2014-2016 Ebola Crisis: US Preparedness

2014-2016 Ebola Crisis: US Preparedness   The 2014-2016 Ebola Crisis and the Effects on U.S. Emergency Preparedness The 2014-2016 Ebola crisis in West Africa proved to be a difficult lesson for the African countries affected as well as for the state of U.S. emergency preparedness when dealing with a relatively unknown infectious disease. Erupting from within a Guinean prefecture in December of 2013, the disease would spread through Guinea, Sierra Leone, and Liberia unchecked due to lack of awareness and emergency preparation due to the unfamiliarity of the disease (Baize et al., 2014). The World Health Organization, Doctors without Borders, and the Centers for Disease Control and Prevention, among others, would collaborate with regional government and public health officials to contain the disease, but the efforts would require extensive time, funding, education, and preparation, and would ultimately result in the loss of over 11,000 lives (Centers for Disease Control and Prevention, 2014, 2016). It would be the largest Ebola outbreak known to date. While U.S. public health agencies and military b ased support would play a crucial role in the end to the outbreak in 2016, the U.S. would have to come to terms with its own lack of planning and emergency preparedness when dealing with an imported infectious disease, and the fear and reservations that plagued its people and healthcare systems in its aftermath. Emergency preparedness has been shaped by a myriad of natural disasters, epidemics, and pandemics that have sieged not only countries, but entire continents. It is the journey in discovering how to approach, contain, treat, and prevent these mass health crises from re-occurring in the future, that has given rise to the complex and unique strategies that keep the general population safe.   These advances in prevention and containment, uncovered particularly in the wake of epidemics and pandemics such as the plague, Spanish Influenza, SARS, and as highlighted in this report, Ebola Virus Disease, prove that the protective measures that responders on the front line must implement to keep disaster at bay, must remain adaptable and ever fluid. The West African Ebola outbreak of 2014-2016 encroached upon the fears and concerns of continental Americans as never before in history. An elusive disease only known by most to be a worry of inhabitants of the sub-Saharan regions of the African continent, Ebola was now knocking on America’s doorstep.   Ã‚  To understand and properly weigh the gravity of the Ebola outbreak, a general understanding of the virus and most recent outbreak is warranted. Ebola virus disease is one of two members of the Filoviridae virus family and is comprised of five differing variations within itself (Centers for Disease Control and Prevention, 2014).   First discovered within Africa in 1976 when two variations of the virus led to outbreaks, the Sudan viral strain, or SUDV within South Sudan, and the Ebola virus strain, or EBOV, in the Democratic Republic of Congo, were introduced (Cenciarelli et al., 2015). The spread of the virus among humans is via contact with infected bodily fluids such as blood, vomit, feces, sweat, and urine, or contaminated fomites (Centers for Disease Control and Prevention, 2014). However, the originating vectors are believed to be fruit bats, which are commonly hunted and eaten as wild game in some areas of Africa, and otherwise known as bushmeat (Saà ©z et al., 2014).    Upon exposure to the virus, the incubation period prior to onset of symptoms ranges anywhere from 2 to 21 days, with symptoms tending to manifest by day 8 through day 10 post-exposure (Signs and Symptoms | Ebola Hemorrhagic Fever | CDC, 2014). It has been identified that infected individuals are not contagious while asymptomatic (Cenciarelli et al., 2015).   Ã‚  The tell-tale symptoms of Ebola virus primarily begin with fever, which progresses to onset of profuse diarrhea and vomiting usually after 3 to 5 days of fever (Chertow et al., 2014).   Accompanied with pain, lethargy, and secondary complications (including hemorrhaging) that occur if the patient is not given supportive treatment, the rapid deterioration in health that transpires due to hypovolemia, shock, or multi-organ failure, will ultimately lead to death (Chertow et al., 2014).   Survivors of the virus tend to improve near day 10 of active viral symptoms and are generally expected to live once they have made it to day 13 (Chertow et al., 2014). Those that do not improve and succumb to the virus tend to pass away between days 7 and 12 of viral infection (Chertow et al., 2014). The case fatality rates for the Ebola virus range anywhere from 50% to 90%, and to date there is still no definitive cure available (World Health Organization, 2018). The unfolding of the 2014-2016 crisis was fast, and the virus rampant by the time the nature of the culprit had been properly unmasked.   Ã‚  A sudden rash of illness exhibiting the characteristics of a filovirus, was first reported by health agencies within the Guà ©ckà ©dou and Macenta prefectures in Guinea in March of 2014, raising the initial red flag of outbreak (Baize et al., 2014).   A team of professionals was sent to the area in mid-March by Medecins sans Frontieres, also known as â€Å"Doctors without Borders†, and research began that same month to uncover the cause of the illnesses (Baize et al., 2014).  Ã‚   Coinciding with the beginning of surveillance and research of the outbreak of illness by Doctors without Borders in March of 2014, the Centers for Disease Control and Prevention, or CDC, also arrived on deck with a small team, lending an additional hand with research and guidance to the Guinean government. The CDC had already maintained a supportive presence in Guinea, Sierra Leone, and Liberia, due to the assistance that it offered in vaccination of the population, and other public health related programs including combating diseases such as malaria and polio (Bell et al, 2016).   Alongside the World Health Organization, UNICEF and International Federation of Red Cross partners, a structured, five-pronged investigation emerged, with the Guinean government primarily orchestrating the response efforts (Dahl et al., 2016).   Extensive investigation and contact tracing led the researchers to surmise that the illness was in fact the EBOV, or Ebola virus, and that the suspected â€Å"patient zero† was a 2-year old from Meliandou in the Guà ©ckà ©dou prefecture (Baize et al., 2014). The toddler had succumbed to the virus in December of 2013, with the second through fourth victims passing afterwards the following January, all within the same prefecture of Guà ©ckà ©dou (Baize et al., 2014).   The agencies worked side by side with the Guinean Ministries of Health to get ahead of the outbreak, as surveillance methods in the region demanded strengthening to debilitate the spread of a disease known to have high case fatality rates, exhibiting at that time an initial 71% case fatality rate (Baize et al., 2014). The CDC, alongside the other agencies worked to support the various villages, towns, and districts through continued tracing of contacts, providing education regarding contact precautions, safety when isolating those that were ill or potentially ill, as well as options for handling the deceased with care (Bell et al, 2016).   Researchers were able to discover that it was a healthcare worker, or the 14th victim, that initiated the spread of EBOV outside of the Guà ©ckà ©dou boundaries, with further incidences popping up in surrounding areas such as Kissidougou and Macenta (Baize et al., 2014). Research indicated that at the close of March, there were well over 100 potential EBOV cases in Guinea, with almost 80 dead (Baize et al., 2014).    The voracity at which the disease spread would be fueled by unchecked traveling of contacts between Guinea and its surrounding countries, as well as individuals and healthcare workers in contact with the homes, surroundings, and families of those sick or becoming sick, unaware that the illness was in fact Ebola, and extremely infectious (Ebola in Sierra Leone: A slow start to an outbreak that eventually outpaced all others, 2015).   By April of 2014, the presence of Ebola had been officially confirmed in Sierra Leone and Liberia (Bell et al, 2016).   The first case of Ebola in Sierra Leone is believed to have been a woman that attended the burial of the â€Å"patient zero† in Meliandou in December of 2013 (Ebola in Sierra Leone: A slow start to an outbreak that eventually outpaced all others, 2015). The woman was apparently still in the home of the family of the first case when they too fell ill, and later returned to her home in Sierra Leone, where she subsequently became sick and passed away (Ebola in Sierra Leone: A slow start to an outbreak that eventually outpaced all others, 2015).   The Lofa County in Liberia, which skirts the Guinean border, was able to confirm its first cases of Ebola at the end of March 2014 (A timeline of the Ebola outbreak, 2014). By the end of April 2014, there were well over 200 cases across the region, however it appeared that the amount of cases was stabilizing, and on the decline in areas such as Liberia (Briand et al., 2014, Centers for Disease Control and Prevention, 2016). However, after the next two months of apparent stability, reporting indicated a renewed upward trend in Ebola cases, and the fresh report of confirmed Ebola cases in the city of Monrovia, the heavily populated capital of Liberia, unveiled an exploding time bomb of infection (Liberia: A country-and its capital-are overwhelmed with Ebola cases, 2015). Even with the best efforts of all participating agencies, it had become elusive to keep up with the massive chains of potential contacts, and with the disease now appearing in Monrovia, Liberia, the city was found to be ill-prepared to deal with such a contagion, allowing it to spread like wildfire (World Health Organization, 2015). It is notable to mention that West Africa had not experienced an Ebola outbreak of any measurable magnitude, and the experience and lessons in containing the disease were bestowed upon those countries such as the Democratic Republic of Congo, and Uganda (World Health Organization, 2015). Monrovia’s major health center was in desperate need of repairs and had limited resources, in turn opening the door for widespread infection of healthcare personnel on top of the patient care load (Liberia: A country-and its capital-are overwhelmed with Ebola cases, 2015).   With the onset of July, cases of Ebola doubled in Liberia, and a rising trend of infection persisted in Guinea and Sierra Leone (Centers for Disease Control and Prevention, 2016). This rash of new cases that now plagued the region prompted the CDC to employ an Emergency Operations Center, or EOC, on July 9th, 2014 (Dahl et al., 2016). The engagement of this operation led the CDC to forward task an increased presence of personnel to directly assist the regional governments, supplying epidemiologists, laboratory scientists and a plethora of supportive staff (Dahl et al., 2016). WHO, UNICEF, and Doctors without Borders remained prominently active during the amplification of support, and with the increased presence of American aid, all agencies worked tirelessly with the local government leaders and Ministries of Health to establish a much-needed emergency management plan capable of supporting and withstanding the outbreak (Dahl et al., 2016). As the supportive efforts amongst first responders and the new cases of Ebola both drew to a fervor in the early summer of 2014, American citizens and other countries became aware of the uniqueness of this Ebola outbreak.   Word spread globally of the first case of Ebola transported into Nigeria in July of 2014 (Fasina et al.,2014). Flying from Liberia to Nigeria after exposure to the disease, the individual was symptomatic in flight, and succumbed to the illness just 5 days after the flight into Nigeria (Fasina et al.,2014). The individual was Patrick Sawyer, an American citizen from Minnesota (Man Who Died of Ebola in Nigeria Was American Citizen: Wife, 2014). A native of Liberia, but an American citizen, Mr. Sawyer had been working and living in Liberia, while his wife and children continued to reside in the United States (Minnesota Man Who Died of Ebola in Nigeria Was American Citizen: Wife, 2014).   On July 31st, 2014, a few days after the death of Patrick Sawyer, the Centers for Disease Control and Prevention issued a class 3 travel warning, advising against travel to the affected region, and highlighting measures being taken to screen travelers leaving the region to ensure that they are not infected (Centers for Disease Control and Prevention, 2014). Along with this advisory, the CDC also reported an additional advisory issued to U.S. healthcare workers, to address protocols to be followed when addressing the possibility of encountering potentially infected patients (Centers for Disease Control and Prevention, 2014). As confirmed cases throughout the affected region peaked to over 1300, with over 700 dead, the CDC announced in the July 2014 advisory that the United States would continue to work with international partners over the next several years to help strengthen and enhance emergency response efforts in the region, with the president of the United States aiming to dedicate $45 million dollars towards the cause (Centers for Disease Control and Prevention, 2014, 2016).   The steps that the United States would need to take to ensure its own readiness to handle Ebola would soon be put to the test, when around the same time that the CDC issued its health alert and travel advisory, it was announced that two American healthcare workers had contracted Ebola while stationed in Monrovia, Liberia (CBS/AP,2014). In late July of 2014, Dr. Kent Brantly, a doctor employed in a post-residency position with the aid group Samaritan’s Purse, became infected with Ebola while serving as a medical director in relief efforts in the area (CBS/AP,2014).   Nancy Writebol, an aid worker with the group called Serving in Mission, had also contracted Ebola in the same timeframe while working as a hygienist in the Samaritan’s Purse Ebola care center (CBS/AP,2014). Plans immediately commenced to arrange for the workers to be transported back to the United States to continue supportive care (Achenbach, Dennis, & Hogan, 2014). As part of the CDC’s recent health alert, healthcare agencies within the United States were advised to inquire of patients if they have recently traveled to or from the West African region within the prior 21-day timeframe (Centers for Disease Control and Prevention, 2014). The CDC stressed the importance of healthcare provider awareness of the signs and symptoms of Ebola, as well as activation of isolation and contact procedures immediately upon any suspicion of the disease (2014). Just as West Africa had never experienced an Ebola outbreak, the CDC was also aware that U.S. healthcare facilities had never dealt with the Ebola disease head on, and problems could arise if facilities were not properly equipped to handle infected patients (Morbidity and Mortality Weekly Report (MMWR), 2017).   Thus, in planning for the transport of Dr. Brantly and Mrs. Writebol, plans were cemented to arrange for their arrival at Emory University Hospital in Atlanta (Achenbach, Dennis, & Hogan, 2014). Emory University Hospital is one of four facilities across the United States that can treat patients diagnosed with highly infectious diseases (Courage, 2014). The two-room isolation unit housed within Emory Hospital, and constructed in hand with the Centers for Disease Control and Prevention, provides an optimal environment for healthcare personnel and patients when managing infectious diseases (Courage, 2014). Touting state of the art digital pressure monitoring, negative air pressure and HEPA filtration, a safe zone workspace and prep area, contained bathroom facilities, and specialized laboratory space, workers can essentially care for a patient without risk of any contact with the remainder of the facility (Courage, 2014). Regarding medical waste, which is a key concern when dealing with highly infectious cases, the hospital dilutes all bodily waste in toilets with bleach for a set period prior to flushing, and all other items to include personal protective equipment from staff, and other solid items are sanitized and then incinerated (Courage, 2014).   The remaining three facilities across the United States with comparable biocontainment facilities include the National Institutes of Health’s Special Clinical Studies Unit located in Bethesda, MD, the University of Nebraska Medical Centers Biocontainment Patient Care Unit, and Saint Patrick Hospital in Missoula, MT (Courage, 2014).   As Dr. Brantly arrived at Emory University Hospital at the end of July 2014, followed by Mrs. Writebol in the first week of August, President Obama addressed the United States regarding the outbreak, assuring the American public that screening precautions in airports were in effect in West Africa and in the United States to reduce the risk of infected individuals entering the country   (Achenbach, Dennis, & Hogan, 2014). By the 8th of August in 2014, the West African Ebola Virus epidemic had become extreme enough for the World Health Organization to make an international announcement, that the situation had now become an emergency detrimental to public health (Cenciarelli et al., 2015.)   By this time, the total cases over the region equated to just over 1700, with deaths rising to near 1000 (Centers for Disease Control and Prevention, 2016).   The numbers of cases and deaths associated with the current outbreak exceeded the worst Ebola outbreak previously documented in Uganda in the year 2000, where there were 425 cases and 244 deaths (Bell et al., 2016). The implementation of this Public Health Emergency of International Concern, or PHEIC, by the World Health Organization, is a deliberate tool meant to be used when disaster calls (Briand et al., 2014).   Meant to put emergency plans into action with the assistance of international partners, the beginning of collaborative efforts would begin to aid in mitigating the toll that the virus has taken on the affected countries.   In response to the emergency declaration by the World Health Organization, the CDC would in turn increase the amount of personnel that it had deployed to the area (Dahl et al., 2016). The White House followed suit with an official press release detailing the U.S. response to the crisis. On September 16, 2014, the White House relayed the expansion of funding and support to the evolving outbreak (The White House Office of the Press Secretary, 2014). Along with supplying additional U.S. funding to bring a total of almost $175 million invested collectively towards various supportive efforts, the White House also activated a cell of U.S. Africa Command personnel to provide on ground support in Liberia to arrange operational oversight of the U.S. based activities aligned with response efforts (The White House Office of the Press Secretary, 2014). The press release also entailed the deployment of additional personnel through the U.S Disaster Assistance Response Team, or DART, as well as the supply of care kits, training, and the institution of additional Ebola Treatment Units, as well as laboratory support (The White House Office of the Press Secretary, 2014).   The latter only briefly touches on some of the response efforts engaged by the U.S. in support of the affected region, however the need for effective emergency management measures would hit home, when just days after the White House press release, a man whom had recently traveled from Liberia to Texas to attend his son’s graduation, would arrive at the emergency room of Texas Health Presbyterian Hospital in Dallas, TX (Chevalier et al., 2014, VOA News, 2014). Texas Health Presbyterian’s ER would send Thomas Duncan home after treating him for what was believed to be sinusitis (Chevalier et al., 2014). Presenting to the ER with a fever, headache and stomach pain, Mr. Duncan had informed the staff that he had recently arrived from Africa, and while this information was documented in his record, the ER physician at that time somehow overlooked it, and did not conclude that Ebola virus disease should be suspected (Dallas News, 2014). The hospital would later acknowledge this oversight, as three days later, Mr. Duncan would be transported to the Texas Presbyterian Hospital’s ER, this time via ambulance, with an exacerbation of symptoms to include vomiting and diarrhea (Dallas News, 2014, VOA News, 2014). This time, Mr. Duncan’s recent arrival from Liberia would be accounted for in his medical assessment, and subsequent testing would conclude that he was in fact infected with Ebola (Dallas News, 2014).   Further exposing the fissures within the handling of this case, the hospital’s holding company later acknowledged that the clinician training regarding the Ebola virus had been available but was not required of staff at the time when Mr. Duncan presented to the facility (Dallas News, 2014).   The facility was also aware of the CDC health alert from July of 2014 that stressed the possibility of an infected traveler arriving in America due to the magnitude of the outbreak, and the need for American healthcare facilities to be on the lookout for the very symptoms Mr. Duncan presented with on September 25th, 2014 (Dallas News, 2014).   As a result, numerous people would need to be traced and evaluated relating to their contact with Mr. Duncan during his travel and after his arrival to Dallas, TX.   As Texas responders and the CDC personnel worked to trace the 48 potential contacts for Mr. Duncan, the man would eventually succumb to the disease on October 8th, 2014, becoming America’s first death from Ebola Virus Disease (VOA News, 2014.)   Some experts say that the initial misdiagnosis of Mr. Duncan is due to human error, since travel should have been an essential question asked of the patient upon assessment by the physician (Dallas news, 2014). However other experts acknowledge the difficulty of identifying a disease that has never been diagnosed on American soil (Dallas news, 2014). It was more than likely a combination of these factors that led to the results of Mr. Duncan’s case, and while Texas health officials dealt with the missteps of the event, just 3 days after Mr. Duncan’s death, one of the nurses that participated in his care would be diagnosed with Ebola, with a second nurse testing positive 4 days after the first (McCarty et al., 2014). The second nurse diagnosed with Ebola after taking care of Mr. Duncan, reported that she had traveled to Ohio from Texas prior to her diagnosis (McCarty et al., 2014).   Enlisting the CDC to support in guidance and training, Ohio public health officials began the process of tracing contacts (McCarty et al., 2014).   Learning through first-hand experience how to identify and monitor individuals that may have interacted with the infected nurse, as well as how to prepare local health facilities regarding ability to properly triage, isolate, and safely transport infected patients, Ohio officials hoped to avert a crisis while assuring the protection of healthcare staff and the general population (McCarty et al., 2014). The total effort in Ohio was extensive and required cooperation from a considerable portion of the state’s counties, with 164 contacts to follow (McCarty et al., 2014). While most of the facilities were determined to be ready to act in the event of an active case of Ebola, the transportation plans and other points of coordination such as transfers between various agencies needed to be established, and the information gleaned from this real-world scenario exemplified the necessity for healthcare facilities to have these forms of emergency preparedness already in place (McCarty et al., 2014). As the number of Ebola cases continued to escalate in the West African region, with confirmed diagnoses reaching over 8,000 into the first couple weeks of October 2014, and deaths numbering over 4,000, the American public attempted to process that two of its own had contracted Ebola on U.S. soil (Centers for Disease Control and Prevention, 2016).   Fear pervaded the comfort zones of many Americans. Some protested allowing anyone from the African continent to travel to the United States, while others feared encountering individuals that had been anywhere near Africa (Sanburn, 2014). During the various stages of emergency preparedness in Ohio after the turn of events surrounding Mr. Duncan, one business closed when it was learned that an employee was a contact of the Ebola-positive nurse from Texas (Sanburn, 2014). The fear of infection also hit healthcare workers particularly hard. As the investigation ensued into how the two nurses in Texas acquired the Ebola virus, despite employing protective measures, the uncertainty regarding the reliability and proper use of personal protective equipment (PPE) against Ebola, was compounded with the question of whether training among healthcare personnel was effectively being implemented (Fernandez, 2014).   Both nurses recovered from the disease, and the biocontainment ready facilities in Nebraska and Atlanta would carry on to successfully treat up to 11 total Ebola-positive patients transferred from the West African region by April of 2015 (Hewett, Varkey, Smith, & Ribner, 2015).   The successful treatment and ability to prevent cross-infection of other healthcare workers proved that the U.S. could properly manage an uncommon infectious disease abroad and at home. However the initial problems that led to the fear and uncertainty of the aftermath of Ebola virus disease within the United States, point to unfamiliarity with the disease in general, as well as lack of preparedness at a level that allowed for proper management of a highly infectious patient from the moment they present to a healthcare facility to diagnosis and commensurate care (Hewett, Varkey, Smith, & Ribner, 2015). Management of Ebola virus demands an intricately woven web of planning and preparation that not only carries the foresight of how to identify potential cases, but how to prepare healthcare staff to properly protect themselves and use PPE, how and when to arrange the transport of a patient while preserving a chain of clean and safe hand-off with all involved agencies, and how to conserve the safety of all personnel throughout (Hewett, Varkey, Smith, & Ribner, 2015). This lesson hearkens to the explosion of the outbreak in West Africa as well. Unfamiliar with Ebola virus, many care centers in the affected region attributed initial cases of Ebola to more familiar diseases endemic to the area, such as malaria and yellow fever (World Health Organization, 2015). A combination of initial misinterpretation of disease, lack of effective protocols that would have prevented the continuous spread of cases in both the healthcare facilities and in the civilian sector, populations were simply unaware of the gravity of the situation until it was too late (World Health Organization, 2015). The 2014-2016 Ebola outbreak highlighted the need within the United States to filter more time, attention, and funding into research and planning to deal with unique public health emergencies such as Ebola virus (Gostin, Hodge, & Burris, 2015). U.S. assistance via the CDC, U.S. public health affiliates and aid organizations, in hand with military support, was crucial to the eventual containment of the Ebola crisis in West Africa. Clinical trials would lead to the implementation of a promising vaccination against Ebola known as ZMapp, however a cure remains out of reach to date (U.S. Department of Health and Human Services, 2016). As the outbreak finally died out in 2016, with over 28,000 cases and over 11,000 deaths collectively, a haunting reminder of mistakes and lessons learned would follow all agencies and countries involved (Centers for Disease Control and Prevention, 2016).   The phoenix that would arise from this event is the understanding that the United States would be required to fortify its public health awareness and planning, along with tightening emergency preparedness protocols to remain ahead of the inevitability that one day, another infectious disease may find its way to America’s doorstep. References Achenbach, J., Dennis, B., & Hogan, C. (2014, August 02). Special air ambulance to carry American Ebola victims to Atlanta for treatment. 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Retrieved from https://www.nbcnews.com/storyline/ebola-virus-outbreak/man-who-died-ebola-nigeria-was-american-citizen-wife-n167546 McCarty, C. L., Basler, C., Karwowski, M., Erme, M., Nixon, G., Kippes, C., & Stone, N. D. (2014). Response to importation of a case of Ebola virus disease—Ohio, October 2014.  Morbidity and Mortality Weekly Report,  63(46), 1089-1091. Morbidity and Mortality Weekly Report (MMWR). (2017, July 17). Retrieved from https://www.cdc.gov/mmwr/volumes/65/su/su6503a8.htm Response to Importation of a Case of Ebola Virus Disease Ohio, October 2014. (2014, November 14). Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e1114a6.htm Saà ©z, A. M., Weiss, S., Nowak, K., Lapeyre, V., Zimmermann, F., Dà ¼x, A., & Sachse, A. (2014). Investigating the zoonotic origin of the West African Ebola epidemic. EMBO molecular medicine, e201404792. Sanburn, J. (2014, October 20). Ebola: Psychology of Fear During Disease Outbreak. Retrieved from http://time.com/3525666/ebola-psychology-fear-symptoms/ Signs and Symptoms | Ebola Hemorrhagic Fever | CDC. (2014, November 2). Retrieved from https://www.cdc.gov/vhf/ebola/symptoms/index.html The White House Office of the Press Secretary. (2014, September 16). FACT SHEET: U.S. Response to the Ebola Epidemic in West Africa. Retrieved from https://obamawhitehouse.archives.gov/the-press-office/2014/09/16/fact-sheet-us-response-ebola-epidemic-west-africa U.S. Department of Health and Human Services. (2016, October 13). Study finds Ebola treatment ZMapp holds promise, although results not definitive. Retrieved from https://www.nih.gov/news-events/news-releases/study-finds-ebola-treatment-zmapp-holds-promise-although-results-not-definitive VOA News. (2014, October 08). Liberian Man Infected with Ebola Dies at Texas Hospital. Retrieved from https://www.voanews.com/a/second-un-staffer-infected-iwth-ebola-in-liberia/2476380.html World Health Organization. (2015, September 22). Factors that contributed to undetected spread of the Ebola virus and impeded rapid containment. Retrieved from http://www.who.int/csr/disease/ebola/one-year-report/factors/en/ World Health Organization. (2018, January). Ebola virus disease. Retrieved  March  1, 2018, from http://www.who.int/mediacentre/factsheets/fs103/en/

Income and Analytic Skills

Principles of Macroeconomics, 9e – TB1 (Case/Fair/Oster) Chapter 6 Measuring National Output and National Income 6. 1 Gross Domestic Product 1 Multiple Choice 1) The total market value of all final goods and services produced within a given period by factors of production located within a country is A) gross domestic product. B) gross national product. C) net national product. D) net national income. Answer: A Diff: 1 Topic: Gross Domestic Product Skill: Definition 2) Gross domestic product measures A) the total spending of everyone in the economy. B) the value of all output in the economy. C) he total income of everyone in the economy. D) all of the above Answer: D Diff: 2 Topic: Gross Domestic Product Skill: Definition 3) Which of the following is an example of a final good or service? A) wheat a bakery purchases to make bread B) coffee beans Starbucks purchases to make coffee C) lumber purchased by a construction company to used in building houses D) a computer purchased by Federal Express to track shipments Answer: D Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 4) Which of the following is a good or service counted in GDP? A) tires Ford buys to put on a car B) used tire you buy for your personal car C) a new tire you buy for your personal car D) used tires bought by a used car dealer to put on a car on his lot Answer: C Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 5) Which of the following is an example of an intermediate good? A) the dough you buy to fix yourself a pizza for dinner B) the chocolate you buy to make yourself some cookies C) the pizza sauce you purchase to make pizzas to sell for a fund-raiser for an organization you belong to D) lumber you buy to build a house for your dog Answer: C Diff: 2 Topic: Gross Domestic ProductSkill: Conceptual AACSB: Reflective Thinking 6) Double counting can be avoided by A) including the value of intermediate goods in the current y ear. B) not counting the value of intermediate goods in GDP. C) including the value of intermediate goods in the GNP but not in the GDP. D) including the value of intermediate goods in the production year but not in the selling year of those goods. Answer: B Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 7) Which of the following would NOT be counted in 2007's GDP? A) the value of a 2005 boat you purchase from a boat dealer in 2007 B) he 2007 salary of a used motorcycle salesperson C) the commissions earned by a real estate agent in selling condominiums built prior to 2007 D) the value of a refrigerator manufactured in 2007 but not sold in 2007 Answer: A Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 8) Which of the following would be counted in 2003's GDP? A) the value of a loan you take in 2003 B) the value of a TV that was produced in 2002 but not sold until 2003 C) the bonus check a stockbroker gets from his /her company in 2003 D) the value of a bond sold by the federal government Answer:C Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 9) Which of the following is NOT included in 2008's GDP? A) the value of a motorcycle produced in the United States and exported to Japan B) the profit earned in 2008 from selling a stock that you purchased in 2005 C) the value of a motor that is used in the production of a lawn mower D) the commission earned by a headhunter when she locates a job for a client Answer: B Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 10) Gross national product is the total market value ofA) all final and intermediate goods and service produced by resources owned by a country in a given year. B) all final and intermediate goods and services produced in a country, regardless of who owns the resources. C) all final goods and services produced in a country in a given year, regardless of who owns the resou rces. D) all final goods and services produced by resources owned by a country, regardless of where production takes place. Answer: D Diff: 1 Topic: Gross Domestic Product Skill: Definition 11) If no foreign companies produce in a country, but many of the country's companies produce abroad, then A) he country's GNP will tend to exceed its GDP. B) the country's GDP will tend to exceed its GNP. C) the country's GNP and GDP will tend to be equal. D) the country's GDP will tend to be equal to its domestic income. Answer: A Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 12) Which of the following is included in both the U. S. GDP and GNP? A) The value of all cars produced by Ford in Mexico. B) The value of all cars produced by General Motors in the U. S. C) The value of all cars produced by Toyota in the U. S. D) The value of cars produced by Nissan in Japan and the U. S. Answer:B Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflectiv e Thinking 13) Which of the following is NOT counted in the GNP of the United States? A) The wage of a U. S. citizen who works in a foreign country for a foreign firm. B) The interest earned by a U. S. bank on loans to a business firm located in Brazil. C) The profit earned by a restaurant located in the United States but owned by a Mexican company. D) The value of services that are produced by state and local governments in the United States. Answer: C Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 14)The value of what KFC produces in Japan is included in the U. S. ________ and in the Japanese ________. A) GDP; GDP B) GNP; GNP C) GNP; GDP D) GDP; GNP Answer: C Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 15) Profits earned in the United States by foreign-owned companies are included in A) the U. S. GDP but not GNP. B) neither the U. S. GDP nor GNP. C) the U. S. GNP but not GDP. D) both the U. S. GDP and GNP. Answer: A Diff: 1 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 16) The GDP of the U. S. in 2002 was around $10 trillion. This means A) hat the value of output in the U. S. in 2002 was around $10 trillion. B) that total income in the U. S. in 2002 was around $10 trillion. C) that total spending on final goods and services in the U. S. in 2002 was around $10 trillion. D) all of the above Answer: D Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 17) The GDP includes A) the value of all intermediate goods and services. B) the value of all final goods and services. C) the value of both intermediate and final goods and services. D) the value of all transactions. Answer: B Diff: 2 Topic: Gross Domestic Product Skill: ConceptualAACSB: Reflective Thinking 18) Income Mexican citizens earn in the U. S. counts in A) U. S. GNP. B) Mexican GNP. C) Mexican GDP. D) both U. S. and Mexican GDP. Answer: B Diff: 2 Topic: Gross Domestic Pr oduct Skill: Conceptual AACSB: Reflective Thinking 2 True/False 1) GDP measures the total income of everyone and the total spending by everyone in the economy. Answer: FALSE Diff: 1 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 2) Total income in the economy can sometimes be greater than total spending. Answer: FALSE Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking ) The income of U. S. citizens working abroad counts in U. S. GDP. Answer: FALSE Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 4) Stock market transactions are part of GNP. Answer: FALSE Diff: 2 Topic: Gross Domestic Product Skill: Conceptual AACSB: Reflective Thinking 5) Value added is the difference between the value of good as they leave a stage of production and cost of the goods as they entered that stage of production. Answer: TRUE Diff: 2 Topic: Gross Domestic Product Skill: Definition 6. 2 Calculating GDP 1 Multiple Choice 1) The equation for GDP using the expenditure approach isA) GDP = C + I + G + EX – IM. B) GDP = C + I + G + (IM – EX). C) GDP = C + I + G + EX + IM. D) GDP = C + I + G – EX – IM. Answer: A Diff: 1 Topic: Calculating GDP Skill: Definition 2) The single largest expenditure component in GDP is A) government spending. B) investment. C) consumption. D) net exports. Answer: C Diff: 1 Topic: Calculating GDP Skill: Fact Refer to the information provided in Table 6. 1 below to answer the questions that follow. Table 6. 1 [pic] 3) Refer to Table 6. 1. Personal consumption expenditures in billions of dollars are A) 1,000. B) 1,300. C) 1,500. D) 2,000. Answer: D Diff: 2Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 4) Refer to Table 6. 1. The value for gross private domestic investment in billions of dollars is A) 300. B) 375. C) 425. D) 450. Answer: C Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 5) Refer to Table 6. 1. The value for net exports in billions of dollars is A) 150. B) 250. C) 650. D) 800. Answer: A Diff: 1 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 6) Refer to Table 6. 1. The value of gross domestic product in billions of dollars is A) 3,000. B) 3,075. C) 3,125. D) 3,750. Answer:B Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 7) Refer to Table 6. 1. The value of government spending in billions of dollars is A) 100. B) 200. C) 300. D) 500. Answer: D Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills Refer to the information provided in Table 6. 2 below to answer the questions that follow. Table 6. 2 [pic] 8) Refer to Table 6. 2. Personal consumption expenditures in billions of dollars are A) 900. B) 1,100. C) 1,400. D) 1,600. Answer: C Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 9) Refer to Table 6. 2.The value for gross private domestic investment in billions of dollars is A) 740. B) 810. C) 850. D) 890. Answer: D Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 10) Refer to Table 6. 2. The value for net exports in billions of dollars is A) -200. B) -150. C) 50. D) 250. Answer: B Diff: 1 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 11) Refer to Table 6. 2. The value for gross domestic product in billions of dollars is A) 2,900. B) 3,140. C) 3,440. D) 3,650. Answer: B Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 12) Refer to Table 6. 2.The value of government spending in billions of dollars is A) 200. B) 600. C) 800. D) 1,000. Answer: D Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 13) A company produced 8 dishwasher machines in 2005. The company sold 6 in 2005 and added 2 to its inventories. The market value of the dishwasher machines in 2005 was $200 per unit. What is the value of this company's output that will be included in the 2005 GDP? A) $400. B) $1,400. C) $1,600. D) $2,000. Answer : C Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 14) A farmer buys a new tractor from John Deere to use on her cotton farm.This tractor is included in GDP as A) part of gross private domestic investment. B) a durable consumption good. C) a service. D) a nondurable consumption good. Answer: A Diff: 2 Topic: Calculating GDP Skill: Conceptual AACSB: Reflective Thinking 15) The change in business inventories is measured as A) final sales minus GDP. B) final sales plus GDP. C) GDP minus final sales. D) the ratio of final sales to GDP. Answer: C Diff: 2 Topic: Calculating GDP Skill: Conceptual AACSB: Reflective Thinking 16) In 2007 final sales equal $200 billion, and the change in business inventories is $50 billion. GDP in 2007 A) s $250 billion. B) is $200 billion. C) is $150 billion. D) is $40 billion. Answer: A Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 17) In 2006 final sales equal $350 billion and the change in business inventories is -$60 billion. GDP in 2006 A) is $290 billion. B) is $295 billion. C) is $410 billion. D) cannot be determined from this information. Answer: A Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 18) In 2008 the change in business inventories is -$70 billion and GDP is $200 billion. Final sales in 2008 A) are $130 billion. B) are $200 billion.C) are $270 billion. D) are $340 billion. Answer: C Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 19) In 2007, GDP was exactly equal to final sales. This implies that A) there was accumulation of inventories that year. B) there was a decline in inventories that year. C) there was no change in inventories that year. D) GDP did not grow that year compared to the year before. Answer: C Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 20) If the change in business inventories is zero, then final sales are A) zero. B) less than GDP. C) greater than GDP. D) qual to GDP. Answer: D Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 21) If in a year there is a positive inventory investment, then final sales A) exceed GDP. B) are less than GDP. C) equal GDP. D) are zero. Answer: B Diff: 1 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 22) Net investment equals A) GDP minus final sales. B) gross investment minus final sales. C) gross investment minus depreciation. D) depreciation plus GDP. Answer: C Diff: 1 Topic: Calculating GDP Skill: Definition 23) If net investment is zero, then A) gross investment is greater than depreciation.B) gross investment is less than depreciation. C) gross investment equals depreciation. D) depreciation is zero. Answer: C Diff: 1 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 24) Suppose that net investment in 2008 was $20 billion and depreciation was $4 billion. Gross investment in 2008 was A) $16 billion. B) $20 billion. C) $24 billion. D) $28 billion. Answer: C Diff: 1 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 25) The total value of all capital goods newly produced in a given period is A) the change in business inventories. B) depreciation. C) net investment. D) ross investment. Answer: D Diff: 1 Topic: Calculating GDP Skill: Definition 26) The change in capital stock in a period is equal to A) the ratio of the amount of the capital at the beginning of the period to the amount of depreciation. B) the amount of the capital stock at the beginning of the period plus gross investment minus depreciation. C) the amount of the capital at the beginning of the period plus gross investment. D) the amount of the capital at the beginning of the period minus net investment. Answer: B Diff: 2 Topic: Calculating GDP Skill: Definition 27) Net investment is A) gross investment minus depreciation.B) gross investment plus depreciation. C) depreciation minus gross investment. D) GNP minus final sales. Answer: A Diff: 1 Topic: Calculating GDP Skill: Definition 28) D epreciation is A) the decrease in the overall price level. B) the additional capital stock in a year. C) the amount of used up machinery in a year. D) the amount of decline in business inventories. Answer: C Diff: 1 Topic: Calculating GDP Skill: Definition 29) If net investment in 2007 is $350 billion and gross investment in 2007 is $500 billion, depreciation in 2007 is A) $0. 7 billion. B) $150 billion. C) $175 billion. D) $250 billion.Answer: B Diff: 1 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 30) If net investment in 2008 is $500 billion and gross investment in 2008 is $900 billion, depreciation in 2008 is A) -$500 billion. B) $0. C) $400 billion. D) $1,400 billion. Answer: C Diff: 1 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 31) If gross investment in 2008 is $750 billion and depreciation in 2008 is $850 billion, net investment in 2008 is A) -$50 billion. B) -$100 billion. C) -$800 billion. D) -$1,600 billion. Answer: B Diff: 1 Topic: Calcu lating GDP Skill: Analytic AACSB: Analytic Skills 32)If gross investment in 2008 is $200 billion and depreciation in 2008 is $1,000 billion, net investment in 2008 is A) -$900 billion. B) -$800 billion. C) $1,000 billion. D) $1,200 billion. Answer: B Diff: 1 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 33) Exports equal A) imports – net exports. B) net exports + imports. C) net exports – imports. D) imports + (exports + imports). Answer: B Diff: 1 Topic: Calculating GDP Skill: Definition 34) When calculating GDP, exports are ________ and imports are ________. A) added; added B) added; subtracted C) subtracted; added D) subtracted; subtracted Answer: BDiff: 1 Topic: Calculating GDP Skill: Conceptual AACSB: Reflective Thinking 35) If the value of net exports is negative, then A) exports exceed imports. B) imports exceed exports. C) exports equal imports. D) imports are zero. Answer: B Diff: 1 Topic: Calculating GDP Skill: Conceptual AACSB: Reflective Thi nking 36) The largest income component of GDP is A) proprietors' income. B) rental income. C) compensation of employees. D) corporate profit. Answer: C Diff: 2 Topic: Calculating GDP Skill: Fact 37) What should be subtracted from GDP to calculate national income? A) depreciation B) indirect taxes C) personal income taxes.D) net factor payments to the rest of the world Answer: A Diff: 2 Topic: Calculating GDP Skill: Conceptual AACSB: Reflective Thinking 38) Proprietors' income is A) the income of unincorporated businesses. B) the income of all businesses? incorporated and unincorporated. C) the income of sole proprietorships. D) the income of partnerships. Answer: A Diff: 2 Topic: Calculating GDP Skill: Definition 39) Net interest is the interest on loans paid by A) businesses, households, and the government. B) businesses and households. C) businesses and the government. D) businesses. Answer: D Diff: 3 Topic: Calculating GDP Skill:Definition 40) Interest paid by households and by t he government is A) counted in national income, but not in GDP. B) not counted in GDP because it is not assumed to flow from the production of goods and services. C) not counted in GDP but is counted in GNP because it is paid by U. S. citizens to people living in the United States. D) included in both GDP and GNP because it represents an expenditure by one group and a receipt of income by another group. Answer: B Diff: 3 Topic: Calculating GDP Skill: Conceptual AACSB: Reflective Thinking 41) What type of tax affects the amount of money you pay for a product? A) direct taxB) income tax C) indirect tax D) all of the above Answer: C Diff: 2 Topic: Calculating GDP Skill: Conceptual 42) Depreciation is A) subtracted from national income to get GDP. B) added to national income to get GDP. C) subtracted from GNP to get NNP. D) added to GNP to get NNP. Answer: C Diff: 2 Topic: Calculating GDP Skill: Conceptual AACSB: Reflective Thinking Refer to the information provided in Table 6. 3 below to answer the questions that follow. Table 6. 3 [pic] 43) Refer to Table 6. 3. The value for national income in billions of dollars is A) 585. B) 600. C) 635. D) 850. Answer: C Diff: 2 Topic:Calculating GDP Skill: Analytic AACSB: Analytic Skills 44) Refer to Table 6. 3. The value for gross domestic product in billions of dollars is A) 485. B) 680. C) 685. D) 710. Answer: D Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 45) Refer to Table 6. 3. The value of net factor payments to the rest of the world is A) 5. B) 15. C) 25. D) 35. Answer: A Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 46) Refer to Table 6. 3. The value of disposable income A) is 505. B) is 560. C) is 605. D) cannot be calculated given the information in Table 6. 3. Answer: D Diff: 2Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 47) If receipts of factor income from the rest of the world exceed payments of factor income to the rest of the world, then A) GD P is greater than GNP. B) GDP equals GNP. C) GNP equals NNP. D) GNP is greater than GDP. Answer: D Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills Refer to the information provided in Table 6. 4 below to answer the questions that follow. Table 6. 4 [pic] 48) Refer to Table 6. 4. The value for GDP in billions of dollars is A) 910. B) 920. C) 950. D) 1,050. Answer: C Diff: 2 Topic: Calculating GDPSkill: Analytic AACSB: Analytic Skills 49) Refer to Table 6. 4. The value for GNP in billions of dollars is A) 900. B) 930. C) 980. D) 1,010. Answer: B Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 50) Refer to Table 6. 4. The value for NNP in billions of dollars is A) 890. B) 910. C) 940. D) 970. Answer: A Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 51) Refer to Table 6. 4. The value for national income in billions of dollars is A) 890. B) 910. C) 940. D) 970. Answer: A Diff: 2 Topic: Calculating GDP Skill: Analytic AACS B: Analytic Skills 2) Refer to Table 6. 4. The value for personal income in billions of dollars is A) 870. B) 890. C) 950. D) 960. Answer: A Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 53) Refer to Table 6. 4. The value for disposable personal income in billions of dollars is A) 750. B) 770. C) 820. D) 990. Answer: A Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 54) If GNP is $600 billion, receipts of factor income from the rest of the world are $50 billion, and payments of factor income to the rest of the world are $30 billion, then GDP is A) $520 billion. B) 580 billion. C) $620 billion. D) $680 billion. Answer: B Diff: 3 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 55) If GNP is $200 billion, receipts of factor income from the rest of the world are $10 billion, and payments of factor income to the rest of the world are $30 billion, then GDP is A) $160 billion. B) $210 billion. C) $220 billion. D) $240 billion. Ans wer: C Diff: 3 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 56) If GDP is $500 billion and depreciation is $40 billion, then net national product A) is $460 billion. B) is $500 billion. C) is $540 billion. D) annot be determined from this information. Answer: D Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 57) If GDP is $300 billion, depreciation is $30 billion, and net factor income from the rest of the world is -$40 billion, then net national product is A) $230 billion. B) $270 billion. C) $290 billion. D) $310 billion. Answer: D Diff: 3 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 58) If GNP is $800 billion and depreciation is $90 billion, then net national product is A) $710 billion. B) $845 billion. C) $890 billion. D) $980 billion. Answer: A Diff: 1 Topic:Calculating GDP Skill: Analytic AACSB: Analytic Skills 59) If GNP is $200 billion and depreciation is $20 billion, then net national product is A) $100 billion. B) $18 0 billion. C) $210 billion. D) $220 billion. Answer: B Diff: 1 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 60) If depreciation equals zero and retained earnings equal $5 billion, then A) GNP is less than net national product by $5 billion. B) GNP equals net national product. C) Net national product is less than GNP by $5 billion. D) GNP is greater than GDP by $5 billion. Answer: B Diff: 1 Topic: Calculating GDP Skill:Analytic AACSB: Analytic Skills 61) Net national product is A) GDP plus depreciation. B) GDP minus depreciation. C) GNP minus depreciation. D) GNP plus depreciation. Answer: C Diff: 1 Topic: Calculating GDP Skill: Definition 62) The total income of households is A) net national product. B) personal income. C) national income. D) production income. Answer: B Diff: 1 Topic: Calculating GDP Skill: Definition 63) Personal income is national income minus A) depreciation. B) net factor income to the rest of the world. C) the amount of national income not goi ng to households. D) imports. Answer: C Diff: 2 Topic: Calculating GDPSkill: Fact 64) If national income is $600 billion, personal income is $400 billion, personal taxes are $120 billion, then disposable income equals A) $480 billion. B) $320 billion. C) $280 billion. D) $80 billion. Answer: C Diff: 2 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 65) Which of the following is subtracted from national income to get to personal income? A) retained earnings B) personal interest income C) depreciation D) personal Taxes Answer: A Diff: 2 Topic: Calculating GDP Skill: Conceptual AACSB: Reflective Thinking 66) Personal income A) is always less than national income. B) s always greater than national income. C) may be greater than or less than national income. D) will always equal national income. Answer: C Diff: 2 Topic: Calculating GDP Skill: Conceptual AACSB: Reflective Thinking 67) If personal income is $925 billion and personal income taxes are $70 billion, the value of disposable personal income is A) $835 billion. B) $855 billion. C) $890 billion. D) $995 billion. Answer: B Diff: 1 Topic: Calculating GDP Skill: Analytic AACSB: Analytic Skills 68) If personal saving is -$10 billion and disposable personal income is $370 billion, then personal consumption spending A) is $360 billion.

Bottlenecks in a Process Paper

Bottlenecks in a Process Paper Tino Hearn OPS/571 James Powell April 13, 2010 RUNNING HEAD: Bottlenecks in a Process Paper The daily exercise process design is not an extensive process. The cycle time may vary daily. There are potential bottlenecks but not many relating to the daily exercise process design. â€Å"Good intentions often lead to bad habits. This is evident when bottlenecks occur from relying too heavily on highly productive individuals or systems. It is common practice to place more responsibility on an individual if that person consistently demonstrates the capacity for it† (Executive Blueprints, 2010). The writer notices a couple of bottlenecks that occurs due to natural elements of the process. For example, the flowchart displays the writer decides the length of time and the distance he will run. This is a potential bottleneck because if the weather is inclement, there will be a delay in the writer’s ability to begin running at the designated time. This will produce a buffer prior to the next stage of the process because the anticipated time of the next stage which is the abdominal workout will be prolonged. Another bottleneck would be if the writer starts his run and he gets muscle cramps or fatigue. This will potentially cause the writer to discontinue his run. However, these bottlenecks are not necessarily part of the normal process. Other potential bottlenecks could include the writer’s heart rate and vital signs being abnormal. The writer would have to his exercise regiment for that particular day. The bottlenecks in the exercise process will hinder the writer from reaching his overall health goals of losing weight; lower his cholesterol and acquiring better general health. Some potential buffers could involve the writer being too fatigued or exhausted to complete the cool down period. This would also prevent the writer from getting into the abdominal and weight lifting phase of the process. In essence, there are limited amount of bottlenecks in the exercise program flowchart. The bottlenecks are not detrimental to the overall objective of getting a good workout and exercise program prior to starting the workday. The bottlenecks can potentially help the writer fine tune some steps in the process to get better results. References Executive Blueprints (2010). Eliminating bottlenecks for process improvements. Retrieved April 13, 2010 from http://www. executiveblueprints. com/tips/090511bottlenecks. htm Tino, process analysis is a basic skill needed to understand how a business operates. I notice you used a source of reference to define bottlenecks and it is different than our course of study. However, I am not sure if you understand the concept of bottleneck correctly as evidence discussed in your paper. Except for you mentioning heart rate and vital signs being abnormal and these factors can limit the capacity of your workout and there is limited discussion about this bottleneck. (-3) Consider using a value-added analysis (focused on eliminating the non–value-adding activities), you might be able to reduce the workout time and maintain an acceptable heart rate for your activities. I would like to have seen you support your perspectives of the process and support it with theoretical concepts from the assigned reading where necessary. (-. 25) As presented your paper earned . 4. 75 out of 8. 0 points.

The Future of Academic Honesty - Paper - 5010 Words

91 THE FUTURE OF ACADEMIC HONESTY Peggy Choong, Niagara University Bob S. Brown, Marshall University Graduate College ABSTRACT Cheating has permeated many facets of American life. Reports on cheating are found in business, the media and on college campuses. Perhaps one of the more disturbing trends is reports on increasing cheating among grade and high school teachers and administrators. This makes the behavior, motivation and training of education students relevant for scrutiny. The paper examines academic dishonesty among college students training to be teachers. The study uncovers through factor analysis four salient dimensions of cheating, namely Flagrant Cheating, Insidious Cheating, Collusion and Illicit Collaboration. It also†¦show more content†¦The sample consisted of 198 students in teacher education classes at a private university in the northeast. Each questionnaire was placed in an unmarked envelope. Completed questionnaires were replaced in these envelopes and sealed by the student. The questionnaires were voluntarily completed during class time. Students who declined to parti cipate were encouraged to engage in other reading or writing activities. Respondents were assured that their responses were confidential and anonymous. The average age of the respondents was 28 years. About 80% of the respondents were females and more than 80% were registered for more than twelve credits. The mean and the mode of salary expectations were between $30,001 and $35,000 with more than a quarter of the respondents (28%) expecting salaries between $35,001 to $40,000. RESULTS Uncovering the salient dimensions of academic dishonesty In order to uncover the salient dimensions of academic dishonesty, the sixteen dishonest practices were submitted to factor analysis. Factor analysis is a procedure for summarizing the information ratings on the sixteen practices into a smaller number of salient dimensions which can then be identified as the dimension underlying the respondents’ ratings. It is in this way that the commonalities in responses are effectively discerned. Four factors were extracted which had an Academy of Educational Leadership Journal, Volume 11, Number 2, 2007 93 eigenvalue more than one.Show MoreRelatedAcademic Honesty - Essay 31242 Words   |  5 PagesIn reading and researching the topic of academic honesty and integrity I have found that there are varying views on what is considered cheating, and that cheating occurs in all academic levels and fields of study. Interestingly business students do not believe that cheating is as serious as students in other fields. I also found that there are many parties that are responsible for teaching students why academic honesty and integrity are so important. 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