Medication Adherence In African Americans - Free Essay Example

Sample details Pages: 17 Words: 5108 Downloads: 10 Date added: 2017/06/26 Category Ethics Essay Type Essay any type Tags: Africa Essay Did you like this example? 2. Methodology: Critically examine possible quantitative and qualitative approaches to examining medication adherence/compliance in African Americans and choose the à ¢Ã¢â€š ¬Ã‹Å"bestà ¢Ã¢â€š ¬Ã¢â€ž ¢ research method (support your choice). Denote the strengths and weaknesses of using multiple regression and logistic regression when analyzing data. When you have a dependent variable that can be continuous or dichotomous, choose which regression you would use and support your answer. What are the ethical implications of examining perceived injustice, coping, and relationship with health care provider in African Americans? Methodology Quantitative Approaches to Medication Adherence/Compliance in African Americans The purpose of the research study conducted by Thomas (2007) was to examine the relationship of components of self-concept (body sensation, body image, self-consistency, self-idea, and moral-ethical-spiritual self) and cognitive perceptions with adherence to prescribed recommended health regimes (low sodium diet, regular aerobic activity, and prescribed medications) in individual with heart failure (HF). This study used a descriptive correlational design was used to determine if relationships existed between predictor variables and medication regimes was a threat or challenge to self-concept and the outcome variable of adherence to prescribe health regime. Because of the some of the wording when describing the variables, clarity was problematic and re-reading was done several times to get an understanding of what the study was trying to measure. The research questions were written clearer than the description of the statistical analysis with the independent and dependent variabl es. A power analysis was conducted. The effect size of 0.13 was considered small and may not adequately measure the strength of the relationship between variables. Institutional Review Board (IRB) approval was obtained. The convenience sample was identified by clinic staff from two different heart failure clinics that screened for inclusion and exclusion criteria, 97 out of 134 subjects met the criteria. There was no mention of how the principal investigator trained the data collector to ensure consistency. No instruments were found that used Royà ¢Ã¢â€š ¬Ã¢â€ž ¢s Self-concept Mode Theory to investigate adherence in individual with HF, so a demographic questionnaire and three research instruments were developed using expert assistance. One of the instruments, the HF screening test (10 items) was not pilot tested prior to use. The cognitive perception of cardiovascular healthy lifestyles (57 items) was pilot tested and considered reliable. The adherence questionnaire (6 items) had low reliability scores. Validity indexes were high for all three instruments. Descriptive correlational and predictive correlation analysis using Pearson product moment correlation and stepwise multiple regression was appropriate statistical test to answer the research questions. Of the two research questions, one addressed relationships and the other addressed explaining variances. SPSS was used for data analysis. All data was collected during a regularly scheduled office visit by clinic staff. Verbal consent was obtained and implied consent was evidenced by completion of the questionnaires. Verbal and written instructions were given and confidentiality was explained. Subjects were given the questionnaires, pen, clipboard, and return envelope. Questionnaires were collected by the principal investigator, and kept in a locked, secure file until entered in the database. Returned questionnaires were 70 to 90 percent incomplete. No mechanism was developed to ensure that data col lection was complete, such as taking the subjects to a quiet comfortable setting, thoroughly explaining the need that all blanks be filled, and visually scanning the questionnaires after completion. It seems as if subjects completed the questionnaire in an office waiting room that may have had frequent interruptions. No incentive was offered to subjects and this may have affected their commitment to the research study. The most obvious challenges with this study included the instrumentation and collection of data. The reliability of the adherence questionnaire was low, so more testing and refinement may be needed. In addition, the procedure for data collection could have been improved to engage subjects more into the study, such as private area for testing and small incentives. Next, is a 12-week intervention study (Resnick, et al., 2009) was conducted to test the People Reducing Risk and Improving Strength through Exercise, Diet, and Drug Adherence (PRAISEDD) in a group of el derly African Americans who were low income. The sample resided in a senior housing site and were 65 years of age and older. IRB approval and inclusion and exclusion criteria was listed. Recruitment was completed in one meet-and-greet session at the housing site. The sample size was 22 out of 40 who had expressed interest in the study. The social ecological model was used to guide the study. The PRAISEDD method was designed to motivate, educate, and exercise subjects toward the outcome of improved self-efficacy and adherence to cardiovascular disease preventive measures such as exercise, diet, and medication. The first of the 12 weeks was an education class on preventive measures and goal setting, with advanced practice nurses and a pharmacist teaching the material. Weeks 2-12 were focused on a one hour exercise class three days per week with blood pressure and weights, motivational activities, health promotion education, and review of daily goal activities. These activities w ere lead by an experienced lay exercise trainer and the research nurse. Treatment fidelity was monitored to ensure PRAISEDD interventions were delivered as planned. A number of efficacy measurement tools were completed by the subjects: medication adherence self-efficacy scale (26 items), cardiac medication adherence outcome expectation scale (5 items), self-efficacy for health related diet (20 items), diet outcome expectations (1 item), self-efficacy for exercise (9 items), and outcome expectations for exercise (13 items). All instruments had established reliability and validity for older adults except the cardiac medication adherence outcome expectation scale, that was adapted from the osteoporosis scale and revised to address antihypertensives and lipid-lowering agents. Test-retest reliability and validity was established for this study. Instruments and baseline data was completed prior to the PRAISEDD intervention. This seemed to be a lot of instruments for this elderly popula tion. There was no mention of the time involved to administer the instruments nor if frequent breaks were given. Outcome behaviors included the Yale physical activity survey (questionnaire on physical activity), block brief food questionnaire (for recall of sodium and cholesterol intake), compliance questionnaire (self-report of medication taking), and blood pressure. All outcome measures except blood pressure were subjective and based on recall. Better objective outcome measures such as actigraphy (to monitor physical activity), pill counts (medication adherence), food diary (recall of food intake), and serum cholesterol and urine sodium (monitor food intake). Data was analyzed using descriptive statistics and a repeated-measures analysis of variance to detect changes from baseline to 4-month follow-up. The statistical software package was not mentioned. In summary, the study was well designed, but the outcome measures were a major weakness. Recruitment efforts should have been more aggressive than just one day. Objective outcome data would have made this a solid study. In addition, a control group may strengthened the study as well by providing comparison data. Although follow-up was provided a four months to post test the instruments, a periodic follow-up at weekly intervals may have helped to maintain the sustainability of health behavioral activities and goals. Don’t waste time! Our writers will create an original "Medication Adherence In African Americans" essay for you Create order Qualitative Approaches to Medication Adherence/Compliance in African Americans In a study conducted by Ogedegbe, Harrison, Robbins, Mancuso, and Allegrante (2004), the perceived barriers and facilitators to medication adherence in African Americans with hypertension was explored. An open-ended individual interview was used to gather data on subjects in two primary care practices during the course of a year. Purposeful sampling was used to recruit the best participants who could provide the useful information about medication adherence for this study. IRB approval and inclusion and exclusion criteria were listed. No incentives were provided and confidentiality was ensured. Subjects were identified from computerized medical records and appointment logs and approached during office visits or via telephone. Those who consented verbally were interviewed immediately, lasting about 20-45 minutes. Interviewing continued until saturation occurred. Four open-ended question guided the interview: (1) What difficulties so you have in taking your blood pressure medicati ons as prescribed by your doctor; (2) What situations make it hard for you to take your blood pressure mediations as prescribed by your doctor; (3) What situations make it easy for you to take your blood pressure medications as prescribed by your doctor; and (4) What are the skills that make it necessary for you to take your blood pressure medications as prescribed? All interviews were tape recorded and transcribed. Medical records were used to determine if blood pressure was controlled at less than 140/90 mmHg and retrieve antihypertension medications and comorbidities. Data analysis and collection occurred at the same time. Grounded theory methodology was used to analyze data whereby data of previous subjects was compared to that of new subjects. Transcripts were read over and over until recurring concepts to coding, to categories to themes to final coding to final categories. A qualitative software package, Ethnograph, was used to organize date and help with analysis. No menti on was made of moving to the theoretical level in the research study. The grounded theory approach was a good choice, considering the limited research in 2004 when this study was completed. One area of concern was the telephone interview, since the non-verbal responses were not captured. From the methodological perspective, the visualization of an emerging theory was not evident. The study seems more like phenomenology, the lived experience rather than grounded research. In another study (Lukoschek, 2003), focus groups were used to explore different beliefs held by adherent and nonadherent subjects that affect treatment. Uninsured, Medicaid-insured, and lower socioeconomic class African Americans with hypertension who attended an outpatient medical clinic in a large urban setting were invited to participate in this study. Contacts were made during visits, via telephone, or mail. IRB approval and inclusion and exclusion criteria was listed. A qualitative, comparative case de sign was used to categorized subjects as nonadherent, noncontrolled hypertensive, or as adherent, controlled hypertensive. Groups were in session for 90 minutes. All groups were audiotaped and tapes were transcribed. Sociodemographic variables were obtained and subjects received a $15 incentive for participation. Eight focus groups were obtained from 42 subjects. African American research assistants who were trained in focus group methodology served as moderators along with an assistant who took care of logistics such as refreshments, tape recording, and took field notes. The moderator began each session with a story to foster nonjudgemental atmosphere. Groups were asked eight identical, open ended questions that evolved from the health belief model. Examples of questions included: What do you think is hypertension; Why do you think some people get hypertension; Is there anything a person could do to treat hypertension; and What do you think patients about the medication that doc tors give to patients for their hypertension? SPSS was used to compute statistical analysis sociodemographic data. A comparison of the three groups was completed with chi-square for categorical data and f-test for continuous data. The principal investigator along with moderators and assistants analyzed all transcripts, independently for themes, and group discussion and agreement of categories and themes. Group work continued until themes were identified and agreed on by all and theoretical saturation occurred. The QRS NUD*IST software program was used for data analysis. The à ¢Ã¢â€š ¬Ã‹Å"Bestà ¢Ã¢â€š ¬Ã¢â€ž ¢ Research Method For the purposed research study on medication adherence issues in African American women with hypertension, a quantitative research design will serve as the best methodological approach. From the review of the literature, two qualitative studies were found on the proposed topic. According to Munhall (2007), quantitative research has its origins in qualitative research. The descriptions, interpretations, and understandings from qualitative data, if appropriate, may become the focus of a quantitative study, and unexplained grey areas of statistical data may lead back to another qualitative study. Munhall (2007)describes this process as the qualitative-quantitative cyclical continuum. A number of qualitative studies have been written on African Americans with hypertension (L. M. Lewis, Askie, Randleman, Shelton-Dunston, 2010; Lukoschek, 2003; Ogedegbe, et al., 2004; Ogedegbe, Schoenthaler, Fernandez, 2007; Peters, Aroian, Flack, 2006; Wexler, Elton, Pleister, Feldman, 2009). Al l of these studies mention antihypertension medication adherence in some form. As a result, the data has begun to repeat itself or saturate. Many of the themes are similar. In other words, we have a good idea of the problem, now it is time to determine relationships among variables and determine if certain combinations of variables predict adherence to the prescribed treatment regimen. Quantitative research will allow more sophisticated manipulation of data. When unexplained grey areas arise, we can resort back to qualitative research to gain more insight and the cyclical continuum may continue to evolve. Strengths and Weaknesses of Using Multiple Regression Multiple regression is concerned with relationships and prediction among variables. Multiple regression involves a single dependent variable (DV) and two or more independent variables (IV). The IV can be dichotomous or continuous and the DV is continuous (Huck, 2008; Tabachnick Fidell, 2007). For example, a study might want to learn, what are the best predictors of an elevated blood pressure (greater than 140/90)? The dichotomous IV can have two values such as reactance/nonreactance or coping/not coping. A continuous IV such as age, or a continuous DV such as blood pressure can have infinite measures. There are many strengths of multiple regression such as more than two IVs. These IVs can be combined to predict a value of the DV. For example, the relationship between a set of IVs such as coping, perceived racism, and trust in health care provider can be correlated with the DV blood pressure (Tabachnick Fidell, 2007). When each of the IVs are strongly correlated with the DV, th e regression is better (Polit, 1996; Tabachnick Fidell, 2007). With multiple regression, IVs can be analyzed in different units of measure by converting the IVs to z scores, thus making standardized scores for all IVs. This allows all IVs to be measured on the same scale with a mean of zero and a standard deviation of one (Polit, 1996). Multiple regression can be set up to accommodate covariates that researchers wish to control while looking at the impact of other IVs on the DV (Huck, 2008). In addition, regression modeling can be done whereby variables can be placed in or taken out of the model using methods such as simultaneous, hierarchical, or stepwise regression strategies (Polit, 1996). Another strength is the ability to ensure accurate and reliable statistical results by calculating a power analysis. The sample size is dependent on the number of IVs, the desired power, alpha level, and expected effect size(Tabachnick Fidell, 2007). In addition, when data is missing, i t can be estimated from other variables and instead of the grand mean by using computer statistical packages such as SPSS (Tabachnick Fidell, 2007). There are many weaknesses of multiple regression, one of which is assumptions. The results of multiple regression are not trustworthy when assumptions are violated, resulting in Type I or Type II error. Knowledge of assumption violations and not reporting them leads to serious bias and the validity of data is questioned and difficult to interpret (Tabachnick Fidell, 2007). Assumptions include independence, normality, linearity, and homoscedasticy. Of these assumptions, independence is robust to violation, if the violations are not too bad. Normality violations indicate skewed distributions representing increased variance in the form of outliers. Outliers are problematic, can affect the multiple regression analysis, and cause bias results, but they can also a means for further investigation to determine the reason they occurred (Huc k, 2008). Nonlinearity is problematic because the residuals are not concentrated in the center along a straight line (Polit, 1996). The homoscedasticity assumption is violated when the variance is not constant (Polit, 1996). If assumptions are violated, transformations can be done to stabilize linearity and normality (Polit, 1996). Another potential weakness is multicollinearity that occurs when two or more IVs are highly correlated to each other, and essentially measuring the same thing(Tabachnick Fidell, 2007). An example would be two predictors of high blood pressure: (1) not taking blood pressure medications and (2) not taking blood pressure medications on most days. The medication taking behavior is redundant since the blood pressure medication is rarely to never taken. In addition, if the sample size is too small, taking the time, energy, and resources to complete the research study is futile. If the sample is too large, results are vague and not useful (Tabachnick Fid ell, 2007). Also, missing data could be problematic. For example, if study participants refuse to answer sensitive demographic data such as income, which may be related to another variable such as reactance, then if the participantà ¢Ã¢â€š ¬Ã¢â€ž ¢s data is deleted, it could distort the sampleà ¢Ã¢â€š ¬Ã¢â€ž ¢s values on the reactance variable (Tabachnick Fidell, 2007). Misinterpretations of data analysis are seen as a weakness, not of the statistic, but with the researcher. With multiple regression, only relationships can be determined and there is never an underlying cause and effect mechanism (Huck, 2008). For example, there may be a strong relationship between lower income and blood pressure measurements 140/90, but we cannot conclude that lower income causes an elevated blood pressure. The most likely explanation of the correlation may be medication nonadherence related to an inability to afford the costs of medications (these variables need to be included in the study t o determine their relationship to high blood pressure). The higher the blood pressure, two or more drug categories may be needed to manage the blood pressure. Lastly, statistical data may have statistical significance but have little to no clinical significance (Huck, 2008). With an increased emphasis on evidence-based research, studies that yield practical clinical significance are held in high regard. Strengths and Weaknesses of Using Logistic regression Like multiple regression, logistic regression is also concerned prediction, trying to predict whether something will or will not happen. Logistic regression involves a single DV and one or more IVs. The DV is dichotomous, for example, a study might want to learn, whether or not a person will adhere to their blood pressure medication regime. The IVs can be categorical or continuous. A categorical IV has no numerical meaning such as gender, neighborhood, or types of comorbidities and an example of continuous IVs may be blood pressure, height, or weight. Logistic regression has several advantages, one of which includes less restrictive assumptions than multiple regression. For instance, logistic regression does not assume multivariate normality (Polit, 1996). In addition, IVs do not have to be linearly related or have equal variances within each group. Another strength, like multiple regression is that logistic regression can be done using methods such as simultaneous, hierarchical , or stepwise regression strategies (Tabachnick Fidell, 2007). In addition, the DV is calculated into the probability that an event will happen using an odds ratio, that transforms the probability of an event occurring into two probabilities, occurring or not occurring. An example is the probability of developing cardiovascular disease or the probability of adhering to hypertension medications. Overall, logistic regression is a more flexible analysis than multiple regression. Logistical regression has several disadvantages, one of which is that too few cases to the number of IVs predicts outcomes poorly. Therefore, a power analysis will needed to determine sample size. In addition, logistic regression can be costly especially when the number of IVs is large. Also, with multiple regression, there is a sensitivity to high correlations among IVs and this could result in multicollinearity whereby redundant variables need to be deleted. Lastly, sensitivity to outliers is problematic as with multiple regression. Which Regression for Continuous or Dichotomous Dependent Variable In summary, when a DV is continuous, multiple regression is used and when a DV is dichotomous, logistic regression is used. Multiple regression allows the measurement of variables that are continuous or interval, representing a numerical value such as age, income, and blood pressure. On the other hand, logistical regression allows the measurement of variables that are categorical or nominal, representing two possible levels such as gender (male or female), religious (yes or no), and neighborhood (urban or rural). It is possible for continuous variable such as age or income to be transformed into dichotomous variables, for example age can be displayed as 65 years of age or 65 years of age, and income can be displayed as $30,000 or $30,000. For the proposed research study on à ¢Ã¢â€š ¬Ã…“Issues Influencing Mediation Adherence among African American Women with Hypertensionà ¢Ã¢â€š ¬?, logistic regression will be chosen to analyze data resulting from the proposed aims and ass ociated research questions listed: Examine the relationships of demographic characteristics, perceived injustice, relationship with health care provider, medication knowledge, and coping to medication adherence in African American women with hypertension. Q1. Do the demographic characteristics (age, education, income, etc.), perceived injustice, relationship with health care provider, medication knowledge, and coping predict medication adherence in African American women with hypertension? Q2. When controlling for demographic characteristics, do perceived injustice, relationship with health care provider, medication knowledge, and coping predict medication adherence in African American women with hypertension? Explore the association between antihypertensive medication adherence and reactant behaviors in African American women. Q3. Is there a relationship between medication adherence and reactant behaviors in African American women with hypertension? The research q uestion drives the method and in this instance, the IVs are categorical (education, perceived injustice, relationship with health care provider, medication knowledge, and coping) or continuous (age, income) and the DV is dichotomous (medication adherence; adhere or not adhere). The intent of the research questions are to determine which IVs are predictors of whether or not medication adherence will occur and to determine if the odds ratio for these IVs indicate the likelihood of whether or not medication adherence will occur. Ethical Implications of Perceived Injustice in African Americans Justice implies equality, being just, treating people fairly and equally (Hall, 1996). Many African Americans in the U. S. have experienced perceived injustices in the health care system and been victims of disparate health care. Research findings confirmed the perceptions of injustices and discrimination experienced by many African Americans in various health care situations. An extensive study (Unequal treatment: What healthcare providers need to know about racial and ethnic disparities in healthcare, 2002) revealed that minorities are less likely than Caucasians to receive needed services, procedures, and routine treatments for common health problems and diseases such as cancer, cardiovascular disease, and diabetes. For example, cardiac care is one area of health care that consistently demonstrates disparity in health care access and delivery. When compared to Caucasians with similar clinical manifestations for cardiovascular disease, African Americans are less likely to r eceive pharmacological therapy (e.g. thrombolytic therapy), diagnostic angiography, heart transplantation, cardiac catheterization and invasive surgical treatments (e.g. coronary bypass surgery) even when treatments and procedures are judged to be appropriate. Although disparate health care is evident, another factor is the strong link between finances and access to cardiac care (Mayberry, Mili, Ofili, 2002). A sad but true revelation in healthcare as well as other facets of life is that injustice is pervasive among the poor and needy. African Americans have the highest poverty rate in the U.S. at 24.7% as compared to 8.6% of Caucasians (Income, poverty and health insurance coverage in the United States: 2008, 2009, September). However, this does not explain the injustices to people of color who have the ability to pay for health care (Kennedy, Mathis, Woods, 2007). Coping with perceived injustices may contribute to illness. A cross-sectional comparative study on discriminat ion and hypertension in older African Americans and Caucasian adults provided support that perceived discrimination was associated with higher diastolic BP. Authors concluded that discrimination may cause adverse effects on BP levels in people of African American descent (T. T. Lewis, et al., 2009). In another cross-sectional study of diverse middle aged women (African-American, Hispanic, White, Japanese, and Chinese women) examined the association between perceived unfair treatment and hypertension. African American women reported the highest levels of perceived unfair treatment followed by Chinese women. However, results did not indicate a positive correlation between perceived unfair treatment and elevated blood pressure (Brown, Matthews, Bromberger, Chang, 2006). Although the results of these studies show conflicting results, the realities of prolonged exposure to perceived injustices may contribute to illness. The issues surrounding hypertension are complex with multiple ca uses for this complex health disparity that results in disproportionate mortality rates. According to Fiscella and Holt (2008) the elimination of racial disparities in African Americans with hypertension will substantially decrease the number of deaths from cardiovascular disease. Better control of hypertension among African Americans can be obtained with adequate resources to discover and address treatment adherence (Fiscella Holt, 2008; Fongwa, Evangelista, Doering, 2006). However, it is imperative that current resources are equitable, and clients are treated fairly and given quality health care without regard to racial or ethnic status (Clark, 2009). Ethical Implications of Coping in African Americans Non-maleficence is the duty to do no harm or duty not to harm others (Hall, 1996). In the health care arena, harm seems inherent for those with a lower socioeconomic status, especially when healthcare services are not readily available when illnesses occur. Being unable to get proper medical care may create undue harm by overtaxing an individualà ¢Ã¢â€š ¬Ã¢â€ž ¢s coping skills with multiple fears and anxiety because of increased healthcare costs and decreased access to care. Historical evidence has shown that socioeconomic status is a strong predictor of health outcomes with poverty as the leading cause of avoidable morbidity and mortality (Bierman Dunn, 2006). James (1996) noted an inverse correlation between socioeconomic status and health; those with lower socioeconomic status are more likely to experience illness and premature death than those with higher socioeconomic status, thus adversely affecting African Americans, and other minority/ethnic groups. One hypothesis a ccording to James (1996) that may be a possible explanation for how socioeconomic status increases the susceptibility of African Americans and other minority/ethnic groups to increased morbidity and mortality is derived from the legend of John Henry. Based on this folktale, there was a contest between John Henry and a machine; he defeated the machine and suffered mental and physical exhaustion resulting in death. According to James (1996), John Henry symbolizes the relentless struggles of unskilled laborers in their effort to cope with psychosocial, economic, and environmental stressors that eventually erodes their health over time contributing to increased morbidity and mortality. Thus, harm is evident when differences in access to treatment play a role in why morbidity and mortality rates for some diseases are higher among African Americans than among Caucasians (Stover, 2002). African Americans and other minority/ethnic groups as compared to Caucasians have poorer access to he alth care services as evidenced by less annual visits to a health care provider, lower use of preventive services, an increased likelihood of not having a primary health care provider, and the likelihood of being uninsured (Mayberry, et al., 2002). Greater ethnic/racial disparities are found among the uninsured and Medicaid populations than those who are privately insured with indications that financial factors outweigh race/ethnicity when considering access to medical care (Mayberry, et al., 2002). Williams (2009, November) purports that a lower socioeconomic status predicts everything in society from the cradle to the grave, including SAT scores, income, jobs, housing, health, and health insurance coverage. Williams (2009, November) states that socioeconomic status is stronger than genetics and a lower socioeconomic status is greatly impacted when race and racism becomes part of the equation. However, the difference in health disparity between lower versus higher socioeconomic status is bigger than the health disparity between African Americans and Caucasians (Williams, 2009, November). According to Williams (2009, November), the issue is not one of availability of health care, but one of care that is accessible (office hours, distance, transportation, affordability, risk of job loss verses doctor appointment, etc.). In a research study conducted by Kumar, Schlundt and Wallston et al, (2009), a telephone survey of 2001 community based participants revealed that race concordance was not a significant predictor of health care quality. Findings did show that other factors such as higher income, higher education, and health insurance were predictors of better health care quality. In addition, socioeconomic status and access to quality health care were more important factors in achieving health status and health satisfaction. This study provides evidence that access to health care is primarily determined by socioeconomic status and daunting assumption that inaccessible health care may result in undue harm. Ethical Implications of Relationship with Health Care Provider in African Americans Respect for persons has two meanings: the (1) client should be treated as an autonomous agent, able to make their own choices, and (2) client who is unable to be autonomous has the right to be protected. It is important that the client and health care provider establish a working relationship built on mutual trust (Clark, 2009). In relationships, trust is vital, especially since the primary matter is adherence to the treatment regime. For many African Americans, health care disparities have hindered the establishment of a trusting client-provider relationship (L. M. Lewis Ogedegbe, 2008). African Americans differ from other racial/ethnic groups, such as Caucasians and Hispanics, because of their history of slavery, oppression, and discrimination. Because of skin color and other distinctive features such as hair texture, thick lips, body shape, the lives of African Americans was not valued. They were frequently used in medical experiments by Caucasian doctors to perfect their te chnique before attempting procedures on the Caucasian race. These types of exploitations by Caucasian physicians endured a long history (Gamble, 1997). As a result, perceived stereotypes and prejudices experienced by African Americans in the health care arena have resulted in mistrust, refusal of treatment, and/or poor adherence with treatment regimes by African Americans (Unequal treatment: What healthcare providers need to know about racial and ethnic disparities in healthcare, 2002). A study conducted by Benkert, Peters, Clark, and Keves-Foster (2006) found that the majority of low-income, urban dwelling African Americans were fairly trusting of their healthcare providers and satisfied with the health care given, although negative effects of perceived racism on trust and satisfaction were evident. This study confirms that African Americans do experience an element of trust is in their health care providers, but skepticism continues. According to Benkert, Hollie, Nordstrom, Wickson and Bins-Emerick (2009), nurse practitioners have better trusting relationships with African American clients. Study participants with higher trust and satisfaction were in concordant client-provider relationships. Further study findings revealed that African American men reported less satisfaction with care provided by nurse practitioners and were more suspicious of the health care system. Reasons for lack of trust in this study was not investigated. However, if the men in the study perceived that their treatment was different from Caucasian clients, then that may contribute to mistrust (Clark, 2009). Disparate health care among African Americans and other racial/ethnic groups is well documented (Unequal treatment: What healthcare providers need to know about racial and ethnic disparities in healthcare, 2002). Because remnants of African American history continue to exist in subtle configurations, many approach health care with fear, skepticism, and caution (Gamble, 1997 ). Therefore, it is important that health care providers, along with African American clients, devise mechanisms to transcend the effects of history, restore trust in the health system, and overcome barriers to forming relationships to foster optimal health care.

Relationship Between Religion And Language - 1877 Words

MOI UNIVERSITY SCHOOL OF ARTS AND SOCIAL SCIENCE DEPARTMENT OF PHILOSOPHY AND RELIGIOUS STUDIES NAME: MAMATI KING’ASIA REG NO: SASS/PGR/04/2014 COURSE TITLE: THEORIES OF RELIGION COURSE CODE: REL 803 PRESENTED TO: DR.HASSAN JUMA NDZOVU TOPIC: RELATIONSHIP BEWEEN LANGUAGE AND RELIGION DATE: 3RD JUNE 2015 The relationship between Religion and Language Religion and language are largely related to each other. Religion is acquired through the medium of language. However, both religion and language may be closely connected at a deep level and may be acquired in quite similar ways The religious instinct .The basis of religion is not belief but is narrative. Narrative is largely a matter of language: narratives are primarily expressed in words (also in pictures, but the pictures generally require verbal elaboration if they are to be understood). The deep structure of religion is found in Religion being universal in all human societies. 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Ebla’s political structure, language, religion and art all reflectRead MoreEssay about The Soldiers Prayer by Michael Herr 769 Words   |  4 PagesJournalist Michael Herr wrote poignantly of the difference between organized and personal religion in combat in Vietnam: The Soldier s Prayer came in two versions: Standard, printed on a plastic-coated card by the Defense Department, and Standard Revised, impossible to convey because it got translated outside of language, into chaos—screams, begging, promises, threats, sobs, repetitions of holy names until their throats were cracked and dry, some men and bitten through their collar points and rifleRead MoreHuman Primates, Humans, And Humans1679 Words   |  7 PagesEven though we evolve from our non-human ancestors and share similar anatomical structures and characteristics, we are unique in our own ways. We possess specific qualities and abilities that differ from other species. There is a substantial gap between non-human primate and fully developed human. Here we will discuss on the three significant ways in which human beings are different than other animals in terms of biology, cognition and culture. Firstly, humans are biologically different from our

Importantance Of Marketing Research Process †MyAssignmenthelp.com

Questions: 1.Which of the steps of the marketing research process doyouthink is themostimportant and why? 2.Do you think that a company should follow findings from market research? Why or why not? When would it be appropriate (or not)? Answers: 1. Each and every step that is taken in the research methodology process is essential and is important to ensure that the information that is gathered and analyzed is appropriate and is not tampered due to the variation in the relevance of the study. There is a set process that is internationally accepted to follow while constructing a research paper whether it is market research or academic research. This procedure is undertaken to ensure that there is a logical flow of information so that the reader is able to understand the study. Selection of the right data collection tool or instrument is very important to get the right kind of information from the right people at the right time, for example in case the subject requires for a semi structured interview but the chosen tool is survey then the findings may be irrelevant (Hague et al., 2013). Selection of the sample size out of all the steps is the most essential part of market research, the population of the study has to be thorough ly checked and analyzed in order to determine a concrete outcome. Therefore the process of selecting the sample size is essential as the response of these people will manipulate the result of the findings and lead to the conclusion of the research (Burns et al., 2014). 2. I think that a company should follow findings form market research as it helps them to understand the need and requirement of the stakeholders of the company based on the topic of research. It is important to formulate the decisions and policies of the company based on the dynamics of the industry in which the company exists and with the help of market research the company can analyze and determine the various prevalent dynamics o the industry. For example a company is diversifying with an existing product or service idea, in order to initiate the process the organisation requires a lot of capital it is a good idea to undertake a market research regarding the new idea as the response and the findings will help the company understand the perspective of the target market which will in turn help the company save from investing the capital in case the response is negative. References Burns, A. C., Bush, R. F., Sinha, N. (2014).Marketing research(Vol. 7). Boston, MA, USA: Pearson. Hague, P. N., Hague, N., Morgan, C. A. (2013).Market research in practice: How to get greater insight from your market. Kogan Page Publishers.

Rhetocial analyisis free essay sample

In Hanna Guthrie’s article, â€Å"Black History Month,† the UCI New University writer discusses the racism in America. In order for racism to be abolished, Guthrie accentuates racism is being spread through American Citizens self segregation. Though Hanna Guthrie article presents a clear claim and provides a small amount of factual evidence to support in itself, ultimately Guthrie article is unsuccessful because she fails to provide an adequate amount of logic-based information to support her primary claim, excessively dependent upon emotion-driven attacks on those who disagree with her, and frequently fails to present her augment in a approach that makes her creditable. Guthrie primary claim for racism experienced in the United Stated is self imposed. The writer never directly states her primary claim, but it’s inferred due to the sub arguments in the article. Throughout the Black History article, Hanna Guthrie fails to provide a sufficient amount of logical statements that support the little facts she does provide, yet she discredits them with fallacies such as hasty generalization and multiple use of emotional apply, thus forcing her to rely on an outside source to support her augment. Hanna’s first claim states, â€Å"Its irritating how many people believe that racism will end as long as almost every American minority has a special day, week, month club organization dedicated to them. † Hanna exploits the fact that most minority groups have a special day, or some other time frame for acknowledgements, yet she discredits the same fact with her extreme use of drawing conclusions with insufficient evidence. Guthrie second claim states, â€Å"Racism no longer characterizes society as a whole. †(Guthrie 1). Hanna then goes on to discussing an outside article, where she informs the reader on much information that is not needed or relevant. Hanna does not discuss the topic of how racism is no longer a,†characteristic to society as a whole,† but says â€Å"I’m not ignorant or naive about racism within our society. Hanna heavily relies on a writing done by Raina Kelly where she quotes the article 4 times within her 8 paragraphs. Her third and final claim as stated in the text reads, â€Å"I think much of the problem today in the way of racial relations, is with America’s obsession with political correctness. † (Guthrie 1). Once again her use of strong emotional appeal to state her claim, conceals and validates her statement which is truly nothing more than an opinion. She uses the fallacy of appeal to fear, or a â€Å"Scare Tactic†, by using words such as â€Å"obsession† and â€Å"radicalized movements. † When Hanna constructed her paper she didn’t use factual evidence, which in turn completely undermines her primary claim. Hanna Guthrie does anticipate counter augments when she says, â€Å"As it is, you probably think I’m racist for delivering into this issue to begin with. † (Guthrie 1). The author gives another fact when she says, â€Å"It’s a known fact that things like affirmative action give preferential treatment to American minorities. †( Guthrie 1). Hanna discredits this fact by her skewed opinion providing another false sub augment. Hannah Guthrie was a second year English major student when this article was posted in 2010. Hannah being a student questions her creditably because she isn’t an expert and nor does she have a reputation for being advocate on stopping racism. She was a writer for the UCI’s â€Å"New University†, which is a school news paper often stretching to seek attention from the media and other forms of press. The news paper organization she writes for is not a creditable source being it was a school news paper. Her outside source ,which she heavily relied on to support her main arguments, was not a creditable source as well because it was an opinionated article from Newsweek Magazine. Newsweek Magazine provides in depth news, analysis, and opinions on international issues such as politics and culture, but is actively driven by its passionate writers. Hanna then shifts her augment to be supported by political correctness, and personal responsibility, or the lack there of, which immediately discredits most of her strongest facts for her argument. Throughout most of â€Å"Black History Month†, the persistent begging of the question leaves Hanna in an endless cycle. Some may find her article to be persuasive, convincing, and compelling due to the sources the author believed to be creditable. Hanna Guthrie half heartedly supports her claim by stating, â€Å"To make my point we have an â€Å"African American† president; other African American in the spotlight are former Secretary of State Condoleezza Rice, Colin Powell, GOP Chairman Michael Steele, Orpah Winfrey, nationally syndicated talk- radio show host Larry Elder and may more. This isn’t a creditable statement, because it’s a faulty analogy. Her comparison from the icons in the African American culture to an average African American would easily see the appeal to celebrites which undermines the author’s creditably. Hannah Guthrie article is primarily relying upon emotional appeals, inflammatory language, and condescending tone. The augment presented is not strong in its self, and is weakly supported . Hanna starts her article off by appealing to the audience emotions and sense of pride by saying, â€Å" One such example of a holiday that supposedly helps eliminate racism is Black History Month†. (Guthrie 1). She also takes an emotional offense to the term â€Å"African American†, that is followed by a misleading argument over the accepting-ness of Americans and other nationalities with in America. Hanna believes our accepting of different nationalities in America, and recognizing them as such, will lead to â€Å"self segregation†. She appeals to the readers with a false need of being a victim by saying, â€Å"All it [Club organizations and holidays] seeks to do is give preferential treatment to self segregating groups whose main purpose is to cry eternal victimhood. † (Guthrie 1). Using terms such as â€Å"white man† and â€Å"sake of calling† appeals to the audience emotionally again. She reiterate uses emotional appeals to make her false arguments more appealing to her audience. To a group of educated people they will see that her arguments aren’t facts and emotional driven â€Å"paper wasters†. Its apparent that Hanna Guthrie is attempting to sway her audience that racism is self imposed and in order to stop racism no should be anklogeded . Though Hanna Guthrie article presents a clear claim and provides a small amount of factual evidence to support in itself, ultimately Guthrie article is unsuccessful because she fails to provide an adequate amount of logic-based information to support her primary claim, excessively dependent upon emotion-driven attacks on those who disagree with her, and frequently fails to present her augment in a approach that makes her creditable.

St. Anselms Ontological Proof of God

Athletic heart syndrome Essay Example

Athletic heart syndrome Essay Example Athletic heart syndrome Paper Athletic heart syndrome Paper Athletic heart syndrome is a series of conditions steming from a physiologically enlarged heart that is noticed in athletes. Athletic heart syndrome basically as a result of an hypertrophied heart. The resting heart rate, including that measured during exercise, is low when compared with that of other normal persons (both the basal rate and the working rate) (Kenneth et al, 1973).   Muscle contraction is the primary physiological event that occurs during exercising. This is one of the processes in the body that consumes much energy. The cardiovascular system is a conduit for the transport of this energy all round the body. At the same time, the cells are detoxified of all waste products of metabolism.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Exercise puts a whole lot of stress on the cardiovascular system. Athletes are constantly involved in exercising. They frequently strain the cardiovascular system through the demand of the muscle cells (myocytes) for more perfusion. This constant strain on the heart in particular, leads to a physiological hypertrophy of the cardiac muscle cells. The left ventricle of the heart is most affected because it is a high pressure pump that supplies blood to the Aorta, the largest artery in the body. The aorta transmits the blood to other parts of the body including the brain, limbs and all other organs of the body (Kumar et al, 2004) A hypertrophy of the heart is most evident by the thickening of the left ventricle, although, other chambers of the heart are affected. This effect is a sort of physiological conditioning for the heart to be able to cope with the increased load and at the same time, does not feel stressed up. By so doing, athletes ca n persist in the vigorous activity for a longer time than other individuals without overworking the cardiovascular system. (Microsoft Encarta, 2008) Oxygen consumption of like-sized active athletes and normal individuals will be roughly the same at rest or at a given level of exercise. However, the fit individual (the athlete) will be able to achieve greater maximal oxygen consumption, even at a lower heart rate, due to the training effect that takes place with regular exercise. As the athlete engages in regular aerobic exercise, the heart, lungs, and muscles all become more efficient at utilizing oxygen. The heart pumps more blood with cardiac output, the lung capacity of each inhalation increases, and the muscle fibers (myocytes) extract more oxygen from the blood. The training effect on the heart is quite evident when heart rates are compared between long-distance runners and sedentary individuals. The athlete will have a lower heart rate at rest (perhaps as low as 50 beats per minute) and during light jogging, for example, than the non-athlete (who might have a resting rate of 80). During light jogging, the untrained person w ill experience a large increase in heart rate, while the athletes heart rate will not rise nearly as much. MECHANISM The heart has an intrinsic property of being able to generate electrical impulses that excite the myocytes. The Sinoatrial, Atrioventricular, Bundle of His and the Purkinje fibers all make up the electrical conduction system of the heart. Besides this intrinsic control, the heart is control by autonomic nerves that form part of the autonomic nervous system. The sympathetic part of the   ANS causes a stimulation of the heart – the rate and force of contraction are increased. The parasympathetic system on the other hand causes a decrease in the rate and force of contraction of the heart. In times of need, for instance, when an individual is exercising, the heart rate is increased so as to increase the cardiac output of the heart. In athletes, however, the heart rate is not increased in spite of the dramatic increase in the cardiac output of the heart. This is because of the physiological hypertrophy of the myocytes and also the basal firing of Vagal impulses to the heart. The Vagus nerve supplies the parasympathetic innervation to the heart.(Ganong, 2001) DIAGNOSIS Athletic heart syndrome is asymptomatic. The syndrome cannot be detected unless series or medical tests are carried out. A chest x-ray will show an enlarged heart – this is possible by checking the cardiothoracic ratio and determining if it is normal or not.   Other medical tests include stress tests. During stress tests, the athlete is asked to go on a Treadmill and exercise. Assessment of a persons physical fitness includes measurement of aerobic capacity in the form of maximum oxygen consumption during aerobic exercise. At regular intervals, the pulse rate and the blood pressure are measured; this would give an indication of the rate at which these parameters are changing with the progression of exercise. Also, on electrocardiography, increased activity is noticed in the region of the left ventricle, evidenced by a large QRS complex. The complex is tall and peaked, showing an increase in time that that the ventricular muscle fibers have to depolarize and repolarize. Systo lic murmurs, slow heart rates, arrhythmias and alterations in S-T segments and T-waves are all features of the athletic heart syndrome (Kenneth et al, 1973) MORTALITY AND MORBIDITY Athletic Heart Syndrome is asymptomatic therefore, it is a potentially morbid condition. Athletes with this condition are prone to s number of heart diseases. Cardiomyopathy, which is damage to the weakened heart, is likely to occur in some athletes – Heart failure is the ultimate. Also, in some athletes, heart failure has caused sudden death. This is because they were no prior diagnosis of any heart disease. After a period of relative inactivity by the athlete, the myriad of modifications to the cardiovascular system normalize. The cardiomegaly subsides. This is important as it distinguishes this syndrome from other cardiomyopathies. Rich (2007). REFERENCES. W. F. Ganong (2001). Review of Medical Physiology. 20th ed. McGraw Hill Companies. pp 275 290 V. Kumar, A. K. Abbas, N. Fausto (2004) Robins and Cotran Pathologic Basis of Disease, 7th ed. Saunders – Elsevier. pp 460 -466 Microsoft Encarta (2008). The Human Heart. Microsoft Inc. Microsoft Encarta (2008). Exercise. Microsoft Inc. B. Kenneth, A. Benchimol, J. Schumacher (1973). External Pulse and Vectocardiographic Abnormalities in the Athletic Heart Syndrome. â€Å"Ches. American College Of Physicians. Pp 289-295 B. E. Rich (2007). The athletic heart syndrome. Current Sports Medicine Reports. Current Medicine Group LLC

Respond essay Example | Topics and Well Written Essays - 500 words - 1

Respond - Essay Example People need to discard their otherness in the other culture through assimilation. They have to adopt Anglicized names in order to have themselves accepted as normal beings. They do not want to be de alla, for which they have to adopt an identity that is different from one they are born with. Hence, Munoz’s main focus is on the need of people to adopt Anglicized names to adapt in a new culture that is superior to their own. 2. Munoz does not state his thesis statement straight away; instead, he starts with an account of a Mexican woman calling a visitor at the airport, and then describes how his cousins and others in the family changed their names in order to get themselves accepted in the English society. Munoz, much later in the essay, talks about how assimilation affects one’s identity, when he says: â€Å"It applies to needing to belong, of seeing from the outside and wondering how to get in and then, once inside, realizing there are always those still on the fringe† (Munoz, para.17). In the same paragraph, Munoz states how the corrosive effect of assimilation affects an individual’s cultural identity. He states that assimilation results in one culture displacing the other, and this happens when one is not able to sustain two identities in one being, for which he has to leave one and adopt the other that is useful for him in terms of living and profession. One has to give in to the new culture to feel accepted, or in a broader sense, to escape from ethnic/racial discrimination. 3. Munoz gives lists of names to reinforce his thesis statement. He mentions names of his cousins, his grandfather, and others in his family and friends, to emphasize upon his thesis statement. I found it a little bit distracting, although it was helpful in understanding what he really meant to say. A few examples were really necessary to obtain a clear understanding, but I really found it annoying to go through so many names,

Operations Management, Assignment-Supply Chain Assignment

Operations Management, -Supply Chain - Assignment Example y, the core functions entail transporting of goods, fulfilling orders, packaging, labeling, cross docking and other significant services that involve making sure that orders go through the full cycle. Decisively, warehouses and distribution center’s main focus is on customer’s needs and services through the implementation of the techniques that ensure the products are in their best condition observing aspects such as cost and efficiency. Currently, there are warehouse systems operational on the World Wide Web with the multiple advancements in technology; nonetheless, even customary warehouses and distribution centers embrace technology in meeting the objective and performing their roles (Keller 1). Appreciably, technology makes it easier for warehouse to process orders, manage transportation and even use the varying management information systems in scanning bar codes, plan loads among other activities. Definitely, warehouses and distribution centers’ activities base on relationships with the main link being between suppliers and consumers hence the management in these sectors must understand customers’ needs and the most efficient methods of operations. Warehousing and distribution centers’ are among the core areas that continue to advance in supply chain management and as a matter of effectiveness performance measures apply in determining productivity. Due to competition and meeting customers’ needs, the products must be in the right place, at the right time and in the right condition for a warehouse to uphold efficiency hence measuring performance entails the achievement and sustainability of these goals. Essentially, most warehouses and distribution centers use units and lines in the measurement of productivity by calculating the number of units or lines collected per hour in day. However, this does not entirely meet the standards of efficiency so other methods apply in measuring usable space by observing facets such as storage utility (Keller

Research Paper Example | Topics and Well Written Essays - 1250 words - 7

Research Paper Example These physical and psychological demands of the profession of nursing often leads to high job stress amongst nurses. Employee performance on the job is a function of three factors working together: effort, skills and abilities and the work environment. Skills is the set of abilities and knowledge possessed by the employee whereas effort signifies the amount of hard work the employee puts into the job (Levey, 2001). The theoretical framework of a research includes: the variables under study, the nature of relationship between the two and the reason for the same, study of other variables that might affect the outcome of the relationship and a schematic diagram showing the various relationships (Sekara, 2009). The two central variables under study in this study are: job stress and employee performance. There have been many definitions for stress. Michie (2002) defines stress as the psychological and physical state of a human when the resources available with the individual are not sufficient to manage with the demands and pressures of the situation. Although stress can not be said to be harmful in all the cases, it does seem to have significant negative effects. For success it is necessary that organizations provide quality services efficiently. In this scenario, job stress becomes a very important variable to be studied. There have been many factors that may result in employee being stressful at the job. Some of the reasons that may lead to stress at work include: poor physical working conditions, time pressures, work overload, role ambiguity, role conflict, dissatisfaction with the appraisal process, poor relationships with the manager or the subordinate or absence of decision making powers (Michie, 2002). Besides these, issues at home such as financial problems, or life crisis can also lead to job stress. The second important variable that needs study is the employee performance. Job stress often has significant impact on the employee morale.

Macro and Micro Nutrients

Macro and Micro Nutrients Nutrition is basically the process absorbing, consuming and using nutrients needed for the growth of the body, maintenance and development of the life (Wikipedia, 2009). Nutrients are basically chemical substances in foods that strive to nourish the body. Many nutrients in the body can be synthesized. Those nutrients that cannot be synthesized in the body are known as the essential nutrients that are a must to be consumed in the diet. These nutrients include amino acids which are found in proteins, minerals and proteins and certain fatty acids. From the 20 amino acid nutrients, nine of them are known as the essential nutrients. If the essential or necessary nutrients are not supplied in the quantities that are required, deficiencies disorders of nutrition can be the outcome (SHARMA, 2012). To determine as to whether the person is getting the right amount of nutrients a doctor usually examines and asks about the diet and the eating habits, performs a physical assessment to examine the composition (the amount of muscle and fat), and the body functioning. Finally the doctor orders the laboratory tests to measure the exact content of tissues and blood. In general the nutrients are divided into two classes, micro nutrients and macro nutrients. The macro nutrients including fats, carbohydrates, proteins and some minerals are usually required daily in large quantities. They usually make up the bulk of supply and diet, the energy and building blocks required for the growth, activity and maintenance. Micro nutrients on the other hand are required in small quantities usually in milligrams which are calculated to be 1000th of the gram, and one millionth of a gram in micro grams. They usually include trace minerals and vitamins that catalyze the exact utilization of the macronutrients. Other needy components of the food arent metabolized or digested to any kind of an appreciable extent. The components usually consist of fibers such as the pectin, cellulose and gums. The authorities recommend that twenty grams of fiber should be consumed every day to improve the movement and motion in the gastrointestinal tract, normalize the changes in cho lesterol and blood sugar that usually occurs after meals, and maximize the elimination of the cancer causing substances that the bacteria in the large intestine usually produces. The food additives including emulsifiers, preservatives, stabilizers and antioxidants improve the production, processing packaging and storage of foods. The substances such as the flavors, spices, colors, odors, phytochemicals and many other natural products enhance the taste, appearance, taste and stability of foods. The food in the daily diet usually includes or can contain as much as 100000 substances, out of which around 300 are the nutrients, and around 45 are the nutrients that are essential. TYPES OF NUTRITION MACRO NUTRIENTS The organic macro nutrients are usually the fats, carbohydrates and proteins, and they supply around 90% of the dry weight of the diet and energy of around 100%. They are usually digested into the intestine and then they are always broken down into their core or basic units; the glycerol and fatty acids from fat, sugars from the carbohydrates and the amino acids from the proteins. The energy content is usually 4 calories in one gram of carbohydrate or protein and 9 calories in a gram of fat. As the main sources of fats, carbohydrates, energy, and proteins are usually interchangeable in part or proportion to their content of energy. The intake of energy varies a lot from around 1000 to 4000 calories every day depending on the sex, age and physical activity (SELFNUTRITIONDATA, 2012). Ideally the young children, sedentary women, and older adults need around 1600 calories every day. On the other hand older children, sedentary men and adult women need about 2000 calories every day. The young men and adolescent boys need around 2400 calories a day. Around 55% of the calories usually come from carbohydrates, 15% come from protein and around 30% come from fats. If the energy intake is less or insufficient for the bodys needs and requirements, then the act of weight loss comes into play, and the fat that is stored in the body and the protein to a lesser extent is used to supply the energy that is needed for everyday survival. Total starvation can usually cause death in the period of around 8 weeks to 12 weeks. The necessary fatty acids contribute to around 7% of the fat that is consumed in the normal diet, which is thought of to be around 8 grams or 3% of the total calories, and therefore are considered to be macronutrients. They usually include linolenic acid, linoleic acid, eicosapentaenoic acid, arachdidonic acid and docosahexaenpoic acid. The linolenic and the linoleic acid are usually found in the vegetable oils, docosahexaeoic and eicosapentaenoic acid is necessary for the development of the brain and is usually found in the fish oils. In the body the arachidonic and docosahexeonic acid can be created from the linotenic acid despite the fact the fish oil is a more efficient source. Usually the macro minerals are the phosphorus, calcium, sodium, chloride, magnesium and potassium. These macro minerals are considered to be macro nutrients because they are required in large amount of quantities which can be around 1 to 2 grams a day. water which is also a macro nutrient is usually required in the quantities of around 1 millilitre for each calorie of energy or in the range of 2500 milliliters a day. MICRO NUTRIENTS Vitamins and trace minerals are usually known as the micro nutrients. The vitamins are usually classified as water soluble, and this includes eight members of the vitamin B complex and the vitamin C, or fat soluble which includes the vitamins D, A, E and K (SHARMA, 2012). the essential trace minerals usually include the zinc, iron, copper, manganese, molybdenum, iodide, selenium, and fluoride. All of the minerals usually activate the enzymes needed in the metabolism except for the fluoride. Fluoride usually creates a stable compound with calcium, aiding in stabilizing the mineral content of teeth and bones and helping in preventing the tooth decay. Trace minerals including chromium, arsenic, cobalt, silicon, nickel and vanadium which might be essential in animal nutrition have not been usually established as the fundamentals in human nutrition. All the trace minerals are said to be toxic at the upper or higher levels and some minerals such as the nickel, arsenic and chromium have bee n pointed out as the causes of cancer. Healthy diet and dietary tools A healthy diet plan is essential in order for one to lead a healthy life. Thus the correct food choices are essential (Hill) Meals or foods with starch because these foods can provide you with a lot of energy Eat a lot of vegetables and fruits every day. Preferred is to eat 5 varieties of fruits and vegetables every day. Eating more fish can be very beneficial. It is preferred to eat two potions of fish every week. Reduce the usage of salt in your everyday. It is preferred to eat no more than 6 gram of salt per day. Minimize the usage of saturated fat and sugar. Exercise daily and keep your weight healthy. Healthy weight is essential for health. Drink a lot of water since it has no side effect. Preferred intake of daily water is 6-8 glasses. Breakfast is essential and should not be skipped because it gives you all the required energy you need for the day. Bread, eggs, butter and milk can be a good source of breakfast. If above dietary plan is properly followed it will lead to a person having a healthy life and free from any kinds of diseases, physical problems and stress. CONCLUSION Overall nutrients are an essential part of the life of a human being that are required in each and every stage of the life. It is basically the process of absorbing, consuming and using nutrients needed for the growth of the body, maintenance and development of the life. Nutrients are basically che mical substances in foods that strive to nourish the body. Therefore they need to be taken in essential quantities so as to nourish the body of the human beings. Both the macro nutrients and micro nutrients are an essential part of this nutrient process. The macro nutrients normally include the fats, carbohydrates and protein, whereas the macro nutrients usually include the vitamins and trace minerals. What the person or a human being needs to know is that what is the right quantity for him or her to consume and as to what combination of the fats, proteins, carbohydrates and vitamins are essential for them. When the persons are well aware of these things then they are able to eat a healthy diet and usually stay healthy all their life.

organisational diagnosis Essay -- essays research papers

Perform a diagnosis of an organization that you are familiar with, using the diagnostic organizational level analysis. Your diagnosis should include an assessment of the organization’s performance and an indication of the underlying cause of problems. 1. What is diagnosis?   Ã‚  Ã‚  Ã‚  Ã‚  Diagnosis is a systematic approach to understanding and describing the present state of the   Ã‚  Ã‚  Ã‚  Ã‚  organization. 2. The open system: The general diagnosis model based on systems theory that underlines most of OD.   Ã‚  Ã‚  Ã‚  Ã‚  The elements in open system model are: - Input: Information, energy, people - Transformations: Social component, technological component - Output: Finished goods, services and ideas 3. Organizational level diagnosis The elements in organizational level diagnosis are: -  Ã‚  Ã‚  Ã‚  Ã‚  Inputs: General Environment, Industry Structure -  Ã‚  Ã‚  Ã‚  Ã‚  Strategic Orientation: Strategy, Organizational Design -  Ã‚  Ã‚  Ã‚  Ã‚  Output: Organization Performance, Productivity, Stakeholder Satisfaction MICROSOFT CARPOINT ANALYSIS INPUT †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  General Environment: -  Ã‚  Ã‚  Ã‚  Ã‚  Technology—depends on the advancement the technology, e.g. easy to imitate products/services. -  Ã‚  Ã‚  Ã‚  Ã‚  Social and Ethical --- less privacy, accuracy and safety. -  Ã‚  Ã‚  Ã‚  Ã‚  Economic --- different income and spending, e.g. crisis in Asia causes less purchasing power. -  Ã‚  Ã‚  Ã‚  Ã‚  Political and legal --- government regulation, e.g. taxation, domain name registration, copyright. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Company Industry Structure: -  Ã‚  Ã‚  Ã‚  Ã‚  Threat of Entry High barriers: brand identification, economies of scale, international market -  Ã‚  Ã‚  Ã‚  Ã‚  Intensity of Rivalry among Competitors More online car industries, e.g. AutoByTel, AutoWeb, and Auto Vantage Difficult to maintain unique offerings. -  Ã‚  Ã‚  Ã‚  Ã‚  Pressure from Substitute Products The availability of substitute products: traditional dealers, other online car industry. -  Ã‚  Ã‚  Ã‚  Ã‚  Bargaining Power of Buyers More purchase options, more valuable and timely information, and the degree of transaction simplicity. -  Ã‚  Ã‚  Ã‚  Ã‚  Bargaining Pow... ...ned, there are divisional structure which are related to online auto products/services. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  HR system support the Strategic Orientation, to achieve its mission must be supported with well-developed human resources. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Organizational Design and Strategy is aligned, the differentiated strategic intent requires an organization design that focuses on the creation of new ideas, marketing and manufacturing REFERENCE Microsoft CarPoint Case Study, http://webct.buseco.monash.edu.au/MKW1601_S1_01_04/assignments/04145060_carpoint.pdf, Accessed: 4 May 2004. Rayport, J.F., Jaworski, B.J., 2001, Introduction to E-Commerce, 1st edition, McGraw Hill, USA Microsoft corperation, 2004, http://autos.msn.com/finance_insurance/finance.aspx?src=LeftNav, Accessed: 2004, May 15). Redmon, Wash. (1998, November 24). â€Å"MSN CarPoint's Personal Auto Page Wins Big With Customers†, < http://www.showroomatfiat.co.uk/press/pap.asp >, (Accessed: 2004, May 15). Marketing Teacher, The Marketing Environment, , Access Date: 17/05/2004 Waddell, D.M., Cummings, T.G. & Worley, C.G. (2000), Organisation Development and Change, Thomson Learning, USA.

Accreditation Audit AFT Essay

A1. Compliance Status The ongoing survey readiness audits that are conducted in the hospital on a daily basis have identified areas we will focus on to ensure that our accreditation survey results are exceptional. Audits are performed on an ongoing basis with a focus on trends that are most commonly cited by the Joint Commission. Nightingale hospital has proven to have made great improvements over prior survey findings in Emergency Management, Human Resources, Leadership, Medical Staff, Nursing Care, Provision of Care, Treatment and Services, Information Management, Handoff Communication and critical value reporting. We have placed an abundance of resources and efforts into improvement in these categories and will continue to make strides to further improve every aspect of the care we provide to our patients. (The Joint Commission, 2013) A2. Noncompliant Trends The areas we have identified that are not in compliance with the Joint Commission standards are: 1) Environment of care findings with numerous smoke wall penetrations, interim life safely measures for construction projects, blocked fire extinguishers, lack of sufficient evidence of adequate fire drills, lack of testing for medical gas alarm panels, blocked sprinkler clearance as well as cluttered hallways. 2) Falls has continue to be a challenge for our organization and will continue to be a focus for every department in our hospital. 3) Moderate sedation is an area that has been identified that needs a hardwired process for not only the hospital but for the anesthesia providers. The Joint Commission standards for moderate sedation compliance will require teamwork from the hospital and anesthesia group. 4) Pain assessment and reassessment is an ongoing primary focus area that we have not mastered in our organization. We have developed performance improvement processes to work toward compliance. This standard is a focus for every inpatient and outpatient department of our hospital. 5) Authentication of verbal orders continues to be monitored, but remains a challenge for our hospital. 6) Prohibited abbreviations are used periodically throughout our organization and is a piece of our daily audits when performing open record reviews. 7) Medication Management is a  priority focus area for our hospital, which we continue to struggle with various elements of this standard. We are focusing in particular on range order compliance and labeling medications. A3a. Staffing Patterns The case study shows that on unit 4E has the most opportunity for improvement in the number of patient falls and hospital acquired pressure ulcers. The comparison of falls and nursing care hours appears to be inconclusive, however appears to be a trend developing. The data appears that the staffing nursing hours per patient day have increase during the fourth quarter. In October, the falls per 1000 patient days was around 9. During October, the nursing hours per patient day were approximately five. November shows an increase in falls per patient day to 11.5 with nursing hours per patient day of 15.5. December continues the trended increase to 15 falls per 1000 patient days and 15 nursing hours per patient day. The data shows that the more hours per patient day we have, the more falls per 1000 patient days we experience. The data for pressure ulcer prevention follows the same trends. A3b. Staffing Plan The study has shown that the number of staff available is not causing the increase in the patient falls. The staff are obviously not rounding effectively on their patients, and being proactive in fall prevention. The plan to decrease nosocomial pressure ulcers and prevent falls will be presented to all staff on 4E by 4/15/2014 and fully implemented immediately. The new action plan will be evaluated for the remaining second quarter and if successful, will be implemented throughout the organization. The plan will utilize 10 hours per patient day, which is the average of the last quarter. The plan will require the staff to be more efficient and round with purpose in order to stay focused on the needs of the patients. This increased focus should prove to decrease the number of falls per 1000 days. Action Plan: 1) Mandatory education by 4/15/2014 to all staff on 4E 2) All patients will be rounded on hourly beginning 4/16/2014 3) All hourly rounds will address the 4 P’s (Pain, potty, possessions and position) a. Pain i. Is patient experiencing pain at this time ii. If so, ask patient to rate their pain iii. Depending on pain level, offer medication or other intervention b. Potty i. Does the patient need to use the restroom, urinal or ambulate to bathroom and if so, assist them to prevent falls and stay with them until completed c. Possessions i. Is call light, phone, meals, etc†¦ within reach of patient? The patient having their possessions within reach will minimize their need to reach or ambulate without assistance to answer the phone, etc†¦ which will prevent falls d. Position i. Is it time to change the patient’s position (left to right, ambulate, etc†¦) the changing of position frequently will assist in the prevention of pressure ulcers. 4) Each staff member ta performs the hourly round will document each round on the rounding log that will be located in the patient room. Rounds can be done by either the nurse or nurse’s assistant, as long as all needs for medication or other special needs will be immediately addressed by the nurse. The action plan presented will ensure that the patients are seen and their needs are met on an hourly basis. The staff will anticipate the needs of all patients by addressing the areas that cause the majority of falls. The patients will know the staff will be returning within an hour and will no longer have a need to utilize their call light unless in an emergency. The call lights will decrease, which will create a more organized unit that is very focused on being proactive with all patients. The results will be evaluated and changes and update to the plan will be made where necessary to continue improving the fall and pressure ulcer rate on this unit. B. Sources NONE

Microbiology Test Questions Essays

Microbiology Test Questions Essays Microbiology Test Questions Essay Microbiology Test Questions Essay A complex aggregation of microbes, often found on a solid surface, is called a thin film of microorganisms on the surface of a microscope slide is a(n) 9. 110. The gelatinous covering around the cell wall of many microorganisms is called ; a resistant, dormant structure formed within a bacterium that protects t T I room extreme environmental contraltos Is a(n) 1 1. /12. The science of classifying organisms is called the study of the evolutionary history of organisms is called Microbiology 233/Dry. Braun/Practice Test #1 2 13. 114. A pure culture of organisms is called a(n) genetically related groups are called 15. The highest level of classification is called a(n) SHORT ANSWER. (40 points) 16. A. Name the groups at the level of classification referred to in #15. B. What is the basis for distinguishing the groups at this level? 17. Compare and contrast the theories of spontaneous generation and bossiness. 18. A. Briefly state Kochs Postulates. B. Why are these important? Mollycoddled 233/Dry. Braun/Practice lest # 19. A. In descending order, list the 7 major levels of classification. B. Explain or describe a binomial, in scientific nomenclature. Give 2 specific examples. 20. List the 4 major groups of eukaryotic organisms, and the key characteristics of each one. B. Microbiology 233/Dry. Braun/Practice Test #1 4 TRUE / FALSE. (30 points) Circle TRUE or FALSE for each statement. Extra Credit: For each statement you think is false, correct it by crossing out the word(s) that make it false and adding word(s) to make it true. Do not rewrite the whole statement. 21. Microorganisms are identified and classified according to various methods, including morphological features, biochemical tests, differential staining and the type of virus a bacterium is susceptible to. TRUE / FALSE . Methods of comparing the DNA of different organisms include: DNA fingerprinting, Southern blotting, serological testing and nucleic acid habitation. TRUE / FALSE . Both DNA and RNA can be used to identify microbes. 24. Phylogeny relationships can be determined by a molecular clock, which is based on the fact that genetic mutations occur at a fairly constant rate over time. 25. Archaic include both gram-negative and gram-positive bacteria, but none are pathogenic. 26. Photosynthetic bacteria include Contractible, green and purple bacteria, and allotrope- bacteria; oxygen is produced only by the bacteria that use sulfur as an electron acceptor. Gram-positive Etcetera are leave Into 2 groups, oases on ten amount AT and cytosine they have in their DNA. Guanine 28. The main difference between fungi and bacteria is the chemical composition of their cell walls. FALSE Microbiology 233/Dry. Braun,prance -rest 5 29. The main difference between algae and plants is that algae do not have roots, stems and leaves. Helmets are multicultural eukaryote that have various organ systems, except arms, which rely on their hosts for vital functions. Parasitic 31. MATCHING. Microscopy (10 points) Detailed view of internal structures of living microbes. A. Phase-contrast Magnification up to xx; oil improves resolution. Electron Darkled Uses 2 beams of light to improve resolution. B. Con-Focal C. Scanning D. E. -row- Maps atomic and molecular shapes; intracellular temper atures. Photon Fluorescence Deep images of cells in tissues; active cells in real time. G. Scanned-Probe Pathogenic microbes within cells and tissues. Brightened l. Transmission Electron Live microbes that cannot be viewed by other methods. Scanning Acoustic Extremely clear Interference Contrast 2-monsoonal Images. Detrimental High resolution; 3-D view; different layers of a specimen. Living cells attached to another surface, such as cancer cells and arterial plaque. Microbiology 233/Dry. Braun/Practice Test #1 6 32. List the 5 phyla of Bacteria, the key characteristics of each one, and a specific example (40 points) Phylum Key Characteristics with its importance to human beings or the environment. Specific organism its importance

Using the French Expletive Connard in Conversation

Using the French Expletive Connard in Conversation The French noun connard  (pronounced kuh-nar) is an informal term commonly used as an expletive. Loosely translated, it means idiot or jerk, although most people understand it to mean something more obscene. As with all slang, its important to understand what youre saying before you go using it in everyday conversation. You and your friends may toss around expletives like connard  knowing that youre joking. But you probably wouldnt want to use such language in a formal situation or in front of strangers. Translation and Usage A more direct translation of  connard  would be ahole or any number of variations on the f-word. A French person searching for a synonym might choose imbà ©cile  or  crà ©tin.  There is also  a feminine version:  une connarde / une connasse  for cow. Examples of Usage Here are a few examples for context. To be clear, we are not recommending using this term. But it will be useful to understand it because it can be overheard on the streets of any French city or town. Cest un vrai connard ! Hes a real jerk!Tu es le  connard  de lautre nuit.  Casse-toi ! Youre the [expletive] from the other night. Get away!Et je suppose que le sale  connard  veut quelque chose en à ©change.  Ã‚  And I assume the dirty  [expletive] wants something in return.Ecoute, tu devenais un incroyable  connard.   Listen, you were becoming/being an unbelievable jerk.Babe Ruth à ©tait un  connard, mais le baseball reste gà ©nial.  Ã‚  Babe Ruth was  [expletive], but baseballs still  beautiful.Tu peux pas me parler, espà ¨ce de  connard.   You cant talk to me, you son of an  [expletive].Cest pas toi qui pose  la question,  connard.  Ã‚  Youre not asking the question,  [expletive].Vandalisme, arme blanche : Ten prends pour six mois,  connard.   Vandalism, deadly weapon. You get six months in lockup,  [expletive].Ouai, ben, soul ou sobre, tes toujours un  connard.  Ã‚  Yeah, well, drunk or sober, youre still an [expletive].

The Human Genome Project promises a revolutionary insight to the Essay

The Human Genome Project promises a revolutionary insight to the genetic 'blueprint' of the human body. Consider the social, - Essay Example Ethical issues include balancing individual interests against the interests of others, and such considerations as potentially racist applications and unforeseen consequences of information which gene-related activities can produce. Some of the most critical issues such as privacy and the desire not to know are highlighted. Financial implications for society at large, private companies and for individuals are explored. Finally there is assessment of the extent to which the Frankenstein metaphor applies to this project. The paper concludes that the Human Genome Project is an extremely powerful resource which can be used for good or evil purposes, and that we have resolved some, but by no means all, of the major ethical issues that it brings. The Human Genome Project promises a revolutionary insight to the genetic â€Å"blueprint† of the human body. Consider the social, ethical, and economic implications of this project for society, and the potential for applications of this rese arch. Genetic engineering is a relatively new science, which rests on the pioneering work of Gregor Mendel on the garden pea, leading to the formulation of Mendel’s laws in 1866. (Thomas, 2003 pp. 1-3). ... They were motivated by scientific curiosity and, as in so many laboratories, the focus was on the pure science, theories and explanations of what was going on at the tiniest possible levels of genes and chromosomes within the human body. At this stage there was very little concern for the ethical and moral implications of these new discoveries. The field of genetics made further progress with the invention of effective gene sequencing techniques in the mid 1970’s. At first only tiny viruses and bacteria were studied, but with advances in computing and automation, more complex organisms could be studied. Throughout the 1980s techniques improved so considerably that attention turned to the human genome. The Huntingdon’s disease gene was mapped to chromosome 4 in 1983 (Collins and McKusick: 2001, p. 541) but this was only a first step towards accurately locating the disease to its specific position there. There was no systematic way of sequencing all of the genes, and the scale of the task, encompassing some 3 billion base pairs, defeated even the best technology of the time. More resources were needed to tackle such a huge task. In 1989 both private and publicly funded organisations began to map the whole human genome. An international consortium was set up in 1990 and named the Human Genome Project. At this stage, finally, some of the more serious implications of the project were realised, and a portion the funding amounting to between 3% and 5% was set aside for exploration of the moral and ethical issues attached to the research. (Collins and McKusick, 2001, p. 540) Over a period of 13 years, the Human Genome Project was carried out in various locations,

Animation Essay Example | Topics and Well Written Essays - 1500 words

Animation - Essay Example The purpose of this paper is to explore how animation has evolved and changed since the golden age of Disney in the 1930s through to the Pixar films of modern day. To do this, the research will focus particularly on a classic Disney movie (Fantasia) and one of the most popular films released by Pixar (Toy Story). In doing this, some similarities will be uncovered between the two, despite the differences in technology and the vastly different eras in which they were generated and produced. Disney’s Fantasia Fantasia is one of the most influential Disney films, and was released in 1940 (Neuwirth, 2003). The film itself is highly complex for such an early example of animated film, with over 500 characters being present within the story and over 1000 members of staff working on different elements of the production (Neuwirth, 2003). Although related to previous Disney animations (Mickey Mouse and Silly Symphonies), Fantasia is well recognized for having some of the most brightly co lored and intensely lit stills from any other animated movie or short from the period (Lasseter, 1995), perhaps a testament to the developing technology of the time. Color itself is recognized as being one of the most important elements of Fantasia’s success, and Disney requested that each scene be color-coded in a specific way to allow smooth transition between shots. Additionally, artists involved in the picture were encouraged to make 3D models of their characters to understand the movement for a more ‘realistic’ feel, despite the abstract nature of the film (Cavalier, 2011). An important point to note with respect to Fantasia and the early Disney films is that each and every shot in the film was drawn, colored and lit individually; an extremely painstaking process. It is from this starting point that the evolution of animation technology can be considered. Pixar’s Toy Story Like Fantasia, Toy Story is extremely significant in the history of animation. Released in 1995, Toy Story was the first full-length animation to be completely done using computer animation techniques. It also has the credit of being the first film released by Pixar, a hugely successful modern film studio. Toy Story relies on CGI-animation techniques created with PhotoRealistic RenderMan, a Pixar-specific image-rendering application based on the industry standard (Cavalier, 2011). One of the biggest challenges for animating the movie was that the producers wanted the animation to look as realistic as possible, which means a huge attention to detail. In this way, the animation techniques for both Toy Story and Fantasia involve a similar commitment. However, it is worth noting that only 27 animators worked on the production of Toy Story, although over 400 real 3D models were created to allow the animators to study movement and gain a picture of how the characters in the film should move and behave to create the aforementioned realism (Lasseter, 1995). Additional ly, there were challenges involved in creating realistic shadows and lighting, although these could be done to a higher standard than in typical ‘cartoon-style’ animations. Technology & Composition There are 55 years between the release of Disney’s Fantasia and Pixar’s Toy Story, which evidently means that there are a lot of

What was the Monroe Doctrine and what impact has it had on American Essay

What was the Monroe Doctrine and what impact has it had on American history - Essay Example 87). The restrictions ushered to curb the remaining Latin American colonies under Spain and Portugal from gaining the looming independence from Portuguese, as well as Spanish Empires. Together with Britain, United purposed to ascertain total refrain by European Powers into the barred states. The immediate success is that continental powers did not revive the Spanish empire as a result of the British strong Navy following the weakness in U.S military. It never spread like a national doctrine to curb the threat to interest Americans and got hidden from American history for a decade. It culminate to France relinquishing the Maximilian. Besides, Spain stopped interfering with Dominican Republic in 1965. It allowed Unites States forcefully to regulate Dominican Republic’s customs with an objective to revive its economy. It also led to a military confrontation in Haiti and Nicaragua. Monroe doctrine led to harmonious linkages between US and UK (Sexton, 2011, p.

Abnormal Psychology and Therapy Essay Example for Free

Abnormal Psychology and Therapy Essay Psychology can be described as examination of ideas, intuitive feeling, and the way someone thinks and uses his or her wits be it physical, mental, or cognitive. Abnormal psychology is ideas or conduct causing the individual troubles. The deficiency may be sadness, potential fight, or simply uncomfortableness in the individuals daily life. Mental disorders or mental disease are practices not in general associated with a person. A number of these disorders can harm others or the one who is battling with the disorder. There are a number of therapies for these disorders and are different in each case. A closer look and contrast of normal and abnormal psychology is need along with mental disturbance and mental disease from a psychology position polishing off by way of a look at different therapies useful for normal and abnormal psychology. Abnormal and Normal Psychology are likewise, also the two look into behaviors, and because of individuals different cultures and beliefs some behaviors are normal. Then again oftentimes they could be different for the behavior is not really typical or something out the ordinary. To know the difference between normal and abnormal psychology helps with acknowledging mental disturbance from a psychological perspective. To help illustrate our research on abnormal psychology, this section will compare and contrast normal and abnormal psychology. Normal psychology focuses on the different ways different people see life and want to live life, rather than relying on generalizations made about whole populations of people. See more:  Mark Twains Humorous Satire in Running for Governor Essay These generalizations can often do harm because without proper consideration they can often imply norm of behavior inimical to a person’s existence. A normal psychology in this way doesn’t imply a perfect individual existence, nor that there aren’t any pathologies. Abnormal-is the branch of psychology that studies unusual patterns of behavior, emotion and thought, which may or may not be understood as precipitating a mental disorder. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by abnormal. Mental disorders and mental illnesses This next section will examine mental disorders and mental illnesses from the perspective of psychology. Adjustment disorders of mental disorders is related to an identifiable source of stress that causes significant emotional and behavioral symptoms. Anxiety disorders are those that are characterized by excessive and abnormal fear, worry and anxiety. In one recent survey published in the Archives of General Psychology 1, it was estimated that as many as 18% of American adults suffer from at least one anxiety disorder. Cognitive disorders are psychological disorders that involve cognitive abilities such as memory, problem solving and perception. Some anxiety disorders, mood disorders and psychotic disorders are classified as cognitive disorders. Alzheimers disease †¢Delirium †¢Dementia †¢Amnesia Therapies Psychotherapy is a general term that is used to describe the process of treating psychological disorders and mental distress. During this process, a trained psychotherapist helps the client tackle a specific or general problem such as a particular mental illness or a source of life stress. Depending on the approach used by the therapist, a wide range of techniques and strategies can be used. However, almost all types of psychotherapy involve developing a therapeutic relationship, communicating and creating a dialogue and working to overcome problematic thoughts or behaviors. †¢Psychoanalytic: An approach to therapy that involved delving into a patient thoughts and past experiences to seek out unconscious desires or fantasies. Cognitive-behavioral: A type of psychotherapy that involves cognitive and behavioral techniques to change negative thoughts and maladaptive behaviors. Humanistic: A form of therapy that focuses on helping people maximize their potential. Medical therapy for mental disturbance and sicknesses change between each philosophical system. The earlier style of psychotherapy were the psychodynamic therapies. Psychodynamic therapy tries to change personality practices through perceptiveness and the therapist-patient relationship (Kowalski Westen, 2009). Inside this subdivision of therapy dwell the proficiencies of psychoanalysis and psychodynamic psychotherapy. These particular therapies ask the patient to lie on a sofa or sit opposite with a therapist and talk about what one thinks of, a technique known as free association. The two most adept humanistic therapies are Gestalt therapy and the client centered therapy. Gestalt therapy is somewhat like psychodynamic psychotherapy. The most commonly known technique of the therapy is the empty chair technique. Through this method the patient exercises emotional expression by visualizing that the individual him or her wants to converse with is in the chair. The second humanistic therapy is the client centered therapy. Through this technique the therapist exhibits an position of full credence for the patient by listening emphatically. Therapeutic change occurs as the patient hears his or her own thoughts or feelings reflected by the nonjudgmental listener. Conclusion There are a number of therapies for these disorders and are different in each case. Abnormal and Normal Psychology are likewise, also the two look into behaviors, and because of individuals different cultures and beliefs, some behaviors are normal. Lastly, normal and abnormal look into behavior, this behavior may be causing the individual troubles, confrontation, or simply uncomfortableness in daily life. Mental disorders including schizophrenia and Obsessive compulsive disorder can harm others or the individual battling with them. Mental illnesses comprise of perturbations of mentation, experience, and emotion cause operative disability making it very hard to nurture relationships, keep a job, and can lead to suicide. Treatment will change with regards to the form of disorder a individual has and the individuals commitment to look for assistance with a therapist. References Kowalski, R., Westen, D. (2009). Psychology (5th ed.). Hoboken, NJ: Wiley. Nami ( National Alliance on Mental Illnesses, http://www.nami.org/Content/NavigationMenu/Mental_Illnesses/Depression/Mental_Illnesses_What_is_Depression.htm retrieved December 01, 2012. Stanford Encyclopedia of Philosophy, http://plato.stanford.edu/entries/mental-illness/ retrieved December 01, 2012. www.uidaho.edu/psych101/abnormal6.pdf. Retrieved December 02, 2012 Wood, S. E., Wood, E. R. The World of Psychology. Boston, MA: A Pearson Education Company. Page 538