Urban Water Cycle Essay Example | Topics and Well Written Essays - 1250 words - 1

Urban Water Cycle - Essay Example Most urban centers receive their supply of water from a definite water entity such as a river, lake or a dam. The land area that surrounds the water source is its catchment. The level of cleanliness of a catchment area determines the water quality of the dam or river. A town that uses a dam or several dams as water reservoirs will receive water from rivers. In this regard, the state of the river will determine the water quality that enters the dam. The dam is the storage point for the water from rivers. It is normally built adjacent to a river to block a section of the flowing water and store it. It is from the dam that the urban population receive reliable water supply for their use. Although the water in the dam might look clear, it is not fit for human consumption yet. This is because it contains pollen, soil particles and dust. These particles contain viruses, bacteria together with several other microorganisms that can be harmful to human health. To remove these microorganisms, the water from the dam is first processed in a water treatment plant prior to its use. The water goes through some specific stages and steps at the treatment plant. Such stages include pre treatment, flocculation, filtration and chemical dosing. At the pre treatment level, a polymer called coagulant and alum is added to the water. The substances help to capture the solid particles that provide host to bacteria and viruses. The water free of the particles remains less turbid and clean. At the flocculation level, there is the removal of solid particle from the water. Mixing and circulation occurs for the solid particles captured in the pre treatment step to float on top in the form of froth. At the filtration level, the water is pumped through filters to get rid of the remaining particles. Finally, there is the addition of chlorine to get rid of the remaining microorganisms or germs, if any at the chemical dosing stage. This stage also involves the addition of fluorine for teeth prote ction and the adjustment of the pH level of the water.     After the above stages of treatment, the bulk main pipes supply carries the treated water to reservoirs allowing its distribution into smaller pipes into households. The reservoirs help the water stored to adjust with the changing demands. It also assists in the management of the pressure from users so that it flows to taps at expected speeds. Reservoirs can be either above or below the ground. The reservoirs supply water into homes through the service lines than branch from the mains pipe. After use at home, the water goes down the drain from where it enters the network of wastewater. The wastewater then flows into the sewerage system.

Organic certification Essay Example for Free

Organic certification Essay Marketplace Characteristics of U. S. Organic Sector The U. S. organic food industry crossed a threshold in 2000: for the first time, more organic food was purchased in conventional supermarkets than in any other venue. Industry estimates suggest that nearly half of the $7. 8 billion spent on organic food in 2000 was purchased in conventional retail outlets. Organic products are now available in nearly 20,000 natural foods stores (Natural Foods Merchandiser), and are sold in 73 percent of all conventional grocery stores (Food Marketing Institute). Growing consumer demand for organic products has been manifested in the market in many ways. Acreage of certified organic farmland is increasing to meet growing consumer demand. According to the most recent USDA estimates, U. S. certified organic cropland doubled between 1992 and 1997, to 1. 3 million acres. Preliminary estimates for 2001 suggest that certified organic acreage significantly increased between 1997 and 2001. From the consumer side, new products are being introduced rapidly. For example, over 800 new organic products were introduced in the first half of 2000. Desserts made up the majority of new products in 2000, while most new products introduced in 1999 were beverages (Myersand Rorie). The new U. S. Department of Agriculture standards for organic food, slated to be fully implemented by October 2002, are expected to facilitate further growth in the organic foods industry. The USDA standard defines organic production as â€Å"A production system that is managed in accordance with the [Organic Foods Production] Act and regulations in this part to respond to site-specific conditions by integrating cultural, biological, and mechanical practices that foster cycling of resources, promote ecological balance, and conserve biodiversity. † 1 The national organic standards address the methods, practices, and substances used in producing and handling crops, livestock, and processed agricultural products (see box). All agricultural products that are sold, labeled, or represented as organic must be in compliance with the regulations after October 2002. Organic food is sold to consumers through three main venues in the United States—natural foods stores, conventional grocery stores, and direct-to-consumer markets—and a small amount is exported to foreign markets. USDA does not have national statistics on organic retail sales. Industry sources have reported retail sales for organic food, but those data are fragmentary and, at times, inconsistent. A trade publication, the Natural Foods Merchandiser (NFM) reported estimates of total U. S. retail sales of organic foods for 1990 through 1996. NFM estimated total organic sales through all marketing outlets rose steadily from about $1 billion in 1990 to $3. 3 billion in 1996, the last year that total sales were reported. Since 1999, Packaged Facts, a market research firm, has been reporting organic food sales. According to Packaged Facts, organic food sales in all venues totaled $6. 5 billion in 1999 and $7. 8 billion in 2000. This increase continues the streak of industry growth equal to 20 percent or more annually since 1990. Purveyors of natural products were the primary sales force for organic food since the beginning of the organic food movement over half a century ago. Until 2000, the largest retail outlet for organic food was natural foods stores followed by direct markets (such as farmers markets), according to NFM data (fig. 1). In 2000, 49 percent of all organic products was sold in conventional supermarkets, 48 percent was sold in health and natural products stores, and 3 percent through direct-to-consumer methods (Packaged Facts). In contrast, in 1991, 7 percent of all organic products were sold in conventional supermarkets and 68 percent were sold in health and natural products stores (NFM). Fresh produce remains the top-selling organic category (see fig. 2), followed by nondairy beverages, breads and grains, packaged foods (frozen and dried prepared foods, baby food, soups, and desserts), and dairy products. During the 1990s, organic dairy was the most rapidly growing segment, with sales up over 500 percent between 1994 and 1999. Sales of organic yogurt and kefir increased 56. 4 percent between 1999 and 2000. Following closely, sales of nondairy beverages (for example, juice and soymilk) increased 53. 1 percent and sales of fresh produce grew by 51. 4 percent between 1999 and 2000, according to industry sources. Overall, according to Packaged Facts, organic sales in natural product supermarkets and conventional stores increased by 20 percent between 1999 and 2000. Organic farmers market their food directly to consumers much more frequently than conventional farmers do, and the last decade has seen a renaissance in the use of farmers markets across the country. Producers capture a much higher share of the consumer food dollar when they market their produce directly to consumers. Several surveys of certified organic producers show similar findings on theirheavy use of direct -to-consumer marketing. A 1997 survey of certified organic producers in the United States conducted by the Organic Farming Research Foundation (OFRF)—a California nonprofit group that sponsors research on organic farming—found that direct market use is extensive and varies by commodity sector, with fruits and vegetables the highest. Organic producers reported selling produce from about 23 percent of their vegetable acreage directly to consumers through on-farm sales (9 percent), farmers markets (8 percent), â€Å"community supported agriculture† subscriptions (4 percent), and other types of direct-toconsumer markets (2 percent). Also, produce from about 20 percent of the organic fruit and vegetable acreage was marketed directly to grocery retailers and restaurants. A 1994 USDA survey of certified organic vegetable producers in the United States found that the use of direct-toconsumer markets varied with farm size, with 60 percent of the growers with under 10 acres (three-quarters of the respondents) using this channel compared with 12 percent with 10 acres or more (Fernandez-Cornejo et al. ). Smaller growers tended to market directly to grocery retailers (11 percent versus 6 percent for larger growers) and through grower cooperatives (10 percent versus 3 percent for larger growers), while the larger growers marketed more heavily to vegetable packer/shippers, brokers, and food processors. Organically grown food is widely available in farmers markets across the United States, and organic-only farmers markets have been organized in Oregon, Illinois, Missouri, and other States. The renaissance in farmers markets in the United States during the 1990s—fostered by State and local municipalities wanting to revitalize neighborhoods and preserve regional farmland and open space— has been a boon to organic farmers who use this marketing outlet much more heavily than conventional farmers do. States are also producing directories of farm stands and pick-your-own farms, including organic directories, and developing logos like â€Å"Jersey Fresh† to promote locally grown food. Community-supported agriculture (CSA) is an innovative direct marketing arrangement that organic farmers have been pioneering in the United States for about a decade. Consumers subscribe to the harvest of a CSA farmer for the entire upcoming season, and pay for their produce in advance. Under a CSA arrangement, consumers share the production risks and variable harvests of the farmer— including especially abundant harvests—and sometimes participate in festivals and other social activities at the farm. Over 800 CSAs are currently listed in the U. S. database maintained by USDA and the Robyn Van En Center at Wilson College. Most of the CSA farms use organic production systems. Production Characteristics of U. S. Organic Sector A growing body of research in the United States has been devoted to the economics of organic production systems— its yields, input costs, income, profitability, and other economic characteristics. A 1990 review of the U. S. literature concluded that the â€Å"variation within organic and conventional farming systems is likely as large as the differences between the two systems† and found mixed results in the comparisons for most characteristics (Knoblauch, Brown, and Braster, 1990). Several more recent U. S. studies have indicated that organic price premiums are key in giving organic farming systems comparable or higher whole-farm profits than conventional chemical- intensive systems, particularly for crops like processed tomatoes and cotton (Klonsky and Livingston, 1994; Batte, Forster, and Hitzhusen, 1993; Assadian, Esparza, and Ponce, 1999). Other studies have found that organic systems may be more profitable than conventional systems, even without price premiums. For example, some Midwestern organic grain and soybean production was found to be more profitable than conventional systems, even without price premiums, due to higher yields in drier areas or periods, lower input costs, or crop mix (Welsh, 1999). Also, a recent study comparing organic and conventional apple production in California’s Central Coast showed higher yields as well as higher returns under the organic systems (Swezey et al. , 1994). And another recent study compared organic, conventional, and integrated apple production systems in Washington State over a 6-year period, and found that the organic system was more profitable, had similar yields, better tasting fruit, and was more environmentally sustainable and energy efficient than the other systems (Reganold et al. ). We are not aware of recently published research that finds farming with organic methods is less profitable than farming with conventional methods. Of course, net returns to various production systems may vary with biophysical and economic factors (such as soil type, climate, and proximity to markets), and a system that is optimal in one location may not be optimal in another. Also, factors not captured in standard profit calculations, such as convenience, longer-term planning horizons, and environmental ethics, can motivate rational adoption of a particular practice or farming system. Further research is needed to improve our understanding of the factors influencing net returns to organic farming systems. The promising results from the limited number of economic studies to date have led to an increase in research on organic farming systems. USDA, universities, and other U. S. institutions are increasingly examining the long-term economics of organic farming systems through replicated field trial research and a multidisciplinary systems approach. Most of these projects are less than a decade old, and promise to answer basic research questions about yields and profitability as well as to address farmer-defined management and production obstacles to the more widespread adoption of organic production systems. Farmers in 49 States used organic production methods and third-party organic certification services on 1. 35 million acres of farmland in 1997, according to an Economic Research Service (ERS) study. Crops were grown on about two-thirds of the certified U. S. organic farmland, and the rest was pasture. The ERS study analyzed data from 40 State and private certifiers (see box, p. 8, on organic standards and certification). Uncertified acreage was excluded, even though it may represent a large segment of organic production, because of the difficulty in determining the production criteria used by uncertified growers. ERS reports statistics on certified organic U. S. acreage in the Organic Farming and Marketing Briefing Room (www. ers. usda. gov/ briefing/organic). Organic farming has made deeper inroads in the fruit, vegetable, and other high-value specialty crop industries than in the major grain and oilseed industries. While less than two-tenths of 1 percent of the U. S.corn, soybean, and wheat crops were grown organically in 1997, over 1 percent of the dry peas and tomato crops and about 2 percent of the apple, grape, lettuce and carrot crops were organic. And nearly a third of the U. S. herb and â€Å"mixed vegetable† crops were grown organically in 1997. (A â€Å"mixed vegetable† crop is a mixture of numerous horticultural crops (mostly vegetables) grown on a small farm or parcel. ) The markets for organic vegetables, fruits, and herbs have been developing for decades in the United States, and these crops are grown organically in more States than any other type of commodity. State and private certifying groups certified over 180,000 acres of these crops in 44 States in 1997, more than double the amount certified in 1994, with the biggest gains for cultivated and wild-harvested herbs such as St. John’s Wort. About 2 percent of the major fruit and vegetable crops—apples, carrots, lettuce, and grapes—were grown organically, and a third of the organic vegetable acreage was devoted to producing â€Å"mixed vegetables† in 1997. Mixed vegetable farms, as defined in the census of agriculture, are small farms—less than 50 acres—that produce a large number of vegetables. Large farms produce processing tomatoes, organic wine grapes, and other high-value crops on a commercial scale, while numerous small farms still specialize in mixed vegetable production for direct marketing to consumers and restaurants. The top producer of organic fruits and vegetables was California, followed by Arizona, Florida, Texas, and Washington. About a third of the total certified organic vegetable acreage in 1997 was for mixed vegetables. In 1997, U. S. farmers certified nearly 3,000 acres of organic mixed vegetables on farms or parcels that were 5 acres or less, and over 14,000 acres on farms and parcels over 5 acres. New York organic producers had over 1,400 acres in the 5-acres-or-less category. Mixed vegetable producers often target farmers markets, community-supported agriculture subscriptions, restaurants, and other direct marketing outlets. Organic farmers are also growing major grains and oilseeds on a small portion of the planted area in the United States. Wheat was produced under certified organic farming systems on over 125,000 acres in 1997, corn was grown on over 42,000 acres, and soybeans were produced on about 82,000 acres. Other field crops produced organically in 1997 include barley, oats, sorghum, rice, spelt, millet, buckwheat, rye, dry peas, lentils, dry beans, flax, and sunflowers. Organic acreage of these crops, especially soybeans, has undoubtedly increased since 1997. Thirty-nine States had certified organic hay and silage production, with most acreage in Idaho, Wisconsin, and New York. Acreage of these crops expanded 51 percent between 1995 and 1997 as the number of certified organic milk cows more than doubled during that period. Organic meat and poultry markets have lagged behind those for crops partly because meat and poultry could not be labeled as organic until February 1999, when a provisional label was approved by USDA. Food crops and non-meat animal foods (eggs and dairy products) are regulated by the U. S. Food and Drug Administration, which allowed food packages to carry an organic label throughout the 1990s. 2 While the number of certified organic beef cows, hogs, sheep, and lambs declined during the study period (1992-97), the number of dairy cows and layer hens increased sharply. The market for organic meat products is beginning to grow now that organic labeling is permitted, and the growing market for organic milk and eggs has been pushing up the use of certified organic pasture and the demand for certified organic grains and oilseeds. Farmers and ranchers raised a small number of certified organic cows, hogs, and sheep in 23 States in 1997. Dairy cows were raised organically in 13 States in 1997, and New York, Wisconsin, and Minnesota were the top three producers. The number of certified organic milk cows in the United States nearly tripled between 1992 and 1994 and more than doubled between 1994 and 1997. California was the leader in organic poultry production, followed by New York and Virginia. Other organic animal specialties, including goats, fish, and colonies of bees, were certified in several States. Consumption Characteristics of the U. S. Organic Sector A number of academic and industry studies have been conducted to examine consumer behavior and identify their motivation for purchasing organic foods. Many of the industry studies use consumer surveys, which seek to identify how often consumers purchase organic food, their motivations for purchasing organic food, and demographic data on organic food purchasers. University studies have adopted different approaches to assess consumer buying behavior and to identify which characteristics (for example, income, food quality, educational level, concern for the environment, or family size) affect whether consumers will purchase organic food. Several industry groups have surveyed consumers about their preferences and buying habits for organic food. The results of the different surveys are not always consistent. The Nutrition Business Journal reported that 11 percent of consumers purchased some organic food in 2000, and less than 2 percent are regular purchasers. Results of the Hartman Group’s 2000 survey suggest that 3 percent of consumers regularly buy organic products. The Walnut Acres Survey (2001) found that 63 percent of respondents purchased organic food at least sometimes, and 57 percent of the purchasers had been doing so for at least 3 years. The Food Marketing Institute’s survey (2001) found that 66 percent of surveyed shoppers bought organically grown foods. In 2001, the Food Marketing Institute’s survey indicated that 37 percent of shoppers said they purchased organically grown food to maintain their health; and 44 percent of these shoppers had purchased organic food in the past 6 months. Consumers surveyed by the Hartman Group (2000) gave the following reasons for purchasing organic food: health and nutrition (66 percent), taste (38 percent), environment (26 percent), and availability (16 percent). 3 The Fresh Trends (2001) survey revealed that 12 percent of the shoppers surveyed reported that whether a product is organic is a primary factor in their purchasing decision. Sixty-three percent of the respondents of the Walnut Acres Survey believed that organic food and beverages were better for them and were more healthful than their conventional counterparts. Fresh Trends (1996, 1998, 2000, 2002) found little difference between the purchasing habits of men and women. Over the years, Fresh Trends found that, of the shoppers that had purchased organic produce in the previous 6 months, more purchased vegetables than fruit (according to the 1996 survey, 24 percent purchased fruit and 84 percent purchased vegetables; according to the 2000 survey, 35 percent purchased vegetables). Apples and tomatoes led the list of fruit and vegetables purchased by the shoppers surveyed by Fresh Trends. According to the Hartman Survey (2000), the top 10 organic products purchased were strawberries, lettuce, carrots, other fresh fruit, broccoli, apples, other fresh vegetables, grapes, bananas, and potatoes. The Hartman survey also suggested that fruits and vegetables were â€Å"gateway categories† (typically the first organic products purchased by consumers). The Walnut Acres Survey (2002) indicated that 68 percent of consumers revealed that price is the main reason they did not purchase organic food. Academic researchers have taken a slightly different tack in studying organic consumers by complementing surveys with statistical analysis to depict the typical consumer. Some studies reveal conflicting results, most likely because of the different methodological approaches. Consumers considered the following factors important when purchasing fresh produce: price, size and packaging, whether the item is on sale, and whether the item is organic (Estes and Smith). Age, gender, and having a college degree had little impact on a shopper’s decision to buy organic produce (Thompson and Kidwell). Consumers with higher incomes and higher levels of education are willing to pay more for organic potatoes (Loureiro and Hine), while consumers with advanced degrees are less likely to buy organic produce (Thompson and Kidwell). Appearance of fresh produce mattered, and the larger the number of cosmetic defects, the less likely would an organic product be purchased (Estes and Smith, Thompson and Kidwell). One picture of the typical organic shopper is a younger household in which females do the shopping; smaller and higher income households are the most likely purchasers of organic produce (Govindasamy and Italia) and organic apples (Loureiro et al. ). Households knowledgeable about alternative agriculture are more likely to purchase organic produce (Govindasamy and Italia) and those concerned about the environment are more likely to purchase organic apples (Loureiro et al. ). Those concerned about food safety are more likely to buy organic produce (Govindasamy and Italia) and organic apples (Loureiro et al. ). Those who enjoy trying new products are more likely to purchase organic produce (Govindasamy and Italia). Households with children under 18 are more likely to purchase organic produce (Thompson and Kidwell) and organic apples (Loureiro et al. ). Consumers with children are willing to pay less for organic potatoes (Loureiro and Hine) and more likely than other households to purchase organic apples (Loureiro et al. ). Strategies to increase purchases of organic food include shelf-labeling, which had a mixed effect on sales in an upscale grocery store but a significantly positive effect on sales of dairy products, pasta, bread, cereal, and carrots in a discount retailer in the Minneapolis and St. Paul markets (Reicks, Splett, and Fishman). The recent addition of organic food sales to scanner data, by AC Neilson and Information Resources, Inc. , has made possible econometric studies of consumer demand for organic food. Frozen organic vegetables, organic milk, and organic baby food all exhibited high price elasticity of demand, meaning that the quantity purchased responds greatly to price changes (that is, quantity purchased increases by more than 1 percent when prices fall by 1 percent) (Glaser and Thompson, 1999, 2000; Thompson and Glaser, 2001). For some frozen vegetables, there was little crossover between purchases of organic and conventional products, so that changes in prices of either commodity had no significant impact on quantities purchased (Glaser and Thompson 1999). For other products (milk and baby food), the conventional and organic products are substitutes, so that increases in the price of the conventional product result in consumers’ purchasing a greater quantity of the organic products (Glaser and Thompson, 2000; Thompson and Glaser, 2001). The Marketing Chain: From Farm to Market Food passes through many hands as it moves from farm to consumer. Some foods are fresh when delivered (apples and eggs) while others are processed before delivery (pasta and bread). Regardless of whether they are fresh or processed, higher quality products and products with unique attributes (such as organic foods) generally have a higher selling price. As a result, farmers have a strong incentive to produce and sell commodities with quality and other price-enhancing attributes intact. Yet, since most foods pass through a number of intermediaries as they move from the farm to the consumer, maintaining premium product integrity along the marketing chain can sometimes be a challenge. To do so, each agent along the marketing chain must begin by moving the product to the next agent quickly. Farmers need to sell their perishable commodities immediately after harvesting, while distributors, brokers, and wholesalers need to get fresh products to retailers as quickly as possible. Retailers want to be able to purchase a consistent and large enough supply of a wide variety of uniform quality fresh food. Consumers want to be able to buy a wide variety of fresh food that is both high quality and low priced. Organic food consumers, in particular, want to feel confident that they are buying food that not only was grown organically, but also has kept its organic integrity at each stage in its journey to the market. Each commodity, depending in large part on whether it is fresh or processed, follows an individualized path from farm to market. Because fresh foods rapidly deteriorate, they must be delivered to the market quickly. The storage and transportation systems along the way must provide the proper temperature and other conditions that help maintain freshness. Processed foods, on the other hand, have a longer shelf life—but the products that go into them must be harvested at the right time, delivered at the right time and satisfy the processor’s quality requirements. In the next sections, we trace the production and marketing chains for the major organic commodities in the United States, noting applicable regulations as well as observed marketing trends.

Patient Falls and Medication Errors Essay example -- Health Care, Pati

Issue/Problem of Interest Falls are the second most common adverse event within health care institutions following medication errors, and an estimated 30% of hospital-based falls result in serious injury. The severity of this problem led the Joint Commission to make reducing the risk of patient injuries from falls a national patient safety goal for hospitals in 2009 (AHRQ, 2006). Falls are a leading cause of hospital-acquired injury and frequently prolong and complicate hospital stays and result in poor quality of life, increased costs, and unanticipated admissions to long-term care facilities. Changes in health care financing in the 1990s were accompanied by a variety of cost-cutting measures in hospitals across the United States. Common cost-cutting strategies included reducing the total number of nursing hours per patient day and reducing the percentage of hours supplied by registered nurses (RNs), the most highly paid group. The reduction in staffing led to widespread concern that patient care in acute care settings would suffer. In response to concerns about staffing and quality of care, the American Nurses Association (ANA) launched the Patient Safety and Nursing Quality Initiatives in 1994 to address the impact of health care restructuring on patient care and nursing. To facilitate the initiative, ANA established the National Database of Nursing Quality Indicators (NDNQI) in 1997, with two goals: (1) to develop a database that would support empirical monitoring of the impact of nurse staffing on patient safety and quality of care across the nation, and (2) to provide individual hospitals with a quality improvement tool that includes national comparisons of nurse staffing and patient outcomes with similar hospi... ...al adverse incidents, depending on the patient population studied (Hitcho, 2004). The rates vary from 1.9 up to 18.4 falls per 1,000 patient days depending on organization type, and according to a study by the National Council on Aging, 30% of these incidences result in serious injury (Stevens, 2004). Another significant consequence of falls is that they are expensive and contribute to the increasing health care expenditure. An estimate of the average DRG payment for injuries sustained by a patient falling is $25, 643 (Hart, Chen, Rashidee, and Sanjaya, 2009). This is significant in that with the developing atmosphere of pay-for-performance, initiated by CMS, hospitals now have a major monetary stake in reducing the number of fall-related injuries. The CDC estimates that the cost of fall injuries will exceed $23 billion within the next few years (Tzeng, 2008). Patient Falls and Medication Errors Essay example -- Health Care, Pati Issue/Problem of Interest Falls are the second most common adverse event within health care institutions following medication errors, and an estimated 30% of hospital-based falls result in serious injury. The severity of this problem led the Joint Commission to make reducing the risk of patient injuries from falls a national patient safety goal for hospitals in 2009 (AHRQ, 2006). Falls are a leading cause of hospital-acquired injury and frequently prolong and complicate hospital stays and result in poor quality of life, increased costs, and unanticipated admissions to long-term care facilities. Changes in health care financing in the 1990s were accompanied by a variety of cost-cutting measures in hospitals across the United States. Common cost-cutting strategies included reducing the total number of nursing hours per patient day and reducing the percentage of hours supplied by registered nurses (RNs), the most highly paid group. The reduction in staffing led to widespread concern that patient care in acute care settings would suffer. In response to concerns about staffing and quality of care, the American Nurses Association (ANA) launched the Patient Safety and Nursing Quality Initiatives in 1994 to address the impact of health care restructuring on patient care and nursing. To facilitate the initiative, ANA established the National Database of Nursing Quality Indicators (NDNQI) in 1997, with two goals: (1) to develop a database that would support empirical monitoring of the impact of nurse staffing on patient safety and quality of care across the nation, and (2) to provide individual hospitals with a quality improvement tool that includes national comparisons of nurse staffing and patient outcomes with similar hospi... ...al adverse incidents, depending on the patient population studied (Hitcho, 2004). The rates vary from 1.9 up to 18.4 falls per 1,000 patient days depending on organization type, and according to a study by the National Council on Aging, 30% of these incidences result in serious injury (Stevens, 2004). Another significant consequence of falls is that they are expensive and contribute to the increasing health care expenditure. An estimate of the average DRG payment for injuries sustained by a patient falling is $25, 643 (Hart, Chen, Rashidee, and Sanjaya, 2009). This is significant in that with the developing atmosphere of pay-for-performance, initiated by CMS, hospitals now have a major monetary stake in reducing the number of fall-related injuries. The CDC estimates that the cost of fall injuries will exceed $23 billion within the next few years (Tzeng, 2008).

Political Corruption and Empowerment Essay

Participation is dynamic process aimed at involving the masses so that they can formulate their own end goals and work together to realise them. Masses cannot be forced to participate in projects which affect their lives but should be given the opportunity where possible. Empowerment Empowerment is an initiated process that enables the masses to gain power and extend it in such a way that they can use this power to share in changing social, economic and political structures. Empowerment is successful if the participants regard the result of their action as beneficial. Therefore participation is a cornerstone of empowerment. It is a prerequisite for achieving empowerment. Empowerment is one of the consequences of participation, which means that if we want masses to gain power, they must participate. Empowerment is generally seen as a key for good quality of life, increased human dignity, good governance, pro-poor growth, project effectiveness and improved service delivery (Narayan. 2002. 8.). Bureaucracy It means the structure and set of regulations that control the activities of people that work for these organizations. It is characterized by standardized procedure (rule-following), formal division of responsibility, hierarchy, and impersonal relationships. Bureaucratic leader are concerned with ensuring workers follow rules and procedures accurately and consistently. The bureaucracy does not create or initiate policy, but it does implement policy decisions. Why mass participation and empowerment are important Empowerment puts people at the centre of the development process; it implies a participatory approach to development focusing on bottom-up approaches rather than top-down bureaucratic methods. Empowerment increases the capabilities of the poor to influence and hold accountable the institutions that provide for them. To this end, empowerment attempts to give power and knowledge to rural communities to assist in creating a better quality of life, so that in the future they will have the skills to rely less on external forces to provide vital services and infrastructure. Mass participation is an essential part of the process of good local governance, and empowerment. To be meaningful, these processes must be seen as fundamental values of Healthy Cities and so must be developed as an integral part of long-term strategic development. Empowerment of mass is associated with cleaner business and government, and better governance. Specifically, the greater their involvement in public life, the lower the level of corruption, even in countries with the same income, civil liberties, education, and legal institutions. Masses Empowerment through inclusion, voice, and accountability can also promote social cohesion and trust, qualities that help reduce corruption, reinforce government and project performance, and provide a conducive environment for reform, with consequential benefits for development effectiveness and economic growth. Finally, empowerment or lack of it can also have positive or negative socio-political effects on the outcomes of countries’ poverty reduction efforts. Why the concept of mass participation has been illusive in the third world There are some serious failures of the international community to contribute meaningfully to empowerment and participatory approaches. If countries are not willing to support countries that need help, then the future is bleak. Aid allocations need to increase if meaningful solutions are to occur. Making the rural poor involved in empowerment and participatory programs is hard to achieve due to their social exclusion. The gap between the poor in rural areas and those who are more wealthy is large and widening Because the rural poor are socially excluded, often development organisations such as the World Bank think of the poor are ignorant and complacent. More often they are not excluded from participating in projects in a meaningful way, due to pre existing biased views that they are not worthy, or indeed, have the skills to participate effectively. (Courtney et all in Godinot and Wodon (ed). 2006. 3). Lack of empowerment amongst rural people leads to their vulnerability and thus most development projects tend to benefit the benefactors rather than the beneficiaries. In light of this sustainable development is not achieved because non-participation of local people means that rural development is not self-sustaining. Therefore, local rural people play an important role in rural development because they understand their situation and problems better than the government, aid agencies and other stakeholders. This highlights the gap between the reality and ideal of empowerment and participatory development where the poor themselves are considered the centre of the process and the most vital players. Rural areas in developing countries experience large problems associated with access to basic amenities and services. Attempts to resolve this situation involve development programs using community empowerment in rural areas of developing nations to ameliorate instances of poverty. The aspirations deep inside the poor can only be brought out by making them the centre of the development process. They have difficulty expressing them due to their exclusion. How mass participation and empowerment are promoted or discouraged by the action of bureaucracy The problem with bureaucracy is that Executives want to control everything; even the simplest administrative decision has to be approved at the top. . One problem is unnecessary delays in outputs (Waterston 1965:259) , for even though there are more than enough officials in the lower administrative ranks, they are not effectively employed in the posts to which they were appointed. Political involvement of officials – when bureaucracy becomes involved in politics, this stimulates corruption. Officials start taking decision and performing actions that will benefit themselves, or groups in which they have an interest. Corruption is out of control. Development funds are siphoned off to hire friends or relatives. In some cases the money simply disappears. The misuse of office by government functionaries is relatively common in areas of public procurement, revenue collection, government appointments and contracts, licensing and permits. In these areas of specialty, graft and venality are readily executed through anyone of the following activities: The civil servant receives from a private contractor a fixed percentage of awarded government contracts; the kickback may be in kind, such as free education for the children in foreign institutions, or in cash, paid directly into bank account. Police or other law enforcement agents use the threat of sanctions to extort bribes in lieu of official fees or taxes. But paying bribes to avoid taxes or fees is equally damaging to society since governments depend on such revenues to provide public goods. The relative absence of revenues from taxes and fees also means less compensation for civil servants, which leads to more corrupt practices. One of the reasons adduced by low- level government employees for demanding bribes is the infrequency of their monthly salary. Government employees in essential services, e.g. law enforcement, electric power supply, telecommunication etc. Customs agents insist on payments above the official rates or side payments before providing requisite services to both importers and exporters. Those unwilling to pay bribes stand the chance of losing their merchandise through forfeiture or theft. Civil servants award large contracts to companies owned by relatives or partners, and in return receive an agreed upon fee or lavish hospitality. Officials responsible for permits and licenses demand extra payment for services ordinarily called for by their office; in cases where expediency is requested, a great deal more is demanded to speed-up the process. Bureaucracies’ themselves create the causes of corruption. Salaries are low, housing is poor, officials lack professional qualification and status, all of which means that officials do not feel motivated to do good work, or to be loyal to the organisation. When a country’s resources are continually misallocated by corrupt government officials bent on maximizing their short-run selfish interests, development is severely hindered through a multitude of social and economic dislocations. The bureaucracy is unresponsive to the needs of the public; there is an atmosphere of official’s indifference and unsympathetic attitude toward the needs of the people. This is caused by the strictly centralised nature of the bureaucracies, the lack of mass participation and consequent lack of contact with the populace. A bureaucracy, crucially, is not only a structure, a mere organigramme with functional relationships and roles. It is a group of people with lives, emotions, aspirations, energy, passion and values. Those that work in them often have strong values, great intentions and good ideas. Most want to do good and not be negative. Somehow, however, good intent can evaporate as the dynamic of the organizational ‘system’ unfolds. Can the positive virtues and potential of public sector bureaucracies and the people working in them be rediscovered? These include fostering fairness, equity, and equality of opportunity, being neutral and transparent. These are important achievements of democracy, yet the focus on efficiency can obscure these intentions. The most effective organizations are those where people feel they can be engaged and where their commitment to the organization lies beyond a contractual relationship and where a deeper emotional bond can be established both to the work itself and the organization. In these situations people feel they are able ’to be our true selves’ and to have a ‘creative presence’ so that working gives the sense of ‘pregnant possibilities’ and where they can develop ‘an intensity that feels and appears effortless’. Here energy and passion can come into alignment. Conclusion /My view The participation of communities in development projects is a major aspect of an empowering approach. Participation works well at the small scale. Community based organisations if trained correctly can manage and supervise locally based construction and maintenance activities very effectively (Meshack. 2004. 61). There is a fine balance between success and failure of participation in that it needs to be locally based with little input from external forces. Governments and donors can in fact undermine contributions made by the community in that they take over projects and locals lose their sense of ownership (Meshack. 2004. 61). Participation in development projects does however need outside stakeholders but the community needs to be the one driving the project, as there are many people who can contribute to a development project. Empowerment involves expanding the capabilities of the poor. Its main process involves putting the community at the centre of the development process. The community becomes empowered due to the fact that they have a certain degree of control over their own resources, they gain a sense of ownership over the service or infrastructure being provided. One of the main concepts involved in creating efficient empowering projects include the access of the community to information, as informed citizens make better development decisions. Accountability in the development process is another crucial aspect of an empowering approach. Increasing the capabilities of the poor specifically refers to local organisational capacity. This is when a community works together to mobilise resources and tackle problems as a group. This is another major process involved in community empowerment.

Relationship Between the Criminal Justice System and Mental Illness

With nearly 300,000 mentally ill individuals housed within local, state, and federal prison systems, issues of mental health care within the criminal justice system are at the forefront of debate. While steps such as increasing medications and providing at least marginal support for the mentally ill within state institutions are improving the situation, recidivism rates, homelessness, and violence against ill prison inmates is still a major problem in today's society. The product of deinstitutionalization, this problem of warehousing the ill within the criminal justice system must be attended to in order to create an atmosphere of care for the mentally ill. By altering legislation against involuntary assistance, increasing knowledge and awareness through the criminal justice system, and an increase in community care following release, the criminal justice system can create a cost effective solution to the problem of untreated mental illness within the system. The Relationship between the Criminal Justice System The relationship between mental illness and the criminal justice system has been one of intense scrutiny over the past several decades. Issues such as treatment options within state and federal prison systems, behavioral consequences of mental illness, and length of stay issues have all been deliberated intently by the psychiatric and legal community. These studies have indicated that severe problems exist within the system in terms of the care mentally ill individuals receive while incarcerated. This paper will focus on the issues of the mentally ill prison inmate, and will review current literature which suggests that although steps are being taken to solve some of these issues, more work must be undertaken to solve the problem of mental illness within the criminal justice system. In the correctional system today, there are nearly 300,000 mentally ill individuals, as compared to only 60,000 currently residing in state psychiatric hospitals (Faust, 2003). While only five percent of the population within the United States suffers from some form of mental illness, sixteen percent of individuals within the U.S. prison system suffer mental illness, clearly showing an over representation of these individuals within the system (Ditton, 1999). Some studies even suggest that the rate of incarceration of the mentally ill is four times that of the general population for males, and nearly six times that of the general population for females (Cox, 2001). The question, then, may be asked if the criminal justice system is ignoring the issues of mental illness, but studies suggest this is not the case. In the Los Angeles county jail system alone, over $10 million a year is spent on psychiatric medications for inmates (Faust, 2003). Another study showed that nearly half of all U.S. states have, in the last four years, established commissions or task forces specifically designed to look into the connection between the mental health system and the criminal system. Further legislation has been introduced in five states calling for such commissions (Souweine, 2004). In some states, such as Ohio, serious efforts have been put into place to assist the mentally ill. Ohio state prisons have quintupled the number of mental health professionals on staff, developed better mental health screening, provided more beds for the criminally insane, improved guard training, and improved funding for inmate mental health care (Kaufman, 1999). With all of these efforts in place, it is difficult to see why the problem of untreated mental illness exists. In order to understand the problem, it is essential to first understand the origins of the situation. In the mid-1950's through the 1970's, attempts were in force to dismantle the warehouses of the mentally ill through a process known as â€Å"deinstitutionalization†. At the time, mental institutions were simply holding areas for the insane, with sparse living conditions, harsh â€Å"treatment† procedures including electroshock therapy in unsafe conditions, and brutalization of patients (Treatment Advocacy Center, 1999). Following concerns about civil rights issues, cost issues, and a desire to move to a more â€Å"outpatient† approach, numerous legislations were enacted to â€Å"deinstitutionalize† the population of mental health hospitals. First in 1965, the federal government passed legislation that specifically excluded Medicaid payments for inmates housed in state psychiatric hospitals. As a result, the states were now required to provide care, and, looking to lower costs, many discharged hundreds or thousands of patients into society (Treatment Advocacy Center, 1999). In addition, legal reforms in the 1970's were passed that required an individual to be a danger to himself or to others in order for him or her to be treated involuntarily for their illness (Faust, 2003). The result was another mass release of patients into society. The results of deinstitutionalization are clear. Since 1960, nearly 90 percent of psychiatric beds in state hospitals have been removed. In 1955, nearly 600,000 individuals resided in state psychiatric hospitals; the number today is less than 70,000 individuals (Treatment Advocacy Center, 1999). Unfortunately, however, these numbers are misleading, in that they suggest a reduction in the number of mentally ill individuals, which is not the case. For many deinstitutionalized patients, the end result was simply a transinstitutionalization, or change of residence. While the Medicaid funds had been withdrawn for state psychiatric hospitals, those funds were still available for individuals with mental illness residing in nursing homes and general hospitals. As a result, many patients were simply transferred to these types of settings, where treatment options and care for the mentally insane were not nearly as advanced. By the mid 1980's, nearly 23 percent of nursing home residents had some form of mental illness (Treatment Advocacy Center, 1999). For other deinstitutionalized patients, the results were far more disastrous. According to recent studies, nearly 200,000 individuals with schizophrenia or manic-depression are homeless (Treatment Advocacy Center, 1999). Another 200,000 of the homeless population suffer from other forms of mental illness. As homeless individuals, many of these patients are unable to maintain any form of treatment or medications, and thus are unable to receive the care they desperately need in order to function in society (Faust, 2003). Unfortunately, for many of these individuals, criminal incarceration in the final result. In some cases, family members who are unable to force their relatives into treatment facilities due to the involuntary treatment laws have no choice but to wait until the illness causes harmful behaviors. At that junction, the police are contacted, and the individual is removed to a correctional facility (Faust, 2003). Since it is now common practice to give priority to mentally ill individuals awaiting court proceedings, many family members find this method the only option for obtaining assistance (Treatment Advocacy Center, 2000). The result, according to a 1992 study, is that over 29 percent of jails in the U.S. criminal justice system report holding mentally ill individuals with no charges against them. Certain states, such as Montana, Wyoming, and New Mexico, allow such situations if the individual is being held awaiting psychiatric evaluation, a psychiatric bed in a state hospital, or transportation to that hospital (Treatment Advocacy Center, 2000). Many of these individuals are held after arrest for misdemeanors, such as trespassing, disorderly conduct, or vagrancy (Treatment Advocacy Center, 2000). In fact, nearly half of the mentally ill inmates housed within the criminal justice system at any given time have been arrested for a non-violent crime (Ditton, 1999). Additionally, studies have shown that substance abuse is often involved with many mentally ill individuals (Teplin and Abram, 2000). As a result, these individuals are often arrested for alcohol and drug related offenses (Treatment Advocacy Center, 2000). In many of these arrests, police are attempting to protect these individuals from harm, such as robbery, beatings, and rape, and therefore perform â€Å"mercy bookings† or unnecessary arrests in order to house the mentally ill (Treatment Advocacy Center, 2000). While these methods certainly provide some form of housing for the mentally ill, the consequences of that housing are astronomical. First, the costs of mentally ill housing within the criminal justice system are staggering. According to the Department of Justice in 2000, American taxpayers pay $15 billion annually for individuals incarcerated in jails and prisons with mental illnesses (Bureau of Justice Statistics, 2001). Additionally, while these inmates do receive some form of psychiatric care, the costs of such care are much higher than that of community care centers, while the outcomes of such treatment is often much lower. According to the Department of Justice in 2000, one in every eight state prisoners were receiving some form of mental health therapy, and of the 1,558 state correctional facilities in the nation, 1,394 provided some form of mental health care. Nearly 70 percent screen inmates at admission for mental health issues, 65 percent conduct regular psychological assessment, half provide 24-hour psychological services, nearly 75 percent distribute psychotropic medications, and 66 percent assist released individuals with obtaining community mental health services (Bureau of Justice Statistics, 2001). However, even with the steps in place, the programs tend to not be as intensive nor as successful as those in a more clinical or community setting. Drug therapy, used in nearly 60 percent of the mentally ill housed within the correctional system, has been shown to be less effective than drug therapy combined with other forms of therapy (Bureau of Justice Statistics, 2001). Since nearly two-thirds of the mentally ill inmates are housed within units not specializing in mental health services, many are not receiving forms of treatment shown to be effective (Treatment Advocacy Center, 1999). In addition to the problems with mental health care in state institutions, local institutions fare even worse. A 1992 study of American jails functioning outside of the state or federal level showed that one in five systems had no access to mental health services whatsoever. Furthermore, 84 percent of these systems reported their staff to have received either no training or less than three hours of training in dealing with mentally ill inmates (Treatment Advocacy Center, 2000). Clearly, simply housing the mentally ill within the state and local criminal justice system institutions is not cost effective, nor effective in terms of treatment given. However, there are even more drastic consequences of using the criminal justice system as a holding area for the mentally ill. First and foremost, mentally ill patients have special needs outside of simple medicinal requirements. Patterns of illogical thinking, delusions, hallucinations, severe mood swings, and other symptoms of mental illness tend to occur even in medicated mentally ill individuals. In the prison system, these symptoms which lead to bizarre and unpredictable behavior are often misunderstood by personnel that have not been trained in these types of illnesses. As a result, non-ill inmates and the personnel themselves may react with violence and punishment that is detrimental to the already fragile mental health of the individual (Treatment Advocacy Center, 2000). Still further, rape, a commonly known occurrence in prison systems, is more likely to occur in individuals who are unable to defend themselves due to confusion and disorientation as a result of their mental illness (Hiday, et al, 1998). These patterns of behaviors also lead to longer prison sentences for mentally ill inmates. In one study, done in Riker's Island Prison, the average length of stay for an inmate was 42 days. In comparison, the average rate for a mentally ill inmate was 215 days, a length five times that of a non-ill inmate. In a similar study in Pennsylvania, only 16 percent of released prisoners had served their complete sentence. Of those, the mentally ill were three times as likely to serve their complete sentence as those who were not ill (Ditton, 1999). Perhaps one of the largest problems facing the mentally ill who are incarcerated is finding community resources for equal or greater care following their release. A study completed it 1992 showed that nearly 30 percent of mentally ill inmates released commit another act within four months of release (Treatment Advocacy Center, 1999). For many, this recidivism rate is due to a lack of medications necessary to maintain a stable mental health condition. In addition, many of these individuals find themselves homeless following release, which further limits their ability to receive further treatment (Ditton, 1999). It is clear that, although the current criminal justice system certainly attempts to care for the mentally ill, more needs to be done to ensure these individuals are continuously cared for. One such step, supported by the National Sheriff's Association, is to consider new laws altering the requirements for mental ill treatment. The NSA suggests laws which would allow treatment based on a â€Å"need for treatment†, rather than simply a show of â€Å"dangerousness†. The NSA also supports measures to allow a court order to assist in outpatient treatment of individuals in the community who need such treatment, but refuse it (Faust, 2003). Many studies have shown that mentally ill individuals often are not aware of their illness and thus, refuse treatment despite their clear need for such measures (Teplin and Abram, 2000). According to a long term study supported by the NSA, long term treatment combined with routine outpatient services reduced rearrest by nearly 74 percent ( Faust, 2003). Further, increasing the availability of community services following release has shown to be an effective measure in controlling the issue of mentally ill inmates upon their release. In Cook County, Illinois, case management for released inmates is provided by the Thresholds Jail Program. The individuals of Thresholds provide 7 day a week case management for as long as the member needs assistance, and even searches the streets for those individuals who are homeless at the time of release. This commitment has resulted in an 80 percent reduction in the need for hospitalization or incarceration of released inmates. Funded through the Illinois Office of Mental Health, the program costs $25 a day, in comparison to $70 a day for incarceration, or $500 a day for hospitalization (Thresholds, 2006). Additionally, ensuring mental health screening measures, improving personnel training, and providing qualified mental health staff in all criminal justice systems, including local jails, would also help to decrease the issues related to the mentally ill within the system. In Ohio, where such measures have been implemented, there has been a dramatic increase in the care of the mentally ill. Reports show less mentally ill prisoner abuse, smaller punishments for rule infractions, and an overall increase in inmate mental health. Even further, recidivism rates of the mentally ill in Ohio have fallen nearly 80 percent (Kaufman, 1999). Deinstitutionalization had drastic effects on the future of the mentally ill in America. Unfortunately, the criminal justice system has become a replacement warehouse for the mentally ill, providing basic housing and medication for these individuals only for the duration of confinement. Once released, and even in some smaller prison systems, the inmate is left without adequate mental health treatment or medication, resulting in an endless spiral of illness and incarceration that is costing billions of dollars a year, and the lives of many mentally ill individuals. By creating new laws which allow treatment based on need, utilizing existing community resources on release, and increasing the knowledge and awareness of such issues within the personnel of the criminal justice system, these individuals can become productive members of society at a far lower cost, creating a better situation for all involved.