John Keats’ “On the Sonnet” and William Wordsworth “Convent’s narrow room” Essay

Two sonnets, â€Å"On the Sonnet† by John Keats and â€Å"Nuns fret not at their convent’s narrow room† by William Wordsworth, address the same subject, the restrictions of the sonnet. Despite the same subject matter, they approach these restrictions using different forms and imagery, and each has his own opinion of the subject. Keats starts off his sonnet using an allusion from Greek mythology: Andromeda, a princess chained to a rock and in danger of being devoured by a sea monster. This was his main idea and criticism of the structure of the sonnet–if poets are chained by the Shakespearean or Italian format, the sonnet will eventually lose its spirit and be devoured over time. He advises his fellow sonneteers to â€Å"fit the naked foot of poesy†, like us wearing shoes by breaking the rhythm and imposing creativity on the form, so the sonnet can endure. This is because it will stand out among mediocre sonnets. Keats` other allusion is to King Midas and his gold; he uses Midas to express how miserly poets have to be with their words and not to use clichà ©s, â€Å"dead leaves in the bay-wreath crown†. His last allusion is to the Muse-Greek goddess of art-to express the creativeness and freedom needed for the beauty of poetry. With â€Å"the weight of too much liberty†, poetry is as restrictive as ever, argues Wordsworth. If these restrictions are too much, do not write a sonnet because like poets who write a sonnet, nuns choose their convents, hermits their cells, maids their looms and bees their foxglove bells: all make this choice willingly. This vivid imagery makes plain what writing a sonnet is all about: a personal choice to chain ourselves because we enjoy it. It is sometimes better to play in a â€Å"scanty plot of ground† then run through the vast open fields and be lost and confused. The restrictions are what makes it more challenging and forces us to create something more beautiful than just prose. Wordsworth finds peace in a restrictive sonnet, like us when we lock ourselves in our room to do the same. Each true to his word and ideas, the poets practice what they preach in their sonnets. Keats does not write his sonnet in any particular known form. It is broken into three parts; ln 1-6: expressing what poetry is like; ln 7-9:  what poets must pay attention to; ln 10-14: what poets must avoid in writing. He follows what he says about â€Å"if we must be constrained†, that he wrote the poem in iambic pentameter. Wordsworth as well does what he says about writing true to the sonnets restrictions. His entire sonnet consists of only 4 rhymes, abba abba cddc cd, and the poem is also broken into three parts, ln 1-7: comparing the sonnet to other things in life, ln 8-9 ½: his statement on the sonnet restrictions, and ln 9 ½-14: why his statement is so. Neither seems to agree about the roles restrictions play in the sonnet–Keats complains about them and tells us how to make the sonnet better, while Wordsworth is saying, take the challenge and enjoy doing it.

Organ Donating… Good or Bad?

Organ Donation What is going to happen to your body when you die? Will you be buried, cremated, or will you use it for the benefit of others? Organ donations can save lives and be used for research. Organ donation is not solely restricted to people who have passed. Donating is also possible when you are alive. Every American needs to become an organ donor because millions of lives could be saved. Saving lives after death is one of the major motivating factors for organ donations. One organ can save up to eight lives (â€Å"Organ Donation Facts†).There are over 114,000 people waiting for organ transplants (â€Å"Organ Donation Facts†). There was a case of a woman’s husband dying from a car crash and he donated his organs. A few months after his death she got letters in the mail that his organs saved the lives of five people, one of which was a single mother of two small children. On average, eighteen people die a day from being on the waiting list for organ transp lants (â€Å"Organ Donations†). Every ten minutes someone is added to the waiting list (â€Å"The Need Is Real†). These tragic facts are just some of the reasons why people need to become organ donors.It is also possible to donate certain organs while still being alive. While this is more difficult, there is an excellent success rate for the surgeries (CNN Health). Most of these situations involve donating to a family member, saving the life of someone cared for by the donator. Also, by donating to a family member it makes you closer to that person. After you donate you will be contacted by the person that got your donated organ, in case you want to talk to them ( Living Donors Online). In 2010 more than eighteen thousand kidneys were donated by live donors (â€Å"Save A Life†).If a person needs a new kidney they are on dialysis, but if you would donate a kidney to them it would double there life span (â€Å"Benefits Of Living Donation†). Donating an orga n while being alive is an incredibly generous thing to do and every American should consider. Yet another option is whole body donations for science and research. There is a significant shortage of human tissue, the tissue that they have are being used to find cures for cancer and neurological disorders (Fox News). Tissue is also needed to give surgeons operating experience (Fox News).If surgeons do not get the experience they need then when they go into surgery on someone they are not prepared and are more likely to make a mistake. Also firefighters and EMT's need experience with tissue because of burns and emergency medical treatment (Iiam). Also when you donate your entire body it can be used in museums for educational purposes. This educates people on how the body works and why we should be organ donors (Iiam). Donating for science is a very useful way to donate organs after you die. While donating your body and organs is obviously a selfless and beneficial act, there are some p eople who are opposed to organ donation.There are some who argue that if one is in a situation that requires serious medical attention, doctors will not try as hard to save you because you are a donor and could save others. However, doctors will put just as much effort into saving you because only the transplant team knows if you are an organ donor. Some also believe that old people cannot donate organs, making it impossible for people who die of natural causes to donate. There is no defined age limit for a donor; organs have been successfully transplanted from people in their seventies and eighties.Every American needs to become an organ donor to save and help many lives. Your body has no use to you after you have died. Also you could save up to eight peoples lives. Donating organs while you are alive is also an option when donating and it could save the life of someone very important to you. Research is a very important part of organ donating because it trains medical personnel to be better prepared so that they can save lives when they are working. When you get your license or renew your license, be sure to answer yes to being an organ donor.

A Litte Kindness Goes a Long Way Illustration Essay

A simple smile or an honest compliment can change somebody’s life. One example of showing kindness or curiosity for somebody elses feelings happened to me at the Country Market, the store i work at. It was about 8:00 p. m. on a tuesday night when I had just finished for the day and was coming home from school and the gym. I stopped at Country Market, and I went inside to get a drink and pay for my gas. The lines for the cash registers were filled on both sides with about 10 customers waiting at each. I was third in line, behind a middle aged man in his 40’s, and finally an elderly man in front of the line was checking out. The elderly man was in his upper 70’s, and he had a handful of groceries. The cashier asked the man if he needed help out, he replied â€Å"No thank you I can take this out myself†. The old man was struggling to get his groceries, and I noticed the middle aged man was hesitating to help him, so I set my drinks down and went up to the counter and grabbed his groceries and took them out. Little did I know when I was carrying out the mans groceries the middle aged man saw my act of kindness, and he paid for my drinks and my forty six dollars in gas. Another example of ways to show kindness and how it can impact other people’s lives is just by smiling. The power of smiling is amazing, and it takes little or no effort and does not cost you anything. There is a website called To Write Love On Her Arms. TWLOHA is an anti-suicide non profit organization that aims at random acts of kindness or speaking out to those in need. They have a forum on their website about smiling and there has been a handful of cases where teenagers were thinking about committing suicide or feeling so down that they did not wanna live. These teenagers told their stories on this website and there were two that I read that was very sad. This girl said that she was going to kill herself, and the only reason that she did not is because a random old man opened a door for her at school and said â€Å"Smile it looks beautiful on you†. Now this young woman works for TWLOHA and is helping other people with their problems. Other examples of kind acts giving good karma is a story of an old man that works out at my gym with me by the name Jason Overstreet. Jason told me that he was in the drive through for Taco Bell when he decided to pay for the vehicle behind him. He said â€Å"he felt like a million bucks the rest of the day†. A week or so went on when Jason decided to go back through Taco Bell again when he went to get his food from the drive through window. The girl that was working the window recognized him, and told him â€Å"It was really an amazing thing you started the other day. While you bought that lady’s lunch then she bought the car behind hers. It was like a chain reaction that lasted about 7 cars†. Jason was astonished at what he had started just by one simple act of kindness. Anyone can give random kindness anytime of the day. All they have to do is share a bit of their lives with others, or make a simple smile. When you are kind, you bring joy and happiness into the lives of others, and you will also be happier, too. Share your happiness with others, because happiness and kindness make the world go around. You never know when you can change someone’s life with a simple smile. A Litte Kindness Goes a Long Way Illustration Essay A simple smile or an honest compliment can change somebody’s life. One example of showing kindness or curiosity for somebody elses feelings happened to me at the Country Market, the store i work at. It was about 8:00 p. m. on a tuesday night when I had just finished for the day and was coming home from school and the gym. I stopped at Country Market, and I went inside to get a drink and pay for my gas. The lines for the cash registers were filled on both sides with about 10 customers waiting at each. I was third in line, behind a middle aged man in his 40’s, and finally an elderly man in front of the line was checking out. The elderly man was in his upper 70’s, and he had a handful of groceries. The cashier asked the man if he needed help out, he replied â€Å"No thank you I can take this out myself†. The old man was struggling to get his groceries, and I noticed the middle aged man was hesitating to help him, so I set my drinks down and went up to the counter and grabbed his groceries and took them out. Little did I know when I was carrying out the mans groceries the middle aged man saw my act of kindness, and he paid for my drinks and my forty six dollars in gas. Another example of ways to show kindness and how it can impact other people’s lives is just by smiling. The power of smiling is amazing, and it takes little or no effort and does not cost you anything. There is a website called To Write Love On Her Arms. TWLOHA is an anti-suicide non profit organization that aims at random acts of kindness or speaking out to those in need. They have a forum on their website about smiling and there has been a handful of cases where teenagers were thinking about committing suicide or feeling so down that they did not wanna live. These teenagers told their stories on this website and there were two that I read that was very sad. This girl said that she was going to kill herself, and the only reason that she did not is because a random old man opened a door for her at school and said â€Å"Smile it looks beautiful on you†. Now this young woman works for TWLOHA and is helping other people with their problems. Other examples of kind acts giving good karma is a story of an old man that works out at my gym with me by the name Jason Overstreet. Jason told me that he was in the drive through for Taco Bell when he decided to pay for the vehicle behind him. He said â€Å"he felt like a million bucks the rest of the day†. A week or so went on when Jason decided to go back through Taco Bell again when he went to get his food from the drive through window. The girl that was working the window recognized him, and told him â€Å"It was really an amazing thing you started the other day. While you bought that lady’s lunch then she bought the car behind hers. It was like a chain reaction that lasted about 7 cars†. Jason was astonished at what he had started just by one simple act of kindness. Anyone can give random kindness anytime of the day. All they have to do is share a bit of their lives with others, or make a simple smile. When you are kind, you bring joy and happiness into the lives of others, and you will also be happier, too. Share your happiness with others, because happiness and kindness make the world go around. You never know when you can change someone’s life with a simple smile.

Business imformation tech Term Paper Example | Topics and Well Written Essays - 2250 words

Business imformation tech - Term Paper Example 1. Providing for the disposal of the electronics to their clients, for example, the LG company has waste baskets in its points of sale(hot point appliances) to collect the waste from its clients for destruction or for reusing 2. Providing information about manufacturing and the assembly of their products. This information helps the consumers to understand the make of the product, which enable them to extend their lifespan by modifying them when need arises 3. Delaying the release of new products. The manufacturers delay the release of new improved products, which increases the lifespan of the old products as the consumers tend to discard them by increases the amount of time between the successive releases, the manufacturers tend to increase the amount of time before the old products are deemed obsolete. 4. Introduction of new products at a relatively higher cost. The high cost tends to discourage the consumers from discarding of their old products unnecessarily as well as ensuring that the consumers make a long time plans for the new products before the purchase them, increasing their life span and reducing electronic waste (Cieslak, David, and Bob Gaby, 2004). 5. Introduction of recycling cost to electronic products. Where the state supports it, the manufacturers of electronic gadgets add a recycling fee to the price of the product e.g., the state of California passed a law that requires the consumers pay for the recycling of their products. Starting a company that allows people to locate and reuse the used computers and other technologies is a worthwhile venture. it bring most of the electronics within the reach of most people in the third world countries e.g., in Ghana, of the 215 000 tones of electronics imported each year, only 30% are brand new while the remaining 70% are used (assessment of e waste in Ghana). Furthermore, the

Market research and market evaluation Essay Example | Topics and Well Written Essays - 3500 words

Market research and market evaluation - Essay Example Kotler defines marketing research as "the systematic design, collection, analysis and reporting of data relevant to a specific marketing situation facing an organization" (Philip Kotler). It has a wide coverage which includes market potential and market share studies, assessments of customers' satisfaction and purchase behavior, studies of pricing, product, distribution and promotional activities (Philip Kotler). Another book defines marketing research as "a structured approach to getting information about marketing problems and opportunities, for use in making marketing decision" (Frederick Russ). It can be traced to the emergence of the affluent consumers after the World War II wherein marketers sought to convert this new purchasing power into sales therefore the necessity to know what the consumers want and need (Frederick Russ). "The marketing Research process has four steps: defining the problem and research objectives, developing the research plan, implementing the research plan and interpreting the report findings" (Philip Kotler). "Various methods of market research are used to find out information about markets, target markets and their needs, competitors, market trends, customer satisfaction with products and services, etc. Businesses can learn a great deal about customers, their needs, how to meet those needs and how the business is doing to meet those needs. Businesses need not to be experts at methods of research either" (Authenticity Consulting, LLC.) Data Collection can be from primary and from secondary sources. Primary Data Collection includes observation, survey and experiment which can be done personally or impersonally such as through mail or phone (Philip Kotler). Secondary data collection usually includes commercial data sources and online databases and ineternet data sources (Philip Kotler). Quantitative and Qualitative Methods Market research can be either quantitative or qualitative. While quantitative methods are designed to assess, predict and estimate buyer attitudes and behaviors (Power Decisions Group), qualitative marketing research provides the crucial information for the decision-makers and used in exploring new areas or deepen understanding of some market issues (Suite101.de). Quantitative market research can be online, phone,in-person, mail and intercept central location testing (CLT). "The online methods provides a fast implementation especially for complex measurement constructions, the phone provides the top-of-mind brand awareness and first reaction attitudes, the in-person has the hybrid quantitative and qualitative and provides depth in probing attitudes and beliefs by skilled interviewer, the mail allows time for respondent to think about complicated issues without pressure or interviewer influence and the CLT is for both the quantitative questions and for choice exercises in mock stores, and for physical product examiniation and concept testing "(Power Decisions Group). There are at least five considered basic methods of market research. They include surveys, focus groups, personal interview, observation and field trials (AllBusiness.com). Among these, the qualitative ones are focus group an in-depth interviews. Focus Groups

Define your concept of a college education, and what a college Essay

Define your concept of a college education, and what a college education means to you - Essay Example This paper will attempt to explore the importance of college education in an individual’s life and why is it worth the amount of time, hard work and money that students invests on their college education. Tamara Draut in her article ‘Whats a Diploma Worth, Anyway?’ quotes, â€Å"Getting a bachelors degree is the required ticket for entry into the middle class today, but the security once implied in that status is gone. In addition to the exigencies now felt by middle-class Americans of all ages -- rising health care costs, soaring home prices and flat or falling incomes -- todays new generation of college grads bear an added vulnerability of massive debt† (Draut, 203). Personally speaking, nothing is further from truth. College education serves a more profound purpose than providing a promising for a prosperous life. Several evidences points to this very fact. First, not all people, who graduate from elite branded colleges, end up successful and neither all the graduates of mediocre schools stay unsuccessful all their lives. On the contrary, everyone hear rags-to-riches stories about people who attended mediocre colleges or did not go to one at all and did great. Examples include Bill Gates, the founder of Windows and Steve Jobs, the creator and owner of Apple. In addition, there are evidences of graduates of Harvard, Stanford, and Cambridge working at mediocre companies and living an average life. Thus, there is no black and white rule that promises successful prospects after college education. The question now arises, why go to college if a dropout can achieve so much more without a degree? How is it prudent to invest so much money and time in a venture, which is not even remotely reassuring of a good future? The answer lies in under the covers of salary, degree, and fame. The college education serves the purpose of character building. It deepens the attitude and dampens the soul of those who take it seriously. When one studies the

Research the event regarding the shooting of Congresswoman Gabrielle Paper

The event regarding the shooting of Congresswoman Gabrielle Giffords - Research Paper Example The first step to saving her life was the quick reaction of her intern, Daniel Hernandez. He rushed to her side just moments after the shooting, applied pressure to the entry wound to stem the bleeding and lifted her head up to keep her from choking on her own blood. He was called a hero for his quick thinking which played a vital role in saving her life. Gabrielle Giffords was rushed into the hospital immediately just 38 minutes of the shooting. She was conscious when she was immediately rushed to OR where trauma surgeon Peter Rhee, a former military surgeon who served in Afghanistan, worked with remarkable efficiency. The bullet hit at the back of the skull and exited at the front, travelling through the left side of the brain. The fact that the bullet went through and through, rather than staying and damaging was another reason why she survived such a fatal injury. One of her doctors believe that she was fortunate because, had she encountered a bullet in such an area which would almost prove it fatal, according to Michael Lemole, chief of neurosurgery said that they very quickly took her to the operating room, once in the room they performed the routine procedures for such an injury. They had to artificially protect the brain with an artificial layer. Surgeons had to remove some of her damaged tissues, but in her case the damage was not as serious. The biggest challenge that the doctors faced was that the brain may well start responding to commands like squeezing someone’s hand. The bullet of a small caliber pistol entered the back of her head and exited the front damaging the left side which controls speech. Dr Rhee told that Ms, Giffords was fortunate because the bullet stayed on the left side and did not travel through the midline which would have resulted in death. The doctors also did not have to remove so much of the dead brain tissue and bone fragments, because pieces of bones travel within the brain cause

Business strategic management Essay Example | Topics and Well Written Essays - 500 words

Business strategic management - Essay Example 4). They were so focused about directly creating revenues and profits and there was little understanding on how to generate competitive advantage in particular. In years were competition is becoming fierce in the global business, competitive advantage is a must. A company should aim to be a cut above the other. It is in this reason that strategic planning is necessary. Corporate strategies are needed. In the midst of tough competition, companies could not afford to drop their chances to move in the right direction. Thus, businesses are able to grasp once again the importance of strategic management. They are once again trying to sort out their business by cows, dogs, stars and question marks. However, this seems to be classical in nature. The strategic management comes back with substantial interaction with customers and suppliers. In other words, the saturated focus on production approach just to be able to achieve higher revenues and profits was gone.

Philosophy Final Essay Example | Topics and Well Written Essays - 1750 words

Philosophy Final - Essay Example This is applicable because analytic sentences of normal language show a substantial diversity of form and complexity that makes their use in interpretation unreasonable. Although logic is favorable in real time interpretation of concepts, other philosophical applications are also essential in making inferential arguments. Inductive and Deductive Reasoning This reasoning entails evaluation of suggestions resulting from some examples. In this manner, interpretations are made from general ideas to individual instances that suggest truths (Hausman, Kahane and Tidman 5). This concept involves reasoning from detailed observations and processes, which start from discovering patterns and consistencies, articulating some tentative suggestions that are discovered and then formulating a general inferences or theories. The synthesis of ideas from general opinions of specific makes this logic to be called â€Å"bottom up† logic (Burgess 8). For instance, if A is true and B is true, the C i s probable. These logics also employ restrictive probability meanings to signify procedures of the degree to which suggestion statements support theories. Inductive reasoning is probable to fail and produce misconceptions, such as a speedy conclusion mistake. Despite the mistakes made in inductive and considering the level of the limitations, most perception is inductive. For instance, inductive reasoning is applied in cell theory, which is among the basics of current biology uses the concepts of inductive reasoning. This is because all creatures observed are made up of cells. The argument is either true or false because biologists consider that all existing things are made up of cells (Minto 17). On the other hand, deductive reasoning operates to provide the truth of the inference offered that the statement’s evidences are accurate. This explains that, in a deductive argument, the evidences are planned to provide such close support for the deduction that, if the suggestions are true, then it would be inconceivable for the deduction to be untrue. Such an argument where the evidence accurately supports the conclusion is a â€Å"deductively† valid argument. For instance, if A is correct, and B is correct, then C must be true. This means that if a valid claim has true deductions, then the argument is comprehensive and valid. This is approach explains the use of the term "top-down" approach. It entails narrowing down on a topic of interest into comprehensive and specific theories that can be explained (Hausman, Kahane and Tidman 7). However, the variance between the inductive and deductive arguments originates from the connection the author of the claims takes to be between the evidences and the deduction. This implies that if the author of the claim believes that the accuracy of the evidences establishes the truth of the inference due to description, reasonable structure or scientific requirement, then the argument is logical (Burgess 10). On the ot her hand, if the author of the claim does not consider that the accuracy of the evidences establishes the truth of the assumption, but considers that their truth offers good cause to believe the inference true, then the claim is inductive. The two bases of argument help philosophers and authors to make convincing conclusions about their theories or claims. This makes arguments valid and reasonable by the connections derived from claims and conclusions (Burgess 10). Conversely, deductive reason

Terms Ap Us History Essay Example for Free

Terms Ap Us History Essay Sea Dogs-roving English ships that plundered Spanish treasure ships (1560s) St. Augustine–fort Spain created in Florida 1565 to protect the route of its treasure fleet against English ships, French settlers, hostile Indians (1st permanent Euro. settlement in US) Comprehensive Orders for New Discoveries-new policy Spanish leaders introduced after military setbacks to pacify Indians by Christianizing missionaries not conquistadores (1573) Ecomenderos-privelaged spanish landowners in NM, who were allowed by the Franciscans to utilize the goods and forced labor of Indians and their land Popà ©-an Indian shaman, who killed and drove away Spaniards (destroying Spanish churches etc) with his followers in 1680 Samuel de Champlain-founder of the fur-trading post Quebec (1608), first permanent French colony). Colony did badly until 1662 when it was turned to royal colony Robert de La Salle-fur trader who in 1681 traveled down the Mississippi River to the Gulf of Mexico to found Louisiana (and ultimately New Orleans). Traveled so far from Great Lakes/New France region to get rive by taking advantage of of remote Indians who did not know value of their furs Henry Hudson-An English mariner sent by Dutch merchants in 1609 to find a navigable route to East Indies/riches. Explored rivers of the NE (esp. Hudson River) and found plentiful furs Fort Orange-Dutch merchants founded this fur-trading post (now Albany) in 1614 after following H. Hudsons exploration to trade for furs with the Iroquois West India Company-chartered by Dutch government in 1621 and set up New Netherland colony and New Amsterdam (Manhattan) as capital, brining in farmers/artisans to make sustainable. Later acted independently, ignoring New Netherland to profit in other colonies Governor Peter Stuyvesant-governor of New Amsterdam who ruled in authoritarian way by alienating colonys diverse residents and ignoring representation demands. Anglo-Dutch War-series of wars fought between the Dutch and the English in the 1600s and 1700s over control of the seas and trade routes. Early wars confirmed the Dutch Republics position as the leading maritime country and its domination of world trade until the early 1700s. Virginia Company-London company of investors granted all land by King James I of England from NC to NY (1606). Directors named land Virginia and in 1607 group of male traders (no farming experience) settled area of Jamestown with intention of obtaining gold (there was no gold). More than half of first settlers died from voyage, disease, famine. Later encouraged migration by granting free settlers land. Powhatan-chief of local tribes who treated the English traders as potential (trade) allies, and essentially saved them from total famine when he gave them corn (in exchange got metal tools/guns). Saved life of Captain John Smith from his brother Opechancanough. John Rolfe-an English colonist that married Powhatans daughter Pocahontas under his arrangement (diplomatic effort by Powhatan). Rolfe imported tobacco seed from West Indies, producing a profitable and in-demand crop in Europe––spurred migration of thousands of English settlers establishing plantations, and consequently invading Indian land. House of Burgesses-system of representative government in VA issued as a charter from the Virginia Company (1619). Could make laws and levy taxes, but governor/company council in England could veto its acts. Opechancanough-Powhatans brother and successor who attacked the early English invaders (captured Capt. John Smith). Stayed distant from English and refused all treaties while Powhatan chief. Became chief 1621, wanted to wipe out all of Englishmen (land-hungry and conversion minded). Started Indian War of 1622 when killed 1/3 of white English in surprise attack, who then brutally punished Indians and declared perpetual war that lasted 10 years. Privy Council-a committee of political advisers to King James I, who made it a requirement that all legislation passed by the new VA governor and his advisory council of the House of Burgesses (formed in 1624 when King James I revoked VA Companys charter and made VA a royal colony b/c of Indian uprising) had to be ratified by them. Toleration Act of 1649-Lord Baltimore persuaded the assembly (of MD) to pass this act––which protected his fellow Catholics (who had become a minority to the surging Protestants in Marlyand) and granted all Christians the right to follow their beliefs and hold church services. Maryland was no a colony of Christian religious freedom. Freeholds-Small family-farmed (tobacco) plantations that were the main source of tobacco in the Chesapeake region in the early part of the tobacco boom (1620s). Indentured Servant-poor whites in England who were impoverished and abused in Englands city poorhouses who there were displaced to the cities after the go vernment enclosed their lands in the countryside. They wanted to settle in the colonies to obtain land and economic opportunity (social mobility), so to pay for their passage over they signed indentures from merchants (who would sell them to planters) that said they would work as a servant on a plantation for 4-5 years and then were free. Many died en route or were abused to death on plantations, and only 25% actually acquired land and success afterwards. Black Codes-laws enforced by Chesapeake planters to limit the freedom and severely restrict rights of African workers in the colonies (like owning guns, traveling). These codes made slavery legal, and encouraged racist ideas to differentiate poor whites from blacks, elevating them and make slaves inferior beings (all because slave importation skyrocketed when tobacco boom crashed). Navigation Acts-passed by English Parliament in early 1660s as the main device of mercantilist policy in England (wanted to exclusively capitalize on their American colonies raw materials and market for manufactured goods), they prevented colonists from selling tobacco to all countries besides the English (lost money from Dutch), and all tobacco went to England where there were higher import duties. Consequently tobacco prices fell and planters were forced to use the cheaper labor of black slaves, and political problems resulted in the Chesapeake colonies. Governor William Berkeley-royal Governor of Virginia (Jamestown) who was instructed to run the colony only for the benefit of England (1642-1652). He was part of, and favored the planter-merchant elite. Corrupt: to win support in House of Burgesses bribed officials with land grants and took vote away from landless freemen (50% of white pop.). Increased the already growing disparities in wealth and status among VA population. Nathaniel Bacon-a wealthy farmer (was on governors council), he was a leader of colonial frontiersmen in western deep Virginia (west). Like other poorer farming frontiersmen, was angered over Gov. Berkeleys inability to protect western VA frontier land (like his own) from Indian attacks; also angry at the rights and corruption of VAs wealthy inner circle. Bacon’s Rebellion-1676, Nathaniel Bacon led other fellow poor frontiersmen on Indian raids because they were being attacked by Indians. The poor frontiersmen were all angry at the tobacco monopoly that the elite eastern planters had, that they lost their voting rights, and that they were overtaxed. Gained popularity with his Indian raids. Seen as a Martyr when he was arrested by Berkeley and was freed by yeomen. He and forces burned Jamestown, but when he died Berkeley violently crushed rebellion with British military aid. Made colonies turn away from indentured servant labor and toward slave labor. Manifesto and Declaration of the People William Bradford-Puritan who led Puritans and migrants from England (102) to America in 1620 aboard the Mayflower and settled in Plymouth, in SE MA. While en route, he said they lacked a royal charter from England, and issued the Mayflower Compact. Mayflower Compact-issued by William Bradford aboard Mayflower to migrants/Puritans which coalesced the migrants (just wanting to go to VA for economic opportunity) with the Puritans (wanting to be independent and free of Protestant VA) by declaring they would live in a civil body politick using the Puritans self-governing congregation to shape their political structure. John Winthrop-Well-educated Puritan country squire who led the exodus of Puritans from England in 1630 (they were being persecuted against by Catholic King Charles I), to set up govern the Massachusetts Bay Colony (Boston). He declared to his people we shall be as a City upon a Hill. He meant that God had chosen them to be a shining example and hope for all (Christian) religions, like those in what he considered to be a morally corrupt England, wanted to inspire religious reform throughout the Christian world. Massachusetts Bay-Colony established and governed by John Winthrop 1630, who led exodus of Puritans from a morally corrupt England where his people were being persecuted, sought to create a New England that was a reformed Christian society. Colony was a representative political body with an assembly, and made Puritanism the sole state religion (no other religions allowed), only church members could vote/hold office. Used Bible as legal guide, and embraced simple Christian principles––churches were controlled by the people (congregationalist) with no hierarchy and were meetinghouses. These Puritans believed in predestination (John Calvin), a doctrine that God chose only a select few individuals for salvation before they were born. Many sought a born again experience. Because they thought they were chosen as a city upon a hill, they felt the right to seize Indian lands. Roger Williams-Roger Williams was a Puritan minister who opposed congregationalism, praised the separation of church and state, advocated religious tolerance (the government didnt have authority over spiritual lives), and didnt believe in Puritans seizure of Indian land. These were all opposite views than the status quo of Mass. Bay. In 1636, he was banished so he led his followers to settle the town of Providence (Rhode Island) the land he bought from Indians. Got a charter from Parliament in 1644 to establish the colony of Rhode Island (complete religious freedom). Anne Hutchinson-A Mass. Bay wife who held weekly prayer meetings for women, she preached controversial and differing views: she believed salvation could not be achieved through good deeds, people only bestowed by God through the covenant of grace. She said that God spoke his divine truth directly to individuals, not through the church. As a woman with considerable influence, she was banished in 1637, for her heretical views and as a threat to the superiority of men in the Puritan church. Joined Roger Williams in RI. Thomas Hooker-Puritan pastor who brought some Puritans to the Connecticut River Valley in 1636 and established the town of Hartford (left NE because of differing views and search for better farmland). Connecticut became royal colony in 1660 with charter from King Charles II. Had a legally established church but granted voting rights to all land-owning men. Cotton Mather-A popular Puritan theologian who believed in supernatural forces, that unusual events were the power displayed by God or Satan. Lead to the Salem Witch Trials. Spectral Evidence-The evidence allowed by judges at the accused witches trials (in the Salem Witch Trials), which was visions of evil beings and marks seen only by the girls (who suffered supernatural seizures). Praying Towns-Indian villages that Puritan ministers like John Eliot turned into intensely Christian communities by 1670 in efforts to convert Indians. The 1000 Indian residents lost their independence and culture, and new native form of Christianity were made by traditional spiritual beliefs incorporated into churches. Metacom-Chief of the Wampanoags who with two other tribes staged a rebellion in 1675-1676, attacking white settlements all over New England in hopes to finally expel the Europeans. He knew coexistence was unlikely and was angry that NE colonists restricted their trade and accused them of many violations. Had they not run out of gunpowder, the rebellion might have been a success. The NE colonies losses were significant, as some places lost 5% of their population; but Indians lost 25% of their population and the three tribes (Wampanoags, Narragansetts, and Nipmucks) displaced/retreated west to the backcountry.

Blood Donation Safety Procedures: An Overview

Blood Donation Safety Procedures: An Overview Qualification of blood donors has become a lengthy and detailed process, a donor inquisition some would say. Yet blood collection depends on this system of safeguards to protect the donor from injury and the recipient from the risks of allogeneic blood. Sensitive screening tests have been considered the cornerstone of blood safety for more than three decades. However, testing represents only one component of this system. Additional layers of safety include following measures:- Detailed donor education programmes prior to recruitment, Pre-donation informational literature, Stringent donor screening selection and deferral procedures, Post-donation product quarantine Donor tracing and notification when instances of disease transmission are detected. Each element plays a role in preventing tainted units from entering the blood inventory. Most transfusion services have developed evidence-based standards and regulations for the selection of donors and quality systems to assure excellence in all phases of their application. Other standards derive from expert opinion and common sense, and these policies need to be revisited as scientific information becomes available. Blood donors should have the following general qualifications:- They should have reached the age of consent, most often 18 years, but 17 in some countries such as the USA and the UK; They should be in good health, They should have no history of serious illness, Must weigh enough to allow safe donation of a unit and not recognize themselves as being at risk of transmitting infection. Ideally, donation should be strictly voluntary and without financial incentive. Some blood services impose an arbitrary upper limit on age, commonly 65 years, or up to age 70 in Denmark and the UK; however, it seems curiously subjective to exclude donors on the basis of age alone if they are otherwise in good health. The Blood Collection Service should provide informational literature for prospective blood donors. After information and counselling about criteria for donor selection, donors should consent in writing to the terms of donation, including the use of the donated  blood, the extent of testing, the use of testing results (including donor notification of positive results) and the future use of any stored specimens. Donors should be told about the possibility of delayed fainting and about other significant risks of the donation procedure. Blood donation has potential medicolegal consequences. If a donor becomes ill shortly after giving blood, the illness may be attributed to blood donation For this reason, among others, it is important to ensure that donors have no history of medical conditions such as brittle diabetes, hypertension, poorly controlled epilepsy and unstable cardiopulmonary disease that might be associated with an adverse event following phlebotomy. Pregnancy might be adversely affected by the donation process and ordinarily excludes a donor. Donors who become ill within 2 weeks of donation should be encouraged to inform the transfusion service, which may wish to discard the donated blood, recall any plasma sent for fractionation or follow up recipients of the blood components as appropriate. Donors who develop hepatitis or HIV infection within 3-6 months of donation should also i nform the Blood Collection Service. Donor interview The donor interview should be conducted by staff trained and qualified to administer questions and evaluate responses. The donor interview should be conducted in a setting sufficiently unhurried and private as to permit discussion of confidential information. With current practices in the USA, approximately 2% of volunteer donors still disclose risks that would have led to deferral at the time of donation. Introduction of standardized and validated questionnaires and the application of interactive computer-assisted audiovisual health history may reduce errors and misinterpretations during conduct of the donor interview. Physical examination Blood collectors perform a limited physical examination designed to protect donor and recipient. Screeners routinely assess the donors general appearance and defer those who do not appear well or are under the influence of alcohol. A normal range of pulse and blood pressure is defined, although variances may be granted for healthy athletes. Body weight and temperature are measured by some collection services. Both arms are examined for evidence of illicit drug use and for lesions at the venepuncture site. Volume of donation The volume of anticoagulant solutions in collection bags is calculated to allow for collection of a particular volume of blood, which, in the UK, is 450  ± 45 ml. In the USA often 500 ml, but in no case more than 10.5 ml/kg including the additional volume of 20-30 ml of blood collected into pilot tubes. From donors weighing 41-50 kg, only 250 ml of blood is collected into bags in which the volume of anticoagulant solution has been appropriately reduced. In some countries, the volume collected routinely is less than 450 ml, for example 350-400 ml in Turkey, Greece and Italy, and 250 ml in some Asian countries such as Japan, where donors tend to be smaller. Record-keeping It should be possible to trace the origin of every blood donation and records should be kept for several years, depending on the guidelines for each country. In many countries, a system employing unique bar-coded eyereadable donation numbers is now in use. This system makes it possible to link each donation to its integral containers and sample tubes and to the particular donor session record. Information concerning previous donations, such as records of blood groups and microbiology screening tests, antibodies detected, donor deferrals and adverse reactions are important for subsequent attendances. Electronic storage of donor information greatly facilitates accurate identification, release, distribution and traceability of units of blood and blood products. An international code, ISBT 128, is intended to be used by all countries for the accurate identification of donors and donations. These records must be protected from accidental destruction, modification or unauthorized access. Frequency of donors in the population Although in many Western countries, some 60% of the population are healthy adults aged 18-65 years and thus qualified to be blood donors, the highest annual frequency of donation in the world corresponds to about 10% of the population eligible to give blood donating once per year, as in Switzerland. The frequency in most developing countries is less than 1% . The number of units collected per 1000 US inhabitants of usual donor age (18-65) was 88.0 in 2001, up from 80.8 in 1999. Although this number compares favourably with the rate of 72.2 per 1000 in 1997, it pales in comparison with the 100 units per 1000 population collected in Switzerland. As treacherous as it may be to interpret these figures, the numbers suggest that US collecting facilities are progressively improving efficiency. Data from the American National Red Cross indicate that the average volunteer donates about 1.7 times a year. Losses from outdated red cells accounted for 5.3% of the supply but, given the fact that r ed cells can be transfused only to compatible recipients, the number of usable units outdated appears to be extremely small. More than 99% of group O units and 97% of group A units were transfused. The shrinking donor pool: the safety vs. availability conundrum Donor deferrals and miscollected units have an increasing role in blood shortages. In a 1-year study at a regional blood centre, nearly 14% of prospective donors were ineligible on the day of presentation and more than 3.8% of donations did not result in the collection of an acceptable quantity of blood. Short-term deferral for low haemoglobin (Hb) was the overwhelming reason for the deferral of female donors in all age groups, representing more than 50% of all short-term deferrals. In first-time female donors, low Hb accounted for 53-67% of deferrals within different age groups, and for repeat female donors 75-80% of deferrals. In both firsttime and repeat male donors aged 40 years and older, the most common reason for short-term deferral was blood pressure or pulse outside allowed limits. For persons aged 16-24 years, regardless of sex and donation  status, the most common reason for lengthy deferral was tattoo, piercing or other non-intravenous drug use needle exposure. For 25- to 39-year-old female donors, needle exposure was also the most common reason, whereas for male donors, travel to a malarial  area was more common. For all ages over 40, the most common reason for long-term deferral was travel to a malarial area. Measures introduced to increase blood safety may  have the unintended consequence of decreasing blood availability. Results from demographic studies indicate that certain donor groups or donor sites present an unacceptable risk of disease transmission. For example, blood collectors no longer schedule mobile drives at prisons or institutions for the disabled because of the recognized high prevalence of transfusion-transmissible viruses. Few would argue the risk-benefit analysis of these exclusions. More questionable were the temporary exclusions of US soldiers exposed to multiple tick bites at Fort Chaffee, Arkansas, and the lengthy deferrals of veterans who served in Iraq and Kuwait because of the fear that they might harbour Leishmania donovani, an agent infrequently associated with transfusion risk. Donors who have received human growth hormone injections have been indefinitely deferred because of the possible risk of transmitting Creutzfeldt- Jakob disease (CJD); however, relatives of patients with sporadic CJD are still deferred in the US (except for preparation of plasma fractions) despite evidence of their safety. There have now been five case-control studies of more than 600 CJD cases, two look-back studies of recipients of CJD products, two autopsy studies of patients with haemophilia and mortality surveillance of 4468 CJD deaths over 16 years without any link to transmission by transfusion (Centers for Bio logic Evaluation and Research, US Food and Drug Administration 2002). Although the impact of this deferral on the US blood supply has been negligible, the recent indefinite deferral of donors who resided in the UK for a total of 3 months or longer between 1980 and 1996, and the complicated deferral policy for residents and visitors to the European continent, designed to reduce a calculated risk of transmission of the human variant of mad cow disease (variant Creutzfeldt-Jakob disease, vCJD), has had a substantial impact, a loss of as much as 10% by some estimates, particularly on apheresis donors (Custer et al. 2004). Additional donor exclusions appear to be on the horizon. Donor medications constitute another significant area of deferral losses. Certain medications, for example etretinate (Tegison), isotretinoin (Accutane), acitretin (Soriatane), dutasteride (Avodart) and finasteride (Proscar), have been identified as posing potential risk to transfusion recipients because of their teratogenic potential at low plasma concentrations. Such exclusions have little impact on blood safety but each shrinks the potentially eligible volunteer donor pool. More troublesome, although not as numerous, are donor deferrals resulting from false-positive infectious disease screening tests. This problem has been recognized since the introduction of serological tests for syphilis. However, during the past 15 years, the introduction of new screening tests and testing technologies has resulted in numerous deferrals for questionable test results and either complex re-entry algorithms or no approved method to requalify such donors. Surrogate tests used for screening have pro ved particularly troublesome. However, even specific tests result in inappropriate deferrals. Of initial disease marker-reactive donations, 44% proved to be indeterminate or false positive. Each year an estimated 14000 donors are deferred from donating blood for an indefinite period because of repeatedly reactive enzyme immunoassay (EIA) screening tests for human immunodeficiency virus (HIV) and hepatitis C virus (HCV), and several hundred donors are deferred for apparently false-positive nucleic acid testing (NAT) results. Registry of bone marrow donors Voluntary blood donors are highly suitable to become bone marrow or peripheral blood stem cell donors for unrelated recipients, and many transfusion services now recruit them for this purpose. From its founding in 1986 until August 2003, the National Marrow Donor Program in the USA had registered more than 5 million bone marrow and blood stem cell donors, and Bone Marrow Donors Worldwide in the Netherlands records more than 8 million donors from 51 registries in 38 countries. Standards for acceptance of stem cell donors are based on blood donor eligibility. A uniform donor history is being developed. Conditions that may disqualify a donor Carriage of transmissible diseases The most important infectious agents transmissible by transfusion are the hepatitis viruses B and C, HIV, human T-lymphotropic viruses (HTLVs), bacteria and the agents causing malaria and Chagas disease. Increasing attention is being paid to the risks of emerging agents and newly recognized infectious risks of transfusion such as West Nile virus, babesiosis and vCJD. Steps that should be taken to minimize the risk of infecting recipients with the agents of these and other diseases involve exclusion based on geographical residence, signs and symptoms of disease, high-risk activity and demographics associated with risk transmission. Donors who have been exposed to an infectious disease and are at risk of developing it should be deferred for at least the length of the incubation period. Recent inoculations, vaccinations, etc. To avoid the possibility of transmitting live viruses (e.g. those of measles, mumps, rubella, Sabin oral polio vaccine, yellow fever, smallpox), donors should not give blood during the 3 weeks following vaccination. In subjects immunized with killed microbes or with antigens (cholera, influenza, typhoid, hepatitis A and B, Salk polio, rabies, anthrax, tick-borne and Japanese encephalitis) or toxoids (tetanus, diphtheria, pertussis), the interval is normally only 48 h. These recommendations apply if the donor is well following vaccination. Plasma from recently immunized donors may be useful for the manufacture of specific immunoglobulin preparations. Donors who have received immunoglobulins after exposure to infectious agents should not give blood for a period slightly longer than the incubation period of the disease in question. If hepatitis B immunoglobulin has been given after exposure to the virus, donation should be deferred for 9 months to 1 year; similarly, if tetanus immunoglo bulin has been given, donation  should be deferred for 4 weeks. When rabies vaccination follows a bite by a rabid animal, blood donations should be suspended for 1 year. In developed countries, tetanus and diphtheria immunoglobulin is derived from human sources. However, horse serum is still  used in some parts of the world. Donors who have received an injection of horse serum within the previous 3 weeks should not donate blood because traces of horse serum in their blood might harm an allergic recipient. The administration of normal human immunoglobulin before travelling to countries where hepatitis A is endemic is not a cause for deferral. Group O subjects may develop very potent haemolytic anti-A following an injection of tetanus toxoid, typhoid-paratyphoid (TAB), vaccine or pepsindigested horse serum, which may contain traces of hog pepsin. In the past, the use of such subjects as universal donors sometimes led to severe haemolytic transfusion reactions in group A subjects. Platelet concentrates collected by apheresis from subjects with hyperimmune anti-A should not be used for transfusion to group A or AB patients in view of the large volume of plasma needed to suspend the platelet concentrate. Ear-piercing, electrolysis, tattooing, acupuncture   All of these procedures carry a risk of transmission of hepatitis or HIV infection when the equipment used is not disposable or sterilized, and blood donation should then be deferred for 12 months. In the UK, donors are accepted if the acupuncture is performed by a registered medical practitioner or in a hospital. Although  the association between tattooing and exposure to hepatitis C is generally acknowledged, less clear is whether a tattoo performed by licensed and inspected facilities carries more risk than a trip to the dentists surgery. Allergic subjects Subjects who suffer from very severe allergy are unacceptable as donors because their hypersensitivity may be passively transferred to the recipient for a short period. Subjects with seasonal allergy (e.g. hay fever) may donate when not in an active  phase of their hypersensitivity. A screening test for immunoglobulin E (IgE) antibodies would not help to identify those allergic individuals with an increased chance of passively transferring their hypersensitivity. Blood transfusions and tissue grafts Donations should not be accepted for at least 12 months after the subject has received blood, blood components or grafts. Increasingly, donors who have received transfusion in the UK are being deferred indefinitely as a precaution against transmission of vCJD. Surgery and dental treatment When surgery has been carried out without blood transfusion, donation may be considered when the subject has fully recovered. Uncomplicated dental treatments and extractions should not be a cause for prolonged deferral, as utensils are sterilized and the  risk of bacteraemia persisting for more than 1 h is negligible. Medication Many subjects taking medication are not suitable as donors because of their underlying medical condition. Others are unsuitable as donors because the drugs they are taking, for example anticoagulants or cytotoxic agents, may harm the recipients. Subjects who have taken aspirin within the previous week are unsuitable when theirs are the only platelets to be given to a particular recipient. Ingestion of oral contraceptives or replacement hormones such as thyroxine is not a disqualification for blood donation. On the other hand, recipients of human growth hormone (non-recombinant) should be permanently deferred from blood donation as should subjects who have used illicit injected drugs. Deferral for specific medication use is usually an issue of medical discretion. Donors with relatively minor red cell abnormalities In some populations, a considerable number of donors have an inherited red cell abnormality. The three conditions most likely to be encountered are: glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, sickle trait (HbAS) and thalassaemia trait. G-6-PD deficiency. This is the most common red cell enzyme defect; hundreds of molecular variants have been catalogued. Although most G-6-PD-deficient red cells have only slightly subnormal survival and lose viability on storage with adenine at only a slightly increased rate (Orlina et al. 1970), some enzyme variants render the cells unsuitable for transfusion. With the African variant GdA- present in 10% of African  Americans, a relatively small number of red cells are severely affected. However, the Mediterranean variant GdMediterranean and others render the red cell particularly  sensitive to oxidative stress. If the recipient of one of these units develops an infectious illness or ingests fava beans or one of any number of drugs (ph enacetin, sulfonamides, vitamin K, primaquine, etc.), rapid destruction of the donors G-6-PD-deficient cells may  result. Neonatologists avoid using G-6-PD-deficient blood for exchange transfusion, and subjects who have evidenced G-6-PD-related haemolysis should be permanently deferred from donation (Beutler 1994). Sickle trait (HbAS). Sickle trait red cells survive normally in healthy subjects, even after storage. However,  in patients subject to various types of hypoxic stress, these cells survive poorly. HbS polymerizes at low oxygen tension and the cells are trapped in the spleen. Blood from donors with sickle cell trait should not be used for infants or for patients with  sickle cell disease who undergo exchange transfusion. Patients, other than those with sickle Hb, who require general anaesthesia should have no problems if transfused  with HbAS red cells provided that adequate oxygenation is maintained. Red cells from subjects with HbAS are usually unaffected by collection via apheresis,  but those with sickling haemoglobinopathies should not donate by apheresis and are not suitable for intraoperative salvage. If blood from donors with sickle cell trait is  glycerolized for storage in the frozen state, extra wash solution must be used during the deglycerolization procedure. Sickle trait prevents ef fectiveWBC reduction by filtration. Thalassaemia trait This is associated with little or no reduction in red cell lifespan in most subjects with a normal Hb concentration and these subjects may be accepted as donors. Special conditions in which normally disqualified donors may donate In some circumstances, a donor may give blood or components to be used for a special purpose, even although the requirements for normal donation are not met. For example, a donor who is mildly anaemic or who has recently given birth may give plasma or  platelets by apheresis; the plasma may be needed for reagent preparation, for example HLA antibodies, or the platelets may be needed for transfusion to the newborn infant. Donors at risk for carrying malaria may give plasma for fractionation. The usual interval  between donations may be waived for important medical indications. The donor age limitation and a number of other screening criteria may be modified for components directed to the recipient of the donors bone marrow. In every case, medical evaluation should ensure that there is no increased risk to the donors health and that the value of the component outweighs any perceived increase in risk. Under these circumstances, informed consent regarding the variance and documentati on of the circumstances is mandatory. Donation of whole blood Frequency of donation The volume lost from a single unit donation is replaced within 48-72 h. Red cell mass recovers more slowly, requiring 3-6 weeks. Some collection services bleed donors no more than two or three times a year; most do not bleed women who are pregnant or those who have been pregnant within the previous 6 weeks. The primary objective of this policy is to protect the donor from iron deficiency. There is a wide variation in the recommended minimum interval between donations. For example in the US, in line with World Health Organization (WHO) recommendations, the interval can be as short as 8 weeks and a maximum of 3 l of blood per year may be collected. Premenopausal women should not donate as frequently as men. In the Netherlands, men are bled every 3 months and women every 6 months. Because few red cells are lost during platelet and plasmapheresis, these procedures may be performed more often and at shorter intervals. Standards vary by country; in the USA plateletpheresis donors may be dr awn every 48 h up to twice per week and 24 times per year. Commercial plasmapheresis donors are bled even more frequently; however, physical examination is more rigorous and laboratory testing more extensive for these donors. As combinations of components, such as two-unit red cells, are drawn by apheresis, volumes and intervals become individualized, but generally limited by the loss of red cells. Hb regeneration after normal blood donation In 14 normal healthy subjects bled of about 400 ml of blood (8% of their blood volume), circulating reticulocytes increased minimally but significantly and peaked on the ninth day after bleeding. The Hb level was lowest 1 or 2 weeks after bleeding, and increased rapidly thereafter, reaching predonation levels at 3-4 weeks (Fig. 1.1). In a study in which total red cell volumes were measured in subjects who had donated about 190 ml of red cells, about 50 ml of red cells were restored after 1 week and restoration was  almost complete at 6 weeks. Potential health benefits of blood donation For the volunteer donor, the chief benefit lies in the satisfaction of selfless concern for the welfare of others. However, two studies suggest that there may be more tangible health benefits, particularly for middle-aged men, such as lowering the risk of cardiovascular disease. The proffered explanation derives from the so-called iron hypothesis: menstrual iron loss protects women against cardiovascular disease; iron stores correlate with cardiovascular disease across European populations and heart failure is a hallmark of disorders of iron surplus (Sullivan 1981). One proposed mechanism for this association is generation of oxygen free radicals that induce oxidation of lipids. However  the Johns Hopkins Hospital autopsy registry found less coronary artery disease in hearts from patients with haemochromatosis and haemosiderosis than in hearts of age- and sex-matched controls. Salonen and co-workers (1998) conducted a prospective 9-year follow-up study of 2862 men aged 42-60 from eastern Finland, who had participated in the Kuopio Ischemic Heart Disease Risk Factor Study. Only one man out of 153 who had donated blood in the 24 months prior to baseline examination suffered a myocardial infarction, compared  with 316 (12.5%) of the 2529 non-donors. Meyers and co-workers (1997) compared the rate of cardiovascular events of 665 blood donors with that of  3200 non-donors in a telephone survey of a cohort selected from the Nebraska Diet Heart Survey. By multivariate analysis, non-smoking men who had donated at least once in the previous 3 years had a significantly lowered risk of cardiovascular events; no additional benefit was derived from longer or more frequent donation. Directed donations are those given exclusively for named patients, usually by relatives or friends. The use of directed donations contravenes the normal principles of voluntary blood donation, fails to increase  safety and finds medical justification in vanishingly few circumstances: in patients with rare blood groups when the only available compatible donors may be close relatives; in occasional patients awaiting renal transplants, for whom donor-specific transfusions may still play a role; in infants with neonatal alloimmune  thrombocytopenia or haemolytic disease of the newborn, for whom maternal platelets or red cells are occasionally invaluable; (4) in children requiring open-heart or extensive orthopaedic surgery, for whom the total requirements for blood and components can be collected preoperatively, as for autologous transfusion but from designated relatives or parents, thus minimizing the number of donor units to which the children are exposed in  patients with leukaemia in relapse after bone marrow transplantation, for whom donor leucocytes are used as adoptive immunotherapy to induce graft-versusleukaemia  (GvL) effect. The practice of transfusing parental blood to premature newborn infants is not without risks. Mothers may have antibodies against antigens (inherited from the father) on the infants red cells, platelets or white cells and maternal plasma should not be used. Fathers should not serve as cell donors because they may have antigens present on their red cells, which are incompatible with maternally derived antibodies present in  the fetus. Moreover, in view of partial histocompatibility, transfusion of cells from parents and close relatives may result in graft-versus-host disease (GvHD) in  the infants, or older children, especially if the infants are immunodeficient. Circumstances such as these, in which blood or platelet suspensions should be irradiated, are described in. The practice of transfusing parents with blood from their offspring can also be dangerous. Fatal GvHD occurred in two immunocompetent adult patients who  were transfused with fresh whole non-irradiated blood from their children during cardiac surgery. In both cases, one of the donors was homozygous for one of the recipients HLA haplotypes. When such transfusions are indicated, and except for instances in which adoptive immunotherapy is intended, the components should be treated with 25 Gy gamma irradiation. People who donate for friends and family lose their  anonymity and may be subject to influences not placed upon community donors. Such donors may provide less than candid answers to sensitive donor questions, either because they believe that unsafe blood will inevitably be detected by testing procedures or because they wish to conceal information from the recipient or the blood collector.