A Characters View, Drugstore Cowboy Essay

One page essay for Theater 19 acting class Due March 13 2012 By Charles (Chuck) Borges March 13th 5:30am This short essay is about a character in the film â€Å"Drugstore Cowboy† Bob. This is what I think his character is like, and what’s going on in his life before this next scene. Bob is a ringleader or mastermind of an underdeveloped group of drug store robbing addicts who Procure their vices by stealing them from local pharmacies. Bob likes doing drugs. He likes the whole lifestyle. While in the proses of robbing these establishments, Bob gets a euphoric Sense of power. The adrenalin rush is like no other. He risks going to jail, and losing his Freedom to obtain that rush at any expense. As long as it doesn’t come out of pocket. You see, Bob is a poor man†¦ He’s a hype that can shoot up enough dope to kill a horse. But that was then, and this is now. As he sits and ponders his mass confusion that he Called a life, in a small room, in some apartment complex, ran by a person like himself. An X Junkie named Tom. To say the last six months have been easy on Bob would be a lie. Sobriety Is kicking his ass and He’s starting to feel bored and becoming restless at work. Not a good sign. The daily grind was starting to bore into Bob like a drill bit. The addiction was winning its way Back into his life and he knew it. Bob’s life was better now. He has his boring job, boring apartment, boring life. But all in all, a respectable existence, surrounded by regular people with regular, Similar lives. But he’s still feeling alone and thinking of the good times he used to have with a Certain somebody he shared his tawdry past with. He’s feeling melancholy about the way he left her, but knowing that deep in his heart , it was the best solution from a destructive path. But still he is wondering to himself ,† I wonder what ever happened to my buddy who’s girlfriend died, and if they will ever find her body . † I’m thinking , he’s wondering â€Å" Is Diane alright?

Math 533 – Ams

AIMS I will be going over data provided about our customers based oftener location, Income size, household size, years at current location, and the credit balance they carry with our company. Using statistical analysis we can learn more about our customers and hopefully use this information to provide better services to our customers in the future to keep them customers for life.In my analysis I will go over the following: * Customer Location * Customer Income * Store Credit Balance * Credit Balance Compared to Income Level Household Size Compared to Household Location * Household Size Compared to Income Level Where the customer lives, their Income level and the balance they hold with the company are good Indicators of customer loyalty. Extending credit to our customers is a good faith way of us showing the customer that we want their business and are willing to take time to pay off their purchases.Before I fully analyze the numbers I would assume that the greater the income level th e more they are charging. They have the financial meaner to pay the monthly payments and can keep a high balance. Customer location is important because it can help tell us how often you frequent the store. Someone in an urban area might shop 4+ times a month, where someone in a rural area might only shop once a month. But the person shopping 4+ times a month might be spending less than the person living in the rural area who can only come once a month because of distance Issues.Credit balance compared to Income level shows us how much higher Income customers are spending. Comparing the household size to the location can give us a feel for where the families are living marred to the single parent or single person households are. You can use this kind of information to market and advertise special sales as necessary. Finally household size compared to the income level will show us how much large families are spending and how often. This can also be useful to market big sales.Customer Location The above representation is a pie chart which shows are clients' demographic locations. Of the 50 customers used in our sampling the greatest numbers of our clients are In the Urban region, with the rural region being the least frequented. Of the sample we concluded that: eve In an urban area live in a suburban area * 26% live in a rural area This is in my opinion an expected outcome. The ability to come to our store is much greater for those living in suburban and urban areas because it is closer to their proximity.While residents in the rural communities do frequent our stores they do so on a less frequent basis. Further investigation might be able to show that rural residents could possibly shop less frequently, but spend more per trip than someone in the urban area. Customer Income This simple bar graph shows the income level in the $1,000

Advantages of oligopoly in UK supermarket industry

Advantages of oligopoly in UK supermarket industry Oligopoly in UK supermarket industry Supermarket, which provides a retail sales service, is an indispensable place for people who buy the daily things. The definition of oligopoly is that an economic condition in which there are few independent suppliers of a particular product that competitive pricing does not take place (Answer, 2010). It is manifest that the UK supermarket is under the structure of oligopoly. There are four main characteristics of supermarket in the UK. The first point with respect to this is that all the super markets in the UK sell similar products and produce branded products. Secondly, look at the bar chart on the right, the big companies has larger market share, because the big supermarkets will set high barriers to avoid new supermarket into market. More importantly, the companies must be interdependent. If one large supermarket takes an action, it will directly affect another supermarket. The chairman in the supermarkets has to take into account likely rea ctions of rivals to any change in price and output and the interdependence of sellers can keep the price stability. Finally, non-price competition is a significant strategy for selling, such as the VIP cards, online shopping. The term marketing mix refers to different elements within a strategy designed to create demand for a product (Anderton, 2008; 324). Considering of the marketing mix right for the products means all the important bases are covered in the marketing campaign and it will help the companies gain more profits. This market structure creates both advantages and disadvantages. The lower price and the creative services are the advantages, but in the oligopoly market, the collusion between the companies will have detrimental influence upon the consumers. In oligopoly market consumers can enjoy a lower price for the products. Most of supermarkets in the UK sell the products from the same grocery brands, such as Kellogg’s, Heinz and Walkers Crisps (Which, 2007). The products which be sold in different supermarkets are the same and we called it homogeneous. Mysupermarket (2010) illustrates that the same products in different supermarkets have a similar price. Thus, it means that all the supermarkets need to pay almost the same cost of the products. The larger companies might pay slightly lower than the smaller one, because the quantity of the goods which the larger companies need to buy is more than the small companies so that larger companies will have a bigger discount. The lower cost help the larger supermarkets have superiority in the low price to attract the consumers. Because of the oligopolistic market, all the companies compete on price so that different companies take different measures appeal to the consumers. Figure 2 is a kinked demand curve and it assumes that a firm will reduce its price if a competitor starts a price war, but will leave price unchanged if a competitor raises its price. Thanks for the oligopoly structure, price is rigidity. Tesco promotes the discount coupon to the consumers and they can use these coupons to save their money while they buy goods in Tesco (Couponmountain, 2010). Discount coupon appeals consumers to shopping in this supermarket, thereby making the contribution to marketing. BBC(2006) reports â€Å"Supermarket Sainsbury’s is to sell more than 500 of its own-brand products in compostable packs instead of plastic as it seeks to cut packaging waste†. Sainsbury’s uses new packing way to pack the organic fruit and vegetables. This can reduce the cost of products and it is also a good way for the environment. Providing the low price is in the best interests of consumer.

Accounting For Leases And New Proposed Models Essay

Accounting For Leases And New Proposed Models - Essay Example The International Accounting Standards Board calls for a new lease accounting principle that relates to assets and liabilities. This write up proposes criteria to be set for deciding between two interpretations of whether the lease increases or decreases both assets and / or liabilities. SFAS no. 13, which was issued by FASB, was at that time, 2001, showing improvement on the setting of accounting standards for leases. Many write ups on leases followed suit such as 9 FASB amendments, 12 FASB technical bulletins, EITF consensus, 6 FASB interpretations and others. The FASB is continually working to come up with an adjustment to the Statement of Financial Accounting Standards no. 13 (lease) because it has failed to address many questions by many sectors of the accounting, school, business and other companies on the accounting procedures and interpretation of leases. SFAS no 13 states that an asset can be considered a capital lease, where the value of the leased property is included in the balance sheet of the lessee, If the four conditions listed a are met: a) The lease conveys ownership to the lessee at the end of the lease term. b) The lessee has an option to purchase the asset at a bargain price at the end of the lease term. c) The lease term covers 75% or more of the economic life of the asset. d) The present value of the rental payments when using the lessee’s incremental borrowing rate is ninety percent or more of the fair market value of the asset. TWO ALTERNATIVE CONCEPTS OF LEASE ACCOUNTING One of the main points of SFAS 13 is that all lease contracts generate obligations that should be presented in the balance sheet, contrary to what the Financial Accounting Standards Board believes. In fact, SFAS no. 13 states that "a lease that transfers substantially the entire benefits and risks incident to the ownership of property should be accounted for as the acquisition of an asset and the incurrence of an obligation by the lessee and as a sale or financing by the lessor. All other leases should be accounted for as operating leases. (FASB 1976, para. 60)" FASB differs this by saying that not all lease contracts create both a new asset and a new liability. The FASB and G4+1 group have been implementing the FASB standard on lease recording. Companies in Canada, Australia, United Kingdom and New Zealand have also been following the FASB standards. THE CONCEPTUAL FRAMEWORK AND ACCOUNTING FOR LEASES When assessing the generally accepted accounting principles states that accounting information that should be included in the financial statements are those that are submitted on time to the decision makers. These financial statements must also be relevant to the decision making process. Further, the financial statement items should stated in such a way as to permit comparability between two accounting periods or two or more financial entity who are subsidiaries, branches or competitors. Therefore, when rights and obligations are recorded in a lease contract, intangible assets are created. An airline company comes into "existence" when it buys an airplane. According to monsoon, There is a possibility that lessees may record the lease asset in the balance sheet will be boundless because intangible assets cannot be easily estimated. When a bank

Slavery Comes to the American Colonies From 1492-1750 Essay

Slavery Comes to the American Colonies From 1492-1750 - Essay Example Development in the South American colonies and the West Indies were retarded due to the control and dominance by the Spaniards. There was also a drift towards an economy based on agriculture. These two factors contributed to the development of slave-holding societies in the American colonies. In the initial stages local natives were use in the development of commercial agriculture, but the local natives were not able to withstand the heavy workload they were expected to perform and withered away. The decimation of the local communities had the benefit of providing even more land for commercial agricultural production. The lack of local natives for slave labor and the added land available for agricultural production cause the induction of the hardy African Negroes into these lands, as slaves to work on commercial agricultural production sites. (Hinton, K.V., 2005). The use of African Negroes as slaves in the American colony started when King Charles V of Spain granted a license for bringing four thousand African Negroes into the West Indies as slaves. From then on the American colonies were to witness the growth of slavery. The English involvement in trade and use of slaves started in 1562, and subsequent to the revolution in 1688 trading and use by the British was to flourish. With the royalty involved in the slave trade its growth was only enhanced. An English company was formed in 1713 with Queen Anne of England holding a quarter share, and King Philip V of Spain another quarter. This company was given the privilege of supplying 144,000 Negro slaves to the Spanish American colonies for a period of thirty years, and is an indication of the growth in slave trade and the use of slaves in the American colonies. The spread of the use of Negro slaves into the United States of America was a natural extension of the wide use

Churchill, hitler, and the unnecessary war Term Paper

Churchill, hitler, and the unnecessary war - Term Paper Example Germany was also barred from building up large army. Tanks, aircrafts and submarines were also not allowed to be held by Germany. All these steps were deemed to be taken to prevent Germany from initiating any other war. Germany abided by the restrictions imposed by this treaty only by the end of second decade of the 20th century. In January 1933, Adolf Hitler was powered up by the disgruntled and poor people of Germany to take over the throne. The basis of their belief in Hitler was that they wanted a person who might empower Germany again and pull to pieces the unjust and unfair treaty. As a result, Hitler became the Chancellor of Germany. Soon after he became the Chancellor, he started the building up of German forces. He also empowered the German army by equipping it with modern weapons. Initially, all this was done secretly but soon it came to light. However, the Great Britain and France took it lightly. They were of the view that these actions will strengthen and will be helpful in stopping the flourish of Communism in Europe. After having built up the German forces for 2 years, Hitler gave them order to enter into Rhineland in 1936. The reason provided by Germany for this invasion is the threat that Germany was facing as a result of treaty with Russia. So, it became very important for Germany to post its troops in Rhineland. It is also considered by many historians reasonable that as Rhineland was a part of Germany, so, there is no bar if German troops are posted there. However, Germany was very weak at this point and little intervention by Britain or France could have defeated them. However, neither of these two intervened as they did not want to start another war with Germany. Meanwhile, Hitler also stepped forward to make allies with two important countries of Japan and Italy. Later on, Hitler advanced to take back the land of Austria. In March 1938, Hitler ordered German army to march in Austria to occupy the land. Austrian leader was then forced to c onduct a poll to decide whether the people of Austria wanted union with Germany. The results showed the favor of 99% of the citizens of Austria to live with Germany. The Austrian leader asked for help but, on been satisfied from Hitler side, none of Britain and France came to help Austria. Adolf Hitler promised that the union of Austria with Germany will end the aims of expansion of Hitler and he will not move further on. However, breaching his own words, Hitler insisted that the region of Sudetenland of Czechoslovakia should be handed over to Germany. Neville Chamberlain, the then British Prime Minister, met Hitler thrice in September, 1938. Chamberlain was himself of the view that Treaty of Versailles was not just and equitable for Germany. So, he took a soft corner for Germany. Finally, it was decided in Munich Agreement that the region of Sudetenland would be handed over to Germany on the provision of Hitler’s assurance that he would not make claims for any further territ ories. The agreement was mutually decided and signed by German, British, French and Italian leaders. However, Czech government was not involved in the agreement upon which they recorded their protest. However, Hitler occupied whole of the Czechoslovakia in 1939 March. Czechoslovak government asked for help but none of Britain and France intervened in the invasion. However, both of these countries promised that they would take military action against Hitler if the German forces advanced towards Poland. On September 1 1939, German forces occupied Poland

Hewlett Packard takes project management learning to a higher level Term Paper

Hewlett Packard takes project management learning to a higher level - Term Paper Example ency, productivity and profitability of their firm was being negatively impacted by the lack of direct training they provided to middle management; specifically project managers. Accordingly, the firm endeavored to change by providing a visionary and optimistic training program that proved to be the envy of many firms. As a means of understanding and appreciating the approach that Hewlett Packard engaged in, with respect to an overarching project management and training program, the following analysis will seek to draw inference with respect to the key inputs of the deliverables for the project in question, how some of the challenges to the project management process may be defined, and the opinion of this analysis with respect to the quality of the project management that was exhibited within the case in question and why. The key inputs that provided the mechanism for change with regard to the case in question are contingent upon the desire and wherewithal to change, investment in training, and promoting core concepts of interaction and business development. Within such a rubric, HP was focused on achieving a competitive advantage over their rivals by focusing on the quality of the training process and ensuring that the inputs – ability to change, investment in training, and promoting core concepts of interaction and business development – would serve as the platform through which a greater level of IT provision within the firm and a higher level of productivity. Of all the inputs, the investment in time and money that such a program required was immense. As such, many individuals outside HP would have been hesitant to commit such a high level of resources on a thus far unproven program that was intended to maximize future project organization and profitability within the firm. Another relevant input that must be discussed is with regard to the training that took place prior to the program being offered at all. Rather than bringing in outside

Analysis of Bubonic Plague Research Paper Example | Topics and Well Written Essays - 1500 words

Analysis of Bubonic Plague - Research Paper Example Due to the severity and intolerableness of its effects, this plague was considered as a lethal cause of death. The origins of this plague are associated with the East and a rapid spread is acknowledged all around Europe. The plague resulted in a diminishment of entire communities and a lack of resources and manpower to deal with the bodies was also accounted (HistoricUK). This paper will analyze the situation of England by considering social, economic, religious and political grounds during that era. Political Factors The most devastating era for London was during 1563 when the death rate due to the bubonic plague reached its peak. Approximately 80,000 deaths were reported and further analysis reveals almost 1000 weekly death in August 1600 weekly in September and 1800 in October (Miller & Orr). As a result of frequent death reports, people started to migrate from London. The elite class had no issues escaping the infectious plague and left the premises of London easily. Like many ot her accounts, poorer families and the financially unsound population were left to die. Queen Elizabeth also fled without paying heed to the people left behind. The political powers, yet again, seemed to support the privileged rich families with no regard given to the humanity and precious lives of poor people. This was not the end of Elizabeth’s political power and justice, she further passed a law to hang any person who enters from London. This justice was not to protect anyone except her own life. The restrictions on imports were also imposed to protect herself from the deadly plague. However, the plague still prevailed and crossed the borders without paying heed to Elizabeth’s orders and laws in 1578. Elizabeth took a rather realistic step and physicians were directed to find cures and prepare preventions for the plague diseases. Economic Factors The economic condition of England was greatly affected by the Plague. Almost half of the London population died due to th e devastating effects and ultimate demise of the victims. The poorer labor force was affected the most as this class could not flee or escape the horrifying effects of the plague. The high death rate of the labor class resulted in the shortage of labor force in England. This resulted in high pay demands of labors and landowners were forced to move towards money rents and dodge high labor costs. In addition, farming was replaced with grazing practices which needed fewer workforces. The peasants remained privileged due to high wage rates, as long as the rulers or elite class did not put hands on the state’s funds for their personal expenditures and motives. In order to overcome the labor availability issues at reasonable rates and curb the power of labor class, the political step was taken with the fixation of wage rate. The migration, in addition, was prohibited to keep the labor facilities available for their own needs. These steps created a negative attitude of the workforce and the rise of Priests’ Revolt is often associated with these political actions taken during the plague period. Religious Factors The Plague appeared for unknown reasons and the indistinct reasons led to chaos in the minds of the people regarding the underlying reasons for its spread.  Ã‚  

Micro economics Term Paper Example | Topics and Well Written Essays - 2250 words

Micro economics - Term Paper Example Aside from stocks and bonds, other investment instruments are mutual funds, stock options, and other financial derivative securities, which are briefly defined and described here. A stock is ownership of a corporation represented by shares that are a claim on the corporation’s earnings and assets (Downes, John & Goodman, Jordon Elliot, p. 556, Barron’s Educational Series). The price of a stock is the equivalent of the present value of all future dividends; it is also the present value of a dividend stream for the number of years it would have been held, plus the present value of the anticipated price of the stock after that time period (Block, Stanley B. & Hirt, Geoffrey A., p. 284, McGraw-Hill Irwin). Common stocks entitle the shareholder to received dividends in stocks and bonds, and to vote in the election of directors and other matters taken up at shareholder meetings or by proxy (Downes, John & Goodman, Jordon Elliot, p. 556, Barron’s Educational Series). The stock market is the general term referring to the organized trading of securities through the various exchanges and the over-the-counter market (Downes, John & Goodman, Jordon Elliot, p. 563, Barron’s Educational Series). It is likely that the role played by the market in gathering and disclosing information may be more important for large firms because their stocks are traded more often and are followed by many analysts (Demirguc-Kunt, Asli & Maksimovic, Vojislav, p. 49, Finance & Development). Small firms may not benefit as much from stock market development, at least initially, because their access may be limited by high fixed issuance costs (Demirguc-Kunt, Asli & Maksimovic, Vojislav, p. 49, Finance & Development). Even the stock of small firms that are listed on an exchange may not be traded as often as the stock of larger firms, since it

The Nature Of Reality Essay Example for Free

The Nature Of Reality Essay What is reality?   Throughout the history of mankind it seems that we have all been searching for the answer to this question.   The nature of reality cannot be explained in a way that will satisfy us all.   I believe that the nature of reality is lies within the mind of each of us.   What is reality for one person is not reality for another.   Reality is based on individual perception, and the evolution of each person.   What I mean by this is that each person goes through a type of evolution in his/her life where the mind begins to develop a higher awareness. Most of us begin to realize that there is more to the process of life than being born, aging, and dying.   Greek philosopher, Thales thought that â€Å"beneath the world of life and death there must be some basic substance which explained and made possible everything else,† (The Ionian School, undated website article). Many of us begin to believe that we are much more than our physical bodies.   And that leaving our bodies through death is not the end of our existence. Our life force, energy, or soul will continue to live on a different level or dimension.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Of course, believing in a sort of ‘life’ after death is a major topic of debate.   Philosophers continue to ponder if this could be reality, Christians structure their lives around this belief, and scientist argue that reality is only that which can be proven. â€Å"Clearly, the mere fact that one believes in and lives by something is not of itself sufficient evidence that that something has real, as distinct from fictional, existence; that, intellectually, it makes sense, as distinct from nonsense,† (Somerville, 1967).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   I believe that just because we can’t prove something through science does not mean that something can’t exist.  Ã‚   For example, well-know psychics seem to be able to communicate with the dead, and predict future events often with amazing accuracy.  Ã‚   Even ordinary people who have had near-death experiences insist that there is something more, and often claim to have seen the other side of physical life.   Therefore, I believe that the nature of reality is different for everyone.   And the secret to reality is in our own minds.   I believe that what will be real in our lives, will be that which is real in our minds. References Somerville, J. (1967).   The Nature of Reality: Dialectical Materialism.   In The Philosophy of Marxism: An Exposition (pp.3-32).   Minneapolis: Marxist Educational Press. The Ionian School.   Retrieved February 24, 2007, from http://www.hol.gr/greece/texts/aristo.1txt.

Does Descartes Provide A Convincing Argument?

Does Descartes Provide A Convincing Argument? Dualism is the philosophical belief that mind and matter are fundamentally distinct substances. William G. Lycan states that according to Cartesian dualism, minds are purely spiritual and radically non-spatial, having neither size nor location (Lycan, 47) and indeed, Descartes reached his conclusion by arguing that the mind and body are completely different in nature, making it possible for one to exist without the other. Whilst Descartes attempted to argue in favour of substance dualism, it can be said that his argument was ultimately weak, with substance monism being a far stronger viewpoint in the distinction between the mental and the physical. In this essay, I will attempt to argue that Descartes does not provide a convincing argument for the claim that mind and matter are distinct substances and instead, I will argue in favour of materialism through the particular exploration of functionalism. In order to understand dualism, we must first come to terms with Leibnizs Law due to the fact that most dualist arguments rely on this principle. The law states that if A=B, then any property of A is also a property of B (Guttenplan, 431). The first argument for dualism which I will discuss is the doubt argument, which compares the difference between an idea of ones own existence and an idea of ones bodys existence. The argument can be put forward as thus: Because of the nature of my being, my existence cannot be doubted. Because of the nature of my body, its existence can be doubted. Therefore, my mind which is the thinking thing that I am is not identical with my body. (Kim, 36) So in other words, whilst I can be convinced that I exist, it is not possible for me to know that my body exists with the exact same certainty. However, a response to this could be a comparison with another argument of similar structure but with a false conclusion, for example; Mary-Jane believes that Spiderman is a hero but Mary-Jane does not believe that Peter Parker is a hero. Therefore, Spiderman and Peter Parker must be fundamentally distinct. From this argument, we can see that the doubt argument is invalid. A second argument for dualism is the divisibility argument which may be reconstructed as follows: The self or soul lacks any parts into which it is divisible. The body, being spatially extended, is divisible and so composed of parts. Hence, the self and the body are distinct substances and the self is, unlike the body unextended. (Lowe, 8) The basic idea behind this argument is that the body is divisible because it is extended and thus can be separated into any number of parts. But Descartes argues that the mind is not divisible because each part of the mind, despite having different processes, has the same force behind it. Therefore, the mind cannot be seen as an extended entity because unlike extended entities, it cannot be divided into parts. So the same conclusion is reached; mind and body are ultimately distinct. However, the divisibility argument, despite being simple, has the same problem as the argument from doubt. We cant be totally sure that both premises are true. But Descartes was sure you couldnt divide the mind, especially someones thoughts and beliefs. However, it possible to argue that the mind can in fact be divided, if we consider the mind equal to the brain. Descartes may be right in stating that thoughts, beliefs, memories etc. cannot be divided but the substance that they are a state of, the physic al brain, can be separated such as in the case of brain surgery. People with personality disorders or split brains may have a divided mind. The first premise in this argument can only be true if we see the mind as a substance distinct from the brain. Thus, the divisibility argument is ultimately a weak argument in support of dualism. The final argument I will discuss is the argument from disembodied existence. Following the previous arguments, Descartes goes even further yet, stating that the mind is not only separate from the body, but that it can exist without it. The argument can be put as follows: If two things can exist apart from one another i.e. mind and body, they must be distinct. If I can imagine these things existing separately, God must be able to bring it about. If God can bring it about that these things exist separately, they must be distinct. Therefore, it is possible for the mind to exist without the body. In Meditation VI, Descartes expresses that he knows that all the things that he conceives clearly and distinctly can be produced by God precisely as he conceives them (Descartes, 28). Basically, the point that is being made is that if two things can exist separately, then they may be considered distinct. Descartes appeals to God to strengthen his argument, stating that if God can allow two things to exist separately, they must be distinct. But the problem lies in the fact that just because it is possible to perceive the mind and body as distinct, are they really distinct? Kim uses the example of the bronze bust of Beethoven. The bust could exist without being the bust of Beethoven, for example it could easily be the bust of say Brahms. However, if the bust is melted down, could it exist without being a material thing? The answer is no, as being material is a part of its essential nature and it cannot exist without being considered a material thing (Kim, 40). Thus, whilst its conceiva ble that I exist without a body, is it really possible? That is the problematic question that ultimately weakens Descartes argument. As I have shown Descartes argument for dualism to be weak, I will now highlight the ways in which materialism and in particular, functionalism refutes the claim that mind and matter are distinct substances, and fundamentally proves to be the stronger argument. One of the main questions that come from dualism is how the causal interaction of two distinct substances is possible. Materialism states that the universe contains only physical matter rather than distinctions, as in Descartes case. Whilst there are many strands of the materialist theory, functionalism appears to be the strongest. Functionalism is a theory which concerns itself with the idea that mental states are comprised exclusively by their functional roles. It explains how having a non-human brain can still result in mental states and also manages to explain how mental states can come from matter in the first place, without being completely perplexing. One of the strongest arguments in favour of functionalism is the argum ent involving the idea that mental states (such as pain) can be multiply realised because they involve functions. Fodor and Putnam argued that the importance of the state of pain does not lie on the c-fibres firing but what they are doing and what their contribution is to the operation. The point is that the role of the c-fibres could have been performed by anything suitable, as long as it was indeed performed (Lycan, 52). Clark puts the functionalist claim in an interesting way: the mind is to the body/brain as the program is to the physical machine. (Clark, 169) This idea can be seen as a direct response to the dualist view that mind and matter are distinct as the software is the product of material processes rather than being material in itself and any change in the software will cause changes in the computers physical components. Furthermore, it is impossible for the software to function without the hardware and vice versa, indicating that there is no real distinction between th e mental and physical. Ultimately, as I have argued in this essay, I believe Descartes dualist theory to be wholly unconvincing. This is primarily due to the weakness of the three arguments highlighted but also, the lack of strengths that appear in the theory. Descartes is convinced that mind and body are distinct but substance dualism doesnt seem to give an explanation as to why exactly mind and body are distinct and what the purpose of this distinction in. On the contrary, functionalism, a strand of materialism is a far more convincing theory in the discussion of mind and matter. By stating that there is no distinction between the two and that in fact, a mental state is concerned more with its function and its role in the wider system, an analogy can be made between the mind and a computer programme. This analogy is possible to conceive and essentially makes sense. So overall, substance dualism proves to be a far weaker argument in comparison to functionalism.

Night Essay -- essays research papers fc

  Ã‚  Ã‚  Ã‚  Ã‚  Without a doubt, one of the darkest episodes in the history of mankind involved the systematic extermination of Jews, Gypsies, Slavs and gays by Nazi Germany. In order to get a good sense of the horror and despair that was felt by the interned, one simply needs to read the memoirs of Elie Wiesel in his â€Å"Night†, as translated from French by Stella Rodway and copyrighted by Bantam Books in 1960.   Ã‚  Ã‚  Ã‚  Ã‚  Elie Wiesel was born in Sighet, Transylvania. His parents ran a shop and cared for him and his three siblings, Hilda, Bea, and Tzipora. Early on, the Jewish community of Sighet payed little heed to the stories of what had happened to foreign Jews that were expelled. By the time Germans had entered Sighet, it was too late for the people to escape their fates. At first, they were made to give up all of their valuable possessions and move into makeshift ghettos. Next came deportation of the entire community to the Auschwitz internment camp. The way that the people were piled into cattle wagons was only a precurser of appalling events that were to come. The horror really dawned on Elie when he realized that the large smokestacks that he saw were from crematoriums that were set up to burn the bodies of the thousands upon thousands of Jews that were killed in the gas chamber. Elie paints a portrait of life in the camp, which included hours of back-breaking labor, fear o f hangings, and an overall theme throughout the book: starvation. The prisoners were given only black coffee in the morning, and soup and a crust of bread in the evening. The most terrifying aspect of the entire experience was the â€Å"selection†, the picking out of those that were to sick, old, or weak to be useful. These unfortunate souls were thrown into the fires. The one constant in Elie’s life was his father, who along with his son and all other prisoners, were later forced to evacuate to trains that would bring them to the Buchenwald internment camp deep in Germany, under the pressure of the Allied forces on the area. The final horrific scene in this book was how the interned, in mass, were forced to run full speed for hours on end, the people that lagged being shot on sight. The story culminated in the death of Elie’s father, and the eventual freedom of the Survivors of these death camps.   Ã‚  Ã‚  Ã‚  Ã‚   The way that Elie describe... ... day, Pope John Paul II apologized for the past sins of the church, but did not address the way that Pope Pious VII threw a deaf ear towards the Holocaust. What is more disturbing than the fact that their was not opposition to the Nazis by other European countries is the fact that something as horrible as this could happen again. In Bosnia and Herzegovina in the early 1990’s, the â€Å"ethnic cleansing† of Muslims and Croats by Serbs led to the removal of 2.5 million people from cities and villages, mass murders, and the internment of men and boys in as many as 100 concentration camps. Although the situation did not escalate to the point of the Holocaust, it showed the ignorance of people as to past events.   Ã‚  Ã‚  Ã‚  Ã‚  To conclude, Elie Wiesel’s â€Å"Night† is a haunting and accurate account of the cruelty that man can inflict on man. The lessons learned from this account cannot be forgotten. If they are, then they are sure to be repeated. Works Cited â€Å"Ethnic Cleansing.† The Complete Reference Collection. 1998ed. CD-ROM. The   Ã‚  Ã‚  Ã‚  Ã‚  Learning Company, Inc., 1998. â€Å"Holocaust.† The Complete Reference Collection. 1998ed. CD-ROM. The Learning

Is Violent Revolution the Answer? :: The Last Supper Slavery Racism Essays

Is Violent Revolution the Answer? Tomà ¡s Gutià ©rrez Alea’s La Última Cena (The Last Supper) The ideas I intend to express in the following paper are in no way meant to make allowances for the practices of slavery or racism. As I begin this paper, I feel the need to remind the reader that I find slavery, in all of its forms, to be an oppressive and terrible institution. I unwaveringly believe that for centuries, including this one, the narrow-mindedness that slavery has perpetrated is one of the most terrible humiliations leveled upon our civilization. These views are meant only to assess and illuminate the construction of slavery in film. When it comes to films concerning slavery, the role of the filmmaker as educator is significantly heightened. Very often, slavery films unconditionally disparage whites as oppressive forces and stereotype the white class as uniformly tyrannical. The sympathetic, yet comparatively powerless, whites in this arrangement are frequently left out, giving credence to a stance that portrays race as a division between villains and martyrs. While I see an effort in Tomà ¡s Gutià ©rrez Alea’s The Last Supper to move beyond these depictions, how successful the film rises above the typically extreme constructions of character in the slave film is a difficult judgment, particularly for a film from a Cuban director during the Cold War. For John Mraz, the representation of history in Tomà ¡s Alea’s The Last Supper is commendable work. Mraz believes that the film joins a cinematic compilation where â€Å"films meet many of our expectations about what history ought to be† (120). Mraz maintains his praise of Alea’s historical constructions, asserting that the way the film addresses history is impartial and objective: â€Å"The Last Supper follows the classic model of both written and filmed history in insisting on the reality of the world that it has in fact created, however much this universe has resulted from research. The major convention of such history is that it has opened a window onto the past rather than constructed a particular version of it† (121). While I have no qualms with Mraz’s assessment of the uses of the film’s construction of history on the Cuban plantation, I find that the window Mraz speaks of offers a much more vague version of reality than Mraz indicate s initially. The validation of slavery by the white people in the film comes off as ridiculous, and yet the abstract strategies to defend slavery that are at work in the film coincide with the arguments used by slavery allies throughout the nineteenth century.

The Power of Money in Campaign Finance Essay -- American Politics, Pre

It may seem that with the Buckley decision, soft money and PACs the hope for reform has been lost, however there is still hope. The Supreme Court upheld the voluntary public financing of presidential election, which was considered a great step forward because taking public funds requires the candidate to limit their spending on the federal level. There is also the â€Å"hard money† in political campaigns, which is strictly regulated by law through the Federal Election Commission. Hard money is the contrast to soft money meaning that it is the contributions made by a person or PAC that gives to a federal campaign or political party for the use in federal elections. But of course with one step forward there is always two steps back. Because of the way soft money has forged it way into being one of the primary sources of federal campaigns, it has made a mockery of public financing at the federal level. Soft money and all its allied forms of legal cheating and finance loopholes ha ve almost completely stopped any effort or control to regulate and disclose federal campaign funding. From the 1980s to 2002 Congress played an active part in helping the parties and candidates through loopholes (arguably Congress is still presently helping). James Bopp (1999) believes the explosion of soft money in political campaigns in part came from the 1996 elections when national and state party committees would use soft money to pay for advertisements that featured their respective nominees, but were not subject to the spending limitations of publicly funded candidates. These advertisements are referred to as issue ads, which would clearly promote the victory or defeat of candidates, but because they did not use the words â€Å"vote for†, â€Å"elect†, or â€Å"defeat† ... ...nders in congress are willing to go to stretch the line of the laws and legal cheat just to keep their seat and the money flowing into their pockets. In present society politics is at its dirtiest and most cynical, evenly chipping away what our constitution stands for and our democratic values. I cannot in any way say what the future will hold for this uphill battle for disclosure and regulations on campaign finance. But I do know that the time for action is slowly passing by and if something is not done soon I fear the U.S. government may be lost to all and any forms of revival. Our government would basically have to start a new throwing everything off balance. Our government is standing on thin ice not only with its own citizens but also with foreign relations, it only takes waiting a day to long until the ice finally breaks and the American government sinks.

Hills Like White Elephants

Everyday people make decisions that affect their future lives. Do people make the right decisions? What makes a decision a right one? What may be right to some, may be wrong to others. There are no right or wrong decisions but those that people choose and believe to be right varying from each individual. In Hemingway's realistic story, Hills Like White Elephants, Jig attempts to make a crucial change in her life by making the right decision, but is unable to because of her weak characteristic flaws. Hills Like White Elephants†, by Ernest Hemingway, is a short story published in 1927, which is set at a train station in Spain. In this story the reader eavesdrops on a conversation held by â€Å"the American and the girl with him†. Most of the story is predominately dialogue between the two characters. During this conversation, the reader may determine that the couple is at a critical point in their lives when they must make a life-or-death decision on whether the woman should have an abortion. Jig is indecisive about her decision. Even though she realizes the possibilities, she has difficulties letting go of old habits, has a low self-esteem that leads to her being submissive, and puts up a frail fight by hiding her feelings behind her sarcastic comments. Jig faces an immense decision that will change her future. She must choose between the old and the new lifestyle. It is hard for her to let go of old habits that consists of taking no responsibility and the sole intention of seeking pleasure. She must go from a young worry free rebel to a stable adult taking responsibility. It's a hard process since there are three steps to changing: realization, doing the deed, and committing to the change. She definitely realizes she needs to change, but only goes that far. The climax of the story appears when Jig is agitated by their irritating conversation and their romantic relationship. She begins to question about their uncertain future and his true feelings for her. She seems persuaded by the American when she comments on her willingness to do the operation despite her wants and needs because â€Å"she doesn’t care† about herself. At the same time, Jig begins to realize that life may not turn out the way she had planned. She likes to try new things, like the drink, but is often disappointed in the end. She indicates that it is too late for him to make things better. The American believes that Jig is being reasonable for not wanting to having the â€Å"simple† operation done so they can â€Å"be all right and be happyâ€Å" again. He informs her that he has â€Å"known lots of people that have done it† in order to convince her to have the â€Å"awfully simple† operation. He says that the pregnancy is â€Å"the only thing that bothers us. It's the only thing that's made us unhappy. † He sees the whole issue as â€Å"simple† because he does not understand the real problem that is causing the misery. When he finally leaves Jig to get their bags for the train, he observes that the other people are â€Å"waiting reasonably for their train† because in his mind, Jig is the one to blame their troubles because she is â€Å"unreasonably waiting† for a future that he cannot imagine having with her. Ironically, he is unreasonable one because he is the one causing the problems by wanting the abortion. Jig realizes that their withering relationship is not the result of her pregnancy but the result of their failure to understand each other. She realizes that they are incompatible as a couple to have a family together. Even if she does have the abortion, she can no longer stay with him because he can never give her what she longs for. Hemingway leaves the reader wondering about their final destination. He chooses the setting in the valley of the Ebro to symbolize the couple’s situation and options in life. They are on the sunless and barren side of the mountain where they can only see hills that looks like white elephants. At the end of the story, the American remarks â€Å"I'd better take the bags over to the other side of the station,† the side where there is growth and life. The train is representative of two different directions if life, however is unclear whether this signifies that the man has changed his mind about the abortion, or that Jig has decided to go through with the operation and leave him so they have to live separate lives. Jig has desires to change and to live a different life because she is aware of it. She is ready and willing to experience a different life while her lover is not. If so many women were to take that to heart. You should not have to chose someone else’s happiness over your own. We set our paths and no one should think that they have te right to make your own life decisions. If we make a mistake it is our mistake. Life is to precious to waste. Hills Like White Elephants Everyday people make decisions that affect their future lives. Do people make the right decisions? What makes a decision a right one? What may be right to some, may be wrong to others. There are no right or wrong decisions but those that people choose and believe to be right varying from each individual. In Hemingway's realistic story, Hills Like White Elephants, Jig attempts to make a crucial change in her life by making the right decision, but is unable to because of her weak characteristic flaws. Hills Like White Elephants†, by Ernest Hemingway, is a short story published in 1927, which is set at a train station in Spain. In this story the reader eavesdrops on a conversation held by â€Å"the American and the girl with him†. Most of the story is predominately dialogue between the two characters. During this conversation, the reader may determine that the couple is at a critical point in their lives when they must make a life-or-death decision on whether the woman should have an abortion. Jig is indecisive about her decision. Even though she realizes the possibilities, she has difficulties letting go of old habits, has a low self-esteem that leads to her being submissive, and puts up a frail fight by hiding her feelings behind her sarcastic comments. Jig faces an immense decision that will change her future. She must choose between the old and the new lifestyle. It is hard for her to let go of old habits that consists of taking no responsibility and the sole intention of seeking pleasure. She must go from a young worry free rebel to a stable adult taking responsibility. It's a hard process since there are three steps to changing: realization, doing the deed, and committing to the change. She definitely realizes she needs to change, but only goes that far. The climax of the story appears when Jig is agitated by their irritating conversation and their romantic relationship. She begins to question about their uncertain future and his true feelings for her. She seems persuaded by the American when she comments on her willingness to do the operation despite her wants and needs because â€Å"she doesn’t care† about herself. At the same time, Jig begins to realize that life may not turn out the way she had planned. She likes to try new things, like the drink, but is often disappointed in the end. She indicates that it is too late for him to make things better. The American believes that Jig is being reasonable for not wanting to having the â€Å"simple† operation done so they can â€Å"be all right and be happyâ€Å" again. He informs her that he has â€Å"known lots of people that have done it† in order to convince her to have the â€Å"awfully simple† operation. He says that the pregnancy is â€Å"the only thing that bothers us. It's the only thing that's made us unhappy. † He sees the whole issue as â€Å"simple† because he does not understand the real problem that is causing the misery. When he finally leaves Jig to get their bags for the train, he observes that the other people are â€Å"waiting reasonably for their train† because in his mind, Jig is the one to blame their troubles because she is â€Å"unreasonably waiting† for a future that he cannot imagine having with her. Ironically, he is unreasonable one because he is the one causing the problems by wanting the abortion. Jig realizes that their withering relationship is not the result of her pregnancy but the result of their failure to understand each other. She realizes that they are incompatible as a couple to have a family together. Even if she does have the abortion, she can no longer stay with him because he can never give her what she longs for. Hemingway leaves the reader wondering about their final destination. He chooses the setting in the valley of the Ebro to symbolize the couple’s situation and options in life. They are on the sunless and barren side of the mountain where they can only see hills that looks like white elephants. At the end of the story, the American remarks â€Å"I'd better take the bags over to the other side of the station,† the side where there is growth and life. The train is representative of two different directions if life, however is unclear whether this signifies that the man has changed his mind about the abortion, or that Jig has decided to go through with the operation and leave him so they have to live separate lives. Jig has desires to change and to live a different life because she is aware of it. She is ready and willing to experience a different life while her lover is not. If so many women were to take that to heart. You should not have to chose someone else’s happiness over your own. We set our paths and no one should think that they have te right to make your own life decisions. If we make a mistake it is our mistake. Life is to precious to waste.

Syliva Plath

â€Å"Sylvia Plath's poems open up a world of mental anguish for all to see. † Do you agree with this assessment of her poetry? Write a response supporting your points with the aid of suitable reference to the poems you have studied. I agree with this assessment. Before studying Sylvia Plath's poetry I understood mental anguish only as it's definition, â€Å"sustained, dull, painful emotion. † After studying Plath we see mental anguish really applies to her. We see mental anguish appears as anger in â€Å"Poppies in July† and inadequacy in â€Å"Morning Song†.We see Plath being effected by her mental anguish in all of her poems in nearly all of the emotions she shows us so honestly. It's her honesty that attracts us to her and her suffering of her mental anguish. I first came across Plath's mental anguish in â€Å"Poppies in July† which was inspired by the affair her husband had at the time. We see her mental anguish in her anger in this poem. She u ses fiery imagery and places the color red dominantly in our minds. An example of anger in this poem is when Plath says â€Å"Little poppies, little hell flames†. Plath's reference to the â€Å"Little poppies† as â€Å"hell flames† shows her anger by the imagery it gives.The use of â€Å"Little† suggests that Plath is being condescending towards the poppies. Also the reference to the poppies as â€Å"hell flames† says that only Plath sees the seemingly harmless poppies as being what they truly are. Mental anguish is also seen in frustration as well as anger. Frustration is noticed when Plath says â€Å"Little bloody skirts†. In this quote â€Å"little† is used again adding to the condescending feel in the repetition. Plath also says â€Å"bloody† which shows her anger and frustration. The use of â€Å"bloody† also keeps the colour red in our minds reinforcing her sense of anger.After seeing Plath's intense emotions of an ger and frustration she loses these feelings and becomes numb which shows another side of her mental anguish. She feels nothing, just empty, â€Å"dulling and stilling†. As well as the numbness Plath feels hopeless, â€Å"But colorless, colorless. † After feeling her strong emotions the red we felt is gone as she becomes numb and hopeless. From this we can see Plath's mental anguish in her strong emotions and by the way she portrays her words in such an aggressive way in â€Å"Poppies in July†. â€Å"Finisterre† links in to â€Å"Poppies in July† by it's intense atmosphere.Plath shows her mental anguish in her pessimistic outlook of the place which reminded her of a holiday with her ex-husband who we know from â€Å"Poppies in July† had previously an affair. We see her pessimism where she speaks of the deaths of the sailors and their shipwrecks at the cliffs of Finisterre, â€Å"Whitened by the faces of the drowned.. Leftover soldiers from old messy wars†, here Plath speaks darkly of the soldiers who died at the cliffs. We see that she relates to the soldiers and because of her mental anguish she feels like one of them, â€Å"I walk amongst them, they stuff my mouth with cotton. When they free me I am beaded with tears†.Plath also speaks of the mist, â€Å"souls, rolled in the doom-noise of the sea†. The mist represents the souls of the lost sailors who died when their ships struck the cliffs of Finisterre. She says that the sailors live on in the seas mist on the cliffs. As the poem goes on Plath's mental anguish intensifies as the landscape of Finisterre gets darker and becomes quite scary. Plath describes the landscape as the â€Å"sea exploding†, â€Å"messy wars† and â€Å"no bottom†, which creates a disturbing and very threatening image in our minds. The poem becomes less intense but remains dark as the feeling of despair arises.Plath describes the waves of the sea, †Å"They go up without hope like sighs†. At the end Plath's closing line, â€Å"These are our crepes. Eat them before they blow cold†, emphasizes the darkness of the poem by how trivial it is. The last line is so innocent and light it contrasts with the rest of the poem which is dark and intense. From â€Å"Finisterre† we see mental anguish in the intense pessimistic emotions and how Plath relates to the sailors and feels like one of them. We also see mental anguish in the switch of her tone in the last line which suggests deep mental anguish by the instability of the mood.When reading â€Å"Morning Song†, we see it relates to â€Å"Finisterre† by Plath's pessimism. She doubts her ability of being a mother and doesn't feel bonded to her child. We see Plath's mental anguish when she gives birth to her child and doesn't feel the bond they had from pregnancy. We see that she and her husband, Ted Hughes, feel inadequate, â€Å"we stand around blankly as walls†, we see that they are unsure of what to do with the baby and that the baby becomes the main of everyone as Plath and Hughes are as blank â€Å"as walls†.Plath expands more on how she doesn't feel like the baby's mother, â€Å"I am no more your mother than the cloud that distills a mirror†, we see how this really effects Plath from the negativity of the quote which shows us more of her mental anguish. Also the first line of the poem, â€Å"Love set you going like a fat gold watch†, shows how Plath feels towards the child. The word â€Å"fat† which comes across as a harsh strong word, wouldn't usually be associated with ones child which hints how Plath is really being effected by her mental anguish as another person would use â€Å"chubby† or â€Å"cuddly† which is a kinder description rather than â€Å"fat†.From â€Å"Morning Song† we can conclude that Plath's feeling of inadequacy is a result of mental anguish. Her mental anguish forces her to doubt herself and feel pessimistic on a the day of her child's birth which should be one of the happiest days of her life. Again we see pessimism in â€Å"Black Rook in Rainy Weather† like â€Å"Finisterre† and â€Å"Morning Song†. From the title of â€Å"Black Rook in Rainy Weather† a descending mood is already set. In this poem Plath is looking to be inspired to write poetry, but cannot find anything to be inspired by.Her mental anguish keeps her from being inspired and we see her become hopeless. â€Å"I do not expect a miracle†, here we see Plath has given up on hope and her mental anguish grows. We see the mood deteriorate even more as it goes on. She sets the descending mood when she says â€Å"Leaves fall as they fall†, the leaves from this quote represents the falling mood and the image stays with us as we read on. We see Plath become scared and fearful that because of her mental anguish she won't ever b e inspired to write poetry again. In the poem she is â€Å"trekking stubbornly†, hoping to be inspired but cannot.In â€Å"Black Rook in Rainy Weather† mental anguish plays a big role in Plath's life as it keeps her from finding inspiration which affects Plath very much. We can see she her deteriorate as poetry plays a big part in her life but her mental anguish stops her from writing. As well as seeing poetry being affected in â€Å"Black Rook in Rainy Weather† we see Plath's child being affected in â€Å"Child† which is another big part in Plath's life. In â€Å"Child† we see Plath at her absolute worst. We see how her mental anguish truly worsened and took its toll on her.Plath admits to herself that even though she really wants to, she cannot look after her child the way she should. Plath feels hopeless on a larger scale than ever, â€Å"This dark ceiling without a star†, she feels trapped in her mental anguish as if trapped in a dark ro om with no doors, windows or a way out. Plath wants to give her child the best life possible, â€Å"I want to fill it with color and ducks†, but knows that she cannot because of her â€Å"troublous wringing of hands†, and her mental anguish. In Child she realized that she cannot look after her child because of her mental anguish and feels that the child would be better off without her.From these references to Plath's poetry that I have studied we can conclude that Plath did suffer from mental anguish and her poems are evidence of that. We see how mental anguish effected her emotions and her abilities greatly from feeling like an adequate mother in â€Å"Morning Song† and developing writers block in â€Å"Black Rook in Rainy Weather†. We also see in Plath's poems the rollercoaster of emotions she feels due to mental anguish such as in â€Å"Finisterre† where it begins and progresses with a dark and intense atmosphere but ends erruptly in a light and trivial way. This is how Plath's poems open up the world of mental anguish.

Critical Care Sound Environments Health And Social Care Essay

ABSTRACT. Intensive attention units in infirmaries take attention of critically sick patients under really nerve-racking conditions. A turning literature is demoing that intensive attention units ( ICUs ) are frequently really noisy and frequently transcending World Health Organization ( WHO ) guidelines1,2. However few surveies have linked more elaborate analyses of the sound environment, such as mean sound force per unit area degrees, transient sound degrees, and spectral distribution, to nurse well-being and public presentation. This survey differs from old surveies in several ways. Namely, we have studied the possible impact of layout design applications on the features of ICU sound environments. This was accomplished by comparing the subjective and nonsubjective qualities of two ICU sound environments with different layout designs. Furthermore, the survey included: 1 ) detailed nonsubjective and subjective noise degree measurings at multiple locations in each of the two units st udied, and 2 ) analysis of the association between the aim and subjective noise degrees via different statistical trials, including analysis of the impact of the ICU sound environments on sensed nurse results.I. IntroductionThe sound environments of ICUs are aurally demanding while nurses endeavor to put to death complex undertakings. It hence becomes of import to understand the acceptable and unacceptable subjective and nonsubjective qualities of the ICU sound environments from the nurses` point of position. In this survey, we believe nurses ‘ perceptual experience of their workplace sound environment is critical for the rating of undertaking and nurse well-being supportive ICU sound environments. By matching the subjective perceptual experience measurings with nonsubjective sound degree measurings, we can derive a more thorough appreciation of how physical and perceptual acoustic parametric quantities interact in the ICU scene. In order to cast visible radiation on these con cerns, we focused on the undermentioned research inquiries in this comparative research survey: 1 ) Do nonsubjective noise degrees differ: ( a ) between assorted locations within an single critical attention unit? ( B ) when comparing similar locations in the two critical attention units to each other? ( degree Celsius ) when comparing overall ( mean ) degrees in the two critical attention units to each other? ; 2 ) Do nurses` noise-induced irritation and loudness perceptual experience differ: ( a ) between assorted locations within an single critical attention unit? ( B ) when comparing similar locations in the two critical attention units to each other? ; 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? ; 4 ) Is there a relationship between aim and subjective noise degrees? ; 5 ) Is there a relationship between noise degrees and noise-induced nurse results? II. PREVIOUS RESEARCHA. Overview of Hospital Acousticss1. ResultsThe acoustic environment in infirmaries can impact all residents, including staff, patients, and visitants. The undermentioned treatment in relation to the focal point of this survey is largely limited to the effects of noise on staff members: emphasis and irritation ; work public presentation ; wellness results and work overload. Information about how hospital acoustics may impact patients and visitants can be found in beginnings 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 patient 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 mis match between perceived demand and perceived self-capabilities to get by 4. Depending on the badness and continuance, it may take to illness ( i.e. , elevated blood force per unit area, dyspepsia ) , behavioural alterations ( i.e, unhappiness, depression, negative attitudes ) . Anxiety is a psychological responses 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 which 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 mean sound force per unit area degrees predicted higher sensed emphasis, and perceived irritation degrees in a Pediatric-ICU 7. In another survey, less sensitiveness to resound and greater personality robustness ( such as committedness, control, and challenge ) were linked with less noise-induced emphasis 8. In the same survey, ICUs nurses working eight-hour eventide displacements reported that they were significantly distressed by noise. There is some grounds that high noise degrees in attention scenes contribute to staff emphasis and irritation. However, the figure of noise-induced nurse emphasis surveies conducted in the ICUs is really limited. Work public presentation: Hospital sound environments that are supportive of 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 fou nd that noise in the workplace was perceived 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 clip can potentially interfere with work. This multidisciplinary literature reappraisal survey highlighted that undertakings necessitating rapid reaction clip and watchfulness are sensitive to resound. Noise-induced work public presentation research has been more normally conducted in the operating theatres 9-11. The impact of noise on staff public presentation ( particularly in ICUs ) has non been widely examined. Health results: The acoustic environment throughout the infirmary may lend to negative ague or chronic symptoms in staff. Critical attention nursing is a really demanding occupation and it requires uninterrupted watchfulness, watchfulness, and wellbeing to carry on critical undertakings efficaciously. The survey found that of the 47 ICU nurses surveyed in an ICU, reported annoya nce, weariness and concerns due to workplace noise 3. The earlier mentioned survey besides showed that addition in mean sound degrees was significantly related to an addition in bosom rate 7. Elevated bosom rate can tie in with cardiovascular harm particularly in hypertensive persons 12. Noise-induced hearing loss 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 yet 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 perceived work overload. When noise degrees exceed a nurse ‘s get bying abilities it can take to centripetal overload 6. Centripetal overload can do emotional exhaustion, dissatisfaction, and decreased sense of personal achievement. This in bend can do feelings of ineffectualness, awkwardne ss, low satisfaction, and perceived deficiency of success 15. In one survey, it was found that medicine mistake and other inauspicious events necessary for patient 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 bosom unit enhanced acoustical conditions such as decreased echo clip and improved address intelligibility improved staff attitude perceived by patients 18. The limited bing grounds points to a important job that should be investigated farther to find appropriate acoustic conditions that will minimise negative work overload effects.2. Acoustic prosodiesThere is a turning organic structure of literature on infirmary noise. Many 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 different methods have been used in qualifying the infirmary sound environment. The grounds of these methodological analysis differences are non good known 3 but may be related to motivations such as single penchants, practicality, common sense, convenience, the degree of proficient expertness, etc. ( 1 ) Overall noise degree steps: These steps have been preferred most normally. This may be based on their practicality and convenience, in add-on to their incorporation 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 elaborate analysis of the sound environment. ( a ) Leq: It enables the speedy comparing of the noise degrees with recommended values 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 relatio n to the degree of proficient expertness required to show some penetration about more elaborate features of the sound environment. However, this common belief can be misdirecting about the truth and adequateness of the usage of chiefly Leq degrees. ( B ) Lmax, Lpeak and Lmin: The highest and the lowest values measured over clip provide more information about the overall noise degree fluctuations. In most instances, these steps are conventionally 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 counterbalance the restrictions of the overall sound steps, the usage of extra acoustic prosodies is critical for the elaborate analysis of the sound environment. Compared to above mentioned sound steps, Ln percentile ( Ln ) , echo clip ( RT ) , speech intelligibility ( SI ) , and the spectral content such as frequence analysis and noise standards steps h ave been less normally used. Hospital acoustic research has been the involvement of different research groups such as medical groups and proficient groups. Based on the group ‘s proficient expertness on the subject, some acoustic prosodies might hold been preferred to the others. ( a ) Sound quality related steps: In the ICUs, there is diverseness of noise beginnings such as dismaies, HVAC systems, 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 fluctuations, tonic content, spectral distribution, and other features in the noise degrees over clip. ( B ) Speech quality related steps: Some other specific features of the infirmary room acoustic environment have been described 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 criti cal 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 important 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 methodological 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 either in a representative patient room 3,19,20 or in more than one patient room with different characteristics such as distance to the nurse station, occupied-empty, 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- while avoiding any 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 surveies 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 Br uel & 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 fast 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 intervals varied and ranged between 5sec and 24hr ( i.e. 30sec, 1min, 5minaˆÂ ¦etc. ) . Among ICU-noise surveies the usage of 1min averaging 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 A l. and Ryherd et Al. considered twenty-four hours and dark clip based on 12s hr nurse displacements ( twenty-four hours time:7am-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 time:7am-11pm ; 8hr dark time:11pm-7am ) 21. In drumhead, consistence of the methodological penchants in infirmary acoustics research can be really helpful for the dependability of the comparings between 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 â€Å" ICU Design Citation † award in 2008 for its design purpose to heighten the critical attention environment for patients, households and clinicians. Some unit design features include big private patient suites with household studio, dis trusted nurse work countries and care support countries and a scope of noise cut downing applications. High public presentation absorbent acoustic ceiling tiles and bead ceiling applications reside chiefly along the two parallel sides of the corridors and at the nurse Stationss, painted dry wall, vinyl flooring and 6ft broad ( two-wing ) glass patient room doors are some of the surface applications in the unit. Patient attention nucleus of the Neuro-ICU sits about on 19,000sqft. This nursing floor has a bunch type layout. The layout is composed 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 roomaˆÂ ¦etc ) and computerized patient monitoring system. In entire, the unit has two cardinal nurse Stationss and 17 distributed nurse work countries. Approximately 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. Entire 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 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 door 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 path layout design – medical and support countries are located 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 co rridors 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 contrast 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 either 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 venti lator and multiple informations points in the corridors. A sum of 96-hr uninterrupted stationary 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 computation of overall noise degrees in each unit, all sound informations collected at different locations were taken into consideration. Medical equipment dismaies happening in the patient suites, patient proctor dismaies happening 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 overhead 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 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 distance between 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 nurse 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 me asurement 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 units were approved by the charge 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 workpl ace, 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 two 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 between 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 â€Å" 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 unprompted sounds ( LFMax ) in the scenes exceeded peculiar noise degrees. This type analysis consequences are referred as â€Å" happening rate â₠¬  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 degree 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 respirat ory 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 ventilator 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. Average sound force per unit area degree ( LAeq ) differences between nurse Stationss, occupied patient suites and the corrid ors 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 happening 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 ( Table 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 nur se 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 loudness perceptual experience differ between assorted locations within an single critical attention unit?In MedSurg-ICU, perceived loudness degrees at the nurse station were significantly higher ( p & lt ; 0.05 higher ) than other three locations harmonizing to nonparametric significance trial consequences. Average degrees of subjective irritation and volume 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 loudness 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 corrido rs 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?A ­Perceived 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. 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 clearly noticeable noise degree differences occurred between two unit nurse Stationss and occupied patient suites. At 250Hz and 5 00Hz, 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 unfastened infinite in Neuro-ICU. This unfastened infinite about located in the centre of the unit and is non accessible 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 MedSu rg-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 pass on better at longer distances.G. HVAC background noise degreesBackground noise degrees caused by HVAC systems were calculated based on steady 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 accep table 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 lend to the on-going attempts to better health care sound environments. These attempts can enable more comprehensive analysis of helter-skelter 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 sig nificantly 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 impulse 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 be sides suggested important differences when comparing similar unprompted sound environments ( i.e. nurse station, occupied patient room and corridors ) in two units. Unlike 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 their 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 env ironments where major sound beginnings are medical dismaies, telephone ring, staff laugh and talkaˆÂ ¦etc. 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 ap plicationsAbove 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 experiences 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 popula ted 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 as copy-fax machine. Segregation 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 escalate complexness of the perceived sound environment33. 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. Th is happening can be related with unprompted ( high noise degrees at high frequences ) nature 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. Impulsiv eness ( 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 diagnosing 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 d egree 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 n't match to exigency degree of the incidence, integrating of higher engineering for paging health 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 an d 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.RecognitionsThis work has been partly supported by ASHRAE Graduate Student Grant-In-Aid. We appreciate GaTech Healthcare Acoustics squad members` partnership. We are thankful 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.