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order fulfillment manager resume aploon Logistics business plan sample order fulfillment manager resume aploon Logistics business plan sample Disparities in health status between American Indians and other groups in the United States have persisted throughout the 500 years since Europeans arrived in the Americas. Colonists, traders, missionaries, soldiers, physicians, and government officials have struggled to explain these disparities, invoking a wide range of  .order fulfillment manager resume aploon Logistics business plan sample order fulfillment manager resume aploon Logistics business plan sample.

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Phd research proposal development Commonly Used Research Measurement Scales.Related post for Role of manager in research proposal Recent Posts The Persistence of American Indian Health Disparities David S EARLY NAVAJO MIGRATIONS AND ACCULTURATION IN THE nbsp.Related post for Role of manager in research proposal Recent Posts The Persistence of American Indian Health Disparities David S.Jones is with the Center for the Study of Diversity in Science, Technology, and Medicine, Massachusetts Institute of Technology EARLY NAVAJO MIGRATIONS AND ACCULTURATION IN THE nbsp.Jones is with the Center for the Study of Diversity in Science, Technology, and Medicine, Massachusetts Institute of Technology.Requests for reprints should be sent to David S.Jones, MD, PhD, Massachusetts Institute of Technology, 77 Massachusetts Ave, E51–290, Cambridge, MA 02139 (e-mail: @senojsd).

This article has been cited by other articles in PMC.Abstract Disparities in health status between American Indians and other groups in the United States have persisted throughout the 500 years since Europeans arrived in the Americas.Colonists, traders, missionaries, soldiers, physicians, and government officials have struggled to explain these disparities, invoking a wide range of possible causes.American Indians joined these debates, often suggesting different explanations.Europeans and Americans also struggled to respond to the disparities, sometimes working to relieve them, sometimes taking advantage of the ill health of American Indians.

Economic and political interests have always affected both explanations of health disparities and responses to them, influencing which explanations were emphasized and which interventions were pursued.Tensions also appear in ongoing debates about the contributions of genetic and socioeconomic forces to the pervasive health disparities.Understanding how these economic and political forces have operated historically can explain both the persistence of the health disparities and the controversies that surround them.THE INDIAN HEALTH SERVICE (IHS) faced a daunting challenge when it was established in 1955.Indian populations living in rural poverty suffered terribly from disease.

Tuberculosis continued to thrive, and infant mortality reached 4 times the national average.During the past 50 years, the IHS has improved health conditions dramatically, but disparities persist—American Indians continue to experience some of the worst health conditions in the United States.Although this persistence is striking, it is even more striking that the disparities have existed not for 50 years but for 500 years.From the earliest years of colonization, American Indians have suffered more severely whether the prevailing diseases were smallpox, tuberculosis, alcoholism, or other chronic afflictions of modern society.The history of these disparities provides perspective on many vexing problems of contemporary American Indian health policy.

European and American observers have offered a diverse range of causes to explain Indian susceptibility, from the providential theories of Puritan colonists to emphasis on environment, behavior, genetics, or socioeconomic status.How did American Indians and their observers evaluate these long lists of potential causes and determine which were most important or meaningful? Observers have offered a similarly diverse range of responses, from attempts that relieved disparities through health care to efforts that ignored or even exacerbated them.How did political and economic interests shape their choices? The history also raises questions about the actual causes of the disparities.Health disparities have persisted, even as the underlying disease environment has changed.Do American Indians have intrinsic susceptibilities to every disease for which disparities have existed? Or does the history of disparity after disparity suggest that social and economic conditions have played a more powerful role in generating Indian vulnerability to disease? Understanding the histories of health disparities may explain the complex reactions they provoke and why efforts with the best intentions have fallen short.

ENCOUNTERS AND EPIDEMICS American Indians struggled with ill health even before Europeans arrived.Although pre-Columbian populations were spared the ravages of smallpox, measles, influenza, and many other infections, they did not inhabit a disease-free paradise.Careful analyses of skeletal remains have revealed many diseases, including tuberculosis and pneumonia.1 Whereas some populations, such as those of coastal Georgia or Brazil, enjoyed excellent health, many American Indian groups stretched their environments past the limits of sustainability.From the arid southwest to the crowded urban centers of Mexico and Peru, malnutrition, disease, and violence kept life expectancies below 25 years of age.

Health disparities also existed within populations, such as the complex stratified societies of Mesoamerica and the Andes.2 Moreover, paleoanthropologists have documented widespread evidence of worsening malnutrition and disease during the years before Europeans arrived.Baseline ill health made American Indians vulnerable to European diseases.Mortality increased soon after the arrival of Christopher Columbus, and it quickly reached catastrophic proportions.

Estimates of pre-contact American populations vary between 8 and 112 million (2 to 12 million for North America), and estimates of total mortality range from 7 to 100 million.4 Whatever the exact numbers, the mortality was unprecedented and overwhelming.Hispaniola, the first region subjected to Spanish conquest, foretold the fate of other areas: the Arawak population decreased from as many as 400000 in 1496 to 125 in 1570.5 Every new encounter brought new epidemics.Smallpox, measles, influenza, and malaria (and possibly hepatitis, plague, chickenpox, and diphtheria) spread into Mexico and Peru during the 16th century, New France and New England during the 17th century, and throughout North America and the Pacific islands during the 18th and 19th centuries.

Populations often decreased by more than 90% during the first century after contact.As recently as the 1940s and 1960s, new highways and new missionaries brought pathogens to previously isolated tribes in Alaska and Amazonia.6 News of the devastation reached Europe rapidly.In 1516, Peter Martyr condemned Spanish brutality but acknowledged that many Indians died from “newe and straunge diseases.” The combined impact of abuse and disease was horrifying: “They were once rekened to bee above twelve hundreth thousande heades: But what they are nowe, I abhorre to rehearse.

”7 The English first encountered such mortality during their early efforts to colonize North Carolina and Maine.In 1585, Thomas Hariot witnessed epidemics among the Roanok: wherever the English visited, “the people began to die very fast.”8 In 1616, Richard Vines wintered with the Pemaquid in Maine.The local tribes “were sore afflicted with the Plague, for that the Country was in a manner left void of inhabitants.”9 Although its diagnosis remains unclear (smallpox? chicken pox? hepatitis?), the epidemic decimated the coast from Maine to Cape Cod and allowed colonists to move into abandoned Indian villages.

10 Another epidemic, likely smallpox, struck in 1633.11 Wherever the English went, they saw evidence of mortality.According to William Bradford, the victims “not being able to bury one another, their skulls and bones were found in many places lying still above the ground where their houses and dwellings had been, a very sad spectacle to behold.” Bradford estimated overall mortality at 95%.13 The mortality was not completely one-sided.Half of the Ply-mouth colonists died during the first winter.14 Of 6000 colonists sent to Jamestown between 1607 and 1624, only 1200 remained in 1625.15 Despite their own mortality, explorers and colonists marveled at disparities in disease susceptibility.When they remained healthy while the Roanok succumbed, the English wondered whether they should credit the odd epidemic to a recent comet, an eclipse, or a “speciall woorke of God for our sakes.

”16 Although Vines and his crew shared winter cabins with the dying Pemaquid, “(blessed be GOD for it) not one of them ever felt their heads to ake.

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”17 When English colonists nursed American Indians suffering from smallpox in Connecticut in 1633, “by the marvelous goodness and providence of God, not one of the English was so much as sick.”18 By the late 17th century, it was clear that Indian and European populations had followed different trajectories.While the English thrived, northeastern Indians declined, victims of disease, displacement, and warfare of Quebec, the dissertation juxtaposes these proposals with the traditions of dispute   You have always the biggest and best part of my heart, and my   William's War opens in the British North. American colonies. Records indicate a Kahnawake alliance with the French, which was articulated only minimally in practice. 1744..While the English thrived, northeastern Indians declined, victims of disease, displacement, and warfare.

19 As a New York missionary described in 1705, “the English here are a very thriving growing people, and ye Indians quite otherwise, they wast away & have done ever since our first arrival among them (as they themselves say) like Snow agt.

”20 COLONIAL PRECEDENTS The mortality amazed European colonists Get custom writing help construction trades thesis proposal for me Business Sophomore A4 (British/European) 9 days.”20 COLONIAL PRECEDENTS The mortality amazed European colonists.Their responses illustrate many themes that occurred repeatedly as Europeans, and then Americans, witnessed the ongoing health problems among American Indians.As already seen, providential explanations came quickly to Puritan minds best websites to write college general studies coursework Vancouver American double spaced.As already seen, providential explanations came quickly to Puritan minds.John Winthrop, for example, wrote that “Gods hand hath so pursued them, as for 300 miles space, the greatest parte of them are swept awaye by the small poxe.

”21 But providence coexisted with many natural explanations.Although disparities in health status eventually contributed to the formation of modern ideas of racial difference, the colonists did not initially see any intrinsic differences between English and Indian bodies.22 Philip Vincent, a leader of the English forces during the Pequot War, concluded that “we had the same matter, the same mold.Only art and grace have given us that perfection which yet they want, but may perhaps be as capable thereof as we.”23 Believing that English and Indian bodies shared the same vulnerabilities, colonists often explained Indian epidemics in the same ways that they explained their own diseases.

The environment could support both health and disease, with cold winters causing aches and congestions and hot summers bringing fevers and fluxes.William Wood observed that when the Massachusett changed “their bare Indian commons for the plenty of England’s fuller diet, it is so contrary to their stomachs that death or a desperate sickness immediately accrues, which makes so few of them desirous to see England.”24 During these initial years of encounter between colonists and American Indians, providential and natural explanations appeared side by side.

Early modern writers experienced a world in which all events had natural and spiritual causes simultaneously.This synergy of meaning and mechanism provided solace in a bewildering world, reassuring colonists that everything happened according to God’s will.However, the different explanations often existed in tension.When fleeing Massachusett conspirators died in 1623, their leader, Ianough, feared that “the God of the English was offended with them, and would destroy them in his anger.

” Edward Winslow had a more practical explanation: “Through fear they set little or no corn, which is the staff of life, and without which they cannot long preserve health and strength.

”25 Daniel Gookin described similar debates about the deaths of Indian students at Harvard College.Some “attributed it unto the great change upon their bodies, in respect of their diet, lodging, apparel, studies; so much different from what they were inured to among their own countrymen.” Others saw the deaths as “severe dispensations of God,” either because “God was not pleased yet to make use of any of the Indians to preach the gospel” or because Satan “did use all his strategems and endeavors to impede the spreading of the christian faith.”26 In these cases, the colonists did not find integrated synergy of providence and natural mechanism.Instead, they struggled to choose between them.

These debates make a crucial point: providential explanation was not simply the reflexive response of God-fearing colonists.Rather, colonial writers considered many different explanations: providence, environment, nutrition, behavior, and physical differences.Thus, they could emphasize the most meaningful or useful explanations.Their choices reflected local economic and political pressures.English leaders, for instance, had to justify their right to settle lands already inhabited by American Indians.

King James I cited the epidemic-induced depopulation: “Those large and goodly Territoryes, deserted as it were by their naturall Inhabitants, should be possessed and enjoyed by such of our Subjects and People.”27 Many of Winthrop’s most forceful statements of providential interpretation occurred when he argued in favor of English colonization.He believed smallpox “cleered our title to this place.”28 After all, “if God were not pleased with our inheriting these parts, why did he drive out the natives before us? And why dothe he still make roome for us, by deminishinge them as we increace?”29 The English used disparities in health status to convince themselves that their mission in America was righteous.The English were not alone in trying to turn the epidemic disparities to political advantage.

Many Indian groups, at least according to their English chroniclers, were quick to see potential benefits.When the English did not succumb to epidemics that devastated the Roanok, Ensenore and other local elders concluded that the English controlled disease.Hoping to exploit this power, they asked the English to unleash the disease against their tribal enemies.30 Hobbamock, a counselor to Wampanoag Chief Massasoit, made a similar request of the Plymouth colonists: “Being at varience with another Sachem borderinge upon his Territories, he came in solemne manner and intreated the Governour, that he would let out the plague to destroy the Sachem, and his men who were his enemies.”31 Hobbamock and Ensenore hoped that English control over disease would make them powerful allies.

Some Indians also used the disparities in intratribal politics.Squanto, who learned to speak English when he was kidnapped by English explorers in 1614, realized that he could become an influential translator and mediator when the Plymouth colonists arrived in 1620.Believing that his position would be stronger if the Wampanoag feared the English, he manipulated the tribe’s fear of disease.He told Hobbamock that the English stored plague in barrels, which they “could send forth to what place or people we would, and destroy them therewith, though we stirred not from home.” When Hobbamock confronted the English about this, Squanto’s ruse was exposed.

32 In some cases, American Indians engaged Europeans in debates about the etiologies of epidemics.The Jesuits, for instance, introduced smallpox and other ill-defined fevers when they arrived in Quebec in 1625.The Huron asked the Jesuits “why so many of them died, saying that since the coming of the French their nation was going to destruction.

”33 The Jesuits, like the English, attributed the epidemics to a range of factors, including the hardship of Huron lives, Huron religious practices, and contagion.The Huron, who were suspicious of French intent, feared that the French “had a secret understanding with the disease” and could spread disease by a “crafty demon” concealed in a musket, “bewitched” cloaks, or poisoned water.34 Although the French denied Huron allegations of deliberate infection, they did admit their culpability for the epidemics.As Hierosme Lalemant wrote, “Where we were most welcome, where we baptized most people, there it was in fact where they died the most.”35 Within this first generation of colonization in North America, both Indians and Europeans struggled to understand the devastation.

Their responses echoed their own perspectives and interests.SMALLPOX AND THE MORAL LIFE As European settlers moved into the North American interior, each new encounter triggered a new wave of epidemic decimation.Smallpox struck again and again throughout the 17th and 18th centuries.It reached the northwestern plains by the 1780s and the Pacific Northwest by 1802.36 A particularly virulent outbreak struck the upper Missouri valley in 1837.

It afflicted the tribes “with terror never before known, and has converted the extensive hunting grounds, as well as the peaceful settlements of those tribes, into desolate and boundless cemeteries.” Between 10 000 and 150 000 Sioux, Mandan, Blackfeet, Arikara, and Assiniboine died.Abandoned villages covered the plains: “No sounds but the croaking of the raven and the howling of the wolf interrupt the fearful silence.

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”37 Although smallpox dominates the accounts of Indian mortality, observers also described alcoholism, syphilis, and many other fevers and fluxes.Fur traders, soldiers, missionaries, and settlers followed their ancestors’ lead and offered a range of explanations for the American Indians’ susceptibility to smallpox.

Although less prevalent, providence persisted This thesis sets out to interpret Sherman Alexie's Indian Killer, Reservation Blues and. Flight in the   Homi K. Bhabha, I have chosen the concept of ―hybridization‖ and ―Third Space‖ as tropes that help me   account for the racial and cultural hybridity of Native American identity, Sherman Alexie is among the few that  .Although less prevalent, providence persisted.

In 1764, Thomas Hutchinson abandoned his usual skepticism of Puritan mythology: “Our ancestors supposed an immediate interposition of providence in the great mortality among the Indians to make room for the settlement of the English.I am not inclined to credulity, but should not we go into the contrary extreme if we were to take no notice of the extinction of this people in all parts of the continent Resurrecting the Peace Separate Justice and nbsp LSE Theses Online.I am not inclined to credulity, but should not we go into the contrary extreme if we were to take no notice of the extinction of this people in all parts of the continent.”38 Most observers, however, emphasized destructive Indian behaviors: indifference to cleanliness, foreign diets, reckless use of sweat baths, and the “vicious and dissolute life” caused by alcohol.

39 According to George Catlin, these factors, and not “some extraordinary constitutional susceptibility,” explained the smallpox mortality nbd-dhofar.com/coursework/how-to-purchase-a-college-general-studies-coursework-sophomore-proofreading-business-100-plagiarism-free.

39 According to George Catlin, these factors, and not “some extraordinary constitutional susceptibility,” explained the smallpox mortality.

40 Amid the diversity of potential explanations, the emphasis on behavior played a useful role.Although less overtly theological than providential explanations, behavioral theories had clear moral utility: disease became a tool of moral exhortation.According to missionaries, if vice brought disease to American Indians, then acceptance of Christian morality and lifestyles would bring them health.These arguments targeted White audiences as well.It was, after all, Whites who had introduced American Indians to alcohol and other sinful behaviors.

Catlin warned his readers that the legacy of White influence on Indian populations, “an unrequited account of sin and injustice,” would haunt all Americans on judgment day.When an Ioway delegation visited London during the 1840s, an English minister demanded that the Ioway acknowledge smallpox as divine punishment.Their war chief had a quick reply: “If the Great Spirit sent the small pox into our country to destroy us, we believe it was to punish us for listening to the false promises of white men.It is a white man’s disease, and no doubt it was sent among White people to punish them for their sins.

”42 TUBERCULOSIS, EXTINCTION, AND THE CIVILIZING PROCESS Into the early 19th century, many European and American observers dismissed Catlin’s concerns and argued that American Indians had brought mortality on themselves.This position became increasingly untenable during the 19th century.As contact between White and American Indian societies increased, it became obvious that federal policies adversely affected Indian health.The reservation system, which was imposed between the 1830s and the 1870s, transformed patterns of morbidity and mortality.Smallpox, measles, cholera, malaria, venereal diseases, and alcoholism remained common but were reportedly mitigated by government physicians with vaccination, fumigation, and quarantine.

43 These problems, however, were dwarfed by tuberculosis.Consumption and scrofula had been present but rare among American Indians for centuries.44 They quickly became the leading cause of death, especially on the Dakota reservations, where they dominated annual mortality reports, often causing half of all deaths.Daniel believed that “it is practically the only disease that causes their large death rate.”46 Although the burden of disease had shifted from acute to chronic infections, the disparities persisted.The surgeon general reported that the consumption hospitalization rate for Indian soldiers in 1892 was more than 10 times the rate for White soldiers.47 Sioux mortality from tuberculosis alone exceeded the mortality rates from all causes in most major cities.48 Observers had little difficulty explaining the prevalence of tuberculosis among the Sioux.

Many blamed the reservation system and the terrible living conditions imposed on the confined tribes.Damp, poorly ventilated log cabins and inadequate government rations set the tribes up for disaster.However, as had happened before, they also were quick to blame the Sioux for specific behaviors, from unhygienic cooking to religious dances, pipe smoking, and cigarettes that made bad conditions worse.Chapman stated these punitive sentiments most clearly: “The excessive mortality is but the sum total of all these influences combined—is the measure of their transgressions.”50 A broad consensus accepted these problems as the proximate causes of Sioux tuberculosis.The crucial debates of the late 19th century instead confronted the ultimate causes of the disparities in health status, specifically the roles of racial differences and socioeconomic conditions.Ideas of racial hierarchy were firmly entrenched in the national consciousness.Influential works, such as Josiah Nott and George Gliddon’s Types of Mankind, argued that although American Indians had once thrived in America, they could neither compete nor coexist with “Caucasians”: “It is as clear as the sun at noon-day, that in a few generations more the last of these Red men will be numbered with the dead.

”51 Some doctors saw these theories as compelling explanations for the disparities in mortality.Daniel believed that Indians could only be saved by mixing with other groups: they will “die everywhere they go, of tuberculosis, until the race is so thoroughly crossed by ‘foreign blood’ that it will stamp out the tubercle bacillus, and when that is done the Indian race in its original purity will be no more.”52 For those who believed that extinction was inevitable, the reservation system became little more than palliative care for a dying race.53 Other observers rejected these pessimistic visions and argued that the outbreak of tuberculosis was not the inevitable result of hereditary inferiority.Rather, it was the contingent product of the difficult transition from primitive life to civilization.

Physicians who observed the Sioux before and after their confinement saw how quickly the native health of the Sioux deteriorated.George Bushnell, for example, observed Sioux prisoners who were brought to live among Sioux already settled on a reservation in 1881.He described “scrofulous youths from the Agency, their fleshless limbs fully clad, looking on wistfully at the dances of the warriors in the summer twilight … revealing in many instances a magnificent physique and a boundless vitality, which contrasted cruelly with the listless aspect of some of their spectators.”54 Although they knew that reservations had fueled tuberculosis, many physicians and officials maintained their faith in the fundamental value of civilization.Tuberculosis existed not because the civilizing process was wrong but because it had been implemented badly.

Indians were “reduced to the condition of paupers, without food, shelter, clothing, or any of those necessaries of life which came from the buffalo; and without friends, except the harpies, who, under the guise of friendship, feed upon them.”55 The government had to intervene: “We have no right to assume that they are a race given over to God to destruction, and we have less right to doom them ourselves.”56 Health would be restored when the government enabled the Indians to enjoy the full benefits of White civilization.PERSISTENT DISPARITIES Faith that civilization would eventually bring health to the American Indians prevailed in the debate about the ultimate causes of tuberculosis.

Some government officials committed themselves to improving reservations through education, economic reform, and health care.

However, their paternalistic policies, which were based on the assumed superiority of White culture and religion, rarely led to improvement and often made matters worse.Medical campaigns, for example, suffered from inadequate funding.Morgan compared the salaries paid to government physicians in the Army, Navy, and IHS and divided these sums by the populations served.

He then calculated a crude estimate of how the government valued people: $21.57 The enthusiasm of the Progressive era brought new interest and new funding to the problem of Indian tuberculosis.

During the International Congress on Tuberculosis in 1908, Commissioner of Indian Affairs Francis E.Leupp identified tuberculosis as “the greatest single menace to the Indian race.”58 President William Taft committed the government to new action.Congress responded in 1912 with an emergency appropriation of $12000.The Bureau of Indian Affairs (BIA) organized campaigns against tuberculosis, trachoma, infant mortality, house flies, alcoholism, and tooth decay.

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59 Annual appropriations grew steadily and reached $350000 by 1917.That year, for the first time in more than 50 years, more Indians were born than died.Physician George Kober celebrated the progress: “Thanks to the progress of medical science and the splendid humanitarian efforts of our Government, a noble race of people has been snatched from the very jaws of death The health status of American Indians/Alaska Natives lags behind that of the US population. American Indian/Alaska Native (AIAN) nurses are on the front lines of health services for AIAN people. They have the potential to make scientific contributions as well, but are under-represented among researchers working to  .Physician George Kober celebrated the progress: “Thanks to the progress of medical science and the splendid humanitarian efforts of our Government, a noble race of people has been snatched from the very jaws of death.

”60 The 1921 Snyder Act strengthened the mandate for government action, and congressional appropriations continued to grow: $596000 in 1925, $2980000 in 1935, $5730000 in 1945, and $17800000 in 1955.Tuberculosis mortality in 1925 was 87/100000 among the general population, 603/100000 among Indians overall, and 1510/100000 among Arizona Indians operations of the Navajo Project, a cooperative research program of the U.S. National Park Service; the School of. American Research; and the Museum of New Mexico. This project is concerned with the salvage of all archaeological materials endangered by the construction of the Navajo. Dam on the San Juan River in  .Tuberculosis mortality in 1925 was 87/100000 among the general population, 603/100000 among Indians overall, and 1510/100000 among Arizona Indians.62 During World War II, between 10% and 25% of Navajo soldiers and workers had to be returned to the reservation because of active tuberculosis operations of the Navajo Project, a cooperative research program of the U.S. National Park Service; the School of. American Research; and the Museum of New Mexico. This project is concerned with the salvage of all archaeological materials endangered by the construction of the Navajo. Dam on the San Juan River in  .62 During World War II, between 10% and 25% of Navajo soldiers and workers had to be returned to the reservation because of active tuberculosis.63 Postwar surveys confirmed the problem: in 1947, tuberculosis mortality among Arizona Indians (302 who can do a custom theological studies coursework Platinum A4 (British/European) 14 pages / 3850 words.63 Postwar surveys confirmed the problem: in 1947, tuberculosis mortality among Arizona Indians (302.4/100000) dwarfed both the rate among Indians in general (200/100000) and the national population (30/100000).64 The problem was not confined to tuberculosis.

Incidence among the Navajo exceeded that of the general population by a factor of 15.65 The Navajo also had the country’s highest infant mortality rate.66 Explanations for the persistent tuberculosis disparities followed the framework of the late 19th century.

Environmental theories were common; the new challenge was to explain how tuberculosis could thrive in the arid southwest, where the climate was recommended for many convalescing White patients.Physicians who were still critical of American Indian cultures found much to blame in Navajo living conditions: “Benefits to health from an outdoor life are over-balanced by the ill effects of overcrowding, lack of sanitary provisions, and the poverty which leads to a poor, inadequate supply of food.”67 They moved easily from blaming the conditions of poverty to emphasizing behaviors that the Navajo adopted while living in those conditions.Both the healthy and the sick expectorated freely without disinfecting their sputum.The Navajo ate meals irregularly and prepared food poorly.

Intemperance, apathy, indolence, and hopelessness all weakened the people.As physician Sydney Tillim complained, they lacked “intelligence in all things medical.”68 The Navajo expressed both interest and skepticism in these explanations.When Manuelito Begay, a prominent medicine man and a member of the Navajo Tribal Council, saw a microscope slide of the tubercle bacillus, he was impressed but not convinced of its relevance: “They tell me that it is inflicted by a person coughing in your face—that is the way you get tuberculosis in your system.

A person should not be that weak to be susceptible to a man’s cough.”69 Other Navajo also scoffed at medical explanations of tuberculosis.One woman argued that if infected sputum sowed tuberculosis within Navajo homes, then chickens, which constantly pecked at the infected dirt floors, should have been devastated by the disease.70 White doctors shared Begay’s puzzlement about the specific causes of Navajo susceptibility.

Ill-defined genetic explanations remained popular.In 1923, the New Mexico State Department of Health went so far as to assert an ongoing process of natural selection: “Resistant race has not been bred as yet.Now undergoing process of weeding out the nonresistant strains.”71 Genetic explanations were used just as easily to explain the surprisingly low incidence of noninfectious diseases among the Navajo, including hypertension, cancer, heart disease, and baldness.

72 Most doctors, however, rejected genetic determinism.

The National Tuberculosis Association argued in 1923 that “tuberculosis attacks without any racial preference.”73 Studies found that “the character of tuberculous lesions, as determined roentgenologically, is not significantly different from that observed among the white population.”74 Although the reservations clearly suffered severely from tuberculosis, “identical” epidemics existed among populations “living under like conditions among people of the White and Yellow races.”75 These writers believed that socioeconomic conditions, when severe enough, could destroy the health of any population.FIGHTING POVERTY WITH MEDICAL TECHNOLOGY The different explanations had clear implications for American Indian health policy.

Whereas New Mexico officials seemed content to allow natural selection to solve the tuberculosis problem, most government officials accepted the causal role of economic nondevelopment and believed that health could only come from improvements in socioeconomic conditions.This became especially clear when a postwar economic recession struck the Navajo and Hopi reservations.Congressional investigators were shocked by what they found: “So long as the Navajos remain on the barren wasteland on which they live, without communities, roads, water, sanitation, or the opportunity to earn a living wage, they must continue to live in squalor and disease.”76 Congress responded in 1950 with a $90 000 000 program for the long-range rehabilitation of the Navajo and Hopi.77 This intensive program for the Navajo and Hopi reservations paralleled postwar political interest in international economic development.

In each case, policymakers believed that the disparities in health status between developed and developing populations arose from disparities in socioeconomic conditions.Improved health could be achieved most fundamentally by economic development.Although economic development remained the ultimate goal, health officials realized that it could not be achieved easily or quickly enough.They wanted to find ways to improve the health of underdeveloped populations living in rural poverty.One clear problem, which was highlighted in a 1950 American Medical Association report, was the inadequacy of existing health services on the reservations.

78 Annie Wauneka, who led the health committee of the Navajo Tribal Council, agreed during her testimony to Congress: “We think there is no real health program.If there is, we haven’t heard about it or seen it.”79 Emboldened by postwar optimism and by faith in new technologies, such as penicillin, isoniazid, and DDT, health officials believed that they would be able to improve health conditions, even in the absence of economic changes.Walsh McDermott’s “Health Care Experiment at Many Farms” put this question to the test.

80 After choosing a remote area of the Navajo Reservation, McDermott’s team of doctors, anthropologists, and social scientists worked closely with Wauneka and other Navajo leaders to reduce morbidity and mortality in the absence of socioeconomic reforms.They found that their treatment programs controlled tuberculosis but had little impact on the other leading causes of morbidity and mortality, especially childhood diarrhea and pneumonia.These failures surprised the researchers: “When one considers our pre-experiment expectations, soundly grounded in the conventional wisdom, these results were clearly disappointing.”81 Entrenched disparities in health status did not yield easily to medical technology.McDermott’s work was part of a broader effort to reform health care on the reservations.

Frustrated by the continuing failures of the BIA to relieve health disparities, Congress moved the medical services from the BIA to the Public Health Service, thus creating the Indian Health Service in 1955.82 The IHS conducted an initial health survey and found wide disparities in health status and health services between Indians and the general population.Among American Indians, total mortality was 20% higher, infant mortality was 3 times higher, life expectancy was 10 years lower, and infectious diseases and accidents were more prevalent; however, heart disease and cancer were less common.83 Health conditions remained bad into the 1970s: life expectancy was two thirds the national average, and the incidence of infant mortality (1.5 times), diabetes (2 times), suicide (3 times), accidents (4 times), tuberculosis (14 times), gastrointestinal infections (27 times), dysentery (40 times), and rheumatic fever (60 times) also were above the national average.

As a result, the Navajo Tribal Council articulated a new vision of Indian health self-determination and attempted to build its own medical school: “The day will arrive when a more effective health-care delivery system utilizing Indian professionals will replace the current system.The day will arrive when the American Indian will determine what his own health standards and services should be.”84 For Wauneka, the “paramount objective” was clear: “The care by Indians of our peoples’ health.

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”85 The Navajo did not succeed in obtaining funding to establish an independent medical school.However, the IHS steadily increased the participation and the leadership of Indian health professionals within the IHS.

It continued to combat health disparities, and by 1989, it claimed great success, arguing that its efforts since 1955 had reduced tuberculosis by 96%, infant mortality by 92%, pulmonary infections by 92%, and gastrointestinal infections by 93% RESUMES and COVER LETTERS Harvard Office of Career Services.It continued to combat health disparities, and by 1989, it claimed great success, arguing that its efforts since 1955 had reduced tuberculosis by 96%, infant mortality by 92%, pulmonary infections by 92%, and gastrointestinal infections by 93%.

Although parity with the general population had not been achieved, the gap had been narrowed.86 However, as they have done for centuries, the disparities survived.IHS data from the late 1990s showed higher mortality rates among American Indians and Alaskan Natives compared with the general population for most leading causes of mortality: heart disease (1 Tracing Diff rance UiO DUO.IHS data from the late 1990s showed higher mortality rates among American Indians and Alaskan Natives compared with the general population for most leading causes of mortality: heart disease (1.Only with cancer, the second leading cause of death, was American Indian mortality not greater than that of the general population.Furthermore, these disparities all widened between 1995 and 1998.87 Congress and the IHS continue to work to improve conditions on the reservations.The 1975 Indian Self-Determination and Indian Assistance Act (Public Law 93-638) and the 1976 Indian Health Care Improvement Act renewed the government’s commitment to Indian health and gave the tribes more control over their health care services.

88 Working with an annual budget of nearly $3000000000, the IHS now provides services to 1.

89 However, as has been true since the 19th century, per capita expenditures remain far below those in the general population: $1351 for Indians compared with $3766 for the general population overall.90 Casinos have brought wealth to a small number of tribes, but Indian gaming could prove to be catastrophic for Indian health if public perception of American Indians as gambling moguls dissolves the obligation felt by Congress to provide care for them.91 CONCLUSIONS Disparities in health status between American Indians and Europeans and Americans have been recognized for 5 centuries.Many observers have felt that the existence of disparities is fundamentally wrong.

Such moral outrage has motivated centuries of attempts to relieve them.How have disparities been able to persist? How have they been allowed to persist? Several things are clear.First, there are striking patterns in attempts to account for the distribution of health and disease.Explanations have spanned a remarkable range of possible etiologies, including religion, diet, living conditions, climate, cultural practices, racial differences, and socioeconomic status.No single explanation has defined the phenomena of disease so clearly that other explanations have been precluded.

Many of the explanations have persisted throughout the centuries, although their specific details and meanings have changed.Invocations of providence, for example, gave way to genetic determinism as the most common argument for inevitable disparity.Emphasis has also shifted, with religious explanations dominating initially but then giving way to behavioral, genetic, and socioeconomic explanations.Such a trajectory, however, is only a coarse approximation.Far more striking has been the persistence of the diversity of explanations over time.

Second, the enduring existence of an abundance of possible explanations has allowed observers to emphasize the most meaningful or useful understandings of disease.Needing land, colonists saw Massachusett depopulation as a gift of land.Wanting absolution for the destruction of Indian societies, federal officials saw Sioux tuberculosis as proof of Indians’ inevitable demise.These choices could have been constrained by the plausibility of different explanations.Instead, persistent inadequacies in health data for American Indians have often prevented the establishment of clear consensus about the etiology of diseases and disparities.

This has allowed observers to exercise considerable discretion in their assessments and has opened a large window for ideology to influence health data, theories, and policies.Third, choices about explanations have reflected observers’ attitudes about a fundamental question: where should responsibility for disparities be assigned? Although some observers blamed personal choices, others argued that Indian diseases were the product of the disrupted social conditions of colonization., victims of genetic susceptibility) or the healthy (e.

, misguided architects of the reservation system), or it can be transferred to an outside authority (e.These assignments have crucial implications for health policy.

Health disparities have been seen as proof of a natural order that can be exploited for observers’ benefit, and they have been seen as markers of social injustice that observers must remedy.The shifting balance between these ideological poles contributed to the enormous heterogeneity of past federal Indian health policies.Furthermore, because disparities in health status parallel disparities in wealth and power, responses necessarily involve decisions to deploy or withhold economic and political resources.Policy makers have had to balance Indian health with other priorities and obligations of the federal government, including land acquisition, military needs, resource development, or questions about Indian sovereignty.The tensions about responsibility and appropriate response appear in current debates about the genetics of health disparities.

Researchers have proposed that American Indians have genetic susceptibilities to many diseases, from alcoholism to virgin-soil epidemics or Pima diabetes.92 Despite this active research, genetic causes were notably absent from a recent IHS report: “Lower life expectancy and the disproportionate disease burden exist perhaps because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences.”93 What generates the controversy surrounding genetic theories of health disparities? By focusing on biological origins, genetic theories naturalize disparities and reduce the shame and stigma associated with behavioral or cultural explanations.By introducing an aura of inevitability, genetic arguments reduce the obligation to intervene and prevent or reduce disparities.

More practical concerns also contribute.Current interest in molecular genetics makes research into the genetics of disparities a safe bet for researchers in need of grants and publications.In contrast, genetic explanations can be a dead end for policymakers, especially when compared with the many interventions suggested by explanations that emphasize socioeconomic conditions or access to health care.94 Debates about the genetic origins of health disparities raise 1 last question.Empowered by the Human Genome Project, researchers hope to find genes for every disease and disparity.

However, as more and more genetic links are proposed for American Indian ill health, the overall argument becomes harder to sustain.Disparities among American Indians have existed whether the prevailing diseases were acute infections (e., smallpox and measles), chronic infections (e.

, tuberculosis), or the endemic ailments of modern society (e., heart disease, diabetes, alcoholism, and depression).Recent trends suggest that disparities in cancer might also emerge.Is it conceivable that American Indians have genetic vulnerabilities to every class of human disease? The existence of disparities regardless of the underlying disease environment is actually a powerful argument against the belief that disparities reflect inherent susceptibilities of American Indian populations.

Instead, the disparities in health status could arise from the disparities in wealth and power that have endured since colonization.95 Such awareness must guide ongoing research and interventions if the disparities in health status between American Indians and the general population are ever to be eradicated.​ A House-call on the Navajo Reservation.As part of its effort to improve health services for American Indians in the 1950s, the Public Health Service funded a series of innovative health care projects.In one project, based at Many Farms, Arizona, physicians, .

Research Careers for American Indian/Alaska Native Nurses: Pathway to Elimination of Health Disparities Susan J.

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Henly and Roxanne Struthers are with the School of Nursing, University of Minnesota, Minneapolis.Dahlen and Bette Ide are with the University of North Dakota College of Nursing, Grand Forks.Beverly Patchell is with the Indian Nursing Student Success Program at the University of Oklahoma College of Nursing, Oklahoma City Professional dissertation proposal writing sites Allstar Construction.

Beverly Patchell is with the Indian Nursing Student Success Program at the University of Oklahoma College of Nursing, Oklahoma City.

Barbara Holtz-claw is with the Bridge Project, University of Minnesota, Minneapolis.Requests for reprints should be sent to Susan J.Henly, School of Nursing, University of Minnesota, 5-160 WDH, 308 Harvard St.SE, Minneapolis, MN, 55455 (e-mail: @300ylneh).This article has been cited by other articles in PMC.

Abstract The health status of American Indians/Alaska Natives lags behind that of the US population.American Indian/Alaska Native (AIAN) nurses are on the front lines of health services for AIAN people.They have the potential to make scientific contributions as well, but are under-represented among researchers working to understand health disparities.The AIAN MS-to-PhD Nursing Science Bridge, at the University of Minnesota, in partnership with the Universities of North Dakota and Oklahoma, provides support for AIAN nurses during the critical training transition from masters of science to doctoral programs.Partner schools collaborate with AIAN elders, medicine people/spiritual leaders, and academic consultants to (1) foster academic success and strengthen the AIAN identity of students during their research training and (2) bring about institutional change to optimize student experiences.

Future research programs developed by this cadre of AIAN nurse scientists will contribute scientifically sound, culturally acceptable knowledge to effectively improve the health of AIAN people.IN SHARP CONTRAST TO THE US population as a whole, the American Indian/Alaska Native (AIAN) population is characterized by shortened life spans more typical of preindustrial developing countries.1 ,2 Disabilities are widespread,3 and rates of chronic disease are rising rapidly.1 Prevention and treatment concerns, intertwined with elevated unemployment rates and low income, are complex.1 Disparities in access to education and educational achievement4 contribute to and complicate the resolution of health disparities.

The United States has committed to the Healthy People 2010 goal of eliminating health disparities among minority and ethnic populations, including American Indians/Alaska Natives in 6 areas: infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV infection/AIDS, and immunization.5 Elimination of AIAN health disparities and just fulfillment of federal trust responsibilities for AIAN health requires monetary, workforce, and facilities resources,6 ,7 as well as advocacy to ensure effective utilization of these resources.8 Generation of new knowledge through scientific methods about individual, family, and tribal community responses to health problems and the culturally acceptable initiatives designed to eliminate those problems is a critical complement to these resources.9 Nurse researchers are well positioned to discover and develop this needed new knowledge to be used across the range of health services and in the public health arena.Nurses form the largest group of health professionals in nearly all settings, including public health, and are recognized as the “backbone of the IHS Indian Health Service health care team” that provides services to approximately 1.

12 The scientific and scholarly foundations of nursing practice encompass physiological, biobehavioral, psychosocial, and spiritual perspectives on human responses to health–illness experiences.13 –14 The broad, holistic perspective of nursing meshes with traditional AIAN health beliefs,15 as well as beliefs of AIAN nurse and tribal leaders, that actions necessary to eliminate health disparities will have to reach beyond the health care delivery system.9 Since 2001, the AIAN MS-to-PhD Nursing Science Bridge, funded by the National Institute of General Medical Sciences (NIGMS), has been educating AIAN nurses whose scientific training is focused on development and dissemination of knowledge and utilization of research findings to eliminate health disparities.This program prepares a scientific workforce poised to perform culturally congruent research in AIAN communities.

When the project began, approximately 12 AIAN nurses held doctoral-level degrees.The goal of the Bridge project is to correct this grave underrepresentation of AIAN nurses in science.Through its work, the overall number of nurse scientists is projected to double by 2011.We describe here federal scientific workforce policy as it pertains to the AIAN Nursing Science Bridge.We outline the structure, processes, and outcomes of the project and explain how the Bridge is a pathway to the elimination of health disparities among AIAN people.

BRIDGES TO THE FUTURE The project is part of the Bridges to the Future Program,17 1 piece of a larger mosaic of programs at the National Institutes of Health (NIH) designed to increase the number of minority scientists and to improve the health of minority communities.The criterion for success for the Bridges program, set forth in its mission statement, is the creation of a cadre of students from underrepresented minority groups who, instead of receiving terminal masters degrees, see new opportunities for careers as scientists, with their ambitions supported by the highest possible quality of research and training.18 All bridges to the doctorate in the NIH Bridges to the Future program involve partnerships between at least 2 institutions, one of which offers the MS as the highest degree and another that awards doctoral degrees in 1 or more areas of science related to the NIH mission.Project activities vary, but all are designed to support successful MS-to-PhD transitions.

Currently, NIGMS funds approximately 25 projects involving approximately 120 students from underrepresented minority groups at approximately 75 institutions.

Since inception of the Bridges to the Future Program in 1993, more than 250 MS students have been funded, 72 have begun doctoral study, and 12 have earned PhDs in a biomedical or health science.18 The AIAN Nursing Science Bridge is unique among bridges to the doctorate because it focuses on research training for AIAN nurse scientists.The project, based at the University of Minnesota School of Nursing, was initiated in partnership with the University of North Dakota College of Nursing (2001–2004) and is continuing with the University of Oklahoma College of Nursing (2003–2007).All 3 schools are located in states where many American Indians reside.The University of Minnesota was positioned to begin this work by virtue of a longstanding, high-quality PhD program in nursing science, 3 American Indian faculty members, and a research portfolio that emphasizes AIAN health.

Both MS partner schools are home to funded programs to support BSN and MS students in nursing.19 The Recruitment and Retention of Native Americans into Nursing (RAIN) programs, based at the University of North Dakota, is one of the Quentin Burdeck Indian Health Programs funded by the Indian Health Care Improvement Act of 1992.University of Oklahoma is home to the Indian Nursing Student Success Program (INSSP), funded as an IHS Section 112 initiative.Sustained success of AIAN students enrolled in BS and MS programs at partner schools reflects the institutional commitment to AIAN nursing education embodied in these projects.Specific aims of the AIAN Nursing Science Bridge Project are to (1) provide research assistantships to MS students, (2) build research capacity at MS partner schools, (3) ensure culturally informed advisement at the doctoral level, (4) collaborate with AIAN communities in all phases of project implementation, and (5) foster academic success and enhance the AIAN identity of students who, upon earning the PhD in nursing science, are ready to launch research careers focused on elimination of AIAN health disparities.

The bridge project structure designed to support achievement of these aims is pictured in Figure 1 ▶.The “bridge” has 2 cultural abutments: academic and cultural.It is suspended by 6 activities that support students, partner schools, and AIAN communities: faculty development, linked recruitment, dual advisement and mentorship, research participation, research dissemination and utilization with guidance of elders and medicine people or spiritual leaders, and a bicultural project retreat.The project supports the MS-to-PhD transition, as students “cross the bridge” from a science-based undergraduate professional degree to a doctorate and a research career.JOURNEY TO SCIENCE BSN graduates at MS partner schools comprise the initial pool of students for the MS-to-PhD Bridge.However, any AIAN nurse with a BSN degree enrolled in the partner school MS program is eligible to apply for a Bridge-supported research assistantship.Interest in a research career and ability to articulate the framework of a future program of research are essential selection criteria.To date, all participating students have outlined scientific trajectories aimed at eliminating AIAN health disparities.Currently, the 8 AIAN nurses participating in the Bridge represent 7 tribes.

Six of the 8 students are enrolled tribal members, 2 have AIAN heritage by descent, and all are women.Most students began their post–high school education at community or tribal colleges.As a group, they are older than average students.Although research methods and research utilization are standard elements of the BSN curriculum in nursing, none had seriously considered a research career until a RAIN, INSSP, or Bridge staff or faculty had suggested it.

Students are motivated to improve themselves and advance their education to serve American Indians/Alaska Natives.Recommendations included with applications to the program describe students as bright, self-directed, and mature.

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Applicants are characterized as determined, dependable, and diligent, with a commitment to goals they set for themselves.As a group, they are characterized as possessing positive outlooks, bearing compassion, and having a passion for their work.All of these attributes are needed for graduate school success and for a research career developed in collaboration with AIAN communities and health systems Best website to buy a college thesis proposal construction trades 6 hours double spaced Premium British.

All of these attributes are needed for graduate school success and for a research career developed in collaboration with AIAN communities and health systems.

Fostering Academic Success Bridge students are assigned advisors from both the MS and PhD school.The system of joint advisement facilitates continuity over the course of both degree programs.PhD faculty advisors and Bridge staff guide students through the application process for the doctoral program, including encouragement for completion of the Graduate Record Examinations requirement ISR Process GE Healthcare Research Services Sample Customer Service Resume Ghostbusters Authors of a new study propose a strict ban on medical ghostwriting Best custom essay. Construction research proposal sample. Management Roles and Principles. research proposal mla format term paper proposal example  .PhD faculty advisors and Bridge staff guide students through the application process for the doctoral program, including encouragement for completion of the Graduate Record Examinations requirement.In addition to the coursework and projects required for the MS degree, Bridge scholars complete a mentored research assistantship with faculty or community-based investigators engaged in AIAN health disparities research.The Bridge program funds the assistantships nbd-dhofar.com/homework/how-to-get-an-economics-homework-writing-from-scratch-us-letter-size-single-spaced-100-plagiarism-free.

The Bridge program funds the assistantships.

Because students earn a salary for work completed, there is no service payback associated with participation.Project funding of the assistantships provides an incentive for faculty participation because it complements their research budgets or provides an assistant when funding is limited or unavailable (for pilot projects, for example).Most Bridge scholar–mentored research and projects are in priority areas related to the elimination of AIAN health disparities.Projects focus on the scourges of diabetes and its complications, especially renal complications and lower extremity amputation.Projects address health experiences across the lifespan range from prevention of fetal alcohol syndrome to exercise in school-aged children to health experiences and health service needs of elders.

Other projects focus on caring for caregivers of people with dementia and attitudes of nursing students toward persons with disabilities.All students are making timely progress toward degree completion.Three students have transitioned to doctoral study and secured funding.Two students were awarded Graduate School Diversity of Views and Experiences Fellowships in a university-wide competition at the University of Minnesota, and 1 student was awarded a prestigious Hartford Geriatric Nurse Fellowship.20 Enhancing Cultural Identity Cultural conflict continues to be part of the higher education experience of many AIAN students.

The process of completing a doctoral degree conflicts with many AIAN values, such as present-time focus, patience, respect, family, harmony with nature, and circular thinking.21 A huge deterrent for AIAN people enrolling in a university is the loss of AIAN identity.Despite an emphasis on diversity and a goal of cultural competence for graduates, the content and process of nursing education programs tend to be built on and emphasize mainstream values.22 ,23 In this climate, retention and progression are challenging.

For example, AIAN students enrolled in one MS program reported conflicts between AIAN and academic values and feeling isolated from other students.

24 ,25 Students reported that differences in worldviews, rigid academic environments, barriers to effective faculty–student relationships, and the need to develop personal strategies for goal attainment were all part of their graduate school experiences.Upon graduation, American Indian MS students participating in this study reported feeling changed as individuals and often questioned the degree to which the content they had learned would apply to their cultural settings.Faculty also reported significant challenges working with AIAN students.26 A desire for uniformity in the availability to all students and the maintenance of academic and professional standards tended to override efforts to provide individualized, culturally relevant instruction and advisement to AIAN students.For these reasons, Bridge project components were developed to support development of culturally competent advisors.

Native worldviews and experiences were incorporated into a program of faculty development guided by tribal elders, medicine people, and spiritual leaders and were implemented in both academic and AIAN settings.CULTURAL GUIDANCE Indigenous knowledge is fostered and maintained by tribal elders.27 To guide project efforts, tribal elders participate in a consultative role.They assist faculty, staff, and students with the following: (1) distinguishing, maintaining, and fostering cultural traditions, values, and knowledge; (2) encouraging students to proceed with an advanced education and identifying barriers and solutions to overcome obstacles; (3) assisting with the integrity and dignity of the program from an AIAN perspective by teaching and guiding faculty and staff; (4) facilitating ceremonies and rituals as appropriate; and (5) reviewing and recommending plans for recruitment and program evaluation and improvement.Obtaining an advanced research degree is a critical component of scientist development.

However, another goal is holistic health for Bridge scholars whose sense of AIAN identity is enhanced, not sabotaged, by their educational and professional aspirations.Medicine people and spiritual leaders help their clients preserve and nourish a balanced, healthy life-way.28 ,29 We thought that a healthy foundation would enhance the well-being and holistic energy and synergy of the group as well, as they encountered the everyday trials, challenges, and rewards of working on this project.To provide this base, medicine people and spiritual leaders serve as project consultants.Connections with elders and medicine people or spiritual leaders were made in a variety of ways.

The project director invited participants of an urban AIAN elder service providers group to take part.Three individuals subsequently created the programming for a Grandfathers and Grandmothers Supporting Indian Nurse Scholars group.One grandmother continued her participation with a part-time appointment that combines clerical and receptionist, student support, and community liaison activities.Her duties include welcoming and supporting students when they cross over to the doctoral program.Medicine people and spiritual leaders were already working with the University of Oklahoma, were friends of faculty, or were informally nominated by their tribal community.

The family of 1 AIAN academic consultant stepped forward to participate.AIAN academicians provide intertribal and national perspectives.Nurse scientists and student services professionals experienced in supporting AIAN students in high-stakes, competitive academic environments are represented in the consultant group.As a group, the AIAN consultants were part of an earlier wave of students who successfully negotiated the higher education system in relative isolation and then thrived in their careers, even as they maintained their AIAN heritage and identities.They serve as role models to Bridge scholars simply by their presence and in the telling of their personal stories.

They actively advise students to partake of the academic and AIAN worlds to foster academic success and to enhance AIAN identity.The AIAN Nursing Science Bridge holds an annual retreat to bring students, faculty, staff, medicine people and spiritual leaders, elders, and AIAN consultants together.Past retreats have been held at the conference center, tribal offices, and tribal college of the White Earth Band of Chippewa Indians in Mahnomen, Minn.Future retreats are planned in Oklahoma.For AIAN participants, the retreat is a chance to return to the comforts and ways of home.

For non-AIAN faculty and staff, the retreat is a cultural immersion experience that introduces and expands knowledge and understanding of their AIAN students’ life experiences and aspirations as nurse scientists.The project director develops the formal retreat agenda in consultation with others on the project.Medicine people and spiritual leaders use traditional ceremonies and prayers to conduct the retreat.Elders remind everyone to use their AIAN manners.They begin Talking Circles to facilitate acquaintance among Bridge participants and to center each participant’s presence.

Bridge scholars, faculty, and staff become learners as elders teach about traditional ways, describing health, child rearing, and educational experiences; food (rabbit snares, pemmican); ceremonial materials ( knicinik); and handcrafts (especially sewing).Discussion of educational and research topics proceeds in the AIAN-centered, AIAN-surrounded retreat atmosphere, the essence of which will then be carried back to the academic world.Project evaluation data, collected annually or at the conclusion of the retreat, provide some insights into the impact of cultural guidance activities.Deliberate inclusion of enhanced cultural understanding as a goal for everyone involved in the project was identified as a strong feature of the retreat.

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Participants rated activities with medicine people and spiritual leaders (smudging, prayer, individual consultation), AIAN academic consultants (presentation and advisement), and tribal elders (stories, crafts, presence, and guidance) at the retreat and in other settings as “helpful” or “very helpful.

” Faculty and administrators felt that involvement of the community showed a serious commitment to the success of the program.They reported that, with each retreat, they felt a greater depth of understanding and more connection with the AIAN community GRADUATE COLLEGE. As members of the Dissertation Committee, we certify that we have read the dissertation   submission of the final copies of the dissertation to the Graduate College. I hereby certify that I have read   Jadwiga Pieper Mooney in guiding my work in Latin American history and for serving on my doctoral  .They reported that, with each retreat, they felt a greater depth of understanding and more connection with the AIAN community.

Spontaneous interactions and a relaxed atmosphere contributed to memorable and useful experiences.Elders expressed appreciation and gratitude for being included in the project Lake Tribal College ƒ Walter Kawamoto, Ph.D., Family and Consumer Sciences. Department, College of Social Sciences and Interdisciplinary. Studies, California   American Indian and Alaska Native (AI-AN) children, however, have not always been the direct beneficiaries of knowledge gained through research because..Elders expressed appreciation and gratitude for being included in the project.The daughter of one elder (who had never had the opportunity to attend school) said that participation was her mother’s opportunity to shine as she encouraged Bridge scholars in their educational efforts.

The retreat was originally planned as a faculty development activity.Students suggested that they also take part.They were eager for the cultural connectedness that the activity provided, as well as the opportunity to meet faculty and staff from all project schools.Students identified personal guidance and encouragement from the AIAN community, collaboration in development of their research projects, and advisement about the doctoral program application as especially beneficial.

TEACHING–LEARNING SETTINGS The formal research training for Bridge scholars takes place in the classrooms, clinical facilities, and laboratories of participating universities.

The project works at both MS and PhD partner schools to ensure rigorous research training for Bridge scholars in an optimal learning environment.Research During the MS Program At MS partner schools, the goal is to enhance research capacity.Schools with the MS as the highest degree tend to be less research intensive.The institutional goal of enhancing research capacity is designed to ensure that Bridge scholars obtain early research experience that positions them for competitive doctoral program applications.The research strength of the PhD school is used as the springboard to enhance research capacity at the MS school.

Research partnerships among faculty at MS and PhD schools are the key to development of enhanced capacity.A senior nurse scientist serves as liaison between researchers at partnership schools.The nurse facilitates research partnerships by assisting MS partner faculty to articulate programs of research, connect with established researchers at the doctor institution, and use research infrastructure at the doctoral university that is available to him or her.Faculty research interests and accomplishments at partner schools are linked by work on common projects as opportunities for collaboration arise or are developed.Because of the research priorities at both schools and their proximity to AIAN communities, many partnerships focus on health disparities research.

As the research partnerships mature, they will serve as ideal sites for mentored student research.In addition, student research experiences include a structured program focused on acquisition and refinement of skills for clinical science.These include use of literature search tools and bibliographic management systems, facility with data management and statistical analysis programs, and policy and procedure for working with human participants in research.Research activities are discussed at the retreat with medicine people and spiritual leaders, elders, and AIAN consultants.Specific areas of investigation are approached from the points of view of the scientific community and the received knowledge held by AIAN people.

In this way, the rigor of science is combined with traditional understanding to produce integrated perspectives on the health problems under investigation.Doctoral Advisement The number of nurses with earned doctoral degrees is so small that few schools have any experience guiding AIAN students through the PhD process.This is true even for faculty whose research programs are focused on health disparities.AIAN faculty have personal experience with doctoral education, but very few have advised other AIAN students to doctoral degree completion.For these reasons, the goal at the PhD school is to prepare faculty for informed and effective doctoral advisement of Bridge scholars.

Successful guidance and advisement of AIAN students at the MS schools is the strength of this initiative.RAIN, INSSP, and AIAN consultants make formal presentations at the retreat to share the wisdom that they have gained through experience working with students.Faculty from the PhD school become personally acquainted with RAIN and INSSP staff to facilitate direct links to informed consultation about issues related to Bridge scholar progression.Faculty and administrators in key positions at the PhD school (e., Director of Graduate Studies, member of the Doctoral Admissions Committee) take part in project activities.The Bridge then becomes a means to engage the doctoral faculty as a whole in the education of future AIAN nurse scientists.The circle of involvement is extended by the presence and activities of elders at the PhD school.In individual and small group settings, they have provided a personal perspective on the historic experience of AIAN people in educational and health spheres.Elders review and comment on Indian education and health news relevant to Indian nurse scientist training that is printed in tribal and national Native newspapers and other sources.

With these efforts, Bridge scholars proceed in their scientific training in an academic milieu informed by and supportive of their career aspirations.Visions for Research Programs Students articulate an idea for their research programs as part of the Bridge application, and then initiate those ideas as part of their graduate school careers.Programs of study for the MS and PhD degrees, the Bridge research assistantship, and participation in professional and scientific societies provide foundational knowledge and skills.A common element of the envisioned research programs is a desire to generate new knowledge that can be used to eliminate health disparities among AIAN people.Specific areas of research are diabetes and elder health.

Diabetes research programs range from an interest in primary prevention at individual and community levels (e., obesity prevention) to treatment of complications (e.Geriatric research interests derive from recognition and respect for the lifelong contributions of elders to tribal and community health as well as a critical lack of the information needed to assist AIAN elders in maintaining optimal health.A CADRE OF AIAN NURSE SCIENTISTS AIAN people are underrepresented in the ranks of health scientists.The lack of presence is especially acute among nurse scientists, whose work has the potential to impact disparities at the individual, family, community, and population levels.The AIAN Nursing Science Bridge is a concerted, deliberate effort to significantly and efficiently increase the number of AIAN nurse scientists.Bridge activities optimize the training experience by strengthening the academic setting at MS and PhD levels and integrating the academic and AIAN worlds.

After 4 years, 8 of the 12 students needed to double the size of the cadre of nurse scientists are making steady progress toward that goal and degree completion.Continued funding through 2007 will support additional students and ongoing collaboration with AIAN communities at both MS and PhD schools.As Bridge scholars complete their degrees, they will be positioned for leadership in the implementation of research programs aimed at eliminating AIAN health disparities.Acknowledgments The work described here was supported by the National Institute of General Medical Sciences (R25GM63249-01 and R25GM63249-02).

Contributions and support from the administration, faculty, and staff of partnership schools are acknowledged with appreciation.

With great sadness, we report that Roxanne Struthers died on December 10, 2005.Her work and example continue to motivate and inform our efforts.With respect and honor, we thank the elders, medicine people, and spiritual leaders, and the academic consultants who have guided our work.Human Participant Protection Notes Contributors S.

Henly drafted the article and coordinated contributions of other authors.

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Struthers proposed the activities for tribal community involvement.Dahlen served as academic consultant and facilitated elder participation.

Ide was site coordinator at the University of North Dakota, and B How to get an thesis proposal construction trades professional double spaced American Rewriting Premium.Ide was site coordinator at the University of North Dakota, and B.

Patchell was site coordinator at University of Oklahoma College of Nursing.All authors reviewed and commented on the article and participated in creation of the past presentations, proposals, and project reports on which it is based Best website to write thesis proposal construction trades Platinum 24 pages / 6600 words Business American.All authors reviewed and commented on the article and participated in creation of the past presentations, proposals, and project reports on which it is based.Department of Health and Human Services.Rockville, Md: Indian Health Service, Division of Program Statistics; 2004.

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