14.11: Nuclear Weapons
Learning Objectives
- Discuss different types of fission and thermonuclear bombs.
- Explain the ill effects of nuclear explosion.
The world was in turmoil when fission was discovered in 1938. The discovery of fission, made by two German physicists, Otto Hahn and Fritz Strassman, was quickly verified by two Jewish refugees from Nazi Germany, Lise Meitner and her nephew Otto Frisch. Fermi, among others, soon found that not only did neutrons induce fission; more neutrons were produced during fission. The possibility of a self-sustained chain reaction was immediately recognized by leading scientists the world over. The enormous energy known to be in nuclei, but considered inaccessible, now seemed to be available on a large scale.
Within months after the announcement of the discovery of fission, Adolf Hitler banned the export of uranium from newly occupied Czechoslovakia. It seemed that the military value of uranium had been recognized in Nazi Germany, and that a serious effort to build a nuclear bomb had begun.
Alarmed scientists, many of them who fled Nazi Germany, decided to take action. None was more famous or revered than Einstein. It was felt that his help was needed to get the American government to make a serious effort at nuclear weapons as a matter of survival. Leo Szilard, an escaped Hungarian physicist, took a draft of a letter to Einstein, who, although pacifistic, signed the final version. The letter was for President Franklin Roosevelt, warning of the German potential to build extremely powerful bombs of a new type. It was sent in August of 1939, just before the German invasion of Poland that marked the start of World War II.
It was not until December 6, 1941, the day before the Japanese attack on Pearl Harbor, that the United States made a massive commitment to building a nuclear bomb. The top secret Manhattan Project was a crash program aimed at beating the Germans. It was carried out in remote locations, such as Los Alamos, New Mexico, whenever possible, and eventually came to cost billions of dollars and employ the efforts of more than 100,000 people. J. Robert Oppenheimer (1904–1967), whose talent and ambitions made him ideal, was chosen to head the project. The first major step was made by Enrico Fermi and his group in December 1942, when they achieved the first self-sustained nuclear reactor. This first “atomic pile”, built in a squash court at the University of Chicago, used carbon blocks to thermalize neutrons. It not only proved that the chain reaction was possible, it began the era of nuclear reactors. Glenn Seaborg, an American chemist and physicist, received the Nobel Prize in physics in 1951 for discovery of several transuranic elements, including plutonium. Carbon-moderated reactors are relatively inexpensive and simple in design and are still used for breeding plutonium, such as at Chernobyl, where two such reactors remain in operation.
Plutonium was recognized as easier to fission with neutrons and, hence, a superior fission material very early in the Manhattan Project. Plutonium availability was uncertain, and so a uranium bomb was developed simultaneously. Figure \(\PageIndex{1}\) shows a gun-type bomb, which takes two subcritical uranium masses and blows them together. To get an appreciable yield, the critical mass must be held together by the explosive charges inside the cannon barrel for a few microseconds. Since the buildup of the uranium chain reaction is relatively slow, the device to hold the critical mass together can be relatively simple. Owing to the fact that the rate of spontaneous fission is low, a neutron source is triggered at the same time the critical mass is assembled.
Plutonium’s special properties necessitated a more sophisticated critical mass assembly, shown schematically in Figure \(\PageIndex{2}\). A spherical mass of plutonium is surrounded by shape charges (high explosives that release most of their blast in one direction) that implode the plutonium, crushing it into a smaller volume to form a critical mass. The implosion technique is faster and more effective, because it compresses three-dimensionally rather than one-dimensionally as in the gun-type bomb. Again, a neutron source must be triggered at just the correct time to initiate the chain reaction.
Owing to its complexity, the plutonium bomb needed to be tested before there could be any attempt to use it. On July 16, 1945, the test named Trinity was conducted in the isolated Alamogordo Desert about 200 miles south of Los Alamos (see Figure \(\PageIndex{3}\)). A new age had begun. The yield of this device was about 10 kilotons (kT), the equivalent of 5000 of the largest conventional bombs.
Although Germany surrendered on May 7, 1945, Japan had been steadfastly refusing to surrender for many months, forcing large casualties. Invasion plans by the Allies estimated a million casualties of their own and untold losses of Japanese lives. The bomb was viewed as a way to end the war. The first was a uranium bomb dropped on Hiroshima on August 6. Its yield of about 15 kT destroyed the city and killed an estimated 80,000 people, with 100,000 more being seriously injured (see Figure \(\PageIndex{4}\)). The second was a plutonium bomb dropped on Nagasaki only three days later, on August 9. Its 20 kT yield killed at least 50,000 people, something less than Hiroshima because of the hilly terrain and the fact that it was a few kilometers off target. The Japanese were told that one bomb a week would be dropped until they surrendered unconditionally, which they did on August 14. In actuality, the United States had only enough plutonium for one more and as yet unassembled bomb.
Knowing that fusion produces several times more energy per kilogram of fuel than fission, some scientists pushed the idea of a fusion bomb starting very early on. Calling this bomb the Super, they realized that it could have another advantage over fission—high-energy neutrons would aid fusion, while they are ineffective in \({ }^{239} \mathrm{Pu}\) fission. Thus the fusion bomb could be virtually unlimited in energy release. The first such bomb was detonated by the United States on October 31, 1952, at Eniwetok Atoll with a yield of 10 megatons (MT), about 670 times that of the fission bomb that destroyed Hiroshima. The Soviets followed with a fusion device of their own in August 1953, and a weapons race, beyond the aim of this text to discuss, continued until the end of the Cold War.
Figure \(\PageIndex{5}\) shows a simple diagram of how a thermonuclear bomb is constructed. A fission bomb is exploded next to fusion fuel in the solid form of lithium deuteride. Before the shock wave blows it apart, \(\gamma\) rays heat and compress the fuel, and neutrons create tritium through the reaction \(n+{ }^{6} \mathrm{Li} \rightarrow{ }^{3} \mathrm{H}+{ }^{4} \mathrm{He}\). Additional fusion and fission fuels are enclosed in a dense shell of \({ }^{238} \mathrm{U}\). The shell reflects some of the neutrons back into the fuel to enhance its fusion, but at high internal temperatures fast neutrons are created that also cause the plentiful and inexpensive \({ }^{238} \mathrm{U}\) to fission, part of what allows thermonuclear bombs to be so large.
The energy yield and the types of energy produced by nuclear bombs can be varied. Energy yields in current arsenals range from about 0.1 kT to 20 MT, although the Soviets once detonated a 67 MT device. Nuclear bombs differ from conventional explosives in more than size. Figure \(\PageIndex{6}\) shows the approximate fraction of energy output in various forms for conventional explosives and for two types of nuclear bombs. Nuclear bombs put a much larger fraction of their output into thermal energy than do conventional bombs, which tend to concentrate the energy in blast. Another difference is the immediate and residual radiation energy from nuclear weapons. This can be adjusted to put more energy into radiation (the so-called neutron bomb) so that the bomb can be used to irradiate advancing troops without killing friendly troops with blast and heat.
At its peak in 1986, the combined arsenals of the United States and the Soviet Union totaled about 60,000 nuclear warheads. In addition, the British, French, and Chinese each have several hundred bombs of various sizes, and a few other countries have a small number. Nuclear weapons are generally divided into two categories. Strategic nuclear weapons are those intended for military targets, such as bases and missile complexes, and moderate to large cities. There were about 20,000 strategic weapons in 1988. Tactical weapons are intended for use in smaller battles. Since the collapse of the Soviet Union and the end of the Cold War in 1989, most of the 32,000 tactical weapons (including Cruise missiles, artillery shells, land mines, torpedoes, depth charges, and backpacks) have been demobilized, and parts of the strategic weapon systems are being dismantled with warheads and missiles being disassembled. According to the Treaty of Moscow of 2002, Russia and the United States have been required to reduce their strategic nuclear arsenal down to about 2000 warheads each.
A few small countries have built or are capable of building nuclear bombs, as are some terrorist groups. Two things are needed—a minimum level of technical expertise and sufficient fissionable material. The first is easy. Fissionable material is controlled but is also available. There are international agreements and organizations that attempt to control nuclear proliferation, but it is increasingly difficult given the availability of fissionable material and the small amount needed for a crude bomb. The production of fissionable fuel itself is technologically difficult. However, the presence of large amounts of such material worldwide, though in the hands of a few, makes control and accountability crucial.
Section Summary
- There are two types of nuclear weapons—fission bombs use fission alone, whereas thermonuclear bombs use fission to ignite fusion.
- Both types of weapons produce huge numbers of nuclear reactions in a very short time.
- Energy yields are measured in kilotons or megatons of equivalent conventional explosives and range from 0.1 kT to more than 20 MT.
- Nuclear bombs are characterized by far more thermal output and nuclear radiation output than conventional explosives.


24.3: Balanced Binary
24.3 Balanced Binary
A balanced binary form, according to Douglass Green in his book, Form in Tonal Music, features a binary form with a first section (the A section) ending in a new key, and the second section ending with essentially the same cadence , now transposed to the original key, as in the following piece by Bach.
Because the first section of a balanced binary ends in a new key, it is inherently a continuous binary form.
Balanced binary form can be found in movements from the Baroque era, including dance suites by Bach, Handel, and others. The movement below shows the endings of the first and section sections of the Courante from J.S. Bach’s French Suite No. 6 in E major, BWV 817.


15.4: Annotated Sample Reading- Case Study on Louis Victor "Tan" Leborgne
By the end of this section, you will be able to:
- Apply critical thinking and communication in varying rhetorical and cultural contexts.
- Identify and describe the genre conventions and rhetorical situation of case studies.
- Analyze relationships between ideas and patterns of organization.
Introduction
Figure \(15.4\) Pierre Paul Broca (credit: “Paul Broca” by Anonymous/Wikimedia Commons, Public Domain)
French physician Pierre Paul Broca (1824–1880), an early researcher of brain science, is credited with developing theories about how the brain controls motor functions such as language. One of his patients, Louis Victor Leborgne, suffered from a continuing loss of speech that resulted in an inability to form any syllables other than tan. Following Leborgne’s death, Broca examined Leborgne’s brain and observed some abnormalities in the left frontal lobe. These observations would eventually lead to the larger discovery that different areas of the brain control different motor functions.
This sample case study imagines what Broca might have written about Leborgne. The contemporary references at the end of the study are those used by the actual writer of the case study, not Pierre Paul Broca.
Living By Their Own Words
Patient Admission
This 50-year-old Caucasian male was transferred from the psychiatry division to the surgical ward of Bicêtre Hospital in Paris on 11 April 1861. I performed a thorough physical examination upon his admission. The presenting diagnosis is diffuse gangrenous inflammation and infiltration of connective tissue of the entire lower right extremity, extending from the instep upward to the buttock. The patient shows complete paralysis of his right-side limbs. The left limbs are mobile with adequate control and power. Both bowel and bladder control are intact. The eyes are equally focused and reactive to light, although the vision in the left eye has deteriorated more than in the right eye. The patient exhibits difficulty in swallowing food, but the tongue is not paralyzed, and voice is normal.
Introduction. Broca first orients readers to the details of the case study: the participant, Leborgne, and how Leborgne came to be under his care.
Background and Context. Broca gives a detailed description of the case study participant. He notes physical details of Leborgne’s paralysis so that readers understand that Leborgne retains control over his voice and tongue. This knowledge allows Broca to eliminate paralysis as a cause of the subject’s inability to use language.
The patient is completely unable to form words other than the single syllable tan , which he most often repeats twice in rapid succession: “tan-tan.” This is said in varying tones and inflections. Paralysis of the patient’s dominant arm prevents writing. Nevertheless, the patient can communicate to a surprising extent through facial expressions and gestures with his left hand. His intellect appears normal, and he shows no signs of head trauma.
Research Question. In this paragraph, Broca further describes his participant and begins to bring the case study into focus. The details he provides about Leborgne’s ability to communicate and use language will be the focus of the study. Broca observes that Leborgne can communicate nonverbally, and no physical signs indicate that his brain may be affected. Broca wants to understand why Leborgne communicates as he does.
Patient History
Personal History. My personal interviews with family members revealed that Louis Victor Leborgne was born 21 July 1809, in Moret-sur-Loing. The town has many tanneries, a fact that may account for his use of the syllable tan . His father is an elementary school teacher. The patient is one of six siblings. His previous occupation was formier [artisan who made forms for shoemakers]. He is unmarried and has no children. Members of his immediate family visit but have been unable to provide care for him at home, resulting in an extended hospital stay of 21 years. Interviews with other patients in the ward have indicated that the patient is unfavorably viewed as egotistical and vindictive.
Description of Research Methods. In this section, Broca notes that he interviewed Leborgne’s family and other patients in the hospital and provides a hypothesis as to why Leborgne uses the syllable tan to communicate.
Organization. The author uses headings to organize the different sections of the case study. Main headings are centered; subheadings are left-justified.
Medical History. My interviews with family members and hospital staff responsible for his care yielded only a cursory medical history. They did, however, reveal that the patient developed epilepsy in his childhood or youth; the exact age is unknown.
At age 30, the patient lost the ability to speak but did not immediately seek medical attention. When the condition persisted, he came to Bicêtre Hospital and was admitted to the psychiatry division in 1840 (exact date not recorded).
Limitations of Research. Broca again notes the use of personal interview data as a research method / primary source. He acknowledges the limitations of this method (“only a cursory medical history”) but was able to gather relevant details, such as when Leborgne developed epilepsy, when he lost the ability to speak, and when he was first admitted to the hospital.
Approximately 10 years after the onset of his first symptoms, Leborgne experienced gradual weakness of his right arm, which developed into complete paralysis in that limb. This condition was followed by weakness in his right leg and foot. Apparently, it took four years from the start of the paralysis of his right arm until the patient completely y lost the ability to stand. In these years, his vision and mental faculties also deteriorated.
The patient remains in bed, having refused to leave it for the past seven years. During this time, his clothing was changed once a week. The infrequent change of clothes caused a delay in discovering the extent of his gangrenous inflammation and infection. At this point, the patient could hardly move and was transferred to the surgical unit, where I first met him.
Background and Context. More details of Leborgne’s medical history are given. Broca concludes the patient history by relating the circumstances leading to his treatment of Leborgne. This section provides a detailed account of everything known about the participant and his condition. Broca doesn’t rely only on records to gather this history, though. He interviews hospital staff to try to gather additional information not recorded.
Treatment
The gangrene being too extensive for surgery, I confined myself to testing his mental faculties and language comprehension. By using his fingers, the patient was able to respond accurately to mathematical questions. He understood and responded to verbal questions as well. At times, his answers were incorrect, such as claiming to have children; I attribute these lapses to sepsis, which by now was far advanced.
Research Methods. In this section, Broca begins to relate how he observed Leborgne’s ability to communicate.
Analysis of Results. Broca tries to explain the reason for Leborgne’s incorrect responses.
Lacking any physical irregularities that would cause his loss of speech, I conclude the condition must be related to brain function. This condition is so singular that it seems useful to assign it a special name. I will designate it, therefore, as aphemia , or loss of speech.
The patient expired on 17 April 1861 at 11:00 a.m. Cause of death was gangrenous infection and sepsis.
Broad Theory. Broca poses a theory about Leborgne’s limited ability to communicate: “the condition must be related to brain function.” This theory will be tested later in the case study and, if correct, might be applicable to how the brain works for everyone.
Autopsy Findings
I performed an autopsy 24 hours postmortem and found a number of irregularities in the patient’s brain. A softened area over the perisylvian region contained a cavity the size of a chicken’s egg, filled with serous fluid. Volume loss affected the gyri, subcortical perisylvian area, insula, and part of the striate nucleus. I weighed the brain and discovered it to be lighter than normal. I attribute the low weight to the loss of volume in the left cerebral hemisphere.
I observed a significant malformation on the left frontal lobe, which I believe to be the source of the patient’s aphemia and, therefore, the brain location controlling speech production. Wishing to preserve the brain, I performed a surface examination only, without a full dissection. I have placed the preserved brain at the Musée Dupuytren in Paris.
Research Methods. Broca provides details of the autopsy and describes the abnormalities he found in Leborgne’s brain. These details are crucial to the study because of Broca’s earlier comment about Leborgne’s inability to communicate resulting from brain function.
Analysis of Results. Broca further hones his theories based on his observations of Leborgne’s brain. Broca hypothesizes that this malformation is the cause of Leborgne’s condition and, therefore, is located in the part of the brain that is related to speech.
Discussion
I presented Leborgne’s case at the meeting of the Société d’Anthropologie de Paris on 18 April 1861, where it generated considerable controversy. My former teacher Jean-Baptiste Bouillaud had previously advanced the idea that the language function is localized in the frontal lobes, with which, based on my autopsy of Leborgne’s brain, I concur. Anatomist Louis Pierre Gratiolet opposed the idea that there could exist a specific area responsible for speech, arguing that the brain functions as a whole. Esteemed physician Ernest Auburtin asserted that specific areas of the brain have specific functions and further stated that motor articulation is not directly relevant to the ability to conceive words and ideas.
Advancing Knowledge. Broca uses his case study to contribute to the research on brain functions.
Limitations of the Research. Broca notes that not all attending the meeting are in agreement, suggesting that further research is needed to learn more about the brain and whether specific parts control specific functions.
Conclusion
Given my patient Leborgne’s success at responding to verbal and mathematical questions despite his loss of speech, I am convinced that brain function is localized. Auburtin’s theory of more compartmentalized specificity is intriguing, and I intend to pursue this idea. Leborgne’s preserved brain remains at the Musée Dupuytren, where it is available for further study.
What’s Next. Inviting additional research, Broca calls on his audience to research localized brain function. He notes that Leborgne’s brain is available for researchers to observe.
References
Domanski, C. W. (2013). Mysterious “ Monsieur Leborgne ”: The mystery of the famous patient in the history of neuropsychology is explained. Journal of the History of the Neurosciences , 22(1), 47–52. https://www.tandfonline.com/doi/abs/...4X.2012.667528
Konnikova, M. (2013, February 8). The man who couldn’t speak and how he revolutionized psychology. Scientific American . https://blogs.scientificamerican.com...ed-psychology/
Mohammed, N., Narayan, V., Patra, D. P., & Nanda, A. (2018). Louis Victor Leborgne (“Tan”). World Neurosurgery , 114, 121–125. https://doi.org/10.1016/j.wneu.2018.02.021
Ruane, M. (2013, July). Discovering the identity of a 150-year-old patient. Smithsonian . https://www.smithsonianmag.com/histo...tient-4563869/
Discussion Question
- What methods does Broca use in his case study?
- What are Broca’s field observations?
- What types of evidence does Broca gather for his case study?
- How does Broca analyze his data? What conclusion does he reach?
- If Leborgne had lived longer, what are some ways Broca could have expanded his study on his patient’s use of language?
Language and Expression
One significant finding of Broca’s case study was that Leborgne grew up in the town of Moret-sur-Loing. The town had many tanneries, leading Broca to theorize that Leborgne’s use of the syllable tan was related to his home. Why is this theory important? It illustrates how personal history affects people. It is possible that Leborgne used language in this way because of his history and cultural association with his hometown. Culture and identity have a big impact on how people use language, even among people who speak the same language.
Figure \(15.5\) The Broca area—named for French anthropologist and pathologist Pierre Paul Broca (1824–1880), who discovered its function—is the part of the brain that controls articulate speech. The Wernicke area—named for German neurologist Carl Wernicke (1848–1905), who first described the area—is the part of the brain that controls the comprehension of speech. (credit: “BrocasAreaSmall” by NIH publication 97-4257/Wikimedia Commons, Public Domain)


5.1: Introduction
Introduction
Since the early 1500s, the countries of the world have pursued a path to globalize economic, cultural, and political interconnectivity beyond local territories or trading partners across oceans and continents. By the beginning of the 20 th Century (5.1.1), globalization was the primary force as the scale and volume of interconnectivity through capital accumulation, industrial technologies, and governmental systems became part of local life throughout the globe. Globalization brought a system of rules and regulations used throughout the world, a system in its infancy at the beginning of the century. The concepts grew into a sophisticated, advanced system by the end of the century. At the start of 1900, within the system of globalization, some groups or countries amassed wealth and supremacy while others collapsed into financial and political deterioration. European countries had experienced exceptional industrial and military development, and by 1910, they controlled India, Africa, and Southeast Asia, while Japan governed Korea and Taiwan. The United States was expanding development across its vast geographical territory. During this period, China, Central, and South America, and the Ottoman Empire fell into economic decline or were under control by other nations. Along with physical and financial control by European countries, the ideals of their social cultures and sciences were also exported to other places bringing competition between nations to demonstrate advances in the industry, technology, architecture, and scientific concepts of people like Albert Einstein or Sigmund Freud. The declining countries did not develop sophisticated industrialization and were unable to compete successfully in the global world.
In the early part of the 20 th century, a rapid change occurred everywhere; powerful states competed with each other, and other states resisted European domination, leading to significant, later upheavals around the world. With rapid economic and industrial growth came the destruction of the natural environment. Rising economies in non-European parts of the globe and other nationalist movements brought uprisings weakening Europe's control, influence, and power. The United States, Russia, and Japan developed stronger economies. During the early part of the century, and despite the significant changes occurring, "the industrialized regions of Europe, North America, the USSR, and Japan accounted together for about 75 percent of the globe's Gross Domestic Product (GDP)," [1] dominating the financial system in the world. Two new conflicting blocs of power were the United States and the USSR. Populations increased with better technology to grow and harvest food, and control diseases through vaccinations and better medicine, leading to falling death rates. Population growth also expanded in the cities; people migrated from rural areas to the cities. "By 1950, more than 50 percent of people in the most industrialized countries lived in cities, about 40 percent in Latin America and the USSR, and less than 20 percent in the least industrialized regions, including China, South Asia, and much of Africa." [2]
The first half of the 20 th century included two world wars, a great depression, and a significant redistribution of global power. Through industrialization, countries stockpiled modern weapons, built alliances, and instituted financial tariffs and taxes in the competitive marketplace. In 1914, World War I started, a long and destructive war with France, Britain, and the United States against Germany, Austro-Hungarian, and Ottoman Turkish. Millions of people died, and the financial cost was high. During the war, the German incursion into Russia weakened the czar, and a civil war erupted, leading to the growth of communism in Russia. The war brought a breakdown in social norms, changing class structures, race relations, and a fragmented world. Nationalist movements and revolutions began in other countries. India revolted against the British, China's uprising brought the communists to power, multiple leaders in Africa fought for independence, and Mexico revolted against Spanish control. One of the most dangerous changes was Hitler's ideology of Nazism and fascism, Germany's rebellion against the restrictive sanctions from World War I, and support for the rise of authoritarian government. Unrest throughout the world brought the destruction of World War II as Germany invaded Poland in 1939 and Japan attacked mainland China in 1937.
The fragmentation of world order also changed the art world; the disenchantment with previous academic styles led to artists' experimentation and innovation, developing new modes of expression based on their personal experiences. The chaos brought attitudes of antinationalism, and cynicism and created new ideas and genres of art, frequently based on cross-cultural ideas from multiple places in the world. They wanted to develop expressions based on the zeitgeist of the time. Previously, art was based on the reproduction of nature, recognizable elements, people, animals, the sky, or landscapes. With the advent of modernism, art became detached from reproduction, now consumed by the basic elements of line, color, dimension, and the experimental abstraction of those elements. Multiple styles and movements grew, some celebrating technology, fragmented images based on a dislocated life, or unusual pictures of the subconscious. Based on the writings of historian H. W. Janson, he believed the beginning of the 20 th century brought three new courses of art; expression, fantasy, and abstraction. Expression was formulated on feelings about the human condition; fantasy explored the mind's inner workings, and abstraction emphasized the structure of a work. The work ranged from realistic to non-representational, primarily geometric abstraction.
The best works have all three: Without feeling, we are unmoved.
Without imagination, we are bored.
Without order, we see chaos. [3]
Color of Fauvism
Fauvism rejected the pastel palette used by the Impressionists, exploiting a bold set of colors to display the distortion of their subject matter. The colors were unnatural, even assaulting one's mind with the bright color displayed in unexpected places. The colors were fragmented into blocks with little shading or subtleness as the artist started with a form or shape and applied color to express a meaning or movement, an unnatural color for the form; the grass did not have to be green or the sky blue. The paint roughly applied gave the images an energetic or celebratory feeling; the simplified forms developed with the saturated colors gave each element strength. Their raucous, unbalanced palette defied the standards of academic painting, offending the sensibilities of the viewers.
Shapes of Cubism
Cubism developed a total reconstruction of a subject into geometric shapes or geometric abstraction, generally cube-like, arranged to bring a three-dimensional perspective to the viewer. The geometric abstraction used geometric forms positioned in non-illusionistic areas as the artists deconstructed and reformed shapes. The first representation of Cubism was based on the facets of the visual world, as seen in Cezanne's villages. In Analytic Cubism, artists overlapped frontal surfaces placed in linear grids. Synthetic Cubism focused on flat, synthesized shapes arranged in an abstract space, experimenting with the spatial relationships of different materials. The early artists used traditional items, reinventing them in fragmented elements while maintaining identifiable clues to the original shape. Initially, the artists used a muted, limited palette, focusing on the geometric composition instead of color.
Materials of Dadaism
Dada focused on the absurd and irrational, often known as an anti-establishment statement to demonstrate their disdain for this new century's societal, political, and cultural ethics. The artists challenged the very concepts of art and selected readymade or found objects they repurposed into another form. Artists also began to incorporate mundane, everyday objects; newspapers, letters, photographs, wallpaper, and scraps of paper into collages. Sometimes the collage elements were placed, and other times the artist just dropped them on paper and glued them wherever they fell. Wood was a common material, cut into a shape and adorned with different materials; pipe, beads, paper pieces, or other found materials. They used the mixed-media assemblages as a caricature or parody of the violence and corruption of society.
Design of Bauhaus
After World War I, Germany was in disarray and financially broken. The concept of the Bauhaus, founded by Walter Gropius, was to create an academy for artists to help rebuild the ruined country. The ideas included all aspects of art based on the elementary structures, a back-to-basics thought, as simple as a triangle, circle, and square, leaving behind the decorative standards of the past. Mass production was part of the concepts for design resulting in furniture, textiles, and kitchenware, revolutionizing manufacturing and the assembly-line process and bringing artistically designed products to the middle-class masses. Gropius wanted to unify arts based on crafts, the motto of the school, "Art into Industry." The different education workshops included cabinetmaking (using alternative forms of chairs), textiles (weaving with unconventional materials), metalworking (sculptural home products, easy to use), typography (use of sans serif font and integrated photography), and architecture (streamlined style). The concepts of the Bauhaus were to bring those things considered crafts on a par with sculpture and painting in the world of fine arts.
Social Art of Harlem Renaissance
The great migration of African Americans moving from the south to cities in the north and west, especially in New York City, created the opportunity for the Harlem Renaissance. The movement included music and the beginning of the jazz age, literature, and art, all based on the Black experience and their traditional, societal, intellectual, and artistic expressions. Artists, poets, musicians, and writers all came to Harlem, congregating, developing synergy, and producing works that first inspired racial pride and then became incorporated into the larger American psyche.
Subconscious Art of Surrealism
Highly influenced by the writings of Sigmund Freud, Surrealists expressed the subconscious through art with dreamlike and deformed images, unconstrained by the rational mind and societal rules. The artists believed creativity grew from the subconscious based on automatism, those actions not controlled by the conscious mind, for example, breathing or nervous tics. Automatism allowed the free and spontaneous creation of images. Surrealists also based work on their interpretation of dreams without preconceived ideas of a standard work of art instead of a subconscious arrangement of images and meanings. World War I generated hardships throughout the artistic community, and to escape the bleakness surrounding them, the artists wanted to reshape the perception of reality. Freud's works were instrumental in helping artists use their subconscious through dreams or trances, and Surrealism became the symbolic view of the subconscious through abstraction.
[1] Retrieved from https://whfua.history.ucla.edu/eras/era8.php
[2] Retrieved from https://whfua.history.ucla.edu/eras/era8.php
[3] Retrieved from https://www.dartmouth.edu/~matc/math5.geometry/unit16/unit16.html


1.3.2: Stress and Disease
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The relationship between stress and health is complex. Each person perceives and responds to stress differently and there are different types of stresses, both good and bad. For some people, it happens before having to speak in public. For other people, it might be before a first date. What causes stress for you may not be stressful for someone else. With so much variation in stress, it is challenging to determine the exact relationship of stress and disease. However, since about the 1940’s scientists and researchers have been working to better understand the relationship.
People experience both eustress and distress. A person experiences eustress, also referred to as “good stress,” when the stressor helps the body enhance performance or overcome lethargy, it is their optimal level of stress. Distress, or what we view as “bad stress,” is when the body cannot cope with the stressor and leads to fatigue, or behavioral and physical problems. Stress can be helpful if it encourages you to meet a deadline or get things done. But feeling stressed for an extended amount of time can take a toll on your mental and physical health.
Optimal Stress
Although we tend to associate stress and health negatively, there is also a positive association between stress and health. Some stress can be good for you and help you to reach optimal performance. The relationship between stress and optimal performance is called the Yerkes–Dodson law , developed in 1908. Although this is called a law, it is actually a concept explaining that we need a certain amount of stress (arousal) to reach optimal (strong) performance. If we have too little stress or too much stress our performance will weaken. If we are under-aroused, we become bored and will seek out some sort of stimulation. On the other hand, if we are over-aroused, we will engage in behaviors to reduce our arousal/stress.
Most students have experienced this need to maintain optimal levels of arousal (stress) over the course of their academic career. Think about how much stress students experience toward the end of spring semester—they feel overwhelmed with work and yearn for the rest and relaxation of summer break. Their arousal/stress level may be too high. Once they finish the semester, however, it doesn’t take too long before they begin to feel bored; their arousal level is too low and their level of performance or productivity is also typically lower. Generally, by the time fall semester starts, many students are ready to return to school. This is an example of how the arousal theory works.
General Adaptation Syndrome
In the 1930’s a young medical student named Hans Selye became very interested in the relationship of stress and disease and for the next 50 years he systematically studied its relationship. One of his biggest contributions to the field of study was his development of the General Adaptation Syndrome. Selye found that there seemed to be a common or typical stress response pathway that people experienced when confronted with a stressor.
The pathway is simplified into three stages: Stage 1- Alarm, Stage 2- Resistance, and Stage 3- Exhaustion. This pathway begins when a person is exposed to a stressor and they are at first taken off guard and the body launches the Fight or Flight response (alarm stage). If the perceived stress continues, they attempt to maintain homeostasis by resisting the change (resistance stage). Our body wants to stay in homeostasis, which is a state of physiological calmness or balance, and occurs when our bodily functions are running smoothly in conjunction with low stress levels. Finally they eventually fall victim to exhaustion due to prolonged exposure to the stressor and depleting the bodies ability to cope to maintain homeostasis (exhaustion stage). Reaching the exhaustion stage leads to illness due to the resulting wear and tear on the body which leads to suppressing the immune system and causing bodily functions to deteriorate. This can lead to a variety of health issues and illnesses, including heart disease, digestive problems, depression, and diabetes.
For example, you just find out that you have to pass a certification test in 2 months in order to keep your job and have not started studying. Your first reaction might be shock, anger, feelings of hopelessness, or anxiousness. This is the first stage, the alarm stage. You could choose to quit your job and flee from the stress, however you know how important it is, so you make a plan to prepare the test and include deep breathing exercises. In this stage you are resisting the stress with coping mechanisms. As the certification test gets closer you once again begin feeling stress, you might feel like you are doomed to fail this test and feel desperate, feel constantly anxious, have difficulty falling asleep and waking up in the morning. This is the exhaustion stage and where you will be more susceptible to getting sick. The exhaustion of this stage will have deleterious effects on your health by depleting your body resources which are crucial for the maintenance of normal functions. Your immune system will be exhausted and function will be impaired.
Psychoneuroimmunology (PNI)
Unlike the Yerkes-Dodson Law or the General Adaptation Syndrome , Psychoneuroimmunology (PNI) is not a model or framework, but rather a discipline of study. People who study the discipline of PNI study the relationship between the endocrine system, the nervous system, and the immune system to better understand the connection between the mind and the body.
For example, in the 19080’s a married couple, one a psychologist and the other an immunologist, began to become aware of the growing body of research in PNI and realized they had a unique opportunity to bring their disciplines and perspectives together to add to the research on the relationship of stress and disease [1] . Rather than continue with research using animals, as many had before them, they wanted to study the connection between stress and immunity under more natural circumstances. This began years of researching medical students before, during, and after taking a very stressful 3-day exam. They found that the stressful exam brought about a decline in the students’ Natural Killer cells, one of the main immune cells that fight off disease.
There is a wealth of research on how stress impacts immune functioning leading to the belief that every one of the hormones/transmitters secreted by these nervous system regions has been shown to have the potential, either in vivo or in vitro, to alter some aspect of immunity [2] . It has been found that chronic stress is an immunosuppresive, meaning that it suppresses the immune system not allowing the body to have an efficient and effective immune response. It is now well established that psychological factors, especially chronic stress, can lead to impairments in immune system functioning in both the young and older adults.


20.1: Introduction
Maxwell's equations are the fundamental equations that, along with the Lorentz force law, describe classical electrodynamics [1]. It provides a basis for electric and magnetic circuits as well as classical optics. They are named for James Clerk Maxwell [2], who, in 1861 and 1862, published an early form of the equations that included the Lorentz force law. This chapter describes the four equations, which are usually called Gauss's Law, Gauss's Law for Magnetism, Faraday's Law, and the Ampère-Maxwell Law. It then describes some of the implications of these equations, including plane electromagnetic waves and momentum and radiation pressure.
References
- Wikipedia contributors. Maxwell's equations [Internet]. Wikipedia, The Free Encyclopedia.
- Wikipedia contributors. James Clerk Maxwell [Internet]. Wikipedia, The Free Encyclopedia.


5: Electronic Structure and Periodic Properties
The study of chemistry must at some point extend to the molecular level, for the physical and chemical properties of a substance are ultimately explained in terms of the structure and bonding of molecules. This module introduces some basic facts and principles that are needed for a discussion of organic molecules.
-
- 5.1: Light and Atomic Structure
- Light and other forms of electromagnetic radiation move through a vacuum with a constant speed, c. This radiation shows wavelike behavior, which can be characterized by a frequency, ν, and a wavelength, λ, such that c = λν. Light is an example of a travelling wave. Other important wave phenomena include standing waves, periodic oscillations, and vibrations. Standing waves exhibit quantization, since their wavelengths are limited to discrete integer multiples of some characteristic lengths.
-
- 5.2: Development of Quantum Theory
- Macroscopic objects act as particles. Microscopic objects (such as electrons) have properties of both a particle and a wave. but their exact trajectories cannot be determined. The quantum mechanical model of atoms describes the 3D position of the electron in a probabilistic manner according to a mathematical function called a wavefunction, often denoted as ψ. The squared magnitude of the wavefunction describes the distribution of the probability of finding the electron in a particular region in
-
- 5.3: Electronic Structure of Atoms (Electron Configurations)
- The relative energy of the subshells determine the order in which atomic orbitals are filled. Electron configurations and orbital diagrams can be determined by applying the Pauli exclusion principle (no two electrons can have the same set of four quantum numbers) and Hund’s rule (whenever possible, electrons retain unpaired spins in degenerate orbitals). Electrons in the outermost orbitals, called valence electrons, are responsible for most of the chemical behavior of elements.
-
- 5.4: Periodic Variations in Element Properties
- Electron configurations allow us to understand many periodic trends. Covalent radius increases as we move down a group because the n level (orbital size) increases. Covalent radius mostly decreases as we move left to right across a period because the effective nuclear charge experienced by the electrons increases, and the electrons are pulled in tighter to the nucleus. Anionic radii are larger than the parent atom, while cationic radii are smaller.
-
- 5.E: Electronic Structure and Periodic Properties- Homework
- These are homework exercises to accompany the Textmap created for "Chemistry" by OpenStax. Complementary General Chemistry question banks can be found for other Textmaps and can be accessed here. In addition to these publicly available questions, access to private problems bank for use in exams and homework is available to faculty only on an individual basis; please contact Delmar Larsen for an account with access permission.
Contributors and Attributions
-
Paul Flowers (University of North Carolina - Pembroke), Klaus Theopold (University of Delaware) and Richard Langley (Stephen F. Austin State University) with contributing authors. Textbook content produced by OpenStax College is licensed under a Creative Commons Attribution License 4.0 license. Download for free at<EMAIL_ADDRESS>).


5.4: Classical School
Leviathan (1651), Hobbes made a few assumptions about human beings. [1] He assumed humans were at conflict with one another, pursued their self-interests, and were rational. Moreover, people would create authority figures out of fear of others, and people should democratically create rules that all citizens must follow. Hobbes wanted a new type of government, one that was ruled by the people and not by monarchs. He believed people had natural rights such as life, liberty, and the pursuit of happiness. If we grant the assumption that people are rational, we would assume people have the ability to consider the possible consequences of their actions. Hobbes was one of the first social contract thinkers. Social contract thinkers believed people would invest in the laws of their society if, and only if, they know government protected them from those who break the law. People will give up a little of their self-interests as long as everyone reciprocates.
Hedonism is the assumption that people will see maximum pleasure and avoid pain (punishment). Consequently, if we grant the assumptions of classical theory, we can hold people 100% responsible for their actions because it was a choice. These assumptions have been the basis for the American criminal justice system since its inception. Although theories may have changed the landscape of understanding criminal behavior and may have changed the philosophies of punishments over time, the criminal justice system has maintained the assumption that crime is a choice. Hence, we can hold offenders 100% responsible for their actions.
An Essay on Crimes and Punishment (1764), which attacked Europe’s use of harsh treatment. [2] Ideally, he wanted to change the excessive and cruel punishment by applying rationalistic, social contract ideas. At the time, judges had tremendous power to determine guilt and create laws based on their decisions. Intellectuals well received his essay at the time, but the Catholic Church banned it. His ideas were exceptionally radical at the time, mainly because his writing questioned the power structures at the time.
Essay was highly influential during the Enlightenment, and it may have served as a model during the creation of the American Criminal Justice system. For example, Beccaria advocated that punishments should fit the crime and be proportional to the harm done, laws should only be determined by the legislature, judges should only determine guilt, and every person should be treated equally under the law. He claimed the sole purpose of the law was to deter people from committing the crime. Deterrence can be accomplished if the punishment is certain, swift, and severe. These may seem like common sense today, but they were considered radical ideas at the time.
[3]
-
Hobbes, T. (1651/1968).
Leviathan
. Baltimore, MD: Penguin Books.
↵
-
Beccaria, C. (1963).
On crimes and punishments
(H. Paolucci, Trans.). Indianapolis, IN: Bobbs-Merril. (Original work published in 1764)
↵
-
Bentham, J. (1823).
Introduction to the principles of morals and legislation
. Oxford, UK: Oxford University Press.
↵


4.4.0: Gramática
Patrones de conjugación de los verbos irregulares en el pretérito
There are quite a few irregular preterit verbs. While that can seem overwhelming, they do follow several patterns. Review the 5 patterns below.
I. Irregular Verbs
As you might have noticed in the blog, the verbs ser and ir share the same conjugations in the preterit:
| yo fui | nosotros/as fuimos |
|---|---|
| tú/vos fuiste | vosotros/as fuisteis |
| él/ella/usted fue | ellos/ellas/ustedes fueron |
Use context to tell the two verbs apart in the preterit tense. Look at the two examples from the blog:
- Mis compañeros de viaje y yo fuimos a la playa. → You have already learned that ¨ir + a + location¨ is used to talk about where a person is going. The verb IR is used in this context.
- Fue una visita inolvidable. → You have already learned that ser is used for general descriptions. The verb SER is used in this context.
Use this chat mat as you converse with others:
Other verbs that are irregular, but do not follow any specific rules are ver and dar :
| yo vi | nosotros/as vimos |
|---|---|
| tú/vos v iste | vosotros/as visteis |
| él/ella/usted vio | ellos/ellas/ustedes vieron |
| yo di | nosotros/as d imos |
|---|---|
| tú/vos d iste | vosotros/as disteis |
| él/ella/usted dio | ellos/ellas/ustedes dieron |
II. Irregular Yo forms
Some verbs change their spelling in the yo form to maintain the same pattern of pronunciation:
- Verbs ending in -car : c –> qu.
Modelo:
tocar → yo toqué
Other common verbs that follow this model are:
- Buscar
- Practicar
- Tocar
- Verbs ending in -gar : g –> gu.
Modelo:
llegar → yo llegué
jugar → yo jugué
Other common verbs that follow this model are:
- Pagar
- Rogar
- Verbs ending in -zar : z –> c .
Modelo:
comenzar → yo comencé
Other common verbs that follow this model are:
- Empezar
- Almorzar
- Cruzar
III. Irregular third person forms
The following verbs change from -i to -y in the third person singular (él, ella, Ud.) and third person plural (ellos, ellas, Uds.). The rest of conjugations need a written accent on the i.
| yo leí | nosotros/as leímos |
|---|---|
| tú/vos leíste | vosotros/as leísteis |
| él/ella/usted le y ó | ellos/ellas/ustedes le y eron |
| yo oí | nosotros/as oímos |
|---|---|
| tú/vos oíste | vosotros/as oísteis |
| él/ella/usted o y ó | ellos/ellas/ustedes o y eron |
| yo creí | nosotros/as creímos |
|---|---|
| tú/vos creíste | vosotros/as creísteis |
| él/ella/usted cre y ó | ellos/ellas/ustedes cre y eron |
IV. Stem changing verbs
Remember stem-changing verbs? We learned about them in Unidad 2 - do you remember verbs that had stem changes inside the boot ? In this section you will learn a few rules about stem changes in the preterit tense.
Only -ir verbs stem change in the preterit.
-Ar and -er present tense stem changers maintain their original stem in the preterit. In other words, they do not stem change in the preterit tense - take a look at a few examples:
|
Infinitivo |
Presente (stem changes in -ar and -er verbs) |
Pretérito (no stem changes in -ar and -er verbs) |
| acostarse | yo me ac ue sto | yo me ac o sté |
| volver | él v ue lve | él v o lvió |
In the preterit tense of -ir verbs, only the third person singular and plural stem change (el/ella/usted and ellos/ellas/ustedes) - changes occur inside the sandal .
Stem changers go from e to i , or from o to u , regardless of their vowel change in present tense.
Modelo:
e → i
Common verbs that follow this model are:
- Servir ( serví, serviste, s i rvió, servimos, servisteis, s i rvieron )
- Preferir
- Repetir
- Seguir
- Sentirse
- Vestirse
o → u
Common verbs that follow this model are:
- Dormir ( dormí , dormiste , d u rmió , dormimos , dormisteis , d u rmieron )
- Morir
V. Strong Preterits
Completely irregular verbs in the preterit are also called strong preterits. They can be grouped by the letters they use to aid in memorization.
| I Group | V Group |
|---|---|
|
|
| J Group | U Group |
|
|
Even though they are irregular, you will notice that all of the strong preterits listed above follow a pattern with the same endings:
| e | imos |
| iste | isteis |
| o |
ieron *the J group ends in "eron" |


Skip to main content
-
antithyroid drugs
-
inhibit the thyroid hormone so that the body can maintain normal thyroid homeostasis
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bisphosphonates
-
pyrophosphate analogues that inhibit bone resorption and increase bone density
-
calcimimetics
-
drugs that mimic the action of calcium in the parathyroid glands or other tissues
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calcitonin
-
a hormone secreted by the thyroid gland that lowers blood calcium
-
Chvostek sign
-
a twitch of the facial muscles that occurs with gentle tapping of the cheek and in front of the ear
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dihydroxyvitamin D
3
-
an active form of vitamin D
3
that increases uptake of calcium absorption in the intestine
-
endocrine glands
-
glands within the endocrine system that release hormones to control processes that occur within the body
-
goiter
-
an abnormal enlargement of the thyroid gland
-
Graves’ disease
-
an immune disorder that results in the overproduction of thyroid hormones
-
Hashimoto thyroiditis
-
an autoimmune disorder that involves chronic inflammation of the thyroid gland, resulting in hypothyroidism
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iodine
-
a mineral that the body needs to produce thyroid hormones
-
iodotyrosine
-
an iodo-derivative of tyrosine that acts as an intermediary in the biosynthesis of thyroid hormone
-
myxedema coma
-
a rare life-threatening condition caused by advanced hypothyroidism that affects the body’s temperature, growth, heart rate, and metabolism
-
organification
-
the biochemical process that takes place in the thyroid gland, involving the incorporation of iodine into thyroglobulin for the production of thyroid hormone
-
osteoclast
-
a large multinucleated cell responsible for the dissolution and absorption of bone
-
osteonecrosis
-
the death of bone tissue due to a lack of blood supply
-
osteoporosis
-
a condition that leads to the loss of bone mass, which thereby weakens bone
-
Paget’s disease
-
a disease that disrupts the body’s normal bone recycling process of replacing old bone tissue with new bone tissue
-
parathyroid hormone (PTH)
-
a peptide hormone secreted by the parathyroid glands that regulates serum calcium within the body
-
thyroglobulin
-
a protein present in the thyroid gland from which thyroid hormones are synthesized
-
thyroid drugs
-
drugs that replace the thyroid hormone so that the body can maintain its normal function
-
thyroid gland
-
a butterfly-shaped gland located in front of the neck below the voice box that is responsible for metabolism and iodine homeostasis within the body
-
thyroid storm (thyrotoxic crisis)
-
a rare life-threatening condition that occurs when the thyroid gland releases too much thyroid hormone
-
thyroid-stimulating hormone (TSH)
-
a hormone that stimulates the production of thyroxine and triiodothyronine; also known as thyrotropin
-
thyroxine (T4)
-
a hormone released by the thyroid gland that contains iodine and that increases the rate of chemical reactions within cells
-
triiodothyronine (T3)
-
a hormone released by the thyroid gland that plays a role in controlling the body’s metabolic rate, heart and digestive functions, muscle control, brain development and function, and bone maintenance
-
Trousseau sign
-
an involuntary contraction of the muscles in the hand and wrist


4.7: Implementation of Interventions
Implementation is the fifth step of the nursing process (and the fifth Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse implements the identified plan.” The RN may delegate planned interventions after considering the circumstance, person, task, communication, supervision, and evaluation, as well as the state Nurse Practice Act, federal regulation, and agency policy. [1]
Implementation of interventions requires the RN to use critical thinking and clinical judgment. After the initial plan of care is developed, continual reassessment of the patient is necessary to detect any changes in the patient’s condition requiring modification of the plan. The need for continual patient reassessment underscores the dynamic nature of the nursing process and is crucial to providing safe care.
During the implementation phase of the nursing process, the nurse prioritizes planned interventions, assesses patient safety while implementing interventions, delegates interventions as appropriate, and documents interventions performed.
Prioritizing Implementation of Interventions
Prioritizing implementation of interventions follows a similar method as to prioritizing nursing diagnoses. Maslow’s Hierarchy of Needs and the ABCs of airway, breathing, and circulation are used to establish top priority interventions. When possible, least invasive actions are usually preferred due to the risk of injury from invasive options. Read more about methods for prioritization under the “ Diagnosis ” subsection of this chapter.
The potential impact on future events, especially if a task is not completed at a certain time, is also included when prioritizing nursing interventions. For example, if a patient is scheduled to undergo a surgical procedure later in the day, the nurse prioritizes initiating a NPO (nothing by mouth) prescription prior to completing pre-op patient education about the procedure. The rationale for this decision is that if the patient ate food or drank water, the surgery time would be delayed. Knowing and understanding the patient’s purpose for care, current situation, and expected outcomes are necessary to accurately prioritize interventions.
Patient Safety
It is essential to consider patient safety when implementing interventions. At times, patients may experience a change in condition that makes a planned nursing intervention or provider prescription no longer safe to implement. For example, an established nursing care plan for a patient states, “The nurse will ambulate the patient 100 feet three times daily.” However, during assessment this morning, the patient reports feeling dizzy today, and their blood pressure is 90/60. Using critical thinking and clinical judgment, the nurse decides to not implement the planned intervention of ambulating the patient. This decision and supporting assessment findings should be documented in the patient’s chart and also communicated during the shift handoff report, along with appropriate notification of the provider of the patient’s change in condition.
Implementing interventions goes far beyond implementing provider prescriptions and completing tasks identified on the nursing care plan and must focus on patient safety. As front-line providers, nurses are in the position to stop errors before they reach the patient. [2]
In 2000 the Institute of Medicine (IOM) issued a groundbreaking report titled To Err Is Human: Building a Safer Health System . The report stated that as many as 98,000 people die in U.S. hospitals each year as a result of preventable medical errors. To Err Is Human broke the silence that previously surrounded the consequences of medical errors and set a national agenda for reducing medical errors and improving patient safety through the design of a safer health system. [3] In 2007 the IOM published a follow-up report titled Preventing Medication Errors and reported that more than 1.5 million Americans are injured every year in American hospitals, and the average hospitalized patient experiences at least one medication error each day. This report emphasized actions that health care systems could take to improve medication safety. [4]
Read additional information about specific actions that nurses can take to prevent medication errors; go to the “Preventing Medication Errors” section of the “ Legal/Ethical” chapter of the Open RN Nursing Pharmacology textbook.
In an article released by the Robert Wood Johnson Foundation, errors involving nurses that endanger patient safety cover broad territory. This territory spans “wrong site, wrong patient, wrong procedure” errors, medication mistakes, failures to follow procedures that prevent central line bloodstream and other infections, errors that allow unsupervised patients to fall, and more. Some errors can be traced to shifts that are too long that leave nurses fatigued, some result from flawed systems that do not allow for adequate safety checks, and others are caused by interruptions to nurses while they are trying to administer medications or provide other care. [5]
The Quality and Safety Education for Nurses (QSEN) project began in 2005 to assist in preparing future nurses to continuously improve the quality and safety of the health care systems in which they work. The vision of the QSEN project is to “inspire health care professionals to put quality and safety as core values to guide their work.” [6] Nurses and nursing students are expected to participate in quality improvement (QI) initiatives by identifying gaps where change is needed and assisting in implementing initiatives to resolve these gaps. Quality improvement is defined as, “The combined and unceasing efforts of everyone – health care professionals, patients and their families, researchers, payers, planners and educators – to make the changes that will lead to better patient outcomes (health), better system performance (care), and better professional development (learning).” [7]
Delegation of Interventions
While implementing interventions, RNs may elect to delegate nursing tasks. Delegation is defined by the American Nurses Association as, “The assignment of the performance of activities or tasks related to patient care to unlicensed assistive personnel or licensed practical nurses (LPNs) while retaining accountability for the outcome.” [8] RNs are accountable for determining the appropriateness of the delegated task according to condition of the patient and the circumstance; the communication provided to an appropriately trained LPN or UAP; the level of supervision provided; and the evaluation and documentation of the task completed. The RN must also be aware of the state Nurse Practice Act, federal regulations, and agency policy before delegating. The RN cannot delegate responsibilities requiring clinical judgment. [9] See the following box for information regarding legal requirements associated with delegation according to the Wisconsin Nurse Practice Act.
During the supervision and direction of delegated acts a Registered Nurse shall do all of the following:
(a) Delegate tasks commensurate with educational preparation and demonstrated abilities of the person supervised.
(b) Provide direction and assistance to those supervised.
(c) Observe and monitor the activities of those supervised.
(d) Evaluate the effectiveness of acts performed under supervision. [10]
The standard of practice for Licensed Practical Nurses in Wisconsin states, “In the performance of acts in basic patient situations, the LPN. shall, under the general supervision of an RN or the direction of a provider:
(a) Accept only patient care assignments which the LPN is competent to perform.
(b) Provide basic nursing care. Basic nursing care is defined as care that can be performed following a defined nursing procedure with minimal modification in which the responses of the patient to the nursing care are predictable.
(c) Record nursing care given and report to the appropriate person changes in the condition of a patient.
(d) Consult with a provider in cases where an LPN knows or should know a delegated act may harm a patient.
(e) Perform the following other acts when applicable:
- Assist with the collection of data.
- Assist with the development and revision of a nursing care plan.
- Reinforce the teaching provided by an RN provider and provide basic health care instruction.
- Participate with other health team members in meeting basic patient needs.” [11]
Read additional details about the scope of practice of registered nurses (RNs) and licensed practical nurses (LPNs) in Wisconsin’s Nurse Practice Act in Chapter N 6 Standards of Practice .
Read more about the American Nurses Association’s Principles of Delegation.
Table 4.7 outlines general guidelines for delegating nursing tasks in the state of Wisconsin according to the role of the health care team member.
| RN | LPN | CNA | |
|---|---|---|---|
| Assessment | Complete patient assessment | Assist with the collection of data for stable patients | Collect measurements such as weight, input/output, and vital signs in stable patients |
| Diagnosis | Analyze assessment data and create nursing diagnoses | Not applicable | Not applicable |
| Outcome Identification | Identify SMART patient outcomes | Not applicable | Not applicable |
| Planning | Plan nursing interventions | Assist with the development of a nursing care plan | Not applicable |
| Implementing Interventions | Implement independent, dependent, and collaborative nursing interventions; delegate interventions as appropriate, with supervision |
Participate with other health team members in meeting basic patient needs
Reinforce the teaching provided by an RN provider and provide basic health care instruction |
Implement and document delegated interventions associated with basic nursing care such as providing assistance in ambulating or tasks within their scope of practice |
| Evaluation | Evaluate the attainment of outcomes and revise the nursing care plan as needed | Contribute data regarding the achievement of patient outcomes; assist in the revision of a nursing care plan | Not applicable |
Documentation of Interventions
As interventions are performed, they must be documented in the patient’s record in a timely manner. As previously discussed in the “Ethical and Legal Issues” subsection of the “ Basic Concepts ” section, lack of documentation is considered a failure to communicate and a basis for legal action. A basic rule of thumb is if an intervention is not documented, it is considered not done in a court of law. It is also important to document administration of medication and other interventions in a timely manner to prevent errors that can occur due to delayed documentation time.
Coordination of Care and Health Teaching/Health Promotion
ANA’s Standard of Professional Practice for Implementation also includes the standards 5A Coordination of Care and 5B Health Teaching and Health Promotion . [12] Coordination of Care includes competencies such as organizing the components of the plan, engaging the patient in self-care to achieve goals, and advocating for the delivery of dignified and holistic care by the interprofessional team. Health Teaching and Health Promotion is defined as, “Employing strategies to teach and promote health and wellness.” [13] Patient education is an important component of nursing care and should be included during every patient encounter. For example, patient education may include teaching about side effects while administering medications or teaching patients how to self-manage their conditions at home.
Putting It Together
Refer to Scenario C in the “Assessment” section of this chapter. The nurse implemented the nursing care plan documented in Appendix C. Interventions related to breathing were prioritized. Administration of the diuretic medication was completed first, and lung sounds were monitored frequently for the remainder of the shift. Weighing the patient before breakfast was delegated to the CNA. The patient was educated about her medications and methods to use to reduce peripheral edema at home. All interventions were documented in the electronic medical record (EMR).
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
- Robert Wood Johnson Foundation. (2011, April 28). Nurses are key to improving patient safety . https://www.rwjf.org/en/library/articles-and-news/2011/04/nurses-are-key-to-improving-patient-safety.html ↵
- Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system . National Academies Press. https://pubmed.ncbi.nlm.nih.gov/25077248/ ↵
- Institute of Medicine. (2007). Preventing medication errors . National Academies Press. https://doi.org/10.17226/11623. ↵
- Robert Wood Johnson Foundation. (2011, April 28). Nurses are key to improving patient safety . https://www.rwjf.org/en/library/articles-and-news/2011/04/nurses-are-key-to-improving-patient-safety.html ↵
- QSEN Institute. (n.d.). Project overview: The evolution of the quality and safety education for nurses (QSEN) initiative . http://qsen.org/about-qsen/project-overview/ ↵
- Batalden, P. B., & Davidoff, F. (2007). What is "quality improvement" and how can it transform healthcare?. BMJ Quality & Safety, 16 (1), 2–3. https://doi.org/10.1136/qshc.2006.022046 ↵
- American Nurses Association. (2013). ANA’s principles for delegation by registered nurses to unlicensed assistive personnel (UAP) . American Nurses Association. https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principlesofdelegation.pdf ↵
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
- Wisconsin Administrative Code. (2018). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf ↵
- Wisconsin Administrative Code. (2018). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf ↵
- American Nurses Association. (2021). Nursing: Scope and standards of practice ( 4th ed.). American Nurses Association. ↵
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵


11.2: Word Components Related to the Lymphatic and Immune Systems
This section will describe common word components related to the lymphatic and immune systems. These word components help build definitions for many medical terms. Other common prefixes are described in Chapter 1.3 , and common suffixes are described in Chapter 1.5.
Prefixes Related to the Lymphatic and Immune Systems
- a- : Absence of, without
- an- : Absence of, without
- ana- : Up, upward or back, backward
- brady- : Slow
- inter- : Between
- pan- : All
Word Roots Related to the Lymphatic and Immune Systems
- aden /o: Gland
- immun /o: Immune, immunity
- lymph /o: Lymph, lymph tissue
- lymphaden /o: Lymph gland, lymph node
- myel /o: Bone marrow, spinal cord
- phag /o: To eat
- splen /o: Spleen
- thym /o: Thymus gland
- tox /o: Poison
Suffixes Related to the Lymphatic and Immune Systems
- -ac : One affected with
- -apheresis : Withdrawal or removal
- -cyte : Cell
- -ectomy : Excision, cut out
- -itis : Inflammation
- -logist : Specialist who studies and treats
- -logy : Study of
- -megaly : Enlarged, enlargement
- -oid : Resembling
- -oma : Tumor, swelling
- -osis : Abnormal condition
- -pathy : Disease
- -penia : Decrease, deficiency
- -poiesis : Formation, production
- -rrhaphy : Suturing


13.3: Using Gender Neutral Language
- Discuss different strategies to use gender neutral language in business communication
The use of gender-neutral language is now considered standard practice, incorporated in the APA (American Psychological Association) and other style guides that are the linguistic “bibles” for journalists, academics, and students. Purdue University’s Online Writing Lab is an excellent writing resource; their APA Stylistics: Avoiding Bias page links to further discussion and specific recommendations for how to appropriately represent people in your writing, including sections on Disabilities, Race & Ethnicity, and Sex and Gender.
In order to achieve a more gender-inclusive end, The Writing Center at the University of North Carolina at Chapel Hill recommends focusing on three areas: gendered nouns, titles and names, and pronouns. Specific recommendations and examples:
- Replace gendered nouns with more neutral language. This can be challenging, in particular when there is an established expectation or association. In updating the Star Trek franchise, writers replaced the “where no man has gone before” tagline with the more inclusive “where no one has gone before,” retaining both the rhythm and promise of the iconic phrase.
- Choose equitable titles and names. To illustrate, use Ms. or other appropriate title (Professor, Dr., etc.) that doesn’t define a woman in terms of her relationship with a man. In both written and verbal contexts, give a woman the same respect as you would a man. For example, using both a first and last name or title and last name rather than an informal first name.
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Use pronouns equitably.
As mentioned above, using masculine pronouns (“he,” “his,” “him”) as the “default” is no longer an accepted practice. Instead, consider the following options:
- Use more than one pronoun: If you don’t know the gender of the person the pronoun refers to, use “he or she” or her/him. Note: Be aware of your audience; using “he or she” may exclude people who do not relate to either pronoun. In that case, you may want to use a more inclusive, albeit rather lengthy, “he/she/they.”
- Alternate genders and pronouns: If the person being referred to could be either female or male, alternate using the masculine and feminine pronouns. Be sure to do this in a way that doesn’t confuse your listener/reader by making it sound as though multiple people are involved when there’s just one.
- Make your nouns and pronouns plural: This sidesteps the gender issue for your audience by making it sound as if there is more than on for example, he or she becomes they.
- Use “they” as a singular pronoun: Although “they” generally refers to a plural antecedent—that is, is used as a plural pronoun—it is also used as a gender-neutral pronoun. Again, know your audience.
Contributors and Attributions
- Using Gender Neutral Language. Authored by : Nina Burokas. Provided by : Lumen Learning. License : CC BY: Attribution
- cartoon faces polaroids. Authored by : coffeebeanworks. Provided by : Pixabay. Located at : pixabay.com/en/avatar-customers-photos-ecommerce-3127928/. License : CC0: No Rights Reserved


9.12: Estimate the Difference between Population Proportions (3 of 3)
Learning Objectives
- Construct a confidence interval to estimate the difference between two population proportions (or the size of a treatment effect) when conditions are met. Interpret the confidence interval in context.
- Given the description of a statistical study, evaluate whether conclusions are reasonable.
Drawing Conclusions from Confidence Intervals
It is tempting to get involved in the details of calculating and interpreting a confidence interval without thinking about how the data was collected. Whether we are calculating a confidence interval or performing a hypothesis test, the results are meaningless without a properly designed study.
Here is a quick review of what we already know about the connection between study design, use of inference procedures, and valid conclusions.
- The goal of statistical inference is to use sample statistics to estimate population parameters. Therefore, the data must be a representative sample of the population of interest. This also applies to inference that compares two population parameters.
- In general, we can use statistical inference procedures if the data come from randomly selected or randomly assigned individuals.
- Cause-and-effect conclusions are possible when we randomly assign individuals to treatment groups in a well-designed experiment.
- Since inference procedures are based on probability models, the data must also meet the specific conditions for the procedure we have chosen.
In the next activities, we apply these ideas to the use of confidence intervals for estimating a difference between two population proportions (or estimating a treatment effect.)
Try It
Does Involving a Statistician Improve the Chance That a Medical Research Paper Will Be Published?
The following excerpt from “How Statistical Expertise Is Used in Medical Research” (Altman, D. G., S. N. Goodman, and S. Schroter, Journal of the American Medical Association 287(21):2817–20, 2002) describes the data collection method for this study.
- Authors of original research articles who submitted to BMJ [British Medical Journal] and Annals of Internal Medicine from May through August 2001 were sent a short questionnaire….Authors were asked if they received assistance from a person with statistical expertise.
Of the 190 who did not work with a statistician, 134 had papers rejected without peer review. Of the 514 who did work with a statistician, 293 had papers rejected without peer review.
https://assessments.lumenlearning.co...sessments/3936
Comment
Even when inference is inappropriate, exploratory data analysis can give us important information. The authors of the previous study list two other reasons that their data “make inference difficult.” But they end their paper with the following statement. “Nevertheless, this study provides a picture of the norms and practices of this aspect of the medical research enterprise in 2001 and identifies several areas for possible exploration and improvement in the future.”
Community College Student Athletes and Steroid Use
Robert D. Kersey published an article titled “Anabolic-Androgenic Steroid Use among California Community College Student Athletes” ( Journal of Athletic Trainers 31(3):237 – 41, 1996) comparing various aspects of users and nonusers. The study used an advanced random sampling technique to select 10 representative community colleges in California and then to select a random sample of student athletes from the 10 colleges. The group of 1,185 male and female student-athletes completed an anonymous questionnaire. Of the sample, 4.2% of the males and 1.2% of the females admitted to using steroids.
Let’s Summarize
Every confidence interval has the following form:
To estimate a difference in population proportions (or a treatment effect), the statistic is a difference in sample proportions, so the confidence interval is
The margin of error is based on the estimated standard error in the sampling distribution:
If a normal model is a good fit for the sampling distribution, then the 95% confidence interval is
Use this formula only if a normal model is a good fit for the sampling distribution. A normal model is a good fit when the counts of successes and failures in both samples are at least 10.
When the conditions for normality are met, the confidence level is related to margin of error. To find a confidence interval for a different level of confidence, replace 2 with the appropriate z -score.
There are many differences between sample proportions, . Each of these differences generates its own confidence interval. The proportion of confidence intervals that contains the difference between the population proportions, , is equal to the level of confidence.
As always, “garbage in, garbage out.” The results of a confidence interval are meaningless without a properly designed study.
Contributors and Attributions
- Concepts in Statistics. Provided by : Open Learning Initiative. Located at : http://oli.cmu.edu . License : CC BY: Attribution