Hypertension (high blood pressure) Essay Example | Topics and Well Written Essays - 1000 words

Hypertension (high blood pressure) - Essay Example Blood pressure below 120/80 mm Hg is considered as a normal blood pressure. But, some medical experts claim 115/75 mm Hg as a more stable blood pressure level (Luehr et al., 2012, p. 15). Prehypertension, stage 1 hypertension, and stage 2 hypertension are three major hypertension stages. Prehypertension consists of a systolic pressure in the range of 120 to 139 mm Hg or a diastolic pressure in the range of 80 to 89 mm Hg. Stage 1 hypertension and stage 2 hypertension have a systolic pressure in the range of 140 to 159 mm Hg and 160 mm Hg or greater respectively or a diastolic pressure in the range of 90 to 99 mm Hg and 100 mm Hg or greater respectively (Luehr et al., 2012, p. 15). It is not possible to diagnose hypertension on the basis of one blood pressure reading as blood pressure varies several times in a day depending on activities, surroundings, age, and gender. Hence, doctors keep the patient on an observation and check the blood pressure at intervals for several times to diagnose it. Patients are required to avoid smoking, physical exercise, or drinking energetic beverages (especially with caffeine) for at least 30-40 minutes before the blood pressure readings (Simon & Zieve, 2013). As often during the clinical testing, patients are in stress, doctors ask the patients to measure their blood pressure at home too. Usually, doctors recommend the use of specific ambulatory monitoring equipment that measures blood pressure about every 20-30 minutes during the 24-hours period and gives appropriate readings to help the doctors to diagnose the hypertension in patients (Simon & Zieve, 2013). Based on the clinical and home readings of blood pressure at several times a day for period of time and medical history of patient, doctors diagnose the hypertension condition in the patient (Simon & Zieve, 2013). In order to formally diagnose the hypertension, there are various tests which are required to perform.

Research Design Paper Example | Topics and Well Written Essays - 500 words - 2

Design - Research Paper Example This study design is of great importance since it informs policy formulation and implementation strategies and avoids wastage of resources in starting interventions that would not change the state of the population. In the case of HBP the study type would inform the researcher whether the access to a health facility and follow-up are the major causes and therefore policies and interventions to address the same can be put in place to ensure that the interventions are most effective and do not use a lot of resources. HBP management has proven to be technical and requires behavior changes, good diet, along with a regimen of antihypertensive medications that require medical follow-up. Therefore the black men in urban areas have poor access to health services and do not seek care or remain in treatment and this is considered as a great factor in the rate of disability and death in this population. This study design is important in this particular scenario since in order to understand if the factors expressed are the real cause, one half of the population be exposed to the factors and the other not and then assessed over a period of time in order to determine whether the factors have an effect on HBP management. A cohort study is a type of study design which is used widely in cases where the researcher aims at reaching persons with particular similarities. There are different cohorts that can be described in terms of age or condition being suffered from. Most cohorts are attributed by age and therefore age has been the most common dividing factor in cohort studies. It has been expressed widely in this study where Dr Jemmott focuses on reducing risky sexual behavior, primarily among minority adolescents. This clearly illustrates that the target population of the study are the adolescents who are the cohort in this case. The use of cohort study design is important in ensuring that the target population is actually captured

Customer Service Excellence Essay Example | Topics and Well Written Essays - 2250 words

Customer Service Excellence - Essay Example Further theoretical insights would be rendered in terms of understanding potential service strategies that needs to be developed or followed in by organisations to gain an enhanced space in the target market for its products and services. The Case of Google The level of consumer trust for the online services rendered by Google in terms of operating as an effective search engine and faster networking site has countered problems owing to the failure of the company to sustain the parameter of privacy. Google is found to have entered with a contract with another online advertising firm DoubleClick thereby servicing the same with encrypted information relating to the Internet Protocol or IP Addresses of the users through their clicking on the search engine to retrieve results. This activity of the concern is taken as a breach of trust for the user base spread around the world in that the company failed to inform the same about the reason for their merger with DoubleClick. Moreover the org anisation looking after elements concerning electronic privacy also mentioned about the same as a case of deception in trade practices for the online company. This case strongly reflects in how the deceptive practices of Google in terms of its merging with the online advertising company happens to potentially disturb the privacy of users in terms of conducting online surfing. Thus the level of trust for Google actively declines in the online user sphere (Pasquale, 2010, p.405). The Case of Starbucks The case of Starbucks also reflects a reduction in the level of consumer satisfaction and trust in savouring coffee preparations from its different outlets owing to reduction of focus on customer servicing standards. Starbucks is found to focus on moving over to an opening spree where it focuses on opening a large number of different outlets spread along a small region. These large number of outlets created in a closed network tends to increase the level of competition between the differ ent outlets thereby cannibalising its own sales and consumer force. Moreover the company is also found to focus on diversifying into sales of compact discs such that the initial focus of the company on developing its coffee brand goes for a toss. Thus other small coffee brands operating in the same sector are found to gain the lead over Starbucks to help gain over cultivating a larger market share. It is also found that the brand identity of Starbucks in the coffee market is easily copied over by other firms like McDonald’s and similarly by Dunkin Donuts in terms of enhancing their product and service portfolio. This fact adds to the problem of the company in failing to sustain the consumer trust and loyalty (Smale, 2008). The Case of Royal Bank of Scotland (RBS) The case of Royal Bank of Scotland reflects that how the banking corporation happened to strike on a low customer servicing event owing to the emergence of a software problem. The software of the bank was held for up gradation matters that in turn created a problem for the bank executives in servicing the needs of its customers pertaining to banking transactions. The

JC Penney Advertising Essay Example for Free

JC Penney Advertising Essay As time progresses, the world, in terms of business is rather contracting. There is growing communication, interaction and exchange between different parts of the world. Technologies that were once thought of as a far sighted notion are now being used like household commodities and communication mediums that were once considered luxuries available to few are now necessities needed to prosper. And as the world is becoming more integrated and countries are becoming more and more dependent on one another in terms of trade and business the concept of branding, advertising and promotion is becoming more prevalent and widespread. This paper will focus on the marketing of JC penny. It would elaborate on the print as well as online marketing. Moreover it would compare and contrast advertising of online and bricks and mortar companies. Discussion The demand for accountability of marketing is rising and also the pressure of having less absolute dollars to work with so there is utmost need to be sharper, more purposeful and more targeted with marketing. JC Penney is a general retail brand that specializes in clothing, accessories and home furnishing. It has been around for decades and has been catering the needs of consumers of all ages and backgrounds. JC Penneys main target audience at the present times is women as well as youngsters. JC Penney faced criticism for being a brand that accommodated only the high-end and older generation. However, they have been changing their brand image and have been successful in implementing an image that is portraying a more young and trendy vibe. It now focuses on providing products that have the characteristics of being conservative, traditional, modern or trendy. Fundamentally JC Penney has been escalated in the last years is through the fact that it has moved from mass marketing to a more targeted approach. The few reasons for this change is that JC Penney believes that when business is difficult there is a lot greater chance of success with getting the arms around the best customers and increasing frequency share of wallet and trips with the best customers then trying to recruit new customers in tough times that may not shopping the brand. JC Penney has managed to find ways to develop formats that allowed it to get more productivity out the money that is spend. It has also become more targeted in terms of customer selection through becoming much sharper about making sure the right customers get the right format in the right piece. (Fetterman, 2006) JC Penney is one of the brands that hold the significance of being a brick and mortar store as well as an online retailer. Hence, it follows branding through all of the sources of mass media. It publishes magazines and postcards for the promotion of its products. It also advertises it products and offers through newspapers, television ads and online ads. When comparing the online and print media usage it quoted by Mike Boylson the Executive Vice President and Chief Marketing Officer of JC Penney that In the postcard you can deliver more of a sales message, or more of a discount message these postcards may drive the customers online to see the full assortment online where as the larger brand books of JC Penny show a much richer sense of the style that they have and they portray fundamentally completely different messages. The postcard includes the offer and a link to the website to go see the expanded content where as the book itself that goes out shows the product, the customer can then either come in the store or they can go online or place their order on the phone. Direct mail is very important because through versioning and through customer segmentation the company is able to send out more targeted messages that are highly accountable and are also able to track the results in direct mail to a degree that cannot be possible in a lot of the other traditional mass media used by JC Penney. JC Penney has been focusing a great deal over its brand image and has been trying to diversify and broaden its target audience. It has recently changed to a new brand motif; Every day matters along with the new tag line, the company has been working on enhancing its customers services and the opening of several temporary promotional stores. JC Penney is focusing on increasing the popularity of its brick and mortar stores as well as its online retailing through providing customers with latest offers, discounts and showcasing their product line online for ease of access. Sloan, 2007) As the world is advancing so are the technologies and the ease with which communication is possible among all parts of the world. With the advent of the internet and the upscale increase in its popularity, there has been almost nothing that is not available on the World Wide Web. The phenomenon of e-shopping emerged with the internet. The fact that customers could get what they want in the ease of their ho mes, increased the recognition of the internet and also of online shopping. There are numerous differences and similarities between online shopping and traditional shopping. But what holds more importance is the way the companies market their product online and how different it is from the marketing and promotion of brick and mortar companies. (Lowrey, 2008) Marketing over the internet is considered less costly, as it is holds a lower cost of distributing information on a global platform. More and more business are moving towards online retailing due to its outnumbered advantages in terms of cost, convenience and mobility of information over a great distance. One of the major focuses that companies including JC Penney is on the website. The success of online marketing is highly dependent over the outlook, design and the information provided by the website. Both the online companies as well as brick and mortar companies need to identify their target audience before they implement any marketing strategies. This lets them focus on the type of marketing tool they would benefit them. Brick and mortar companies offer a more traditional aspect of shopping and they also follow a traditional approach of marketing. This is mostly through mass media such as newspapers, television broadcast and magazines. With the passage of time, there are less and less companies that focus solely over brick and mortar business. Most companies are now available online as there is less overheads and larger audience prone to response through the internet. Conclusion In the end it is imperative to recognize the increasing importance of internet in business. Both, online retailing and brick and mortar companies hold their own set of characteristics that make them distinct. As the progress of online shopping is increasing there is still need for brick and mortar stores for traditional shoppers. Most companies, however, imply both the alternatives and hence, carry out their marketing accordingly.

Strategies for the Dietary Control of Diabetes

Strategies for the Dietary Control of Diabetes A survey of the recent strategies for the dietary control of diabetes in the Middle East INTRODUCTION Significant changes in the political and socio-economic climates have been the hallmark of the last decade in the many of the countries in the Middle East especially those located in the territories of the Arabian Gulf. These changes have impacted in no small way on the demographics of the affected countries. Notable are the obvious shifts in age distribution and a perceptible increase in healthy life expectancy. Furthermore, there have been alterations in the conventional lifestyles of the people living in these countries perhaps due largely to westernization, rapid urbanization and industrialization (Abdella et al 1995). It is also worth mentioning that disease types, trends and or their prevalence have also changed dramatically. Prominent among these is diabetes. Diabetes – delineation The incidence and prevalence of diabetes have consistently increased in the last 20 years; these changes have paralleled environmental transformation as well as the adjustments to changes above mentioned (Abdella et al 1995; Zimmet et al 1977). The current projection of the World Health Organisation (WHO 2007) indicates that there will be further increases in the prevalence of diabetes in the Middle East. A working committee of the WHO on diabetes defined the disease as ‘a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both; the effects being long-term damage, dysfunction and failure of various organs’ (Alberti and Zimmet 1998). Diabetes is caused by a lack of the hormone insulin, which is produced by the ÃŽ ²-islet cells of the pancreas. Glucose is the primary energy source for all cells and is provided by digest ion of carbohydrates from the diet. Insulin enhances the body cells’ uptake of glucose from blood plasma. Hence, defects in insulin secretion, insulin action, or, most commonly, both leads to decreased uptake of glucose by the cells and an increase in blood glucose levels. Sustained increases in blood glucose level will lead to the excretion of glucose in the urine when such increases exceed the renal threshold of the molecule. This in turn leads to the typical symptoms of diabetes: excessive production of urine (polyuria) and extreme thirst (polydipsia). Fatty acids from fat stores are metabolized as an alternative energy source when the body senses a lack of glucose, the result is weight loss and fatigue other common symptoms of diabetes (Maitra and Abbas 2004). The clinical profile of diabetes varies minimally between the countries of the Middle East. In Kuwait for example, because of the marked disparity between individuals in their age of diabetes onset, mode of present ation, and the degree of obesity, the clinical profile of the disease is heterogeneous (Abdella et al 1995). Diabetes mellitus is not a single disease entity, but rather a group of metabolic disorders sharing the common underlying feature of hyperglycemia. Type 1 (early-onset diabetes or insulin-dependent diabetes (IDDM) and Type 2 (maturity-onset diabetes or non-insulin-dependent diabetes (NIDDM) diabetes are well known types and are characterized by the different metabolic processes of the disease (Alberti and Zimmet, 1998). Type 2 accounts for about 80% of the disease worldwide. The chronic hyperglycemia and attendant metabolic dysregulation may be associated with secondary damage in multiple organ systems, especially the kidneys, eyes, nerves, and blood vessels (Maitra and Abbas 2004). The Role of Diet in the Management of Diabetes Nutritional therapy is an integral part of the management of diabetes and plays a vital role in helping people with diabetes achieve and maintain optimal blood glucose level (United Kingdom (UK) Prospective Diabetes Study Group (UKPDS), 1990; Delahanty, 1998). The nutritional management of patients is based on evidence-based principles and recommendations for the treatment and prevention of diabetes and related complications (American Diabetes Association, 2002). These recommendations are based on evidence published in the international literature and from consensus and expert opinion as required (Ha and Lean, 1998). The benefit of tight control of both blood glucose and blood pressure in people with type 1 and type 2 diabetes has been demonstrated in several well controlled randomized large-scale studies (Diabetes Control and Complications Trial Research Group, 1993; UKPDS 1998a,1998b). Generally, the objectives of strategies for the dietary control of diabetes are complementary to the aims of medical treatment. Dyson (2002) reported that these includes but not limited to the following: Maintaining blood glucose within predetermined target range Minimizing the risk of hypoglycaemia for those patients taking insulin or oral hypoglycaemic agents Achieving weight loss in the obese patient Reducing the risk of long-term complications of diabetes Maintaining blood pressure and lipid levels within predetermined target ranges Improving and maintaining suitable quality of life. (Dyson 2002) Rationale for the project Contemporary management of diabetes places emphasis on the individual patient’s responsibility for diabetes control of blood sugars and of food consumption. The concept of self-care with regard to a recommended diet is thus considered important in order for patients to maintain normoglycaemia and reduce or prevent diabetes-related complications (Rubin and Peyrot, 1992; Rubin et al, 1997). The diabetic patient is expected to monitor his/her carbohydrate metabolism, energy expenditure and the effects of insulin or recommended medicaments on blood pressure and sugar levels. This inevitably demands a level of understanding about diabetes and of the effect of diet on the progression and or management of the disease. This survey will explore the individual patients’ approach to control or support the pharmacotherapeutic management of his/her diabetes using diet. The study will shed light on diabetic patient’s adherence to guideline dietary recommendations in the Middle East or on novel dietary strategies for the control of the disease. The results of this study is essential to health policies makers in the region and pivotal for governmental strategies to minimize the burden of the diabetic epidemics in the Middle East. Using Kuwait as First Port of Call for the Middle East Diabetes Diet Study (MEDDS) The middle east comprise a large region that covers parts of northern Africa, southwestern Asia, and south eastern Europe consisting of Bahrain, Cyprus, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Sudan, Syria, Turkey, United Arab Emirates, and Yemen. The ‘Middle East Diabetes Diet Study’ (MEDDS) will focus on Kuwait in its first phase. Implementation of the study in other countries of the Middle East will stem from its success in Kuwait following appropriate modifications to adapt the study tools to the settings and subjects of these countries. Description of First Target site: Kuwait is a relatively small country, (17, 818 km2 in surface area) and is situated in the North Eastern part of the Arabian Peninsula. Kuwait shares the north and west borders with Iraq, is bordered on the south by Saudi Arabia and on the east by the Arabian Gulf. Total population of Kuwait in 2005 was 2, 867, 000 and over 88% of these were aged 15 and over; percent Urban population out of total population was 100% during the same period (WHO 2007). The prevalence of diabetes in Kuwait was 104,000 in 2000 and the projection for the year 2030 is 319,000; this will amount to about 44% of the projected total population (WHO 2007). AIM AND OBJECTIVES Aim: The aim of this proposal is to develop a plan for the conduct of a cross-sectional survey of the recent ( Objectives: To purposely select a panel of experienced diabetes practitioners/clinicians to conceive questions assessing patients’ knowledge of their diabetes and the effects of their food types and feeding pattern on glycaemia and blood pressure control (in 11 main domains) To develop and validate a diabetes-diet questionnaire tool for the study To implement the diabetes-diet instrument during a face to face semi-structured interview designed to further explore recent dietary strategies for the control of diabetes To administer a 7-day diet dairy to respondents. Repeat the survey in other countries of the Middle East METHODOLOGY Development of Study Instruments An initial list of 11 patient’s knowledge domains as shown below will be used: Basic knowledge about diabetes Knowledge of patient’s own current management if involving pharmacotherapy Consumption of olives, fruits and vegetables, nuts and cereals in recent times. The intake of legumes in cooked foods in the last 5 years Recent intake of dairy and meat products. Consumption of alcohol/wine in the last 5 years Knowledge of other food types consumed recently Knowledge of feeding pattern in recent times Knowledge of occurrences of diabetes complications and or hospitalisations in the last 5 years Knowledge of the effect of food types and pattern of intake on control of blood pressure in the last 5 years Knowledge of the effect of food types and pattern of intake on the control of blood glucose in the last 5 years Under each domain, important points regarding each topic will be identified. To ensure content validity, a panel of 10 senior practitioners in the area of diabetes management will be identified and asked to participate in diabetes-diet (MEDDS) instrument development phase (Kline 1986; Streiner and Norman 1989). The expert reviewers will include 2 pharmacists involved in care of diabetes patients, 3 diabetes staff nurses, 3 diabetes specialist dietitians and 2 consultants in the area of diabetes. These will be identified based on their records of diabetes patient care experiences and on their knowledge of the factors impacting on the progression of the disease. The diabetes-diet (MEDDS) instrument’s content experts will rate each of the topic domains and indicate the percentage weight of each domain within the entire study tool. Between 6 and 12 multiple-choice questions will be created for each domain, with a focus on information ranked by the experts as most important for the objectives of the study. The multiple-choice question format is chosen because it is easy to administer and it will be easy to psychometrically validate the ensuing instrument (Kline 1986). Each multiple choice question will have 4 possible responses, namely one correct answer and 3 distracters. However, in order to fully capture any emerging theme, respondents will be allowed time to comment freely on the questions and the multiple choices in a semi-structured interview. These will then be transcribed for analysis. Existing questions from previous studies may be harnessed and modified by the panel. The expert panel will also rank the questions within the domain in descending order based on its relative importance to patients’ diabetes diet requirement/knowledge. After the initial item bank is compiled, the expert panel members will be asked to rank the overall quality of each item on a scale of 1 to 5 (1 = poor, 5 = excellent) in terms of how well it tested each information point. These rankings will be used to eliminate questions and create a 20-30 item pilot instrument. An item bank will be developed based on this information. Questions will be written at 7th grade reading level as determined by the Flesch/Flesch-Kincaid Readability Tests calculated from Dave Taylor and Intuitive systems (2007). Respondents will also be asked to fill a 7-day diet diary. Inclusion criteria Adult volunteers aged 18-85, living in the study site with not less than 3 years diagnosis of type 1 or type 2 diabetes. Since retinal and vascular problems associated with diabetes mellitus are common, attempts will be made to administer the tools also in carers of blind diabetic patients. Exclusion criteria Anyone diagnosed with a mental illness as it may be difficult to determine the truthfulness of information collected from these patients. Patients who are deaf; this is because a researcher and the interviewee would need to be proficient in sign language for any meaningful interview to take palce Data-collection tools Three data-collection tools will eventually be used; (1) the diabetes diet questionnaire (MEDDS tool), (2) a semi-structured interview using validated questions developed by the experts group and (3) a health diary. The interview and diet questionnaire will be the main data source. The semi-structured interview will last for 20 -30 minutes and will be conducted to further explore dietary trends for the control of diabetes in the last 5 years; this will be done at any location convenient for the respondents. The MEDDS questionnaire will be self or researcher administered during the face-to-face interview. A team of 8 interviewers will be trained by the researchers for 4 days before the start of data collection. The questionnaire will be translated into the local language of the study site. The study tools will be pre-tested for about 1 week in diabetes patients across age and sex variables of the target diabetic cohort as shown by Abdella et al (1995) for diabetic Kuwaiti. Larger scal e administration of the instrument will be for 6 months following the pre-test period. Study population Based on the household registry linked to databases of diabetes organisations in Kuwait, the survey will stratify the area of Kuwait into seven strata according to the degree of urbanization, geographic location, and administrative boundaries. Townships or districts will be selected from each stratum with the selection probability being proportional to its size. Sample selection will involve the use of multi-stage cluster random sampling procedure at the district level to select sub districts and zones from where the study sample could be drawn. In each district, the area will be sub-divided into sub districts from which 3 zones will be selected based on population size. Within the selected zones, households will be randomly numbered, and houses assigned ‘even numbers’ will be selected into the final sample. . Instrument Administration Diabetes patients or their carer (as may be necessary) will be identified for face-to-face semi-structured interview, the administration of the diet questionnaire and the filling of a diet diary in the final sample population. Knowledge of dietary recommendations for the management of their diabetes will be investigated; types of food as well as feeding pattern in the last 5 years will be evaluated for each diabetes type. Answers will also be sought to questions that will provide insight into patients recent general daily energy intake and expenditure; daily amount of carbohydrate and protein in the diet, control of blood pressure and glucose levels in the last 5 years. Respondents will also provide insights into changes in local custom for dietary control of diabetes. Following the interview and administration of the diet questionnaire, each participant will be given a 7-day diet diary to complete after each meal or at the end of each day. It will be explained that the diet diary sh ould contain food types and time of eating and all dietary tactics taken to maintain normal blood glucose level (4–7 mmol/litre). The diet diary will further explore the truthfulness of information provided in the interview/ questionnaire as well as shed light on how the respondents have presented their recent self-care dietary strategies for the control of their diabetes. The Use of Interpreters Linguistic competency is central to cross-cultural studies and problems that may arise due to the researchers not understanding the local language could be overcome by the use of an interpreter (Davies, 1999). It may also be reassuring for the respondents to see someone with whom they share the same culture and language during the interview periods (Freed, 1988). Interpreters will either provide verbatim translation during the face to face interview or conduct the interview independently following adequate training (Baker, 1981). Psychometric Analysis of the Questionnaire for the Dietary Control of Diabetes Ensuring content and construct validity are appropriate methods to develop a knowledge instrument. Questionnaire validity is ideally established by comparing the new instrument being developed with an established recognized standard. There are no such standard for the target patients of this study. Reliability is also a vital attribute of a sound knowledge instrument. The diabetes-diet (MEDDS) instrument will be said to be reliable when scores are consistent over time within a site or as implementation moves from one site/country to another. The variability of the instrument’s results should in this case be due to true differences among the individuals patients that will be enrolled into the study (Streiner and Norman 1989). Content Validity Content validity refers to the extent to which a set of items reflects the intended content domain (De vellis 1991). A systematic approach to identifying important domains and developing specific items based on consultations amongst experienced practitioners in the management of diabetic patients will ensure the content validity of the ‘Middle East Diabetes Diet Survey’ (MEDDS) instrument’. This method follows those employed by Zeolla et al (2006) in determining patients’ knowledge of the management of their disease. Construct Validity Construct validity determines the instrument’s ability to function for its intended purpose (Kline 1986). The ‘contrasted group’ method will be used in this study to determine the construct validity of the MEDDS tool (Kline 1986). Reliability of the Diet Questionnaire A proportion of the diabetic patients recruited into the study will be followed-up after 4 months and urged to complete the diet questionnaire only. The time elapse is considered sufficient to reduce the impact of recall (Streiner and Norman 1989). A correlation coefficient will be calculated between the test scores from each administration. A coefficient of 0.80 or higher is considered acceptable for demonstrating test–retest reliability (Streiner and Norman 1989). Hypothesis for Construct Validity If the MEDDS instrument is a valid tool to assess the recent approaches for the dietary control of diabetes, patients managed for diabetes, should be more knowledgeable and achieve significantly higher scores than those not diagnosed or managed for the disease. To confirm this hypothesis, the response of diabetic patients to the final instrument will be compared with responses of age-matched subjects without diabetes in the same setting. Construct validity would be confirmed if the mean generated score for diabetic subjects were significantly higher than those not diagnosed or managed for diabetes. . Statistical and Data Analysis Statistical analyses will be by SPSS version 14. The results of the pre-test will be excluded from the analysis. Student’s t-test will be used to compare the differences in mean scores of patients managed and not managed for diabetes. Using chi-square (à ¯Ã‚ Ã‚ £2), demographics characteristics will be compared between patients managed and not managed for diabetes. Pearson’s correlation coefficient will be used for the test–retest reliability analysis. Descriptive statistics will be used to report patient demographics. The interview transcripts and the health diaries will be deliberated upon on more than one occasion to fully understand patients’ self care approach and identify individual patient’s dietary care strategies. Themes emerging from the interview will then be compared with dietary patterns observed in the 7-day diet diary and the diet questionnaire. Following a detailed analysis of the results of all 3 tools, perceptions of respondentsà ¢â‚¬â„¢ conformity to recommended dietary regimen or their general philosophy/strategy of managing diabetes with diet will be reached. ETHICAL CONSIDERATION The study qualitative paradigm protocol will be submitted for review and approval by the local ethics committee for the study region. A covering letter describing the goals of the study will be provided to patients agreeing to participate. The purpose of the study will be very carefully explained to the respondents and their consent will be individually obtained before the study tools are administered. Each participant will also complete a brief demographic questionnaire. In cases of identified illiteracy, the information contained in the form will be read by the study interpreter and informed consent sought. All respondents will assured of anonymity, confidentiality and that they could withdraw from participation in the study at any time. EXPECTED OUTPUT Interventions to prevent diabetes in the Middle East should include culturally appropriate and effective ways to improve the nutritional adequacy of the diet in line with international guidelines for the dietary control of diabetes. The result of the study will indicate the knowledge gaps if any in the study population. Tight glycaemia control associated with certain food types and feeding strategies identified in the study may become basis for its recommendation and use in other parts of the world for the control of the worldwide diabetes epidemic. References Abdella Nabila A., Moustafa M. Khogalib, Amani D. Salman’, Shaker A. Ghuneimi†, Jasbir S. Bajajd (1995) Pattern of non-insulin dependent diabetes mellitus in Kuwait Diabetes Research and Clinical Practice 29.1 29-136 Alberti, K.G. Zimmet, P. Z. (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1:Diagnosis and classification of diabetes mellitus, provisional report of a WHO commission. Diabetic Medicine, 15, 539^553. American Diabetes Association (2002) Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 25: S50–S60 Baker N (1981) Social work through an interpreter. Soc Work 26:391–97 Dave Taylor and Intuitive system (2007) [Internet] [Accessed 21st April 2007] http://www.readability.info/ Davies CA (1999) Reflexive Ethnography: A Guide to Researching Selves and Others. Routledge, London Delahanty LM (1998) Clinical significance of medical nutrition therapy in achieving diabetes outcomes and the importance of process. J Am Diet Assoc 98: 28–30 Devellis RF (1991). Scale development: theory and applications. Newbury Park, CA: Sage Publications. Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus. N Engl J Med 329: 977–86 Dyson Pamela (2002) Nutrition and diabetes control: advice for non-dietitians British Journal of Community Nursing Vol 7, No 8. 414-419 Freed AO (1988) Interviewing through an intrepreter. Soc Work 33(4): 315–97 Ha TKK, Lean MEJ (1998) Recommendations for the nutritional management of patients with diabetes mellitus. Eur J Clin Nutr 52: 467–81 Kline P. (1986) A handbook of test construction: introduction to psychometric design. New York: Methuen Co. Maitra A and Abbas A.K (2004). The endocrine system. In: Robbin’s and Cotran Pathologic Basis of Disease (edited by V. Kumar, A.K. Abbas N. Fausto). Pp. 1189-1207, 7th edn. Philadelphia, PA: Elsevier Saunders Company. Streiner DL, Norman GR. (1989) Health measurement scales: a practical guide to their development and use. New York: Oxford University Press. UKPDS (1998a) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes: UKPDS 33. Lancet 352: 837–53 UKPDS (1998b) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317: 703–13 UKPDS (1990) Response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients: UKPDS 7. Metabolism 39: 905–12 WHO (2007) [Internet] Available: http://www.who.int/diabetes/facts/world_figures/en/ Accessed 21st April 2007 Zeolla M. M., Michael R Brodeur, Angela Dominelli, Stuart T Haines, and Nicole D Allie (2006). Development and Validation of an Instrument to Determine Patient Knowledge: The Oral Anticoagulation Knowledge Test Ann Pharmacother 40:633-8. Zimmet, P., Taft, P., Guinea, A., Guthrie, W. and Tchoma, L. (1977) The high prevalence of diabetes mellitus on a central Pacific island. Diabetologia 13, 111-115.

The Struggle in Bread Givers Essay -- Bread Givers Essays

The Struggle in Bread Givers  Ã‚     Ã‚  Ã‚   Several changes have occurred since the 1920s in traditional family values and the family life. Research revealed several different findings among family values, the way things were done and are now done, and the different kinds of old and new world struggles. In Anzia Yezierska's Bread Givers, Sara and her father have different opinions of what the daughters' role should be. Sara believed that she should be able to choose what her life will be, because it is her life. She was assimilated to the new world in this sense. She felt that since she lived in America she should have the right to be free to chose her lifestyle and make it what she wanted. She believed that she should be able to keep some of her hard earned money for herself and that the father should get off his behind and work instead of reading the Torah all day long over and over. Her father believed that he should be able to chose what his daughters and wife did. He wanted them to work and give the money to the family. In the meantime he practiced the Torah. He felt that he should have all the good portions of the meal even though he did not work to provide the meal. This is an example of the new world VS. the old world. There is a definite generational tension over assimilati on, into America and expectations are different for the father from that of the women in the family. Sara's father also feels that he should get to pick the man that his daughters will marry. This is so old world, and Sara is not going to have it. She has watched her sisters who are so unhappy with the husbands that the father picked for them. Her father believes, "No girl can live without a father or a husband to look out for her," "It says in th... ... point of view the story of her life and her experiences. She does a wonderful job of depecting the struggles that she had with her father and the desire to become independent. This book shows us an in depth description of the life of an immigrant and their struggles to fit in and be like all the others. She works through the hard times and makes her life what she wants and fulfills her goal. Sara inspires us by showing us that if we work hard enough we can overcome anything and meet the goals of our life. Works Cited Cowan, Neil M. and Cowan, Ruth Schwartz, Our Parents' Lives. New York: New York Press, 1989. Kristeva, Julia, Strangers To Ourselves. New York: Addison-Wesley, 1991. Yerkes, Robert M., Book Review Digest: Reviews Of 1925 Books. New York: H. W. Wilson Co., 1926. Yezierska, Anzia, Bread Givers. New York: Persea Books, Inc., 1999.    The Struggle in Bread Givers Essay -- Bread Givers Essays The Struggle in Bread Givers  Ã‚     Ã‚  Ã‚   Several changes have occurred since the 1920s in traditional family values and the family life. Research revealed several different findings among family values, the way things were done and are now done, and the different kinds of old and new world struggles. In Anzia Yezierska's Bread Givers, Sara and her father have different opinions of what the daughters' role should be. Sara believed that she should be able to choose what her life will be, because it is her life. She was assimilated to the new world in this sense. She felt that since she lived in America she should have the right to be free to chose her lifestyle and make it what she wanted. She believed that she should be able to keep some of her hard earned money for herself and that the father should get off his behind and work instead of reading the Torah all day long over and over. Her father believed that he should be able to chose what his daughters and wife did. He wanted them to work and give the money to the family. In the meantime he practiced the Torah. He felt that he should have all the good portions of the meal even though he did not work to provide the meal. This is an example of the new world VS. the old world. There is a definite generational tension over assimilati on, into America and expectations are different for the father from that of the women in the family. Sara's father also feels that he should get to pick the man that his daughters will marry. This is so old world, and Sara is not going to have it. She has watched her sisters who are so unhappy with the husbands that the father picked for them. Her father believes, "No girl can live without a father or a husband to look out for her," "It says in th... ... point of view the story of her life and her experiences. She does a wonderful job of depecting the struggles that she had with her father and the desire to become independent. This book shows us an in depth description of the life of an immigrant and their struggles to fit in and be like all the others. She works through the hard times and makes her life what she wants and fulfills her goal. Sara inspires us by showing us that if we work hard enough we can overcome anything and meet the goals of our life. Works Cited Cowan, Neil M. and Cowan, Ruth Schwartz, Our Parents' Lives. New York: New York Press, 1989. Kristeva, Julia, Strangers To Ourselves. New York: Addison-Wesley, 1991. Yerkes, Robert M., Book Review Digest: Reviews Of 1925 Books. New York: H. W. Wilson Co., 1926. Yezierska, Anzia, Bread Givers. New York: Persea Books, Inc., 1999.   

Samuel Gander

Samuel Gander Mr. Dunham English 102 April 25, 2012 Farming On a Whole New Level Although people have worked in agriculture for more than 10,000 years, advance in technology assisted with maintaining and protecting land, crops, and animals. The demand to keep food affordable encourages those working in the agriculture industry to operate as efficiently as possible (Newman & Ruiz, pp. 33-47). Almost all people and companies in the industry have many acres of land they must maintain, and it is not always feasible for farmers to take frequent trips around the property to perform basic tasks such as watering soil in the absence of rain.The number of people-hours required to water soil manually on several thousand acres of land might result in businesses spending thousands of dollars in labor and utility costs. If the irrigation process is automated, sensors detect how much rain has fallen recently, as well as whether the soil is in need of watering. The sensors then send this data to a c omputer that processes it and decides when and how much to water. In addition to keeping the soil moist and reducing maintenance costs, computer also can utilize sensor to analyze the condition of crops in the field and determine whether pests or diseases are affecting the crops.If sensor detects pests and/or diseases, computers send a notification to the appropriate individual to take corrective action. In some cases, according to Brewster, the discovery of pests might trigger a pesticide to discharge in the affected area automatically (Agriculture: Expanding and Growing). Many farmers use technology in a daily basis to regulate soil moisture and to keep their crop pest free. With technology, farming can be much more convenient and efficient. ——————————————– [ 1 ]. Barton states the many automated home irrigation system also are programmable and use rain sensor (pp. 67-73)