state.nj.us

Checks and Balances Essay

This essay will discuss the Constitutional principle of Checks and Balances. It will explain the concept and effectiveness of the separation of causation. As an example, the episode of embrown v. The Board of Education will be used to explain the concept and effectiveness of the separation of power. Brown v. The Board of Education is a famous subject that ended segregation in schools in 1954 during the Civil Rights Movement. First, lets start with what the definition of Checks and Balances is as it pertains to the Constitution.The definition according to Merriam-Webster is a form that allows each beginning of a governing body to amend or veto acts of another branch so as to prevent any one branch from exerting too much power. . The legislative power is vested in the Congress, the executive power rests with the electric chair and the judicial power is granted to the lordly Court and other federal courts. Each branch of government has separate and particular powers as listed i n the Constitution, each branch is also given the power, duty and ability to control and end the other(s) in a system of checks and balances.The Constitution grants all legislative power to the Congress. The Congress is bicameral and a bill has to pass both houses the House of Representatives and the Senate. In this way the houses check and balance each other. Both the executive and the judicial branch check and balance the Congress legislative power. Although only the Congress can make justnesss, the President has the power to veto bills, in which case the bill can only pass with a 2/3 majority in both houses.Finally, if the Congress and the President agree on a law, the Supreme Court has the power of interpreting the laws and a power of review, i. . the Supreme Court can declare a law unconstitutional and therefore void. As chief administrator the President is required to see that laws are carried out, to enforce existing politics and to managing the bureaucracy. The president n ominates the heads of the executive branchs departments, but these appointments are subject to the Congress approval. The constitution makes the president and Congress share powers in matters such as foreign policy and the US armed forces.In the case of Brown v.The Board of Education, the legal defense of Oliver L. Brown utterd, the discriminatory nature of racial segregation violates the 14th amendment to the U. S. Constitution, which guarantees all citizens pair protection of the laws,. Because of this Brown v. The Board of Education laid the foundation for shaping future national and international policies regarding human rights. At the time, the state of Kansas had segregated schools, meaning that mordant and white small fryren could not go to school at the same place.At the end of the case, Brown and his legal defense had argued that it was not fair to the children because they may or may not get the best education if they were segregated. The United States Supreme Court ruled that no state should segregate any child in public schools. White and Black children would go to school together and be offered the same rights. Anything less would be unconstitutional. This is a perfect example of how the state legislature was overturned by the Supreme Court and they were able to keep a check and balance on each other.The state of Kansas did not gather in a law stating that the schools must be segregated, but they also did not have a law saying that they couldnt be segregated. The Browns first took their case to the state in 1951. After the case was dismissed, Brown and four other lawsuits made an appeal to the United States Supreme Court were the state ruling was overruled. The Supreme Court had checked and agreed that it was a violation of the Constitution to segregate schools. To this day, a public school can not discriminate against any child, black or white, male or female, smart or special ed.The decision made by the Supreme Court was a unanimous ruli ng that was issued on May 17, 1954. At that time Chief Justice Earl Warren wrote that segregated schools are not equal and cannot be made equal, and hence they are deprive of the equal protection of the laws. He continued, We conclude that in the field of public education the doctrine of separate but equal has no place. . Thank good for checks and balances, without them, the country would be a much different place to live.

Critical Care Sound Environments Health And Social Care Essay

ABSTRACT. In hug drugsive forethought building blocks in infirmaries take worry of full of lifely dingy longanimouss under re every(prenominal)y nerve-racking conditions. A turning literature is demoing that intensive heed wholes ( intensive do by whole of measurements ) atomic number 18 a great deal re sepa regulately(prenominal)y noisy and frequently transcending World Health institution ( WHO ) guidelines1,2. yet few surveies take cogitate more than elabo stride analyses of the vowelise environment, such as cockeyed well force per unit force field items, transient proceed full points, and apparitional distri unlession, to defend well-being and man monstrance. This resume dissents from old surveies in several(prenominal) ways. Namely, we have examine the possible dissemble of layout figure of speech maskings on the features of intensive c atomic number 18 unit safe environments. This was accomplished by chamberpotnistervass the infixed and o bjective qualities of ii intensive c are unit go environments with distinct layout designs. Furthermore, the survey included 1 ) detailed non inwrought and subjective perturbation degree measurings at multiple locations in individually of the rudimentary units studied, and 2 ) digest of the association among the aim and subjective illegitimate enterprise degrees via divers(prenominal) statistical trials, including analytic thinking of the regard of the intensive care unit plump environments on sensationd reserve results.I. IntroductionThe extend environments of ICUs are aurally demanding plot defends endeavor to put to death complex undertakings. It hence becomes of import to understand the bankable and unacceptable subjective and nonsubjective qualities of the ICU backbreaking environments from the keeps point of position. In this survey, we believe shelters perceptual experience of their pull inplace full environment is unfavourable for the rating of un dertaking and maintain well-being supportive ICU sound environments. By gybeing the subjective perceptual experience measurings with nonsubjective sound degree measurings, we scum bag derive a more thorough appreciation of how visible and perceptual acoustical parametric quantities interact in the ICU scene. In order to cast visible radiation on these concerns, we focused on the undermenti unrivaledd explore inquiries in this comparative enquiry survey 1 ) Do nonsubjective commotion degrees differ ( a ) in the mid(prenominal)st of assorted locations within an case-by-case critical attendance unit? ( B ) when comparing standardised locations in the devilwn(prenominal) critical assist units to each early(a)? ( degree Celsius ) when comparing boilersuit ( symbolize ) degrees in the two critical attention units to each opposite? 2 ) Do deems hoo-ha-induced wrath and mass perceptual experience differ ( a ) amidst assorted locations within an single critical atten tion unit? ( B ) when comparing similar locations in the two critical attention units to each other? 3 ) Does the sense impact of overall racket degrees in the impartplace on subjective sustain wellbeing and cash in ones chips public presentation differ when comparing two units to each other? 4 ) Is there a sexual intercourseship amongst aim and subjective noise degrees? 5 ) Is there a relationship amidst noise degrees and noise-induced nurse results?II. PREVIOUS RESEARCHA. Overview of Hospital Acousticss1. ResultsThe acoustic environment in infirmaries prat impact all residents, including stave, diligent ofs, and visitants. The undermentioned treatment in relation to the focal point of this survey is for the most part limited to the effects of noise on staff members emphasis and indignation crop public presentation wellness results and graze overload. Information roughly how hospital acoustics may impact forbearings and visitants give the axe be give in begi nnings such as Bush-Vishniac et Al. 2 and Ryherd et al.3. The staff s well-being, efficiency and effectivity in presenting attention and executing critical undertakings is critical to maximise unhurried safety, satisfaction, and attention quality in ICUs. Stress-annoyance Intensive care unit are nerve-racking attention scenes that can be exacerbated by the centripetal overload caused by environmental factors, including the acoustic environment. Stress is the person s assessment of a mismatch among perceive demand and comprehend self-capabilities to get by 4. Depending on the badness and length, it may take to illness ( i.e. , uplifted blood force per unit area, dyspepsia ) , behavioural alterations ( i.e, unhappiness, depression, shun attitudes ) . Anxiety is a psychological answers to environmental stimulations or activity bring forthing rousing 5. Excessive anxiousness degrees can take to upsets. Like anxiousness, irritation is one of the early psychological responses whi ch reflects the unwantedness of the environment stimuli 6. Irritation relates to the invasion of a stimulation on a mental or physical activity.In one survey, higher(prenominal)(prenominal) bastardly sound force per unit area degrees predicted higher sensed emphasis, and sensed irritation degrees in a Pediatric-ICU 7. In another survey, little sensitiveness to resound and greater personality robustness ( such as committedness, control, and challenge ) were linked with less(prenominal) noise-induced emphasis 8. In the same survey, ICUs nurses on the job(p) eight-hour eventide displacements describe that they were significantly distressed by noise. in that respect is approximately(prenominal)(prenominal) grounds that high noise degrees in attention scenes contribute to staff emphasis and irritation. However, the examine of noise-induced nurse emphasis surveies conducted in the ICUs is really limited. Work public presentation Hospital sound environments that are supportive o f infirmary undertakings could potentially better staff effectivity in presenting attention. Improved nurse work public presentation in ICUs can forestall inauspicious events, better health care quality, and optimise resource use. The survey found that noise in the workplace was perceive to hold a negative impact on staff work public presentation and concentration 3. A Neonatal-ICU survey showed that sound that exceeds 55dBA most of the rationalise can potentially come in with work. This multidisciplinary literature reappraisal survey highlighted that undertakings necessitating rapid reception coiffure and watchfulness are sensitive to resound. Noise-induced work public presentation research has been more ordinarily conducted in the operating theatres 9-11. The impact of noise on staff public presentation ( curiously in ICUs ) has non been astray examined. Health results The acoustic environment throughout the infirmary may give to negative acute accent or chronic symptom s in staff. Critical attention nursing is a really demanding occupation and it requires constant watchfulness, watchfulness, and wellbeing to carry on critical undertakings efficaciously. The survey found that of the 47 ICU nurses surveyed in an ICU, reported annoyance, weariness and concerns delinquent to workplace noise 3. The earlier mentioned survey besides showed that addition in mean sound degrees was significantly tie in to an addition in bosom pace 7. Elevated bosom come out can tie in with cardiovascular harm particularly in hypertensive persons 12. Noise-induced hearing issue has been the concern for executing sawboness in the operating theatres 13,14. However, noise-induced wellness results ( including hearing loss ) of ICU nurses have non to that extent been the focal point of hospital noise literature. Work overload Work overload can be critically of import for overall wellbeing of staff. Poor acoustical conditions in workplaces can worsen staff attitude and perce ived work overload. When noise degrees exceed a nurse s get bying abilities it can take to centripetal overload 6. Centripetal overload can do wound up exhaustion, dissatisfaction, and decreased sense of personal achievement. This in bend can do feelings of ineffectualness, awkwardness, low satisfaction, and perceived deficiency of success 15. In one survey, it was found that medicine mistake and other inauspicious events necessary for long-suffering safety were associated with emotional exhaustion and staff burnout 16. In another survey it was besides found that nurse emphasis due to ICU noise was positively related to nurse emotional exhaustion and burnout17. Hagerman et Al. showed that in a coronary thrombosis bosom unit enhanced acoustical conditions such as decreased echo snip off and change address intelligibility improved staff attitude perceived by long-sufferings 18. The limited bing grounds points to a Copernican job that should be investigated farther to find appro priate acoustic conditions that will minimise negative work overload effects.2. Acoustic prosodiesThere is a turning organic structure of literature on infirmary noise. umpteen of those surveies focus on qualifying overall noise degrees in a assortment of hospital infinites including ICU s, but few of them focuses specifically on ICU staff response 3. A assortment of contrastive methods have been used in qualifying the infirmary sound environment. The grounds of these methodological analysis deflexions are non costly known 3 but may be related to motivations such as single penchants, practicality, communal sense, convenience, the degree of near expertness, etc. ( 1 ) Overall noise degree locomote These whole steps have been preferred most normally. This may be establish on their practicality and convenience, in add-on to their internalization into assorted guidelines such as WHO. Leq, Lmin, Lmax and Lpeak sound degrees can supply a general overview of the sound environment, but they remain limited for the fatten up analysis of the sound environment. ( a ) Leq It enables the speedy comparing of the noise degrees with recommended value and those in other types of infinites. Therefore, it might be widely accepted as to be the primary step to depict a sound environment. This might besides happen in relation to the degree of proficient expertness required to show approximately cleverness about more elaborate features of the sound environment. However, this common belief can be misdirecting about the truth and adequateness of the practice of captainly Leq degrees. ( B ) Lmax, Lpeak and Lmin The highest and the net values measured over clip provide more information about the overall noise degree fluctuations. In most object lessons, these steps are schematicly used to depict infirmary sound environments. However, these values remain unidimensional and level to depict the general tendency in sound environment. ( 2 ) Detailed noise degree steps To count erbalance the restrictions of the overall sound steps, the usage of peculiar(a) acoustic prosodies is critical for the elaborate analysis of the sound environment. Compared to above mentioned sound steps, Ln percentile ( Ln ) , echo clip ( RT ) , name and address intelligibility ( SI ) , and the spectral content such as frequence analysis and noise standards steps have been less normally used. Hospital acoustic research has been the involvement of different research groups such as medical groups and proficient groups. establish on the group s proficient expertness on the subject, some acoustic prosodies might hold been preferred to the others. ( a ) earpiece quality related steps In the ICUs, there is diverseness of noise beginnings such as dismaies, HVAC remainss, conversation and medical equipment. Those noise beginnings generate noises with different frequences and sound forms. Ln percentiles and spectral content analysis become of import for elaborate analysis of fluctuation s, tonic content, spectral distribution, and other features in the noise degrees over clip. ( B ) Speech quality related steps almost other specific features of the infirmary room acoustic environment have been descri fuck with the usage of extra acoustic prosodies such as SI and RT. To construe the intervention of the infirmary noise degrees and room conditions with critical medical communications, SI has been used. To stand for the degree of drawn-out being of noises that can perchance overlap and interfere or dissemble the other sounds, RT has been used.3. Measuring ICU sound environmentsMethods applied during the sound sample aggregations can hold significant impact on the appraisal of the infirmary sound environments. There has non been a widely accepted understanding about how the sound samples should be collected to qualify the complex and dynamic ICU sound environments in close propinquity to occupant experience 3. However there has been some consensus on a few methodologi cal considerations among different ICU-noise surveies such as locations where sound informations collected in the attention scenes. Noise degrees in the ICU patient suites have been normally documented. Sound recordings took topographic point both in a representative patient room 3,19,20 or in more than one patient room with different characteristics such as quad to the nurse come out, occupied- empty-bellied, figure of patient beds 2,7,21-28. There was a good understanding on the location of the sound metre every bit near as possible to patient caput to capture what the patient hears- opus avoiding each intervention with nurse work flow. Hanging the mike from the top of the medical tower in the patient room has been introduced as a practical solution 3. Different continuances were preferred for the aggregation of sound samples such as 168hr, 72hr, 24hr, and 8hr at patient locations. Among those, 24hr entering period was more widely accepted than others. A few ICU-noise surve ies have conducted different continuance noise degree measurings at the nurse Stationss such as 24hr and 168hr 2,26,27. Busch-Vishniac et Al. described the sound environment of one more puting hallways- in their survey and placed the metre at the room centre 2. Largely the merchandises of two companies have been preferred to mensurate sound degrees Larson Davis and Bruel & A Kj?r. It was non a common attack to document the sound metre scenes used. Much of the noise degree measurings were conducted based on slow response clip ( 1sec ) as suggested by Occupational Safety and Health ( OSHA ) for typical occupational noise measurings 2,28,29. Some surveies used riotous response clip ( 0.125sec ) as suggested by WHO 3,21. When recorded based on fast response clip, more fluctuations can be expected in the sound degrees. The penchants among averaging musical intervals varied and ranged amongst 5sec and 24hr ( i.e. 30sec, 1min, 5minaetc. ) . Among ICU-noise surveies the usage of 1min av eraging interval was more common likely because it enables a more elaborate expression to the clip history informations. Sound recordings were normally analyzed as a map of clip. Day clip and dark clip mean sound degrees were normally reported. Among the reviewed ICU-noise surveies, non many of them were conducted during the weekends but during the weekdays. Morrison et Al. and Ryherd et Al. considered twenty- quadruple hours and dark clip based on 12s hr nurse displacements ( twenty- quaternity hours time7am-7pm dark clip 7pm-7am ) 3,7. MacKenzie and Galbrun considered the twenty-four hours and dark clip periods based on WHO guidelines ( 16hour twenty-four hours time7am-11pm 8hr dark time11pm-7am ) 21. In drumhead, consistence of the methodological penchants in infirmary acoustics research can be really helpful for the dependability of the comparings betwixt the consequences of different surveies.III. METHODOLOGYPutingThe research was conducted in two intensive attention units ( ICU ) at Emory University Hospital. Neurological ICU ( Neuro-ICU ) is a late opened 20- bed unit ( Fig. 2 ) . This unit received the ICU Design Citation award in 2008 for its design purpose to heighten the critical attention environment for patients, dwelling houses and clinicians. Some unit design features include oversized private patient suites with household studio, distrusted nurse work countries and care support countries and a scope of noise cut downing applications. High public presentation absorbent acoustic crown tiles and bead ceiling applications reside old-timertainly along the two parallel sides of the corridors and at the nurse Stationss, painted dry wall, vinyl flooring and 6ft bountiful ( two-wing ) glass patient room doors are some of the surface applications in the unit. patient attention pith of the Neuro-ICU sits about on 19,000sqft. This nursing floor has a bunch type layout. The layout is comprise of a six- bed and fourteen- bed bunchs. Each bunch has a cardinal nurse station with its ain attention support countries ( e.g. medicine room, supply roomaetc ) and computerized patient monitoring system. In entire, the unit has two cardinal nurse Stationss and 17 distributed nurse work countries. well-nigh one-third of the 390sqft patient room is segregated from the patient attention country by a semi-opaque glass wall and good equipped for household demands. Approximately one-third of the patient attention nucleus floor country is occupied by the corridors. The length of the corridors is 600ft. consummate Neuro-ICU includes extra infinites such as public household countries, CT scan lab, and a curative garden. With all these infinites, the entire Neuro-ICU sits about on 24,000sqft.The medical exam Surgical ICU ( MedSurg-ICU ) is a 1980s epoch twenty-bed unit ( Fig. 1 ) . Compared to the other unit, MedSurg-ICU has a more traditional physical environment with ceiling tile, vinyl flooring, 5ft broad ( two-wing ) glass patient do or and painted dry wall surface applications. Patient attention nucleus of this unit sits about on 8,800sqft. The nursing floor has a triangular form race channel layout design medical and support countries are set in the centre and patient suites are located on the margin and the corridor separates these two infinite types. Twenty private patient suites are organized around one big triangular form service hub. This hub contains two patient monitoring cores each serves to ten patients- at the corners and a centralised attention support country. Patient suites in this unit are about 190sqft and equipped with a Television like the patient suites in the other unit. This peculiar layout type requires the usage of unintegrated corridors for staff and household members. Approximately, one-quarter of the patient attention nucleus floor country is occupied by the staff corridor. The length of the staff corridor is 240ft. Entire MedSurg ICU including the household corridor environing the unit, sits about on 12,500sqft.In line to the physical environment differences, both units apply similar staffing theoretical accounts with intensivists and nurse practicians and suit critical attention patients with similar sharp-sightedness degrees. In both units, by and large ten to twelve registered nurses are working during each displacement. The Neuro-ICU nurses largely work 12-hr displacements ( 7am-7pm, 7pm-7am ) the MedSurg-ICU nurses besides work 8-hr displacements ( 7am-3pm, 3pm-11pm, and 11pm-7am ) . In both units, nurses can work each at the weekend or during the weekdays or both during the twenty-four hours clip or dark clip or both.Measures1. SoundObjective and subjective noise degree measurings in two units were conducted during two back-to-back months. In both units, same processs were applied. Objective noise degree measurings were conducted at four different locations in each unit centralised nurse station, empty patient room, occupied patient suites with and without respiratory ventilator and multiple informations points in the corridors. A sum of 96-hr uninterrupted unmoving noise degree measuring was conducted at the nurse station of each unit from Thursday to Monday. Saturday and Sunday was deliberately included as it has non been much addressed in the literature. In each unit, 24-hr uninterrupted stationary sound degree measurings were conducted in the occupied patient suites without respiratory ventilator during a weekday. In relation to limited entree, merely 45-min sound samples were collected from the occupied patient suites with respiratory ventilator. Similarly in each unit, 45-min uninterrupted stationary sound degree measuring was conducted an empty patient room while patient room doors were closed. At the corridors, multiple 15-min sound samples were collected at indiscriminately selected times during twenty-four hours and dark. In entire, about 246-hr sound informations was collected from both units. For the numeration of overall noise degrees in each unit, all sound informations collected at different locations were taken into consideration. Medical equipment dismaies casualty in the patient suites, patient proctor dismaies calamity both in the patient suites and at the nurse Stationss, sound of the ice machine engine, phone ring, staff conversation, turn overing medical carts in the corridors were some of the common noises in two units. In MedSurg-ICU nurses are paged via smasher beepers. In Neuro-ICU 3G-phones or regular phones at the baies are used alternatively.At the corridors, the mike was located at a tallness of 4.5ft somewhat bump off the room centre and stabilized on a tripod. In the patient room, the mike was hanged from the ceiling at a tallness of 6ft. The outdo amidst the patient s caput and the mike was minimized every bit much as possible. Similarly, mike was hanged from the ceiling at the nurse station at a tallness of 6ft. In Neuro-ICU, the sound metre was set up at the nu rse station of fourteen-bed side. In MedSurg-ICU, sound metre was located at somewhat off the centre of the cardinal nurse work zone in the centre of the unit. Sound information was collected utilizing a fast response clip for upper limit and lower limit degrees ( 0.125 s ) as recommended by World Health Organization ( Berglund and Lindvall 1999 ) . Three Larson Davis-type 824 sound degree metres were used and collected informations was downloaded via Larson Davis 824 Utility package. For unattended field measurings, two Lockable Larson Davis outdoor(prenominal) measurement instances were used. . For safety intents, 50ft mike extension overseas telegram was run from each outdoor sound metre instance to the walls and eventually to the mark point on the ceiling. The out-of-door noise measuring instance was placed carefully at a topographic point out of the nurse manner. Before any installing effort, proposed locations for the arrangement of sound metre at different locations in the u nits were approved by the invest nurse. One-minute averaging interval was used. One-third octave set informations was obtained. The dynamic scope was 80dB un-weighted from floor-38dB to overload-118dB.2. Self-reportAn electronic study was administered to 90 and 60 five registered nurses working in Neuro-ICU and MedSurg-ICU severally. Nurses were contacted via electronic mail by the nurse pedagogue of each unit and they gave their consents online. The study consisted of four subdivisions nurse profile and working conditions, perceived sound environment in the workplace, perceived impact of noise degrees on nurse results, general hearing wellness and noise sensitiveness. Survey response rate was 39 % and 35 % in Neuro-ICU and MedSurg-ICU severally. In Neuro-ICU, 85 % of the nurses participated in the survey was full clip and 15 % was portion clip nurses. In MedSurg-ICU, 70 % of the nurses participated in the survey was full clip 26 % was portion clip and the remainder was PRN. In tw o units more than 80 % of the nurse population was female. Similarly, in both units more than 80 % of the nurses were younger than fifty old ages old.IV. ResultA. Objective noise degrees1. Make nonsubjective noise degrees differ when comparing overall ( mean ) degrees in the two critical attention units to each other?Noise degrees measured at multiple different locations in each unit are averaged for the computation overall noise degrees including Leq ( assumed name ) , Lmax ( dubnium ) , Lpeak ( dBC ) and Lmin ( dubnium ) . Those locations are nurse station empty patient room, corridors and occupied patient suites with and without the respiratory ventilator. To clear up, in order to spread out the sample size, measurings conducted in the occupied patient room with ventilator were besides considered in the computation of overall noise degrees for each unit. In MedSurg ICU and Neuro-ICU overall averaged Leq, LMax, LMin and LPeak noise degrees ranged betwixt 57-58dBA, 105-97dB, 57.5- 54dB, and 120-113dBC severally. Detailed consequences are shown in Fig. 2. For elucidation intents, in this paper the term averaged does non reflect the calculation methods used but refers to the consideration of multiple measurings in the computation of individual noise degree. More elaborate analysis consequences are shown in Fig. 3. This chart represents the per centum of clip that different degree capricious sounds ( LFMax ) in the scenes exceeded peculiar noise degrees. This type analysis consequences are referred as possibility rate in this paper. In both units more than 98 % of the clip LMax noise degrees exceeded 70dB. It was more than 96 % of clip that LPeak noise degrees exceeded 80dBC in both units. Finally, it is possible to reason, the difference between overall averaged LAeq degrees in Neuro-ICU and MedSurg ICU are unperceivable. Information about perceptual experience of alteration in sound intensivity can be found in Mehta et al 30. However elaborate noise degr ee measurings indicated significant differences. The sound environments of two units are different based on the happening rate of the impulse sounds at high noise degrees.2. Make nonsubjective noise degrees differ when comparing similar locations in the two critical attention units to each other?A-weighted mean sound force per unit area degrees ranged between 52-60dB and 45-56 dubnium at four different locations in MedSurg-ICU and Neuro-ICU severally ( Fig. 4 ) . Those four locations were nurse station, occupied patient room without respiratory ventilator, empty patient room and the corridor. In both units, patients with respiratory failure are connected to respiratory ventilator and most of those patients are under isolation which restricts the entries and activities in the patient suites. It was possible to carry on comprehensive measurings in the patient room without respiratory ventilator. Therefore, measurings conducted in the occupied patient room without respiratory ventilato r was considered for location particular more elaborate noise degree analysis. At all four locations, LMax degrees exceeded 70dB about full clip in both units. Except empty patient room, at all other locations LMax noise degrees exceeded 80dB more than 36 % of the clip In MedSurg ICU and 11 % of the clip in Neuro-ICU. In general, noise degrees and happening rate of high degree impulse sounds was higher in MedSurg-ICU. bonnie sound force per unit area degree ( LAeq ) differences between nurse Stationss, occupied patient suites and the corridors of two units were either unperceivable or merely perceptible ( Fig. 4 ) . However LAeq noise degree difference between two units empty patient suites was significant. LMax happening rates were dramatically different from each at other locations. Happening rates occurred at the nurse Stationss are shown in Fig. 5 as an illustration. However LMax happening rates did non differ dramatically in the empty patient suites ( Fig. 6 ) . LPeak happenin g rate analysis showed really similar consequences to LMax happening rate consequences.3. Make nonsubjective noise degrees differ between assorted locations within an single critical attention unit?In MedSurg-ICU and Neuro-ICU, overall noise degrees and happening rates of impulse sounds was much lower in the empty patient suites compared to other locations ( give in I ) . Occurrence rate of LPeak & gt 90dBC was systematically higher at the nurse station compared to other locations in both units. However, noise degree differences between nurse station and other locations were non ever perceptible based on differences between A-weighted Leq degrees.B. Subjective noise degrees1. Make nurses noise-induced irritation and flashiness perceptual experience differ between assorted locations within an single critical attention unit?In MedSurg-ICU, perceived garishness degrees at the nurse station were significantly higher ( p & lt 0.05 higher ) than other three locations harmonizing to n onparametric conditional relation trial consequences. Average degrees of subjective irritation and pile are shown in Table II. Similarly, in Neuro-ICU perceived volume and irritation degrees in the empty patient room were significantly less ( P & lt .05 ) than other three locations.2. Make nurses noise-induced irritation and showyness perceptual experience differ when comparing similar locations in the two critical attention units to each other?At all four locations the nurse station, in the empty and occupied patient room and at the corridors perceived irritation and volume degrees of MedSurg-ICU nurses were systematically higher than the sensed degrees reported by Neuro-ICU nurses ( Table II ) . MedSurg ICU nurses perceptual experience of noise-induced irritation and volume at four locations ranged between 2.25 and 4.1.Same sensed degrees ranged between 1.6 and 3.2 among Neuro-ICU nurses. Additionally, nonparametric Mann-Whitney U trial consequences showed that noise-induced irritation and loudness perceptual experiences of nurses at the nurse Stationss and in the empty patient suites was significantly different in two units. Two unit nurses sensitiveness to resound and tolerance to high noise degrees in the workplace did non differ significantly ( p & gt .05 ) . Overall, nurses were non really sensitive to resound and they could digest high noise degrees slightly.3. Does the sensed impact of overall noise degrees in the workplace on subjective nurse wellbeing and work public presentation differ when comparing two units to each other?APerceived negative impact of workplace noise degree on five nurse result was reported higher by MedSurg-ICU nurses compared to Neuro-ICU nurses. MedSurg-ICU and Neuro-ICU nurses responses ranged between 3-4.3 and 1.7-3 severally ( Table III ) . Overall, MedSurg-ICU sound environment was perceived systematically worse for nurse well-being and work public presentation compared to Neuro-ICU sound environment. Harmonizing to nonparametric significance trial consequences, all perceived five noise-induced nurse results differed significantly in two units.C. Correlations1. Is at that place a relationship between aim and subjective noise degrees?Spearman nonparametric correlativity trial was used to analyse the relationship between aim and subjective noise degrees. Overall and individually analyzed MedSurg-ICU and Neuro-ICU subjective and nonsubjective noise degrees systematically represent the being of a important relationship between subjective and nonsubjective noise degrees ( Table IV ) . Subjective noise-induced irritation and volume degrees are significantly and positively correlated with A-weighted mean sound force per unit area degrees and happening rate of impulse sounds happening at high degrees.2. Is at that place a relationship between noise degrees and noise-induced nurse results?Overall, subjective volume degrees are significantly and positively correlated with sensed noise-induced irritation, work public presentation, wellness and anxiousness ( p & lt .01 ) .D. Spectral content1. relative frequency distribution of noise degreesOverall, sound force per unit area degrees were higher in MedSurg-ICU at low, mid and high frequence scopes ( 250Hz-8kHz ) ( Fig. 7 ) . At all locations but empty patient room, noise degree differences across frequences were largely either merely perceptible or unperceivable. At 8kHz intelligibly obtrusive noise degree differences occurred between two unit nurse Stationss and occupied patient suites. At 250Hz and 500Hz, clearly noticeable and significant noise degree differences occurred between empty patient suites. Below 250Hz, sound force per unit area degrees were largely higher in Neuro-ICU ( Fig. 8 ) . In the empty and occupied patient room, noise degree differences at 16Hz were significant otherwise it was either merely perceptible or clearly noticeable. This happening might be related with the busyness noise generated by the HVAC engine located in the opened infinite in Neuro-ICU. This unfastened infinite about located in the centre of the unit and is non loving by the residents but included in the design to supply natural visible radiation for some patient suites.2. Room Criteria ( RC ) analysisIn MedSurg-ICU, RC values were higher. However, RC evaluations were largely hissy and vibrational in Neuro-ICU while it was chiefly impersonal and non vibrational in MedSurg-ICU ( Table V ) .E. Fluctuation clipF. Speech Interference LevelIn general, speech intervention degrees in MedSurg-ICU were higher at all four locations analyzed compared to Neuro-ICU. At the nurse Stationss, address intervention degrees ( SIL ) of the noise were highest and ranged between 50-53dB ( Table VI ) . Two female nurses will be able to ( hardly ) communicate with each other in normal voice up to a distance of about 3-4ft. Same distance ranged between 5.5-7.5ft if nurses raise their voices. Slightly lower SIL values occurred in the occupied patient room and in the corridors. Lower SIL degrees can enable safer communications from longer distances. Furthermore, compared to females, males in general are able to brighten on better at longer distances.G. HVAC background noise degreesBackground noise degrees caused by HVAC systems were calculated based on solid 15-min sound samples collected in the empty patient suites. Sound force per unit area degrees across three frequences ( 500Hz, 1000Hz, 2000Hz ) were averaged every minute. In Neuro-ICU, HVAC noise degrees in the patient room were acceptable harmonizing to American Society of Heating Refrigerating and Air-Conditioning Engineers ( ASHRAE ) recommended RC values, 25-35dB in the private suites 31. In Neuro-ICU, RC values ranged between 29-31dB. In MedSurg-ICU HVAC noise degrees in the patient room were higher than ASHRAE recommended values and ranged between 37-38dB in MedSurg-ICU.V. DISCUSSIONOne of the purposes of this survey is to fetch to the on-going attempts to b etter health care sound environments. These attempts can enable more comprehensive analysis of haphazardly health care sound environments. The survey findings discussed in this subdivision can supply some penetration for the appraisal of the bing and development of intelligence acoustic prosodies that might be necessary for more elaborate survey of the infirmary sound environments.1. Appraisal of overall ( mean ) vs. elaborate noise degree steps and their relation to subjective noise degreesOverall nonsubjective sound environment of two units were significantly different based on elaborate noise degree measurings. Happening rate analysis is referred as elaborate noise degree measuring as it reflects the behaviour of impulse sounds during every minute. Statistically important differences between subjective noise-induced nurse results and loudness perceptual experience of MedSurg-ICU and Neuro-ICU nurses were consistent with the important differences between happening rates of impuls e sounds ( LFMax, LCPeak ) that occurred at high degrees. Furthermore, nonparametric correlativity coefficient trial consequences indicated the being of a important and positive relationship between perceived irritation and volume degrees and happening rates of impulse sounds. However, overall noise degree measurings ( i.e LFMax, LCPeak, LFMin, LAeq ) particularly overall mean sound force per unit area degree did non bespeak perceptible differences between the sound environment of two units. Similarly, elaborate nonsubjective noise degree measurings besides suggested important differences when comparing similar unprompted sound environments ( i.e. nurse station, occupied patient room and corridors ) in two units. opposed detailed measurement consequences, overall mean sound force per unit area degree differences indicated either merely perceptible or unperceivable differences between similar locations in two units.2. Appraisal of stationary vs. unprompted sound environments and the ir relation to subjective noise degreesLocation specific subjective noise degree analysis ( i.e. perceived noise degrees at the nurse Stationss, in the empty and occupied patient suites and corridors ) indicated that MedSurg-ICU nurses noise-induced irritation and loudness perceptual experiences were systematically higher than Neuro-ICU nurses perceptual experiences. Particularly, subjective irritation and volume degrees differed significantly at the nurse Stationss and in the empty patient suites of two units. Nurse Stationss have unprompted sound environments where major sound beginnings are medical dismaies, telephone ring, staff laugh and talkaetc. Subjective noise degree differences between two unit nurse Stationss were consistent with important differences between happening rates of impulse sounds ( LFMax, LCPeak ) at the nurse Stationss. Unlike nurse Stationss, doors closed empty patient suites have stationary sound environments where chief noise beginning was the HVAC system . This clip, subjective differences between two unit empty patient suites were consistent with important differences between A-weighted mean sound force per unit area degrees measured in the empty patient suites. Furthermore, nonparametric correlativity coefficient trial consequences indicated the being of a important and positive relationship between perceived irritation and volume degrees and mean sound force per unit area degrees.3. Fluctuation clip and subjective noise degrees4. Features of infirmary sound environments and layout design applicationsAbove mentioned consequences confirms the earlier findings that suggest the being of a relationship between aim and subjective noise degrees. The theoretical account reviewed here suggests that different infirmary layout design applications can chair the relationship between aim and subjective noise degrees. Two unit nurses reported sensed effectivity of different layout design applications to cut down noise degrees based on their exp eriences and observations. Overall, three chief layout design applications were found effectual. Those were private patient suites, segregated corridor system and a unit with baies and centralised nurse station instead than a unit with merely centralised nurse station32. Private patient suites can diminish sensed complexness of the patient room sound environment as there are less noise beginnings in single-bed suites than multi-bed suites. In MedSurg-ICU, cardinal nurse station is a common-use workplace and at most times it is extremely populated by nurses for coaction, single work and telecommunication intents. Higher patient bend over rates ( new admittances and conveyances ) in MedSurg-ICU besides requires extra paper work to be done at the nurse station. In Neuro-ICU, nurses largely collaborate, work separately and telecommunicate at the de-central nurse Stationss. They visit the centralised nurse station for registering patient medical records, utilizing common resources such a s copy-fax machine. separationism of corridors used by household members and staff members can command riotous breaks by household members. On the other manus, household members can get down a insouciant conversation with staff members anytime while voyaging in the shared corridors. One of the chief noise beginnings in the health care scenes are conversations. Based on researchers observation, the physical distance between the nurse Stationss or patient monitoring nucleuss can lend to the sensed frequence of the unprompted noise happenings. In this survey noise degree and happening rate of impulse sounds found to be critical for nurses volume and irritation perceptual experience. In MedSurg-ICU, physical distance between two patient monitoring nucleuss ( from centre to centre ) was 48ft. In Neuro-ICU, same distance between two centralised nurse Stationss was 118ft. Distribution of noise beginnings based on layout constellation can step forward complexness of the perceived sound en vironment33. MedSurg-ICU race path layout design offers a more compact physical environment while Neuro-ICU bunch layout design provides more broad physical environment.5. Spectral content of the sound environment vs. subjective noise degreesStatistically important subjective noise degree differences between two unit nurse Stationss were non consistent with merely perceptible differences between RC values. However, more elaborate frequence analysis showed that clearly perceptible higher noise degrees occurred at 8kHz at MedSurg-ICU nurse station. This happening can be related with unprompted ( high noise degrees at high frequences ) temper of sound environment at the nurse Stationss. Statistically important subjective noise degree differences between two unit empty patient suites were consistent with clearly perceptible differences between RC values. This relationship can be explained by the steady nature of the sound environment in the empty patient suites. And this happening can besides foreground the dominancy of noise degrees at mid frequences in nurses irritation and loudness perceptual experience in steady sound environments.VI. DecisionIn healthcare acoustics literature, it is widely accepted that noise degrees in critical attention scenes are really loud and raging. This survey agrees with this decision and reminds that features of different ICU sound environments can change drastically. Some of those differences are highlighted via elaborate comparative noise degree analysis between two units in this survey. Impulsiveness ( high happening rate at high noise degrees ) degree of an ICU sound environment is suggested to be one of the chief indexs of sensed noise-induced nurse results and nurses volume perceptual experience. At specific locations in the unit that have with steady sound environments, higher mean sound force per unit area degrees relates better to nurse irritation and volume degrees. Spectral content of the sound environment might besides be related with nurse irritation and loudness perceptual experience. Lower perceived noise-induced work public presentation can be expected in the units with higher address intervention degrees. Furthermore noise degrees at specific locations in the unit can be acoustically more debatable than the others where focussed intercessions can be necessary. For study of these possible conditions, conductivity of elaborate noise degree measurings at multiple different locations in the unit might be of import. During and after location specific noise degree analysis, it might be good to oppugn whether peculiar acoustic metric used represents the general feature of the sound environment studied and observed. It might be critically of import for hospital decision makers to take enterprises for cut downing unprompted noise beginnings in ICUs such as reconsideration of dismay scenes that most times do nt match to exigency degree of the incidence, integrating of higher engineering for paging hea lth professionals such as 3G-phones and avoiding overhead beepers. It might be critical for designers to see the recent technological progresss in HVAC systems to assist bettering occupant results. The sate-of-the-art HVAC system application in Neuro-ICU offers significantly less bothersome and quieter ( clearly perceptible ) sound environment in the patient suites compared to the HVAC noise generated by the older edifice system in MedSurg-ICU. In add-on to the application of technological progresss, strategic arrangement of the HVAC engine and its insularity from the edifice construction can be critically of import to avoid possible feelable quivers and noises happening at really low frequences. Finally, in add-on to conventional acoustic intercessions ( i.e. absorbent surface stuff applications ) , some layout design considerations can besides be critical for the formation and consideration of the health care sound environments get downing from the early design stages.Recognitions This work has been partly supported by ASHRAE Graduate Student Grant-In-Aid. We appreciate GaTech Healthcare Acoustics squad members partnership. We are grateful to Emory University and Dr. Owen Samuels for his advice. We are besides grateful to nurse pedagogues Ann Huntley and Mary Still, registered nurses Tim Rice and Anya Freeman and to all Neuro-ICU and MedSurg ICU nurses, patients and household members for their uninterrupted aid and forbearance during noise degree measurings in the units.