Gas Adsorption in Metal-Organic Frameworks Essay

Gas Adsorption in Metal-Organic Frameworks - Essay Example This is essentially a tool to custom build materials for various ranges of gas adsorption requirements. Also, the new materials can adsorb gases both superficially and morphologically, which is probably why they are capable of adsorbing larger volumes of gases reversibly than any other materials available today. The specific properties that determine the functionalities of the final product are the length and functionalities of the organic units as well as the number of rings that are within these units. The metallic portions aid in the process of strengthening the bonds within the crystalline structures of the materials which are thus quite robust and can thus undergo adsorption without breaking up. The true implications of these combined functionalities of these new materials are that they can be utilized for such urgent functions as adsorbing greenhouse emission gases like carbon dioxide and energy-relevant gases like hydrogen. Two major problems that face the World community at large are - global warming and the energy crisis. The first is a phenomenon that is created by the annually increasing emission of carbon dioxide as a result of burning of fossil fuels to meet energy needs. Emission statistics shows that the volume of emission has been steadily increasing yearly since the industrial revolution of the 18th and 19th century when large-scale usage of fossil fuels began to feed the energy needs of organized industry. The increasing yearly discharge of the gas from that time has upset the balance of natural composition of the atmosphere. Though carbon dioxide is being increasingly released into the atmosphere it is not being removed from it at the same rate. The result is excessive percentage of the gas in the atmosphere. Since the gas is relatively heavy it remains close to the ground acting

COMPARE AND OR CONTRAST THE EFFECTS OF THE SETTING ON THE MAIN Essay

COMPARE AND OR CONTRAST THE EFFECTS OF THE SETTING ON THE MAIN CHARACTERS OF THE FOLLOWING TWO SHORT STORIES. THE LAST LEAF, BY WILLIAM SIDNEY PORTER (O. HEN - Essay Example To illustrate the various ways in which setting can be used to identify and mold the characters of a story, we will compare and contrast the effects of setting on the main characters involved in William Sidney Porter’s â€Å"The Last Leaf† (O. Henry) and Nadine Gordimer’s â€Å"The Ultimate Safari.† In â€Å"The Last Leaf,† the story opens with a description of the â€Å"crazy and broken† streets that â€Å"make strange angles and curves.† Immediately the reader is placed in mind of either a broken down part of town or an artist’s mecca, which indeed this area of town has become as we learn in the very next paragraph. As the area becomes associated with artists in the reader’s mind, an idea of the culture of the area becomes clear. With this association to the land of imagination, creativity and make-believe, the reader is more inclined to believe one of the main characters, Johnsy, would truly die once the last leaf fell from the ivy vines outside her window. This belief is, to some degree, also shared by her roommate Sudie and their downstairs neighbor, Mr. Behrman. Understanding that Sudie’s fear regarding the vine is strong enough to mention her concern to their neighbor indicates this conviction of her roommate’s is at least halfway believable to the character. This is further emphasized as Sudie and Mr. Behrman â€Å"peered out the window fearfully at the ivy vine. Then they looked at each other for a moment without speaking.† Mr. Behrman’s final masterpiece is also an indication of just how much he buys into the concept of an artist who might die simply based on her convictions. To contrast against this culture, this belief in the power of the vine to number out the time Johnsy has left to live, is not shared by the good doctor, who is not a part of the artist culture and cannot understand a woman who would live in order to someday paint the bay of Naples but not for the hope of a good man. However, he is a good doctor who

Reacher paper about A rose for Emily Essay Example | Topics and Well Written Essays - 1250 words

Reacher paper about A rose for Emily - Essay Example This world of the present with its absence of social propriety is strange and unrecognizable to Miss Emily, who has always been kept strictly within the bounds of Old South expectations. Miss Emily’s relationship with the town is therefore one of superior distance because of her social position and isolation as a result of her strangeness. To more fully understand this unique position she was placed in, it is helpful to understand the various cultures involved and how they each served to influence the other. To demonstrate how Miss Emily was a woman trapped by her society, it is necessary to examine the Southern culture as well as the Northern culture before it is possible to compare the two and understand the differences in approaches taken by the characters in the story. Faulkner introduces Miss Emily Grierson as a woman who has been strictly contained within the boundaries of her father’s old Southern ideals. â€Å"None of the young men were quite good enough to Mis s Emily and such. We had long thought of them as a tableau; Miss Emily a slender figure in white in the background, her father a spraddled silhouette in the foreground, his back to her and clutching a horsewhip, the two of them framed by the back-flung front door† (437). This created a situation in which Miss Emily â€Å"got to be thirty and was still single† (437). ... â€Å"Attitudes about class shaped in southern England and in the border regions of Britain coupled with the appearance early on of race-based slavery would produce a class system that consigned blacks to the bottom and that paradoxically appeared to foster both the idea of equality for whites and large differences between upper and lower class whites in terms of power, privilege and wealth† (Beck, Frandsen & Randall, 2007: xxvii). The Griersons become the town’s image of the Old South and, as a result, the town cannot think of Miss Emily in any way other than in her association with the values and traditions of these old ways, meaning she is not able to mingle with the common white people of the town and must always be seen to be upholding the ideals of the past for the rest of the community. After her father’s death, Miss Emily is seen to attempt to break out of the mold he has placed her in through her willingness to date Homer Barron and begin adopting more N orthern ideals. The North was founded and characterized by its mostly Puritan founders who had fled England with a vision of a more equal and less socially rigid and materially oriented society (Woodworth, 2000). Once the Civil War was over, the North had little to rebuild and plenty of factories ready to go to work, with increasing numbers of Southerners fleeing the poverty of the war-ravaged South to find work in the Northern cities. Thus, the North was characterized by growth, progress, energy and new ideas such as women’s suffrage. When Miss Emily is seen in public following her father’s funeral, â€Å"her hair was cut short, making her look like a girl, with a vague resemblance to those angels in colored church

Eminent Domain Case Study Example | Topics and Well Written Essays - 250 words - 30

Eminent Domain - Case Study Example The city plan did not violate the constitutional taking clause. The takings clause protects the private property from conversion by the state for public use without just compensation. The plan was engineered to boost the low economy by providing jobs to the unemployed and increase the tax receipts that would eventually see the city's economy stabilize. This step is beneficial to the public both directly and indirectly and a legitimate public use of the justly acquired land. The economic benefits, on the other hand, appear to be secondary and incidental as brought forth by the dissenting judge. The developers seem to be the primary beneficiary of the acquisition and there is no surety that unemployment will be curbed and hence have the public benefit. All in all, the entire takings clause is objected towards just compensation of the private landowners where the government acquires such land for public use. From the foregoing, the land was put into public use that is faced as economic development having compensated the owners justly. It thus follows that the takings clause was not violated.

Modern gadgets Essay Example for Free

Modern gadgets Essay Symbian OS is designed for the mobile phone environment. It addresses constraints of mobile phones by providing a framework to handle low memory situations, a power management model, and a rich software layer implementing industry standards for communications, telephony and data rendering. Even with these abundant features, Symbian OS puts no constraints on the integration of other peripheral hardware. This flexibility allows handset manufacturers to pursue innovative and original designs. Symbian OS is proven on several platforms. It started life as the operating system for the Psion series of consumer PDA products (including Series 5mx, Revo and netBook), and various adaptations by Diamond, Oregon Scientific and Ericsson. The first dedicated mobile phone incorporating Symbian OS was the Ericsson R380 Smartphone, which incorporated a flip-open keypad to reveal a touch screen display and several connected applications. Most recently available is the Nokia 9210Communicator, a mobile phone that has a QWERTY keyboard and color display, and is fully open to third-party applications written in Java or C++. The five key points small mobile devices, mass-market, intermittent wireless connectivity, diversity of products and an open platform for independent software developers are the premises on which Symbian OS was designed and developed. This makes it distinct from any desktop, workstation or server operating system. This also makes Symbian OS different from embedded operating systems, or any of its competitors, which werent designed with all these key points in mind. Symbian is committed to open standSymbian OS is designed for the mobile phone environment. It addresses constraints of mobile phones by providing a framework to handle low memory situations, a power management model, and a rich software layer implementing industry standards for communications, telephony and data rendering. Even with these abundant features, Symbian OS puts no constraints on the integration of other peripheral hardware. This flexibility allows handset manufacturers to pursue innovative and original designs. Symbian OS is proven on several platforms. It started life as the operating system for the Psion series of consumer PDA products (including Series 5mx, Revo and netBook), and various adaptations by Diamond, Oregon Scientific and Ericsson. The first dedicated mobile phone incorporating Symbian OS was the Ericsson R380 Smartphone, which incorporated a flip-open keypad to reveal a touch screen display and several connected applications. Most recently available is the Nokia 9210Communicator, a mobile phone that has a QWERTY keyboard and color display, and is fully open to third-party applications written in Java or C++. The five key points small mobile devices, mass-market, intermittent wireless connectivity, diversity of products and an open platform for independent software developers are the premises on which Symbian OS was designed and developed. This makes it distinct from any desktop, workstation or server operating system. This also makes Symbian OS different from embedded operating systems, or any of its competitors, which werent designed with all these key points in mind. Symbian is committed to open standards. Symbian OS has a POSIX-compliant interface and a Sun-approved JVM, and the company is actively working with emerging standards, such as J2ME, Bluetooth, MMS, SyncML, IPv6 and WCDMA. As well as its own developer support organization, books, papers and courses, Symbian delivers a global network of third-party competency and training centers the Symbian Competence Centers and Symbian Training Centers. These are specifically directed at enabling other organizations and developers to take part in this new economy. Symbian has announced and implemented a strategy that will see Symbian OS running on many advanced open mobile phones. Small devices come in many shapes and sizes, each addressing distinct target markets that have different requirements. The market segment we are interested in is that of the mobile phone. The primary requirement of this market segment is that all products are great phones. This segment spans voice-centric phones with information capability to information-centric devices with voice capability. These advanced mobile phones integrate fully-featured personal digital assistant (PDA) capabilities with those of a traditional mobile phone in a single unit. There are several critical factors for the need of operating systems in this market. It is important to look at the mobile phone market in isolation. It has specific needs that make it unlike markets for PCs or fixed domestic appliances. Scaling down a PC operating system, or bolting communication capabilities onto a small and basic operating system, results in too many fundamental compromises. Symbian believes that the mobile phone market has five key characteristics that make it unique, and result in the need for a specifically designed operating system: 1) mobile phones are both small and mobile. 2) mobile phones are ubiquitous they target a mass-market of consumer, enterprise and professional users. 3) mobile phones are occasionally connected they can be used when connected to the wireless phone network, locally to other devices, or on their own. 4) manufacturers need to differentiate their products in order to innovate and compete in a fast-evolving market. ards. Symbian OS has a POSIX-compliant interface and a Sun-approved JVM, and the company is actively working with emerging standards, such as J2ME, Bluetooth, MMS, SyncML, IPv6 and WCDMA. As well as its own developer support organization, books, papers and courses, Symbian delivers a global network of third-party competency and training centers the Symbian Competence Centers and Symbian Training Centers. These are specifically directed at enabling other organizations and developers to take part in this new economy. Symbian has announced and implemented a strategy that will see Symbian OS running on many advanced open mobile phones. Small devices come in many shapes and sizes, each addressing distinct target markets that have different requirements. The market segment we are interested in is that of the mobile phone. The primary requirement of this market segment is that all products are great phones. This segment spans voice-centric phones with information capability to information-centric devices with voice capability. These advanced mobile phones integrate fully-featured personal digital assistant (PDA) capabilities with those of a traditional mobile phone in a single unit. There are several critical factors for the need of operating systems in this market. It is important to look at the mobile phone market in isolation. It has specific needs that make it unlike markets for PCs or fixed domestic appliances. Scaling down a PC operating system, or bolting communication capabilities onto a small and basic operating system, results in too many fundamental compromises. Symbian believes that the mobile phone market has five key characteristics that make it unique, and result in the need for a specifically designed operating system: 1) mobile phones are both small and mobile. 2) mobile phones are ubiquitous they target a mass-market of consumer, enterprise and professional users. 3) mobile phones are occasionally connected they can be used when connected to the wireless phone network, locally to other devices, or on their own. 4) manufacturers need to differentiate their products in order to innovate and compete in a fast-evolving market.

PTSD; The Battle Wounds You Can’t See Essay Example for Free

PTSD; The Battle Wounds You Can’t See Essay â€Å"I engaged the enemy in numerous gun battles. I was close to someone that was killed or injured. Fear and death were all around me. The military even had me plan for my own death I was numb inside. When I returned home, did you really expect me to pick up from where I left off?† (Combat PTSD) Post Traumatic Stress Disorder is one of the most overlooked stressed related diseases of all time. PTSD can affect anyone after an event or a series of events that threatens your life or others; causing intense fear, horror, and since of hopelessness. People who suffer from Post Traumatic Stress Disorder can often have a short attention span, making them unable to sit for long periods of time. Victims of PTSD find it hard to stay focused on normal, everyday activities. Almost anything can trigger an anxiety attack. PTSD affects the mind, causing a victim to be on constant edge. People with PTSD often find themselves feeling as if they are re-living a traumatic event, causing them to be unable to focus on the present. PTSD is a whole body tragedy inside humans that causes enormous difficulties in everyday life. My uncle, who is a retired United States Navy Veteran, spent 25 years traveling around the world and in many war situations. He finds himself getting side tracked all the time. There are many times he finds himself in situations he doesn’t remember getting himself into. One second he is working on paying bills, then the next he is staring into space, not thinking at all. He told me that he use to think it was impossible to not think at all. Yet, it is common when you have a mental disease that controls your life. Everyone has their own priorities to worry about, their own problems they need to block out; but with PTSD the exhaustion does it for them. Victims of PTSD find the numbness that comes with being exhausted normal.  They live in chaos that only exists in their head. They try to keep themselves busy so they don’t relapse and have a mental breakdown. Society can replace damage that was caused by war efforts: buildings, houses, and shopping centers. But the soldiers, they never get over it. Memorizing daily routines may not seem like a huge deal to all of us, but victims of PTSD find it almost impossible. The ability to memorize is a gift that humans are given to help make life easier. Freighting situations stimulate the brain to activate the nervous system and the adrenal glands causing the glands to secrete stress related hormones. Everyone’s human mind is made up of all the same pieces and parts. But how and when our brain chooses to project them is how we all differ. Our brains develop this selective nature of what we memorize. Our ability to remember traumatic events can harm us. Memories that trigger an anxiety attack with PTSD victims react when a stress related hormone activates the memory gland in our brain. This causes PTSD victims to only remember traumatic events. My ROTC instructor Sargent First Class Fredrick Lawshe has many experiences with his memory. He said that he once was driving to pick up his daughter from school, and while on the way there he forgot why he was driving and ended up turning around and pulling back into his driveway. His wife walked into their living room and asked him, â€Å"Where is Maggie? I thought you were heading to pick her up?† He said to me that after she brought it up, it all hit him again. He ran back to his truck and flew to her school. After all was said in done he came to the realization that while he was driving the first time he found himself back into a war state of mind. He stated, â€Å"I use to drive around Afghanistan in tanks all alone, with the orders of, â€Å"If you see anything move, shoot it.† I guess when I was driving in the car, I thought I was back in Afghanistan driving a tank.† Every human is born with the ability to memorize (exempt rare disease, and head injuries). People without PTSD memorize things without effort. It just comes natural. People with PTSD have to work at memorizing things making it more of a chore, especially when it may not be permanent. PTSD victims are put into reality without first letting go of the past. Nightmares are likely for people who suffer from PTSD. Nightmares can wake up a person in the middle of the night, making sleep a little less than impossible. Without the needed hours of sleep one can become physically and mentally abusive to ones self. People with PTSD often worry about general problems that can put them into danger. If the thought of always having to protect them at night, they will stay up to do whatever it takes to do so. Matthew Rottman stood a six-hour post every day. Standing post is the military term for standing guard while everyone else is asleep. While on post, Rottman was on constant watch, reacting to every noise that he heard. Still today Rottman stays awake while his wife and two children sleep; to make sure that nothing will harm them during the night. The feeling of always needing to be on the look out makes it difficult to get a good nights rest. Some victims of PTSD turn to alcohol or even drugs to help them cope with their symptoms. But in fact, to much alcohol can change the quality of sleep, making it less refreshing. It is not the victims of PTSD that do not want to sleep; it’s the fact that when they do, they have no control of what the mind thinks. It makes for another sleepless night. Post Traumatic Stress Disorder can cause the brain to go into relapse mode, causing a victim of PTSD to go into a rampage. Sometimes if a victim suffers to a higher degree of PTSD; attempts or murder, or violence will increase towards others has been brought about in some court cases Even though this is rare occurrence, it is possible. The human body can be very sensitive when it comes to how the brain operates. When a victim of PTSD is triggered be something around them, the brain tells the adrenal glands to release epinephrine. Epinephrine is the body’s way to show excitement and to pump adrenaline throughout the body. Meaning that if to much is produced parts of the brain can shut down making the victim go into a â€Å"crazy† state of mind; placing them back into the event that caused PTSD. The victim no longer can control what the brain does, leaving them in no control of their own body. Sometimes victims get so wrapped up into what is around them the  PTSD takes over, and the violence starts. In a blog chartroom an adult explains his experience with violence involving PTSD. â€Å"After being diagnosed with PTSD from abuse as a child. I do lash out when triggered, especially if someone touches me and I dont see them coming and super especially if anyone goes near my head. I lash out with words (very loud usually) and have swung my fists instinctively. I dont plan it, intend it or mean it it just happens. It feels like a defense, even if its a total overreaction.† We have all read these newspaper headlines: â€Å"PTSD made him a Murderer!† â€Å"Psychologist: Killer has PTSD!† â€Å"War damaged vet kills girlfriend; PTSD to blame?† â€Å"Officer uses PTSD defense for strangling, battering his wife.†(Andy O’Hara, Sergeant) It is the headlines like theses that are making society fear veterans. Society has a view towards them because of the social media. If civilians understood the mental characteristics of PTSD, that would not be so quick to judge. PTSD is not what is wrong with you; it is what happened to you. Almost every victim of PTSD will engage in some degree of depression from high dosages to very slim. Depression is when you loss interest in activities that use to give joy, significant change in weight, and feelings of guilt and uselessness. PTSD and depression go together because PTSD constantly brings back flashbacks of events that can cause depression. Some victims with PTSD go through depression stages where they feel their life is not worth living, and attempt it end it. Depression can cause anxiety attacks that end up with most people in therapy. Treatments can include antidepressants, counseling, and sometimes group therapy is recommended so others with PTSD can all express their feelings so they are able to see how others with PTSD are copping with it. PTSD and depression therapy are not one hundred percent accurate for cure, but it is a start to a long life of recovery. Judy, a wife and a mother or 5 children; was abused as a child and as her life continues she feels as if she can longer love her husband, and no longer live her life to the fullest. â€Å"†¦I couldn’t remember most of my childhood, why even the word â€Å"childhood† felt like a heavy blanket over me. The memories were so real that I often experienced physical reactions to them, such as spontaneous bleeding. I was diagnosed with PTSD, as well as depression, and things finally started to make sense†¦Ã¢â‚¬  Even though depression is a whole mental disability itself PTSD can often led to it, causing recovery almost impossible. Being put into the war scene isn’t like what you see in movies or play in video games. Maybe the guns and the technology are the same but unlike video games where you have unlimited lives, in real combat you only have one. When many veterans finally get home it is not what they expected. Some come from war with no stable income or even a family. Throwing a solider into the real world after a 4-year tour over seas is like throwing a wild bear into a dog show; he’s going to have no idea what he’s doing there. (Meadows) Most veterans who commit suicide are veterans who didn’t receive treatment for their PTSD. Suicide rates will al ways be high but studies have shown that risk is higher in people diagnosed with PTSD. After a 7 year tour in combat Sargent Erik Willie came home to his beautiful wife, and 2 loving children. The four of them were the picture perfect family; when he returned home he refused to talk to anyone about what he encounter. His wife started to notice him tossing and turning in the middle of the night. When she would question him, he would laugh it off; but onetime he did not find it as funny. When she confronted him to stop tapping his fork on the kitchen table, he then stood up grabbed her by the arms and pinned her against the wall. She screamed at him to let her go. He then dropped her to the grown, slowly backed off. As he went to help her up she pushed him away. She ran into the bathroom. Willie then noticed that his PTSD was serious, but still refused to seek medical help. As the days went on, Willie was cautious of every move he took. His wife blew off the whole incident as if nothing happened. Willie found himself in places and situations he didn’t remember putting himself into. After many more violent episodes, his eight-year-old son found him sitting on the end u p of the bed with the barrel of the gun in his mouth. Willie stood up, kissed his son on the forehead and shut the door. Around and hour later he walked in on his dad; but this time he was sitting in the bed; he was lying on the floor with a pool of blood around him. Depression affects everyone different, but unfortunately for Willie, it took his life. Military Veterans make up 7 percent of the American population, but they account for 20 percent of its  suicides. In 2012 more United States soldiers died by their own hands than in battle; suicide was the number one cause of death among US troops that year (CBSnews). People without PTSD face typical daily tasks such as driving a car, socializing with others, and sleeping. But to ones with PTSD see these simple tasks as obstacles. Because PTSD affects parts of the brain that interact with social inability a victim with PTSD finds it almost impossible to do â€Å"normal† everyday activities. Everyone has their times of frustration when they cannot do a simple task; but with PTSD victims live with the fear of the unknown. They fear the judgment of others when they are unable to do a task. They also fear the agony that could be forced upon them. PTSD victims are scared to even make one wrong move that could trigger an emotional breakdown. Bipolar disease is one of the common diseases that are associated with PTSD. One second someone with PTSD could be with there loved one, having the time of his or her life, then in a few seconds they are back in a combat zone fighting for their life. Up to 30 percent of PTSD patients will also be diagnosed with bipolar disease at some point. Bipolar mental disability is the act of having mood swings based on the environment around you. Bipolar, patients are more likely to have high suicide number attempts. Because depression, anxiety, and PTSD can make recovering from bipolar worse, therapy is recommended to every patient. Survivors of a traumatic event sometimes lack interest in social or sexual activities. They start to feel detached and worried in their relationships. They start believing that everyone is an enemy. They also may feel as if they need to protect their loved ones. This makes them come across as tense or demanding. For example, if someone was sexual abused as a child by a family member they sometimes will have issues with others touching them, or even trusting them. Amy Douglas; a 30 year old woman that claims that still after 25 years she can not forget her stepdads hands on her body. At night she wakes up screaming because of the nightmares that happen over and over again. She can’t keep a job because they thought of trusting a man with hire authority frightens her. She cannot keep a steady boyfriend because her fears of a man taking advantage of her. â€Å"I also believed that the older I got, the more I would forget about it all†¦ I never was the one to show my emotions, in high school I had a lot of friends, but I never got into boys.† Amy states that, â€Å"†¦but now I am older, the flashbacks are more intense, I can hear myself  telling him no, and that I wouldn’t tell mommy. I’ve tried to love but nobody wants to be with a girl who has monsters in her head that never sleep†. Post Traumatic Stress disorder is a state of mind that no human could live a normal life with. It is where you are afraid to ask for help because you believe it will destroy whomever you tell, so you cope by keeping it deep inside yourself; where it will only destroy you. With PTSD your head is a horrible place to be; everyone is a threat, you start to see that quiet people have the loudest minds. Where space is craved to help others breathe; where being around others is exhausting. It’s where you wake up useless, terrified, and unskilled in your own habits. It is where the old you disappears and a new shell is formed around you. PTSD is where caring for yourself is an act of survival not just a life quality. Works Cited David. Brain Affected in Ptsd. CNSforum. N.p., n.d. Web. 08 Apr. 2013. . O’Hara, Andy. NATIONAL CENTER for PTSD Home. NATIONAL CENTER for PTSD Home. Department of Veterans Affairs, n.d. Web. 15 Apr. 2013. . Schirald, Glenn. The Post-Traumatic Stress Disorder Sourcebook: A Guide to Healing, Recovery, and Growth [Paperback]. The Post-Traumatic Stress Disorder Sourcebook: A Guide to Healing, Recovery, and Growth: Glenn Schiraldi: 9780071614948: Amazon.com: Books. N.p., n.d. Web. 15 Apr. 2013. . Print Wood, David. â€Å"Combat Veterans With PTSD, Anger Issues More Likely To Commit Crimes: New Report, â€Å"The Huffington Post. TheHuffingtonPost.com, 09 Oct. 2012. Web. 28. 2013

Measurements of Universal Health in Ethiopia

Measurements of Universal Health in Ethiopia TASK The UK Department for International Development (UK-DFID) has recently decided to allocate funds for establishing universal health coverage in low income countries. The Director of the Global Health Division of the UK-DFID invites you to submit a scoping report with a critical assessment of the type of indicators needed to evaluate and monitor universal health coverage in a low income country of your choice. Your report will be judged on the basis of the following criteria: Illustration and critical assessment of at least 5 relevant direct or indirect indicators (statistics), their sources and overall quality of data. The sources (online) and any other supporting references cited should be numbered either in the footnote or in the Bibliography at the end of the document. Use and reliability of those selected indicators for planning and programme interventions Potential country-specific barriers, where applicable, in implementing the universal health coverage Clarity of presentation, independent critical thinking and creativity One of the main aims of the UK department for international development is to promote the development and eradication of poverty through the establishment of Universal Global Health coverage in low in come countries. As a result this scoping report focuses on Ethiopia a low income region which has a history of high birth rates, famine, war and the second highest population in Africa (91million) [1]. The regions health care system as consequence is among one the poorest in Africa, making it an ideal region in assigning the types indictors needed to provide UGH [2]. In order to monitor and evaluate UGH it is important to firstly acknowledge that there is no one metric measurement or indicator of health, as health differs from one individual to another and as a outcome an average or optimum is often defined to monitor the overall health of the population [3]. The World Health Report 2013 has provided a widely used framework in order to successfully monitor UGH [4]. Figure 1 illustrates the framework which focuses on three main areas of health. Service coverage: the vital health care services that are needed, Financial coverage: Ability to acquire these services without financial difficulty and Population coverage: the number people that have access to these services. The indictors used in this report aim to cover these three dimensions while also being tailored specifically to Ethiopia’s health requirements. Table 1: Statistics adapted from WHO data repository [8] Population using improved drinking-water sources (%) Year Rural Urban 1990 4% 80% 2000 19% 87% 2011 39% 97% Adequate access to clean water is a basic human right and the seventh Millennium Development Goal [5]. Clean water is essential to ample quality of life and is used in a diverse range of fields from basic hydration, irrigation, sanitation to complex health care institutions such as hospitals making it a vital component of health [6]. This indicator is categorised into ether improved or unimproved source with improved sources indicating clean water. This classification makes it a simple indicator allowing identification of areas where safe water sources are abundant and areas that need improved water source access, perhaps through water aid programs. This indicator is particularly useful as it can show the range of human impacts on the quality of water through the presence of nitrate as well as compounds and bacteria which can indicate waterborne pathogens the common cause of disease. [7]. Data is provided through national household surveys, the demographic health surveys (DHS) and RA DW (Rapid assessment of drinking water quality project) which is carried out by both the WHO and UNICEF with the DHS often providing high quality statistics [4]. Table 1 illustrates that the percentage of improved water sources is disproportionate from 97% users in urban area in 2011 compared to just 39% in rural areas in 2011. This suggests that water sanitation programs should be focused in rural areas where there are less people using improved drinking sources. The results also illustrate that although there are far more users of improved sources in urban areas, the number of users in rural area over three decades have seen a greater increase from just 4% in 1990 to over 39% in 2011 which could be attribute to better surveying in these areas in recent times. The indicator however is a proxy to number of people that have access to clean water as it shows the percentage of users of improved sources and not the amount people that have access to safe drinking water, meaning some soci al-economic groups such as the isolated poor or elderly are not accounted for as they are less likely to have â€Å"access† to these improved sources [7]. The indictor is limited only showing percentages for rural and urban areas; an indication of sub-urban regions would provide are more in-depth analysis of overall water quality in the region. Recognition of which gender the improved water source is mainly being used by i.e. men, women or children is also unaccounted for which could be crucial indicator as children are highly impacted from waterborne pathogens [2]. Furthermore even though water is being used from an improved source, this water still needs to be obtained from larger sources leading to possible contamination during transportation or even storage invalidating the indicator. Guidelines presented by WHO for safe drinking water is also assumed constant over time by indictor limiting it accuracy [9], overall this indicator can provide an overview of water quality b ut accuracy of the indicator can be skewed to urban areas. The overall health of the population is often measured by life expectancy, this indicator is widely used and data regarding this indictor is readily available. Life expectancy is a longer term measure of health and an overall indication of health over the years. Life expectancy in Ethiopia has been improving over the years from around 55 years at birth in 2004 to 62 years in 2011[8]. It is an important indicator in reflecting the overall mortality of the population; this is helpful for the governmental as it illustrates the trend through time of the overall population and improvements in life expectancy can reflect better nutrition, hygiene and effective medical intervention within the nation [10]. However unless a comprehensive cohort/period life table is developed, life expectancy at birth assumes that health conditions remain constant throughout the lifespan of the individual, an inaccurate assumption given the higher mortality rates in the first year of life and lower mortality a t around middle age. Table 3: Data adapted from WHO, World Bank and DHS. [8], [10],[11] BCG among 1 year’s olds (%) [8] Under 5 mortality rate per 1000 births [10] Children Fully Immunised (%) [11] Year: 1980 0 240 N/A 2000 51% 146 14.3% 2011 80% 68 24% Vaccination is an essential component of health in many low-income countries with the fourth MDG main aim being the reduction of child morbidity and mortality [5]. Immunisation can help reduce mortality and usually is cost effective while also being an excellent indictor of the health among children. BCG is the best indicator of full immunisation coverage as the WHO states children can be classified full immunised once they have received a tuberculosis vaccination (BCG) [9] therefore a BCG indicator is vital in monitoring health of children. Table 3 illustrates the importance of BCG vaccination with the percentage of coverage improving over the years from no vaccination in 1980 to over 80% of 1 year olds having being immunised in 2012 suggesting an improvement in the protection of children against TB, this is further reinforced by the decline in under five mortality rate. The validity of the indictor can be backed up by it its correlation to under 5 mortality rate; Table 3 illustrate s a linear relationship in increasing immunisation and declining child mortality, showing the success of the indictor in monitoring UGH among children. However universal health through immunisation in reality is hindered by a delay in diagnosis of tuberculosis in Ethiopia which can exacerbate the disease [12], combined with the majority of children and citizens being concentrated in rural areas where there is no real means of transportation available to attend a hospital for vaccination, [2] making the indicator biased to people who can access vaccination facilities. The BCG indicator is effectively used in TB prevention, treatment and psychological suffering through basic programmes such as stop TB strategy programme [4]. Data provides estimations between the accurately reported immunisation figures by national authorities and those where data may present misleading figures [8]. This means the data may not be fully accurate as it is a estimation of actual and misclassified figures. However this indicator is vital for monitoring and guiding disease and eradication programmes and efforts in Ethiopia. Although BCG percentage shows a high coverage over tuberculosis it does to provide accurate analysis of UGH in terms of other diseases such as malaria. The percentage of full immunised children is a better indictor for UGH as it indicates children which are protected against all diseases. However only 24% of children are fully immunised which suggest that although 80% of children are immunised this is misleading as this 80% are only immunised against TB and not other deadly diseases. Although the WHO suggests children are not fully covered against diseases until they are immunised from TB, the immunisation of other diseases prior to the TB vaccination needs to be considered. Anaemia is defined as a condition which is characterised by low levels of haemoglobin in our blood, in the case of Ethiopia anaemia is a major concern with low come groups being among highest at risk [13]. This is an important indicator in children as anaemia is associated with impaired mental and physical development and increasing morbidity and mortality. This indicator is particularly helpful because it has allowed a number of preventions programmes to be put into place such as enhanced outreach Strategy and Targeted supplementary foods intervention programme which aim to improve nutrient in among children. More than 44% of population in 2011 is still anaemic with 21% percent of children having moderate anaemia illustrating the importance of this indicator in monitoring UGH in children and future programme intervention development. However this indicator is constraint to children limiting its capability, it is also misleading as there are also other factors related to anaemia such iron deficiency, and Vitamin A levels which this indictor does not account for providing inaccurate assessment [9]. Table 3: Indicators adapted from WHO, DHS and UN [8],[11],[14] Maternal Mortality Ratio MMR per 100,000 live births [8] Live Births Delivered at Health Facility (%) [11] Births attended by skilled heath Personnel (%) [15] Year: 1990 950 N/A NA 2005 700 5.3% 5.7% 2011 350 9.9% 10.0% Maternal mortality in Ethiopia is among the highest in the world and it is the biggest killer of women in Sub-Saharan Africa with the fifth MDG aiming for a reduction of 75% from 1990 to 2015 [5]. Maternal health is often measured by the maternal mortality ratio which is expected to be useful in indicating the deaths among women, the risk associated with pregnancy, monitoring achievement towards MDG 5 and the capacity of health systems within Ethiopia to provide effective health care [14]. Table 1 illustrates the maternal mortality ratio, illustrating initially that there is reduction in maternal morality in Ethiopia and an improvement over the years with some considerable progress towards MDG 5. However the MMR ratio does not take into consideration several key factors that can impact women during her pregnancy. The indictor is irrespective of the duration of pregnancy and also where the birth took place giving an inaccurate assumption how amount of mortalities. The relationship bet ween the MMR to percentages of live births that took place in health facility shows a poor correlation because although there has been a significant reduction in mortality from 1990 to 2011 this is misleading as only 9.9% of these births took place in adequate well equipped hospitals suggesting MMR should be higher. Measuring mortality is difficult and inaccurate as it is a ratio based on estimations between the total maternal deaths and total live births which does not account for women which have died during the pregnancy. The ratio also fails to show the factors which lead to high or low level of mortality which could prove vital to reducing mortality as an indication of this would allow a focus in future planning to reduce the MMR. Sources of data are varied with different methods being used to derive country estimates, with many rural areas having no data at all making results biased [14]. A more accurate indictor of UGH of maternal health is number of live births in health fac ilities and births attended by skills personal, both indictors show low percentages suggesting and poor health care service as an increase in number births at hospital and with better equipped personnel is likely to reduce maternal deaths. These two indictors also show why maternal death rates are so high as apposed just showing number of deaths. The MMR indictor used is not a reliable indictor of UGH among pregnant women and more focused indictors such one shown in table 3 are recommended for UGH. As stated in the introduction there is no one measure of universal health among a country, individual, or the world. Each indicator has it own weakness and strengths as illustrated above. All the indictors in this report have been chosen as they are most suited to Ethiopia and it requirements, this report suggests that some indictors i.e. Immunisation and percentage population using improved water sources may be better indictors than other such as life expectancy and maternal health in monitoring UGH. However any indictors used to monitor UGH should be chosen for future policy planning, MDG assessments and intervention schemes. Bibliography: 1: The World Bank, working for a world free of poverty. http://www.worldbank.org/en/country/ethiopia (Accessed 15 February 2014). 2: Murray, J.S., Moonan, M. Recognizing the healthcare needs of Ethiopia’s children. Journal for Specialists in Pediatric Nursing 2012; 17(4):339-343. 10.1111/j.1744-6155.2012.00328.x (Accessed 15th February 2014). 3: Abraha, M.W., Nigatu, T.H. Modeling trends of health and health related indicators in Ethiopia (1995-2008): a time-series study. Health Research Policy and Systems 2009;7(1)1-17 http://www.health-policy-systems.com/content/7/1/29/abstract (Accessed 12 February 2014). 4: World Health Organization, research for universal health coverage: world health report 2013. The World Health organisation 2013. 5: United Nations Millennium Development Goals: We can end poverty http://www.un.org/millenniumgoals/ (Accessed 12 February 2014). 6: Onda, K., LoBuglio, J., Bartram, J. Global Access to Safe Water: Accounting for Water Quality and the Resulting Impact on MDG Progress. International Journal of Environmental Research and Public Health 2012;9(3)880–894. 10.3390/ijerph9030880 (Accessed 12 February 2014). 7: Bain, R., Gundry, S., Wright, J., Yang, H., Pedley, S., Bartram, J.. Accounting for water quality in monitoring access to safe drinking-water as part of the Millennium Development Goals: lessons from five countries. Bulletin of the World Health Organization 2012;90(3),228–235. 8: The World Health Organisation, Global Health Observatory. http://www.who.int/gho/database/en/ (Accessed 15 February 2014). 9: Central Statistical Agency [Ethiopia] and ICF International. 2012. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International. 10: The World Bank, Indicators. http://data.worldbank.org/indicator (Accessed 13 February 2014). 11: Demographic and Health Surveys, Country Quickstats. http://www.measuredhs.com/Where-We-Work/Country-Main.cfm?ctry_id=65c=EthiopiaCountry=Ethiopiacn=r=1 (Accessed 15th February 2014). 12: Demissie, M., Lindtjorn, B., Berhane, Y. Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health 2002; 2(1) 1-7 http://www.biomedcentral.com/1471-2458/2/23/abstract (Accessed 13th February 2014). 13: Balarajan, Y., Ramakrishnan, U., Ozaltin, E., Shankar, A.H., Subramanian, S.V. Anaemia in low-income and middle-income countries. Lancet 2011;378(9809) 2123–2135 10.1016/S0140-6736(10)62304-5 (Accessed 16Th February 2014). 14: The World Health Organisation, Indicator and measurement registry. http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=26 (Accessed 19th February 2014). 15: UN Data, Statistics. http://data.un.org/Data.aspx?d=MDGf=seriesRowID:570 (Accessed 19 February 2014).