Life expectancy at birth in the United States

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Americans weren’t a particularly healthy lot even before COVID-19 killed one million of us. On the contrary, life expectancy at birth in the United States had actually declined for at least three consecutive years prior to the arrival of the pandemic, a trend that is both worrisome and nearly unprecedented.

Just in case you were wondering, the last time the U.S. saw life expectancy decline three years in a row was in the wake of the Flu Pandemic of 1918, which killed more than 600,000 Americans before it ran its course.

 

So, what was killing us in the halcyon days before we were encouraged to wear masks to the grocery store? The short answer is: it’s complicated.

Most researchers point the finger at some combination of the excessive prescription of drugs like Oxycontin, the wide availability of black market opiates and opioids (i.e., heroin, fentanyl, etc.), and widespread socioeconomic changes that effectively hollowed out formerly prosperous communities.

 

The four readings below each address what is colloquially known as “The Opioid Epidemic,” albeit with slightly different goals and from slightly different perspectives.

 

Objectives

The main purpose of this assignment is for you to use the readings below to develop your own notion of the key similarities and differences between qualitative and quantitative research. So, yeah… try to do that, okay?

Readings

I’d like you to begin with this overview of the opioid crisis. It’s not the most exciting item on this list, but it will help you put the other three in context.

The second reading is an excerpt from a book called Deaths of Despair and the Future of Capitalism (Links to an external site.) by Anne Case and Angus Deaton.

Both Case and Deaton are economists by training, though they’re also considered experts in public health.

The third item is an eye-opening account of how the average person goes about transitioning from taking Oxycontin to shooting heroin.

Finally, we have an excerpt from a book called Dopesick: Dealers, Doctors, and the Drug Company that Addicted America (Links to an external site.) by Beth Macy.

Although I strongly disapprove of anyone’s using the word “addicted” as a verb, Macy has done a helluva job compiling detailed interviews and crafting them into a compelling, if heartbreaking, narrative.

Assignments

In total, this assignment requires that you write four blurbs (one for each of the aforementioned readings) and one brief summary conclusion. Each blurb should address the following questions:

 

Does this article tend more towards the quantitative end of the spectrum (i.e., surveys, figures, and/or numbers) or towards the qualitative end of the spectrum (i.e., interviews, quotes, etc.)?

What is the objective of this article? In other words, is there a clear research question? What aspect(s) of the opioid crisis is the author trying to explain/address?

What information/context/viewpoint does this particular article add to the discussion of the opioid crisis that isn’t available in the other three articles?

If someone were to skip the other three articles and ONLY read this one, what information/context/viewpoint would they miss out on?

If I were doing this assignment, one of my blurbs might read something like this:

 

“Because this article mostly relies on interviews, it’s definitely more on the qualitative side of things. The author’s objective is to highlight the ways in which Purdue Pharma’s deceptive marketing tactics downplayed the addictive potential of its flagship painkiller, Oxycontin.

Given that the other articles focus primarily on the damage caused by the opioid crisis, this article provides important context by examining how so many people became addicted in the first place.

That is, the other readings trace how someone might progress from pills to syringes to an early grave, but they don’t mention that many of the victims of this crisis got started while recovering from something as simple as a routine surgery.

Finally, if someone were to skip the other pieces and just read this one, they might not fully grasp the devastation this crisis has wrought on individuals and families. This article makes the whole situation sound more like a white-collar crime than anything else.”

 

Finally, you will conclude this assignment by writing a brief, 1-2 sentence summary in which you explain what you see as the most salient difference between quantitative and qualitative research.

Anyone who chooses to complete that summary in the form of either a limerick or haiku will receive up to five extra credit points on their final project (I say “up to five extra credit points” because not all student poetry deserves the full complement of bonus points; if you half-ass it, you might only get 2.5).

Slippery Slope of Legalization of Physician-Assisted Suicide

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The Slippery Slope of Legalization of Physician-Assisted Suicide. The American College of Physicians (ACP) positionpaper on the legalization of physician-assisted sui- cide reaffirms the ACP’s opposition to this practice, even though it is now legal in several countries and U.S. jurisdictions (1).

The ACP’s position deserves credit for its clarity and courage.

Among other achievements, the ACP paper identi- fies “euthanasia” and “medical assistance in dying” as euphemisms. These terms do what euphemisms are supposed to do: make a distasteful subject palatable, or at least discussable.

The social process of change in ethical and moral standards makes bold use of such euphemisms. At one time, “mercy killing” and physician-assisted suicide were both illegal and un- thinkable. However, times are changing, and the changes have followed a recognizable pattern (2).

First, the unthinkable becomes discussable although highly controversial. After a while, it is seen as acceptable un- der certain circumstances. As it becomes more familiar, it seems increasingly sensible and reasonable. Finally, it is established as a legal right. In this way, what was once unthinkable can eventually become policy, or even a duty (3).

Space limitations permit only a brief consideration here of arguments for and against medically assisted suicide.

The argument in favor that is based on “non- abandonment” ignores a conscientious physician’s commitment to relieve suffering and to accompany sick and dying patients to the very end. We all should provide “medical assistance in dying” and not abandon our suffering patients. This argument also tends to stig- matize those who object to suicide as a solution to suffering.

The “slippery-slope” objection to medical suicide and euthanasia may be dismissed as alarmist, but it is not easily refuted. Euthanasia was legalized in the Neth- erlands in 2002, with multiple safeguards against abuse.

However, in 2015, the Dutch government re- ported that hundreds of persons were put to death without their express consent or because of psychiatric illness, dementia, or just “old age” (4). In addition, the Groningen protocol has legalized infanticide in the Netherlands. In view of these developments, it is laud- able that Oregon, Canada, and other jurisdictions have built safeguards into their end-of-life legislation. How- ever, a slope still exists, and it may be fairly steep.

The argument based on intractable suffering ap- peals to a physician’s sense of empathy.

However, if hard cases make bad law, they also may produce un- wise medical policies, and the argument surely greases the slippery slope. If intractable physical suffering is a justification for actively ending life, why should intracta- ble existential angst, a severe sense of personal alien- ation, or the helplessness and hopelessness of severe depression not be as well?

The principle of patient autonomy seems the weightiest of the arguments in favor of medical eutha- nasia or suicide, and with good reason.

It alone of the 4 pillars of medical ethics can survive Western society’s transition toward a post-Christian antinomianism. Be- neficence would now be defined as whatever the pa- tient believes to be helpful. Nonmaleficence and justice would be whatever the patient says they are, absent external standards. Autonomy alone would stand unas- sailed and, by default, carry the day.

Who is to say that what I want for myself is the wrong thing?

A person might say it is wrong if he or she recog- nizes an objective moral standard, namely that human life has intrinsic worth and dignity and that its value extends beyond the individual to the community. This might be true even if its owner doesn’t recognize it for a time or if others believe that one’s life is “not worth living.” Some hold that this moral standard (along with many others) can be known from nature or discovered by reason.

Others reach it intuitively or find it in revela- tion, still others in all of the above. Of course, in a plu- ralistic society, not everyone believes in or will agree on objective moral standards, or which one prevails when they seem to conflict.

One may reply that the dignity and worth of human life are not absolute values. For example, it is recog- nized that some life-prolonging treatments are dispro- portionate or even futile.

However, as the ACP position paper points out, neither is patient autonomy an abso- lute value. We do not always give patients whatever they ask for: A futile treatment? No. An illegal prescrip- tion? No.

We therefore find ourselves weighing differ- ent considerations with regard to assisted suicide.

Many will give considerable weight to the presumption that human life is intrinsically valuable, especially in view of what may happen if this value is held as less compelling than autonomy, or utility, or health care economics.

The weakest part of the ACP’s position against medical suicide is its objection on the basis that such provision lies outside the scope of medical practice. I disagree.

If assisted suicide and euthanasia are right and good, physicians should willingly accede; if they are wrong, they should not be done by anybody.

With clarity and courage, the ACP has reaffirmed its opposition to physician-assisted suicide. Perhaps the vote was close; the tide of opinion may be turning, and the next iteration of the ACP’s position might be differ- ent. Autonomy and self-determination are ascendant, and there are warnings of intolerance toward those who object.

Nonetheless, physicians opposed to the provision of euthanasia and medically assisted suicide should not be cowed by attempts to place them “out- side the mainstream.” Where these practices are legal, I believe that physicians should firmly decline to participate.

This article was published at Annals.org on 19 September 2017.

Annals of Internal Medicine EDITORIAL

© 2017 American College of Physicians 595

 

 

It is time to return to our duty at the bedside. Our compassion calls us there, as Dr. Edward Trudeau is credited to have said, “to cure sometimes, to relieve often, to comfort always,” but not to kill or to assist in or facilitate killing.

With time, we will see whether our col- lective cultural conscience, including respect for the in- trinsic value of human life, can keep us from sliding down the slope. Otherwise, it will merely mitigate our speed as we descend.

William G. Kussmaul III, MD Media, Pennsylvania

Disclosures: The author has disclosed no conflicts of interest. Form can be viewed at www.acponline.org/authors/icmje /ConflictOfInterestForms.do?msNum=M17-2072.

Requests for Single Reprints: William G. Kussmaul III, MD, 5 Arrowhead Trail, Media, PA 19063; e-mail, w.kussmaul @verizon.net.

Ann Intern Med. 2017;167:595-596. doi:10.7326/M17-2072

References 1. Snyder Sulmasy L, Mueller PS; Ethics, Professionalism and Human Rights Committee of the American College of Physicians. Ethics and the legalization of physician-assisted suicide: an American College of Physicians position paper. Ann Intern Med. 2017;167:576-8. doi:10 .7326/M17-0938 2.

Marsh L. The flaws of the Overton window theory: how an obscure libertarian idea became the go-to explanation for this year’s crazy politics. New Republic. 27 October 2016. Accessed at https: //newrepublic.com/article/138003/flaws-overton-window-theory on 21 August 2017. 3. Stahl RY, Emanuel EJ. Physicians, not conscripts— conscientious objection in health care. N Engl J Med. 2017;376:1380-5.

[PMID: 28379789] doi:10.1056/NEJMsb1612472 4. Francis N. Netherlands—2015 euthanasia report card. Dying for Choice Web site. Accessed at www.dyingforchoice.com/resources /fact-files/netherlands-2015-euthanasia-report-card on 18 August 2017.

EDITORIAL The Slippery Slope of Legalization of Physician-Assisted Suicide

596 Annals of Internal Medicine • Vol. 167 No. 8 • 17 October 2017 Annals.org

 

 

Copyright © American College of Physicians 2017.

To help reduce eutrophication and the speak of dead zones in the gulf of mexico

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If you were in charge of an effort to help reduce eutrophication and the speak of dead zones in the gulf of mexico, which of the following policies would you not make a priority for the midwestern region of the country ?

Relational Communication messages as predictors of transformational leadership style

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Identify the variables which you are exploring for this study- “Relational Communication messages as predictors of transformational leadership style in supervisor and employee Relationships”.Describe each variable and the model or theory aligned to the variable. Identify and name an instrument which measures the variable or variables.Identify an empirical study which used the variable you will be researching. Find the model or theory for the variable in that article or in the validation article on the instrument used to measure it.Provide the Theoretical Foundation section in your prospectus.

No chickens eat pickles

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All chickens are green.No green birds eat pickles.Therefore, no chickens eat pickles.Why is this valid? in laymen’s terms.

Critical thinking processes

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This project can be completed in an actual workplace or it might be completed as a result of role plays and simulations designed by the assessor.

Identify and describe in detail two different workplace limitations or problems then explain how you used critical thinking processes to overcome or resolve each.

To provide evidence of this you must document the critical thinking procedures you followed to:

identify the limitations or problems

access information from a range of different sources and ask appropriate questions to help you:

determine the root causes

identify the necessary outcomes of the problem solving process

develop options for solving the problems

make appropriate decisions

develop a proposal for the problem resolution ready for presentation to stakeholders

Submit for each workplace limitation or problem:

a description of the limitation or problem and its impact on your work area

a list of the information sources you accessed for information about the problem and for assistance with its resolution and any questions you asked to help you identify both the problem and the solution

a description of the problem solving steps you followed

a copy of the proposals you developed for submission

an analysis or evaluation of your performance with regard to overcoming the limitations or resolving the problems

the outline of a plan that will contribute to the ongoing development of your critical thinking skills and your own professional development

Alternatively:

If you have actively participated in overcoming two different limitations or resolving two different problems in the workplace and have successfully used critical thinking procedures, you could submit a portfolio of evidence to support this.

Your portfolio of evidence must:

be verifiably your own work

cover all aspects of the evidence requirements for this particular unit

show that you used critical thinking and that you followed appropriate processes to identify, assess and resolve two different problems

You might submit a work diary or a logbook outlining steps you followed. You must also provide a copy of the proposals you submitted, evidence of using feedback and self reflection to evaluate your own performance and a plan that will contribute to the ongoing development of your critical thinking skills and your own professional development.

 

oil use and the auto industry

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Current news and politics is full of concern about the environment, particularly as it is related to oil use and the auto industry. There are a number of ethical considerations that arise out of these issues. Please be sure to answer ALL of the following questions:

  • Some propose that these concerns could be alleviated if our use of cars was limited by increased gasoline taxes–if gas is more expensive, we will use less of it and, as a beneficial by-product, improve the environment. What do you think of this proposal and what theory would support your position? Are there injustices built into such measures?
  • What about the possibility that the US auto industry, encouraged by its partial owner, the US government, will no longer produce large gas guzzlers (think Hummer) or will subsidize hybrid or green cars? Is it ethical for the government to essentially prevent a US company from producing a legal good or encourage a company to produce one good over another? What ethical theory supports your position?
  • What are the possible ethical considerations of banning or restricting the import of cars that do not meet certain emission standards? Volkswagen was recently embroiled in a major business disaster when it was discovered that software engineers had inserted a “fix” in their cars that was designed to fool emission tests.  While illegal, was that unethical?
  • Finally, the world today is full of news about fracking, the process by which a high volume of liquid is pumped into the ground to fracture rock and extract natural gas. What are the ethical considerations of either permitting or prohibiting property owners from using their property in this manner?

Diversity, Multiculturalism and Talent Management

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Part A: Diversity, Multiculturalism and Talent Management

What are some of the organizational benefits of attracting and retaining a culturally diverse workforce? How can diversity support an organization’s talent management strategy? How can multiculturalism support an organization’s talent management strategy? What policies would you develop as an HRM to ensure your organization achieves these benefits? Use the articles and resources provided to support your ideas.

Part B: Exploring Diversity Programs

Select an organization and explore their diversity program.  It could be an organization you have worked for, one you are familiar with, or one you are curious about.  Describe the major components of their diversity program and what makes it effective. Include the website in your reference list.

o include citations from at least two sources you used to develop your responses!

Application of the condition of practice error management for training bus drivers

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Explain what would be an unsafe application of the condition of practice error management for training bus drivers. Why is this application unsafe?  B) How could you safely use error management training while training a bus driver? C) What do you think is the best condition of practice to use while training bus drivers how to deal with unruly, aggressive, or problematic passengers who need to be removed from the bus, and why

The causes of Human and Animal behavior

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Researchers often use a method called an experiment in order to study the causes of human and animal behavior. Design such an experiment based on a change in behavior you have observed in yourself or your roommates this past semester (e.g., eating or sleeping habits, exercise regime, game playing, etc.).

Select a behavior that you are particularly interested in studying, and then design the experiment to investigate a possible cause of that behavior. Address the following questions.

  • What is the hypothesis you will test in your experiment?
  • What are the independent and dependent variables?
  • Who will be the subjects or participants in your study?
  • What are the experimental and control group conditions? Here, you may assume that you have the resources necessary to conduct your experiment and that you can control, or manipulate, the environment of your subjects as necessary. For example, suppose your hypothesis is as follows: Higher levels of stress from a heavy course workload increase eating activity. Assume that you have the ability to control the workload, etc., of your subjects.
  • How will you assign your subjects to groups?
  • What are the possible results of your study, and what might these results indicate about your hypothesis?

In a multi-paragraph , describe your experiment and explain how you will conduct this experiment to test your hypothesis.

Be sure to propose your hypothesis, and then describe the independent and dependent variables, the experimental and control conditions, the subject or participant groups, and the conclusions you can draw based on the results of your experiment.

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