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Pleasant Dreams

Pleasant Dreams is the sixth studio album by the American punk rock band Ramones, released on July 20, 1981, through Sire Records. While the band members wanted Steve Lillywhite to produce, Sire chose Graham Gouldman in an attempt to gain popularity through a well-known producer. The recording process brought about many conflicts between band members, most notably the strife between Joey Ramone and Johnny Ramone, due to Johnny starting a relationship with Joey's girlfriend. There were also disputes about the overall direction of the album, with Johnny leaning towards hard rock and Joey towards pop punk. Ultimately, the album incorporated high production values and varying musical styles, straying from traditional punk rock on songs such as "We Want the Airwaves", "She's a Sensation" and "Come On Now". It is the first Ramones album not to feature any cover songs.

Despite Sire's efforts to broaden the band's appeal by enlisting Gouldman to produce, the album was not commercially successful, peaking at #58 on the Billboard 200 and only charting outside of the US in Sweden. The album also met with mixed critical reception.

Conception
The writing process for Pleasant Dreams began in January 1981. With Sire Records management being insistent on allowing a celebrity record producer to work on the album, they hired Graham Gouldman—songwriter and musician for the British band 10cc—to produce the album. Prior to working with Gouldman, the Ramones had recorded demos for the album with audio engineer Ed Stasium, and while the band had intended for Steve Lillywhite to produce the album, this decision was rejected by Sire. The studio recording process began on March 30, 1981, and initiated several conflicts between band members. This tension was partially due to Dee Dee Ramone's drug addiction, as well as Marky Ramone and Joey Ramone developing problems with alcohol, resulting in the frustration of Johnny Ramone. These conflicts and differences became evident in the songwriting as, for the first time on a Ramones album, each song was now credited to individual members rather than multiple members.

The time period of recording was a high-point in musical style for both Joey and Johnny, though they directed their sound towards different styles of music: Joey's inspiration from pop music became evident in his writing, while Johnny's keenness of hard-rock guitar riffs are apparent in much of his performing on the album. Johnny thought that this did not result well for the band's sound, saying: "I knew going in that this was not going to be the type of album I wanted. It really could have used another two of three punk songs ... All I want to do is keep our fans happy and not sell out. I'm fighting within the band. They are trying to go lighter, looking for ways to be more commercial. I'm against the band for doing that." Joey countered by explaining: "By Road to Ruin [and] End of the Century, I was doing the majority of the songwriting. I started feeling that the Ramones were faceless; there were no individual identities in the band." Joey went on to say that, while this method had worked well in the beginning of their career, it began to annoy him, since "everything [he] wrote, the band would take credit for."

Even though he expressed dissatisfaction with the album, working with Graham Gouldman, Johnny admitted, "was easy—he was always a gentleman. He changed a lot of the songs: "Here's a nice chord for the bridge, you should be playing a minor chord instead of a major chord," things like that." Gouldman also had ideas for vocal harmonies, guitar overdubs, and melodic basslines. If he suggested a guitar part, it had to sound like it came from Johnny, "or he wouldn't play it," Gouldman said. Gouldman also revealed that there were certain tracks he actually played guitar on. "I'd show [Johnny] and he'd say, "You play it," but I had to play very restrictive, nothing fancy at all." He went on to say that there wasn't much work to do with the songs. "We changed arrangements slightly, but it was basic stuff, like, "Let's put an end on this song rather than fade it, let's double up on the chorus at the end." Dee Dee recalled that "Graham really produced. He put something into the album, some harmony ideas."

During early stages of the album's development, Joey was dating Linda Daniele. After the album was released, however, Daniele left Joey and became Johnny's girlfriend. Ramones' road manager Monte Melnick relates: "Joey was devastated. It affected him deeply. Johnny knew it was bad and kept Linda totally hidden from that point on. She didn't come to many shows and if she did he'd hide her in the back; she wouldn't come backstage. He'd run out to meet her and leave as soon as they were done." While Johnny would eventually marry Linda, Joey held a strong grudge against them both, and, though they continued to perform and tour together, the two rarely talked to each other. Joey explained that Johnny had "crossed the line" once he started dating Daniele, and noted that "he destroyed the relationship and the band right there". Johnny defended himself by stating that had Daniele not left Joey for him, "he wouldn't have even been talking about her and saying how much he loved her because he wouldn't have been obsessed about it."

Composition and lyrics
The album opens with "We Want the Airwaves", which has instrumentation that strays from traditional punk rock and more towards hard rock. Music journalist Chuck Eddy described the song as "a sort of Black Sabbath punk rock". Record World described "We Want the Airwaves" as a "brash rocker" that "[avoids] any subtlety." Though it was long rumored that the album's third track, "The KKK Took My Baby Away", was written about Johnny stealing Joey's girlfriend,  the song was reportedly written some time before Joey had found out about this. Joey's brother Mickey Leigh relates: "The fluky connection between Johnny and the KKK raised a specter that keeps friends and fans speculating to this day. At the time, though, it had to be an unusual situation for him being that, as often happens with song lyrics, his words now took on a whole new meaning." The following track, "Don't Go", was described in Musician, Player, and Listener as "Spector-ish", likening the song's production values to those of music producer Phil Spector, the infamous producer of the band's previous record, End of the Century. According to the magazine, the lyrics detail "an archivist's sense of young love by the book and how innocent rock 'n' roll is supposed to sound." Everett True, author of Hey Ho Let's Go: The Story of the Ramones (2005), explains that the album's fifth track, Dee Dee's "You Sound Like You're Sick", "returns to the bassist's traditional institutionalised theme." Side A ends with "It's Not My Place (In the 9 to 5 World)", which was described by music critic David Fricke as "driven home" by drummer Marky's "feisty, Bo Diddley-style" drum beat, noting that it borrows the middle eight (of thirty-two-bar form) from the Who song "Whiskey Man".

Side B of the album begins with "She's a Sensation", which was said by author Dave Thompson to have a 1960s melody which "melts through the hard rock". The next song, "7-11", deals with dating at a young age, where the couple goes on dates to places like convenience stores and record swaps. The lyrics follow a boy who meets a girl by a Space Invaders arcade machine, who eventually has to let her go after she dies in a car crash. True relates: "You can lose your heart within the singer's torched '7-11'. Joey details in time-honoured girl group fashion the beauty of young love that takes place among the most mundane, humdrum of surroundings." "You Didn't Mean Anything to Me", written by Dee Dee, reflects the desolation and vacillation that the bassist was feeling in his personal life, as well as within the band. This is evident through lines like "Every dinner was crummy/Even the ones for free." The pop-oriented song "Come On Now" was described by True as a "sparkling rush of blood to the head from the 'comic book boy'," with True adding that it was comparable to songs by The Dave Clark Five and 1910 Fruitgum Company. The eleventh track on the album, "This Business Is Killing Me", was written by Joey about how everyone expects him to please others but how he simply cannot please everyone all the time. Pleasant Dreams concludes with "Sitting in My Room", which David Fricke quoted in the conclusion of his review of the album, saying: "'It's us against them,' sneers Joey ... 'They just wanna worry ... /They just wanna be so lame/Maybe they should try and sniff some glue.' Or put Pleasant Dreams on the box and crank it up to ten."

Reception
Released on July 20, 1981, the album was not commercially successful, failing to spawn a single hit. Though Sire Records had merged with Warner Bros. Records, none of the singles from Pleasant Dreams were released in the US. Sire had insisted that the album be produced by a celebrity producer, hiring Graham Gouldman to the job expecting this to help expand the band's fan base. Joey relates: "The record company told us the album would bomb if we didn't use Graham Gouldman, so we worked with Graham--and the album bombed anyway." The album would only chart in the US and Sweden, peaking at 58 on the Billboard 200 and 35 on the Sverigetopplistan chart, with the singles released from the album failing to chart.

Pleasant Dreams received mixed reviews from critics, with many pointing out that the high quality sound production made the band stray from their roots even more so than the change in style. Stephen Thomas Erlewine, senior editor for AllMusic, noted that Gouldman steers the band's style away from "bubblegum, British invasion, and surf fetishes" and toward "acid rock and heavy metal". He went on to say that the sound quality was "too clean to qualify as punk" and that the music on the album had "lost sight of the infectious qualities that made their earlier records such fun". The Spin Alternative Record Guide panned the "halfhearted metal moves."

Music critic Robert Christgau said that the album "comes off corny" compared to the band's first four releases, which he described as "aural rush and conceptual punch". While he felt that the songs featured on the album were better than those on End of the Century, he claimed the album was "less focused" compared to Leave Home, but "fun anyway". David Fricke of Rolling Stone began his review by writing "Pity the poor Ramones", and went on to give it a mixed review of four out of five stars. He stated that the Ramones are a “comic relief,” not shrinking away from real life. Fricke noted "studio sleight of hand: fortified vocal harmonies, an occasional dash of keyboards, a certain production gimmickry. But the ironically titled Pleasant Dreams is actually the Ramones‘ state-of-the-union message, an impassioned display of irrepressible optimism and high-amp defiance laced with bitterness over what they see as corporate sabotage of their rock & roll fantasies.“

The New York Times concluded that "the Ramones have made a record that sounds like a New York version of the Beach Boys... The tempos are considerably faster, but so is life in the big city." The Boston Globe praised Gouldman's "intelligent, balanced production, in contrast with Phil Spector's stultifying barrier of sound on the band's last album."

Track listing
Track listing adapted from AllMusic.

 * Note
 * Tracks 13–19 are previously unissued.

Pleasant Dreams (New York Mixes) - 2023

Recording information
Four tracks from the Pleasant Dreams recording sessions have subsequently been re-recorded: "All's Quiet on the Eastern Front" on Dee Dee Ramone's 1994 solo album I Hate Freaks Like You; "Come On Now" on Dee Dee Ramone's 2000 solo album Greatest & Latest; "I Can't Get You Out of My Mind" (as "Can't Get You Outta My Mind") on the 1989 Ramones album Brain Drain; "Touring" on the 1992 Ramones album Mondo Bizarro.
 * Tracks 1–14: basic tracks recorded at Mediasound, New York City, March–April 1981. Keyboards, percussion, backing vocals, and most of Joey Ramone's vocals were recorded at 10cc's Strawberry Studios in Stockport and Dorking, England, April 1981.
 * Track 15: recording information unknown.
 * Tracks 16–19: recorded at Daily Planet Studios, New York City, January–February 1981. Produced by Ed Stasium.

Personnel
Ramones
 * Joey Ramone – lead vocals and backing vocals
 * Johnny Ramone – electric guitar and backing vocals
 * Dee Dee Ramone – bass, lead vocals (track 18) and backing vocals
 * Marky Ramone – drum and backing vocals

Additional musicians
 * Vic Emerson – synthesizers
 * Dave Hassell – percussion
 * Graham Gouldman – rhythm guitar and backing vocals
 * Russell Mael – backing vocals
 * Ian Wilson – backing vocals
 * Debbie Harry – backing vocals (track 15)
 * Kate Pierson – backing vocals (track 15)
 * Cindy Wilson – backing vocals (track 15)

Production
 * Graham Gouldman – producer
 * Lincoln Y. Clapp – engineer (Mediasound)
 * Harvey Goldberg – engineer (Mediasound)
 * Chris Nagle – engineer (Strawberry North)
 * Keith Bessey – engineer, mixing (Strawberry South)
 * Harry Spiridakis – assistant engineer (Mediasound)
 * Andy Hoffman – assistant engineer (Mediasound)
 * John Dixon – assistant engineer (Strawberry North)
 * Mark Cockburn – assistant engineer (Strawberry North)
 * Steve Cooksey – assistant engineer (Strawberry South)
 * Melvyn Abrahams – mastering
 * Michael Somoroff – photos
 * M & Co. – design
 * Guy Juke – uncredited cover art

title: Pleasant Dreams


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Roberto Raschi

Roberto Raschi (born 11 August 1964) was Captain Regent of San Marino.

He was in office with Giuseppe Arzilli during the six-month term from 1 October 2004 to 1 April 2005.

He is a member of the San Marinese Socialist Party.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Roberto Raschi


text:
User:Numerousfalx

Numerousfalx

I am an Army veteran who believes that I am enlightened to the basic human condition and I am politicaly conservative and fiscally responsible. I believe that the world could be made a better place and that goodness and evil does exist. I am spiritual without being religious as I believe that a persons spiritualality is their own business.

title: User:Numerousfalx


text: File:Lollywood Billboards - Prince Cinema Budha Bigra Jaye Billboard.JPG


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Fabio Berardi

Fabio Berardi (born 26 May 1959 in Borgo Maggiore, San Marino) is a Sammarinese politician.

He served as a Captain Regent of San Marino from April 2001 until October 2001 and from October 2016 to April 2017. From October 2001 until December 2003, he served as Secretary of State for Planning, Environment and Agriculture. From January 2004 until July 2006 he served as the minister of foreign and political affairs of San Marino until he was succeeded on 27 July by Fiorenzo Stolfi. From July 2006, he was minister of public health until September 2008. Since December 2008, he has served as Secretary of State for Tourism, Sports, Economic Planning and Relations.

Berardi was a member of the Sammarinese Socialist Party and its successor the Party of Socialists and Democrats until September 2008 when he and another member, Nadia Ottaviani, splintered off to form a new party, Arengo and Freedom, which he now leads.

title: Fabio Berardi


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Little Round Top

Little Round Top is the smaller of two rocky hills south of Gettysburg, Pennsylvania—the companion to the adjacent, taller hill named Big Round Top. It was the site of an unsuccessful assault by Confederate troops against the Union left flank on July 2, 1863, the second day of the Battle of Gettysburg, during the American Civil War.

Little Round Top was successfully defended by a brigade under Colonel Strong Vincent, who was mortally wounded during the fighting and died five days later. The 20th Maine Volunteer Infantry Regiment, commanded by Colonel Joshua Lawrence Chamberlain, fought its most famous engagement there, culminating in a dramatic downhill bayonet charge. The battle at Little Round Top subsequently became one of the most well-known actions at Gettysburg, and of the entire war.

Geography
Little Round Top is a large diabase spur of Big Round Top with an oval crest that forms a short ridgeline with a summit of 63 ft prominence above the saddle point to Big Round Top to the south. It is located in Cumberland Township, approximately two miles (3 km) south of Gettysburg, with a rugged, steep slope rising 150 ft above nearby Plum Run to the west and strewn with large boulders. The summit is a total of 650 ft above sea level. Historically, the western slope was generally free of vegetation, while the summit and eastern and southern slopes were lightly wooded. Directly to the south is Big Round Top, 130 ft higher and densely wooded.

The igneous landform was created 200 million years ago when the "outcrop of the Gettysburg sill" intruded through the Triassic "Gettysburg plain". Subsequent periglacial frost wedging during the Pleistocene formed the hill's extensive boulders.

There is no evidence that the name "Little Round Top" was used by soldiers or civilians during the battle, although Col. Franklin A. Haskell, writing to his brother on July 16, 1863, calls it so. Although the larger hill was known before the battle as Round Top, Round Top Mountain, and sometimes Round Hill, accounts written in 1863 referred to the smaller hill with a variety of names: Rock Hill, High Knob, Sugar Loaf Hill, Broad Top Summit, and granite spur of Round Top. Historian John B. Bachelder, who had an enormous influence on the preservation of the Gettysburg battlefield, personally favored the name "Weed's Hill", in honor of Brigadier General Stephen H. Weed, who was mortally wounded on Little Round Top. Bachelder abandoned that name by 1873. One of the first public uses of "Little Round Top" was by Edward Everett in his oration at the dedication of the Soldiers' National Cemetery on November 19, 1863.

Battle of Gettysburg
On the second day of the Battle of Gettysburg, July 2, 1863, at about 4 PM, Confederate Lt. Gen. James Longstreet's First Corps began an attack ordered by General Robert E. Lee that was intended to drive northeast up the Emmitsburg Road in the direction of Cemetery Hill, rolling up the Union left flank. Maj. Gen. John Bell Hood's division was assigned to attack up the eastern side of the road, Maj. Gen. Lafayette McLaws's division the western side. Hood's division stepped off first, but instead of guiding on the road, elements began to swing directly to the east in the direction of the Round Tops. Instead of driving the entire division up the spine of Houck's Ridge (the boulder-strewn area known to the soldiers as the Devil's Den), parts of Hood's division detoured over Round Top and approached the southern slope of Little Round Top.

There were four probable reasons for the deviation in the division's direction: first, regiments from the Union III Corps were unexpectedly in the Devil's Den area and they would threaten Hood's right flank if they were not dealt with; second, fire from the 2nd U.S. Sharpshooters at Slyder's farm drew the attention of lead elements of Brig. Gen. Evander M. Law's brigade, moving in pursuit and drawing his brigade to the right; third, the terrain was rough and units naturally lost their parade-ground alignments; finally, Hood's senior subordinate, General Law, was unaware that Hood had been wounded and he was now in command of the division, so he did not exercise control.

In the meantime, Little Round Top was undefended by Union troops. Maj. Gen. George Meade, commander of the Army of the Potomac, had ordered Maj. Gen. Daniel Sickles' III Corps to defend the southern end of Cemetery Ridge, which would have just included Little Round Top. Sickles, defying Meade's orders, moved his corps a few hundred yards west to the Emmitsburg Road and the Peach Orchard. This caused a large salient in the line, which was also too long to defend properly. His left flank was anchored in Devil's Den.

When Meade discovered this situation, he dispatched his chief engineer, Brig. Gen. Gouverneur K. Warren, to attempt to deal with the situation south of Sickles' position. Climbing Little Round Top, Warren found only a small Signal Corps station there. He saw the glint of bayonets in the sun to the southwest and realized that a Confederate assault into the Union flank was imminent. He hurriedly sent staff officers, including Washington Roebling, to find help from any available units in the vicinity.

The response to this request for help came from Maj. Gen. George Sykes, commander of the Union V Corps. Sykes quickly dispatched a messenger to order his 1st Division, commanded by Brig. Gen. James Barnes, to Little Round Top. Before the messenger could reach Barnes, he encountered Col. Strong Vincent, commander of the 3rd Brigade, who seized the initiative and directed his four regiments to Little Round Top without waiting for permission from Barnes. He and Oliver W. Norton, the brigade bugler, galloped ahead to reconnoiter and guide his four regiments into position.

Upon arrival on Little Round Top, Vincent and Norton received fire from Confederate batteries almost immediately. On the western slope, he placed the 16th Michigan, and then proceeding counterclockwise were the 44th New York, the 83rd Pennsylvania, and finally, at the end of the line on the southern slope, the 20th Maine. Arriving only ten minutes before the Confederates, Vincent ordered his brigade to take cover and wait, and he ordered Col. Joshua Lawrence Chamberlain, commander of the 20th Maine, to hold his position, the extreme left of the Army of the Potomac, at all costs. Chamberlain and his 385 men waited for what was to come.

Battle of Little Round Top
The approaching Confederates were the Alabama Brigade of Hood's Division, commanded by Brig. Gen. Evander M. Law. (As the battle progressed and Law realized he was in command of the division, Col. James L. Sheffield was eventually notified to assume brigade command.) Dispatching the 4th, 15th, and 47th Alabama, and the 4th and 5th Texas to Little Round Top, Law ordered his men to take the hill. The men were exhausted, having marched more than 20 miles (32 km) that day to reach this point. The day was hot and their canteens were empty; Law's order to move out reached them before they could refill their water. Approaching the Union line on the crest of the hill, Law's men were thrown back by the first Union volley and withdrew briefly to regroup. The 15th Alabama, commanded by Col. William C. Oates, repositioned further right and attempted to find the Union left flank.

The left flank consisted of the 386 officers and men of the 20th Maine regiment and the 83rd Pennsylvania. Seeing the Confederates shifting around his flank, Chamberlain first stretched his line to the point where his men were in a single-file line, then ordered the southernmost half of his line to swing back during a lull following another Confederate charge. It was there that they "refused the line"—formed an angle to the main line in an attempt to prevent the Confederate flanking maneuver. Despite heavy losses, the 20th Maine held through two subsequent charges by the 15th Alabama and other Confederate regiments for a total of ninety minutes.

Chamberlain (knowing that his men were out of ammunition, his numbers were being depleted, and his men would not be able to repulse another Confederate charge) ordered his men to equip bayonets and counterattack. He ordered his left flank, which had been pulled back, to advance in a 'right-wheel forward' maneuver. As soon as they were in line with the rest of the regiment, the remainder of the regiment would charge akin to a door swinging shut. This simultaneous frontal assault and flanking maneuver halted and captured a good portion of the 15th Alabama. While Chamberlain ordered the advance, Lieutenant Holman Melcher spontaneously and separate to Chamberlain's command initiated a charge from the center of the line that further aided the regiment's efforts. During their retreat, the Confederates were subjected to a volley of rifle fire from Company B of the 20th Maine, commanded by Captain Walter G. Morrill, and a few of the 2nd U.S. Sharpshooters, who had been placed by Chamberlain behind a stone wall 150 yards to the east, hoping to guard against an envelopment. This group, who had been hidden from sight, caused considerable confusion in the Confederate ranks.

Thirty years later, Chamberlain received a Medal of Honor for his conduct in the defense of Little Round Top. The citation read that it was awarded for "daring heroism and great tenacity in holding his position on the Little Round Top against repeated assaults, and ordering the advance position on the Great Round Top."

Despite this victory, the rest of the Union regiments on the hill were in dire straits. While the Alabamians had pressed their attacks on the Union left, the 4th and 5th Texas were attacking Vincent's 16th Michigan on the Union right. Rallying the crumbling regiment (the smallest in his brigade, with only 263 men) several times, Vincent was mortally wounded during one Texas charge and was succeeded by Colonel James C. Rice. Vincent died on July 7, but not before receiving a deathbed promotion to brigadier general.

Before the Michiganders could be demoralized, reinforcements summoned by Warren—who had continued on to find more troops to defend the hill—had arrived in the form of the 140th New York and a battery of four guns—Battery D, 5th U.S. Artillery, commanded by Lt. Charles E. Hazlett. (Simply maneuvering these guns by hand up the steep and rocky slope of the hill was an amazing achievement. However, this effort had little effect on the action of July 2. The artillerymen were exposed to constant sniper fire and could not work effectively. More significantly, however, they could not depress their barrels sufficiently to defend against incoming infantry attacks.)

The 140th charged into the fray, driving the Texans back and securing victory for the Union forces on the hill. Col. Patrick "Paddy" O'Rorke, who personally led his regiment in the charge, was killed. Reinforced further by Stephen Weed's brigade of the V Corps, Union forces held the hill throughout the rest of the battle, enduring persistent fire from Confederate sharpshooters stationed around Devil's Den. General Weed was among the victims, and as his old friend Charles Hazlett leaned over to comfort Weed, the artilleryman was also shot dead.

Evening and July 3
Later that day, Little Round Top was the site of constant skirmishing. It was fortified by Weed's brigade, five regiments of the Pennsylvania Reserves, and an Ohio battery of six guns. Most of the stone breastworks that are currently visible on the hill were constructed by these troops after the fighting stopped. Troops of the II, V, VI, and XII Corps passed through the area and also occupied Round Top.

Little Round Top was the starting point for a Union counterattack at dusk on July 2, conducted by the 3rd Division of the V Corps (the Pennsylvania Reserves) under Brig. Gen. Samuel W. Crawford, launched to the west in the direction of the Wheatfield.

On July 3, Hazlett's battery (six 10-pounder Parrott rifles, now under the command of Lt. Benjamin F. Rittenhouse) fired into the flank of the Confederate assault known as Pickett's Charge. Near the end of that engagement, General Meade observed from Little Round Top and contemplated his options for a possible counterattack against Lee.

Impact
Of the 2,996 Union troops engaged at Little Round Top, there were 565 casualties (134 killed, 402 wounded, 29 missing); Confederate losses of 4,864 engaged were 1,185 (279 killed, 868 wounded, 219 missing).

While agreeing that the fighting on Little Round Top was extremely fierce and soldiers on both sides fought valiantly, historians disagree as to the impact of this particular engagement on the overall outcome of the Battle of Gettysburg. The traditional view—one that emerged in the 1880s —is that the left flank of the Union Army was a crucial position. An example of this view is from 1900: "If the Confederates had seized [Little Round Top] and dragged some of their artillery up there, as they easily could have done, they would have enfiladed Meade's entire line and made it too unhealthy for him to remain there."

An alternative claim is that the hill's terrain offered a poor platform for artillery, and that had Longstreet secured the hill, the Union Army would have been forced back to a better defensive position, making the attack on the hill a distraction from the Confederates' true objective. This latter theory is supported by General Lee's writings, in which he appears to have considered Little Round Top irrelevant. In Lee's report after the Gettysburg Campaign, he stated in part, "General Longstreet was delayed by a force occupying the high, rocky hills on the enemy's extreme left, from which his troops could be attacked in reverse as they advanced", suggesting Longstreet was ordered on a course intended to bypass Little Round Top—had the hill been a key objective of the assault, Lee would not have used the phrase "delayed by" in describing the effects of the engagement.

Garry Adelman has countered the argument that a Confederate capture of Little Round Top would have badly hurt the Union effort. Examining the number of troops available in the vicinity in the late afternoon, he determined that at most 2,650 Confederates could have been available to defend the hill after capturing it, and that these men would have been exhausted from combat and short on ammunition. In contrast, 11,600 fresh Union reinforcements were available within a mile, primarily from Maj. Gen. John Sedgwick's VI Corps. In addition, the value of Little Round Top as an artillery position has been overstated—the shape of the crest of the hill forces guns to be placed one behind the other, limiting their effectiveness when engaging targets directly to the north, such as the Union line on Cemetery Ridge.

While Chamberlain and the 20th Maine have gained popularity in the American national consciousness, other historical figures such as Strong Vincent, Patrick O'Rourke, and Charles Hazlett arguably played equal roles in the Union success at Little Round Top. Their deaths at the scene, however, did not allow their personal stories to be told.

Postbellum history
During visits by 13 generals in 1865, points were identified on Little Round Top at which markers were subsequently erected, and a 40 ft observatory was built by 1886, before a stone monument with observation deck was dedicated to the 44th New York in 1892. In the late 1880s, the 20th Maine Volunteer Infantry Regiment monument on Little Round Top was dedicated with a speech by Joshua Chamberlain.

In 1935, two "hairpin curves" of the avenue on Little Round Top were removed by the Continental Contracting Company to create a "by-pass, a stretch of .399 mile," from the Round Top Museum southward to north of the guard station on the south slope at Sykes Avenue and Chamberlain Avenue was subsequently closed. The summit parking lot was also created at this time.

In popular culture
The battle for Little Round Top is a key plot point of Ward Moore's 1953 alternate history novel Bring the Jubilee. The 1974 novel The Killer Angels, and its 1993 film adaptation, Gettysburg, depicted a portion of this battle. Filmmaker Ken Burns praised Chamberlain in his PBS documentary The Civil War and in subsequent interviews for possibly saving the Union with his actions during the engagement.

In the 2016 song "Ballad of the 20th of Maine" by Maine folk group The Ghost of Paul Revere, the famous bayonet charge and Andrew Tozier's defiant stand is chronicled: Well, our western flank was missing / As the confederates, they pushed on / And I fought them tooth and nail / Our ammunition all but gone ... And then appeared our Lion, he was roaring bayonets / And we charged on down the mountain with what forces we had left / We're as steadfast as Katahdin, we're as hard as winter's rain / Go straight to hell with your Rebel yell, we are the boys of Maine.

title: Little Round Top


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Domenico Fattori

Domenico Fattori was a Sammarinese politician who was the Secretary for Foreign Affairs of San Marino from 1860 to 1908. Fattori also served as a captain regent of San Marino 12 times between 1857 and 1914, each for the usual six-month terms. He was the Captain Regent with the longest cumulative term (six years).

title: Domenico Fattori


text:
File:Mgs3box.jpg

Metal Gear Solid 3: Snake Eater cover art. Source:

Rationale for the fair use of this image in the article Metal Gear Solid 3: Snake Eater:

 * Konami has not released any such images to the public domain
 * The image is used to identify the subject of the article
 * The image is used to demonstrate the game's distinctive art style
 * The image is being used in an informative way and does not detract from the game
 * The image is web-resolution
 * The image does not limit Konami's ability to sell the game

title: File:Mgs3box.jpg


text: User talk:DoubleCross

title: User talk:DoubleCross


text:
User:Rhobite/Images

These are photographs I've taken and added to Wikipedia. Some of them are from my photoblog and some I took for specific articles here.

title: User:Rhobite/Images


text:
Preventive healthcare

Preventive healthcare, or prophylaxis, is the application of healthcare measures to prevent diseases. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes that begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.

Each year, millions of people die of preventable causes. A 2004 study showed that about half of all deaths in the United States in 2000 were due to preventable behaviors and exposures. Leading causes included cardiovascular disease, chronic respiratory disease, unintentional injuries, diabetes, and certain infectious diseases. This same study estimates that 400,000 people die each year in the United States due to poor diet and a sedentary lifestyle. According to estimates made by the World Health Organization (WHO), about 55 million people died worldwide in 2011, and two-thirds of these died from non-communicable diseases, including cancer, diabetes, and chronic cardiovascular and lung diseases. This is an increase from the year 2000, during which 60% of deaths were attributed to these diseases.

Preventive healthcare is especially important given the worldwide rise in the prevalence of chronic diseases and deaths from these diseases. There are many methods for prevention of disease. One of them is prevention of teenage smoking through information giving. It is recommended that adults and children aim to visit their doctor for regular check-ups, even if they feel healthy, to perform disease screening, identify risk factors for disease, discuss tips for a healthy and balanced lifestyle, stay up to date with immunizations and boosters, and maintain a good relationship with a healthcare provider. In pediatrics, some common examples of primary prevention are encouraging parents to turn down the temperature of their home water heater in order to avoid scalding burns, encouraging children to wear bicycle helmets, and suggesting that people use the air quality index (AQI) to check the level of pollution in the outside air before engaging in sporting activities. Some common disease screenings include checking for hypertension (high blood pressure), hyperglycemia (high blood sugar, a risk factor for diabetes mellitus), hypercholesterolemia (high blood cholesterol), screening for colon cancer, depression, HIV and other common types of sexually transmitted disease such as chlamydia, syphilis, and gonorrhea, mammography (to screen for breast cancer), colorectal cancer screening, a Pap test (to check for cervical cancer), and screening for osteoporosis. Genetic testing can also be performed to screen for mutations that cause genetic disorders or predisposition to certain diseases such as breast or ovarian cancer. However, these measures are not affordable for every individual and the cost effectiveness of preventive healthcare is still a topic of debate.

Overview
Preventive healthcare strategies are described as taking place at the primal, primary, secondary, and tertiary prevention levels. Although advocated as preventive medicine in the early twentieth century by Sara Josephine Baker, in the 1940s, Hugh R. Leavell and E. Gurney Clark coined the term primary prevention. They worked at the Harvard and Columbia University Schools of Public Health, respectively, and later expanded the levels to include secondary and tertiary prevention. Goldston (1987) notes that these levels might be better described as "prevention, treatment, and rehabilitation", although the terms primary, secondary, and tertiary prevention are still in use today. The concept of primal prevention has been created much more recently, in relation to the new developments in molecular biology over the last fifty years, more particularly in epigenetics, which point to the paramount importance of environmental conditions, both physical and affective, on the organism during its fetal and newborn life, or so-called primal period of life.

Primal and primordial preventions
Primal prevention is health promotion par excellence. New knowledge in molecular biology, in particular epigenetics, points to how much affective as well as physical environment during fetal and newborn life may determine adult health. This way of promoting health consists mainly in providing future parents with pertinent, unbiased information on primal health and supporting them during their child's primal period of life (i.e., "from conception to first anniversary" according to definition by the Primal Health Research Centre, London). This includes adequate parental leave, ideally for both parents, with kin caregiving and financial help where needed.

Primordial prevention refers to all measures designed to prevent the development of risk factors in the first place, early in life, and even preconception, as Ruth A. Etzel has described it "all population-level actions and measures that inhibit the emergence and establishment of adverse environmental, economic, and social conditions". This could be reducing air pollution or prohibiting endocrine-disrupting chemicals in food-handling equipment and food contact materials.

Primary prevention
Primary prevention consists of traditional health promotion and "specific protection". Health promotion activities include prevention strategies such as health education and lifestyle medicine, and are current, non-clinical life choices such as eating nutritious meals and exercising often, that prevent lifestyle-related medical conditions, improve the quality of life, and create a sense of overall well-being. Preventing disease and creating overall well-being prolongs life expectancy. Health-promotional activities do not target a specific disease or condition but rather promote health and well-being on a very general level. On the other hand, specific protection targets a type or group of diseases and complements the goals of health promotion.

Food
Food is the most basic tool in preventive health care. Poor nutrition is linked to various chronic illnesses. Because of this, having a healthy diet and proper nutrition can be used to prevent illnesses.

Access
The 2011 National Health Interview Survey performed by the Centers for Disease Control was the first national survey to include questions about ability to pay for food. Difficulty with paying for food, medicine, or both is a problem facing 1 out of 3 Americans. If better food options were available through food banks, soup kitchens, and other resources for low-income people, obesity and the chronic conditions that come along with it would be better controlled. A food desert is an area with restricted access to healthy foods due to a lack of supermarkets within a reasonable distance. These are often low-income neighborhoods with the majority of residents lacking transportation. There have been several grassroots movements since 1995 to encourage urban gardening, using vacant lots to grow food cultivated by local residents. Mobile fresh markets are another resource for residents in a "food desert", which are specially outfitted buses bringing affordable fresh fruits and vegetables to low-income neighborhoods.

Food education and guidance
It has been proposed that healthy longevity diets are included in standard healthcare as switching from a "typical Western diet" could often extend life by a decade.

Protective measures
Specific protective measures such as water purification, sewage treatment, and the development of personal hygienic routines, such as regular hand-washing, safe sex to prevent sexually transmitted infections, became mainstream upon the discovery of infectious disease agents and have decreased the rates of communicable diseases which are spread in unsanitary conditions.

Scientific advancements in genetics have contributed to the knowledge of hereditary diseases and have facilitated progress in specific protective measures in individuals who are carriers of a disease gene or have an increased predisposition to a specific disease. Genetic testing has allowed physicians to make quicker and more accurate diagnoses and has allowed for tailored treatments or personalized medicine.

Food safety has a significant impact on human health and food quality monitoring has increased. Water, including drinking water, is also monitored in many cases for securing health. There also is some monitoring of air pollution. In many cases, environmental standards such as via maximum pollution levels, regulation of chemicals, occupational hygiene requirements or consumer protection regulations establish some protection in combination with the monitoring.

Preventive measures like vaccines and medical screenings are also important. Using PPE properly and getting the recommended vaccines and screenings can help decrease the spread of respiratory diseases, protecting the healthcare workers as well as their patients.

Secondary prevention
Secondary prevention deals with latent diseases and attempts to prevent an asymptomatic disease from progressing to symptomatic disease. Certain diseases can be classified as primary or secondary. This depends on definitions of what constitutes a disease, though, in general, primary prevention addresses the root cause of a disease or injury whereas secondary prevention aims to detect and treat a disease early on. Secondary prevention consists of "early diagnosis and prompt treatment" to contain the disease and prevent its spread to other individuals, and "disability limitation" to prevent potential future complications and disabilities from the disease. Early diagnosis and prompt treatment for a syphilis patient would include a course of antibiotics to destroy the pathogen and screening and treatment of any infants born to syphilitic mothers. Disability limitation for syphilitic patients includes continued check-ups on the heart, cerebrospinal fluid, and central nervous system of patients to curb any damaging effects such as blindness or paralysis.

Tertiary prevention
Finally, tertiary prevention attempts to reduce the damage caused by symptomatic disease by focusing on mental, physical, and social rehabilitation. Unlike secondary prevention, which aims to prevent disability, the objective of tertiary prevention is to maximize the remaining capabilities and functions of an already disabled patient. Goals of tertiary prevention include: preventing pain and damage, halting progression and complications from disease, and restoring the health and functions of the individuals affected by disease. For syphilitic patients, rehabilitation includes measures to prevent complete disability from the disease, such as implementing work-place adjustments for the blind and paralyzed or providing counseling to restore normal daily functions to the greatest extent possible.

The general use of machinery that has adequate ventilation and airflow is suggested for these patients in order to halt progression and complications of disease. A study conducted in nursing homes to prevent diseases concluded that the use of evaporative humidifiers to maintain the indoor humidity within the range 40–60% can reduce respiratory risk. Certain diseases thrive in different humidities, so the use of the humidifiers can help kill the particles of diseases.

United States
The leading preventable cause of death in the United States is tobacco; however, poor diet and lack of exercise may soon surpass tobacco as a leading cause of death. These behaviors are modifiable and public health and prevention efforts could make a difference to reduce these deaths.

Worldwide
The leading causes of preventable death worldwide share similar trends to the United States. There are a few differences between the two, such as malnutrition, pollution, and unsafe sanitation, that reflect health disparities between the developing and developed world.

However, several of the leading causes of death – or underlying contributors to earlier death – may not be included as "preventable" causes of death. A study concluded that pollution was "responsible for approximately 9 million deaths per year" in 2019. And another study concluded that the global mean loss of life expectancy (a measure similar to years of potential life lost) from air pollution in 2015 was 2.9 years, substantially more than, for example, 0.3 years from all forms of direct violence, albeit a significant fraction of the LLE is considered to be unavoidable (such as pollution from some natural wildfires).

A landmark study conducted by the World Health Organization and the International Labour Organization found that exposure to long working hours is the occupational risk factor with the largest attributable burden of disease, i.e. an estimated 745,000 fatalities from ischemic heart disease and stroke events in 2016. With this study, prevention of exposure to long working hours has emerged as a priority for prevention healthcare in workplace settings.

Child mortality
In 2010, 7.6 million children died before reaching the age of 5. While this is a decrease from 9.6 million in 2000, it was still far from the fourth Millennium Development Goal to decrease child mortality by two-thirds by 2015. Of these deaths, about 64% were due to infection including diarrhea, pneumonia, and malaria. About 40% of these deaths occurred in neonates (children ages 1–28 days) due to pre-term birth complications. The highest number of child deaths occurred in Africa and Southeast Asia. As of 2015 in Africa, almost no progress has been made in reducing neonatal death since 1990. In 2010, India, Nigeria, Democratic Republic of the Congo, Pakistan, and China contributed to almost 50% of global child deaths. Targeting efforts in these countries is essential to reducing the global child death rate.

Child mortality is caused by factors including poverty, environmental hazards, and lack of maternal education. In 2003, the World Health Organization created a list of interventions in the following table that were judged economically and operationally "feasible," based on the healthcare resources and infrastructure in 42 nations that contribute to 90% of all infant and child deaths. The table indicates how many infant and child deaths could have been prevented in 2000, assuming universal healthcare coverage.

Obesity
Obesity is a major risk factor for a wide variety of conditions including cardiovascular diseases, hypertension, certain cancers, and type 2 diabetes. In order to prevent obesity, it is recommended that individuals adhere to a consistent exercise regimen as well as a nutritious and balanced diet. A healthy individual should aim for acquiring 10% of their energy from proteins, 15-20% from fat, and over 50% from complex carbohydrates, while avoiding alcohol as well as foods high in fat, salt, and sugar. Sedentary adults should aim for at least half an hour of moderate-level daily physical activity and eventually increase to include at least 20 minutes of intense exercise, three times a week. Preventive health care offers many benefits to those that chose to participate in taking an active role in the culture. The medical system in our society is geared toward curing acute symptoms of disease after the fact that they have brought us into the emergency room. An ongoing epidemic within American culture is the prevalence of obesity. Healthy eating and regular exercise play a significant role in reducing an individual's risk for type 2 diabetes. A 2008 study concluded that about 23.6 million people in the United States had diabetes, including 5.7 million that had not been diagnosed. 90 to 95 percent of people with diabetes have type 2 diabetes. Diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness in American adults.

Sexually transmitted infections
Sexually transmitted infections (STIs), such as syphilis and HIV, are common but preventable with safe-sex practices. STIs can be asymptomatic, or cause a range of symptoms. Preventive measures for STIs are called prophylactics. The term especially applies to the use of condoms, which are highly effective at preventing disease, but also to other devices meant to prevent STIs, such as dental dams and latex gloves. Other means for preventing STIs include education on how to use condoms or other such barrier devices, testing partners before having unprotected sex, receiving regular STI screenings, to both receive treatment and prevent spreading STIs to partners, and, specifically for HIV, regularly taking prophylactic antiretroviral drugs, such as Truvada. Post-exposure prophylaxis, started within 72 hours (optimally less than 1 hour) after exposure to high-risk fluids, can also protect against HIV transmission.

Malaria prevention using genetic modification
Genetically modified mosquitoes are being used in developing countries to control malaria. This approach has been subject to objections and controversy.

Thrombosis
Thrombosis is a serious circulatory disease affecting thousands, usually older persons undergoing surgical procedures, women taking oral contraceptives and travelers. The consequences of thrombosis can be heart attacks and strokes. Prevention can include exercise, anti-embolism stockings, pneumatic devices, and pharmacological treatments.

Cancer
In recent years, cancer has become a global problem. Low and middle income countries share a majority of the cancer burden largely due to exposure to carcinogens resulting from industrialization and globalization. However, primary prevention of cancer and knowledge of cancer risk factors can reduce over one third of all cancer cases. Primary prevention of cancer can also prevent other diseases, both communicable and non-communicable, that share common risk factors with cancer.

Lung cancer
Lung cancer is the leading cause of cancer-related deaths in the United States and Europe and is a major cause of death in other countries. Tobacco is an environmental carcinogen and the major underlying cause of lung cancer. Between 25% and 40% of all cancer deaths and about 90% of lung cancer cases are associated with tobacco use. Other carcinogens include asbestos and radioactive materials. Both smoking and second-hand exposure from other smokers can lead to lung cancer and eventually death.

Prevention of tobacco use is paramount to prevention of lung cancer. Individual, community, and statewide interventions can prevent or cease tobacco use. 90% of adults in the U.S. who have ever smoked did so prior to the age of 20. In-school prevention/educational programs, as well as counseling resources, can help prevent and cease adolescent smoking. Other cessation techniques include group support programs, nicotine replacement therapy (NRT), hypnosis, and self-motivated behavioral change. Studies have shown long term success rates (>1 year) of 20% for hypnosis and 10%-20% for group therapy.

Cancer screening programs serve as effective sources of secondary prevention. The Mayo Clinic, Johns Hopkins, and Memorial Sloan-Kettering hospitals conducted annual x-ray screenings and sputum cytology tests and found that lung cancer was detected at higher rates, earlier stages, and had more favorable treatment outcomes, which supports widespread investment in such programs.

Legislation can also affect smoking prevention and cessation. In 1992, Massachusetts (United States) voters passed a bill adding an extra 25 cent tax to each pack of cigarettes, despite intense lobbying and $7.3 million spent by the tobacco industry to oppose this bill. Tax revenue goes toward tobacco education and control programs and has led to a decline of tobacco use in the state.

Lung cancer and tobacco smoking are increasing worldwide, especially in China. China is responsible for about one-third of the global consumption and production of tobacco products. Tobacco control policies have been ineffective as China is home to 350 million regular smokers and 750 million passive smokers and the annual death toll is over 1 million. Recommended actions to reduce tobacco use include decreasing tobacco supply, increasing tobacco taxes, widespread educational campaigns, decreasing advertising from the tobacco industry, and increasing tobacco cessation support resources. In Wuhan, China, a 1998 school-based program implemented an anti-tobacco curriculum for adolescents and reduced the number of regular smokers, though it did not significantly decrease the number of adolescents who initiated smoking. This program was therefore effective in secondary but not primary prevention and shows that school-based programs have the potential to reduce tobacco use.

Skin cancer
Skin cancer is the most common cancer in the United States. The most lethal form of skin cancer, melanoma, leads to over 50,000 annual deaths in the United States. Childhood prevention is particularly important because a significant portion of ultraviolet radiation exposure from the sun occurs during childhood and adolescence and can subsequently lead to skin cancer in adulthood. Furthermore, childhood prevention can lead to the development of healthy habits that continue to prevent cancer for a lifetime.

The Centers for Disease Control and Prevention (CDC) recommends several primary prevention methods including: limiting sun exposure between 10 AM and 4 PM, when the sun is strongest, wearing tighter-weave natural cotton clothing, wide-brim hats, and sunglasses as protective covers, using sunscreens that protect against both UV-A and UV-B rays, and avoiding tanning salons. Sunscreen should be reapplied after sweating, exposure to water (through swimming for example) or after several hours of sun exposure. Since skin cancer is very preventable, the CDC recommends school-level prevention programs including preventive curricula, family involvement, participation and support from the school's health services, and partnership with community, state, and national agencies and organizations to keep children away from excessive UV radiation exposure.

Most skin cancer and sun protection data comes from Australia and the United States. An international study reported that Australians tended to demonstrate higher knowledge of sun protection and skin cancer knowledge, compared to other countries. Of children, adolescents, and adults, sunscreen was the most commonly used skin protection. However, many adolescents purposely used sunscreen with a low sun protection factor (SPF) in order to get a tan. Various Australian studies have shown that many adults failed to use sunscreen correctly; many applied sunscreen well after their initial sun exposure and/or failed to reapply when necessary. A 2002 case-control study in Brazil showed that only 3% of case participants and 11% of control participants used sunscreen with SPF >15.

Cervical cancer
Cervical cancer ranks among the top three most common cancers among women in Latin America, sub-Saharan Africa, and parts of Asia. Cervical cytology screening aims to detect abnormal lesions in the cervix so that women can undergo treatment prior to the development of cancer. Given that high quality screening and follow-up care has been shown to reduce cervical cancer rates by up to 80%, most developed countries now encourage sexually active women to undergo a Pap test every 3–5 years. Finland and Iceland have developed effective organized programs with routine monitoring and have managed to significantly reduce cervical cancer mortality while using fewer resources than unorganized, opportunistic programs such as those in the United States or Canada.

In developing nations in Latin America, such as Chile, Colombia, Costa Rica, and Cuba, both public and privately organized programs have offered women routine cytological screening since the 1970s. However, these efforts have not resulted in a significant change in cervical cancer incidence or mortality in these nations. This is likely due to low quality, inefficient testing. However, Puerto Rico, which has offered early screening since the 1960s, has witnessed almost a 50% decline in cervical cancer incidence and almost a four-fold decrease in mortality between 1950 and 1990. Brazil, Peru, India, and several high-risk nations in sub-Saharan Africa which lack organized screening programs, have a high incidence of cervical cancer.

Colorectal cancer
Colorectal cancer is globally the second most common cancer in women and the third-most common in men, and the fourth most common cause of cancer death after lung, stomach, and liver cancer, having caused 715,000 deaths in 2010.

It is also highly preventable; about 80 percent of colorectal cancers begin as benign growths, commonly called polyps, which can be easily detected and removed during a colonoscopy. Other methods of screening for polyps and cancers include fecal occult blood testing. Lifestyle changes that may reduce the risk of colorectal cancer include increasing consumption of whole grains, fruits and vegetables, and reducing consumption of red meat.

Health disparities and barriers to accessing care
Access to healthcare and preventive health services is unequal, as is the quality of care received. A study conducted by the Agency for Healthcare Research and Quality (AHRQ) revealed health disparities in the United States. In the United States, elderly adults (>65 years old) received worse care and had less access to care than their younger counterparts. The same trends are seen when comparing all racial minorities (black, Hispanic, Asian) to white patients, and low-income people to high-income people. Common barriers to accessing and utilizing healthcare resources included lack of income and education, language barriers, and lack of health insurance. Minorities were less likely than whites to possess health insurance, as were individuals who completed less education. These disparities made it more difficult for the disadvantaged groups to have regular access to a primary care provider, receive immunizations, or receive other types of medical care. Additionally, uninsured people tend to not seek care until their diseases progress to chronic and serious states and they are also more likely to forgo necessary tests, treatments, and filling prescription medications.

These sorts of disparities and barriers exist worldwide as well. Often, there are decades of gaps in life expectancy between developing and developed countries. For example, Japan has an average life expectancy that is 36 years greater than that in Malawi. Low-income countries also tend to have fewer physicians than high-income countries. In Nigeria and Myanmar, there are fewer than 4 physicians per 100,000 people while Norway and Switzerland have a ratio that is ten-fold higher. Common barriers worldwide include lack of availability of health services and healthcare providers in the region, great physical distance between the home and health service facilities, high transportation costs, high treatment costs, and social norms and stigma toward accessing certain health services.

Economics of lifestyle-based prevention
With lifestyle factors such as diet and exercise rising to the top of preventable death statistics, the economics of healthy lifestyle is a growing concern. There is little question that positive lifestyle choices provide an investment in health throughout life. To gauge success, traditional measures such as the quality years of life method (QALY), show great value. However, that method does not account for the cost of chronic conditions or future lost earnings because of poor health.

Developing future economic models that would guide both private and public investments as well as drive future policy to evaluate the efficacy of positive lifestyle choices on health is a major topic for economists globally. Americans spend over three trillion a year on health care but have a higher rate of infant mortality, shorter life expectancies, and a higher rate of diabetes than other high-income nations because of negative lifestyle choices. Despite these large costs, very little is spent on prevention for lifestyle-caused conditions in comparison. In 2016, the Journal of the American Medical Association estimated that $101 billion was spent in 2013 on the preventable disease of diabetes, and another $88 billion was spent on heart disease. In an effort to encourage healthy lifestyle choices, as of 2010 workplace wellness programs were on the rise but the economics and effectiveness data were continuing to evolve and develop.

Health insurance coverage impacts lifestyle choices, even intermittent loss of coverage had negative effects on healthy choices in the U.S. The repeal of the Affordable Care Act (ACA) could significantly impact coverage for many Americans as well as "The Prevention and Public Health Fund" which is the U.S. first and only mandatory funding stream dedicated to improving public health including counseling on lifestyle prevention issues, such as weight management, alcohol use, and treatment for depression.

Because in the U.S. chronic illnesses predominate as a cause of death and pathways for treating chronic illnesses are complex and multifaceted, prevention is a best practice approach to chronic disease when possible. In many cases, prevention requires mapping complex pathways to determine the ideal point for intervention. Cost-effectiveness of prevention is achievable, but impacted by the length of time it takes to see effects/outcomes of intervention. This makes prevention efforts difficult to fund—particularly in strained financial contexts. Prevention potentially creates other costs as well, due to extending the lifespan and thereby increasing opportunities for illness. In order to assess the cost-effectiveness of prevention, the cost of the preventive measure, savings from avoiding morbidity, and the cost from extending the lifespan need to be considered. Life extension costs become smaller when accounting for savings from postponing the last year of life, which makes up a large fraction of lifetime medical expenditures and becomes cheaper with age. Prevention leads to savings only if the cost of the preventive measure is less than the savings from avoiding morbidity net of the cost of extending the life span. In order to establish reliable economics of prevention for illnesses that are complicated in origin, knowing how best to assess prevention efforts, i.e. developing useful measures and appropriate scope, is required.

Effectiveness
There is no general consensus as to whether or not preventive healthcare measures are cost-effective, but they increase the quality of life dramatically. There are varying views on what constitutes a "good investment." Some argue that preventive health measures should save more money than they cost, when factoring in treatment costs in the absence of such measures. Others have argued in favor of "good value" or conferring significant health benefits even if the measures do not save money. Furthermore, preventive health services are often described as one entity though they comprise a myriad of different services, each of which can individually lead to net costs, savings, or neither. Greater differentiation of these services is necessary to fully understand both the financial and health effects.

A 2010 study reported that in the United States, vaccinating children, cessation of smoking, daily prophylactic use of aspirin, and screening of breast and colorectal cancers had the most potential to prevent premature death. Preventive health measures that resulted in savings included vaccinating children and adults, smoking cessation, daily use of aspirin, and screening for issues with alcoholism, obesity, and vision failure. These authors estimated that if usage of these services in the United States increased to 90% of the population, there would be net savings of $3.7 billion, which comprised only about -0.2% of the total 2006 United States healthcare expenditure. Despite the potential for decreasing healthcare spending, utilization of healthcare resources in the United States still remains low, especially among Latinos and African-Americans. Overall, preventive services are difficult to implement because healthcare providers have limited time with patients and must integrate a variety of preventive health measures from different sources.

While these specific services bring about small net savings, not every preventive health measure saves more than it costs. A 1970s study showed that preventing heart attacks by treating hypertension early on with drugs actually did not save money in the long run. The money saved by evading treatment from heart attack and stroke only amounted to about a quarter of the cost of the drugs. Similarly, it was found that the cost of drugs or dietary changes to decrease high blood cholesterol exceeded the cost of subsequent heart disease treatment. Due to these findings, some argue that rather than focusing healthcare reform efforts exclusively on preventive care, the interventions that bring about the highest level of health should be prioritized.

In 2008, Cohen et al. outlined a few arguments made by skeptics of preventive healthcare. Many argue that preventive measures only cost less than future treatment when the proportion of the population that would become ill in the absence of prevention is fairly large. The Diabetes Prevention Program Research Group conducted a 2012 study evaluating the costs and benefits in quality-adjusted life-years or QALYs of lifestyle changes versus taking the drug metformin. They found that neither method brought about financial savings, but were cost-effective nonetheless because they brought about an increase in QALYs. In addition to scrutinizing costs, preventive healthcare skeptics also examine efficiency of interventions. They argue that while many treatments of existing diseases involve use of advanced equipment and technology, in some cases, this is a more efficient use of resources than attempts to prevent the disease. Cohen suggested that the preventive measures most worth exploring and investing in are those that could benefit a large portion of the population to bring about cumulative and widespread health benefits at a reasonable cost.

Cost-effectiveness of childhood obesity interventions
There are at least four nationally implemented childhood obesity interventions in the United States: the Sugar-Sweetened Beverage excise tax (SSB), the TV AD program, active physical education (Active PE) policies, and early care and education (ECE) policies. They each have similar goals of reducing childhood obesity. The effects of these interventions on BMI have been studied, and the cost-effectiveness analysis (CEA) has led to a better understanding of projected cost reductions and improved health outcomes. The Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) was conducted to evaluate and compare the CEA of these four interventions.

Gortmaker, S.L. et al. (2015) states: "The four initial interventions were selected by the investigators to represent a broad range of nationally scalable strategies to reduce childhood obesity using a mix of both policy and programmatic strategies... 1. an excise tax of $0.01 per ounce of sweetened beverages, applied nationally and administered at the state level (SSB), 2. elimination of the tax deductibility of advertising costs of TV advertisements for "nutritionally poor" foods and beverages seen by children and adolescents (TV AD), 3. state policy requiring all public elementary schools in which physical education (PE) is currently provided to devote ≥50% of PE class time to moderate and vigorous physical activity (Active PE), and 4. state policy to make early child educational settings healthier by increasing physical activity, improving nutrition, and reducing screen time (ECE)." The CHOICES found that SSB, TV AD, and ECE led to net cost savings. Both SSB and TV AD increased quality adjusted life years and produced yearly tax revenue of 12.5 billion U.S. dollars and 80 million U.S. dollars, respectively.

Some challenges with evaluating the effectiveness of child obesity interventions include:
 * 1) The economic consequences of childhood obesity are both short and long term. In the short term, obesity impairs cognitive achievement and academic performance. Some believe this is secondary to negative effects on mood or energy, but others suggest there may be physiological factors involved. Furthermore, obese children have increased health care expenses (e.g. medications, acute care visits). In the long term, obese children tend to become obese adults with associated increased risk for a chronic condition such as diabetes or hypertension.  Any effect on their cognitive development may also affect their contributions to society and socioeconomic status.
 * 2) In the CHOICES, it was noted that translating the effects of these interventions may in fact differ among communities throughout the nation. In addition it was suggested that limited outcomes are studied and these interventions may have an additional effect that is not fully appreciated.
 * 3) Modeling outcomes in such interventions in children over the long term is challenging because advances in medicine and medical technology are unpredictable. The projections from cost-effective analysis may need to be reassessed more frequently.

Economics of U.S. preventive care
As of 2009, the cost-effectiveness of preventive care is a highly debated topic. While some economists argue that preventive care is valuable and potentially cost saving, others believe it is an inefficient waste of resources. Preventive care is composed of a variety of clinical services and programs including annual doctor's check-ups, annual immunizations, and wellness programs; recent models show that these simple interventions can have significant economic impacts.

Clinical preventive services and programs
Research on preventive care addresses the question of whether it is cost saving or cost effective and whether there is an economics evidence base for health promotion and disease prevention. The need for and interest in preventive care is driven by the imperative to reduce health care costs while improving quality of care and the patient experience. Preventive care can lead to improved health outcomes and cost savings potential. Services such as health assessments/screenings, prenatal care, and telehealth and telemedicine can reduce morbidity or mortality with low cost or cost savings. Specifically, health assessments/screenings have cost savings potential, with varied cost-effectiveness based on screening and assessment type. Inadequate prenatal care can lead to an increased risk of prematurity, stillbirth, and infant death. Time is the ultimate resource and preventive care can help mitigate the time costs. Telehealth and telemedicine is one option that has gained consumer interest, acceptance, and confidence and can improve quality of care and patient satisfaction.

Economics for investment
There are benefits and trade-offs when considering investment in preventive care versus other types of clinical services. Preventive care can be a good investment as supported by the evidence base and can drive population health management objectives. The concepts of cost saving and cost-effectiveness are different and both are relevant to preventive care. Preventive care that may not save money may still provide health benefits; thus, there is a need to compare interventions relative to impact on health and cost.

Preventive care transcends demographics and is applicable to people of every age. The Health Capital Theory underpins the importance of preventive care across the lifecycle and provides a framework for understanding the variances in health and health care that are experienced. It treats health as a stock that provides direct utility. Health depreciates with age and the aging process can be countered through health investments. The theory further supports that individuals demand good health, that the demand for health investment is a derived demand (i.e. investment is health is due to the underlying demand for good health), and the efficiency of the health investment process increases with knowledge (i.e. it is assumed that the more educated are more efficient consumers and producers of health).

The prevalence elasticity of demand for prevention can also provide insights into the economics. Demand for preventive care can alter the prevalence rate of a given disease and further reduce or even reverse any further growth of prevalence. Reduction in prevalence subsequently leads to reduction in costs. There are a number of organizations and policy actions that are relevant when discussing the economics of preventive care services. The evidence base, viewpoints, and policy briefs from the Robert Wood Johnson Foundation, the Organisation for Economic Co-operation and Development (OECD), and efforts by the U.S. Preventive Services Task Force (USPSTF) all provide examples that improve the health and well-being of populations (e.g. preventive health assessments/screenings, prenatal care, and telehealth/telemedicine). The Affordable Care Act (ACA) has major influence on the provision of preventive care services, although it is currently under heavy scrutiny and review by the new administration. According to the Centers for Disease Control and Prevention (CDC), the ACA makes preventive care affordable and accessible through mandatory coverage of preventive services without a deductible, copayment, coinsurance, or other cost sharing.

The U.S. Preventive Services Task Force (USPSTF), a panel of national experts in prevention and evidence-based medicine, works to improve health of Americans by making evidence-based recommendations about clinical preventive services. They do not consider the cost of a preventive service when determining a recommendation. Each year, the organization delivers a report to Congress that identifies critical evidence gaps in research and recommends priority areas for further review.

The National Network of Perinatal Quality Collaboratives (NNPQC), sponsored by the CDC, supports state-based perinatal quality collaboratives (PQCs) in measuring and improving upon health care and health outcomes for mothers and babies. These PQCs have contributed to improvements such as reduction in deliveries before 39 weeks, reductions in healthcare associated bloodstream infections, and improvements in the utilization of antenatal corticosteroids.

Telehealth and telemedicine has realized significant growth and development recently. The Center for Connected Health Policy (The National Telehealth Policy Resource Center) has produced multiple reports and policy briefs on the topic of Telehealth and Telemedicine and how they contribute to preventive services. Policy actions and provision of preventive services do not guarantee utilization. Reimbursement has remained a significant barrier to adoption due to variances in payer and state level reimbursement policies and guidelines through government and commercial payers. Americans use preventive services at about half the recommended rate and cost-sharing, such as deductibles, co-insurance, or copayments, also reduce the likelihood that preventive services will be used. Despite the ACA's enhancement of Medicare benefits and preventive services, there were no effects on preventive service utilization, calling out the fact that other fundamental barriers exist.

Affordable Care Act and preventive healthcare
The Patient Protection and Affordable Care Act, also known as just the Affordable Care Act or Obamacare, was passed and became law in the United States on March 23, 2010. The finalized and newly ratified law was to address many issues in the U.S. healthcare system, which included expansion of coverage, insurance market reforms, better quality, and the forecast of efficiency and costs. Under the insurance market reforms the act required that insurance companies no longer exclude people with pre-existing conditions, allow for children to be covered on their parents' plan until the age of 26, and expand appeals that dealt with reimbursement denials. The Affordable Care Act also banned the limited coverage imposed by health insurances, and insurance companies were to include coverage for preventive health care services. The U.S. Preventive Services Task Force has categorized and rated preventive health services as either A or B, as to which insurance companies must comply and present full coverage. Not only has the U.S. Preventive Services Task Force provided graded preventive health services that are appropriate for coverage, they have also provided many recommendations to clinicians and insurers to promote better preventive care to ultimately provide better quality of care and lower the burden of costs.

Health insurance
Healthcare insurance companies are willing to pay for preventive care despite the fact that patients are not acutely sick in hope that it will prevent them from developing a chronic disease later on in life. Today, health insurance plans offered through the Marketplace, mandated by the Affordable Care Act are required to provide certain preventive care services free of charge to patients. Section 2713 of the Affordable Care Act, specifies that all private Marketplace and all employer-sponsored private plans (except those grandfathered in) are required to cover preventive care services that are ranked A or B by the U.S. Preventive Services Task Force free of charge to patients. UnitedHealthcare insurance company has published patient guidelines at the beginning of the year explaining their preventive care coverage.

Evaluating incremental benefits
Evaluating the incremental benefits of preventive care requires a longer period of time when compared to acutely ill patients. Inputs into the model such as discounting rate and time horizon can have significant effects on the results. One controversial subject is use of a 10-year time frame to assess cost effectiveness of diabetes preventive services by the Congressional Budget Office.

Preventive care services mainly focus on chronic disease. The Congressional Budget Office has provided guidance that further research is needed in the area of the economic impacts of obesity in the U.S. before the CBO can estimate budgetary consequences. A bipartisan report published in May 2015 recognizes the potential of preventive care to improve patients' health at individual and population levels while decreasing the healthcare expenditure.

Mortality from modifiable risk factors
Chronic diseases such as heart disease, stroke, diabetes, obesity and cancer have become the most common and costly health problems in the United States. In 2014, it was projected that by 2023 that the number of chronic disease cases would increase by 42%, resulting in $4.2 trillion in treatment and lost economic output. They are also among the top ten leading causes of mortality. Chronic diseases are driven by risk factors that are largely preventable. Sub-analysis performed on all deaths in the United States in 2000 revealed that almost half were attributed to preventable behaviors including tobacco, poor diet, physical inactivity and alcohol consumption. More recent analysis reveals that heart disease and cancer alone accounted for nearly 46% of all deaths. Modifiable risk factors are also responsible for a large morbidity burden, resulting in poor quality of life in the present and loss of future life earning years. It is further estimated that by 2023, focused efforts on the prevention and treatment of chronic disease may result in 40 million fewer chronic disease cases, potentially reducing treatment costs by $220 billion.

Childhood vaccinations
Childhood immunizations are largely responsible for the increase in life expectancy in the 20th century. From an economic standpoint, childhood vaccines demonstrate a very high return on investment. According to Healthy People 2020, for every birth cohort that receives the routine childhood vaccination schedule, direct health care costs are reduced by $9.9 billion and society saves $33.4 billion in indirect costs. The economic benefits of childhood vaccination extend beyond individual patients to insurance plans and vaccine manufacturers, all while improving the health of the population.

Health capital theory
The burden of preventable illness extends beyond the healthcare sector, incurring costs related to lost productivity among workers in the workforce. Indirect costs related to poor health behaviors and associated chronic disease costs U.S. employers billions of dollars each year.

According to the American Diabetes Association (ADA), medical costs for employees with diabetes are twice as high as for workers without diabetes and are caused by work-related absenteeism ($5 billion), reduced productivity at work ($20.8 billion), inability to work due to illness-related disability ($21.6 billion), and premature mortality ($18.5 billion). Reported estimates of the cost burden due to increasingly high levels of overweight and obese members in the workforce vary, with best estimates suggesting 450 million more missed work days, resulting in $153 billion each year in lost productivity, according to the CDC Healthy Workforce.

The health capital model explains how individual investments in health can increase earnings by "increasing the number of healthy days available to work and to earn income." In this context, health can be treated both as a consumption good, wherein individuals desire health because it improves quality of life in the present, and as an investment good because of its potential to increase attendance and workplace productivity over time. Preventive health behaviors such as healthful diet, regular exercise, access to and use of well-care, avoiding tobacco, and limiting alcohol can be viewed as health inputs that result in both a healthier workforce and substantial cost savings.

Quality-adjusted life years
Health benefits of preventive care measures can be described in terms of quality-adjusted life-years (QALYs) saved. A QALY takes into account length and quality of life, and is used to evaluate the cost-effectiveness of medical and preventive interventions. Classically, one year of perfect health is defined as 1 QALY and a year with any degree of less than perfect health is assigned a value between 0 and 1 QALY. As an economic weighting system, the QALY can be used to inform personal decisions, to evaluate preventive interventions and to set priorities for future preventive efforts.

Cost-saving and cost-effective benefits of preventive care measures are well established. The Robert Wood Johnson Foundation evaluated the prevention cost-effectiveness literature, and found that many preventive measures meet the benchmark of <$100,000 per QALY and are considered to be favorably cost-effective. These include screenings for HIV and chlamydia, cancers of the colon, breast and cervix, vision screening, and screening for abdominal aortic aneurysms in men >60 in certain populations. Alcohol and tobacco screening were found to be cost-saving in some reviews and cost-effective in others. According to the RWJF analysis, two preventive interventions were found to save costs in all reviews: childhood immunizations and counseling adults on the use of aspirin.

Minority populations
Health disparities are increasing in the United States for chronic diseases such as obesity, diabetes, cancer, and cardiovascular disease. Populations at heightened risk for health inequities are the growing proportion of racial and ethnic minorities, including African Americans, American Indians, Hispanics/Latinos, Asian Americans, Alaska Natives and Pacific Islanders.

According to the Racial and Ethnic Approaches to Community Health (REACH), a national CDC program, non-Hispanic blacks currently have the highest rates of obesity (48%), and risk of newly diagnosed diabetes is 77% higher among non-Hispanic blacks, 66% higher among Hispanics/Latinos and 18% higher among Asian Americans compared to non-Hispanic whites. Current U.S. population projections predict that more than half of Americans will belong to a minority group by 2044. Without targeted preventive interventions, medical costs from chronic disease inequities will become unsustainable. Broadening health policies designed to improve delivery of preventive services for minority populations may help reduce substantial medical costs caused by inequities in health care, resulting in a return on investment.

Policies
Chronic disease is a population level issue that requires population health level efforts and national and state level public policy to effectively prevent, rather than individual level efforts. The United States currently employs many public health policy efforts aligned with the preventive health efforts discussed above. The Centers for Disease Control and Prevention support initiatives such as Health in All Policies and HI-5 (Health Impact in 5 Years), and collaborative efforts that aim to consider prevention across sectors and address social determinants of health as a method of primary prevention for chronic disease.

Obesity
Policies that address the obesity epidemic should be proactive and far-reaching, including a variety of stakeholders both in healthcare and in other sectors. Recommendations from the Institute of Medicine in 2012 suggest that "concerted action be taken across and within five environments (physical activity (PA), food and beverage, marketing and messaging, healthcare and worksites, and schools) and all sectors of society (including government, business and industry, schools, child care, urban planning, recreation, transportation, media, public health, agriculture, communities, and home) in order for obesity prevention efforts to truly be successful."

There are dozens of current policies acting at either (or all of) the federal, state, local and school levels. Most states employ a physical education requirement of 150 minutes of physical education per week at school, a policy of the National Association of Sport and Physical Education. In some cities, including Philadelphia, a sugary food tax is employed. This is a part of an amendment to Title 19 of the Philadelphia Code, "Finance, Taxes and Collections", Chapter 19-4100, Sugar-Sweetened Beverage Tax that was approved 2016, which establishes an excise tax of $0.015 per fluid ounce on distributors of beverages sweetened with both caloric and non-caloric sweeteners. Distributors are required to file a return with the department, and the department can collect taxes, among other responsibilities. These policies can be a source of tax credits. Under the Philadelphia policy, businesses can apply for tax credits with the revenue department on a first-come, first-served basis. This applies until the total amount of credits for a particular year reaches one million dollars.

Recently, advertisements for food and beverages directed at children have received much attention. The Children's Food and Beverage Advertising Initiative (CFBAI) is a self-regulatory program of the food industry. Each participating company makes a public pledge that details its commitment to advertise only foods that meet certain nutritional criteria to children under 12 years old. This is a self-regulated program with policies written by the Council of Better Business Bureaus. The Robert Wood Johnson Foundation funded research to test the efficacy of the CFBAI. The results showed progress in terms of decreased advertising of food products that target children and adolescents.

Childhood immunization policies
Despite nationwide controversies over childhood vaccination and immunization, there are policies and programs at the federal, state, local and school levels outlining vaccination requirements. All states require children to be vaccinated against certain communicable diseases as a condition for school attendance. However, only 18 states allow exemptions for "philosophical or moral reasons." Diseases for which vaccinations form part of the standard ACIP vaccination schedule are diphtheria tetanus pertussis (whooping cough), poliomyelitis (polio), measles, mumps, rubella, haemophilus influenzae type b, hepatitis B, influenza, and pneumococcal infections. The CDC website maintains such schedules.

The CDC website describes a federally funded program, Vaccines for Children (VFC), which provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay. Additionally, the Advisory Committee on Immunization Practices (ACIP) is an expert vaccination advisory board that informs vaccination policy and guides on-going recommendations to the CDC, incorporating the most up-to-date cost-effectiveness and risk-benefit evidence in its recommendations.

title: Preventive healthcare


text:
Talk:Baker, California

Census import
I notice this is a new page -- how'd it not get included in the census import?
 * I was wondering that too. Nothing about it on city-data.com, which has almost everything. Good sized town, too, considering the location. -- Scott Burley 00:31, Oct 2, 2004 (UTC)
 * To answer your question in the edit comment, yeah, it's exactly 2/3 of the way, depending upon your address in LA (or your destination in Vegas). Tempshill 01:24, 2 Oct 2004 (UTC)
 * According to the census bureau, this town does not exist (do a search at http://factfinder.census.gov/servlet/SAFFFacts?_sse=on). Nelson Ricardo 04:10, Oct 14, 2004 (UTC)
 * Somebody had better tell the locals that they don't exist. -- Scott Burley 01:36, Oct 28, 2004 (UTC)

Don't forget...
We have a Starbucks now...what an oasis in the desert! :-)

The Starbucks has since been closed thanks to corporates cutbacksSokennethwasall (talk) 21:24, 25 September 2009 (UTC) Sokennethwasall (talk) 14:37, 28 April 2009 (UTC) —The preceding unsigned comment was added by 66.217.90.53 (talk) 03:27, 21 February 2007 (UTC).

Gas Prices?
Many people who stop in Baker, CA for gas are usually shocked at the unusually high price of gas there. Would this be worthy of a mention? —Preceding unsigned comment added by 76.100.163.33 (talk) 03:30, 30 January 2008 (UTC)
 * No. It's not unusual for gas stations in isolated communities, far from competition, to have higher prices. They may also be affected by the longer hauls from refineries to deliver fuel to such stations. Activist (talk) 04:42, 8 April 2015 (UTC)

Cleanup & Issues
I've done a general cleanup & dealt with some of the issues metioned, bur will leave the tag up for now. --Pete Tillman (talk) 03:29, 4 August 2008 (UTC)

Choo choo
Is there still a railway stop or station? Thanks, Maikel (talk) 08:42, 23 April 2017 (UTC)

In Popular Culture
The fallout new vegas fact is not true 2601:900:4300:46A0:1C91:49E4:682E:B1B0 (talk) 22:28, 26 June 2024 (UTC)

title: Talk:Baker, California


text:
Talk:Rwandan genocide

Semi-protected edit request on 20 February 2024
"kinship" is mistakenly worded as "kingship" in the section "Pre-independent Rwanda and the origins of Hutu, Tutsi and Twa groups" Vladverde (talk) 17:35, 20 February 2024 (UTC) — Urro[ talk ] [ edits ] ⋮ 18:44, 20 February 2024 (UTC)

Semi-protected edit request on 7 April 2024
Not Rwandan Genocide but 1994 Genocide against the Tutsi 2A00:F41:34A3:1AAA:1CC3:E4EB:B04D:665B (talk) 21:47, 7 April 2024 (UTC)
 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. Cannolis (talk) 21:55, 7 April 2024 (UTC)

Semi-protected edit request on 11 April 2024
It is not 'Rwandan Genocide' but "The Genocide against the Tutsi in Rwanda" for the former contributes to genocide tactical denialism,and doesn't align with UN General Assembly Decision 72/550 of 26 January 2018 and (2) Resolution A/RES/74/273 of 20 April 2020, in which the General Assembly “[reaffirmed] 7 April as the International Day of Reflection on the 1994 Genocide against the Tutsi in Rwanda”.: https://press.un.org/en/2018/ga12000.doc.htm

The Genocide against the tutsi" captures the historical facts of what happened in 1994 — genocide against the Tutsi in Rwanda — and left no room for ambiguity. The tactics of genocide denial and revisionism were well known and documented.  Some people promoted the theory of double genocide in the futile belief that it might divert their own responsibility.  The more than 1 million people who perished in the genocide were killed in the most horrendous conditions because they belonged to a group that was dehumanized and targeted for total extermination"-Rwanda in General assembly,26 January 2018

Genocide requires a special intent. Indeed, to be qualified as genocide, a crime needs to fulfil at least three conditions: (1) it must be committed against members of a specific group listed in the Convention;a national, ethnic, racial, or religious group (2) the members must be targeted "as such" (as members of that group), and (3) they must be targeted with the intent to destroy them in whole or part.

Therefore, based on this definition, it's impossible that the 1994 genocide in Rwanda targeted Rwandans altogether, unless the author of "Rwandan genocide" suggests that (1) there were three separate genocides in Rwanda – one against each group:hutu;tutsi;Twa or (2) a single genocide against the Rwandan national group, which would mean that victims would have been targeted, not for their “ethnicity” but for their Rwandan nationality. And we know that both options are historically untrue.

2) The crime of genocide in a specific place doesn’t exist just because it was defined in an international convention. This crime needs to be established by a court of law, which has to demonstrate that members of one of the four groups mentioned in the Genocide Convention were targeted, as such, to be destroyed in whole or part.

For the case of Rwanda, the crime of genocide was established by the Trial Chamber of the UN International Criminal Tribunal for Rwanda (#ICTR) in its very first judgment, "Prosecutor against Jean-Paul Akayesu" of 2nd September 1998. In this judgement, the Tribunal concluded that “the crime of genocide was indeed committed in Rwanda in 1994 against the Tutsi as a group”.

This judgement was confirmed by the Appeals Chamber of the ICTR, which, on 16 June 2006, issued a judicial notice (ICTR-98-44-AR73(C)) that concluded that it was a “fact of common knowledge” that “between 6 April and 17 July 1994, there was a genocide in Rwanda against the Tutsi ethnic group”. This judicial notice settled, once and for all, the legal debate on (1) the qualification of the crime that was committed in Rwanda in 1994 – it was a genocide – and (2) the group that was targeted – it was the Tutsi ethnic group.Therefore it's not Rwandan Genocide but Genocide against the tutsi in Rwanda.

https://www.un.org/africarenewal/magazine/april-2021/remembering-genocide-against-tutsi-rwanda-27-years-later Sage2024 (talk) 18:58, 11 April 2024 (UTC)
 * Red information icon with gradient background.svg Not done for now: please establish a consensus for this alteration before using the template. See the previous discussion on this topic for the community's views, in particular policy regarding WP:COMMONNAME. Jonathan Deamer (talk) 19:41, 11 April 2024 (UTC)

Semi-protected edit request on 15 April 2024
Umwana250 (talk) 11:45, 15 April 2024 (UTC)

I want to add accurate information about the Genocide Against the Tutsi in Rwanda
 * Semi-protection-unlocked.svg Not done: According to the page's protection level you should be able to edit the page yourself. If you seem to be unable to, please reopen the request with further details.  (talk | contribs) 11:49, 15 April 2024 (UTC)

Semi-protected edit request on 16 April 2024
"Change Rwandan genocide to The 1994 genocide against the tutsi" Y3rash (talk) 06:51, 16 April 2024 (UTC)
 * Move-protection-shackle.svg Not done: page move requests should be made at Requested moves.  (talk | contribs) 06:53, 16 April 2024 (UTC)
 * For further context, this has been disputed before. I think a formal RfC should be requested if a change such as this is sought. -Indy beetle (talk) 09:01, 16 April 2024 (UTC)

Semi-protected edit request on 11 May 2024
change the title "Rwandan Genocide" to "1994 Genocide against the Tutsi" or "1994 Genocide against the Tutsi in Rwanda" Tam7ust24 (talk) 15:00, 11 May 2024 (UTC)

 * Why? My real namm  (💬talk · ✏contribs) at 15:24, 11 May 2024 (UTC)
 * Red information icon with gradient background.svg Not done for now: please establish a consensus for this alteration before using the template. Jamedeus (talk) 18:20, 11 May 2024 (UTC)

title: Talk:Rwandan genocide